EPITHELIAL DIFFERENTIATION ANTIGENS AND EPIDERMAL GROWTH-FACTOR RECEPTORS IN TRANSITIONAL-CELL BLADDER-CARCINOMA - CORRELATION WITH PROGNOSIS

Epithelial differentiation antigens have been correlated with morpholo gic differentiation of neoplastic urothelium. Moreover, epidermal grow th factor, which is a polypeptide regulating growth and differentiatio n of normal and neoplastic cells, is found in high concentrations in t he urine while its receptors (EGFR) have been identified in bladder tu mors. The aim of this study was to investigate the immunohistochemical expression of cytokeratin, epithelial membrane antigen (EMA), CEA and EGFR in transitional cell bladder carcinomas (TCC) and to define any correlation of their expression with tumor grade, stage and patient su rvival. Twenty-four biopsy specimens obtained from patients with TCC w ere studied retrospectively. There were 23 men and 1 woman with a mean follow-up of 64 months. Eight biopsy specimens, which represented tum or recurrences of 4 patients, were also included in our material. The immunohistochemical avidin-biotin complex method was performed on para ffin sections for the detection of cytokeratin and EGFR with monoclona l antibodies as well as CEA with a polyclonal antibody. Cytokeratin wa s detected in 83.5% of the TCC, EMA in 62% and CEA in 70%. The express ion of the epithelial differentiation antigens in TCCs was heterogenou s, showing an increased incidence in high-grade and high-stage TCC. Th e CEA expression in TCC demonstrated a statistically significant corre lation with patient survival (p < 0.02). EGFR was detected in 50% of t he TCC. Although not statistically significant, a trend was found for a higher percentage of EGFR detection in high-grade TCC. EGFR expressi on was significantly associated with tumor stage and patient survival (p < 0.01 and p < 0.04, respectively). In conclusion, EGFR and CEA exp ression is a property of biologically aggressive malignant urothelium. Studies on larger series are to be performed to define if these marke rs are prognostic indicators in bladder cancer patients.