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中华普外科手术学杂志(电子版)

中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (06) : 623 -626. doi: 10.3877/cma.j.issn.1674-3946.2023.06.011

论著

TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究
江振剑, 蒋明†(), 黄大莉   
  1. 571700　海南儋州，海南西部中心医院普外科
  • 收稿日期:2022-11-28 出版日期:2023-12-26
  • 通信作者: 蒋明

The expression and prognostic value of TK1 and Ki67 proteins in differentiated thyroid carcinoma

Zhenjian Jiang, Ming Jiang†(), Dali Huang   

  1. Department of General Surgery, Hainan Western Central Hospital, Danzhou Hainan Province 571700, China
  • Received:2022-11-28 Published:2023-12-26
  • Corresponding author: Ming Jiang
  • Supported by:
    Hainan Provincial Health Industry Scientific Research Project(20A200169)
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江振剑, 蒋明, 黄大莉. TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 623-626.

Zhenjian Jiang, Ming Jiang, Dali Huang. The expression and prognostic value of TK1 and Ki67 proteins in differentiated thyroid carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(06): 623-626.

目的

探讨癌组织中胸苷激酶1（TK1）、细胞增殖抗原67（Ki67）蛋白表达与经乳晕入路腔镜辅助甲状腺切除术治疗的分化型甲状腺癌（DTC）患者预后的关系。

方法

采用病例对照研究，将2012年6月至2016年6月40例接受经乳晕入路腔镜切除术治疗预后不良的DTC患者，纳入预后不良组；将同期40例接受经乳晕入路腔镜切除术治疗预后良好的DTC患者，纳入预后良好组。所有患者完成5年随访。用SPSS 23.0软件进行数据处理，计数资料以[例(%)]表示，用χ2检验；等级资料用秩和检验；全部计量资料均经Shapiro-Wilk正态性检验，符合正态分布用（）表示，组间比较采用独立样本t检验；偏态分布的计量资料用[M(P25,P75)]表示，组间比较用Mann-Whitney U检验；绘制受试者工作曲线（ROC）分析TK1、Ki67蛋白表达与DTC患者经乳晕入路腔镜切除术后预后的关系。以P<0.05为差异有统计学意义。

结果

DTC癌组织中TK1、Ki67蛋白阳性表达率（66.25%、71.25%）高于癌旁正常组织（21.25%、23.75%）（P<0.05）；预后不良组患者甲状腺球蛋白（Tg）、促甲状腺激素（TSH）水平高于预后良好组，TK1、Ki67蛋白阳性表达率高于预后良好组（P<0.05）；ROC曲线显示，TK1、Ki67蛋白表达预测经乳晕入路腔镜切除预后不良价值的AUC分别为0.825（95%CI: 0.728-0.922）、0.863（95%CI: 0.775-0.950），有一定预测价值。

结论

DTC患者预后与癌组织中TK1、Ki67蛋白表达有关。

关键词: 甲状腺肿瘤, 胸腺激酶1, 细胞增殖抗原67, 经乳晕入路腔镜切除, 预后
Objective

To investigate the relationship between the expression of thymidine kinase 1(TK1) and cell proliferation antigen 67(Ki67) protein in cancer tissues and the prognosis of patients with differentiated thyroid carcinoma (DTC) treated by endoscopic assisted thyroidectomy via areola approach.

Methods

In a case control study, 40 DTC patients with poor prognosis who received endoscopic resection via areola from June 2012 to June 2016 were included in the poor prognosis group. At the same time, 40 patients with DTC with good prognosis who received endoscopic resection via areola approach were included in the good prognosis group. All patients were followed up for 5 years. SPSS 23.0 software was used for data processing. The enumeration data were expressed as [cases (%)], and χ2 test was used. Rank sum test was used for grade data; all measurement data were tested by Shapiro-Wilk normality test, and the normal distribution was expressed as (). Independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as [M(P25, P75)], and Mann-Whitney U test was used for comparison between groups. The receiver operating curve (ROC) was drawn to analyze the relationship between the expression of TK1 and Ki67 protein and the prognosis of DTC patients after endoscopic resection via areola approach. P<0.05 was considered statistically significant.

Results

The positive expression rate of TK1 and Ki67 protein in DTC cancerous tissues (66.25%, 71.25%) was higher than that in adjacent tissues (21.25%, 23.75%) (P<0.05); the levels of thyroglobulin (Tg) and thyroid stimulating hormone (TSH) in patients with poor prognosis were higher than those in patients with good prognosis, and the positive expression rates of TK1 and Ki67 protein were higher than those in patients with good prognosis (P<0.05). The ROC curve was drawn. The results showed that the AUC of TK1 and Ki67 protein expression predicting the poor prognosis of endoscopic resection via areola approach were 0.825 (95% CI: 0.728-0.922) and 0.863 (95% CI: 0.775-0.950), respectively, which had certain predictive value.

Conclusion

The prognosis of DTC patients may be related to the expression of TK1 and Ki67 proteins in cancer tissues, and TK1 and Ki67 proteins can be used as prognostic indicators of DTC patients.

Key words: Thyroid Neoplasms, Thymidine Kinase1, Proliferating Antigen Ki67, Endoscopic Resection Via Areola Approach, Prognosis
图1 TK1在分化型甲状腺癌组织中的表达 注：A=癌组织中TK1蛋白强阳性（+++）表达（×200）；B=癌组织中TK1蛋白弱阳性（+）表达（×400）。
图2 Ki67在分化型甲状腺癌组织中的表达（×200） 注：A=癌组织中Ki67蛋白强阳性（+++）表达；B=癌组织中Ki67蛋白阳性（++）表达。
表1 DTC患者癌组织、癌旁组织TK1、Ki67蛋白表达比较[例(%)]
组织部位 例 TK1蛋白阳性 Ki67蛋白阳性
癌组织 80 53（66.3） 57（71.3）
癌旁组织 80 17（21.3） 19（23.8）
χ2值 32.914 36.190
P值 <0.001 <0.001
表2 80例接受经乳晕入路腔镜甲状腺切除不同预后两组患者相关基线资料比较[例(%)]
项目 预后不良组(n=40) 预后良好组(n=40) 统计值 P值
性别 男 13(32.5) 11(27.5) χ2=0.238 0.626
女 27(67.5) 29(72.5)
年龄[(),岁] 34.5±4.5 34.5±3.7 t=0.027 0.978
病理类型 乳头状 31(77.5) 30(75.0) χ2=0.069 0.793
滤泡状 9(22.5) 10(25.0)
肿瘤个数 ≥2个 11(27.5) 9(22.5) χ2=0.267 0.606
1个 29(72.5) 31(77.5）
淋巴结转移 有 22(55.0) 20(50.0) χ2=0.201 0.654
无 18(45.0) 20(50.0)
TNM分期 Ⅰ期 34(85.0) 35(87.5) Z=0.354 0.723
Ⅱ期 4(10.0) 4(10.0)
Ⅲ期 2(5.0) 1(2.5)
肿瘤直径[(),cm] 1.3±0.2 1.2±0.2 t=0.670 0.505
Tg[M(P25,P75), μg/L] 51.5(41.2,56.7) 42.2(39.8,45.4) U=3.984 <0.001
TSH[M(P25,P75), mU/L] 13.6(10.3,17.3) 11.2(9.5,12.2) U=2.747 0.006
TK1蛋白 阳性 32(80.0) 21(52.5) χ2=6.765 0.009
阴性 8(20.0) 19(47.5)
Ki67蛋白 阳性 34(85.0) 23(57.5) χ2=7.383 0.007
阴性 6(15.0) 17(42.5)
图3 DTC患者癌组织TK1、Ki67蛋白表达预测经乳晕入路腔镜切除预后不良风险的ROC曲线图
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