Retinoblastoma protein expression predicts response to bacillus Calmette-Guérin immunotherapy in patients with T1G3 bladder cancer.

OBJECTIVES: Bacillus Calmette-Guérin (BCG) immunotherapy is regarded as the current treatment of choice for stage T1 grade 3 (T1G3) bladder cancer (BC), though its efficacy is limited by high recurrence and progression rate. Identification of molecular prognosticators that might be helpful in discriminating between responders and nonresponders to BCG treatment is therefore of major clinical importance; thus we focused on the cell-cycle related retinoblastoma protein (pRB), which had been already investigated in bladder cancer. The goal of our study was specifically to address whether its expression predicts the outcomes of BCG treatment for patients with T1G3 disease. MATERIALS AND METHODS: To address this issue, paraffin-embedded specimens of 27 patients having undergone transurethral resection of T1G3 BC and intravesical instillations of BCG (induction + 1 year maintenance) were immunostained with pRB monoclonal antibody. Patients in whom the bladder muscle was not clearly visible, and healthy, as well as patients with TaG3 tumors or with concomitant carcinoma in situ were excluded. Mean follow-up was 60 months (range 15-135). RESULTS: Thirteen tumors showed normal (1% to 50% labeling index) while 14 showed altered pRB expression, consisting of no expression (0% labeling index) in six and overexpression (>50% labeling index) in eight. Recurrence occurred in 10 (37%) patients and mean time to recurrence was 22.8 months (range 6-48). Recurrence rate was 57% in patients with altered and 15% in those with normal pRB expression, with a statistically significant difference in disease-free survival (P = 0.037). Progression occurred in five (18.5%) patients and mean time to progression was 24 months (range 6-48). Progression rate was 36% in patients with altered and 0% in patients with normal pRB expression, with a statistically significant difference in progression-free survival (P = 0.018). CONCLUSIONS: In this homogeneous population of T1G3 bladder tumors, altered pRB expression predicted recurrence and progression after BCG treatment. These findings outline the potential role of pRB immunostaining in predicting T1G3 BC response to BCG immunotherapy.

Altered p53 and pRb expression is predictive of response to BCG treatment in T1G3 bladder cancer.

BACKGROUND: The aim of this study was to determine the prognostic value of p53 and retinoblastoma protein (pRb) expression in patients with stage T1 grade 3 (T1G3) bladder cancer (BC) treated by transurethral resection of bladder tumour (TURBT) and intravesical instillations of bacillus Calmette-Guerin (BCG). MATERIALS AND METHODS: p53 and pRb expression were independently recorded within a homogeneous series of 27 patients. Fisher exact test and the log-rank test were carried out, along with Kaplan-Meier survival analysis. RESULTS: Sixteen tumours showed altered p53 expression, while 14 showed altered pRb expression. Overall, 7 tumours showed normal expression of both markers, 10 altered expression of one of the two markers, and 10 altered expression of both markers. Only altered pRb expression was an independent predictor of both recurrence (p=0.037) and progression (p=0.018); altered expression of both markers was a strong predictor (p=0.001) of progression. CONCLUSION: This is the first study demonstrating that altered p53 and pRb expression are predictive of T1G3 BC response to BCG treatment. These findings provide grounds for inclusion and prospective validation of these markers in the decision-making process for treating BC.

Endoscopic treatment of a large leiomyoma of the bladder.

Leiomyoma is a benign neoplasm rarely found in the bladder. We present a case of a large leiomyoma of the bladder treated successfully by endoscopic transurethral resection.