Abstract
BackgroundA new modality is necessary to prevent recurrence of superficial bladder cancer after complete transurethral resection because of the high recurrence rate even with current prophylaxis protocols.MethodsIn order to analyze the predictive value of cyclooxygenase-2 (COX-2) expression and tumor infiltrating lymphocytes (TILs) in recurrence of this disease tumor specimens from 127 patients with solitary papillary non-muscle invasive bladder cancer (NMIBC), 78 with recurrent disease and 49 without recurrence during follow up of minimum 5 years, were retrieved for tissue microarrays construction and immunohistochemical analysis. COX-2 expression was scored according to Allred’s scoring protocol, while presence of TILs was categorized as absent (no) or present (yes) on whole tissue sections.ResultsCOX-2 immunoreactivity was presented in 70 (71%), weak in 16% and strong in 55% of cases, while 29 (29%) tumors were negative. TILs were present in 64 (58%) NMIBC, while 44 cases (41%) did not reveal mononuclear infiltration in tumoral stroma. Statistical analysis demonstrated a higher proportion of patients with recurrence in the group with the COX-2 score 0, and lower in the group with score 2 (p=0.0001, p=0.0101, respectively). In addition, a higher proportion of recurrent patients in the group with no TILs, and lower proportion in the group with TILs were found (p=0.009, p=0.009, respectively). Univariate and multivariate analysis revealed overexpression of COX-2 and presence of TILs as negative predictors.ConclusionPatients with lower COX-2 expression and absence of TILs in NMIBC need to be followed up more vigorously and probably selected for adjuvant therapy.Virtual slideThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1411318819790406
Highlights
A new modality is necessary to prevent recurrence of superficial bladder cancer after complete transurethral resection because of the high recurrence rate even with current prophylaxis protocols
Clinicopathological data The tumor specimens analyzed in this study were obtained from a total of 127 patients with solitary papillary non-muscle invasive bladder cancer (NMIBC) treated with initial transurethral resection (TUR), as a standard procedure at the Department of Urology, Rijeka University Hospital Center in Rijeka, between 1996 and 2006
Tumors divided according to their size in ≤3 or >3 cm, according to their pathology in groups of papillary urothelial neoplasms of low malignant potential (PUNLMP) and low grade papillary urothelial carcinoma (LGPUC), and according to their stage in Ta and T1 were nearly distributed
Summary
A new modality is necessary to prevent recurrence of superficial bladder cancer after complete transurethral resection because of the high recurrence rate even with current prophylaxis protocols. The mortality from transitional cell carcinoma (TCC) of the urinary bladder increases significantly with the progression of superficial to invasive disease. Intravesical instillations of Bacille Calmette–Guerin (BCG) has been demonstrated to reduce the recurrence rate and the risk of progression to muscle-invasive disease in patients with carcinoma in situ (pTis), as well as non-muscle-invasive urothelial carcinomas [3,4]. A significant percentage of patients will fail initial BCG therapy. These patients would have much more benefit if they were oriented early to other therapeutic approaches. Another 30% to 50% of BCG responders will develop recurrent tumors within 5 years [6,7]
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