Patterns of multiple recurrences of superficial (Ta/T1) transitional cell carcinoma of bladder and effects of clinicopathologic and biochemical factors

Abstract

BACKGROUND Although multiple sequential recurrences are one of the most important characteristics of superficial transitional cell carcinoma (TCC) of the bladder, few studies have examined multiple sequential recurrence patterns and the clinicopathologic and biochemical factors associated with these patterns. METHODS Two hundred seventy superficial TCC bladder carcinoma patients were followed. Clinical, pathologic, and tumor marker (p53, MIB‐1, bcl‐2, c‐erb B‐2, and epidermal growth factor receptor) data were collected at baseline and during followup. The Kaplan‐Meier (KM) method was used to describe multiple recurrences. The Wei, Lin, and Weissfeld (WLW) marginal proportional hazards model was used to assess the effects of clinicopathologic and immunohistochemic factors on multiple recurrences. RESULTS Among the 270 patients, 126 (46.7%) had one or more recurrences, 38 (14.1%) had two or more recurrences, and 14 (5.2%) had three or more recurrences during the followup. The median times for the first, the second, and the third recurrences were 23 months, 15 months, and 13 months, respectively. In KM analysis, Stage T1, higher grades, and Ki‐67 stain positivity were associated with the first recurrence, and p53 stain positivity was marginally significant. Other markers were not significant. For the second recurrence, only p53 stain positivity was significant. In multivariate analysis (WLW method), stage was significantly associated with the first recurrence (risk ratio [RR] = 2.03), and Ki‐67 was marginally significant (RR = 1.49). For the second recurrence, only p53 positivity was statistically significant (RR = 2.73). CONCLUSIONS Among superficial TCC bladder carcinoma patients, multiple recurrences are common phenomena. The time for recurrence becomes shorter as the number of recurrences increases. In addition to tumor stage and grade, Ki‐67 can be used to identify patients at high risk for a first recurrence; and p53 can be used to identify patients at high risk for a second recurrence. Cancer 2002;95:1239–46. © 2002 American Cancer Society. DOI 10.1002/cncr.10822

Immunohistochemical expression of p63, p53 and MIB-1 in urinary bladder carcinoma. A tissue microarray study of 158 cases

“…Santos et al [35] have shown that MIB-1-positive tumors have a worse course of disease. Yan et al [47] observed that MIB-1 could be used to identify patients with high risk for recurrence. Helpap and Köllermann [10] have shown that pattern and intensity of staining for MIB-1 and 34βE12 might help to distinguish grades.…”

“…p63 staining was considered positive if nuclear percentage between 0 (stained cells <10%), 1 (>10% stained cells <80%) and 2 (stained cells >80-100%) was assessed. Regarding p53, tumors with nuclear immunoreactivity of more than 10% were considered positive according to other pervious studies [26,27,47].…”

“…Immunohistochemical investigations with p53 and MIB-1 have shown to be predictive markers in the progression of bladder cancer [34,37,47]. p53 over-expression has shown to be associated with grade and stage [12,39] and correlated with recurrence in pTa and T1 cancers as well as tumor progression [12,22,37], but its association with overall survival and clinical outcome is still controversial [12,22].…”

Should we screen for bladder cancer in a high‐risk population?

“…4 The grade distribution for patients with T0 and T1 disease was 29%, 52.6%, and 18.4% for WHO Grades 1, 2, and 3, respectively, based on weighted means derived from 6 articles involving 4514 patients. [13][14][15][16][17][18] In patients with T2 disease and higher, 90% of patients had high-grade disease. 11 Cancer recurrence and progression rates depend heavily on the stage of disease.…”

Valor pronóstico de progresión de las moléculas reguladoras del ciclo celular en tumores vesicales T1G3

“…Su valor como factor predictivo en el cáncer vesical está todavía también por determinar. Los estudios recientes mayoritariamente consideran que la expresión inmunohistoquímica de esta proteína no presenta un valor significativo ni en el análisis univariante ni en el multivariante 1, [30][31][32][33][34] . En tumores pT1G3, Wolf HK y cols.…”