Expression and clinical significance of Ki-67 and P16 after neoadjuvant chemotherapy for locally advanced cervical cancer

Abstract

Abstract Objective To investigate the relationship between Ki-67 and P16 expression levels after neoadjuvant chemotherapy and the clinicopathological characteristics and prognosis of patients with locally advanced cervical cancer. Methods Patients who underwent neoadjuvant chemotherapy combined with radical hysterectomy in stage IB2 and IIA2 (FIGO 2009) at the First Hospital of Chongqing Medical University between January 2015 and December 2019 were retrospectively collected to correlate postoperative ki-67 and P16 expression levels with clinicopathological factors, and the optimal threshold for predicting recurrence was analyzed using ROC curves for the Ki67 index and univariate and multifactorial Cox regression analysis for the association between clinicopathological features including ki-67 and P16 and recurrence-free survival of the disease. Results A total of 334 patients had a median Ki-67 index of 60% (0–90%), with 303 (90.7%) positive and 31 (9.3%) negative P16 expressions; The cut-off value of ki-67 for determining patient recurrence was 67.5% according to the Receiver operating characteristic curves (ROC) (ROC curve) analysis; in multifactorial Cox analysis, lymphatic vascular space (p = 0.003) and ki-67 index (p = 0.005) increased the risk of tumor recurrence and were independent prognostic factors for cervical cancer recurrence, while the expression of P16 levels was not statistically significant (p = 0.097 OR = 0.319), and patients with cervical cancer in the high Ki-67 expression group (Ki-67 ≥ 67.5%) had lower recurrence-free survival (RFS) and overall survival (OS) than those in the low Ki-67 expression group (Ki-67 < 67.5%) (p = 0.001, p = 0.036). Conclusion The expression levels of ki-67 and P16 after neoadjuvant chemotherapy for locally advanced cervical cancer correlated with tumor differentiation; ki-67 values of 67.5% predicted the risk of recurrence in patients with stage IB2 and IIA2. High expression of ki-67 (Ki-67 ≥ 67.5%) may indicate poorer recurrence-free survival and overall survival, positive expression of P16 was not significantly associated with the prognosis of patients with stage IB2 and IIA2 cervical cancer.