Multi-Institutional Evaluation Of The Predictive Value Of P53 Immunohistochemical Staining In Patients With PT1-2 No Disease At Radical Cystectomy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Conferences;  Clinical Trials / Drug Trials
Article Date: 09 Jun 2008 - 3:00 PST

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ORLANDO, FL (UroToday.com) - The authors tested whether p53 expression could predict disease recurrence and disease-specific survival after radical cystectomy in patients with pT1-2N0M0 urothelial carcinoma of the bladder (UCB). They evaluated 272 patients from five centers who had pT1-2N0M0 bladder cancer treated with radical cystectomy and bilateral lymphadenectomy (median follow-up: 5 and 12 years, respectively). None of the patients received neoadjuvant or adjuvant chemotherapy.

Overall, 33.5% of patients had altered expression of p53 (p53alt) and 18% died of bladder cancer. In multivariate analyses, patients with p53alt tumors had a significantly increased hazard ratio for both disease recurrence (4.88; p<0.001) and cancer-specific mortality (4.91, p<0.001).p53 status and lymph vascular invasion were both predictive of disease recurrence and cancer-specific mortality after adjusting for other risk factors. Addition of p53 increased the predictive ability of models based on age, gender, pT1 vs pT2 stage, tumor grade, lympho-vascular invasion, number of lymph nodes removed, and concomitant carcinoma in situ for disease recurrence and cancer-specific mortality by 9.2% (60.8% versus 70.0%, p<0.001) and 9.5% (63.4% versus 72.9, p<0.001), respectively. 60% of the p53alt patients were free of disease at 5 years compared to 15% of the p53 normal patients.

The authors concluded that assessment of p53 in bladder cancer specimens improves the prediction of disease recurrence and survival in patients with pT1-2N0M0 disease treated by radical cystectomy. These findings suggest that evaluation of p53 could help identify patients who may benefit from adjuvant treatment after radical cystectomy.

Presented by Shahrokh F Shariat, et.al., MD at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor David P. Wood, MD

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