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Ann Thorac Surg 2001;71:1765-1771
© 2001 The Society of Thoracic Surgeons

Original article: general thoracic

Prognostic implication of Ki-67 immunostaining in treating subclinical pleural cancer found at thoracotomy in lung cancer patients

Mitsutoshi Shiba, MDa, Kimitaka Kakizawa, MDa, Hiromasa Kohno, MDa, Kiyoshi Shibuya, MDa, Hisami Yamakawa, MDa, Kenzo Hiroshima, MDb, Takehiko Fujisawa, MDa

a Department of Surgery, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, Chiba, Japan
b Department of Pathology, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, Chiba, Japan

Accepted for publication February 13, 2001.

Address reprint requests to Dr Fujisawa, Department of Surgery, Institute of Pulmonary Cancer Research, Chiba University School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan
e-mail: msiba{at}hotmail.com

Background. Therapeutic principles for managing subclinical pleural cancer found unexpectedly during intraoperative examination are unclear. We analyzed prognostic factors including the tumor proliferative marker Ki-67 in these circumstances.

Methods. The cases of 65 surgically treated patients with lung cancer and subclinical T4 pleural cancer, microscopic in 25 and macroscopic in 40, were reviewed.

Results. The overall 5-year survival rate of patients undergoing lobectomy was 14.3%. For patients with T4 N0 disease, the 5-year survival rate was 46.7%. In patients with a low Ki-67 labeling index, the 5-year survival rate was 28.6%. The Ki-67 labeling index was a significant (p < 0.05) indicator of survival. Multivariate analysis demonstrated Ki-67 labeling index, lymph node involvement, and tumor differentiation to be the most influential prognostic factors for postoperative survival (p < 0.01).

Conclusions. In the treatment of lung cancer patients with subclinical pleural cancer found at thoracotomy, tumor resection is not necessarily contraindicated. Resection appears to be beneficial in patients with no nodal involvement or a low tumor Ki-67 labeling index. This index is a good therapeutic indicator for lung cancer patients.






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