Prognostic Value of Ki67 Expression for Patients with Surgically Resected Hepatocellular Carcinoma: Perspectives from a High Incidence Area

Background: Antigen Ki-67 (Ki67) is a documented tumor biomarker known to be aberrantly expressed in many human cancers. However, to our knowledge, its prognostic value for surgically resected hepatocellular carcinoma (HCC) for high incidence areas of China has not been described. Methods: We retrospectively investigated 339 patients with HCC who underwent surgery to remove the primary cancer at one center in Fujian, China, an area with a high incidence of HCC from 2004 to 2012. Immunohistochemistry (IHC) was used to quantify Ki67 expression in surgically resected HCC (RHCC) tissues. The survival curves were estimated by Kaplan-Meier analysis and the prognostic significance of Ki67 was analyzed using the log-rank test. The identification of relevant prognostic factors was performed by multivariate Cox regression analysis. Results: Differential Ki67 expression was measured in 339 tissues from HCC. Among them 155 showed high Ki67 expression (>= 3+), whereas the other 184 had low expression of Ki67 (-, +, or ++). High Ki67 was significantly related to preoperative serum a-fetoprotein > 400 mu g/L (p = 0.001) and decreased aminotransferase (ALT) (p < 0.001). Moreover, multivariate Cox regression analysis confirmed that high Ki67 expression was strongly associated with increased death risk (HR = 2.287, 95% CI: (1.652 - 3.166)) and recurrence risk (HR = 1.625, 95% CI: (1.162 - 2.274)). Conclusions: High Ki76 expression has prognostic value for poor survival for RHCC patients, and detection of Ki67 with IHC may be promising for estimating survival for RHCC patients in areas with high-incidence for this disease in China.