Abstract
BackgroundNeoadjuvant chemotherapy has been shown to have benefit in T1 high-grade or T2 bladder cancer. However, neoadjuvant chemotherapy fails in some patients. Careful patient selection for neoadjuvant chemotherapy is therefore needed. Several reports show that Snail is associated with resistance to chemotherapy. We hypothesized that Snail expression could predict survival in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy.MethodsThe participants were 44 patients with T1 high-grade and T2 bladder cancer receiving neoadjuvant chemotherapy. Immunohistochemical analysis was used to determine Snail expression in specimens of bladder cancer obtained by transurethral resection before neoadjuvant chemotherapy. The relationships between Snail expression and patients’ outcomes were analyzed.ResultsSnail expression was positive in 15 of the 44 patients (34.1%) and negative in 29 (65.9%). Disease-free survival was significantly shorter for the Snail-positive group than for the Snail-negative group (p = 0.014). In addition, disease-specific survival was also significantly shorter for the Snail-positive group than for the Snail-negative group (p = 0.039). In multivariate analysis, Snail expression level was identified as an independent prognostic factor for disease-specific survival (p = 0.020).ConclusionsThe results indicate that Snail expression may predict poor outcome in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy.
Highlights
Neoadjuvant chemotherapy has been shown to have benefit in T1 high-grade or T2 bladder cancer
The present study demonstrated a significant association between Snail expression and survival in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy
A high level of Snail expression was associated with decreased disease-free survival and diseasespecific survival time in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy
Summary
Neoadjuvant chemotherapy has been shown to have benefit in T1 high-grade or T2 bladder cancer. We hypothesized that Snail expression could predict survival in T1 high-grade and T2 bladder cancer patients treated with neoadjuvant chemotherapy. A meta-analysis of 11 trials involving 3005 patients demonstrated an absolute benefit of 5% in 5-year overall survival among patients who were treated with platinum-based neoadjuvant chemotherapy [7]. We reported that CYFRA 21-1 may be a useful indicator for monitoring neoadjuvant chemotherapy [10]. This marker could not predict the efficacy of neoadjuvant chemotherapy before the fact, and neoadjuvant chemotherapy fails in some patients. Novel markers that predict resistance to chemotherapy in bladder cancer patients are needed
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