摘要目的 探讨Ki-67阳性指数在滤泡性淋巴瘤(follicular lymphoma,FL)病理分级中的临界值.方法 回顾性分析2014年6月至2016年1月北京友谊医院病理科诊断的350例FL患者的临床病理学资料,对Ki-67阳性指数进行定量评估和相关统计分析.结果 在350例FL患者中,男女比例为1.1:1.0,平均年龄(50.2±14.0)岁,中位年龄51岁(范围4～82岁).病理分级Ⅰ～Ⅱ级215例(61.4％),ⅢA级105例(30.0％),ⅢB级30例(8.6％).经Mann Whitney U检验,在FL低级别(Ⅰ～Ⅱ级)和高级别(ⅢA和ⅢB)中Ki-67阳性指数的平均值差异具有统计学意义[(22.8％±8.3％)比(50.4％±10.7％),P<0.01].受试者工作特征(ROC)曲线法分析,诊断FL低级别最佳的临界值为35％,敏感度为96.3％,特异度为93.3％,ROC曲线下面积(AUC)最大(AUC=0.990,P<0.01,95％CI为0.982～0.998).四格表诊断试验分析Ki-67阳性指数>40％是预测FL高级别的重要因素(χ2=230.733,P<0.01).Ki-67阳性指数临界值为40％时诊断为高级别FL有最大的灵敏度(98.1％)和特异度(87.7％).Ki-67阳性指数与FL的病理分级呈显著正相关性(r=0.836,P<0.01).结论 Ki-67阳性指数小于临界值35％是诊断FL低级别的可靠指标,>40％提示可能是高级别FL.Ki-67阳性指数的临界值可作为FL病理分级的依据或重要辅助指标.

abstractsObjective To determine the cut-off values of Ki-67 labeling index ( LI ) in the histological grading of follicular lymphoma ( FL ) . Methods Clinicopathological data of 350 FL patients diagnosed at Beijing Friendship Hospital from June 2014 to January 2016 were analyzed retrospectively by quantitative evaluation and statistical analysis of Ki-67 LI. Results Of the 350 patients with FL, the male and female ratio was 1. 1 and the average age was (50. 2±14. 0) years with a median age of 51 years (range 4 to 82 years) . The tumors were graded as grade Ⅰ-Ⅱ in 215 cases ( 61. 4％) , grade Ⅲ A in 105 cases ( 30. 0％) , and grade Ⅲ B in 30 cases ( 8. 6％) . The average Ki-67 values were ( 22. 8％± 8. 3％) for the FL low ( grade Ⅰ-Ⅱ) and ( 50. 4％± 10. 7％) for high grade (Ⅲ A and Ⅲ B ) and were statistically significant by Mann Whitney U test ( P<0. 01) . Receiver operated characteristic curve analysis showed that the best diagnostic cut-off value of low grade FL was 35％ ( sensitivity of 96. 3％ and specificity of 93. 3％) with the largest area under curve (AUC=0. 990,P<0. 01, 95％CI for 0. 982-0. 998). According to the analysis of four lattice diagnostic tests, Ki-67 LI >40％ was an important factor (χ2=230. 733,P<0. 01) in predicting high grade FL. When the cut-off value of Ki-67 LI was set at 40％, high grade LF could be diagnosed with the greatest sensitivity ( 98. 1％) and specificity ( 87. 7％) . Moreover, a significant correlation between the Ki-67 LI and the pathological grade of FL ( r=0. 836, P<0. 01 ) was observed. Conclusions Ki-67 LI of below a cut-off value of 35％ is a reliable indicator of low grade FL. Ki-67 over 40％ is consistent with high grade FL. These Ki-67 cut-off values may serveas an important auxiliary indicator in the grading of FL.