Prognostic value of programmed death ligand 1, p53, and Ki-67 in patients with advanced-stage colorectal cancer

Lisha Wang, Zebing Liu, Kurt W. Fisher, Fei Ren, Jiaojie Lv, Darrell D. Davidson, Lee A. Baldridge, Xiang Du, Liang Cheng

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Current prognostic indicators are ineffective for identifying advanced-stage colorectal cancer (CRC) patients with high risk of recurrence after surgical resection. We investigated the prognostic value of p53, Ki-67, and programmed death ligand 1 (PD-L1) in 254 patients with stage II and III CRC. The expression of p53 was positive in 63% of cases. Up-regulation of p53 was associated with smaller tumor size (P =.001) and higher Ki-67 labeling index (LI) (P =.031). The tumor Ki-67 LI was high (≥20%) in 197 (78%) of the patients. High Ki-67 LI was associated with higher TNM stage (P =.031), positive p53 expression (P =.031), and negative PD-L1 expression (P =.003). The 5-year relapse-free survivals (RFS) were 53% and 89%, respectively, for the p53-positive and Ki-67 LI–high patients and the p53-negative and Ki-67 LI–low patients (P <.001). In univariate analysis, negative p53 (P =.001), low Ki-67 LI (P =.006), low PD-L1 expression (P =.044), low TNM stage (P <.001), rectosigmoid location (P =.026), and small size (P =.013) were significantly related to RFS. In multivariate Cox regression analysis, positive p53 expression (hazard ratio [HR]: 2.48; 95% confidence interval: 1.34–4.59, P =.004), high Ki-67 LI (HR, 2.62; 95% CI, 1.12–6.14, P =.027) and high TNM stage (HR, 2.598; 95% CI, 1.55–4.37, P <.001,) were independent predictors of unfavorable prognosis. In summary, PD-L1, Ki-67, and p53 staining individually had significant prognostic value for patients with stage II and III CRC. Moreover, combining p53 H-score ≥35 and Ki-67 LI ≥20% identifies patients with poor clinical outcome.

Original languageEnglish (US)
Pages (from-to)20-29
Number of pages10
JournalHuman Pathology
StatePublished - Jan 2018
Externally publishedYes


  • Biomarkers
  • Colorectal cancer
  • Ki-67 labeling index
  • PD-L1
  • Prognosis
  • p53

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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