Prognostic factors in bladder carcinoma: Histologic parameters and expression of a cell cycle‐related nuclear antigen (Ki‐67)

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Abstract
A total of 316 biopsies from patients with bladder carcinoma who entered a trial of the genito‐urinary group of the European Organization for Research and Treatment of Cancer (EORTC) were reviewed. The histological data were subsequently correlated with the clinical course. A strong correlation between the number of mitoses and the time of first recurrence, muscle invasion, and death was noted. Next the expression of Ki‐67 in frozen sections from 49 transitional cell carcinomas (TCCs) and the DNA content of the tumour cells were determined. The frequency of Ki‐67‐positive tumour cells increased with tumour grade and stage. Grade II TCCs and superficially infiltrating TCCs showed a wide range of Ki‐67 scores. There was a significant difference in Ki‐67 score between non‐infiltrating (Ta) and superficially infiltrating (T1) grade II TCCs. All DNA‐aneuploid carcinomas but also 15 out of 36 DNA‐diploid tumours contained more than 10 per cent Ki‐67‐positive cells. Only some of these tumours were DNA‐aneuploid or ‐tetraploid. The results indicate that the number of Ki‐67‐positive cells in grade II tumours may be a useful aid in separating grade II TCCs with a favourable prognosis from those with a poor clinical outcome.