Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas

Introduction Since the Fourth edition of the WHO classification, PPGLs have been recognized for their metastatic potential, though no clear features can accurately predict this behavior. The prognostic value of Ki-67 in assessing the risk of progression, relapse, or metastasis in PPGLs remains debat...

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Main Authors: Zilan Luo, Xu Yan, Yang Liu, Fengrui Nan, Yuhong Lei, Yuan Ren, Lingyu Li
Format: Article
Language:English
Published: Taylor & Francis Group 2025-12-01
Series:Annals of Medicine
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Online Access:https://www.tandfonline.com/doi/10.1080/07853890.2025.2478312
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author Zilan Luo
Xu Yan
Yang Liu
Fengrui Nan
Yuhong Lei
Yuan Ren
Lingyu Li
author_facet Zilan Luo
Xu Yan
Yang Liu
Fengrui Nan
Yuhong Lei
Yuan Ren
Lingyu Li
author_sort Zilan Luo
collection DOAJ
description Introduction Since the Fourth edition of the WHO classification, PPGLs have been recognized for their metastatic potential, though no clear features can accurately predict this behavior. The prognostic value of Ki-67 in assessing the risk of progression, relapse, or metastasis in PPGLs remains debated.Methods This cohort study included 501 patients diagnosed with PPGLs at the First Hospital of Jilin University between 2000 and 2022, with clinical data, treatment details, pathological indicators, and germline gene test results collected. Bulk sequencing was performed on formalin-fixed paraffin-embedded (FFPE) primary tumor samples from 87 patients. Progression-free survival (PFS) was analyzed using multivariable Cox regression.Results Among the 119 enrolled patients with PPGLs, the average age was 45.7 ± 14.0 years, and the median follow-up time was 46 months. A significant finding was the high expression of CDK1, a gene known to be significantly associated with the metastatic risk of PPGLs, in samples with Ki-67 ≥ 3% (p < 0.0001). More importantly, patients with PPGLs and a Ki-67 level ≥ 3% had a 3.59-fold higher risk of progression, relapse or metastasis compared to those with Ki-67 < 3% (HR = 4.59, 95% CI: 1.06–11.95), after adjusting for all confounding factors. In the composite model, the addition of Ki-67 enhanced the predictive ability of the combined model of SDHB, primary site, tumor size, and invade neighboring tissue (AUC = 0.888, 95% CI: 0.808–0.967 vs. AUC = 0.874, 95% CI: 0.783–0.965).Conclusion A Ki-67 level ≥ 3% is associated with an increased risk of progression, relapse or metastasis in patients with PPGLs.
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spelling doaj-art-f0630cd79b39445882cdbe62ba0424eb2025-08-20T03:22:15ZengTaylor & Francis GroupAnnals of Medicine0785-38901365-20602025-12-0157110.1080/07853890.2025.2478312Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomasZilan Luo0Xu Yan1Yang Liu2Fengrui Nan3Yuhong Lei4Yuan Ren5Lingyu Li6Cancer Center, The First Hospital of Jilin University, Changchun, ChinaPathology Department, The First Hospital of Jilin University, Changchun, ChinaTumor Immunotherapy Research Center of Jilin University, Changchun, ChinaTumor Immunotherapy Research Center of Jilin University, Changchun, ChinaTumor Immunotherapy Research Center of Jilin University, Changchun, ChinaTumor Immunotherapy Research Center of Jilin University, Changchun, ChinaCancer Center, The First Hospital of Jilin University, Changchun, ChinaIntroduction Since the Fourth edition of the WHO classification, PPGLs have been recognized for their metastatic potential, though no clear features can accurately predict this behavior. The prognostic value of Ki-67 in assessing the risk of progression, relapse, or metastasis in PPGLs remains debated.Methods This cohort study included 501 patients diagnosed with PPGLs at the First Hospital of Jilin University between 2000 and 2022, with clinical data, treatment details, pathological indicators, and germline gene test results collected. Bulk sequencing was performed on formalin-fixed paraffin-embedded (FFPE) primary tumor samples from 87 patients. Progression-free survival (PFS) was analyzed using multivariable Cox regression.Results Among the 119 enrolled patients with PPGLs, the average age was 45.7 ± 14.0 years, and the median follow-up time was 46 months. A significant finding was the high expression of CDK1, a gene known to be significantly associated with the metastatic risk of PPGLs, in samples with Ki-67 ≥ 3% (p < 0.0001). More importantly, patients with PPGLs and a Ki-67 level ≥ 3% had a 3.59-fold higher risk of progression, relapse or metastasis compared to those with Ki-67 < 3% (HR = 4.59, 95% CI: 1.06–11.95), after adjusting for all confounding factors. In the composite model, the addition of Ki-67 enhanced the predictive ability of the combined model of SDHB, primary site, tumor size, and invade neighboring tissue (AUC = 0.888, 95% CI: 0.808–0.967 vs. AUC = 0.874, 95% CI: 0.783–0.965).Conclusion A Ki-67 level ≥ 3% is associated with an increased risk of progression, relapse or metastasis in patients with PPGLs.https://www.tandfonline.com/doi/10.1080/07853890.2025.2478312Ki-67paraganglioma and pheochromocyteprogressionrelapsemetastasis
spellingShingle Zilan Luo
Xu Yan
Yang Liu
Fengrui Nan
Yuhong Lei
Yuan Ren
Lingyu Li
Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas
Annals of Medicine
Ki-67
paraganglioma and pheochromocyte
progression
relapse
metastasis
title Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas
title_full Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas
title_fullStr Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas
title_full_unstemmed Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas
title_short Prognostic significance of Ki-67 in assessing the risk of progression, relapse or metastasis in pheochromocytomas and paragangliomas
title_sort prognostic significance of ki 67 in assessing the risk of progression relapse or metastasis in pheochromocytomas and paragangliomas
topic Ki-67
paraganglioma and pheochromocyte
progression
relapse
metastasis
url https://www.tandfonline.com/doi/10.1080/07853890.2025.2478312
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