title: Human telomerase reverse transcriptase (hTERT) and Ki-67 are better predictors of survival than established clinical indicators in patients undergoing curative hepatic resection for colorectal metastases.
abstract: BACKGROUND
  We evaluated hTERT and Ki-67 expression in patients who underwent curative resection of hepatic colorectal metastases to determine if these markers of cell proliferation correlated better with survival than an established scoring system that is based on clinical predictors.
  
  
  METHODS
  Patients operated on between 1993 and 1997 whose survival time was known were analyzed. For each patient, the clinical prognostic score was derived on the basis of primary node status, disease-free interval, number of hepatic tumors, largest tumor, and carcinoembryonic antigen level, and tumor specimens were analyzed for Ki-67 and hTERT with use of standard immunohistochemical techniques. The immunohistochemical analysis was blinded to all patient characteristics.
  
  
  RESULTS
  The study included 66 patients. Twenty-six survived less than 2 years after surgery, 19 survived 2-5 years, and 21 survived more than 5 years. Ki-67 positivity and hTERT positivity (labeling indexes greater than or equal to 50%) were observed in 24 patients and 23 patients, respectively. The clinical score did not predict survival, although there was a weak trend toward a lower score in patients with better survival. Both Ki-67 (P =.04) and hTERT (P =.0001) correlated better with survival than did the clinical score.
  
  
  CONCLUSIONS
  In patients undergoing curative resection of hepatic colorectal metastases, hTERT and Ki-67 are better predictors of survival than is a score based on clinical features.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Soria
authors.forename: Luc
authors.initials: L
authors.lastname: Morat
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Yang
authors.forename: Laure
authors.initials: L
authors.lastname: Sabatier
authors.forename: Diane D
authors.initials: DD
authors.lastname: Liu
authors.forename: Rabih A
authors.initials: RA
authors.lastname: Nemr
authors.forename: Asif
authors.initials: A
authors.lastname: Rashid
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
mesh_terms: D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D004268:DNA-Binding Proteins; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000378:metabolism*; D008113:Liver Neoplasms / Q000378:metabolism* / Q000401:mortality* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D019098:Telomerase / Q000378:metabolism*
chemical_list: D004268:DNA-Binding Proteins; D019394:Ki-67 Antigen; D019098:Telomerase