|
KMID : 0358319960370010028
|
|
Korean Journal of Urology
1996 Volume.37 No. 1 p.28 ~ p.40
|
|
|
Evaluation of Appropriateness of Radical Cystectomy Using p53 and nm23-H1 Protein Experssion in Grade3, Muscle Invasive Transitional Cell Carcinoma of Bladder
|
|
|
|
|
Abstract
|
|
|
Objective:
@EN About 50% of patients undergoing radical cystectomy for muscle invasive bladder cancer have occult distant micrometastasis. Most of these patients have clinical mainfestations of distant metastasis within 1 year of operation, and not likely
to
achieve 2-year survival. But in other words, the remaining half of patients can expect definite survival benifit from radical surgery. Therefore if those who have micrometastasis can be selected preoperatively, unnecessary cystectomies can be
avoided,
and bladder preservation by anticancer chemotherapy, radiotherapy, and partial cystectomy can be employed instead.
@ES materials and methods:
@EN From 1985 to 1993, 45 patients diagnosed with high grade muscle invasive transitional cell carcinoma at transurethral resection of bladder (TURB) who later confirmed to have stage t2, T3a, and T3b tumors after radical cystectomy were
selected.
Patients with double primary tumor, early death, follow up period under 2 years, and poor quality of paraffinized tissue preservatin were excluded. Immunostaining of tumor suppressor gene p53 (DO7 and Pab1801; both wild and mutant type0 and
antimetastatic gene nm23-H1(NM301)were performed and the survival function was analysed. Stainings were interpreted as positive when more than heterogeous pattern for p53, and stronger than moderately stained for nm23-H1 were seen.
@ES Results:
@EN Pathological nodal status (pN stage), combination of p53 and nm23-H1 expression, and p53 expression were correlated with survival. Pathological tumor stage (pT stage), nm23-H1 expression alone were not correlated with survival. Expression of
p53 was
44.4% (20/45) and nm23-H1 expression was seen in 55.6% (25/45). Combinations of p53 negative plus nm23-H1 negative, p53 negative plus nm23-H1 positive, 53 positive plus nm23-H1 negative, and p53 positive plus nm23-H1 positive were 12, 13, 8, and
12
cases, respectively. Cases when both proteins wer expressed poor survival was observed. Detection time elapsed from cystectomy to metastasis and duration from detection of metastasis to death was only related with N stage.
@ES Conclusion:
@EN 1. When cellular grade of TURB specimen is III, muscle invasive, and positive for both p53 and nm23-H1, the chance of surgical cure by radical cystectomy is signkificantly reduced. 2. In high grade tumors, the degree of muscle invasion does
not
affect survival, but might affect the detection time elapsed from cystectomy to metastasis and the duration from detection of metastasis to death. 3. Lymph node metastasis is related to survival, and especially p53 expression is related to
survival.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
  
|
|
|
Listed journal information
|
|
  
|
|