Epidermal growth factor receptor status predicts local response to radical radiotherapy in muscle-invasive bladder cancer.

AIMS: Epidermal growth factor receptor (EGFR) is expressed by over 70% of muscle-invasive bladder tumours and is associated with diminished overall survival. In model tumour systems, ionising radiation has been shown to activate EGFR, leading to cellular proliferation and is therefore a possible mechanism of underlying radioresistance. We carried out an immunohistochemical study relating the clinical outcome of patients receiving radical radiotherapy for muscle-invasive bladder cancer to tumour EGFR status. MATERIALS AND METHODS: Archived paraffin-embedded tumours from 110 consecutive patients receiving radical radiotherapy for muscle-invasive bladder cancer between 1991 and 1997 were immunohistochemically stained for EGFR. Data were collected concerning the tumour stage and grade, the presence of ureteric obstruction, the response to radiotherapy at 3 months, local recurrence rates, metastatic spread and survival. Multivariate analysis of potential independent prognostic factors of impaired bladder cancer-specific survival was carried out using Cox's regression. RESULTS: Of 110 tumours, 79 (72%) stained positively for EGFR. Of 87 patients undergoing the 3-month check cystoscopy, 60 (69%) had a positive response to radiotherapy. A positive response to radiotherapy correlated significantly with a negative EGFR status (chi(2) test, P = 0.05). Kaplan-Meier survival analysis revealed a trend towards improved bladder cancer-specific survival in EGFR-negative patients (Log-rank, P = 0.10). A lack of response to radiotherapy at 3 months, local recurrence, metastatic spread and the presence of ureteric obstruction were all independent prognostic factors for diminished bladder cancer-specific survival (Cox's regression: P = 0.009, P = 0.001, P = 0.04 and P = 0.005, respectively). CONCLUSIONS: EGFR status predicts the local response to radiotherapy but does not provide prognostic utility in relation to overall or bladder cancer-specific survival. As EGFR status seems to be linked to the initial response to radiotherapy, its inhibition may be a means of enhancing the radio-responsiveness of these poor prognosis tumours. Colquhoun, A. J.

erbB receptor expression patterns in human bladder cancer.

OBJECTIVES: To investigate expression patterns of erbB receptors in a panel of 58 human bladder tumors. Aberrant functional and structural interactions of erbB type I receptor tyrosine kinase cell surface receptors are important in the development and maintenance of the malignant phenotype. Few studies have focused on the remaining family members or patterns of receptor coexpression in urothelial cancer. METHODS: Frozen tumor samples from 58 patients with newly diagnosed bladder cancer were collected; 18 had Stage Ta, 20 Stage T1, and 20 had Stage T2 or worse. The grade was G1 in 5, G2 in 24, and G3 in 29 patients. Seven normal urothelial samples were obtained from patients with benign urologic conditions. The tumor material was probed using conventional immunoblotting and enhanced chemiluminescence. The blots were captured with digital imaging, and protein expression was quantified with gel analysis software. RESULTS: Most tumors exhibited detectable expression of at least one erbB receptor. Examples of coexpression of epidermal growth factor receptor (EGFr) and erbB-2 were also found. Detectable erbB-3 or erbB-4 protein expression was lacking in this series. Compared with other tumors, the T1 samples exhibited the greatest mean levels of erbB-2 protein expression (P = 0.0028). Of the 58 tumors, 10 (17.2%) coexpressed EGFr and erbB-2; this was associated with T1 disease (P = 0.03). CONCLUSIONS: Varied levels of expression of both EGFr and erbB-2 appear to exist in human bladder cancer. These preliminary data do not support erbB-3/4 as major protagonists in this tumor system. The observations presented suggest a role for EGFr and erbB-2 in the development and progression of bladder cancer that should be explored further.

Prognostic significance of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1 in voided urine samples from patients with transitional cell carcinoma of the bladder.

PURPOSE: To study the role of urinary matrix metalloproteinase-1 (MMP-1) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in bladder cancer and their relationship to tumor progression. EXPERIMENTAL DESIGN: MMP-1 and TIMP-1 were measured by ELISA in urine samples from 131 patients with bladder tumors (7 cis, 74 Ta, 29 T1, and 21 T2-T4; 46 G(1), 41 G(2), and 37 G(3)), 5 patients with prostate cancer, 33 patients with benign lower urinary tract disorders, and 36 healthy volunteers. Complete clinical data were available for 100 patients with bladder cancer with a median follow-up time of 24 months (range: 4-39 months). RESULTS: MMP-1 was detected in urine samples from 21 of 131 (16%) patients with bladder cancer but was undetectable in samples from all other groups (P < 0.0001). Urinary MMP-1 was detected in a higher percentage of patients with T2-T4 tumors and G(3) tumors than patients with cis/Ta/T1 or G(1)-G(2) tumors (P = 0.04 and P = 0.0074, respectively). Patients with detectable concentrations of urinary MMP-1 had higher rates of disease progression (P = 0.04) and death from bladder cancer (P = 0.02) than patients with undetectable urinary MMP-1. All patient groups had higher urinary TIMP-1 concentrations than healthy volunteers (P = 0.02). Patients with muscle-invasive tumors had higher concentrations of urinary TIMP-1 than patients with cis/Ta/T1 tumors (P = 0.037), but there was no association between TIMP-1 and tumor grade. Urinary TIMP-1 levels strongly correlated with tumor size (P = 0.0002). Progression-free survival rates were lower for patients with urinary TIMP-1 concentrations above the median (1.8 ng/ml, P = 0.04), but urinary TIMP-1 levels were not related to disease-specific survival. Patients with T2-T4 tumors and G(3) tumors had significantly lower urinary MMP-1:TIMP-1 ratios than patients with Ta/T1 bladder tumors (P = 0.039) or G(1)-G(2) tumors (P = 0.0415). CONCLUSIONS: Where urinary MMP-1 is detectable, the patient is more likely to have a bladder tumor of advanced stage or grade and may be at increased risk of disease progression and death of bladder cancer. The relationship between urinary TIMP-1, muscle-invasion, and disease progression in bladder cancer is at variance with its role as an inhibitor of MMPs and warrants additional evaluation.

Caveolin-1 expression is associated with high-grade bladder cancer.

OBJECTIVES: To assess the levels of caveolin-1 in a series of bladder tumor specimens of varying stage and grade and to identify possible links between caveolin-1 status and clinical behavior. Caveolae have emerged as sites of important regulatory events at the cell membrane in many different cell types. Caveolins are the main structural components of caveolae and belong to a family of highly conserved integral membrane proteins. The function of caveolin-1 appears to be intrinsically linked to cell signaling modulation by multiple pathways. Modification of CAV-1 gene expression appears to be a common feature of the oncogenically transformed phenotype. METHODS: Using a rabbit polyclonal antibody against caveolin-1 and immunohistochemistry, we assessed caveolin-1 protein expression in 89 formalin-fixed, paraffin-embedded bladder tumor sections. The patient group studied included 71 men and 18 women (mean age +/- SD 69.7 +/- 10.9 years). The stage was Ta-T1 in 68 and T2-T4 in 21 tumors in this series. The clinical follow-up was 1 to 38 months (mean 21.2 +/- 9.9). RESULTS: A statistically significant association was observed between caveolin-1 immunoreactivity and tumor grade (P = 0.0118, chi-square test), with 8 (21%) of 38 G3, 1 (3%) of 30 G2, and 0 of 21 G1 tumors positive for caveolin-1. When the clinical data were examined in conjunction with caveolin-1 status, no statistically significant relationship was seen between caveolin-1 expression and tumor multiplicity, tumor recurrence, tumor progression, or patient survival. CONCLUSIONS: The results of our study demonstrate that altered expression of caveolin-1 protein is a component of tumor dedifferentiation in a subset of high-grade bladder cancers. This pilot study provides a basis for further investigation of the role of caveolin-1 and the function of caveolae in the most aggressive forms of this tumor.