RESUMO
INTRODUCTION: It is not usual to use as prognostic factor the bladder lymphatic vessels invasion. METHOD & MATERIAL: 519 T1 bladder tumors with complete resection and follow up of one year at least. Prophylaxis with 81 mg of BCG weekly during six weeks in 54%. RESULTS: Follow up without recurrence of 38 months. 49%. Tumour recurrence of 49% and progression of 7%. 5.8% of the tumours are L1 and 70.7% L0. There are significative statistic relation between lympatic invasion and progression (p. 005), tumoral grade (p. 000) and actual situation (p. 02). 23% of the L1 tumours progressed vs 5% of L0. Prophylaxis with BCG reduces progression risk (33% without treatment vs 16 with BCG (p n.s.)). In multivariate analysis, resected volume (p. 024) and prophylactic treatment are independent variables for recurrence and lymphatic vessels invasion (p. 0478) and tumoral grade (p. 092) for progression. CONCLUSIONS: 1) L1 tumours has more probabilities of progression. 2) BCG disminishes progression rate but this is not statistical significative. 3) We need new markers to select which L1 tumours will progress.
Assuntos
Metástase Linfática , Neoplasias da Bexiga Urinária/patologia , Administração Intravesical , Idoso , Vacina BCG/uso terapêutico , Terapia Combinada , Cistectomia , Progressão da Doença , Feminino , Seguimentos , Humanos , Imunoterapia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/patologia , Prognóstico , Risco , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/terapiaRESUMO
OBJECTIVE: Evaluate the utility of Ki-67 label index, p53 expression and flow cytometry-DNA ploidy in the selection of groups to be treated with prophylactic BCG and the prognostic value compared with the classic variables (grade, lymphatic permeation, multiplicity, volume, primary). MATERIAL & METHOD: 121 superficial bladder tumors T1. 10% Cut-off level for Ki-67 and p53. Aneuplody is defined as a tumor with DNA index different of 1 or more than 20% in G2-M phase. 71 (58.7%) received BCG. RESULTS: In uni and multivariate analysis positivity to Ki-67 is correlated with recurrence. Progression is correlated with lymphatic permeation (p .0003), volume (p .016), ploidy (p .022) and positivity to p53 (p .007). In multivariate analysis, volume and positivity to p53 are independent variables. None were of utility to prevent recurrence, but Ki-67 positive or aneuploid treated tumors had less progression (p .025 and p .009 respectively). The p53 negative treated tumors had less progression too. CONCLUSIONS: Only Ki-67 is correlated with tumoral recurrence. P53 and tumor volume are correlated with stage progression. If the results are confirmed with bigger series, the Ki-67 positive and/or aneuploid tumors would obtain benefits of prophylactic treatment with BCG.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Vacina BCG/uso terapêutico , Regulação Neoplásica da Expressão Gênica/genética , Antígeno Ki-67/genética , Ploidias , Proteína Supressora de Tumor p53/biossíntese , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/prevenção & controle , Idoso , Feminino , Citometria de Fluxo , Humanos , Masculino , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Proteína Supressora de Tumor p53/genética , Neoplasias da Bexiga Urinária/patologiaRESUMO
OBJECTIVE: Observe the correlation between Ki-67 label index, p53 expression and flow cytometry-DNA ploidy with the classic variables (grade, lymphatic permeation, multiplicity, volume, primary). MATERIAL AND METHOD: 121 superficial bladder tumors T1. 10% Cut-off level for Ki-67 and p53. Aneuploidy is defined as a tumor with DNA index different of 1 or more than 20% in G2-M phase. RESULTS: Statistical correlation with grade and lymphatic permeation. Ki-67 label index and p53 expression can distinguish between G1, G2 vs G3 and Lx, L0 vs. L1. The volume correlates with positivity to p53. CONCLUSIONS: Aneuploidy and positivity to Ki-67 and p53 increase with grade and lymphatic permeation.
