CLINICAL PREDICTIVE VALUE OF P53 AND C-ERBB-2 OVEREXPRESSION IN 54 PATIENTS WITH TRANSITIONAL-CELL CARCINOMA (TCC) OF THE URINARY-BLADDER

Various reports reveal that mutations of the p53 tumor suppressor gene and of the c-erbB-2 proto-oncogene occur in Transitional Cell Carcino mas (TCC) of the bladder, and that they correlate with the established prognostic factors (particularly tumor grading and stage), suggesting their possible clinical use in defining patients prognosis. The aim o f this study was to confirm the hypothesis that altered expression pat terns of the p53 tumor suppressor gene and of the c-erbB-2 oncogene ar e associated with disease progression and clinical outcome in bladder TCSS. We examined tissue specimens from surgical resection in 54 patie nts with primary TCCs of the bladder. Nuclear overexpression of p53 an d membrane staining of c-erbB-2 were evaluated by immunohistochemical analysis and the results were correlated with the following parameters : patient age, tumor grading and stage, nodal status, vascular and lym phatic invasion. In our study p53 overexpression was more frequent in invasive (pT2-pT3-pT4) than in superficial (pTa-pT1) tumors, and there were significantly more p53 positive cases in G3 than in G1-G2 cancer s. A weaker association was observed for lymphatic and venous invasion . C-erbB-2 overexpression showed a weak correlation with tumor grading , stage, nodal status, lymphatic and venous invasion. In univariate su rvival analysis, p53 overexpression was significantly correlated with poor outcome (p=0.0000), while c-erbB-2 showed a much weaker relations hip with patient survival distribution (p=0,039). In multivariate anal ysis, c-erbB-2 overexpression showed no prognostic value, while p53 sh owed a high prognostic value with respect to the fundamental clinico-p athological parameters. Our results confirm that p53 immunoreactivity may be of clinical use to define bladder TCC patients subgroups of dif ferent prognosis; on the contrary, c-erbB-2 seems to be less valuable in defining patient outcome.