Impact of immunohistochemistry-based molecular subtype on predicting chemotherapy response and survival in patients with T1 stage bladder cancer after bladder-preserving treatment

• Published in: Japanese journal of clinical oncology Vol. 51; no. 3; pp. 424 - 433
• Main Authors: Lu, Jiangli, Zhang, Yijun, Wu, Chenyan, Chu, Chengbiao, Liu, Zhuowei, Cao, Yun
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 03.03.2021
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biomarkers, Tumor - metabolism; Cisplatin - therapeutic use; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Epirubicin - therapeutic use; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neoplasm Staging; Organ Sparing Treatments; Prognosis; Progression-Free Survival; Treatment Outcome; Urinary Bladder Neoplasms - classification; Urinary Bladder Neoplasms - drug therapy; Urinary Bladder Neoplasms - pathology; gemcitabine plus cisplatin intra-arterial chemotherapy; immunohistochemistry; bladder cancer; molecular subtype; survival
• ISSN: 1465-3621; 1465-3621
• DOI: 10.1093/jjco/hyaa219

Abstract Objective To explore the immunohistochemistry-based molecular subtypes of bladder cancer, and their impact on the prognosis and the chemotherapy response between gemcitabine plus cisplatin intra-arterial chemotherapy and epirubicin-inducted intravesical chemotherapy, in patients with T1 stage bladder cancer after bladder-preserving treatment. Methods One hundred and seventy-six patients with T1 stage bladder cancer were selected for this study. Thirty-three patients underwent radical cystectomy, 43 received gemcitabine plus cisplatin intra-arterial chemotherapy and 100 received intravesical chemotherapy. The markers labeled with luminal (GATA3, Uroplakin II, CK20) and basal (CK5/6, CK14, CD44) phenotypes were chosen as candidate markers. Results One hundred and seventy-six patients were divided into 76 patients as basal/squamous (BASQ), 45 as the luminal A and 55 as the luminal B. Compared with the luminal B and BASQ tumors, the luminal A tumors showed a trend for better recurrence-free survival (P = 0.105) and progression-free survival (P = 0.093). The combination of CK20 and GATA3 was practical to identify the molecular phenotypes with total 84.9% accuracy and significantly associated with recurrence-free survival (P = 0.025) and progression-free survival (P = 0.004). The patient with BASQ tumors who received intravesical chemotherapy showed a trend for worse progression-free survival than the patient who received gemcitabine plus cisplatin intra-arterial chemotherapy or radical cystectomy. Furthermore, the patients with BASQ tumors experienced a significant improvement in progression-free survival after gemcitabine plus cisplatin intra-arterial chemotherapy compared with the patients who received intravesical chemotherapy (P = 0.011). Conclusions The immunohistochemistry-based molecular subtypes could predict the patient’s prognosis and clinically different chemotherapeutic survival outcomes in patients with T1 stage bladder cancer after bladder-preserving treatment. The immunohistochemistry-based molecular subtypes were a predictor for prognosis and clinically different chemotherapeutic survival outcomes in patients with T1 stage bladder cancer after bladder-preserving treatment.