Prognostic significance of p27(Kip1) and Ki-67 expression in carcinoma of the renal pelvis and ureter

Objective To determine the significance of p27(Kip1) (p27) for tumour behav iour and prognosis of patients with transitional cell carcinoma (TCC) of th e renal pelvis and ureter, Patients and methods Using immunohistochemical staining, the relationship w as evaluated between p27 protein level (low <50%, high >50%) and the Ki-67 labelling index (low <30%, high >30%) and clinicopathological features of 3 7 consecutive Japanese patients with TCC of the renal pelvis and ureter. Results Low levels of p27 correlated with higher tumour stage (P < 0.05) an d positive lymph node metastases (P < 0.05). There was no significant assoc iation between p27 staining and the grade and tumour proliferation as asses sed by the Ki-67 index. A high Ki-67 index correlated with higher grade and stage (P < 0.05). Kaplan-Meier plots of survival rate in patients with low or high p27 staining showed that low levels correlated with a shorter dise ase-free and over-all survival (P < 0.001 and P < 0.01, respectively). Simi larly, patients with a high Ki-67 index with a low Ki-67 index (P < 0.01 an d P < 0.05, respectively), The Cox proportional hazards model showed that a low level of p27 was an independent predictor of a shorter disease-free (P < 0.01) and overall survival (P < 0.05) on univariate analysis, but not of overall survival on multivariate analysis. A high Ki-67 index was an indep endent prognostic marker for shorter disease-free survival on univariate an d multivariate analysis (P < 0.01) and for overall survival on multivariate analysis (P < 0.05). In those with a high Ki-67 index, increased p27 stain ing was associated with a better prognosis than decreased staining For dise ase-free and overall survival (log-rank test, P < 0.01 and P < 0.05, respec tively). Conclusions The finding that a low level of p27 is associated with tumour i nvasion and unfavourable prognosis indicates that p27 may be a useful progn ostic marker for survival in upper urinary tract cancer.