Prognostic value of cyclooxygenase-2 and p53 expression in stage T1 grade III bladder cancer

Purpose: The prognostic value of p53 remains controversial in stage T1, grade III (T1GIII) transitional cell carcinomas (TCC) of the bladder. Recent studies have reported increased expression of cyclooxygenase-2 (COX-2) in bladder cancer. The prognostic values of p53 and COX-2 were compared in T1GIII TCC of the bladder. Materials and methods: Among 57 consecutive patients, diagnosed with T1GIII TCC of the bladder by transurethral resection (TURB), 37 were eligible for this study. Exclusion criteria included; the first TURB performed elsewhere, no or inadequate (less than 6 weeks) bacillus Calmette-Guerin treatment and postoperative follow-up of less than 1 year. The expressions of p53 and COX-2 were evaluated by immunohistochemical staining of TURB tissues. Possible correlations of the p53 and COX-2 expressions with the clinicopathological features, such as age, shape and multiplicity of tumor, recurrence and progression, were examined. Results: During a mean follow-up of 27 months, the disease recurred in 43.2% and progressed in 16.2%. Of the 37 specimens, 31 (83.8%) and 16 (43.2%) stained positive for COX-2 and p53 expressions, respectively. There were no significant differences in age, shape and multiplicity of the tumors, recurrence-free survival and progression-free survival between the p53 positive and negative groups. However, the recurrence-free and progression-free survivals were significantly lower in the COX-2 positive than in the COX-2 negative group (p=0.049 and p=0.027, respectively). When combined, p53 and COX-2 more accurately predicted recurrence than COX-2 alone (p=0.036), but not the progression (p=0.776). Conclusions: In the pathologically homogeneous group of T1GIII TCC of the bladder, COX-2 was superior to p53 in predicting the prognosis.