Определение порогового значения индекса Ki-67 для прогнозирования метастатического поражения лимфатических узлов при раке желудка

Поиск биологических маркеров для оценки метастатического поражения лимфатических узлов при раке желудка — одно из ключевых направлений в определении тактики лечения. Роль индекса Ki-67 как маркера клеточной пролиферации при раке желудка остается актуальной. Целью нашего исследования является определение порогового значения индекса Ki-67 при локализованном раке желудка для прогнозирования метастатического поражения лимфатических узлов. Ретроспективный анализ данных 154 больных раком желудка показал независимую и статистически значимую связь глубины инвазии опухоли T (p = 0,002), степени дифференцировки G (p = 0,010), значения индекса Ki-67 (p < 0,0001) с метастатическим поражением лимфатических узлов. С помощью ROC анализа выявлено, что при значении Ki-67 больше или равно 45% получен оптимальный уровень чувствительности (84,2%), специфичности (55,9%) и точности (73,4%) метода AUC 0,738 (p < 0,043; 95% CI 0,654–0,823). При оценке общей выживаемости пациентов с индексом пролиферативной активности в опухоли Ki-67 больше 45% медиана составила 32 месяца [HR 2,2; 95% CI 1,2–3,9; p = 0,005], а при значении Ki-67 меньше 45% медиана общей выживаемости на сегодняшний день не достигнута.

Значение индекса Ki-67 ≥ 45% является оптимальным пороговым значением для определения вероятности метастатического поражения лимфатических узлов при локализованном раке желудка.

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