OVEREXPRESSION OF P53 PROTEIN IN A HIGH-RISK POPULATION OF PATIENTS WITH SUPERFICIAL BLADDER-CANCER BEFORE AND AFTER BACILLUS-CALMETTE-GUERIN THERAPY - CORRELATION TO CLINICAL OUTCOME

Purpose: We have previously demonstrated that p53 overexpression is pr edictive of disease progression and survival in Ta, Tis, and T1 tumors . instillation of Bacillus Calmette-Guerin (BCG) is now accepted to be the most efficient adjuvant therapy far superficial bladder carcinoma . The aim of this study was to determine if p53 status, assessed befor e and after intravesical BCG therapy, can predict clinical outcome in a high-risk population of patients with superficial bladder carcinoma. Materials and Methods: We examined 196 tissue specimens from 98 patie nts, obtained immediately before and after intravesical BCG therapy, T he pretherapy population was composed of 22 To, 57 Tis, and 19 T1 tumo rs. After BCG, 66 specimens were T0 and 32 had residual turners, Nucle ar p53 overexpression was analyzed in relation to time to disease prog ression and disease-specific survival. Results: The median follow-up d uration was 44 months. The detection of nuclear p53 overexpression bef ore BCG therapy did not predict response to BCG therapy, Pre-BCG p53 p rotein overexpression, response to BCG therapy, and pre-BCG stage were ail independent markers of disease progression, In patients with resi dual disease after BCG therapy (nonresponders), multivariate analysis confirmed that posttherapy p53 overexpression was the only independent marker of disease progression. Conclusion: In this high-risk populati on of patients with superficial bladder tumors, patients who have p53 nuclear overexpression in the tumor and stage T1 disease before BCG th erapy are at high risk of disease progression, Furthermore, in the gro up of patients with residual disease after BCG therapy, p53 status is a better predictor of disease progression than post-BCG stage.