P53 OVEREXPRESSION AS A PROGNOSTIC FACTOR FOR ADVANCED-STAGE BLADDER-CANCER

Overexpression of the TP53 gene protein detected by immunohistochemist ry appears to identify those patients with superficial bladder cancer at risk of the development of muscle invasive or metastatic disease. H owever, the role of p53 overexpression in patients with advanced or me tastatic bladder cancer is not yet well established. In the present st udy, 44 specimens from 44 patients with advanced stage bladder tumours (T-2-T-4) undergoing radical cystectomy were investigated for differe nt biological and clinical characteristics as possible prognostic fact ors: sex, age, depth of tumour infiltration, T-stage, histological gra de, lymph node status, application of adjuvant systemic chemotherapy ( MVAC), proliferative activity (staining for proliferating cell nuclear antigen (PCNA) by monoclonal antibody (PC10) as well as overexpressio n of the p53 oncoprotein (monoclonal antibody pAb 1801)). After a medi an follow-up of 22 months, 16 of the 23 patients (70%) with more than 40% of tumour cells stained positively for p53 (Group B) died from tum our progression compared with 7 of the 21 patients (33%) with less tha n 40% of tumour cells positive for p53. During univariate analysis, p5 3 overexpression (P = 0.008), staining for PCNA (greater than or equal to 80% of cells positive) (P = 0.01) and tumour stage (P = 0.01) were significant prognostic factors for survival, among which p53 overexpr ession (P = 0.023) as well as T-stage (P = 0.012) remained independent significant predictors during multivariate analysis. Prospective stud ies are needed to confirm the independent prognostic potential of p53 overexpression in patients with advanced bladder cancer. The availabil ity of more refined prognostic factors should assist decision making r egarding the value of more aggressive treatment options, such as adjuv ant or neoadjuvant chemotherapy, for prognostically defined subgroups of patients.