BORDERLİNE MÜSİNÖZ OVER TÜMÖRLERİNDE Kİ67'NİN PROGNOSTİK DEĞERİ

Amaç Overin müsinöz borderline tümörleri (MBT), borderline over tümörlerinin en sık görülen ikinci alt tipidir. Belirsiz patogenezleri ve biyolojik davranışları nedeniyle, benign veya malign kategorilere açıkça sınıflandırılamadıkları için klinik seyir hakkında daha prognostik bilgi sağlayan ve rutin pratikte kolaylıkla değerlendirilebilecek bir parametrenin belirlenmesine ihtiyaç vardır. Ki67, tümör hücreleri de dahil olmak üzere hücresel proliferasyonla güçlü bir şekilde ilişkili olan ve rutin olarak kullanılan bir immünohistokimyasal belirteçtir. Bu çalışmada MBT'lerde Ki67 sayımının prognostik önemini değerlendirmeyi ve prognostik eşik değerini belirlemeyi ve klinikopatolojik özellikleri, nüks ve uzun süreli sağkalım durumu ile ilişkisini araştırmayı ve ayrıca literatüre daha fazla bilgi sağlamayı amaçladık. Gereç ve Yöntem Müsinöz borderline over tümörü tanısı koyulan toplam 20 vaka çalışmaya alındı. Tümörü en iyi temsil eden örnek üzerinde immünohistokimyasal çalışmalar yapıldı. Nükleer boyanma pozitif kabul edildi ve iki patolog tarafından değerlendirildi Bulgular Ki67 proliferasyon indeksi (P.I) medyan %15 (1-47% ve ortalama %16'dır. Ki67 P.I. progresyonla %20 eşik değerinde ve 5 yıllık OS ile %30 eşik değerinde istatistiksel olarak anlamlılığa ulaştı. (sırasıyla p=0.021 ve p=0.032). Ki67 P.I. yaşla birlikte artma eğilimindeydi. Kİ67 P.I. ile tümör boyutu, lateralite, kapsül bütünlüğü, intraepitelyal karsinom ve fokal atipi dahil olmak üzere diğer klinikopatolojik parametreler arasında istatistiksel bir ilişki yoktu. Sonuç Çalışmamızda Ki67 %20'den yüksek olduğunda nüksün daha sık oluşu, Ki67 %30'dan yüksek olduğunda 5 yıllık sağkalımın daha düşük oluşu Ki67 indeksinin daha agresif seyir ve ölüm ile ilişkili olduğunu düşündürdü. Bu nedenle Ki 67'nin hastaların takip sıklığını belirlemede ve prognozlarını tahmin etmede faydalı olacağını öngördük. Ancak bu sonucun daha geniş seriler ile desteklenmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler:

Borderline, Ki67, Müsinöz, Over, Tümör

PROGNOSTİC VALUE OF Kİ67 İN BORDERLİNE MUCİNOUS OVARİAN TUMORS

Objective Ovarian borderline tumors (OBTs) are an intermediate type of ovarian neoplasm. Ovarian mucinous borderline tumors (MBT) are the second most common subtype of OBT. Because of their uncertain pathogenesis and biological behaviour they cannot be classified clearly into benign and malign categories. There is a need to identify a parameter that provides more prog- nostic information about the clinical course and can be evaluated easily in routine practice. Ki67 is a routinely used immunohistochemical marker that is strongly associated with cellular proliferation, including tumor cells. We aimed in this study to evaluate the prognostic significance and to determine prognostic cut-off value of Ki67 counting in the MBTs and to investigate its relationship with clinicopathologic features, recurrence, and long term survival status and also to provide more information to the literature. Material and Method A total of 20 cases diagnosed with ovarian mucinous borderline tumors were identified. Immunohistochemical studies were performed on the most representative sample of the tumor. Positive signal was nuclear and it was evaluated by two pathologists. Results Ki67 proliferating index (P.I) value with a median of 15%(1-47%) and a mean of 16% Ki67 P.I. reached statistically significance at 20% cut-off value with progression and at 30% cut-off value with 5-year OS. (p=0.021 and p=0.032, respectively). Although the Ki67 P.I. tended to increase with age, there was no statistical association between Kİ67 P.I. and other clinicopathological parameters including tumor size, laterality, capsule integrity, intraepithelial carcinoma and focal atypia. Conclusion In our study, recurrence was more frequent when Ki67 was greater than 20%, and 5-year survival was lower when Ki67 was greater than 30%, suggesting that the Ki67 index was associated with a more aggressive course and death. Therefore, we predicted that Ki 67 would be useful in determining the frequency of follow-up of patients and predicting their prognosis. However, we think that this result should be supported by larger series.

Keywords:

Borderline, Mucinous, Ovary, Tumor, Ki67,

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