The Predictive Value Of Ki67 Expression Level In Locally Advanced Nasopharyngeal Carcinoma And Neoadjuvant Chemotherapy

Objective:To explore the role of Ki67 proliferation antigen expression level in tumor volume in predicting the efficacy of Induction Chemotherapy(IC)in Locally advanced nasopharyngeal carcinoma(LA-NPC).Methods:Retrospective data were used to analyze 390 patients with initial treatment of nasopharyngeal carcinoma at stage III-IVA in Sichuan Cancer Hospital from 2013 to 2019.Among them,195 patients received Induction Chemotherapy plus Concurrent chemoradiotherapy(IC+CCRT),and 195 patients received Concurrent chemoradiotherapy(CCRT)alone.The clinical data of all patients including the Ki67 value of the primary lesion were collected by the medical record system,and all enrolled patients were followed up by telephone.The ROC curve in Med Calc statistical software was used to obtain the Ki67 cutoff value for the total patients.Two groups of patients(IC+CCRT group,CCRT group)were selected for inclusion in this study through propensity matching score analysis by RStudio.A total of 334 patients were selected for inclusion in this study.Then,survival analysis was conducted according to the personal clinical data of 334 patients in the two groups.Kaplan-Meier was used in SSPS23.0 statistical analysis software for univariate survival analysis of the two groups of patients eventually included in this study,and Cox regression was used for multivariate survival analysis,including Overall survival(OS),Distance metastasis-free survival(DMFS)and Local recurrence free survival(Local recurrence free survival,LRFS),Progression-free survival(PFS)and progression-free survival(LRFS).According to the expression level of Ki67,the benefit of locally advanced NPC patients included in the statistical analysis in neoassistance was analyzed,and whether there were differences in OS,DMFS,LRFS and PFS among the locally advanced NPC patients at both ends of the truncation value when choosing different treatment regimens was analyzed.Results:ROC curve analysis with Med Calc statistical software showed that the Ki67 cutoff value was 50% in 390 patients.A total of 334 patients were selected for the final statistical analysis by RStudio for propensity matching score analysis,of which 167 patients with LA-NPC received induction chemotherapy plus concurrent chemoradiotherapy(IC+CCRT)and 167 patients with LA-NPC received concurrent chemoradiotherapy alone(CCRT).Compared with synchronous chemoradiotherapy(IC+CCRT)alone,the OS,DMFS,LRFS and PFS were 93.4%vs78.6%(P=0.0.038),87.5%vs77.3%(P=0.027),90.0%vs95.7%(P=0.697),and 80.8%vs77.3%(P=0.065).When the expression level of Ki67 supercharged antigen was greater than 50%,the OS of IC+CCRT compared with CCRT was 96.7%vs75.5%(P=0.011),DMFS was91.9%vs66.7%(P=0.003),LRFS was 88.9%vs94.1%(P=0.530),and PFS was81.7%vs66.7%(P=0.007).Compared with simple CCRT,IC+CCRT had OS of91.1% VS80.4%(P=0.631),DMFS of 84.0% VS85.2%(P=0.913),LRFS of91.6% VS96.7%(P=0.312),and PFS of 80.9% VS85.2%(P=0.921)when the expression level of Ki67 proliferation antigen was less than 50%(including50%).Conclusion: When the Ki67 proliferation antigen expression level in the tumor of the patient is greater than 50%,the OS,DMFS,and PFS of the locally advanced nasopharyngeal carcinoma receiving the IC+CCRT regimen are significantly better than the simple CCRT regimen(P<0.05),and the difference is statistically significant;When the Ki67 proliferation antigen is less than 50%(including 50%),the difference in OS,DMFS,and PFS between the two groups is not statistically significant.Even in this case,the direct use of the CCRT regimen may reduce the local recurrence of LA-NPC.