Gontero P, Casetta G, Zitella A, Ballario R, Pacchioni D, Magnani C, Muir G H, Tizzani A
Division of Patologia Urologica, University of Torino, Italy.
Eur Urol. 2000 Sep;38(3):287-96. doi: 10.1159/000020295.
OBJECTIVES: To confirm the interrelationship between p53, ki67, mitotic index with others known prognostic factors such us stage, grade, multifocality, tumour size, history of recurrence in transitional cell carcinoma (TCC) of the bladder and to determine the prognostic impact of p53, Ki67 and mitotic index in predicting recurrence in superficial bladder cancer. METHODS: Two hundred and fourteen patients with apparently superficial TCC of the bladder underwent TURBT and the 192 histologically Ta-T1 were divided into 104 primary lesions (group 1, mean follow-up 26 months) and 88 recurrent tumours (group 2, mean follow-up 28 months). Data concerning focality, tumour size, number of recurrences and recurrence-free survival were considered in each patients. All samples were immunohistochemically stained with p53 and Ki67 monoclonal antibodies. Mitotic index (MI) was calculated on haematoxylin and eosin stained sections. RESULTS: Recurrence-free survival was significantly lower in superficial recurrent tumours (group 2) compared with primary tumours (group 1). P53 staining was correlated with grade and stage for both 5 and 20% positivity thresholds. Ki67 and MI were significantly different over strata defined by stage, grade and focality in both patients groups but only Ki67 showed a correlation with p53 status. Recurrence-free survival could not be predicted either by p53 status or MI. A 20% cut-off level of Ki67 staining resulted a good predictor of recurrence in group 1 Ta-T1/G1-G2 tumours (p = 0.03). Only Ki67 and multifocality were found to be independent prognostic factors of recurrence in multivariate analysis. Stratifying Ta-T1/G1-G2 patients according to these variables, Ki67 provided a useful tool to predict early recurrence in monofocal lesions from both groups. CONCLUSIONS: P53 and MI despite a fairly good correlation with traditional prognostic factors in bladder TCC seem to play no role in the prediction of tumoural recurrence. A Ki67 index over 20% predicts those single well-differentiated (Ta-T1/G1-G2) tumours which are likely to recur within one year of treatment.
目的：确认p53、ki67、有丝分裂指数与其他已知预后因素（如分期、分级、多灶性、肿瘤大小、膀胱癌移行细胞癌（TCC）的复发史）之间的相互关系，并确定p53、Ki67和有丝分裂指数对预测浅表性膀胱癌复发的预后影响。 方法：214例膀胱明显浅表性TCC患者接受了经尿道膀胱肿瘤切除术（TURBT），192例组织学Ta-T1期患者被分为104例原发性病变（第1组，平均随访26个月）和88例复发性肿瘤（第2组，平均随访28个月）。考虑了每位患者的灶性、肿瘤大小、复发次数和无复发生存的数据。所有样本均用p53和Ki67单克隆抗体进行免疫组织化学染色。在苏木精和伊红染色切片上计算有丝分裂指数（MI）。 结果：与原发性肿瘤（第1组）相比，浅表性复发性肿瘤（第2组）的无复发生存率显著降低。对于5%和20%的阳性阈值，p53染色与分级和分期相关。在两个患者组中，Ki67和MI在由分期、分级和灶性定义的分层中存在显著差异，但只有Ki67与p53状态相关。p53状态或MI均无法预测无复发生存率。Ki67染色20%的截断水平是第1组Ta-T1/G1-G2肿瘤复发的良好预测指标（p = 0.03）。在多变量分析中，仅发现Ki67和多灶性是复发的独立预后因素。根据这些变量对Ta-T1/G1-G2患者进行分层，Ki67为预测两组单灶性病变的早期复发提供了有用的工具。 结论：尽管p53和MI与膀胱TCC的传统预后因素有相当好的相关性，但它们似乎在肿瘤复发预测中不起作用。Ki67指数超过20%可预测那些单一高分化（Ta-T1/G1-G2）肿瘤，这些肿瘤在治疗后一年内可能复发。
Virchows Arch. 2008-4
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