title: Prognostic value of Ki-67 expression in 182 soft tissue sarcomas. Proliferation--a marker of metastasis?
abstract: Soft tissue sarcomas (STS) are characterized by deregulated proliferation. Ki-67 is a cell cycle antigen which may be elevated in proliferative states. We analysed Ki-67 expression in fixed and embedded tissues from STS in order to examine associations between proliferation, primary tumour characteristics, and metastasis. One hundred and eighty-two adult patients with trunk wall or extremity STS were treated at our institution between 1980 and 1992 (35 developed local recurrence and 56 developed metastases). Median follow-up time for survivors was 6 years (1-13). We used a semiquantitative score to the assess percentage of Ki-67-positive cells: < or = 10% (n = 86), > 10-25% (n = 57), > 25-50% (n = 30), > 50-75% (n = 7), > 75-100% (n = 2). Increasing Ki-67 expression correlated positively with tumour size, malignancy grade, necrosis, vascular invasion, S-phase fraction, and metastasis. A Ki-67 index Ki-D < or = 10% (n = 86) and > 10% (n = 96) defined two groups who had 84% and 56% 3-year metastasis-free survival (p = 0.0001), respectively. Tumours with Ki-D > 10 were typically large, high grade, necrotic, DNA aneuploid, and had intravascular invasion and a higher S-phase fraction. Ki-67 expression may be helpful in predicting survival of patients with soft tissue sarcomas.
authors.affiliation: Department of Orthopedics, University Hospital, Lund, Sweden.
authors.forename: P F
authors.initials: PF
authors.lastname: Choong
authors.forename: M
authors.initials: M
authors.lastname: Akerman
authors.forename: H
authors.initials: H
authors.lastname: Willén
authors.forename: C
authors.initials: C
authors.lastname: Andersson
authors.forename: P
authors.initials: P
authors.lastname: Gustafson
authors.forename: B
authors.initials: B
authors.lastname: Baldetorp
authors.forename: M
authors.initials: M
authors.lastname: Fernö
authors.forename: T
authors.initials: T
authors.lastname: Alvegård
authors.forename: A
authors.initials: A
authors.lastname: Rydholm
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002453:Cell Cycle; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009363:Neoplasm Proteins / Q000032:analysis*; D009687:Nuclear Proteins / Q000032:analysis*; D011379:Prognosis; D012509:Sarcoma / Q000737:chemistry* / Q000401:mortality / Q000473:pathology* / Q000556:secondary; D016019:Survival Analysis
chemical_list: D004273:DNA, Neoplasm; D019394:Ki-67 Antigen; D009363:Neoplasm Proteins; D009687:Nuclear Proteins