Prognostic significance of the proliferation index in surgically resected non-small-cell lung cancer

Arch Surg. 1993 Dec;128(12):1382-90. doi: 10.1001/archsurg.1993.01420240090017.


Objective: To determine the utility of measuring the tumor proliferation index as a prognostic marker in patients with non-small-cell lung cancer.

Design: Immunostaining for the proliferation-associated antigen Ki-67, quantitated using computer-assisted image cytometry, was used to derive the tumor proliferation index for 61 fresh-frozen, banked specimens of non-small-cell lung cancer. DNA ploidy was measured concomitantly for all specimens. A median follow-up of 38 months was achieved for survival analyses.

Setting: A large southeastern United States private referral institution and affiliated hospital provided the study environment.

Participants: A consecutive, convenience sample of 61 patients was enrolled based on resected tissue preservation and viability over a five-year accruement.

Main outcome measures: Significant associations between DNA content, proliferation index, established clinicopathological parameters, and outcome were examined.

Results: A significant inverse association between patient survival and tumor proliferation index was found that was independent of other established clinicopathological predictors of outcome. Patients whose tumors harbored a proliferation index of less than 3.5 survived significantly longer than patients with tumors demonstrating higher values. No association between DNA content and proliferation index was uncovered.

Conclusion: Measurement of the proliferation index, as derived from quantitative Ki-67 immunostaining and analyzed by image cytometry, may provide significant complementary, if not independent, prognostic information for patients with non-small-cell lung cancer.

MeSH terms

  • Aged
  • Biopsy
  • Carcinoma, Non-Small-Cell Lung / chemistry
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / pathology*
  • Carcinoma, Non-Small-Cell Lung / surgery
  • DNA, Neoplasm / analysis*
  • Diagnosis, Computer-Assisted
  • Female
  • Flow Cytometry / methods
  • Follow-Up Studies
  • Humans
  • Immunohistochemistry / methods
  • Ki-67 Antigen
  • Lung Neoplasms / chemistry
  • Lung Neoplasms / mortality
  • Lung Neoplasms / pathology*
  • Lung Neoplasms / surgery
  • Macrophages*
  • Male
  • Middle Aged
  • Mitotic Index*
  • Neoplasm Proteins / analysis*
  • Neoplasm Staging
  • Nuclear Proteins / analysis*
  • Ploidies*
  • Prognosis
  • Proportional Hazards Models
  • Reproducibility of Results
  • Survival Analysis


  • DNA, Neoplasm
  • Ki-67 Antigen
  • Neoplasm Proteins
  • Nuclear Proteins