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Prognostic Role of Ki-67 in Adrenocortical Carcinoma After Primary Resection: A Retrospective Mono-Institutional Study



Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. It is vitally important to predict prognosis and restrict unnecessary adjuvant treatments for patients with ACC. This study aims to confirm the prognostic value of Ki-67 and provide a prognostic evaluation on ACC after primary surgery.


A total of 66 patients satisfied the inclusion criteria and their complete data were collected and reviewed. The correlation between Ki-67 index and clinicopathologic variables was analyzed using chi-square tests and Pearson’s or Spearman’s test. Survival curves were generated by Kaplan–Meier analysis and compared with the log-rank test. The Cox regression model was performed to estimate hazard ratios for univariate and multivariate analyses.


Of the 66 patients, recurrence was observed in 30 patients (45.5%) and 26 patients (39.4%) died of progressive ACC. The evaluated median overall survival (OS) of the entire study population was 16.5 (range 1–104) months and recurrence-free survival (RFS) was 9.0 (range 0–104) months. Increased Ki-67 expression (> 20% and > 3%) was negatively correlated with OS and RFS (chi-square, P = 0.006 and 0.044, respectively). In multivariate analysis, the Ki-67 index with 20% and 3% cutoff as an independent prognostic factor for OS and RFS was validated [hazard ratio (HR) 3.289; 95% CI 1.345–8.042; P = 0.009 and HR 4.471; 95% CI 1.086–18.410; P = 0.038, respectively].


Ki-67 is a reliable, convenient, and independent prognostic marker for ACC. Additionally, as an indicator with a divergent prognostic role at different cutoff values (20% and 3%), Ki-67 could be used for stratifying patients with a high risk of death or rapid recurrence.

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We thank the participants of the study in addition to Chuan Zhou and Jiayu Liang for their contributions to the collection of data and revision of the manuscript.


This study and its publishing expenses including Rapid Service fee were funded by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University and the Science and Technology Foundation of the Sichuan Province (2017SZ0123 to Zhihong Liu).


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Fan Zhang and Zhihong Liu contributed equally to this study.


All named authors, Fuxun Zhang, Fan Zhang, Zhihong Liu, Kan Wu, Yuchun Zhu, and Yiping Lu, have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously collected data and does not contain any new studies with human participants or animals performed by any of the authors. The institutional review board of West China Hospital had approved this study and all patients included in this study provided informed consent for the use and publication of their data.

Data Availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Corresponding authors

Correspondence to Yuchun Zhu or Yiping Lu.

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Zhang, F., Zhang, F., Liu, Z. et al. Prognostic Role of Ki-67 in Adrenocortical Carcinoma After Primary Resection: A Retrospective Mono-Institutional Study. Adv Ther 36, 2756–2768 (2019).

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  • Adrenocortical carcinoma
  • Cutoff value
  • Ki-67
  • Marker
  • Prognosis