Analysis of Clinicopathological Parameters and Ki 67 Immunoexpression in Urothelial Neoplasms of Bladder

  • Megala Chandrasekar Vinayaka Missions Kirupananda Variyar Medical College.Salem, Tamil Nadu, INDIA.
  • Saranya V SKS Hospitals, Salem. Tamil Nadu, INDIA
  • Surekha B Vinayaka Missions Medical College, Karaikal-609609. India
Keywords: Bladder neoplasms, ki 67, mitotic count, proliferative markers


Background: Mitotic count is one of the most important determinant of proliferative capacity of any tumour. Immunohistochemical expression of ki 67 is an alternative and effective way of determining the growth fraction. This study was conducted to assess the expression of Ki 67 proliferative marker in bladder urothelial tumors, and to correlate proliferative markers with histopathological grading & staging, thereby helps in identifying high risk patients for disease progression and recurrence who may thus benefit from perioperative systemic chemotherapy. Methods: This study was conducted in department of pathology in collaboration with department of urology in the period of I year from March 2018-March 2019. Results was evaluated on paraffin embedded tissues of bladder neoplasm specimens by immunohistochemical methods and correlated with clinical parameters. Result: In present study, high grade tumours have over expression of Ki 67 and graded as 3+ and 4+. Low grade tumours have low expression and have grades 1+and 2+. Out of 30 cases,40% (12 cases) show 4+ and 27% show (8 cases)3+, both being high grade tumors. Whereas, 27% (8 cases) have 1+ and 7% (2 cases) have 2+, both being low grade tumours). p value is highly significant which is p<0.001. Conclusion: Expression of Ki 67 does correlate with grade and stage of the tumour thereby on prognostic significance. Hence ki 67 may be used as marker to predict aggressive behaviour of bladder neoplasms and also to differentiate high grade and low grade tumours.

Author Biography

Megala Chandrasekar, Vinayaka Missions Kirupananda Variyar Medical College.Salem, Tamil Nadu, INDIA.
Department of Pathology


1. Surbhi G,1 Usha RS,1 Sonal S,1 Navneet K 2. Correlation of Mitotic Indices, AgNor Count, Ki-67 and Bcl-2 with Grade and Stage in Papillary Urothelial Bladder Cancer, uro J 2014:11:1239-47

2. Maruniak NA, Takezawa K, Murphy WM. Accurate pathologic staging of urothelial neoplasm requires better cystoscopic sampling. J Urol 2002;167:2404-7.

3. Nakopoulou L, Vourlakou C, Zervas A, Tzonou A, Gakiopoulou H, Dimopoulos MA. The prevalence of bcl-2, p53, and Ki-67 immuno-reactivity in transitional cell bladder carcinomas and their clinicopathologic correlates. Hum Pathol 1998;29:146 –54

4. Li R, Heydon K, Hammond ME, Grignon DJ, Roach M 3rd,Wolkov HB, Sandler HM, Shipley WU, Pollack A, Ki-67staining index predicts distant metastasis and survival in locally advanced prostate cancer treated with radiotherapy: an analysis of patients in radiation therapy oncology groupprotocol 86-10, Clin Cancer Res, 2004, 10(12 Pt 1):4118–4124.

5. Gimotty PA, Van Belle P, Elder DE, Murry T, Montone KT, Xu X, Hotz S, Raines S, Ming ME, Wahl P, Guerry D, Biologic and prognostic significance of dermal Ki67 expression, mitoses, and tumorigenicity in thin invasive cutaneous melanoma, J Clin Oncol, 2005, 23(31):8048–8056

6. MargulisV, Shariat1 S.F, Ashfaq R, Sagalowsky A, and Lotan Y. Ki-67 Is an Independent Predictor of Bladder Cancer Outcome in Patients Treated with Radical Cystectomy for Organ-Confined Disease. doi: 10.1158/1078-0432.CCR-06-1472 Clin Cancer Res December 15, 2006 12; 7369

7. Alaa S. Jumma the assessment of proliferative activity in transitional cell carcinoma of the urinary bladder by using ki 67 overexpression and its effects on prognosis of the tumor in correlation to prognostic markers (staging and grading); immunohistochemical study. kufa me jour 2011:vol

8. Ding W, Gou Y, Sun C, Xia G, Wang H, Chen Z, Tan J, Xu K, Qiang D,KI 67 IS AN INDEPENDENT predictor in non muscle invasive bladder cancer(NMIBC);Combination of EORTC risk scores and ki 67 expression could improve the risk stratification of NMIBC, Urol onco,2014 Jan ;32(1):42.

9. Enache M, Cristiana S, Luana CL. KI 67 and BCL2 immunoexpression in primitive urothelial bladder carcinoma. Rom J Morphol Embryol 2012,53(3):521-525.

10. Maximillian burger epidemiology and risk factors of urothelial bladder cancer. European urology 2013:234-241.

11. Adam J, Carder PJ, Downey S, Fobes MA, MacLennan K, Allgar V, Kaufman S, Hallam S, Bicknell R, Walker JJ, Cairnduff F, Selby PJ, Perren TJ, Lansdown M, and Banks RF:VEGF in breast cancer: comparison of plasma , serum and tissue VEGF and micro vessels density and effects of tamoxifen. Cancer research June 1, 2000:66:2898-2905

12. Michael N, Athanasios P, Maria-EK, Stavros T, Ioannis V, Georgios S, Georgios A, and Ploutarchos A. Urothelial Carcinoma of the Urinary Bladder in Young Adults: Presentation, Clinical behavior and Outcome. Advances in Urology, Volume 2011, Article ID 480738.
13. Augustine A, Hebert JR, Kabat GC, Wydner EL. Bladder cancer in relation to cigarette smoking. Cancer Res. 1988;48:4405–8.
14. Pich A, Chiusa L, Formiconi A, Galliano D, Bortolin P, Navone R (2001). Biologic differences between non invasive papillary urothelial neoplasms of low malignant potential and low-grade (grade1) papillary carcinomas of the bladder. Am J Surg Pathol 25: 1528-15334

15. Lei C.X, Bing-xun L, Hai-lin Ch., Qi-guang Ch, Zhe Z, Jian-bin B, Chui-ze K. Expression and Significance of Fascin and Ki-67 Proteins in BladderCarcinoma. Journal of China Medical University 2010-02 [DOI]:CNKI:SUN:ZGYK.0.2010-02-017

16. Ro JY, Ayala AG, El-Naggar A. Muscularis mucosa of urinary bladder: importance for staging and treatment. Am J Surg Pathol 1987;11:668-673.

17. Philip AT, Amin MB, Tamboli P, et al. Intravesical adipose tissue. Quantitative study of its presence and location with implications for therapy and prognosis. Am J Surg Pathol 2000;24:1286-1290.

18. Moore KL. Clinically oriented anatomy, 2nd ed. Baltimore: Williams & Wilkins, 1985:265.

19. Korkolopoulou P, Christodoulou P, Kapralos P, Exarchakos M, Bisbiroula A,Hadjiyannakis M, Georgountzos C, Thomas-Tsagli E (1997). The role of p53, MDM2 and c-erb B-2 oncoproteins, epidermal growth factor receptor and proliferation markers in the prognosis of urinary bladder cancer. Pathol Res Pract 193: 767-775.

20. Parag G Impact of age and gender on the clinicopathological characteristics of bladder cancer. Indian j urol.2009:207-210.
Original Article