Expression of Ki-67 in papillary thyroid carcinoma and its clinicopathologic significance_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KONG Xiangyu ^1,2 , ZHU Xixi ^1,2 , LI Zhihui ¹ , LIU Jiaye ¹ , LEI Jianyong ¹ ,  WANG Xiaofei ¹

1. Division of Thyroid Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China College of Clinical Medicine, Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

WANG Xiaofei, Email: docwxf@scu.edu.com

Keywords：

papillary thyroid carcinoma; Ki-67; biomarker

DOI：

10.7507/1007-9424.202503023

Video：

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Objective To detect the expression of Ki-67 in papillary thyroid carcinoma (PTC) and investigate its clinical significance. Methods A retrospective analysis was conducted on PTC patients treated at West China Hospital of Sichuan University from August 2024 to February 2025. The relation between the Ki-67 expression in the postoperative pathological tissues and clinicopathologic features was analyzed. Additionally, the concordance of Ki-67 expression between the preoperative fine-needle aspiration samples and postoperative pathological tissues was evaluated by Bland-Altman analysis. The significance level was set at α=0.05. Results A total of 290 PTC patients met the inclusion and exclusion criteria were enrolled. Patients with classical PTC, M1 classification, TNM stage Ⅳ, and those achieving thyroid stimulating hormone (TSH) suppression targets at one month postoperatively had higher Ki-67 expression than those with follicular variant PTC, M0 classification, TNM stages Ⅰ–Ⅲ, or inadequate TSH suppression (all P＜0.05). No significant differences were observed in other subgroups (P>0.05). Furthermore, Bland-Altman analysis of 27 paired samples showed a mean bias of 1.269% between preoperative and postoperative measurements. Elevated variability occurred in high Ki-67 cases, with 11.1% (3/27) exceeding ±6% limits of agreement. Conclusions The study demonstrates that Ki-67 expression correlates with malignant attributes including tumor aggression and advanced disease. It may serve as a prognostic biomarker for assessing malignant potential in PTC.

Citation： KONG Xiangyu, ZHU Xixi, LI Zhihui, LIU Jiaye, LEI Jianyong, WANG Xiaofei. Expression of Ki-67 in papillary thyroid carcinoma and its clinicopathologic significance. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(8): 1011-1014. doi: 10.7507/1007-9424.202503023 Copy

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12.	Molinaro E, Romei C, Biagini A, et al. Anaplastic thyroid carcinoma: from clinicopathology to genetics and advanced therapies. Nat Rev Endocrinol, 2017, 13(11): 644-660.
13.	Zhang K, Wang X, Wei T, et al. Comparative study between poorly differentiated thyroid cancer and anaplastic thyroid cancer: real-world pathological distribution, death attribution, and prognostic factor estimation. Front Endocrinol (Lausanne), 2024, 15: 1347362. doi: 10.3389/fendo.2024.1347362.
14.	李函玥, 王奕洋, 刘慧, 等. 第九版肺癌TNM分期系统: 精细分期指导精准诊疗. 中华外科杂志, 2024, 62(6): 537-542.
15.	Reid MD, Bagci P, Ohike N, et al. Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies. Mod Pathol, 2015, 28(5): 686-694.
16.	Yerushalmi R, Woods R, Ravdin PM, et al. Ki67 in breast cancer: prognostic and predictive potential. Lancet Oncol, 2010, 11(2): 174-183.
17.	Yang Z, Tang LH, Klimstra DS. Effect of tumor heterogeneity on the assessment of Ki67 labeling index in well-differentiated neuroendocrine tumors metastatic to the liver: implications for prognostic stratification. Am J Surg Pathol, 2011, 35(6): 853-860.
18.	Uxa S, Castillo-Binder P, Kohler R, et al. Ki-67 gene expression. Cell Death Differ. 2021, 28(12): 3357-3370.
19.	Lloyd RV, Buehler D, Khanafshar E. Papillary thyroid carcinoma variants. Head Neck Pathol, 2011, 5(1): 51-56.
20.	Shi X, Liu R, Basolo F, et al. Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants. J Clin Endocrinol Metab, 2016, 101(1): 264-274.
21.	Wu XL, Tu Q, Faure G, et al. Diagnostic and prognostic value of circulating tumor cells in head and neck squamous cell carcinoma: A systematic review and meta-analysis. Sci Rep, 2016, 6: 20210. doi: 10.1038/srep20210.

1. Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol, 2016, 12(11): 646-653.
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
3. 何林烨, 王艺超, 李志辉. 2022年中国甲状腺癌流行情况分析: 基于《中国肿瘤登记年报》2005-2018年数据. 中国普外基础与临床杂志, 2024, 31(7): 790-795.
4. Chen DW, Lang BHH, McLeod DSA, et al. Thyroid cancer. Lancet, 2023, 401(10387): 1531-1544.
5. Jung CK, Bychkov A, Kakudo K. Update from the 2022 World Health Organization classification of thyroid tumors: a standardized diagnostic approach. Endocrinol Metab (Seoul), 2022, 37(5): 703-718.
6. Pacini F, Fuhrer D, Elisei R, et al. 2022 ETA consensus statement: what are the indications for post-surgical radioiodine therapy in differentiated thyroid cancer?. Eur Thyroid J, 2022, 11(1): e210046. doi: 10.1530/ETJ-21-0046.
7. Nickel B, Tan T, Cvejic E, et al. Health-related quality of life after diagnosis and treatment of differentiated thyroid cancer and association with type of surgical treatment. JAMA Otolaryngol Head Neck Surg, 2019, 145(3): 231-238.
8. 方三高, 于永娟, 王丛. 2022年第五版WHO内分泌器官肿瘤分类. 诊断病理学杂志, 2023, 30(5): 519-521.
9. Haddad RI, Bischoff L, Ball D, et al. Thyroid carcinoma, version 2. 2022, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2022, 20(8): 925-951.
10. Lechner MG, Bernardo AC, Lampe A, et al. Changes in stage distribution and disease-specific survival in differentiated thyroid cancer with transition to American Joint Committee on cancer 8th edition: a systematic review and meta-analysis. Oncologist, 2021, 26(2): e251-e260. doi: 10.1634/theoncologist.2020-0306.
11. 李春华, 覃胜, 伏桂明, 等. 低分化甲状腺癌治疗策略探讨. 中华内分泌外科杂志, 2021, 15(1): 36-40.
12. Molinaro E, Romei C, Biagini A, et al. Anaplastic thyroid carcinoma: from clinicopathology to genetics and advanced therapies. Nat Rev Endocrinol, 2017, 13(11): 644-660.
13. Zhang K, Wang X, Wei T, et al. Comparative study between poorly differentiated thyroid cancer and anaplastic thyroid cancer: real-world pathological distribution, death attribution, and prognostic factor estimation. Front Endocrinol (Lausanne), 2024, 15: 1347362. doi: 10.3389/fendo.2024.1347362.
14. 李函玥, 王奕洋, 刘慧, 等. 第九版肺癌TNM分期系统: 精细分期指导精准诊疗. 中华外科杂志, 2024, 62(6): 537-542.
15. Reid MD, Bagci P, Ohike N, et al. Calculation of the Ki67 index in pancreatic neuroendocrine tumors: a comparative analysis of four counting methodologies. Mod Pathol, 2015, 28(5): 686-694.
16. Yerushalmi R, Woods R, Ravdin PM, et al. Ki67 in breast cancer: prognostic and predictive potential. Lancet Oncol, 2010, 11(2): 174-183.
17. Yang Z, Tang LH, Klimstra DS. Effect of tumor heterogeneity on the assessment of Ki67 labeling index in well-differentiated neuroendocrine tumors metastatic to the liver: implications for prognostic stratification. Am J Surg Pathol, 2011, 35(6): 853-860.
18. Uxa S, Castillo-Binder P, Kohler R, et al. Ki-67 gene expression. Cell Death Differ. 2021, 28(12): 3357-3370.
19. Lloyd RV, Buehler D, Khanafshar E. Papillary thyroid carcinoma variants. Head Neck Pathol, 2011, 5(1): 51-56.
20. Shi X, Liu R, Basolo F, et al. Differential clinicopathological risk and prognosis of major papillary thyroid cancer variants. J Clin Endocrinol Metab, 2016, 101(1): 264-274.
21. Wu XL, Tu Q, Faure G, et al. Diagnostic and prognostic value of circulating tumor cells in head and neck squamous cell carcinoma: A systematic review and meta-analysis. Sci Rep, 2016, 6: 20210. doi: 10.1038/srep20210.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Expression of Ki-67 in papillary thyroid carcinoma and its clinicopathologic significance

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