Prognostic Value of p53, p21/WAF1, Bcl-2, Bax, Bak and Ki-67 Immunoreactivity in pT1 G3 Urothelial Bladder Carcinomas

• Published in: Tumor biology 2001-09, Vol.22 (5), p.328-336
• Main Authors: Wolf, H.K., Stöber, C., Hohenfellner, R., Leissner, J.
• Format: Article
• Language: English
• Subjects: Bak protein; bcl-2 Homologous Antagonist-Killer Protein; bcl-2-Associated X Protein; Biological and medical sciences; Biomarkers, Tumor - analysis; Carcinoma, Transitional Cell - mortality; Carcinoma, Transitional Cell - pathology; Carcinoma, Transitional Cell - surgery; Cyclin-Dependent Kinase Inhibitor p21; Cyclins - analysis; Disease-Free Survival; Follow-Up Studies; Humans; Immunohistochemistry; Ki-67 Antigen - analysis; Ki-67 protein; Medical sciences; Membrane Proteins - analysis; Neoplasm Invasiveness; Nephrology. Urinary tract diseases; p21 protein; Predictive Value of Tests; Prognosis; Proto-Oncogene Proteins - analysis; Proto-Oncogene Proteins c-bcl-2 - analysis; Research Article; Retrospective Studies; Survival Rate; Time Factors; Tumor Suppressor Protein p53 - analysis; Tumors of the urinary system; urinary bladder carcinoma; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urinary tract. Prostate gland; WAF1 gene
• ISSN: 1010-4283; 1423-0380
• DOI: 10.1159/000050635

pT1 G3 bladder carcinomas are heterogeneous with respect to tumor recurrence and progression. Whereas some urologists treat these carcinomas by repeated transurethral resections often followed by intravesical chemotherapy or BCG instillation, others recommend cystectomy after tumor recurrence or early cystectomy after the initial diagnosis. Our goal was to determine the prognostic value of p53, p21/WAF1, Bcl-2, Bax, Bak, and Ki-67 immunoreactivity in these tumors. There were 30 patients with a new histopathological diagnosis of pT1 G3 urothelial carcinoma based on a transurethral resection specimen. Representative sections of these specimens were examined for the above markers. All patients were followed up regularly and were classified as being tumor free or having tumor recurrence or progression. The mean follow-up period was 43 months (range: 8–102 months). Twenty-five patients underwent radical cystectomy and 7 of these (28%) suffered from tumor progression and died of bladder cancer. In 5 patients, surgery was limited to a transurethral resection and 4 of these patients developed superficial tumor recurrence. There was a significant difference in tumor-free survival between patients with p53-immunoreactive (mean: 30 months) and p53-negative tumors (mean: 82 months; p = 0.0341). Bcl-2 positivity was also associated with decreased tumor-free survival (p = 0.043). The other markers had no significant prognostic impact. We conclude that p53 and Bcl-2 immunoreactivity labels the most aggressive pT1 G3 bladder carcinomas.