Prognostic markers in pT3 bladder cancer: A study from the international bladder cancer tissue microarray project

Gang Wang, Peter C. Black, Peter J. Goebell, Lingyun Ji, Carlos Cordon-Cardo, Bernd Schmitz-Dräger, Debra Hawes, Bogdan Czerniak, Sarah Minner, Guido Sauter, Frederic Waldman, Susan Groshen, Richard J. Cote, Colin P. Dinney

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Purpose: We evaluated the prognostic value of 10 putative tumor markers by immunohistochemistry in a large multi-institutional cohort of patients with locally advanced urothelial cancer of the bladder (UCB) with the aim to validate their clinical value and to harmonize protocols for their evaluation. Materials and Methods: Primary tumor specimens from 576 patients with pathologic (p)T3 UCB were collected from 24 institutions in North America and Europe. Three replicate 0.6-mm core diameter samples were collected for the construction of a tissue microarray (TMA). Immunohistochemistry (IHC) for 10 previously described tumor markers was performed and scored at 3 laboratories independently according to a standardized protocol. Associations between marker positivity and freedom from recurrence (FFR) or overall survival (OS) were analyzed separately for each individual laboratory using Cox regression analysis. Results: The overall agreement of the IHC scoring among laboratories was poor. Correlation among the 3 laboratories varied across the 10 markers. There was generally a lack of association between the individual markers and FFR or OS. The number of altered cell cycle regulators (p53, Rb, and p21) was associated with increased risk of cancer recurrence (P < 0.032). There was no clear pattern in the relationship between the percentage of markers altered in an 8-marker panel and FFR or OS. Conclusions: This large international TMA of locally advanced (pT3) UCB suggests that altered expression of p53, Rb, and p21 is associated with worse outcome. However this study also highlights limitations in the reproducibility of IHC even in the most expert hands.

Original languageEnglish
Pages (from-to)301.e17-301.e28
JournalUrologic Oncology: Seminars and Original Investigations
Issue number5
StatePublished - May 2021


  • Bladder cancer
  • Prognostic Markers
  • Tissue microarray


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