PROGNOSTIC FACTORS IN MUSCLE-INVASIVE BLADDER-CANCER TREATED WITH RADIOTHERAPY - AN IMMUNOHISTOCHEMICAL STUDY

Objective To determine the prognostic role of p53, Ki-67 and p21 for p atients with muscle-invasive bladder cancer treated with curative inte nt by radiotherapy. Patients and methods The study included 131 patien ts (24 women and 107 men, median age 72 years, range 40-86) with trans itional cell carcinoma (T2-T4) treated with external definitive pelvic radiotherapy between 1985 and 1994. Paraffin-embedded pretreatment bi opsies from the patients were examined for the presence of p53, p21 an d Ki-67, detected by immunohistochemistry, and related to tumour stage , grade and patient survival. Results The expression of p53 protein co rrelated positively with the detection of Ki-67 (P<0.05) but did not c orrelate with p21. None of the immunohistochemical variables (p53, p21 or Ki-67) correlated with T category and only Ki-67 correlated with h istological grade. Patients with >5% p21 expression tended to live lon ger than these with <5% (P=0.09). In a multivariate analysis, the T ca tegory (T2/T3 vs. T4), histological grade (2 vs. 3) and p21 expression (less than or equal to 5% vs. >5%) were independent prognostic factor s for overall survival. Conclusion Further investigation is warranted in patients with muscle-invasive bladder cancer undergoing different t ypes of treatment. p21 seems to play an independent prognostic role in these patients, in addition to T category and grade.