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Predictive Value of Cell Cycle Markers p53, MDM2, p21, and Ki-67 in Superficial Bladder Tumor Recurrence
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE
Predictive Value of Cell Cycle Markers p53, MDM2, p21, and Ki-67 in Superficial Bladder Tumor Recurrence C. PFISTER, L. MOORE, P. ALLARD, H. LARUE, L. LACOMBE, B. TETU, F. MEYER Recherche en Cancerologie, Universite de Laval, Quebec, Canada
AND
Y. FRADET, Centre de
Clin Cancer Res, 5: 4079 – 4084, 1999 The aim of the study was to determine whether the expression of the cell cycle markers p53, MDM2, p21, and Ki-67 was predictive of superficial bladder cancer recurrence and to compare the relative predictive power for tumor recurrence of a cell cycle index based on the number of abnormally expressed cell cycle markers with a clinicopathological index based on primary clinical tumor characteristics. The expression of p53, MDM2, and p21 proteins and the value of the Ki-67 index were analyzed for 244 patients. One hundred ninety-four lesions were determined to be superficial papillary tumors (pTa), whereas 50 tumors invaded the lamina propria (pT1). Tumor grade was noted low (grade 1) in 83 cases and high (grades 2–3) in 161 cases. An avidin-biotin peroxidase method was performed using monoclonal antibodies against p53, MDM2, p21, and Ki-67 antigens after antigen retrieval treatment of formalin-fixed specimens. The cell cycle marker index was created using the number of abnormally expressed cell cycle markers according to the following cutoff points: p53 (⬎5%), MDM2 (⬎20%), p21 (⬍5%), and Ki-67 (⬎10%). The clinicopathological index was created using the following adverse tumor characteristics: grades G2–G3, stage pT1, multifocality, and diameter of tumors ⬎3 cm. Cox regression models were used to calculate the relative risks and their 95% confidence intervals associated with disease recurrence for the clinicopathological index and the cell cycle marker index. The chi2 test was performed to describe the correlation between the Ki-67 index and p53, MDM2, and p21 protein expression. Kaplan-Meier survival curves were generated to demonstrate the disease-free survival according to these two prognostic indexes. The clinicopathological index was a strong, independent predictor of disease recurrence where tumors with three or four adverse tumor characteristics at initial resection had over four times the risk of recurrence than tumors with no risk factors (P for trend ⫽ 0.0001). A strong correlation was observed between the Ki-67 index ⬎10% and both MDM2 and p21 proteins. MDM2 was overexpressed in 106 tumors (43%), and p53 was overexpressed in 47 (19%); Ki-67 was ⬎10% in 171 cases (70%). Thirty-nine tumors (16%) were p21 negative. The risk of recurrence increased slightly with the number of abnormally expressed cell cycle markers, but when the clinicopathological index was taken into account in multivariate analysis, the cell cycle marker index was not predictive of disease recurrence (P for trend ⫽ 0.72). The cell cycle markers studied provided no added prognostic information on disease recurrence after initial resection of papillary superficial tumors when the clinicopathological parameters were taken into account. Editorial Comment: This study of abnormal expression of cell cycle markers for Ta and T1 bladder cancers showed association with clinical pathological features known to predict tumor recurrence but no added value in a multivariate analysis. Such data emphasize the rich predictive value of grade 2 to 3, T1 stage, multifocality and diameter greater than 3 cm, factors that are readily available to all clinicians. James E. Montie, M.D.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE Laparoscopic Radical Cystectomy With Continent Urinary Diversion (Rectosigmoid Pouch) Performed Completely Intracorporeally: An Intermediate Functional and Oncologic Analysis S. DEGER, R. PETERS, J. ROIGAS, A. H. WILLE, I. A. TUERK AND S. A. LOENING, Department of Urology, Charite-Campus Mitte, Charite´ University Medicine, Berlin, Germany, and Department of Urology, Lahey Clinic, Burlington, Massachusetts Urology, 64: 935–939, 2004 Objectives. To present our experience with the first series of rectosigmoid pouch creation performed completely laparoscopically for continent urinary diversion after radical cystectomy to treat transitional cell carcinoma of the bladder. We evaluated the intermediate functional and oncologic outcomes. Methods. Between April 2000 and January 2004, 20 patients underwent laparoscopic radical cystectomy with urinary diversion for transitional cell carcinoma at the Department of Urology, Charite´ Hospital, Campus Mitte. Of the 20 patients, 12 received a rectosigmoid pouch for urinary diversion. The procedures were performed completely laparoscopically, including free-hand laparoscopic suturing and in situ knot tying techniques. The mobilized specimens were removed in an endoscopy bag by way of the rectum or vagina.
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Predictive Value of Cell Cycle Markers p53, MDM2, p21, and Ki-67 in Superficial Bladder Tumor Recurrence C. PFISTER, L. MOORE, P. ALLARD, H. LARUE, L. LACOMBE, B. TETU, F. MEYER Recherche en Cancerologie, Universite de Laval, Quebec, Canada
AND
Y. FRADET, Centre de
Clin Cancer Res, 5: 4079 – 4084, 1999 The aim of the study was to determine whether the expression of the cell cycle markers p53, MDM2, p21, and Ki-67 was predictive of superficial bladder cancer recurrence and to compare the relative predictive power for tumor recurrence of a cell cycle index based on the number of abnormally expressed cell cycle markers with a clinicopathological index based on primary clinical tumor characteristics. The expression of p53, MDM2, and p21 proteins and the value of the Ki-67 index were analyzed for 244 patients. One hundred ninety-four lesions were determined to be superficial papillary tumors (pTa), whereas 50 tumors invaded the lamina propria (pT1). Tumor grade was noted low (grade 1) in 83 cases and high (grades 2–3) in 161 cases. An avidin-biotin peroxidase method was performed using monoclonal antibodies against p53, MDM2, p21, and Ki-67 antigens after antigen retrieval treatment of formalin-fixed specimens. The cell cycle marker index was created using the number of abnormally expressed cell cycle markers according to the following cutoff points: p53 (⬎5%), MDM2 (⬎20%), p21 (⬍5%), and Ki-67 (⬎10%). The clinicopathological index was created using the following adverse tumor characteristics: grades G2–G3, stage pT1, multifocality, and diameter of tumors ⬎3 cm. Cox regression models were used to calculate the relative risks and their 95% confidence intervals associated with disease recurrence for the clinicopathological index and the cell cycle marker index. The chi2 test was performed to describe the correlation between the Ki-67 index and p53, MDM2, and p21 protein expression. Kaplan-Meier survival curves were generated to demonstrate the disease-free survival according to these two prognostic indexes. The clinicopathological index was a strong, independent predictor of disease recurrence where tumors with three or four adverse tumor characteristics at initial resection had over four times the risk of recurrence than tumors with no risk factors (P for trend ⫽ 0.0001). A strong correlation was observed between the Ki-67 index ⬎10% and both MDM2 and p21 proteins. MDM2 was overexpressed in 106 tumors (43%), and p53 was overexpressed in 47 (19%); Ki-67 was ⬎10% in 171 cases (70%). Thirty-nine tumors (16%) were p21 negative. The risk of recurrence increased slightly with the number of abnormally expressed cell cycle markers, but when the clinicopathological index was taken into account in multivariate analysis, the cell cycle marker index was not predictive of disease recurrence (P for trend ⫽ 0.72). The cell cycle markers studied provided no added prognostic information on disease recurrence after initial resection of papillary superficial tumors when the clinicopathological parameters were taken into account. Editorial Comment: This study of abnormal expression of cell cycle markers for Ta and T1 bladder cancers showed association with clinical pathological features known to predict tumor recurrence but no added value in a multivariate analysis. Such data emphasize the rich predictive value of grade 2 to 3, T1 stage, multifocality and diameter greater than 3 cm, factors that are readily available to all clinicians. James E. Montie, M.D.
DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE Laparoscopic Radical Cystectomy With Continent Urinary Diversion (Rectosigmoid Pouch) Performed Completely Intracorporeally: An Intermediate Functional and Oncologic Analysis S. DEGER, R. PETERS, J. ROIGAS, A. H. WILLE, I. A. TUERK AND S. A. LOENING, Department of Urology, Charite-Campus Mitte, Charite´ University Medicine, Berlin, Germany, and Department of Urology, Lahey Clinic, Burlington, Massachusetts Urology, 64: 935–939, 2004 Objectives. To present our experience with the first series of rectosigmoid pouch creation performed completely laparoscopically for continent urinary diversion after radical cystectomy to treat transitional cell carcinoma of the bladder. We evaluated the intermediate functional and oncologic outcomes. Methods. Between April 2000 and January 2004, 20 patients underwent laparoscopic radical cystectomy with urinary diversion for transitional cell carcinoma at the Department of Urology, Charite´ Hospital, Campus Mitte. Of the 20 patients, 12 received a rectosigmoid pouch for urinary diversion. The procedures were performed completely laparoscopically, including free-hand laparoscopic suturing and in situ knot tying techniques. The mobilized specimens were removed in an endoscopy bag by way of the rectum or vagina.
487