Ulceration in bladder cancer associates with extravesical disease, independent of cell cycle, or hypoxia pathways status: Integrating gross morphology and expression profiles in cystectomies

Ulceration is common in bladder tumors, but its prognostic role, although intuitive, is not established. We aim to explore the presence of gross ulceration and its relationship with other morphological and biological features classically associated with extravesical disease, in patients submitted to...

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Published in:Urologic oncology 2016-11, Vol.34 (11), p.484.e9-484.e17
Main Authors: Schultz, Luciana, Spagnul, Samuel J T, Damm, Gilcy R, da Cunha, Isabela W, Bezerra, Stephania M, da Costa, Walter H, Guimaraes, Gustavo C, Zequi, Stenio deC, Soares, Fernando A
Format: Article
Language:English
Subjects:
Aged
Antineoplastic Agents - therapeutic use
BCG Vaccine - therapeutic use
Carcinoma, Transitional Cell - chemistry
Carcinoma, Transitional Cell - complications
Carcinoma, Transitional Cell - secondary
Carcinoma, Transitional Cell - therapy
Cell Cycle
Cell Hypoxia
Combined Modality Therapy
Cystectomy
Female
Humans
Hypoxia-Inducible Factor 1, alpha Subunit - analysis
Lymph Node Excision
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Proteins - analysis
Tumor Burden
Ulcer - etiology
Ulcer - pathology
Urinary Bladder Neoplasms - chemistry
Urinary Bladder Neoplasms - complications
Urinary Bladder Neoplasms - pathology
Urinary Bladder Neoplasms - therapy
Vascular Endothelial Growth Factor A - analysis
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Summary:Ulceration is common in bladder tumors, but its prognostic role, although intuitive, is not established. We aim to explore the presence of gross ulceration and its relationship with other morphological and biological features classically associated with extravesical disease, in patients submitted to radical cystectomy. Tumor size and morphology were noted on 101 cystectomy patients (2000-2010). Papillary, exophytic, and vegetant tumors were grouped as "papillary" and solid/nodular, ulcerated and infiltrative as "nonpapillary." Ulceration was noted grossly in every case as a binary parameter, regardless of morphology. Immunohistochemistry was performed for hypoxia (hypoxia-inducible factor-1α and vascular endothelial growth factor), and cell cycle proteins (pRb, p53, and cyclin D1). Mean age was 66.7 year, male:female ratio was 2:1, 20 patients received bacillus Calmette-Guerin and 10 neoadjuvant chemotherapy. Upstaging rate was 56.4%. Ulcerated lesions presented mostly as nonpapillary and nonorgan confined (nOC), whereas nonulcerated tumors were often papillary and organ confined (OC). Tumor size was smaller in nonpapillary tumors (P = 0.002), but did not associate with altered hypoxia or cell cycle expressions. pRb and cyclin D1 loss and p53 overexpression were more frequent in ulcerated and non-OC tumors as did the phenotype vascular endothelial growth factor-negative/hypoxia-inducible factor-1α-low (P
ISSN:1873-2496
DOI:10.1016/j.urolonc.2016.05.031