J Cancer 2016; 7(7):758-767. doi:10.7150/jca.14214

Research Paper

What is the Prognostic Significance of Ki-67 Positivity in Oral Squamous Cell Carcinoma?

Shang Xie1*, Ying Liu1*, Xue Qiao2, Rui-Xi Hua3, Kan Wang1, Xiao-Feng Shan1✉, Zhi-Gang Cai1✉

1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China;
2. Department of Physiology and Pathophysiology, Peking University Health Science Center, Beijing 100191, China;
3. Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China.
* These authors contributed equally to this work.


BACKGROUD: Numerous studies have stated that Ki-67 is a good prognostic marker in oral squamous cell carcinoma (OSCC). However, some researchers believe the contrary. To address this controversy, we performed a systematic literature retrieval to estimate the prognostic significance of Ki-67 expression in patients with OSCC. METHODS: Databases covering Pubmed, Ovid, Web of Science, Embase and the Cochrane library were searched regardless of publication year. Overall survival (OS), local recurrence (LR) and disease-free survival (DFS) were the main outcome measures. Relative risks (RRs) and its 95% confidential intervals (CIs) were used for statistical analysis. RESULTS: Twenty-seven articles with 2146 patients were included in this study. The results of the meta-analysis suggested that the pooled RRs and its CIs for OS, LR, and DFS were 1.45 (1.15 - 1.84), 1.76 (0.74 - 4.16) and 1.52 (1.07 - 2.14), respectively. However, the heterogeneities of OS and LR were obvious (I-squared (OS) = 59.4%, I-squared (LR) = 72.6%). After subgroup analysis based on systemic treatment, the cut-off value of Ki-67 expression, ethnicity and types of antibody, the heterogeneities became acceptable. It was observed that systemic treatment, cut-off values of Ki-67 expression, ethnicity and the types of antibody affected the results. The statistical analyses of subgroups suggested that non-systemic treatment, (OR=1.77, 95% CI = 1.39-2.25, p = 0.000) and Asian populations (OR=2.09, 95% CI = 1.32-3.32, p = 0.002) are high risks for Ki-67 high expression, and low cut-off value of Ki-67 expression (OR = 1.44, 95% CI = 1.001-2.072), MIB-1 antibody (OR = 1.48, OR 95% = 1.10-1.99) might affect the identification of results. CONCLUSIONS: According to this meta-analysis, high Ki-67 expression might be a negative prognostic marker of patients with OSCC, especially in Asian populations. In addition, Ki-67 expression affects the treatment response.

Keywords: Ki-67, Oral squamous cell carcinoma, OSCC, Prognosis, Survival, Meta-analysis.

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How to cite this article:
Xie S, Liu Y, Qiao X, Hua RX, Wang K, Shan XF, Cai ZG. What is the Prognostic Significance of Ki-67 Positivity in Oral Squamous Cell Carcinoma?. J Cancer 2016; 7(7):758-767. doi:10.7150/jca.14214. Available from http://www.jcancer.org/v07p0758.htm