- Design
- Retrospective cohort with digital Ki67 analysis
- Population
- 75 jejunoileal NETs with nodal metastasis and/or mesenteric deposit
- Primary outcome
- Progression and disease-specific death
- Effect
- Deposit Ki67 HR 1.22 per 1% (95% CI 1.02 to 1.46) for progression; primary and nodal Ki67 not predictive
A US cohort of 75 jejunoileal neuroendocrine tumours with nodal metastases or mesenteric tumour deposits stained the largest primary, node and deposit in each case for Ki67, counted with QuPath and validated by manual counts.
In 68% of cases a node or deposit had a higher Ki67 than the primary. On multivariable analysis, only the Ki67 of the largest deposit predicted progression (HR 1.22 per 1% increase, 95% CI 1.02 to 1.46); the primary, the node and the highest index anywhere did not. Deposit size was associated with overall survival (HR 1.51 per cm).
Most laboratories grade the primary. This suggests that for jejunoileal NETs with deposits, the deposit is the more informative block. The study is modest in size with few deaths, but the change costs one extra stain.
- When a mesenteric deposit is present, stain the largest deposit for Ki67.
- Report the deposit Ki67 alongside the primary's.
- Grade on the higher value, and state which lesion it came from.
- Measure and report the size of the largest deposit.
Why it matters
The block most laboratories grade from may not be the one that predicts what happens next.
Don't overread it
A single cohort with 21 recurrences; the deposit Ki67 did not predict survival, only progression.
The statistics, in plain English
An HR of 1.22 per 1% rise means each percentage point of Ki67 in the deposit was associated with 22% higher risk of progression. With 21 recurrences, the interval is wide and its lower end (1.02) is close to no effect.
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