Blood Res.  2016 Jun;51(2):127-132. 10.5045/br.2016.51.2.127.

Prognostic relevance of the Ki-67 proliferation index in patients with mantle cell lymphoma

• Jeong TD
• Chi HS
• Kim MS
• Jang S
• Park CJ
• Huh JR

• KMID: 2309215
• DOI: http://doi.org/10.5045/br.2016.51.2.127

Abstract

BACKGROUND
A high Ki-67 proliferation index (PI) in neoplastic cells is associated with poor survival in mantle cell lymphoma (MCL). We aimed to determine the cut-off values for the Ki-67 PI as a prognostic factor in MCL according to bone marrow findings.
METHODS
Immunohistochemical (IHC) staining for Ki-67 was performed on formalin-fixed paraffin-embedded biopsy tissues from 56 patients with MCL. Patients were grouped based on their Ki-67 PI values. Survival analyses were carried out and the cut-off value for the Ki-67 PI was determined.
RESULTS
Of the 56 patients, 39 (69.6%) showed bone marrow involvement of MCL; 21 of these patients had leukemic manifestations at the time of diagnosis. The results of the Ki-67 IHC staining were as follows: ≤10% in 22 patients, 11-20% in 14 patients, 21-30% in 3 patients, 31-40% in 4 patients, 41-50% in 4 patients, and >50% in 9 patients. A cut-off value of 20% revealed significantly different survival rates with mean survival times of 69.8 months (Ki-67 PI≤20%) and 47.9 months (Ki-67 PI>20%), irrespective of bone marrow findings (P=0.034). Clinical outcomes did not differ, regardless of bone marrow findings. However, in cases with bone marrow involvement, the Ki-67 cut-off value of 30% for overall survival was required to yield statistical significance (P=0.033).
CONCLUSION
The 20% cut-off value for the Ki-67 PI was clinically meaningful, regardless of bone marrow involvement of MCL. For patients with bone marrow involvement, the statistically significant cut-off value increased to 30%.

Keyword

Bone marrow; Ki-67 proliferation index; Mantle cell lymphoma; Prognosis

MeSH Terms

Biopsy
Bone Marrow
Diagnosis
Humans
Lymphoma, Mantle-Cell*
Prognosis
Survival Rate

Figure

• 

  Fig. 1 Overall survival according to the Ki-67 proliferation index (PI). (A) A cut-off of 20% reveals significant differences in survival, regardless of bone marrow findings (N=56, P=0.034). (B) In patients with bone marrow involvement of mantle cell lymphoma, a cut-off of 30% is statistically significant (N=39, P=0.033).

• 

  Fig. 2 Comparison of Ki-67 immunohistochemical staining results between tissue and bone marrow biopsies. A good correlation is observed between tissue biopsy with a Ki-67 PI <30% and bone marrow biopsy results (Spearman's correlation coefficient=0.559, P=0.024).

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