The prognostic significance of p53, bcl-2, cytokeratin 20 and ki-67 in primary superficial papillary transitional bladder carcinoma

Abstract EN

Background : Identification of factors that determine individual patient risk for recurrence and progression in superficial papillary carcinoma of the bladder is a subject of extensive research as it would be a major outcome in patient management.

It has been well recognized that traditional prognostic markers as tumor grade and stage are not accurate enough in predicting biological behavior.

A large number of markers have been investigated as potential prognostic factors and relatively few can help in predicting outcome.

Material and Methods : Forty-nine cases undergoing complete transurethral resection for primary superficial papillary transitional cell carcinoma were subjected to clinic pathologic evaluation as well as immunohistochem-ical staining for p53, bcl-2, cytokeratin 20 and Ki-67.

The CAS-200 image analyzer was used to estimate the Ki-67 labeling index.

Results : Recurrence was observed in 19 cases (38.8 %) and progression in 7 cases (14.3 %) with a median follow-up of 49 months (range 24-84 months).

p53 was detected in 33 tumors (67.3 %).

There was a significant correlation between p53 expression and tumor stage (p < 0.001).

Six (85.7 %) of 7 cases that progressed had a p53-positive tumor at initial diagnosis.

Bcl-2 overexpression was observed in 30 cases (61.2%).

The expression of bcl-2 did not correlate with histological grade, clinical stage, or relapse.

Five cases showed normal pattern of staining with cytokeratin 20 (2 pTa and 3 pT1).

All cases with normal expression of cytokeratin 20 showed no recurrence or progression.

Ki-67 labeling index ranged from 1% to 60%.

We could not detect prognostic significance of Ki-67 labeling index using multiple cut off values.

Sixteen cases (32.7 %) were associated with bilharzias is.

The frequency of p53 positivity, bcl-2, abnormal cytokeratin 20 expression and high Ki-67 labeling index appeared to be similar in bilharzia and non-bilharzia cases.

Conclusions : these results suggest that evaluation of p53 may help to identify patients with higher probability of disease progression.

Assessment of cytokeratin 20 can be used in predicting biologic behavior in patients with papillary urothelial pTa and pT1 neoplasms.

However, prospective studies of large cohorts of patients are needed to confirm these findings and to justify the use of these markers as useful prognostic tools in tailoring treatment and follow-up schedule of patients with superficial bladder.