Oncotarget

Meta-Analysis:

Significance of Ki-67 in non-muscle invasive bladder cancer patients: a systematic review and meta-analysis

Kyungtae Ko _, Chang Wook Jeong, Cheol Kwak, Hyeon Hoe Kim and Ja Hyeon Ku

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Oncotarget. 2017; 8:100614-100630. https://doi.org/10.18632/oncotarget.21899

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Abstract

Kyungtae Ko1, Chang Wook Jeong2, Cheol Kwak2, Hyeon Hoe Kim2 and Ja Hyeon Ku2

1Department of Urology, Kandong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

2Department of Urology, Seoul National University Hospital, Seoul, Korea

Correspondence to:

Ja Hyeon Ku, email: [email protected]

Keywords: bladder cancer, urothelial carcinoma, Ki-67, prognosis, meta-analysis

Received: August 13, 2017     Accepted: September 23, 2017     Published: October 13, 2017

ABSTRACT

Purpose: This meta-analysis evaluated the prognostic significance of Ki-67 in non-muscle invasive bladder cancer (NMIBC).

Materials and Methods: We selected 39 articles including 5,229 patients from Embase, Scopus, and PubMed searches. The primary outcomes, recurrence-free survival (RFS), progression-free survival (PFS), disease-specific survival (DSS), and overall survival (OS) were determined using time-to event hazard ratios (HRs) with 95% confidence intervals (CIs). Study heterogeneity was tested by chi-square and I2 statistics. Heterogeneity sources were identified by subgroup meta-regression analysis.

Results: Two studies were prospective; 37 were retrospective. Immunohistochemistry was performed in tissue microarrays or serial sections. A wide range of antibody dilutions and Ki-67 positivity thresholds were used. Study heterogeneity was attributed to analysis results in studies of RFS (p < 0.0001). Meta-regression analysis revealed that region and analysis results accounted for heterogeneity in PFS studies (p = 0.00471, p < 0.0001). High Ki-67 expression was associated with poor RFS (pooled HR, 1.78; 95% CI, 1.48–2.15), poor PFS (pooled HR, 1.28; 95% CI, 1.13–2.15), poor DSS (pooled HR, 2.24; 95% CI, 1.47–2.15), and worse OS (pooled HR, 2.29; 95% CI, 1.24–4.22).

Conclusions: The meta-analysis found that current evidence supports the prognostic value of Ki-67 in NMIBC patients.


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