Objectives

Despite numerous trials on its prognostic relevance the impact of p53 accumulation on the prognosis remains unclear. The aim of this multiinstitutional retrospective trial on p53 immunohistochemistry in bladder cancer was to analyse the present data and disclose potential reasons for the conflicting results.

Material and Methods

3207 data sets from 24 different studies were obtained, transformed and statistically analysed using the SPSS software. Herein, the results of the first 1706 patients are given. The study group was composed from 1336 males (78.3%) and 370 females. The mean age was 69.5 years. 1177 patients (69%) had superficial tumors Ta (726), TIS (12) and T1 (439) (42.7, 0.6, and 25.7%, respectively), the median follow-up was 11.1 years. The remaining 523 patients had advanced tumors (>T2) with a median survival time of 1.9 years. Of 1272 patients assessable for survival 299 died of bladder cancer, another 199 from intercurrent disease.

Results

Cumulative survival analysis yielded no differences for sex and age. These factors were also equally distributed among the different centers. In contrast, considerable differences were observed with regard to the distribution of tumor stage, multifocal tumor lesions and tumor progression. Tumor grade and tumor stage were clearly correlated with patient survival. Survival time differed significantly between the different centers indicating patient selection. The number of p53 positive tumor cells was lower (16+24.9%) in superficial as compared to advanced tumors (36+37.6%). Using a breakpoint of 23% positive tumor cells 170 of 684 (25%) assessable patients with  uperficial tumors and 187 of 388 patients (48%) with advanced tumors showed p53 accumulation.

Conclusions

This preliminary analysis of the data demonstrates that differences between the different studies with regard to the prognostic impact of p53 can be explained in most cases, by differing study designs and heterogenous study populations. Cumulative analysis of the data shows that p53 accumulation is highly correlated with tumor stage and grade. This ongoing study should further delineate reasons for the different study results.

 Members and Contributors

 

Bernd J. Schmitz-Dräger, Fürth, Germany Peter J. Goebell, Essen, Germany Manfred Heydthausen, Düsseldorf, Germany Guido Sauter, Basel, Switzerland Thomas C. Gasser, Basel, Switzerland Yves Fradet, Quebec, Canada Helene LaRue, Quebec, Canada Pertti K. Lipponen, Kuopio, Finland Tapani JO Liukkonen, Mikkeli, Finland Pertti Rajala, Mikkeli, Finland M´Liss Ann Hudson, Washington, USA Peter A. Humphrey, Washington, USA Giovanni Casetta, Torino, Italy Alessandro Tizziani, Torino, Italy Stefan Wellek, Mannheim, Germany Michael Stöckle, Homburg, Germany Staffan Jahnson, Ørebrø, Sweden B. Risberg, Ørebrø, Sweden Pierfrancesco Bassi, Padova, Italy Anna Rosa Del Mistro, Padova, Italy

T.R. Leyshon Griffiths, Newcastle, UK David E. Neal, Newcastle, UK Mutsuo Furihata, Kochi, Nankoku, Japan N.N., Nankoku, Japan Dominique Chopin, Creteil, France Zivko Popov, Creteil, France Alan Pollack, Houston, USA Gunar K. Zagars, Houston, USA Paolo Dalla Palma, Trento, Italy Lucio Luciani, Trento, Italy Lydia Nakopoulou, Athens, Greece Robert A. Gardiner, Herson, Australia Mark A. Underwood, Glasgow, UK Yoshiyuki Kakehi, Kyoto, Japan Toyoaki Uchida, Kanagawa, Japan Jack A. Schalken, Nijmegen, The Netherlands Alexandre R. Zlotta, Bruxelles, Belgium H. Barton Grossman, Houston, USA George N. Thalman, Bern, Switzerland David J. Thomas, Newcastle, UK