High Ki-67 expression is significantly associated with poor prognosis of ovarian cancer patients: evidence from a meta-analysis

  • Dongmei Qiu
  • Wanqiu Cai
  • Zhiqiao ZhangEmail author
  • Hongyan Li
  • Dongmei Zhou
Gynecologic Oncology



The prognostic significance of Ki-67 expression in patients with ovarian cancer was controversial in various studies. Therefore, we carried out a meta-analysis to determine the prognostic significance of Ki-67 in ovarian cancer patients.


We searched PubMed, Cochrane Library, EMBASE, Web of Knowledge, China National Knowledge Infrastructure database and WanFang digital database for eligible studies from January 1, 1990 to June 1, 2017. The pooled hazard ratios and 95% confidence intervals were calculated to assess the prognostic significance of Ki-67 expression for overall survival in ovarian cancer patients.


Finally, 38 eligible studies and 5004 ovarian cancer patients were included in the current study. The pooled hazard ratio was 1.35 (95% confidence interval 1.24–1.46, P = 0.001) for overall survival in ovarian cancer patients. The funnel plot bias was obviously asymmetrical and Egger’s test also detected significant publication bias (P = 0.001). The Contour-enhanced funnel plot with trim-and-fill method supplemented 11 dummy studies to balance the funnel plot and nine new supplementary studies were in area with statistical significance. Sensitivity analysis and cumulative meta-analysis further demonstrated that the association between high Ki-67 expression and poor overall survival of ovarian cancer patients was stable and reliable.


High Ki-67 expression is significantly related to poor overall survival and may serve as a prognostic biomarker for ovarian cancer patients.


Ovarian cancer ki-67 Meta-analysis Prognostic value 


Author contributions

Conceptualization: ZZ, DQ, WC. Data curation: ZZ, WC. Formal analysis: ZZ, WC. Funding acquisition: ZZ. Investigation: ZZ, WC, DQ. Methodology: ZZ, WC, DQ. Project administration: ZZ, DZ. Resources: ZZ, HL. Software: ZZ, DZ, HL. Supervision: ZZ, WC. Validation: ZZ, DQ,WC. Visualization: ZZ, HL. Writing - original draft: ZZ, WC. Writing- review& editing: ZZ, WC.


This study was funded in part by Health Department and Finance Department of Guangdong Province. The Grant Numbers were No: B2018237 (Grant Recipient: Zhiqiao Zhang) and No: A2016450 (Grant Recipient: Zhiqiao Zhang).The total funding account was RMB 5000. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The URLs of Health Department of Guangdong Province was

Compliance with ethical standards

Conflict of interest

The authors have declared that they had no conflict of interests in relation to the work described. The authors have declared that they have had full control of all primary data and that they agreed to allow the Journal to review their data if requested.

Ethical approval

The present study is a meta-analysis and ethical approval is not needed for meta-analysis.

Supplementary material

404_2019_5082_MOESM1_ESM.doc (69 kb)
Supplementary file1 (DOC 69 kb)
404_2019_5082_MOESM2_ESM.dta (6 kb)
Supplementary file2 (DTA 7 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyThe Affiliated Chencun Hospital of Shunde Hospital of Southern Medical UniversityShundePeople’s Republic of China
  2. 2.Department of Internal MedicineThe Affiliated Chencun Hospital of Shunde Hospital, Southern Medical UniversityShundePeople’s Republic of China

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