Prognostic Significance of the Ki-67 Index in Predicting Tumor Recurrence for Low-grade Superficial Transitional Cell Carcinoma of the Urinary Bladder

以Ki-67指數看原發性低度惡性表淺性膀胱癌的預後

陳建旭(Jian-Shiu Chen) ； 吳東霖(Tony T. Wu) ； 盧誌明(Chih-Ming Lu) ； 李瀛輝(Ying-Huei Lee) ； 黃榮慶(Jong-Khing Huang)

《臺灣泌尿科醫學會雜誌》 13卷3期 (2002/09) Pp. 114-118

摘要

研究目的:表淺性膀胱癌的患者約有70%會復發。雖然癌細胞分化的程度（grade）以及侵犯的期別（stage）有助於預測病人的預後，但卻無法完全預測哪些病人的膀胱癌會復發。Ki-67這種抗原只會出現在正在分裂的細胞，我們試著用Ki-67指數（即染出有Ki-67抗原的細胞所佔比例）來預測表淺性膀胱癌病人的預後。
材料與方法:我們收集了79位原發性、表淺性、且低度惡性膀胱癌的病人，這些病人都接受經尿道膀胱腫瘤切除。其中25人（31.6%）膀胱腫瘤復發至少一次。將79位病人的腫瘤細胞用抗Ki-67抗體加以染色，計算Ki-67指數（即染出有Ki-67抗原的細胞所佔比例）並統計結果。
結果:統計結果發現Ki-67指數與癌細胞分化的程度（grade）有密切的相關，而原發性與復發性膀胱癌的Ki-67指數並沒有差異。若以這些病人Ki-67指數的中位數（median=10.9）作區分，以Kaplan-Meier curve看disease-free survival curve發現Ki-67指數能幫助預測哪些病人的膀胱癌會復發。但Ki-67在多變項分析則未出現顯著差異。
結論: Ki-67是否為影響recurrence rate的單一重要因子尚待進一步研究證實。

關鍵字

膀胱癌 ； Ki-67指數

並列摘要

OBJECTIVES: Most transitional cell carcinomas (TCCs) of the urinary bladder follow a relatively benign course, but some cases recur or progress rapidly. Pathological staging and grading do not necessarily have sufficient prognostic value. Herein, we assess the feasibility of using the Ki-67 index as a new prognostic indicator.
MATERIALS AND METHODS: In total, 79 primary, superficial, low-grade TCCs treated by transurethral resection of the bladder tumor (TURBT) were retrospectively reviewed. Twenty-five patients(31.6%) experienced tumor recurrence. Seven of them progressed to stage T2-3 disease. Representative blocks were recut and stained with anti-Ki-67 antibody. The Ki-67 labeling index was defined as the percentage of positively labeled cells. The correlation between the Ki-67 index and tumor grade was assessed by Pearson’s Chi-square test. The prognostic significance of the ki-67 index was evaluated using the log rank test.
RESULTS: In the present study, the Ki-67 index correlated well to tumor grade (p=0.0009). Recurrent tumors did not have a higher Ki-67 index (primary tumor, 13.4% vs. recurrent tumor, 9.8%, p=0.285). At a cutoff value of 10.9%(median Ki-67 index), the Ki-67 index may be a useful prognostic indicator for primary superficial low-grade TCCs. (p=0.0478).
CONCLUSIONS: The Ki-67 index showed a significant difference in the log-rank test but otherwise no significant difference in the Cox proportional hazards model. Therefore further studies should be done to ensure that the Ki-67 index is the single most-important factor influencing the recurrence rate in patients with primary superficial, low-grade TCCs of the urinary bladder.

並列關鍵字

bladder cancer ； Ki-67