This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Margulis, V. Articles by Lotan, Y. Search for Related Content PubMed PubMed Citation Articles by Margulis, V. Articles by Lotan, Y.

Ki-67 Is an Independent Predictor of Bladder Cancer Outcome in Patients Treated with Radical Cystectomy for Organ-Confined Disease

Authors' Affiliations: Departments of ¹ Urology and ² Pathology, University of Texas Southwestern Medical Center, Dallas, Texas

Requests for reprints: Yair Lotan, Department of Urology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9110. Phone: 214-648-0389; Fax: 214-648-8786; E-mail: Yair.Lotan{at}UTSouthwestern.edu.

Purpose: To determine the association of the cell proliferative marker Ki-67 with pathologic features and disease prognosis in patients with transitional cell carcinoma (TCC) of the urinary bladder.

Methods: Immunohistochemical staining for Ki-67 was done on serial cuts from tissue microarrays containing cystectomy specimens from 9 patients without bladder cancer and 226 consecutive patients with bladder TCC. We also assessed malignant lymph nodes from 50 of the 226 cystectomy patients.

Results: Ki-67 expression was increased in 42.5% cystectomy specimens and in 54% metastatic lymph nodes. In contrast, it was absent in all nine benign cystectomy specimens. Ki-67 overexpression was associated with advanced pathologic stage, higher grade, lymphovascular invasion, and metastases to lymph nodes (P = 0.001, 0.040, 0.031, and 0.036, respectively). In multivariate analyses, pathologic stage and lymph node metastases were independent predictors of disease recurrence and bladder cancer-specific mortality. In the subgroup of patients with organ-confined disease (<pT₃ N₀; n = 91), excluding patients who received neoadjuvant or adjuvant chemotherapy, Ki-67 status was an independent predictor of both disease recurrence (risk ratio, 7.591; P = 0.001) and bladder cancer-specific mortality (risk ratio, 4.045; P = 0.041).

Conclusions: Ki-67 overexpression is associated with features of aggressive bladder TCC and adds independent prognostic information to standard pathologic features for prediction of clinical outcome after radical cystectomy.

This article has been cited by other articles:

				S. F. Shariat, P. I. Karakiewicz, G. Godoy, and S. P. Lerner Review: Use of nomograms for predictions of outcome in patients with advanced bladder cancer Therapeutic Advances in Urology, April 1, 2009; 1(1): 13 - 26. [Abstract] [PDF]

				V. Margulis, Y. Lotan, P. I. Karakiewicz, Y. Fradet, R. Ashfaq, U. Capitanio, F. Montorsi, P. J. Bastian, M. E. Nielsen, S. C. Muller, et al. Multi-Institutional Validation of the Predictive Value of Ki-67 Labeling Index in Patients With Urinary Bladder Cancer J Natl Cancer Inst, January 21, 2009; 101(2): 114 - 119. [Abstract] [Full Text] [PDF]