Predictive Value Of TERT Expression In High Risk Superficial Bladder Cancer Patients Treated With Adjuvant BCG Immunotherapy

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 30 Mar 2009 - 3:00 PDT

email to a friend   printer friendly   opinions  

UroToday.com - Development of new molecular prognostic markers is critical in non-muscle invasive bladder cancer. hTERT activity has been shown to provide prognostic and predictive information in a variety of epithelial neoplasms. Telomerase is a ribonucleoprotein reverse transcriptase that elongates telomeres. As cells age. the telomeres get shorter, except in cancer cells when the telomeres are elongated without regulation due to overexpression of the telomerase gene either at the DNA, RNA or protein level.

These authors prospectively evaluated expression of telomerase reverse transcriptase (hTERT) in patients with high-grade non-muscle invasive bladder cancer who were receiving BCG intravesical therapy to determine if the test could predict BCG response. Thirty patients with high-grade T1 tumors were evaluated. Pre-BCG TURBT and post-BCG specimens were analyzed for hTERT nucleolar expression by immunohistochemistry. Virutally all bladder tumors and none of the normal bladder mucosa had hTERT expression. Post-BCG hTERT expression was statistically significantly lower than pre-BCG hTERT expression. Pre-BCG hTERT nucleolar staining in more than 75% of cells was associated with worse recurrence free survival (9 months vs. not yet reached, P = 0.05), while post-BCG hTERT nucleolar staining in more than 50% of the cells was associated with worse recurrence free survival (6 months vs. not yet reached, P = 0.001) and development of invasive disease. In multivariate analysis, post-BCG hTERT expression was independently associated with RFS and development of invasive disease.

The authors conclude that immunohistochemical evaluation of hTERT may help define a subset of high-risk SBC patients that will eventually fail BCG and may therefore benefit from early salvage cystectomy. This work will need to be duplicated in a larger series of patients to validate the predictive ability of hTERT in non-muscle invasive bladder cancer.

Zachos I, Konstantinopoulos PA, Vandoros GP, Karamouzis MV, Papatsoris AG, Podimatas T, Papachristodoulou A, Chrisofos M, Deliveliotis C, Papavassiliou AG
J Cancer Res Clin Oncol. 2009 Feb 12. (Epub ahead of print)
10.1007/s00432-009-0557-9

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

UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice.

To access the latest urology news releases from UroToday, go to: www.urotoday.com

Copyright © 2009 - UroToday

• Additional
• References
• Citations