Apoptosis, p53, bcl-2, and Ki-67 in invasive bladder carcinoma: possible predictors for response to radiochemotherapy and successful bladder preservation.

PURPOSE: Several groups have reported the value of bladder preservation by a combined treatment protocol, including transurethral resection (TUR-B) and radiochemotherapy (RCT). As more experience is acquired with organ-sparing treatment, patient selection should be optimized. The purpose of this study was to investigate the role of several biologic markers that may predict response to RCT in muscle-invasive bladder carcinoma. METHODS AND MATERIALS: The apoptotic index (AI), Ki-67, p53, and bcl-2 were evaluated by immunohistochemistry on pretreatment biopsies from 70 patients treated for invasive bladder cancer by TUR-B and RCT. Expression of each marker was correlated with initial response, local control, and cancer-specific survival with preserved bladder. An exploratory multivariate analysis was also performed that included clinical and immunohistochemical variables. RESULTS: A high AI (> median = 1.6%) and a high Ki-67 index (> median = 8.8%), but not the p53- and bcl-2 expression, were significantly related to initial complete response (CR) and local control with preserved bladder after 5 years. When the AI and Ki-67 expression were considered simultaneously, the association with initial CR (p < 0. 001), local control (p = 0.0002), and cancer-specific survival with preserved bladder (p = 0.008) was highly significant. In an exploratory multivariate analysis (final model), only AI, Ki-67, and the combined AI/Ki-67 variable retained significance for local control with preserved bladder at 5 years. CONCLUSION: Patients with a high spontaneous AI and a high pretreatment Ki-67 index should be considered preferentially for treatment with RCT, whereas tumors with low proliferation and low levels of apoptosis are less likely to respond to RCT.

In vitro study concerning the efficiency of the frequency-doubled double-pulse Neodymium:YAG laser (FREDDY) for lithotripsy of calculi in the urinary tract.

BACKGROUND AND OBJECTIVES: In a preclinical study we have tested both in vitro and in vivo, a new type of pulsed solid-state laser system that has not been applied in urology so far and has been developed for optimized intracorporal lithotripsy of biliary, salivary, and urinary calculi. STUDY DESIGN/MATERIALS AND METHODS: Sixty one calculi from the human urinary tract were split in vitro into fragments with a remaining particle size of

Flow cytometric analysis of DNA-aneuploidy subgroups and proliferation in renal cell carcinoma.

BACKGROUND: The course of patients suffering from renal cell carcinoma varies considerably and cannot be predicted by tumor stage and grade alone. However, it is crucial to select patients with high risk of progression and to commence adjuvant immuno-chemotherapy in good time. MATERIALS AND METHODS: Multiple samples of 71 kidney tumors were studied by DNA flow cytometry. Aneuploidy was classified into subgroups employing the DNA-index. In tumors of euploid pattern and corresponding normal tissue cell cycle analysis was performed. RESULTS: 39% of tumors were found to be aneuploid. Mean proliferation fraction was distinctly higher in euploid tumors (15.6%) than in normal tissue (6.1%). DNA ploidy pattern correlated significantly (p < 0.05) with histological grading. With increasing tumor size the clonal spectrum changed as well: Tetraploid cell lines fell from 40% to 28%. The number of triploid clones rose from 33% to 56%. CONCLUSION: Based on selection of tri- and hypertetraploid carcinomas, a high-risk-group for tumor recurrence can be associated within the predominating T2/3 G2 kidney tumors. The aim is to treat these patients following curative surgery at the stage of probable micro-metastases while keeping risk of overtreatment as low as possible.