title: Low-level Ki-67 expression as an independent predictor of bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy.
abstract: OBJECTIVE
  To evaluate the association of molecular markers and conventional clinicopathological factors with bladder tumour recurrence in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy.
  
  
  METHODS
  The expressions of Ki-67 and P53 were measured by immunohistochemical staining prospectively in 115 consecutive patients with primary upper tract urothelial carcinoma from March 2004 to February 2014. The Cox proportional hazards regression model was used to identify independent predictors. The association between Ki-67 expression and clinicopathological variables was assessed by the χ(2) test.
  
  
  RESULTS
  Intravesical recurrence occurred in 13 out of 115 (11.3%) patients with a mean follow-up of 54.2 months (range: 7-130). Low-level Ki-67 expression (P = 0.010), older age (>65, P = 0.040) and lower ureter tumour (P = 0.001) were independent predictors of bladder tumour recurrence in Cox regression analysis. Ki-67 expression was elevated with the progression of tumour grade (P = 0.004) but not with stage (P = 0.186). Ki-67 overexpression was also significantly higher in aggressive pathological types (P = 0.008), but only shows an inclination towards poor oncologic outcomes in the cancer-specific survival rate (P = 0.107) and the overall survival rate (P = 0.063).
  
  
  CONCLUSIONS
  Low-level Ki-67 expression was an independent predictor for bladder tumour recurrence, while Ki-67 overexpression was associated with adverse clinicopathological parameters and poor prognosis in patients with primary upper tract urothelial carcinoma after radical nephroureterectomy.
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing Beijing Institute of Geriatrics, Ministry of Health, Graduate School of Peking Union Medical College, Beijing.
authors.forename: Pengjie
authors.initials: P
authors.lastname: Wu
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Pathology, Beijing Hospital of the Ministry of Health, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing Beijing Institute of Geriatrics, Ministry of Health, Graduate School of Peking Union Medical College, Beijing.
authors.forename: Yaoguang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing Beijing Institute of Geriatrics, Ministry of Health, Graduate School of Peking Union Medical College, Beijing Department of Urology, Beijing United Family Hospital and Clinics, Beijing, China zhugang2000@aliyun.com dongwei63@hotmail.com wangjy@bjhmoh.com.cn.
authors.forename: Gang
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing Beijing Institute of Geriatrics, Ministry of Health, Graduate School of Peking Union Medical College, Beijing zhugang2000@aliyun.com dongwei63@hotmail.com wangjy@bjhmoh.com.cn.
authors.forename: Dong
authors.initials: D
authors.lastname: Wei
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing.
authors.forename: Ben
authors.initials: B
authors.lastname: Wan
authors.affiliation: Department of Urology, Beijing Hospital of the Ministry of Health, Beijing Beijing Institute of Geriatrics, Ministry of Health, Graduate School of Peking Union Medical College, Beijing zhugang2000@aliyun.com dongwei63@hotmail.com wangjy@bjhmoh.com.cn.
authors.forename: Jianye
authors.initials: J
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D002295:Carcinoma, Transitional Cell / Q000601:surgery*; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007150:Immunohistochemistry; D019394:Ki-67 Antigen / Q000032:analysis*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D009392:Nephrectomy; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014516:Ureteral Neoplasms / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen
keywords: Ki-67 expression; bladder tumour; nephroureterectomy; predictor; upper tract urothelial carcinoma