Abstract.Patients with aggressive urothelial cell carcinoma (UCC) that undergo radical cystectomy or nephroureterectomy exhibit markedly high rates of disease recurrence and mortality. To select appropriate adjuvant thxerapies in addition to radical surgery, the identification of predictive prognostic markers for UCC patients is required. The aim of the present study was to identify such markers, by evaluating the association of UCC complement component 5 (C5) fragment a (C5a) receptor (C5aR) expression, detected using immunohistochemistry, with clinicopathological parameters and survival outcomes of UCC patients. The results revealed that C5aR was expressed in cancer cells, particularly at the invasive front, but not in noncancerous urothelial cells or adjacent cells. The UCC C5aR-positive rate of patients treated with radical surgeries was 73% (38/52) and the rate was 83% (20/24) at stages I-II of disease. No correlation between C5aR expression and any of clinicopathological parameters, which included gender, tumor location, World Health Organization grade, T stage, vessel invasion and stage of disease, was identified. However, univariate and multivariate analyses revealed that C5aR-positive UCC patients exhibited significantly lower overall survival rates [hazard ratio (HR), 3.14; 95% confidence interval (CI), 1.03-9.60; P=0.035 and HR, 3.92; 95% CI, 1.15-13.4; P=0.029, respectively] and 5-year survival rates (0.42 vs. 0.83) compared with C5aR-negative UCC patients. Furthermore, 5-year survival and disease-specific survival rates were lower in patients with C5aR-positive UCC (0.51; 95% CI, 0.30-0.71) than patients with C5aR-negative UCC (0.83; 95% CI, 0.62-1.00). These results indicate that UCC C5aR expression is predictive of poor patient outcomes and thus may lead to the appropriate selection of adjuvant therapies at earlier UCC stages, which could improve patient prognosis.
IntroductionUrothelial cell carcinoma (UCC) is one of the most common types of cancer in the USA, accounting for ~4.5% of all newly diagnosed cancer cases and 2.8% of all cancer-associated mortalities in 2013 (1). In the USA, the most common site of UCC is the bladder, and bladder UCC is the fourth most common type of cancer and the sixth leading cause of cancer-associated mortality in males (1). Bladder UCC may be classified into two subtypes at diagnosis, non-muscle and muscle-invasive, which exhibit distinct clinical features (2). The non-muscle-invasive subtype commonly recurs in the bladder cavity and accounts for 70-80% of cases of bladder UCC, with muscle invasion present in only 10-20% of cases. The 5-year survival rate of the non-muscle-invasive subtype of UCC is >90%. By contrast, muscle-invasive bladder UCC, which accounts for ~20% of bladder UCC cases, exhibits a poor prognosis with a 5-year survival rate of <50%. Carcinoma in situ (CIS), which is classified into the non-muscle invasive aggressive subtype, is localized to the epithelium and exhibits invasive and metastatic potential. In patients with aggressive bladder UCC (...