Survivin mRNA copy number in bladder washings predicts tumor recurrence in patients with superficial urothelial cell carcinomas.

Abstract

Urothelial cell carcinoma (UCC) is the most common form of bladder cancer (1). Approximately 70% of patients diagnosed with UCC have superficial tumors (designated Ta or T1) and are treated by transurethral resection of the tumor (TURT). Most of these patients develop recurrences after TURT and therefore need to be followed intensively. Cystoscopy is the gold standard to check a patient’s bladder for recurrences. Unfortunately, cystoscopy is invasive, labor-intensive, and costly. Accurate prediction of UCC recurrence could significantly reduce the number of cystoscopies performed during patient follow-up. Currently, the major determinants of a patient’s follow-up scheme and treatment procedures are pathologic tumor stage and grade. However, pathology-based assessment of bladder tumor stage and grade is subject to variability (2)(3). Furthermore, it is important to address other disease characteristics, such as tumor multiplicity and tumor size, to carefully assess the risk of recurrence in patients with superficial UCC (4)(5)(6). As a possibly better and more standardized estimation of the risk of recurrence in patients with UCC, molecular biological alterations have been studied (7)(8)(9)(10). An important molecular tumor marker that has emerged is survivin (11). The concentrations of both survivin protein and mRNA in tumor tissue from patients with superficial UCC are indicative of the risk of tumor recurrence (12)(13). Assessment of prognosis in UCC is usually restricted to analysis of the resected tumor tissue. However, routine cystoscopy frequently overlooks carcinoma in situ and small, solid high-grade or papillary tumors (14)(15). These lesions may thus not be removed during TURT, and consequently, prognostic information may be missed. As an advantage over tumor biopsies, bladder washings cover the entire urothelium and may reflect the general molecular biological status of the bladder (16)(17)(18 …