The diagnostic and prognostic values of Ki 67/MIB 1 expression in thyroid cancer: a meta analysis with 6,051 cases
Background Growing evidence has demonstrated that Ki 67/MIB 1 has an effect on the clinical progression and prognosis in cancers. However, the diagnostic and prognostic values of Ki 67/MIB 1 in thyroid cancer remain unclear. Materials and methods The meta analysis was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. Studies were retrieved from PubMed, EBSCO, EMBASE, ISI Web of Science, China National Knowledge Infrastructure, WanFang and Chinese VIP databases. MetaDiSc and STATA12.0 were used to analyze the meta analysis. Fixed effect analysis and random effect analysis were applied to pool the relative ratio based on heterogeneity in this meta analysis. Results In the meta analysis, 51 eligible studies were included. The pooled sensitivity of Ki 67/MIB 1 was 0.61 (95% confidence interval [CI] 0.59 0.63) and specificity was 0.75 (95% CI: 0.74 0.77) in thyroid cancer. The pooled positive likelihood ratio was 3.19 (95% CI: 2.30 4.42) and negative likelihood ratio was 0.43 (95% CI: 0.35 0.54) In the diagnosis of thyroid cancer, the pooled diagnostic odds ratio of Ki 67/MIB 1 was 8.54 (95% CI: 5.03 14.49) The area under the symmetric receiver operating characteristic curve was 0.804 (standard error =0.031) Our results showed that there were statistical associations between Ki 67/MIB 1 and age (odds ratio [OR] =1.71, 95% CI: 1.14 2.57, P=0.010) tumor size (OR =1.86, 95% CI: 1.17 2.96, P=0.008) lymph node metastasis (OR =2.49, 95% CI: 1.42 4.39, P=0.002) metastasis status (OR =6.96, 95% CI: 2.46 19.69, P<0.001) tumor node metastasis stage (OR =6.56, 95% CI: 3.80 11.34, P<0.001) and extrathyroid extension (OR =1.91, 95% CI: 1.27 2.87, P=0.002) Furthermore, thyroid cancer patients with a high level of Ki 67/MIB 1 had a worse disease free survival as compared to patients with a low level of Ki 67/MIB 1 (hazard ratio =5.19, 95% CI: 3.18 8.46, P<0.001) Also, Ki 67/MIB 1 was found to be associated with increased risk of mortality (hazard ratio =3.56, 95% CI: 1.17 10.83, P=0.025) Conclusion Our results demonstrated that Ki 67/MIB 1 might act as a potential factor in diagnosing thyroid cancer in Chinese. Also, the meta analysis indicated that Ki 67/MIB 1 might have an effect on prognosis in non Chinese thyroid cancer patients.
OncoTargets and therapy