Prognostic value of Ki‐67 expression in 182 soft tissue sarcomas. Proliferation — a marker of metastasis?

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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: ≥ 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 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.