A prospective pilot evaluation of urinary and immunohistochemical markers as predictors of clinical stage of urothelial carcinoma of the bladder

Objective To determine, in patients newly diagnosed with bladder cancer, wh ether p53, epidermal growth factor receptor (EGFR), microvessel density (MV D), urinary bladder tumour antigen (BTA TRAK(TM), Bion Diagnostic Sciences, Redmond, WA) and cytology were predictive of clinical stage, evaluated as a function of the clinical stage obtained at transurethral resection of the bladder tumour with and without the addition of clinical grade, a known st rong predictor of clinical stage. Patients and methods Between December 1997 and September 1998, 22 men and s even women with a cystoscopic diagnosis of urothelial bladder carcinoma wer e prospectively enrolled in the study. Urine was collected for cytological and BTA TRAK evaluation before transurethral resection, Tumour grade and cl inical stage were obtained from the transurethral resection specimen, MVD w as evaluated by computerized calculations of 'optimal MVD' (OMVD) and 'area -weighted MVD' (AWMVD) while p53 and EGFR information was obtained by manua l immunohistochemical techniques; 21 patients had sufficient tissue for all immunohistochemical assessments and comprised the study group. Univariate and multivariate comparisons were carried out to determine the contribution of each variable to the prediction of clinical stage. Results Although there was a trend, cytological analysis and p53 and MVD im munoreactivity did not significantly correlate with clinical stage, while t umour grade, BTA TRAK and EGFR immunoreactivity did. In a univariate analys is, tumour grade and BTA TRAK were related to clinical stage. In a multivar iate analysis, grade was the single best predictor of clinical stage. This analysis also showed that the addition of BTA TRAK and MVD information to g rade incrementally improved the predictive ability of grade. Conclusions This pilot study suggests that BTA TRAK and MVD contribute incr emental information to tumour grade in predicting the clinical stage of uro thelial carcinomas of the bladder; grade remains the most important predict or. These results suggest that further work with BTA TRAK and MVD in more p atients and on biopsy material obtained during clinic cystoscopy is warrant ed for the future development of less invasive methods of identifying patie nts with invasive bladder cancer.