80% of patients with transitional cell carcinoma of the urinary bladder are initially diagnosed with superficial disease (Ta, Tl). Following transurethral resection, 70-80% of these patients develop recurrent disease within 6-12 months. At this time 10-20% will already have developed muscle-invasive tumors or metastatic disease. In contrast, the other 50-60% of patients will suffer recurrences of superficial bladder cancer without the development of muscle-invasive tumors. This observation indicates the existence of bladder cancer with variable biological characteristics. Multiple studies have tried to determine prognostic parameters for superficially growing and muscle-invasive bladder tumors, in order to use therapeutic strategies adjusted for the prognosis of the individual patient. However, the majority of these factors, eg. S phase fraction, mitotic index, expression of blood group antigens or unmasking of the Thomsen-Friedenreich antigen, did not provide prognostic information superior to classical parameters such as tumor (T) stage and histological grade (G). The use of cytogenetic and moleculargenetic techniques seems to achieve a better prognostic value and may permit a satisfactory prediction of the prognosis of the individual patient. The p53 tumor suppressor gene is located on chromosome #17p at 13.1. For a variety of human malignancies a correlation between inactivation of the p53 gene and the clinical course of the disease has been demonstrated. Recent studies have demonstrated that alterations of p53 in superficial bladder cancer will lead to a 60-85% likelihood for the development of muscle-invasive tumors, while the likelihood for p53-negative tumors will be less than 10%. A similarly important predictive value of p53 alterations also seems to exist for locally advanced bladder cancer with respect to overall survival of the patients. The results may serve as a molecular basis for therapeutic decision, such as early radical cystectomy or adjuvant chemotherapy for high-risk patients. Prospective studies will need to incorporate prognostic factors at the molecular level.

Keywords:
Bladder cancer, –superficial, –muscle-invasive, Prognostic factors, Genetic markers, p53 tumor suppressor gene
This content is only available via PDF.
© 1995 S. Karger AG, Basel
1995
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.