Department of Urology, Clínica Universitaria Universidad de Navarra, Pamplona, Spain.
BJU Int. 2011 Jun;107(11):1833-8. doi: 10.1111/j.1464-410X.2010.09653.x. Epub 2010 Sep 14.
What's known on the subject? and What does the study add? SXR and MDR1 are known as responsible for chemo and radiotherapy resistance in some cancers, like kidney cancer (MDR1). Invasive bladder cancer is an aggressive disease, with different behaviour upon its tumoral stage, and also within the same tumoral stage, therefore molecular markers are sought. This study shows a new molecular marker, which has shown as a predictor for bad prognosis cancers, therefore, allowing us for a better patient selection for aggressive therapies.
To investigate the prognostic value of steroid and xenobiotic receptor (SXR) and multidrug resistance 1 (MDR1) gene expression in relation to survival among patients with invasive bladder cancer.
The prospective study included 67 patients diagnosed with invasive bladder cancer and treated with radical cystectomy at one of two institutions. SXR and MDR1 gene expression was assessed by real-time quantitative polymerase chain reaction (RT-PCR) in tumoral and normal tissue from frozen surgical specimens.
Patients were followed for a mean of 29 months; 31 patients (46%) had progression. In univariate analysis, significant predictors of overall survival (OS) were pathological stage, lymph node (LN) status, histological grade, vascular-lymphatic invasion, and SXR expression. In multivariate analysis, independent predictors of OS were LN status (odds ratio [OR], 2.96; P=0.034), vascular-lymphatic invasion (OR, 2.50; P=0.029), and SXR expression (OR, 1.05, P=0.03). Among the 51 patients with negative LNs (pN0), univariate predictors of OS were SXR expression, MDR1 expression, and pathological stage. In multivariate analysis, SXR expression (OR, 1.06; P=0.01) and MDR1 expression (OR, 3.27; P=0.03) were independently associated with survival. Within the pN0 group, patients with SXR expression had shorter progression-free survival than did those without expression (P=0.004). This association persisted in the N0 subgroup with stage pT3-pT4 disease (P=0.028). However, in the pN1 group SXR expression did not have any influence.
For patients with invasive bladder cancer, SXR expression has value as a predictor of survival independent of the standard pathological predictors. Its maximum importance appears to be in patients with stage pT3-pT4 pN0 disease.
研究甾体和异生物质受体（SXR）和多药耐药基因 1（MDR1）在接受根治性膀胱切除术的浸润性膀胱癌患者中的表达与生存的关系。
前瞻性研究纳入 67 例在两家机构之一接受根治性膀胱切除术的浸润性膀胱癌患者。采用实时定量聚合酶链反应（RT-PCR）检测肿瘤和正常组织中 SXR 和 MDR1 基因的表达。
患者平均随访 29 个月，31 例（46%）患者出现进展。单因素分析中，总生存（OS）的显著预测因子包括病理分期、淋巴结（LN）状态、组织学分级、血管淋巴管浸润和 SXR 表达。多因素分析中，OS 的独立预测因子包括 LN 状态（优势比[OR]，2.96；P=0.034）、血管淋巴管浸润（OR，2.50；P=0.029）和 SXR 表达（OR，1.05，P=0.03）。在 51 例 LN 阴性（pN0）患者中，OS 的单因素预测因子包括 SXR 表达、MDR1 表达和病理分期。多因素分析中，SXR 表达（OR，1.06；P=0.01）和 MDR1 表达（OR，3.27；P=0.03）与生存独立相关。在 pN0 组中，SXR 表达的患者无进展生存期短于无表达的患者（P=0.004）。这种相关性在 pT3-pT4 疾病的 N0 亚组中持续存在（P=0.028）。然而，在 pN1 组中，SXR 表达没有任何影响。
对于浸润性膀胱癌患者，SXR 表达作为独立于标准病理预测因子的生存预测因子具有价值。其最大的重要性似乎在于 pT3-pT4 pN0 疾病的患者。
