Proliferative status is a risk index for recurrence in primary superficial (pTa/T1) low-grade urothelial bladder carcinoma

• Published in: Hinyokika kiyo. Acta urologica Japonica Vol. 49; no. 11; p. 649
• Main Authors: Su, Jing-Shi, Arima, Kiminobu, Hasegawa, Mariko, Franco, Omar E, Yanagawa, Makoto, Sugimura, Yoshiki, Kawamura, Juichi
• Format: Journal Article
• Language: English
• Published: Japan 01.11.2003
• Subjects: Adult; Aged; Aged, 80 and over; Female; Humans; Immunohistochemistry; Ki-67 Antigen - analysis; Ki-67 Antigen - biosynthesis; Male; Middle Aged; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Proto-Oncogene Proteins c-bcl-2 - biosynthesis; Risk Factors; Tumor Suppressor Protein p53 - biosynthesis; Urinary Bladder Neoplasms - metabolism; Urinary Bladder Neoplasms - pathology
• ISSN: 0018-1994

The current clinicopathologic study for evaluation of superficial bladder cancer still has limitations in predicting the true behavior of recurrence. To determine the high-risk recurrence factors, we studied the influence of Ki-67, c-erbB-2, p53 and multidrug resistance-associated protein (MRP) expression. Samples were obtained from 33 pTa and 46pT1 diagnosed bladder cancer patients with a mean follow-up of 48.7 +/- 30.6 months. The contingency table method, Kaplan-Meier curve and multivariate analysis were used to evaluate the association among the immunohistochemical factors expression, clinicopathologic parameters with tumor recurrence. Stage pT1 tumors, sessile tumors and large tumors (> 3 cm) showed a significantly high recurrence rate (p = 0.0158, p = 0.0162, p = 0.0001 respectively). Tumors with overexpression of Ki-67, c-erbB-2 and p53 were more likely to recur (p = 0.0035, p = 0.0027, p = 0.0076 respectively), MRP expression was not associated with recurrence. Multivariate analysis showed that large tumors and high Ki-67 expression were independent indicators of recurrence. On the other hand, in tumors less than 1 cm, recurrence was significantly correlated with overexpression of Ki-67 and p53. High Ki-67 expression could discriminate higher recurrence cases in grade 2, pT1 and single tumors. The c-erbB-2 overexpression was more frequently associated with recurrence in sessile tumors, large tumors, multiple and grade 1 tumors. The p53 overexpression also predicted a higher risk of recurrence in pTa tumors. These data demonstrated that the use of proliferative related proteins yields significant prognostic information in addition to clinicopathological factors, high Ki-67 expression is a reliable indicator of recurrence. A combination rather than any factor alone could more accurately predict tumor recurrence.