Prognostic Significance of p53, pRb, and p21(waf1) in T1G3 Bladder Cancer

Cho, Soung Yong; Kim, Young Sik; Hong, Sung Joon

Abstract

PURPOSE: There is no reliable method for predicting which patient with a T1G3 bladder tumor will progress and possibly benefit from an early cystectomy. The prognostic significance of p53, pRb, and p21(waf1) expression was evaluated in patients with a T1G3 bladder tumor.
MATERIALS AND METHODS
Of the 787 patients with a newly diagnosed bladder tumor, 485 were superficial. Of these patients, 57 had a T1G3 transitional cell carcinoma. Overall, a total of 30 patients were included in this study. A tumor with nuclei staining more than 10% with either p53 or p21(waf1) antibodies were defined as having altered p53 or p21(waf1) expression. The relationship between recurrence and progression and the results of immunostaining in a T1G3 bladder cancer was analyzed.
RESULTS
A pathological diagnosis consisted of 14 papillary and 16 non-papillary including 2 mixed transitional cell cancers. An associated carcinoma in situ was noted in 3 patients. Of the 30 patients, 11 had a recurrence. A progression to muscle invasive bladder cancer had developed in 6 cases at a mean interval of 10.2 months. Each separate expression of p53, p21(waf1) and pRb did not correlate with tumor recurrence or progression. However, patients with combination of a positive p53 with a negative p21(waf1) and a negative pRb test had a significantly higher rate of progression to muscle invasive disease.
CONCLUSIONS
A combination of altered immunostaining for a positive p53 with a negative p21(waf1) and a negative pRb test correlated with progression of a T1G3 TCCa of the bladder but not with a recurrence. Therefore, early cystectomy should be considered in a T1G3 bladder tumor with an altered expression of p53 with either p21(waf1) or with pRb.