Téma: 

Prognostic value of ki-67 and pcna expression in ta-t1 urothelial bladder cancer.

Roman Tomaškin, Katarína Macháleková, Pavol Slávik, Boris Eliáš, Karol Kajo, Ján Kliment

Aim of study: To implement immunohistochemistry of bladder tumours into our clinical practice, to correlate the expression of proliferative antigens Ki-67 and PCNA with clinical and histopathological factors, to determine their prognostic value in prediction of Ta-T1 bladder cancer clinical behaviour. Material and methods: Immunohistochemical study was performed in 50 primary bladder cancers (patients age 31 - 85 ys, mean 64.6 ys). Patients were followed-up for at least 36 months after transurethral resection (cystoscopy every 3 - 6 months). Grading, pT stage, number of tumours, Ki-67 and PCNA expression (threshold 10 % of positive cells) were evaluated. At most 1 recurrence during 3-year follow-up was considered as clinically favourable but not during first 12 months, otherwise clinically unfavourable behaviour was recorded. Results: Significant correlation was determined between Ki-67 expression and grading (p = 0.004), number of tumours (p = 0,047) and marginally pT stage (p = 0.051). PCNA expression correlated significantly with grading (p = 0.018) and pT stage (p = 0.042), with no relation to number of tumours. There was found no difference in evaluated parameters in univariate and multivariate analysis of all patients according to favourable and unfavourable tumour behaviour. The trend of worse prognosis was noticed with higher Ki-67 expression (> 10 % of positive cells, p = 0.063, Cox regression p = 0.066), with three-fold higher risk for unfavourable behaviour, in Ta group almost nine-fold higher. Only Ki-67 expression significantly influenced tumour-free survival (estimated as time to first known recurrence) in Kaplan-Meier analysis of all tumours (log rank test, p = 0.019) and G2 tumours (log rank test, p = 0.047). Conclusion: Immunohistochemistry of Ki-67 can have additive value to clinical and histopathological prognostic factors in predicting bladder cancer prognosis. Our recommendation is to extend the interval between cystoscopies for at least 6 months in the low and medium risk group with low Ki-67 expression. In patients with multifocal T1 tumours with low Ki-67 expression intravesical chemotherapy to immunotherapy is prefered.

Ročník 2007  Témy časopisu Clinical urology 3 / 2007

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