Ki-67 index enhances the prognostic accuracy of the urothelial superficial bladder carcinoma risk group classification
Ki-67 index enhances the prognostic accuracy of the urothelial superficial bladder carcinoma risk group classification
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DOI：
10.1002/ijc.11049
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发表时间：
2003-06-10
影响因子：
6.4
通讯作者：
Lopes, C
中科院分区：
文献类型：
--
作者：
Santos, L;Amaro, T;Lopes, C
大约80%的膀胱肿瘤是尿路上皮浅乳头状癌(USPC)。尽管预后总体良好，但这些肿瘤有很强的复发倾向，与疾病进展相比，其中约三分之一是复发。对这些浅表肿瘤的组织学评估不足以作为判断预后的指标；因此，我们决定评估P53和Ki-67在低级别(GI-II)USPC中的表达对预后的意义，以预测这些肿瘤的潜在预后。为探讨P53和Ki-67在159例浅表性膀胱癌无复发、无进展生存中的作用。评价了基于分级、分期和多病灶的预后风险模型。P53积聚与肿瘤进展显著相关(p=0.006)。在多因素分析中，高Ki-67指数(大于或等于18%)和多灶性与复发(P=0.0001)和无进展生存率(P=0.0001)显著相关，是独立的预后因素。基于分级、分期和多焦点的预后风险模型不是有效的预后判别器。将Ki-67指数加入到风险模型中，将单个PTA/T1-G1Ki-67阳性肿瘤重新归类为中等风险。在重新分类后，风险组模型确定了PTA/T1-G1亚组具有高复发和进展的风险。Ki-67指数是尿路上皮浅表性膀胱癌可靠的预后指标，将其纳入低级别USPC的危险因素分类，可提高预后判断的准确性。(C)2003年Wiley-Liss，Inc.
Approximately 80% of bladder tumors are urothelial superficial papillary carcinomas (USPC). Despite a generally good prognosis, these tumors have a strong propensity to recur and about 1/3 of them compared to disease progression. Histological assessment of these superficial tumors is not sufficiently discriminator in predicting prognosis; therefore, we decided to evaluate the prognostic significance of p53 and Ki-67 immunoexpression in low-grade (GI-II) USPC in order to predict the potential outcome of these tumors. P53 and Ki-67 immunoexpression were studied in function of recurrence-free and progression-free survival in 159 primary superficial bladder tumors. A prognostic risk model based on grade, stage and multifocality was also evaluated. P53 accumulation was significantly related to tumor progression (p=0.006). High Ki-67 index (greater than or equal to18%) and multifocality were significantly related to recurrence (both p=0.0001) and progression-free survival (both p = 0.0001) and were independent prognostic factors in the multivariate analysis. The prognostic risk model based on grade, stage and multifocality was not an efficient discriminator of outcome. Adding the Ki-67 index into the risk model, single pTa/T1-G1 Ki-67 positive tumors, usually classified as low risk, were reclassified as of intermediate risk. After this reclassification, the risk group model identified a subgroup of pTa/T1-G1 with a high risk of recurrence and progression. Ki-67 index is a reliable prognostic marker in urothelial superficial bladder carcinoma and, when included into a risk profile classification of the low-grade USPC, the accuracy of the prognostic discrimination is enhanced. (C) 2003 Wiley-Liss, Inc.