黑色素瘤患者种系抗原及核抗原Ki-67的表达水平及其与预后的关系

目的 ：明确黑色素瘤组织中种系抗原及核抗原Ki-67的表达情况并分析其与患者生存预后的关系。方法 ：回顾性分析2008年2月至2020年8月期间就诊于北京大学肿瘤医院黑色素瘤内科的黑色素瘤患者的病理资料主要关注黑色素瘤种系抗原（包括S-100、HMB-45、Melan-A）和Ki-67的表达情况]以及人口统计学、临床特点及生存数据。对黑色素瘤种系抗原及Ki-67表达情况与黑色素瘤特异性生存时间（melanoma-specific survival，MSS）进行相关性分析。结果 ：共纳入603例患者，中位随访时间47.4个月。其中S-100的阳性率为92.8%、HMB-45为92.1%、Melan-A为90.0%。患者黑色素瘤种系抗原评分（S-100，HMB-45和Melan-A三者纳入计分，阳性者各计1分，阴性计0分）为0、1、2和3分的患者分别占0.5%、5.0%、15.6%和78.8%，Ki-67评分为0、1、2和3的患者分别占43.0%、36.3%、16.3%和4.5%。Ki-67在黏膜及进展期黑色素瘤中呈高表达。在多因素分析中，Ki-67的表达水平是较差MSS的独立预后因素，Ki-67每升高25%，出现MSS终点事件的几率增加约50% （HR=1.506, 95%CI：1.248-1.818, P<0.001）；而黑色素瘤种系抗原表达评分与MSS无统计学意义上的相关性（HR=0.991, 95%CI：0.759-1.293, P=0.94）。结论 ：黑色素瘤组织中存在黑色素瘤种系抗原的高表达，Ki-67为黑色素瘤特异性生存的独立预后因素。

Expressions of melanoma lineage antigens and nuclear antigen Ki-67 and their correlations with prognosis in melanoma patients

Abstract: To explore the expression patterns of melanoma lineage antigens and nuclear antigen Ki-67 and their correlations with survival in melanoma patients.Methods: A retrospective analysis was conducted to analyze the pathological data of melanoma patients treated at the Department of Melanoma, Peking University Cancer Hospital from February 2008 to August 2020, mainly including the expression patterns of melanoma lineage antigens (S-100, HMB-45, Melan-A) and Ki-67, demographics, clinical features and survival. The correlation between expression patterns of melanoma lineage antigens, Ki-67 and melanoma-specific survival (MSS) was analyzed.Results: In total, 603 patients were included in this study. The median follow-up time was 47.4 months. The positive rates of S-100, HMB, and Melan-A were 92.8%, 92.1% and 90.0%, respectively. The percentages of patients with melanoma lineage antigen scores(S-100, HMB-45 and Melan-A was scored each, as 1 when positive and 0 when negative) of 0, 1, 2, and 3 were 0.5%, 5.0%, 15.6%, and 78.8%, respectively. The percentages of patients with Ki-67 scores of 0, 1, 2, and 3 were 43.0%, 36.3%, 16.3%, and 4.5%, respectively. Ki-67 was highly expressed in mucosal and progressive melanomas. In a multivariate analysis, Ki-67 expression was an independent prognostic factor for poorer MSS (HR=1.506, 95%CI: 1.248-1.818, P<0.001) as the incidence of MSS event increased by 50% per 25% increase in Ki-67 expression, whereas there was no statistical correlation between melanoma lineage antigen expression and MSS (HR=0.991, 95%CI: 0.759-1.293, P=0.94).Conclusion: High expressions melanoma lineage antigens are ubiquitous in melanoma tissues, and Ki-67 is an independent prognostic factor for MSS.