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Prognostic value of ki67 in BCG-treated non-muscle invasive bladder cancer: a meta-analysis and systematic review
  1. Yuhui He1,2,
  2. Ning Wang3,
  3. Xiaofeng Zhou1,2,
  4. Jianfeng Wang2,
  5. Zhenshan Ding2,
  6. Xing Chen2,
  7. Yisen Deng1,2
  1. 1 Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
  2. 2 Department of Urology, China-Japan Friendship Hospital, Beijing, China
  3. 3 College of Psychology, North China University of Science and Technology, Tangshan, Hebei, China
  1. Correspondence to Dr Xiaofeng Zhou; doctorzxf{at}


Objectives The aim of this study was to explore the prognostic value of ki67 as a marker in patients with non-muscle invasive bladder cancer (NMIBC) treated with BCG.

Methods Studies were systematically retrieved from the relevant databases (Web of Science, PubMed, Cochrane Library and Embase), and the expiry date was May 2017. The research steps referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

Results A total of 11 studies that complied with the inclusion criteria were included. The expression of ki67 was not statistically significantly associated with recurrence-free survival (RFS) (HR 1.331; 95% CI 0.980 to 1.809). No significant heterogeneity was found among all included studies (I2 =36.7%, p=0.148). The expression of ki67 was statistically significantly associated with progression-free survival (PFS) (HR 2.567; 95% CI 1.562 to 4.219), and the overexpression of ki67 was the risk factor for PFS. Significant heterogeneity was noted among all the included studies (I2 =55.6%, p=0.021). The studies that might cause heterogeneity were excluded using the Galbraith plot, and then the meta-analysis was performed again. The results showed that the expression of ki67 was still associated with PFS (HR 2.922; 95% CI 2.002 to 4.266).

Conclusions The overexpression of ki67 was the risk factor for PFS, and the relationship between the expression of ki67 and RFS was not statistically significant in patients with NMIBC treated with BCG intravesical immunotherapy. Well-designed, prospective, with a large sample size are still needed to validate the findings.

  • Ki67
  • meta-analysis
  • non-muscular-invasive bladder cancer
  • prognosis

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors YH, NW and XZ conceived and designed the experiments. XC and YD extracted the data. YH, NW and XZ analysed the data. ZD, JW and XC contributed reagents/materials/analysis tools. YH and NW wrote the paper. XZ critically revised the report.

  • Funding This study was supported by grants from the International S&T Cooperation Program of China (ISTCP) (Grant No.2014DFE30010).

  • Disclaimer The contents of the present study are solely the responsibility of the author. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Extra data can be accessed via the Dryad data repository at with

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