Ck20 And Ki-67 As Significant Prognostic Factors In Human Bladder Carcinoma

OBJECTIVE: Bladder carcinoma (BCa) is the most common malignant tumor of the urinary tract and the second most common malignancy, after prostatic carcinoma, of the urogenital system [1]. In Western populations, BCa is the 4th most common malignant neoplasm in men and the 8th in women. Radical cystectomy has been regarded as the gold standard treatment for invasive BCa with an overall 5-year recurrence-free survival rate of approximately 50~70% [1].Thus, these findings suggest a pressing need to identify patients who are at high risk of disease recurrence following radical cystectomy. The most commonly utilized cytological examination of urine has a high specificity, but gives false-negatives in about half of cases, mainly in patients with low-grade, early-stage tumors . So it is of great significance to search for a more sensitive and more specific BCa marker that can provide valuable information for the diagnosis and treatment of the disease.Cytokeratin 20 (CK20) is a member of cytokeratin family containing at least 20 types of cytoplasmic intermediate filaments which was found in epithelial cells [. Expression of cytoskeletal proteins is determined by cell type, stage of development, and differentiation. Abnormal expression of cytokeratin has been found in various forms of neoplasia and other diseases . CK20 is restricted to superficial and occasional intermediate cells of the normal urothelium of the bladder . Aberrant CK20 expression has been detected in BCa and is associated with recurrence of this tumor . On the other hand, the identification of proliferating activity in tumors may be useful to predict the biological behavior of the lesion. Ki-67, one of proliferative markers, is expressed in proliferative cells throughout the G1, S, G2, and M phases, and provides a reliable index of cellular proliferation . However, there are few reports simultaneously investigating the clinicopathological features of CK20 expression in BCa and concerning the relation between proliferating activity and clinical aspect of BCa. Therefore, in order to know the biological behavior of BCa and verify whether biological behavior of BCa has any relation with CK20 and Ki-67 or not, we performed this study by using monoclonal anti-CK20 antibody and monoclonal anti-Ki-67 antibody.This study was to investigate the correlations of CK20 and Ki67 expressions in tumor to metastasis ,invasion, and prognosis of bladder cancer . and explore the biological value of CK20 and Ki-67 for diagnosis of bladder cancer.Methods: 154 fresh BCa tissues were provided by First Municipal People's Hospital of Guangzhou .CK20 and Ki-67 expression in paraffin-embedded specimens gathered from 154 cases of BCa were detected by the method of immunohistochemistry. The Spearman correlation was calculated between the expression levels of CK20 and Ki-67 in BCa tissues. The association of CK20 and Ki-67 protein expression with the clinicopathological characteristics and with the prognosis of BCa was subsequently assessed.RESULTS: 1,Positive rate of CK20 was 66.9% in bladder cancer tissues.CK20 staining in cancer tissue was positively related with T stage and distant metastasis(P<0.05) .2,Positive rate of Ki67 was 81.8% in bladder cancer tissues.Ki67 staining in cancer tissue was positively related with pathologic grade and T stage and distant metastasis(P<0.05) .3,Spearman′s rank correlation had showed both correlations. (P<0.05)4,Correlation between CK20 and Ki-67 expression in BCa tissues and patient survival in all four groups, CK20+/Ki-67+ patients had the poorest prognosis. There was a significant difference in the progression-free survival among the four groups (p<0.001).CONCLUSION: CK20 and Ki67 maybe participate in invasion and metastasis of bladder cancer .CK20 and Ki67 may be an prognostic factor and , when used in combination with pathologic grading and clinical staging, may increase accuracy of predicting prognosis of patients with bladder cancer .