title: Ki 67 is an independent predictive biomarker of cancer specific and local recurrence-free survival after lung tumor ablation.
abstract: BACKGROUND
  The objective of this work was to evaluate the feasibility of histopathological analysis of tissue extracted on multitined electrodes and assess whether tissue characteristics can be used as biomarkers of oncologic outcomes after lung tumor radiofrequency (RF) ablation.
  
  
  METHODS
  Treatment-related data regarding RF ablation of lung malignancies at our institution was collected using a Health Insurance Portability and Accountability Act-compliant ablation database. Institutional review board waiver was obtained for this study. Immunohistochemical analysis of tissue extracted from the electrodes after lung tumor RF ablation was performed for proliferation (Ki-67) and apoptosis (caspase-3). Patient, tumor demographics, and ablation parameters were recorded. Local tumor progression-free survival (LPFS), disease-specific survival (DSS), and overall survival (OS) were assessed using Kaplan-Meier methodology. Multivariate analysis determined factors affecting these oncological outcomes.
  
  
  RESULTS
  A total of 47 lung tumors in 42 patients were ablated; 30 specimens were classified as coagulation necrosis (CN) and 17 as Ki-67-positive (+) tumor cells (viable). Tumor sizes were similar in the CN and Ki-67+ groups (P = 0.32). Median LPFS was 10 versus 16 months for Ki-67+ and CN groups, and 1-year LPFS was 34 and 75 %, respectively (P = 0.003). Median OS was 20 and 46 months (P = 0.12), and median DSS was 20 and 68 months (P = 0.01) for the Ki-67 + and CN groups, respectively. Identification of Ki-67+ tumor cells more than tripled the risk of death from cancer [hazard ratio (HR) = 3.65; 95 % confidence interval (95 % CI), 1.34-9.95; P = 0.01] and tripled the risk of local tumor progression (LTP) (HR = 3.01; 95 % CI, 1.39-6.49; P = 0.005).
  
  
  CONCLUSIONS
  Ki-67+ tumor cells on the electrode after pulmonary tumor RF ablation is an independent predictor of LTP, shorter LPFS, and DSS.
authors.affiliation: Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA, sofoclec@mskcc.org.
authors.forename: Constantinos T
authors.initials: CT
authors.lastname: Sofocleous
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Garg
authors.forename: Perry
authors.initials: P
authors.lastname: Cohen
authors.forename: Elena N
authors.initials: EN
authors.lastname: Petre
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Erinjeri
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.forename: William D
authors.initials: WD
authors.lastname: Travis
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Solomon
mesh_terms: D000230:Adenocarcinoma / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017209:Apoptosis; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002289:Carcinoma, Non-Small-Cell Lung / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D017115:Catheter Ablation; D049109:Cell Proliferation; D015179:Colorectal Neoplasms / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000378:metabolism*; D008175:Lung Neoplasms / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D055752:Small Cell Lung Carcinoma / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen
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