Transitional Cell Carcinoma Of The Upper Urinary Tract Research Articles

Impact of p53, MIB-1 and PECAM-1 expression on the prognosis of urothelial carcinoma of the renal pelvis

ObjectiveDetermining whether the overexpression of p53, MIB-1 and PECAM-1 of protein levels is of interest in predicting the prognosis of transitional cell carcinoma of the upper urinary tract (TCC-UUT) with the primary seat in the renal pelvis. Materials and methodsA univariate and multivariate analysis was conducted for prognosis prediction in a series of 82 patients with TCC-UUT of the renal pelvis who had no metastases at diagnosis (N0/Nx M0) and were treated exclusively with nephroureterectomy. We assessed clinicopathological parameters (age, gender, tumor grade and extent, histological variety, growth pattern, vascular invasion, infiltration of the renal parenchyma, and tumor necrosis) and the immunohistochemical expression of p53, MIB-1 (ki-67) and PECAM-1 (CD31) in sections performed with tissue microarray (TMA). ResultsA total of 47.6% of the patients had high-grade lesions according to the USIP-WHO classification. The growth pattern was flat in 15.85%. The distribution by T category was: 3.7% pTa, 51.2% pT1, 11% pT2, 29.3% pT3 and 4.9% pT4. The mean follow-up was 46.8±38.5 (range 4–172) months. The median survival was reached at 57 (95% CI 44–63) months. The univariate analysis revealed that survival in these patients is associated with tumor size (p=.028), histological variety (p<.0001), growth pattern (p<.0001), grade (p<.0001), pT (p=.01), vascular invasion (p=.025), necrosis (p=.004) and overexpression of p53 (p=.0006), PECAM-1 (p=.0036) and MIB-1 (p=.0038). The Cox regression model showed that high-grade (HR, 4.2; 95% CI 1.28–13.79; p=.018), flat-growth pattern (HR, 2.52; 95% CI 1.05–6.03; p=.038) and p53 overexpression (HR, 2.8; 95% CI 1.22–6.44; p=.015) were independent predictors. ConclusionHistological grade, tumor growth pattern and p53 overexpression were established as the primary predictors of prognosis for primary TCC-UUT of the renal pelvis. The independent value of MIB-1 observed in other studies was not reproduced in this study.

Impacto de la expresión de p53, MIB-1 y PECAM-1 en el pronóstico del carcinoma urotelial de la pelvis renal

ObjectiveDetermine whether the overexpression p53, MIB-1 and PECAM-1 of protein levels is of interest in predicting the prognosis of transitional cell carcinoma of the upper urinary tract (TCC-UUT) with the primary seat in the renal pelvis. Material and methodA univariate and multivariate analysis was conducted for prognosis prediction in a series of 82 patients with TCC-UUT of the renal pelvis who had no metastases at diagnosis (N0/Nx M0) and were treated exclusively with nephroureterectomy. We assessed clinicopathological parameters (age, gender, tumor grade and extent, histological variety, growth pattern, vascular invasion, infiltration of the renal parenchyma, tumor necrosis) and the immunohistochemical expression of p53, MIB-1 (ki-67) and PECAM-1 (CD31) in sections performed with tissue microarray (TMA). ResultsA total of 47.6% of the patients had high-grade lesions according to the USIP-WHO classification. The growth pattern was flat in 15.85%. The distribution by T category was: 3.7% pTa, 51.2% pT1, 11% pT2, 29.3% pT3 and 4.9% pT4. The mean follow-up was 46.8+38.5 (range, 4-172) months. The median survival was reached at 57 (95% CI 44-63) months. The univariate analysis revealed that survival in these patients is associated with tumor size (P=.028), histological variety (P<.0001), growth pattern (P<.0001), grade (P<.0001), pT (P=.01), vascular invasion (P=.025), necrosis (P=.004) and overexpression of p53 (P=.0006), PECAM-1 (P=.0036) and MIB-1 (P=.0038). The Cox regression model showed that high-grade (HR, 4.2; 95% CI 1.28-13.79; P=.018), flat growth pattern (HR, 2.52; 95% CI 1.05-6.03; P=.038) and p53 overexpression (HR, 2.8; 95% CI 1.22-6.44; P=.015) were independent predictors. ConclusionHistological grade, tumor growth pattern and p53 overexpression were established as the primary predictors of prognosis for primary TCC-UUT of the renal pelvis. The independent value of MIB-1 observed in other studies was not reproduced in this study.

Transitional Cell Carcinoma of the Native Urinary Tract After Kidney Transplantation: Recommendations Following a Long-Term Retrospective Analysis

IntroductionThe aim of the current study was to explore the clinico-oncological characteristics, and the therapeutic and survival parameters, of renal transplant recipients who developed de novo transitional cell carcinoma (TCC) over a 30-year period at the authors’ center. MethodsRetrospective analysis of records from all registered patients who underwent kidney transplantation at the center between November 1979 and January 2010 who developed de novo TCC of the urinary tract. ResultsFrom all 2001 patients analyzed during the study period, 21 recipients developed 19 TCCs of the bladder and 6 TCCs of the upper urinary tract. Among bladder TCCs, 13 (68.4%) cases were confined to mucosa (pTa or carcinoma in situ, n=7) or submucosa (pT1, n=6) and 6 others (31.6%) infiltrated the detrusor muscle (≥p T2); the grading distribution was 5 cases of G1, 6 of G2 and 8 of G3. All recurrent cases (n=8) revealed local or systemic progression. The overall and tumor-specific patient survival rates were 80.2%, 54.0% and 30.0% and 84.9%, 67.4% and 58.9% for 1, 5 and 10 years, respectively. ConclusionsIn the light of the observed increased aggressiveness of TCC in renal transplant recipients, more frequent examinations and possibly more invasive follow-up protocols should be considered for patients with 1 or more risk factors for development of TCC. Urine cytology (including ureteral wash cytology) may be used as a reliable diagnostic tool in these patients. Prophylactic contralateral nephroureterectomy might be an option in patients at high risk.

Efficacy of Adjuvant Gemcitabine-Cisplatin Chemotherapy: A Comparative Study between Locally Advanced Transitional Cell Carcinoma of the Bladder and Upper Urinary Tract

Objective: To evaluate the comparative efficacy of adjuvant gemcitabine and cisplatin (GC) chemotherapy between patients with locally advanced transitional cell carcinoma (TCC) of the bladder and upper urinary tract. Patients and Methods: From 2001 to 2005, we retrospectively selected a total of 64 patients with locally advanced TCC of the bladder and upper urinary tract who received at least 3 cycles of adjuvant GC chemotherapy. We compared disease-free and overall survival between the 2 groups. Results: The recurrence rate was 30.3% in TCC of the bladder and 25.8% of the upper urinary tract (p = 0.633). Statistical analysis revealed that there was no significant difference in the disease-free or overall survival rate between TCC of the bladder and upper urinary tract treated with adjuvant GC chemotherapy. Conclusion: Under the circumstances of limited data about TCC of the upper urinary tract, this study may suggest that adjuvant GC chemotherapy in locally advanced TCC of the upper urinary tract is as effective as those of bladder.

Transitional cell carcinoma of upper urinary tract vs. benign lesions: distinctive MSCT features

The transitional cell carcinoma (TCC) of the upper urinary tract is relatively uncommon. The clinical presentation of TCCs and many other diseases of the upper urinary tract are nonspecific, and most of these lesions are usually necessary to be evaluated by computed tomography (CT) urography. CT appearances of TCCs can be classified as papillary, infiltrating papillary, and diffusely infiltrating tumor. Most TCCs of the upper urinary tract can be identified on the bases of characteristic CT appearances. However, some benign lesions may mimic different categories of TCCs and should be taken into account for differentiating diagnosis. These lesions include endometriosis, nephrogenic adenoma, mycetomas, malacoplakia, and inflammatory pseudotumor which are similar to infiltrating papillary TCCs; complex urolithiasis, passed stone of ureter and ureteropelvic junction, chronic ureteropelvic junction obstruction with superimposed infection, atypical pyelonephritis, and tuberculosis which mimic diffusely infiltrating TCCs, and fibroepithelial polyp which has the same CT appearances as papillary TCCs. The useful CT signs to make differential diagnosis involve enhanced pattern, location of lesion, induration of urinary tract, and range of thickening of urinary wall. The three-dimension (3D) reconstructed images is useful in making differential diagnosis.

Initial Experience with Robot-Assisted Minimally-Invasive Nephroureterectomy

Various techniques have been described for laparoscopic nephroureterectomy. We reviewed our initial experience of laparoscopic nephroureterectomy with robot-assisted extravesical excision of the distal ureter and bladder cuff. Nine consecutive patients aged 43 to 83 years underwent laparoscopic nephroureterectomy for transitional cell carcinoma (TCC) between August 2005 and March 2007. The first five patients were repositioned after laparoscopic nephrectomy from flank to lithotomy position to dock the robot for excision of the distal ureter and bladder cuff by a single surgeon. In contrast, the last four patients remained in flank position throughout the entire procedure, with the robot docked in flank position following laparoscopic nephrectomy. A two-layer closure re-approximated the cystotomy and a urethral catheter was left in place for a mean of 5 days. Eight men and one woman with a mean age of 64.2 years and mean body mass index (BMI) of 28.4 kg/m(2) underwent flexible cystoscopy and laparoscopic nephroureterectomy for five right-sided and four left-sided tumors. Mean operative time was 303 minutes (range 210-430 minutes), estimated blood loss was 211 mL (range 50-700 mL), and mean length of hospital stay was 2.3 days. Pathologic staging revealed T(3) for five (55.6%), T(a) for two (22.2%), carcinoma in situ (CIS) for two (22.2%) patients, and high-grade disease for seven (77.8%) patients. With a mean follow-up of 16.2 months (range 4.3-24.3 months), three patients with a history of bladder cancer have experienced recurrence in the bladder, and one of the three has also developed metastatic disease. Laparoscopic nephroureterectomy with robot-assisted extravesical excision of the distal ureter and bladder cuff appears to be a feasible alternative for patients with TCC of the upper urinary tract.

Independent predictors of metachronous bladder transitional cell carcinoma (TCC) after nephroureterectomy for TCC of the upper urinary tract

To identify the prognostic factors predictive of metachronous bladder transitional cell carcinoma (TCC) in a multi-institutional dataset of patients who had undergone nephroureterectomy (NU) for nonmetastatic upper urinary tract (UUT) TCC. The clinical and pathological data of 231 patients who had had NU for UUT-TCC from 1989 to 2005 in three European centres were collected retrospectively, and analysed for clinical and pathological variables. The median follow-up was 38 months; during the follow-up, bladder TCC was detected in 109 patients (47.2%), and was significantly more common in patients who had UUT-TCC after previous bladder TCC (P < 0.001), in those with ureteric cancer (P = 0.022), and in those with pT2 UUT-TCC (P = 0.017). On multivariate analysis, a previous history of bladder TCC was the only independent predictor of metachronous bladder TCC (hazard ratio 2.825; P < 0.001). The 5-year probability of being free from metachronous bladder TCC was 45.5%. A history of bladder TCC (P < 0.001) and UUT tumour site (P = 0.01) were significantly associated with the probability of bladder recurrence-free survival. On multivariate analyses, a previous history of bladder TCC (hazard ratio 2.226; P < 0.001) and the presence of ureteric TCC (1.562; P = 0.036) were independent predictors of the probabilities of being free from metachronous bladder TCC. In this multi-institutional study of patients who had had NU for UUT-TCC, a history of bladder TCC was the only independent predictor of metachronous bladder TCC, while both a history of bladder TCC and the presence of ureteric tumours were predictive of the probabilities of being free from metachronous bladder TCC.

Prognostic Value of Lymph Node Dissection in Patients with Muscle-Invasive Transitional Cell Carcinoma of the Upper Urinary Tract

ObjectivesTo analyze the prognostic role of lymphadenectomy (LND) in patients with muscle-invasive transitional cell carcinoma (TCC) of the upper urinary tract (UUT) managed with radical surgery. MethodsFrom 1986 to 2003, 132 consecutive patients with muscle-invasive TCC of the UUT underwent radical surgery. LND was performed in 95 cases. Patients were stratified according to the presence of LND and lymph node (LN) status. Univariable and multivariable Cox regression models determined the effect of age, pT, grade, nodal status (pN), number of LNs removed, year of surgery, and postoperative chemotherapy on disease-free survival (DFS) and cancer-specific survival (CSS) in the overall population and in patients who underwent LND. ResultsThe actuarial 5-yr CSS in pNx patients was significantly worse than in pN0 patients (48% vs. 73%, p=0.001) and comparable to pN+ outcome (48% vs. 39%, p=0.476). In the entire population, multivariable Cox regression analyses indicated that pT and pN status were independent predictors of DFS (p=0.04, hazard ratio [HR]=1.82 and p<0.01, HR=1.34, respectively) and CSS (p<0.01, HR=2.42 and p=0.04, HR=1.32, respectively). In patients who underwent LND, the number of LNs removed was an independent predictor of DFS (p=0.03, HR=0.928) and of CSS (p=0.007, HR=0.903). The extent of LND again resulted in an independent predictor either of DFS or CSS (p=0.04, HR=0.904 and p=0.01, HR=0.867, respectively) in the subgroup of pN0 patients. ConclusionsLND emerged as a strong independent predictor of DFS and CSS in patients surgically managed for a muscle-invasive TCC of the UUT.

Impact of Caveolin-1 Expression on the Prognosis of Transitional Cell Carcinoma of the Upper Urinary Tract

This study aimed to investigate the relationship of caveolin-1 expression with prognosis in patients with transitional cell carcinoma of the upper urinary tract (TCC-UUT). Formalin-fixed, paraffin-embedded tissue sections of TCC-UUT from 98 patients, who had undergone radical nephroureterectomy, were stained immunohistochemically using antibodies against caveolin-1. The expression pattern of caveolin-1 was compared with the clinicopathological variables. The caveolin-1 expression was significantly correlated with T stage (p<0.001) and grade (p=0.036). The survival rate of patients with caveolin-1 positive tumors was significantly lower than that of patients with caveolin-1 negative tumors (p<0.0001). The univariate analyses identified T stage, grade, and caveolin-1 expression as significant prognostic factors for cancer-specific survival, whereas the multivariate analyses indicated that T stage and caveolin-1 expression were independent prognostic factors. These results show that the increased expression of caveolin-1 is associated with tumor progression and poor prognosis in TCC-UUT, suggesting that caveolin-1 may play an important role in the progression of TCC-UUT.

MP-16.02: The prognostic value of cyclooxygenase-2 expression and microvessel density in transitional cell carcinoma of the upper urinary tract

Cyclooxygenase (COX)-2 plays an important role in cancer progression by affecting tumor cell proliferation, resistance to apoptosis, angiogenesis, immune suppression, and tumor invasion in several types of cancers. However, studies about COX-2 expression in transitional cell carcinoma of the upper urinary tract (TCC-UUT) have been limited. In this study, the relationship between COX-2 expression and microvessel density (MVD), a reflection of angiogenesis with prognosis in patients with TCC-UUT, was investigated.

Retroperitoneal Lymph Node Dissection (RPLD) in Conjunction with Nephroureterectomy in the Treatment of Infiltrative Transitional Cell Carcinoma (TCC) of the Upper Urinary Tract: Impact on Survival

ObjectivesTo evaluate the prognostic impact of retroperitoneal lymph node dissection (RPLD) performed during nephroureterectomy on time to recurrence and survival in patients with infiltrative transitional cell carcinoma (TCC) of the upper urinary tract. MethodsThe charts of 82 patients with T2–T4 TCC of the upper tract were retrospectively reviewed. The median patient age was 67.7 yr. Seventy-nine patients underwent nephroureterectomy and three had partial nephrectomy. Forty patients (48.8%) had RPLD with removal of more than five nodes after nephroureterectomy (group 1), whereas 42 (51.2%) had nephroureterectomy only (group 2). Median follow-up was 64.7 mo. The prognostic role of RPLD, T (2 vs. 3–4), G (2 vs. 3), N (0 vs. 1–2 vs. x), age (<65 vs. >65 yr) and sex on time to recurrence and survival were evaluated. ResultsMedian time to recurrence and overall survival were 51.2 and 52.5 mo, respectively, in group 1 and 18.5 and 21.2 mo in group 2. Univariate analysis demonstrated that RPLD and T and N status were significantly related both to time to recurrence (p=0.009, 0.008, and 0.009, respectively) and survival (p=0.000006, 0.003, and 0.003). When analyzed using the Cox proportional hazard model, RPLD and T category were the only two factors demonstrating independent significance on overall survival (p=0.004 and 0.008). ConclusionsThe results indicate a possible curative role of RPLD in the treatment of patients with infiltrative TCC of the upper urinary tract. Further randomized trials are needed to confirm these results.

Correlation of Cyclooxygenase-2 Expression and Microvessel Density with Prognosis in Transitional Cell Carcinoma of the Upper Urinary Tract

Purpose: The aim of this study was to investigate the relationship of cyclooxygenase (COX)-2 expression and microvessel density (MVD), a reflection of angiogenesis, with prognosis in patients with transitional cell carcinoma of the upper urinary tract (TCC-UUT). Materials and Methods: Formalin-fixed, paraffin-embedded tissue sections of TCC-UUT from 91 patients, who had undergone radical nephroureterectomy, were examined immunohistochemically using antibodies against COX-2 and CD34. MVD was determined with CD34-stained slides. The expression patterns of COX-2 and MVD were compared with the clinicopathological variables. Results: The COX-2 expression was significantly correlated with T stage (p=0.002), N stage (p=0.010), and grade (p=0.027). MVD was also significantly correlated with T stage (p<0.001), N stage (p=0.002), and grade (p=0.001). The COX-2 expression was significantly correlated with MVD (p=0.001). The survival rate of patients with COX-2 positive tumors or high MVD was significantly lower than that of patients with COX-2 negative tumors or low MVD, respectively (p=0.0013, p=0.0312). Univariate analyses identified T stage, N stage, grade, COX-2 expression, and MVD as significant prognostic factors for cancer-specific survival; multivariate analyses indicated that T stage was the only independent prognostic factor. Conclusions: The increased expression of COX-2 and MVD is associated with a worse prognosis in TCC-UUT. The COX-2 expression is correlated with MVD. These results suggest that COX-2 may play an important role in the progression of TCC-UUT and angiogenesis may be affected by COX-2 during the progression of TCC-UUT. (Korean J Urol 2007;48: 376-382)

Pathological function of prostaglandin E2 receptors in transitional cell carcinoma of the upper urinary tract

The prostaglandin E2 receptor, EP4 receptor (EP4R), plays an important role in the development of transitional cell carcinoma of the upper urinary tract (TCC-UUT). However, the clinical significance of other EP receptors (EP1R-3R) is not clear. Furthermore, the pathological function of EP receptors in such patients is not understood. In the present study, we examined the expression of EP1R-3R in 101 TCC-UUT tissues by immunohistochemistry. Furthermore, we defined the relationship between cyclooxygenase (COX)-2 and EP receptor expression, proliferation index (PI), microvessel density (MVD), and expression of metalloproteinase-2 (MMP-2), urokinase-type plasminogen activator (uPA), and exon v6 containing CD44 isoform (CD44 v6) by multivariate analysis. The expression of EP1R, EP2R, and EP3R was positive in 20 (19.8%), 26 (25.7%), and 14 (13.9%) tumor samples, respectively. Expression of these receptors was not associated with pathological findings or survival. COX-2 and EP4R were independently associated with MVD and MMP-2, and uPA or PI and MMP-2, respectively. Other EP receptors were not influenced by any factors. Our results suggest that EP1R-3R play a minimal role in cancer progression in patients with TCC-UUT. On the other hand, EP4R regulates tumor progression via cancer cell proliferation and MMP-2, distinct from COX-2.

The prognostic value of p53, Ki‐67 and matrix metalloproteinases MMP‐2 and MMP‐9 in transitional cell carcinoma of the renal pelvis and ureter

To investigate the prognostic and predictive relevance of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 in patients with transitional cell carcinoma (TCC) of the upper urinary tract. The expression of p53 protein, Ki-67 antigen, MMP-2 and MMP-9 was examined by immunohistochemistry in 69 patients with TCC of the upper urinary tract. Correlation of p53, Ki-67, MMP-2 and MMP-9 over-expression with conventional pathological parameters and patient survival was examined. p53 over-expression was significantly correlated with histological grade (P < 0.05), but not with pathological stage, vascular invasion, lymphatic invasion or lymph node metastasis. Ki-67 over-expression was significantly correlated with stage, grade, lymphatic invasion and vascular invasion (P < 0.05). In survival analyses, Ki-67 over-expression was a significant prognostic factor in the univariate analysis (P < 0.05), but it did not have a significant impact on survival in the multivariate analysis. Ki-67 labeling index was a significant prognostic factor in patients with a low p53 labeling index, but not in patients with a high p53 labeling index. Ki-67 over-expression is of prognostic value in TCC of the upper urinary tract, while p53, MMP-2 and MMP-9 are of limited value.

EXPRESSION OF CYCLOOXYGENASE-2 AND EP4 RECEPTOR IN TRANSITIONAL CELL CARCINOMA OF THE UPPER URINARY TRACT

Prostaglandin E2, produced by cyclooxygenase (COX)-2, affects the behavior of tumor cells possibly through 1 of the prostaglandin E2 receptors, the EP4 receptor (EP4R). The relationship between tumor development and EP4R in transitional cell carcinoma of the upper urinary tract (TCC-UUT) has not been fully understood. We determined the relationships between clinicopathological features and prognosis with expressions of COX-2 and EP4R in nonmetastatic TCC-UUT. We examined expressions of COX-2 and EP4R by immunohistochemical technique in 101 patients. Histological features including tumor grade, pT stage and lymph node metastasis were examined using formalin fixed and paraffin embedded specimens from the radical operation. The predictive values of these expressions of prognosis were investigated by Kaplan-Meier curve and Cox proportional hazards analysis in multivariate model. Expression of COX-2 and EP4R was observed in 46 (45.5%) and 51 (50.5%) cases, respectively. Each expression was significantly associated with pT stage and grade. Patients with co-expression of these proteins had a higher frequency of extra-urinary tract recurrence (33.3%). Postoperative survival time of patients with co-expression of COX-2 and EP4R was significantly shorter than that of patients with other expression patterns (p <0.001). Although COX-2 or EP4R expression was not an independent factor for cause specific survival in a multivariate model, co-expression of these proteins was an independent one (odds ratio 12.26 and p = 0.0038). Co-expression of COX-2 and EP4R is a potentially useful marker for tumor progression and survival in patients with nonmetastatic TCC-UUT.

Microsatellite Instability in Urothelial Carcinoma of the Upper Urinary Tract

Transitional cell carcinoma (TCC) of the upper urinary tract (TCC-UUT) may develop with high frequency in patients with hereditary nonpolyposis colorectal cancer syndrome. Tumors in patients with this syndrome show genomic lesions in DNA mismatch repair genes that are detectable as microsatellite instability (MSI). Because little is known about genetic lesions in TCC-UUT compared with bladder TCC, we determined the genetic profiles (MSI and allelic loss) in a series of 26 upper urinary tract tumors using 5 informative microsatellite markers. A total of 26 paraffin embedded samples from 24 patients with clinically diagnosed TCC-UUT (renal pelvis and/or ureter) were tested for loss of heterozygosity (LOH) and MSI with the dinucleotide markers D9S171 (9p21) and D5S346 (5q22), and the mononucleotide repeats BAT25 (4q12), BAT26 (2p16) and BAT40 (1p13.1). MSI was detected at 1 or more microsatellite loci in 12 of the 26 tumors (46%). The markers BAT40, BAT25, BAT26, D9S171 and D5S346 showed instability in 7, 4, 4, 2 and 3 tumor samples, respectively. LOH at D9S171 was detected in 58% of the cases and 10 of the 14 tumors showing LOH were superficial. LOH at D5S346 occurred in 27% of the cases and it was a feature of invasive high grade TCC-UUT. Frequent LOH at D9S171 in TCC-UUT confirms that LOH at 9p21 is not only observed in bladder TCC, but rather in whole urinary tract TCC. Furthermore, our study indicates a high level of MSI in TCC-UUT, although it is a rare event in bladder cancer. The establishment of distinct genetic profiles between upper and lower urinary tract tumors could provide an additional tool to improve diagnosis, disease monitoring and prediction of prognosis.

Expression of survivin does not predict survival in patients with transitional cell carcinoma of the upper urinary tract.

The members of the IAP (inhibitors of apoptosis) family, which includes survivin, have recently emerged as modulators of an evolutionarily conserved step in apoptosis. Survivin is present during embryonic and fetal development, but it is downregulated in normal adult tissues. However, it becomes re-expressed in a variety of cancers. We investigated the prognostic importance of the expression of survivin in transitional cell carcinoma of the upper urinary tract (TCC-UUT). In 126 cases of TCC-UUT, we examined its expression (using immunohistochemistry), and also its relationship with the expressions of bcl-2 oncoprotein, p53 oncoprotein, and proliferating cell nuclear antigen (PCNA) immunoreactivity, clinicopathologic parameters, and clinical outcome. A positive expression of survivin was recognized in 12.7% of samples, a granular pattern being apparent within the cytoplasm of tumor cells. Survivin expression did not correlate with clinicopathologic findings, bcl-2 oncoprotein expression, p53 oncoprotein expression, PCNA index, or prognosis. In the normal urothelium, its expression was not detected. In conclusion, the expression of survivin does not predict prognosis in TCC-UUT.

Expression of Telomerase Catalytic Subunit (hTERT) mRNA Does Not Predict Survival in Patients with Transitional Cell Carcinoma of the Upper Urinary Tract

Telomerase is a ribonucleoprotein enzyme that synthesizes telomeric repeats onto chromosomal ends using a segment of its RNA component as a template. Its activity has become an established indicator of the diagnosis, biological behavior, and prognosis of several tumors. However, few studies have investigated the diagnostic and prognostic importance of the expression of telomerase catalytic subunit (hTERT) mRNA in transitional cell carcinoma of the upper urinary tract (TCC-UUT). We investigated the expression of hTERT mRNA using in situ hybridization in 125 cases of TCC-UUT, and also its relation with the expression of telomerase RNA component (hTERC), proliferating cell nuclear antigen (PCNA) immunoreactivity, clinicopathologic parameters, and clinical outcome. A positive expression of hTERT mRNA was recognized in 93.6% of the samples and was apparent within the cytoplasm of tumor cells. In the normal urothelium examined in a few cases, its expression was barely detected. hTERT mRNA scores showed a significant association with hTERC score. However, no relationship was found between the expression of hTERT mRNA and clinicopathologic findings, PCNA index, or prognosis. These results suggest that the expression of hTERT mRNA does not predict prognosis in TCC-UUT.

Expression of p27Kip1 Protein in Transitional Cell Carcinoma of the Upper Urinary Tract

The expression of p27Kip1, a negative regulator of the cell cycle, has been reported to correlate with the biological behavior and prognosis of several tumors. However, its prognostic importance in transitional cell carcinoma of the upper urinary tract (TCC-UUT) has not previously been investigated. We investigated p27Kip1 protein expression using immunohistochemistry in 132 cases of TCC-UUT and also its relation to proliferating cell nuclear antigen (PCNA) immunoreactivity, p53 oncoprotein immunoreactivity, clinicopathologic parameters, and clinical outcome. A positive expression of p27Kip1 protein was recognized in 94.7% of the samples and was apparent within tumor nuclei. In the normal urothelium, its expression was identified in all cell layers. A positive expression of p53 oncoprotein was recognized in 27.2% of the patients. The PCNA index was 7.4 to 93.1% (mean, 66.4%). Examination of the relationships between the expression of p27Kip1 protein and clinicopathologic findings, PCNA index, and the expression of p53 oncoprotein revealed that the expression of p27Kip1 protein decreased significantly with stage and grade. In a univariate analysis of disease-free and overall survival rates, no correlation was found between the expression of p27Kip1 protein and prognosis. The expression of p27Kip1 protein appears to be of little or no value in informing the prognosis in TCC-UUT.

Editorial Comment: Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter

Journal of EndourologyVol. 15, No. 4 Transitional-cell Carcinoma of the Renal PelvisEditorial Comment: Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal UreterFray F. MarshallFray F. MarshallSearch for more papers by this authorPublished Online:6 Jul 2004https://doi.org/10.1089/089277901300189411AboutSectionsPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Editorial Comment: Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter." , 15(4), p. 397FiguresReferencesRelatedDetailsCited ByLaparoscopic Approaches to Renal MalignanciesCurrent Problems in Cancer, Vol. 30, No. 4 Volume 15Issue 4May 2001 To cite this article:Fray F. Marshall.Editorial Comment: Retroperitoneal Laparoscopic Nephroureterectomy and Management Options for the Distal Ureter.Journal of Endourology.May 2001.397-397.http://doi.org/10.1089/089277901300189411Published in Volume: 15 Issue 4: July 6, 2004PDF download