[The proliferating nuclear fraction as a prognostic factor in superficial bladder carcinomas]. / Estudio de la fracción proliferativa nuclear como factor pronóstico en los carcinomas de vejiga superficiales.

OBJECTIVE: Low grade, low stage superficial bladder tumors have, in general, a good prognosis; however, some of these tumors progress and behave more aggressively, displaying a high incidence of recurrence and rapid transformation into a higher grade of malignancy with deep invasion of the bladder wall. Numerous studies have been conducted on markers which help to predict this transformation. METHODS: The expression of the anti-proliferating cell nuclear antigen (PCNA) was examined in bladder specimens from 72 patients with superficial transitional cell carcinoma utilizing the PC10 monoclonal antibody. We have compared expression of PCNA with other markers. The cases were divided into three groups: group A comprised patients with good clinical behaviour; group B comprised patients who developed recurrences of the same histological grade and group C comprised patients with superficial TCC who developed muscle wall invasion within 2 years. RESULTS/CONCLUSIONS: Our results demonstrate that the monoclonal antibody PC10 is an excellent marker for the aggressive, low stage and low grade superficial bladder tumours and can distinguish these from those which have a good clinical behaviour.

[Prognostic markers in transitional carcinoma of the bladder]. / Marcadores pronósticos en el carcinoma transicional de vejiga.

Due to the diversity of the biologic behaviour of the low-grade and low-stage superficial bladder carcinomas, particularly those that present a high recurrence rate, most of the research has been oriented towards finding prognostic markers of recurrence and future invasion of the tumor. Among these markers there are two that have demonstrated their usefulness: the study of the contents of the cellular DNA by flow cytometry and the study of blood group antigens. The latter are carbohydrate structures that form a complex, genetically-regulated signal code which intervenes in the cellular growth and maturation processes. Recently published works describing genetic alterations in transitional bladder carcinomas, oncogenic mutations, loss of the 9q chromosome that regulates the formation of A and B antigens, support the hypothesis that in neoplastic transformation processes, genetic alterations cause enzymatic deficiencies and disorders, and these produce several antigenic changes of the cellular membrane and thus interfere in the biologic behaviour of the malignant cell.

Blood group isoantigens ABO (H) in transitional carcinoma of the bladder: a clinicopathological study.

Blood group A, B and H antigens were investigated in 183 paraffin embedded biopsies from 58 patients with transitional cell carcinoma of the urinary bladder, by a modified specific red cell adherence test, direct immunofluorescence with Ulex Europeus lectin and indirect immunoperoxidase method with monoclonal antibodies against blood group antigens. The results were correlated with pathological grade and stage and with the clinical course of patients evaluating the recurrence index and clinical state. Histological findings were roughly correlated with the expression of red cell tissue antigens but not with the presence of precursor H substance in biopsies from patients of blood group A or B, in which a higher proportion of H positive results was appreciated. The clinical course was also related to the presence or absence of blood group antigens in referential biopsies: 90 per cent of negative biopsies corresponded to patients who had high recurrence index whereas 75 per cent of positive biopsies corresponded to patients who had low recurrence index or did not have recurrence for five years; 25 per cent of recurrences observed in patients with referential positive biopsy were invasive whereas the proportion of invasive tumor in recurrence from negative biopsies rises to 73 per cent. In addition, all the final biopsies from patients who died of bladder tumor were negative for blood group antigens. The diagnostic and prognostic significance of these tissue antigens in transitional cell carcinoma of the urinary bladder is discussed, and we conclude that the analysis of blood group antigens in bladder biopsies by established techniques is a useful tool in clinical pathology for the screening and followup of bladder tumors, as previously suggested.