Rey A, Lara P C, Redondo E, Valdés E, Apolinario R
Dept. of Pathology, Hospital Nuestra Señora del Pino, Las Palmas de Gran Canaria, Spain.
Arch Esp Urol. 1998 Mar;51(2):204-10.
Nephroureterectomy is the standard treatment for tumors of the renal pelvis and ureter. Conservative management or indication of adjuvant treatment in these neoplasms is based mainly in histological grade and stage. The aim of this study is to assess the relation of Ki67 index with other established prognostic factors and to define its predictive value for long term survival, which could be useful in selecting the best treatment for each individual case.
81 patients with urothelial tumors of the renal pelvis and ureter, diagnosed and treated between 1975 and 1993, comprised the present study. Ki67 immunostaining was performed in paraffin-embedded tissue. A cut-off limit of 20% was chosen. Tumor location, histological grade, histological pattern, local (T), nodal (N), vascular and perineural invasion and stage (TNM) were assessed in relation to the proliferation index and as prognostic criteria for survival in both univariate and multivariate analysis.
The Ki67 proliferation index was found to be related to grade (p < 0.001), T (T0 vs T1-4; p < 0.01), N (p < 0.038), TNM categories (stage 0 vs I-IV; p < 0.048) and perineural invasion (p < 0.01). There was a marginal relation to vascular invasion (p < 0.11). Survival was better for the patients with low proliferating tumors (90%) than for high proliferating ones (67%) (p < 0.02). In the multivariate analysis only T stage was statistically significant (p < 0.01) but a highly suggestive trend was found for the Ki67 index (p < 0.07).
Tumor proliferation assessed by Ki67 immunostaining is related to the progression of the disease and proved to be of predictive value for long-term survival in tumors of the renal pelvis and ureter. The Ki67 index is able to detect high-risk patients that could not be cured by radical surgery alone, raising the need for some type of aduvant treatment in these cases. The treatment predictive effect observed in low grade-low stage cases suggests its possible utility in patients managed conservatively.
肾输尿管切除术是肾盂和输尿管肿瘤的标准治疗方法。这些肿瘤的保守治疗或辅助治疗指征主要基于组织学分级和分期。本研究的目的是评估Ki67指数与其他既定预后因素的关系，并确定其对长期生存的预测价值，这可能有助于为每个病例选择最佳治疗方案。
本研究纳入了1975年至1993年间诊断并接受治疗的81例肾盂和输尿管尿路上皮肿瘤患者。对石蜡包埋组织进行Ki67免疫染色。选择20%作为临界值。评估肿瘤位置、组织学分级、组织学模式、局部（T）、淋巴结（N）、血管和神经周围浸润以及分期（TNM）与增殖指数的关系，并作为单因素和多因素分析中生存的预后标准。
发现Ki67增殖指数与分级（p < 0.001）、T（T0与T1-4；p < 0.01）、N（p < 0.038）、TNM分类（0期与I-IV期；p < 0.048）和神经周围浸润（p < 0.01）相关。与血管浸润有边缘关系（p < 0.11）。增殖低的肿瘤患者生存率较好（90%），高于增殖高的患者（67%）（p < 0.02）。在多因素分析中，只有T分期具有统计学意义（p < 0.01），但发现Ki67指数有高度提示性趋势（p < 0.07）。
通过Ki67免疫染色评估的肿瘤增殖与疾病进展相关，并且被证明对肾盂和输尿管肿瘤的长期生存具有预测价值。Ki67指数能够检测出仅通过根治性手术无法治愈的高危患者，这增加了在这些病例中进行某种类型辅助治疗的必要性。在低分级-低分期病例中观察到的治疗预测效果表明其在保守治疗患者中可能有用。
