Summary The natural history of transitional cell carcinoma (TCC) of the urinary bladder is somewhat variable, with a significant number of tumour recurrences that occasionally evolve towards an infiltrating disease. The aim of this study was to investigate the presence of human papillomavirus (HPV) DNA in 76 TCC specimens, and then correlate such findings with the overall patient survival. However, other classical prognostic clinical and pathological variables such as pathological grade and stage, koilocytosis, age and sex were also tested. HPV DNA was investigated by means of the highly sensitive polymerase chain reaction (PCR). DNA primers specific for HPV types 6, 11, 16 and 18 were used. Our results showed that 7 (9.21%) out of 76 such cases were reactive for HPV 16 DNA; one of them also reacted with HPV 6 DNA. The statistical analysis was done by the Kaplan-Meier method, Wilcoxon's generalised test for studying the differences in survival curves and Cox's regression analysis for independent prognostic factors. A significant P-value was found for pathological grade (P<0.0001) and stage (P<0.0001), HPV 16 DNA (P = 0.0418) and koilocytosis (P = 0.0140). Thus, pathological grade was the only independent factor in the bladder cancer survival. These observations may prove useful in prognostic stratification of patients with TCC of the bladder.Keywords: human papillomavirus; polyamerase chain reaction; transitional cell tumour; urinary bladderThe presence of human papillomavirus (HPV) DNA has been reported most frequently in association with cervical dysplasias which can progress to malignancies, and benign condylomata acuminata (Stoler et al., 1992;Donalson et al., 1993). Recent studies indicate that some HPVs are associated with bladder carcinoma (Del Mistro et al., 1988;Kitamura et al., 1988;Querci Della Rovere et al., 1988;Bryant et al., 1991;Anwar et al., 1992;Chetsanga et al., 1992; LopezBeltran et al., 1992a;Furihata et al., 1993;Chang et al., 1994; Lopez-Beltran and Munioz, 1995). However, the exact incidence of HPV DNA involved in TCC of the bladder remains controversial (Chang et al., 1994; Lopez-Beltran and Muiioz, 1995), since the reported incidence varies between 2.5% and 62% (Anwar et al., 1992;Chetsanga et al., 1992;Lopez-Beltran et al., 1992a; Lopez-Beltran and Mufioz 1995). Negative results have been reported by Chang et al. (1994) and Ashfaq and Vuitch (1994). The prognostic implication of HPV infection in bladder cancer survival was suggested by Lopez-Beltran et al. (1992a) andFurihata et al. (1993), using non-isotopic DNA in situ hybridisation.The aim of the present research was to investigate HPV incidence in 76 TCC specimens, using polymerase chain reaction (PCR) analysis, and then to correlate such findings with the overall patient survival. This study also included other classic prognosticators, such as the pathological grade and stage, patient age and sex, and koilocytosis. An attempt is also made to ascertain their possible prognostic implication in bladder cancer survival.
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