P. Blanchet et al., Prospective evaluation of Ki-67 labeling in predicting the recurrence and progression of superficial bladder transitional cell carcinoma, EUR UROL, 40(2), 2001, pp. 169-175
Purpose:We studied a series of superficial transitional cell carcinoma of t
he bladder to assess whether the Ki-67 labeleing index predicts recurrence
and progression in a cohort of patients treated by transurethral resection
alone or receiving adjuvant intravesical bacillus Calmette-Guerin therapy (
BCG).
Materials and Methods: From 1989 to 1990, we prospectively studied 70 conse
cutive cases of superficial transitional cell carcinoma of the bladder usin
g Ki-67 immunostaining. The tumors were 43 pTa and 27 pT1. Thirteen were tr
eated with transurethral resection only and 57 received adjuvant intravesic
al BCG. The median follow-up times was 64 months. The threshold index value
s of Ki-67 for recurrence and progression were determined using ROC curves.
The relative predictive values of the Ki-67 labeling index and tumor chara
cteristics for recurrence and progression were evaluated using Cox's propor
tional hazards model.
Results:A cutoff value of 13% was determined. The recurrence free survival
rate at 5 years was 68% for cases with a Ki-67 labeling index of 13 or high
er and 71% for those with an index of less than 13 (NS). The progression-fr
ee survival rate at 5 years was 43% in cases with an index of 13 or higher
and 89% in those with an index of less than 13 (p < 0.0001). Using multivar
iate analsis the Ki-67 labeling index is an independent risk factor for tum
or progression with a relative risk of 4.61 (p < 0.05).
Conclusion: When BCG is used for high and intermediate risk superficial bla
dder cancers, the Ki-67 labeling index is an independent predictive factor
of progression but not of recurrence. Copyright (C) 2001 S. Karger AG, Base
l.