Effect of Ki-67 proliferation index on survival in large cell neuroendocrine carcinoma of the lung

Duygulu, Mustafa Emre; Aşık, Esra; Tükenmez, Mehmet Akif; Teoman, Gizem; Yıldırım, Atila; Fidan, Evren

doi:10.1590/1806-9282.20240398

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 70 (9) • 2024 • https://doi.org/10.1590/1806-9282.20240398 copy

Effect of Ki-67 proliferation index on survival in large cell neuroendocrine carcinoma of the lung

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Large cell neuroendocrine carcinoma of the lung is a rare type of lung cancer. There is a limited number of studies on clinical and histopathological characteristics that are effective in survival. The aim of this study was to investigate the relationship between histopathological and clinical characteristics, mainly Ki-67 proliferation index, and survival in patients diagnosed with large cell neuroendocrine carcinoma of the lung.

METHODS:

The data of 38 patients followed up with the diagnosis of large cell neuroendocrine carcinoma of the lung were evaluated. The mean Ki-67 value was determined to be 65.8% (±20.8). The patients’ clinical characteristics and survival times were compared according to the cut-off value determined for Ki-67 index.

RESULTS:

When median overall survival times were compared, it was seen that overall survival was numerically lower in patients aged 65 years and over, in tumors located on the right side, in cases who were in the metastatic stage at diagnosis, whose Ki-67 index was 65% and above, who did not receive chemotherapy, who did not undergo curative surgery, and in patients with chronic diseases (p>0.05). In the Kaplan-Meier analysis, the median overall survival was determined to be 22.2 months (95%CI 21.7–22.7) in the patients with Ki-67<65%, while it was found to be 20.3 months (95%CI 4.5–36.2) in the patients with Ki-67≥65% (p=0.351).

CONCLUSION:

Our study identified subgroups with decreased survival in large cell neuroendocrine carcinoma of lung patients. Studies including a larger number of patients are needed to identify the prognostic importance of these clinical and histopathological characteristics.

KEYWORDS:
Neuroendocrine carcinoma; Lung cancer; Ki-67

Variable		Total n (%)	Ki-67 65%< n (%)	Ki-67 65%≥ n (%)	p-value
ECOG	ECOG 0–2	36 (94.7)	15 (93.8)	21 (95.5)	0.816^* * Pearson chi-square test
ECOG	ECOG 3–4	2 (5.3)	1 (6.3)	1 (4.5)	0.816^* * Pearson chi-square test
Primary tumor side	Left	10 (26.3)	5 (31.3)	5 (22.7)	0.556^* * Pearson chi-square test
Primary tumor side	Right	28 (73.7)	11 (68.8)	17 (77.3)	0.556^* * Pearson chi-square test
T stage (TNM-8)	1	14 (36.8)	6 (37.5)	8 (36.4)	0.331^* * Pearson chi-square test
	2	12 (31.6)	6 (37.5)	6 (27.3)
	3	8 (21.1)	4 (25.0)	4 (18.2)
	4	4 (10.5)	0 (0)	4 (18.2)
N stage (TNM-8)	0	18 (47.4)	10 (62.5)	8 (36.4)	0.400^* * Pearson chi-square test
	1	9 (23.7)	3 (18.8)	6 (27.3)
	2	10 (26.3)	3 (18.8)	7 (31.8)
	3	1 (2.6)	0 (0)	1 (4.5)
M stage (TNM-8)	0	29 (76.3)	12 (75.0)	17 (77.3)	0.871^* * Pearson chi-square test
M stage (TNM-8)	1	9 (23.7)	4 (25.0)	5 (22.7)	0.871^* * Pearson chi-square test
Accompanying histology¹ 1 Adenocarcinoma (n=3). Squamous cell carcinoma (n=2). Small cell carcinoma (n=1). ECOG: Eastern Cooperative Oncology Group.	Absent	32 (84.2)	12 (75.0)	20 (90.9)	0.184^* * Pearson chi-square test
	Present	6 (15.8)	4 (25.0)	2 (9.1)	0.184^* * Pearson chi-square test
Adjuvant/palliative chemotherapy	Absent	6 (15.8)	4 (25.0)	2 (9.1)	0.184^* * Pearson chi-square test
Adjuvant/palliative chemotherapy	Present	32 (84.2)	12 (75.0)	20 (90.9)	0.184^* * Pearson chi-square test
Adjuvant/palliative radiotherapy	Absent	20 (52.6)	11 (68.8)	9 (40.9)	0.090^* * Pearson chi-square test
Adjuvant/palliative radiotherapy	Present	18 (47.4)	5 (31.3)	13 (59.1)	0.090^* * Pearson chi-square test
Curative surgery	Absent	12 (31.6)	5 (31.3)	7 (31.8)	0.970^* * Pearson chi-square test
Curative surgery	Present	26 (68.4)	11 (68.8)	15 (68.2)	0.970^* * Pearson chi-square test
Diabetes mellitus	Absent	28 (73.7)	12 (75.0)	16 (72.7)	0.875^* * Pearson chi-square test
Diabetes mellitus	Present	10 (26.3)	4 (25.0)	6 (27.3)	0.875^* * Pearson chi-square test
Hypertension	Absent	19 (50.0)	8 (50.0)	11 (50.0)	0.995^* * Pearson chi-square test
Hypertension	Present	19 (50.0)	8 (50.0)	11 (50.0)	0.995^* * Pearson chi-square test
Chronic lung disease	Absent	29 (76.3)	13 (81.3)	16 (72.7)	0.542^* * Pearson chi-square test
Chronic lung disease	Present	9 (23.7)	3 (18.8)	6 (27.3)	0.542^* * Pearson chi-square test
Chronic heart disease	Absent	26 (68.4)	10 (62.5)	16 (72.7)	0.503^* * Pearson chi-square test
Chronic heart disease	Present	12 (31.6)	6 (37.5)	6 (27.3)	0.503^* * Pearson chi-square test
Death	Absent	17 (44.7)	7 (43.8)	10 (45.5)	0.917^* * Pearson chi-square test
Death	Present	21 (55.3)	9 (56.3)	12 (54.5)	0.917^* * Pearson chi-square test

Variable		Percentile 25–75 (Median OS)	p-value
Age	65<	5.52–30.98 (20.04)	^b b Mann-Whitney U test. 0.492
Age	65≥	7.68–21.46 (9.75)	^b b Mann-Whitney U test. 0.492
ECOG performance status	ECOG 0–2	6.72–22.68 (13.27)	^b b Mann-Whitney U test. 0.728
ECOG performance status	ECOG 3–4	7.68–18.79 (13.24)	^b b Mann-Whitney U test. 0.728
Primary tumor side	Left	9.32–67.82 (17.52)	^b b Mann-Whitney U test. 0.230
Primary tumor side	Right	5.66–21.82 (12.06)	^b b Mann-Whitney U test. 0.230
T stage (TNM-8)	1	5.21–20.39 (10.29)	^c c Kruskall-Wallis test. 0.445
	2	8.54–43.13 (17.61)
	3	7.9–36.71 (20.52)
	4	6.54–15.15 (8.65)
N stage (TNM-8)	0	5.82–50.96 (13.27)	^c c Kruskall-Wallis test. 0.932
	1	9.89–20.39 (18.79)
	2	5.39–39.07 (10.29)
	3	9.61–9.61 (9.61)
M stage (TNM-8)	0	7.68–39.07 (13.75)	^b b Mann-Whitney U test. 0.184
M stage (TNM-8)	1	5.39–19.68 (9.61)	^b b Mann-Whitney U test. 0.184
Accompanying histology*	Absent	6.72–30.66 (10.29)	^b b Mann-Whitney U test. 0.379
Accompanying histology*	Present	19.68–22.46 (21.82)	^b b Mann-Whitney U test. 0.379
Ki-67 index	<65%	9.79–35.04 (21.82)	^b b Mann-Whitney U test. 0.145
Ki-67 index	≥65%	7.61–20.39 (9.75)	^b b Mann-Whitney U test. 0.145
Adjuvant/palliative chemotherapy	Absent	5.21–22.46 (5.61)	^b b Mann-Whitney U test. 0.262
Adjuvant/palliative chemotherapy	Present	7.97–22.57 (13.75)	^b b Mann-Whitney U test. 0.262
Adjuvant/palliative radiotherapy	Absent	9.61–22.68 (19.24)	^b b Mann-Whitney U test. 0.128
Adjuvant/palliative radiotherapy	Present	5.39–21.46 (8.9)	^b b Mann-Whitney U test. 0.128
Curative surgery	Absent	6.5–18.11 (8.9)	^b b Mann-Whitney U test. 0.182
Curative surgery	Present	7.75–22.89 (19.24)	^b b Mann-Whitney U test. 0.182
Diabetes mellitus	Absent	7.93–30.98 (13.75)	^b b Mann-Whitney U test. 0.273
Diabetes mellitus	Present	5.39–20.68 (8.82)	^b b Mann-Whitney U test. 0.273
Hypertension	Absent	8.18–47.18 (20.39)	^b b Mann-Whitney U test. 0.231
Hypertension	Present	5.5–22.25 (9.89)	^b b Mann-Whitney U test. 0.231
Chronic lung disease	Absent	7.61–22.25 (13.75)	^b b Mann-Whitney U test. 0.986
Chronic lung disease	Present	8.18–22.89 (9.61)	^b b Mann-Whitney U test. 0.986
Chronic heart disease	Absent	7.75–47.18 (13.75)	^b b Mann-Whitney U test. 0.340
Chronic heart disease	Present	5.61–20.97 (10.13)	^b b Mann-Whitney U test. 0.340

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author:
mustafaemreduygulu@gmail.com