Recurrence and Progression in Low Grade Papillary Urothelial Tumors

Holmäng, Sten; Hedelin, Hans; Anderström, Claes; Holmberg, Erik; Busch, Christer; Johansson, Sonny L.

doi:10.1097/00005392-199909010-00019

Cited by 167 publications

(85 citation statements)

References 19 publications

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“…Investigations over the past years have increased the understanding of the biological behavior of this disease and have led to novel prognostic and therapeutic recommendations and approaches (3). However, more than 50 to 70% of non-muscle invasive bladder cancer cases recur within 3 years after primary treatment with a 10 to 30% progression rate to muscle invasive tumor stages (pT2-pT4) (4,5).…”

Section: Introductionmentioning

confidence: 99%

Maspin protein expression correlates with tumor progression in non-muscle invasive bladder cancer

Kramer

Waalkes²,

Hennenlotter³

et al. 2010

Oncology Letters

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Abstract. Maspin is a 42-kDa protein that belongs to the family of serine protease inhibitors. It is involved in various physiological processes. In cancer tissue, Maspin was found to influence angiogenesis, tumor growth, metastasis and the prognosis of tumor patients. This study was performed to analyze the involvement of Maspin in transitional cell carcinoma of the bladder as well as its prognostic impact in a large patient cohort. Specimens from 162 non-muscle invasive bladder cancer patients (pTa, 91; pT1, 71) treated by transurethral resection with a minimum 3-year follow-up (median 58.5 months) were included in the present investigation. Tissue microarrays were constructed, and the specimens were immunohistochemically stained for Maspin protein expression. Each tissue specimen was assessed on a staining scale ranging from 0 (no staining) to 300 (strong staining) and correlated with various clinicopathological parameters. Maspin protein expression predicted progression with a sensitivity of 95% and a specificity of 70% (p<0.001). In predicting recurrence, Maspin staining showed 52% sensitivity and 67% specificity (p<0.05). Kaplan-Meier analyses were performed, and a low Maspin protein expression was correlated with a higher incidence of tumor progression (p<0.0001). However, expression levels of Maspin protein did not distinguish between pTa and pT1 specimens. Multivariate analyses indicated Maspin expression as an independent factor for predicting progression (p<0.0001) and recurrence (p<0.05). The present results suggest that the Maspin protein expression is an independent prognostic indicator for predicting recurrence and progression to muscle invasive disease. This study further emphasizes a possible clinical role of this novel tumor suppressor gene in transitional cell carcinoma of the bladder.

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Section: Introductionmentioning

confidence: 99%

Maspin protein expression correlates with tumor progression in non-muscle invasive bladder cancer

Kramer

Waalkes²,

Hennenlotter³

et al. 2010

Oncology Letters

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“…[1][2][3] Although these factors are relatively accurate in the group of patients with superficial UCC, improvement in the prediction of tumor recurrence in individuals is needed. [4][5][6] Many studies have investigated the prognostic potential of molecular markers to supplement or even replace the current standards.…”

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confidence: 99%

Prediction of recurrence in Ta urothelial cell carcinoma by real‐time quantitative PCR analysis: A microarray validation study

Schultz

Wester

Straatman

et al. 2006

Intl Journal of Cancer

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Accurate prediction of tumor recurrence in patients with superficial urothelial cell carcinoma (UCC) might result in a significant reduction of invasive follow-up cystoscopies. A recent study identified a panel of 26 genes from a large cDNA microarray analysis of bladder tumors that discriminated between early-and late-recurring patients with superficial Ta tumors (Dyrskjøt et al., Nat Genet 2003;33:90-6). We aimed to validate this panel of genes in 44 primary Ta UCCs (23 and 21 tumors from patients with short or prolonged recurrence-free periods, respectively), by real-time quantitative PCR. Statistical analysis showed marginal significant different mRNA expression levels between the 2 patient groups. To evaluate a supplementary effect of genes for the identification of patients with short or prolonged recurrence-free intervals, forward logistic regression analysis was applied. This revealed that a combination of the expression profiles of the genes HNRPK, LTB4DH and ANP32B resulted in the best performance, although the combination only marginally increased the predictive value of HNRPK alone. Comparing the receiver-operating-characteristic curves for HNRPK expression among patients with short or prolonged recurrence-free periods, revealed an area under the curve of 0.696 (95% CI, 0.537-0.855). Using the median HNRPK expression level as cut-off, a sensitivity of 69.6% and a specificity of 71.4% were obtained for the identification of patients with short or prolonged recurrence-free periods, respectively. In conclusion, we were not able to confirm the microarray gene expression pattern of the 26 genes shown by Dyrskjøt et al. The discovery of accurate recurrence predictive markers, therefore, remains a challenge. ' 2006 Wiley-Liss, Inc.Key words: recurrence; urothelial cell carcinoma; real-time quantitative PCR; microarray; validation Urothelial cell carcinoma (UCC) comprises up to 95% of human bladder cancer. It originates in the urothelium, the layer of cells lining the inner bladder wall. The larger part of patients with UCC is diagnosed with superficial tumors, pTNM stages Ta and T1, of which the depth of organ invasion is limited to the stromal mucosa. These tumors can be removed relatively easy by transurethral resection. Unfortunately, 70% of these patients experience recurrences after tumor removal and some will show progression towards muscle invasive disease. This necessitates frequent examination of the bladder by cystoscopy, which is invasive and represents a burden to the patient. The monitoring of these patients also includes those who will remain recurrence-free for several years or even for the rest of their lives. This generates a substantial number of unnecessary cystoscopies, which may be prevented by accurate prediction of tumor recurrence (or nonrecurrence) in patients with superficial UCC.The current standards for the estimation of the risk of recurrence are tumor grade, size and multiplicity. 1-3 Although these factors are relatively accurate in the group of patients with superficial UCC,...

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“…This new classification system recognizes papilloma, papillary neoplasm of low malignant potential (LMP), and low-grade papillary transitional cell carcinoma at the low-grade end of the transitional cell neoplasia spectrum. A recent study has shown that this new classification of low-grade bladder tumors can provide prognostic information (2).…”

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confidence: 99%

Comparison of the WHO/ISUP Classification and Cytokeratin 20 Expression in Predicting the Behavior of Low-Grade Papillary Urothelial Tumors

et al. 2001

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Recurrence and Progression in Low Grade Papillary Urothelial Tumors

Cited by 167 publications

References 19 publications

Maspin protein expression correlates with tumor progression in non-muscle invasive bladder cancer

Maspin protein expression correlates with tumor progression in non-muscle invasive bladder cancer

Prediction of recurrence in Ta urothelial cell carcinoma by real‐time quantitative PCR analysis: A microarray validation study

Comparison of the WHO/ISUP Classification and Cytokeratin 20 Expression in Predicting the Behavior of Low-Grade Papillary Urothelial Tumors

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