학술논문
수술로 절제한 위장관기질종양에서 Ki-67 발현의 예후적 중요성
Prognostic Significance of Ki-67 Expression in Patients Undergoing Surgical Resection for Gastrointestinal Stromal Tumor수술로 절제한 위장관기질종양에서 Ki-67 발현의 예후적 중요성
Prognostic Significance of Ki-67 Expression in Patients Undergoing Surgical Resection for Gastrointestinal Stromal Tumor수술로 절제한 위장관기질종양에서 Ki-67 발현의 예후적 중요성
Document Type
Article
Author
정성연 / Seong Yeon Jeong; 박원우 / Won Wo Park; 김유선 / You Sun Kim; 박영일 / Young Il Park; 김승협 / Seung Hyup Kim; 윤원재 / Won Jae Yoon; 문정섭 / Jeong Seop Moon; 이병모 / Byung Mo Lee; 홍성우 / Seong Woo Hong; 강윤경 / Yun Kyung Kang
Source
대한소화기학회지 / The Korean Journal of Gastroenterology. Aug 30, 2014 64(2):87
Subject
Language
Korean
ISSN
1598-9992
Abstract
목적: 현재까지 위장관기질종양(GIST)을 양성과 악성으로 분류할 수 있는 명확한 조직학적 기준은 없지만, 전이나 재발을 일으킬 수 있는 위험도를 종양세포의 유사분열 수와 종양의 크기를 기준으로 나누고 있다. Ki-67은 세포 증식의 표지자로 사용되는 단백질로, GIST의 예후 인자로의 가능성이 주목되고 있다. 이에 저자들은 수술 치료를 시행한 GIST 환자 중 Ki-67 면역조직화학염색을 시행한 32예의 Ki-67 지수와 유사 분열 지수와의 관련성, GIST의 재발률 및 무병 생존율에 대하여 분석 검토하여 보았다. 대상 및 방법: 인제대학교 서울백병원에서 수술 치료를 통하여 GIST를 제거한 32명의 환자를 대상으로 연구를 시행하였고 환자들의 의무기록을 통하여 성별, 연령, 증상 등의 임상적 특징과, 종양의 크기, 위치 등의 조직학적 특징 및 재발률에 대하여 조사하였다. 결과: NIH 진단기준으로 very low risk는 4예, low risk는 9예, intermediate risk는 14예, high risk는 5예였다. Ki-67 지수는 1-18%의 범위 내에 있었고, 평균은 5.56±4.48%였다. 평균 추적관찰 기간은 35.72±29.04개월이었고 관찰 도중 6 예(18.7%)에서 재발 혹은 전이가 발견되었다. Ki-67 지수가 5% 이하인 군의 누적 무병 생존율은 12개월, 24개월, 60개월에 각각 100%, 100%, 86%였다. 반면 Ki-67 지수가 5% 초과인 군의 누적 무병 생존율은 12개월, 24개월, 60개월에 각각 82.1%, 70.3%, 46.9%로 Ki-67 지수가 5% 이하인 환자에 비하여 무병 생존율에 유의한 차이를 보였다(p=0.007) 결론: Ki-67 지수가 5% 초과할 경우 GIST 재발의 고위험성을 시사한다. 향후 Ki-67 지수의 표준화와 치료 방향의 결정에 미치는 Ki-67 지수의 역할에 대한 연구가 필요하다.
Background/Aims: Assessment of malignant potential in gastrointestinal stromal tumor (GIST) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of GISTs. The Ki-67 labeling index has recently been used as an index of cell growth. The aim of this study was to investigate the prognostic value of K -67 in GIST. Methods: We retrospectively reviewed the medical records of 32 patients with GIST who underwent surgical resection at Inje University Seoul Paik Hospital. We analyzed their Ki-67 expression, histologic finding, and prognosis. Results: According to the tumor size and mitotic count, 4 patients were classified as very low risk, 9 patients as low risk, 14 patients as intermediate risk and 5 patients as high risk. The average Ki-67 index was 5.56±4.48%. The median follow-up duration was 35.72±29.04 months, and local/distant recurrences were observed in 6 (18.7%) patients. The overall cumulative disease free survival rates in patients with Ki-67 index ≤5% at 1 year, 2 years, and 5 years were 100%, 100%, and 86%, respectively. The overall cumulative disease free survival rates in patients with Ki-67 index ＞5% were at 1 year, 2 years, and 5 years were 82.1%, 70.3%, and 46.9%, respectively. There was significant relationship between elevated Ki-67 and disease free survival rate (p=0.007). Conclusions: Our study suggests that Ki-67 index ＞5% confers a higher risk of relapse in patients with GIST. Future work should focus on standardization of Ki-67 assessment and specification of its role in making treatment decisions.(Korean J Gastroenterol 2014,64:87-92)
Background/Aims: Assessment of malignant potential in gastrointestinal stromal tumor (GIST) is still problematic. The maximum tumor diameter and the mitotic index are generally used as an index of malignancy of GISTs. The Ki-67 labeling index has recently been used as an index of cell growth. The aim of this study was to investigate the prognostic value of K -67 in GIST. Methods: We retrospectively reviewed the medical records of 32 patients with GIST who underwent surgical resection at Inje University Seoul Paik Hospital. We analyzed their Ki-67 expression, histologic finding, and prognosis. Results: According to the tumor size and mitotic count, 4 patients were classified as very low risk, 9 patients as low risk, 14 patients as intermediate risk and 5 patients as high risk. The average Ki-67 index was 5.56±4.48%. The median follow-up duration was 35.72±29.04 months, and local/distant recurrences were observed in 6 (18.7%) patients. The overall cumulative disease free survival rates in patients with Ki-67 index ≤5% at 1 year, 2 years, and 5 years were 100%, 100%, and 86%, respectively. The overall cumulative disease free survival rates in patients with Ki-67 index ＞5% were at 1 year, 2 years, and 5 years were 82.1%, 70.3%, and 46.9%, respectively. There was significant relationship between elevated Ki-67 and disease free survival rate (p=0.007). Conclusions: Our study suggests that Ki-67 index ＞5% confers a higher risk of relapse in patients with GIST. Future work should focus on standardization of Ki-67 assessment and specification of its role in making treatment decisions.(Korean J Gastroenterol 2014,64:87-92)