Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Oncology, Shohada-e-Tajrish Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Investig Clin Urol. 2021 May;62(3):274-281. doi: 10.4111/icu.20200425.
A readily accessible biomarker to identify which patients with bladder cancer are more likely to respond to neoadjuvant chemotherapy (NAC) could help clinicians avoid unnecessary chemotherapy and prevent its subsequent complications in some patients. The primary objective of this study was to investigate the association of immunohistochemical markers of tumor subtype with response to NAC and survival of patients with muscle-invasive bladder cancer (MIBC).
MIBC patients treated with NAC were retrospectively included. The tissue microarrays were assembled from transurethral resection of bladder tumor (TURBT) specimens and immunohistochemistry (IHC) was performed. The association of independent variables, including IHC markers, and clinical covariates with clinical complete response to NAC and with overall survival was assessed by using logistic regression and Cox proportional hazard regression analysis, respectively. Kaplan-Meier curves were plotted for different IHC-based tumor subtypes.
Data from 140 MIBC patients treated with NAC were retrospectively reviewed. A total of 63 patients with available TURBT specimens were eligible to be included in the analysis. Our results showed that the IHC signature of KRT5/6(+)/KRT20(-), as a combined marker of basal subtype, was the only covariate significantly associated with complete response to NAC (p=0.037). Moreover, we found no statistically significant differences in overall survival between different IHC-based subtypes (p=0.721).
The IHC expression of KRT5/6 and KRT20, as a readily accessible combined marker, may help us to identify the patients most likely to benefit from chemotherapy. The clinical utility of this marker needs to be established in larger prospective studies.
寻找一种易于获取的生物标志物，以确定哪些膀胱癌患者更有可能对新辅助化疗（NAC）有反应，这将有助于临床医生避免对某些患者进行不必要的化疗，并预防其随后的并发症。本研究的主要目的是研究肿瘤亚型免疫组织化学标志物与肌层浸润性膀胱癌（MIBC）患者对 NAC 的反应和生存的相关性。
回顾性纳入接受 NAC 治疗的 MIBC 患者。组织微阵列由经尿道膀胱肿瘤切除术（TURBT）标本组装，并进行免疫组织化学（IHC）检测。使用逻辑回归和 Cox 比例风险回归分析，分别评估包括 IHC 标志物在内的独立变量和临床协变量与 NAC 临床完全缓解以及总生存的相关性。为不同的基于 IHC 的肿瘤亚型绘制 Kaplan-Meier 曲线。
回顾性分析了 140 例接受 NAC 治疗的 MIBC 患者的数据。共有 63 例有可用 TURBT 标本的患者符合纳入分析的条件。我们的结果表明，KRT5/6(+) / KRT20(-)的 IHC 特征作为基底亚型的联合标志物，是与 NAC 完全缓解唯一显著相关的协变量（p=0.037）。此外，我们发现在不同的基于 IHC 的亚型之间，总生存率没有统计学上的显著差异（p=0.721）。
KRT5/6 和 KRT20 的 IHC 表达作为一种易于获取的联合标志物，可能有助于我们识别最有可能从化疗中获益的患者。该标志物的临床实用性需要在更大的前瞻性研究中得到证实。
