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VOLUME 19 , ISSUE 2 ( February, 2018 ) > List of Articles


Proliferative Index in Invasive Tumor Front of Oral Squamous Cell Carcinoma: A Potential Prognostic Indicator

Sambit Sarangi, Bijoy K Das, Surya N Das, Sarat Nayak

Citation Information : Sarangi S, Das BK, Das SN, Nayak S. Proliferative Index in Invasive Tumor Front of Oral Squamous Cell Carcinoma: A Potential Prognostic Indicator. J Contemp Dent Pract 2018; 19 (2):170-176.

DOI: 10.5005/jp-journals-10024-2232

License: CC BY 3.0

Published Online: 01-07-2014

Copyright Statement:  Copyright © 2018; The Author(s).



The aim of the study was to evaluate the proliferative index (PI) at their invasive front of oral cancer and their association with Bryne's grades of oral squamous cell carcinoma (OSCC) and compare the PI with lymph node metastasis, site of involvement, and habits.

Materials and methods

The Ki-67 antigen expression was immunohistochemically evaluated in a total of 102 cases that included the histopathologically diagnosed archival specimens of OSCCs. They were subdivided by Bryne's histopathological grading into grade I (40 cases), grade II (32 cases), and grade III (30 cases). The nucleus with brown stain was considered positive. Cells were counted under 400× magnification. The proliferative activity thus determined was then expressed as a percentage of Ki-67 labeling index (Ki-67 LI) positive cells.


A stepwise increase in the mean Ki-67 LI was found from grade I to III squamous cell carcinoma, thus correlating with the histological grading. In addition, there was a higher PI seen in cases associated with metastatic lymph node, which concords with the higher biologic aggressiveness and poor prognosis of the lesion.


The present study shows a definitive correlation of Ki-67 antigen with the Bryne's histological grading, all the parameters of Bryne's grading for OSCC and lymph node status of the patient proving its association as an effective tool to grade the tumors and finally read the prognosis of the tumor.

Clinical significance

Cell proliferation is regarded as one of the most important biologic mechanisms in oncogenesis. The role of cell proliferation in tumor progression has been inferred in studies concerned with human cancer by comparing the PI of normal tissue, preneoplastic and neoplastic lesions. The Ki-67 antigen-labeled cells can prove to be an effective aid to grade the tumors. It might be possible to standardize and objectify tumor grading among pathology laboratories.

How to cite this article

Bhuyan L, Sarangi S, Das BK, Das SN, Nayak S. Proliferative Index in Invasive Tumor Front of Oral Squamous Cell Carcinoma: A Potential Prognostic Indicator. J Contemp Dent Pract 2018;19(2):170-176.

  1. Assessment of cellular proliferation in oral verrucous carcinoma and well-differentiated oral squamous cell carcinoma using Ki67: A non-reliable factor for differential diagnosis? Asian Pac J Cancer Prev 2012;13(11):5811-585.
  2. Immunohistochemical study of syndecan-1 down-regulation and the expression of p53 protein or ki-67 antigen in oral leukoplakia with or without epithelial dysplasia. J Oral Pathol Med 2003 Oct;32(9):513-521.
  3. Is the invasive front of an oral carcinoma the most important area for prognostication? Oral Dis 1998 Jun;4(2):70-77.
  4. Analysis of the invasive edge in primary and secondary oral squamous cell carcinoma: An independent prognostic marker: A retrospective study. J Oral Maxillofac Pathol 2016;20(2):239-245.
  5. Measurement of proliferating cell nuclear antigen (PCNA) and its clinical application in oral cancers. Int J Oral Maxillofac Surg 1992 Dec;21(6):369-372.
  6. Cell-cycle-related staining patterns of anti-proliferating cell nuclear antigen monoclonal antibodies. Comparison with brdUrd labeling and ki-67 staining. Am J Pathol 1991 May;138(5):1165-1172.
  7. Common markers of proliferation. Nat Rev Cancer 2006 Feb;6(2):99-106.
  8. Immunohistochemical detection of ki-67 is not associated with tumor-infiltrating macrophages and cyclooxygenase-2 in oral squamous cell carcinoma. J Oral Pathol Med 2010 Aug;39(7):565-570.
  9. Ki-67 is a valuable prognostic factor in gliomas: Evidence from a systematic review and meta-analysis. Asian Pac J Cancer Prev 2015;16(2):411-420.
  10. Increased expression of cyclooxygenase-2 and ki-67 are associated with malignant transformation of pleomorphic adenoma. Auris Nasus Larynx 2007 Mar;34(1):79-84.
  11. Prognostic value of proliferation in invasive breast cancer: A review. J Clin Pathol 2004 Jul;57(7):675-681.
  12. The clinical assessment of proliferation and growth in human tumours: Evaluation of methods and applications as prognostic variables. J Pathol 1990 Feb;160(2):93-102.
  13. Comparison of the value of PCNA and ki-67 as markers of cell proliferation in ameloblastic tumors. Med Oral Patol Oral Cir Bucal 2013 Mar;18(2):e174-e179.
  14. Proliferating cell nuclear antigen distribution in verrucous carcinoma of the skin. Br J Dermatol 1995 Dec;133(6):868-873.
  15. The ki-67 protein: From the known and the unknown. J Cell Physiol 2000 Mar;182(3):311-322.
  16. In situ assessment of cell proliferation at the invasive front of oral squamous cell carcinomas. Virchows Arch 1996 Nov;429(4-5):229-234.
  17. Comparison of cell proliferation in the centre and advancing fronts of oral squamous cell carcinomas using ki-67 index. Cell Prolif 2003 Oct;36(5):255-264.
  18. Prognostic value of various molecular and cellular features in oral squamous cell carcinomas: A review. J Oral Pathol Med 1991 Oct;20(9):413-420.
  19. Analysis of the Ki-67 antigen at the invasive tumor front of human oral squamous cell carcinoma. J Oral Pathol Med 2002 Nov;31(10):598-604.
  20. The relationship of the histologic grade at the deep invasive front and the expression of ki-67 antigen and p53 protein in oral squamous cell carcinoma. J Oral Pathol Med 2005 Nov;34(10):602-607.
  21. The relationship of proliferating cell density at the invasive tumour front with prognostic and risk factors in human oral squamous cell carcinoma. J Oral Pathol Med 2004 Apr;33(4):204-208.
  22. Analysis of KI-67 antigen in human oral squamous cell carcinoma—an immunohistochemical study. J Int Oral Health 2010 Jun;2(1):9-16.
  23. Ki-67 and p53 correlation prognostic value in squamous cell carcinomas of the oral cavity and tongue. Braz J Otorhinolaryngol 2009 Jul-Aug;75(4):544-549.
  24. Analysis of cell proliferation and pattern of invasion inoral squamous cell carcinoma. J Oral Sci 2010 Sep;52(3):417-424.
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