1431 SERUM β-HCG PREDICTS RECURRENCE POST RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive (I)1 Apr 20131431 SERUM β-HCG PREDICTS RECURRENCE POST RADICAL CYSTECTOMY James Douglas, Tamsin Drake, Matthew Sommerlad, and Simon Crabb James DouglasJames Douglas Southampton, United Kingdom More articles by this author , Tamsin DrakeTamsin Drake Southampton, United Kingdom More articles by this author , Matthew SommerladMatthew Sommerlad Southampton, United Kingdom More articles by this author , and Simon CrabbSimon Crabb Southampton, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2785AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder cancer has been associated with ectopic production of the free beta subunit of the hormone, human chorionic gonadotrophin (β-HCG). In pregnancy β-HCG has angiogenic, endocrine and immunosuppressive roles. The objective was to investigate serum and tumor levels of β-HCG in predicting post-cystectomy outcomes in muscle invasive bladder cancer. METHODS Over 200 patients who had bladder cancer treated by cystectomy at a tertiary referral centre, over a 10-year period, had their archived tissue transformed into a tissue micro-array. An associated database was created including blood results for a postoperative β-HCG if performed. Immunohistochemistry was performed for β-HCG. Slides were scored, blinded to clinical details, using a validated scoring system by a pathologist and the lead researcher and discrepancies agreed. In the post-operative period where serum β-HCG was measured, a serum level above 2 IU/L was considered positive. Survival differences were determined by Kaplan-Meier analyses and the log rank test using SPSS software. RESULTS There were representative cores for 180 patients. 8.3% of patients overexpressed beta-HCG. Expression patterns did not predict survival and were not related to serum levels in the patients who subsequently underwent β-HCG serum measurement. 96 patients had post-operative serum β-HCG measurements. 49 patients had a positive blood test and of these 84% had tumour recurrence. Of the 47 patients who had a negative blood test only 23% had a recurrence. Patients who had a positive β-HCG (>2IU/L) had only a 25% 5-year overall survival compared with 68% in the negative group (P=<0.001). Similarly the recurrence free survival was significantly worse in patients who had a positive serum β-HCG with a 5 year RFS of only 26% compared to 75% in the serum negative group (P<0.000). After Cox regression analysis a raised serum β-HCG gave a hazard ratio of 2.99 (P=0.001). CONCLUSIONS Serum β-HCG may be of value as a predictor of recurrence post radical cystectomy and could be used as an adjunct to the surveillance systems currently in use. The lack of a relationship between postoperative serum β-HCG and tumoral β-HCG expression may imply separate processes at the point of tumor metastasis. Prospective studies to assess the role of β-HCG in bladder cancer are warranted. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e586 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Douglas Southampton, United Kingdom More articles by this author Tamsin Drake Southampton, United Kingdom More articles by this author Matthew Sommerlad Southampton, United Kingdom More articles by this author Simon Crabb Southampton, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...