The Value Of Ki-67 Combined With Uroplakin-Ⅲ In Predicting The Prognosis Of Bladder Non-muscle Invasive Urothelial Carcinoma

Objective:To investigate the prognostic value of Ki-67,Uroplakin-Ⅲ and their combination in patients with bladder non-muscle invasive urothelial carcinoma after transurethral resection.Methods:The clinical data and postoperative follow-up data of 224 patients with bladder non-muscle invasive urothelial carcinoma who underwent transurethral resection in the Second Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed.Using receiver operating characteristic curve analysis,the patients were divided into high expression of Ki-67 group and low expression of Ki-67 group according to the best cut-off value.The patients were divided into positive expression group and negative expression group according to the immunohistochemical of Uroplakin-Ⅲ.The combined indicators were divided into 4 groups:high Ki-67+Uroplakin-Ⅲ positive,high Ki-67+Uroplakin-Ⅲ negative,low Ki-67+Uroplakin-Ⅲ positive,and low Ki-67+Uroplakin-Ⅲ negative.The t test was used to compare the measurement data between groups,andχ~2test was used to compare the count data.Recurrence-free survival(RFS),progression-free survival(PFS)and cancer-specific survival(CSS)were analyzed by univariate binary logistic regression.The indicators with P<0.05 in univariate analysis were analyzed by Cox proportional hazards regression model for multivariate analysis.Kaplan-Meier survival analysis was used to draw survival curves,and Log-Rank test was used to compare the differences between groups.Results:The high expression of Ki-67 was correlated with multiple tumors,high-grade tumors and non-papillary tumors.The high expression of UP-Ⅲ was correlated with high-grade tumors.Univariate binary logistic regression analysis showed that tumor grade,Ki-67 and UP-Ⅲ were significantly correlated with recurrence.Tumor number,tumor stage,tumor grade,tumor pattern,Ki-67 and UP-Ⅲ were related to tumor progression.Age,tumor size,tumor stage,tumor grade,tumor pattern and Ki-67 were associated with cancer specific survival.Multivariate COX regression analysis showed that high expression of Ki-67 and positive expression of UP-Ⅲ were significantly associated with reduced RFS.High expression of Ki-67 was significantly associated with reduced PFS.Increased age and high expression of Ki-67were significantly associated with reduced CSS.In univariate Kaplan-Meier analysis,high grade of tumor was associated with reduced RFS,PFS,and CSS.High expression of Ki-67 was associated with reduced RFS,PFS and CSS.Positive expression of UP-Ⅲ was associated with reduced RFS and PFS.In the Kaplan-Meier analysis of the combination of the two indicators,high Ki-67+UP-Ⅲ positive was associated with reduced RFS,PFS and CSS.Conclusions:The results of this study indicate that Ki-67 is an independent prognostic marker for tumor recurrence,progression and death and UP-Ⅲ is an independent prognostic marker for tumor recurrence and progression in patients with bladder non-muscle invasive urothelial carcinoma treated by transurethral resection.High grade tumor,high expression of Ki-67 and positive expression of UP-Ⅲ are associated with poor prognosis,which can be used to improve the risk stratification of patients.Ki-67 combined with UP-Ⅲ has more prominent predictive ability,and its predictive value is worthy of further study.