SAN DIEGO, CA USA (UroToday.com) - In this session, Lotan et al. report on a 5-year prospective study comparing the concordance of molecular marker status of TUR and radical cystectomy specimens from the same patient.
They prospectively performed p53, p21, p27, Ki67, and cyclin E1 immunohistochemical staining on RC specimens from 243 patients treated with RC and pelvic lymphadenectomy. Preceding the RC, 39.5% of patients had staining of the TUR specimen available.
Time from TUR to RC was 2 months (IQR 3.5). Clinical stage was cTa/Tis/T1 (52, 54%), cT2 (37, 39%), cT3/T4 (2, 2%), and unknown (5, 5%). High-grade disease was present in 93% of the patients. Pathologic stage was pT0 (6, 6%), pT1 (40, 42%), pT2 (16, 17%), pT3 (27, 28%), and pT4 (7, 7%). Concomitant carcinoma in situ (CIS) was seen in 34 patients (35%) and lymphovascular invasion in 21 (22%). The median number of removed lymph nodes was 22 (IQR 16-31) and 20 patients (21%) had lymph node metastasis. Overall, 17 (18%) patients underwent neoadjuvant chemotherapy. The concordance of molecular biomarkers between TUR and RC was 89%, 80%, 88%, 86%, and 82% for cyclin E, p21, p27, p53 and Ki-67, respectively.
Authors report a high rate of concordance between status of cell cycle and proliferation-related markers between the two specimens, and also that the likelihood of concordance is not influenced by the clinical or pathologic stage, grade, time from TUR to RC, and use of neoadjuvant chemotherapy.
They concluded that clinical decision-making regarding neoadjuvant chemotherapy and RC could be guided by molecular marker status of the TUR specimen.
Presented by Yair Lotan, Aditya Bagrodia, Niccolo Passoni, Varun Rachakonda, Payal Kapur, Arthur Sagalowsky, and Shahrokh F. Shariat at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Reported for UroToday.com by Reza Mehrazin, MD
