KI-67 PROLIFERATION INDEX AND CLINICOPATHOLOGICAL PATTERNS IN UPPER GASTROINTESTINAL TRACT CARCINOMAS

BACKGROUND: Neoplasms of upper gastrointestinal tracts are common and one of the leading causes of death worldwide. In India esophageal and gastric cancers are the most common cancers found in men. Thus early detection and evaluation of prognosis by various methods plays an important role in management of patient. Proliferative activity of tumor assessed with respect to Ki- 67 antigen expression is a useful prognostic parameter. This study aimed to correlate the various clinicopathological parameters of upper gastrointestinal tract carcinomas with Ki-67 tumor proliferative activity and to evaluate its prognostic significance. METHODS: This is a prospective study for a period of two years from August 2011 to July 2013 in the department of pathology, Andhra Medical College, Visakhapatnam. The various parameters like patient's age, sex, cancer site, histological type and differentiation of the tumor were studied. The above parameters were correlated with KI 67 proliferative indices of the respective cancers and were evaluated statistically. Chi-square tests were used for statistical correlation and p value of <0.05 was considered significant. RESULTS: Most common age group for occurrence of upper gastrointestinal carcinomas was from 4 th to 6th with majority of patients being males (66%). The most common presenting complaints of esophagus and gastric carcinoma patients was dysphagia and dyspepsia respectively while most common presenting complaint of ampullary carcinoma was jaundice. 39% of the patients were alcoholics and 57% of the patients were smokers. Cellular proliferation as assessed by Ki-67 immunohistochemical staining in esophageal carcinoma showed no correlation with age, sex, site, histological type, and grade of the tumor. In carcinoma stomach, statistically significant correlation was seen between Ki-67 proliferation index (PI) and sex and histological type of tumor with males showing higher Ki-67 proliferation index than females, and intestinal type showing higher Ki-67 proliferation index than diffuse type but no correlation was seen between Ki-67 proliferation index and age, site, and grade of tumor. In ampullary carcinoma a correlation was seen between age of the patient and Ki-67 proliferation index with patients aged less than 55 years showing higher proliferation than patients aged more than 55 years but no correlation was seen between Ki-67 expression and sex and tumor differentiation. CONCLUSION: These results indicate that the determination of Ki-67 PI can be a reliable prognostic marker. However in view of the small sample size of the present study further studies are required with larger sample size. KEYWORDS: Ki-67 Proliferation index, Upper gastrointestinal tract, Carcinoma. BACKGROUND: Neoplasms of upper gastrointestinal tract (GIT) are common and one of the leading causes of death worldwide. These include tumors arising from esophagus, stomach and first part of duodenum up to opening of the bile duct in ampulla of vater. The prognosis of patients with cancer may be assessed by TNM staging system but it cannot predict perfectly the outcome for a particular