S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Ki-67 as a Prognostic Marker in Upper Urinary Tract Urothelial Carcinoma: a Systematic Review and Meta-analysis
상부요로상피암에서의 예후 예측용 표지자로서의 Ki-67: 체계적 문헌고찰과 메타분석
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- upper urinary tract ; ureter ; renal pelvis ; urothelial carcinoma ; Ki-67 ; prognosis ; meta-analysis
- 학위논문 (석사)-- 서울대학교 대학원 : 의과대학 의학과, 2018. 2. 구자현.
- Purpose: We tried to systematically evaluate the prognostic significance of Ki-67 on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU).
Materials and Methods: We searched Embase, Scopus, and PubMed databases for all articles published up to February 2016 in line with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Outcomes of interest included intravesical recurrence (IVR) free survival, disease free survival (DFS), cancer-specific survival (CSS), and overall survival (OS). The associations between Ki-67 and survival outcomes were expressed with pooled hazard ratio (HR) and 95% confidence interval (CI).
Results: A total of 12 articles, consisting of 1,351 patients, ranging from 37 to 475, met the eligibility criteria and were finally selected for this meta-analysis. The overexpression of Ki-67 was significantly associated with worse DFS (HR 2.74, 95% CI 1.58-4.74), CSS (HR 2.26, 95% CI 1.70-3.01), and OS (HR, 3.71
95% CI, 1.78-7.75), but not IVR free survival (HR, 0.77
95% CI, 0.10-5.82). Inter-study heterogeneity was observed in the analysis of DFS (I2 = 54%
p = 0.05) and IVR free survival (I2 = 81%, p = 0.005). There was no significant publication bias in the meta-analysis of survival outcome as a result of funnel plot test.
Conclusions: The results drawn in this meta-analysis suggest that the overexpression of Ki-67 may be a promising prognostic indicator predicting the survival outcome after RNU for UTUC. However, a large, well-designed, prospective study is necessary to establish the prognostic value of Ki-67 in UTUC.