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Ki67 is an independent predictor of oncological outcomes in patients with localized clear‐cell renal cell carcinoma
Author(s) -
Gayed Bishoy A.,
Youssef Ramy F.,
Bagrodia Aditya,
Darwish Oussama M.,
Kapur Payal,
Sagalowsky Arthur,
Lotan Yair,
Margulis Vitaly
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12263
Subject(s) - medicine , hazard ratio , renal cell carcinoma , confidence interval , proportional hazards model , pathological , clear cell renal cell carcinoma , stage (stratigraphy) , nephrectomy , oncology , immunohistochemistry , cohort , tissue microarray , cancer , clear cell , kidney , biology , paleontology
Objective To validate the impact of Ki67 expression on oncological outcomes of patients treated for clinically localized clear‐cell renal cell carcinoma ( ccRCC ).Patients and Methods Immunohistochemistry for Ki67 was performed on tissue microarray constructs of patients treated with radical or partial nephrectomy for clinically localized ( M0 ) ccRCC and Ki67 expression >10% was considered abnormal. Clinical and pathological data elements were entered into an institutional review board‐approved database. The K aplan– M eier method and C ox regression models were used to analyse disease‐free survival ( DFS ) and cancer‐specific survival ( CSS ) probabilities.Results Of 401 patients, 59.6% were males. The median (range) age was 58 (17–85) years, follow‐up was 22 (0–150) months and time to death was 27 (0–150) months. A total of 20.2% of patients had advanced stage ( pT3 – T4 ) and 31% had advanced grade (3–4) disease. Abnormal expression of Ki67 was seen in 6.5% of our cohort and was associated with adverse pathological features ( P < 0.05). Patients with high expression of Ki67 were found to have 5‐year DFS and CSS rates of 67 and 84%, respectively, vs 87 and 95%, respectively, in those with normal expression ( P < 0.001 and P < 0.05, respectively). In multivariable analyses, adjusting for stage and grade, abnormal Ki67 expression was an independent predictor of DFS (hazard ratio [ HR ] 3.77, P = 0.011, 95% confidence interval [ CI ] 1.35–10.52), but not of CSS ( HR 3.51 P = 0.137, 95% CI 0.671–18.35).Conclusions Our findings support the role of Ki67 as a powerful independent predictor of inferior oncological outcomes in patients with ccRCC . Further prospective studies are needed to determine the clinical applicability of these findings.