Prognostic value of p53 and Ki-67 expression in intermediate-risk patients with nonmuscle-invasive bladder cancer receiving adjuvant intravesical mitomycin C therapy

Urology. 2010 Aug;76(2):512.e1-7. doi: 10.1016/j.urology.2010.04.040. Epub 2010 Jun 26.


Objectives: To analyze the prognostic values of p53 and Ki-67 expression in intermediate-risk patients with nonmuscle-invasive bladder cancer who were treated with adjuvant intravesical mitomycin C.

Methods: From 2001 to 2006, 129 patients with nonmuscle-invasive bladder cancer who had undergone transurethral resection and adjuvant intravesical mitomycin C therapy. Patients with primary, single, Stage TaG1 lesions and those with T1G3 or carcinoma in situ lesions were excluded. The expression of p53 and Ki-67 was measured by immunohistochemistry on tissue sections after transurethral resection. The clinical and pathologic data were collected in a prospectively maintained bladder cancer database program.

Results: The mean follow-up period was 48.6 months (range 6.1-96.0). Of the 129 patients, 61 (47.3%) developed recurrence and 15 (11.6%) developed progression to muscle-invasive disease. The expression of p53 was not associated with the patient outcomes, but Ki-67 overexpression was related to progression-free survival on univariate analysis (relative risk 4.38, 95% confidence interval 1.48-13.01, P = .006). On multivariate analysis, Ki-67 overexpression was significantly associated with progression-free survival (relative risk 3.40, 95% confidence interval 1.04-11.05, P = .042). In the patients with Ki-67 overexpression, the 1- and 5-year progression-free survival rate was 98.0% and 73.9%, respectively. When the combination of p53 and Ki-67 expression was assessed in the multivariate model, the simultaneous overexpression of p53 and Ki-67 did not predict for progression-free survival (adjusted relative risk 1.16; 95% confidence interval 0.21-6.20, P = .863).

Conclusions: These results suggest that Ki-67 expression can identify a subset of intermediate-risk patients with nonmuscle-invasive bladder cancer in whom intravesical mitomycin C therapy could be effective.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Intravesical
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibiotics, Antineoplastic / administration & dosage*
  • Chemotherapy, Adjuvant
  • Female
  • Humans
  • Ki-67 Antigen / biosynthesis*
  • Male
  • Middle Aged
  • Mitomycin / administration & dosage*
  • Neoplasm Invasiveness
  • Prognosis
  • Prospective Studies
  • Risk Factors
  • Tumor Suppressor Protein p53 / biosynthesis*
  • Urinary Bladder Neoplasms / drug therapy*
  • Urinary Bladder Neoplasms / metabolism*
  • Urinary Bladder Neoplasms / pathology


  • Antibiotics, Antineoplastic
  • Ki-67 Antigen
  • Tumor Suppressor Protein p53
  • Mitomycin