Correlation between Ki-67 immunohistochemistry and 18F-Fluorothymidine uptake in patients with cancer: A systematic review and meta-analysis

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• 作者：A. Chalkidou^a ; ^{anastasia.chalkidou@kcl.ac.uk} ; D.B. Landau^b ; E.W. Odell^c ; V.R. Cornelius^d ; M.J. O&rsquo ; Doherty^e ; P.K. Marsden^e
• 关键词：Fluorothymidine ; Ki-67 ; PET ; QUADAS ; Systematic review ; Meta-analysis
• 刊名：European Journal of Cancer
• 出版年：2012
• 出版时间：December, 2012
• 年：2012
• 卷：48
• 期：18
• 页码：3499-3513
• 全文大小：1423 K

文摘

Background

Positron emission tomography (PET) imaging using the radiotracer 18F-Fluorothymidine (FLT) has been proposed as an imaging biomarker of tumour proliferation. If FLT-PET can be established as such it will provide a non-invasive, quantitative measurement of tumour proliferation across the entire tumour. Results from validation studies have so far been conflicting with some studies confirming a good correlation between FLT uptake and Ki-67 score and others presenting negative results.

Methods

Firstly we performed a systematic review of published studies between 1998 and 2011 that explored the correlation between FLT uptake and Ki-67 score and examined possible variations in the methods used. Studies were eligible if they: (a) included patients with cancer, (b) investigated the correlation between Ki-67 measured by immunohistochemistry and FLT uptake measured with PET scanning, and (c) were published as a full paper in a peer-reviewed scientific journal.

Secondly a meta-analysis of the correlation coefficient values reported from each study was performed. Correlation coefficient (r) values were extracted from each study and 95 % confidence intervals (CIs) were calculated after applying Fisher¡¯s z transformation. For subgroup analysis, studies were classified by the index used to characterise Ki-67 expression (average or maximum expression), the nature of the sample (whole specimen or biopsy) and the cancer type.

Findings

Twenty-seven studies were identified as eligible for the meta-analysis. In the studies we examined there were variations in aspects of the methods and reporting. The meta-analysis showed that given an appropriate study design the FLT/Ki-67 correlation is significant and independent of cancer type. Specifically subgroup analysis showed that FLT/Ki-67 correlation was high in studies measuring the Ki-67 average expression regardless of use of surgery or biopsy samples (r = 0.70, 95 % CI = 0.43-0.86, p < 0.001). Of the studies that measured Ki-67 maximum expression, only those that used the whole surgical specimen provided a significant r value (r = 0.72, 95 % CI = 0.54-0.84, p < 0.001). Studies that used biopsy samples for Ki-67 maximum measurements did not produce a significant r value (r = 0.04, 95 % CI = ?0.18-0.26, p = 0.71). In terms of the cancer type subgroup analysis there is sufficient data to support a strong FLT/Ki-67 correlation for brain, lung and breast cancer. No publication bias was detected.

Interpretation

This systematic review and meta-analysis highlights the importance of the methods used in validation studies comparing FLT-PET imaging with the biomarker Ki-67. The correlation is significant and independent of cancer type provided a study design that uses Ki-67 average measurements, regardless of nature of sample, or whole surgical samples when measuring Ki-67 maximum expression. Sufficient data to support a strong correlation for brain, lung and breast cancer exist. However, larger, prospective studies with improved study design are warranted to validate these findings for the rest of the cancer types.