Journal Article

The impact of stratified management of Ki-67 on the prognosis of small-cell lung cancer

Zheng, Guanghua, Zhang, Xiaofang, He, Mingyang, Bai, Junjun

2025

Overview

Objective The Ki-67 protein is frequently employed in pathological immunohistochemistry to indicate cell proliferation activity. The principal aim of this study was to examine the impact of stratified management of Ki-67 on the clinicopathological characteristics and prognosis of patients with small-cell lung cancer (SCLC). Methods A total of 175 patients with SCLC who underwent surgical treatment were included in the study, with available data on the results of postoperative immunohistochemistry of the Ki-67 protein. A retrospective analysis was conducted to investigate the correlation between the protein and various clinicopathological features of SCLC, as well as its impact on survival. Results The cut-off value for the Ki-67 level was determined to be 75% through receiver operating characteristic (ROC) analysis. An elevated Ki-67 level was found to be associated with preoperative chemotherapy (χ2 = 4.980, P  = 0.028), preoperative radiotherapy (χ2 = 4.600, P  = 0.032), T stage (χ2 = 4.173, P  = 0.041), TNM staging (χ2 = 10.472, P  = 0.005), and lymph node involvement (χ2 = 16.721, P  < 0.0001). The results of the survival analysis indicated that patients with SCLC exhibiting high levels of Ki-67 had a poorer prognosis than those with low Ki-67 levels ( P  = 0.0004). This was particularly evident in patients aged 60 years or older ( P  = 0.034), in males ( P  = 0.046), smoking for a minimum of 30 years ( P  < 0.001), advanced T staging (T3 + T4) ( P  = 0.031), lymph node involvement ( P  = 0.038), and TNM staging ( P  = 0.015), were associated with poorer outcomes. The univariate Cox regression analysis indicated that exposure to tobacco consumption ( P  = 0.040), pathologic T stage ( P  = 0.047), lymph node metastasis ( P  = 0.002), TNM staging [Stage I vs. II ( P  = 0.016), Stage I vs. III ( P  = 0.003)], and Ki-67 positive rate ( P  < 0.001) were the factors related to prognosis in SCLC. The results of the multivariate regression analysis indicated that T stage(HR: 1.519, 95% CI: 1.116–2.015, P  = 0.022), TNM staging[Stage I vs. III (HR: 2.310, 95% CI: 1.320–4.040, P  < 0.001)], and Ki-67 expression(HR: 1.405, 95% CI: 1.025–1.810, P  < 0.001) was identified as an additional risk factor for SCLC-related mortality. Conclusion In summary, the Ki-67 protein is not only strongly associated with the malignant characteristics of SCLC, but also the stratification of Ki-67 has significant implications for the treatment and prognosis of patients with small-cell lung cancer. Clinical trial number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Aged, 80 and over / Biomarker / Biomarkers / Biomarkers, Tumor - metabolism / Biomedical and Life Sciences / Biomedicine / Cancer / Cancer Research / Care and treatment / Cell proliferation / Cellular proteins / Chemotherapy / Clinical outcomes / Female / Health aspects / Health Promotion and Disease Prevention / Hospitals / Humans / Immunohistochemistry / Ki-67 antigen / Ki-67 Antigen - metabolism / Lung cancer / Lung cancer, Small cell / Lung Neoplasms - metabolism / Lung Neoplasms - mortality / Lung Neoplasms - pathology / Lung Neoplasms - therapy / Lymph nodes / Lymphatic system / Male / Medical prognosis / Medical records / Medicine/Public Health / Metastases / Metastasis / Middle Aged / Mortality / Neoplasm Staging / Oncology / Oncology, Experimental / Patients / Physiological aspects / Prognosis / Radiation therapy / Regression analysis / Retrospective Studies / Risk factors / ROC Curve / Small cell lung carcinoma / Small Cell Lung Carcinoma - metabolism / Small Cell Lung Carcinoma - mortality / Small Cell Lung Carcinoma - pathology / Small Cell Lung Carcinoma - therapy / Small-cell lung cancer / Statistical analysis / Surgical Oncology / Survival analysis