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Journal of Neurosurgical Sciences 1999 December;43(4):263-70

lingua: Inglese

Relationship ­between Ki-67 label­ing ­index ­and sur­vi­val in ­high-­grade gli­o­ma ­patients treat­ed ­after sur­gery ­with tamox­i­fen

Mastronardi L. 1, Guiducci A. 2, Puzzilli F., Ruggeri A.

1 Civilian Hospital, Department of Neurological Sciences, Unit of Neurosurgery, Terni, Italy;
­2 Institute of Pathological Anatomy, Terni, Italy


Background. The Ki-67 is a nucle­ar anti­gen ­expressed in ­the G1, S, G2, ­and M phas­es of ­the ­cell ­cycle rec­og­niz­able by ­the mono­clo­nal anti­body ­MIB-1. The Ki-67 labeling index (LI) is con­sid­ered as a mark­er of pro­life­ra­tion (­growth frac­tion ­rate), ­even if ­its ­use as prog­nos­tic indi­ca­tor of cere­bral ­high-­grade gli­o­mas is ­still debat­ed. The ­aim of ­this ­study is to cor­re­late ­the Ki-67 LI ­with sur­vi­val in ­patients oper­at­ed on ­for a malig­nant gli­o­ma ­and treat­ed post­op­er­a­tive­ly ­with tamox­i­fen.
Methods. Using ­the ­MIB-1 anti­body, ­the Ki-67 anti­gen stain­ing of sur­gi­cal spec­i­mens ­was ­obtained in 26 ­patients oper­at­ed on ­for a malig­nant cere­bral gli­o­ma. After oper­a­tion, 9 ­patients start­ed to ­receive 40 mg/­day, 8 ­patients 80 mg/­day, ­and 9 ­patients 120 mg/­day of tamox­i­fen. In 20 cas­es ­one or ­more ­cycles of i.v. car­bop­la­tin ­was admin­is­tered. All ­patients ­received radio­ther­a­py (4500-6000 cGy).
Results. The over­all ­mean sur­vi­val ­rate ­was 19.8 ­months ­and ­the ­median 12 ­months; ­the 12-­month ­and 24-­month sur­vi­val ­rates ­were 47% ­and 23%, respec­tive­ly. The Ki-67 LI ­ranged ­from 2.3% to 62% (­mean 24.1%, ­median 20.5%). Excluding 2 ­patients ­who ­died dur­ing ­the post­op­er­a­tive peri­od, we ana­lyzed ­the sur­vi­val ­rates of ­the remain­ing 24 ­patients in rela­tion to ­the val­ue of Ki-67 LI. In rela­tion to ­the ­index, ­patients ­have ­been divid­ed ­into 3 ­groups, ­with dif­fer­ent sur­vi­val ­rates: L) Ki-67 LI ≤10%, ­with ­mean sur­vi­val ­rate of 30.7 ­months, M) ­from 10.1% to 30%, ­with ­mean sur­vi­val ­rate of 15.8 ­months, ­and H) >30%, ­with ­mean sur­vi­val ­rate of 20.2 ­months.
Conclusions. Our pre­lim­i­nary obser­va­tions ­seem to con­firm ­the effi­ca­cy of ­TAM in mod­i­fy­ing ­the sur­vi­val of malig­nant gli­o­mas ­and ­seem to indi­cate ­that ­tumors ­with a low­er LI ­and ­those ­with a LI >30% ­could be asso­ciat­ed, if treat­ed ­with ­TAM, ­with a bet­ter sur­vi­val ­than gli­o­mas belong­ing to ­group M, ­who ­could ­have a high­er ­tumor pro­life­ra­tion ­rate in com­par­i­son to ­group L ­and a low­er ­response to pro­tein-­kinase-C antag­o­nists ­than ­group H.

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