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. 2009 Sep;135(9):1169-75.
doi: 10.1007/s00432-009-0557-9. Epub 2009 Feb 12.

Predictive value of telomerase reverse transcriptase expression in patients with high risk superficial bladder cancer treated with adjuvant BCG immunotherapy

Ioannis Zachos  1 , Panagiotis A Konstantinopoulos, Gerasimos P Vandoros, Michalis V Karamouzis, Athanasios G Papatsoris, Thomas Podimatas, Antonios Papachristodoulou, Michael Chrisofos, Charalambos Deliveliotis, Athanasios G Papavassiliou
Affiliations

Predictive value of telomerase reverse transcriptase expression in patients with high risk superficial bladder cancer treated with adjuvant BCG immunotherapy

Ioannis Zachos et al. J Cancer Res Clin Oncol. 2009 Sep.

Abstract

Purpose: We conducted a prospective study to determine whether expression of telomerase reverse transcriptase (hTERT) is associated with recurrence-free-survival (RFS) or development of invasive disease in patients with high risk superficial bladder cancer (SBC) that received adjuvant BCG immunotherapy.

Methods: Thirty patients with high-grade T1 tumors were evaluated. Pre-BCG TURBT and post-BCG specimens were analyzed for hTERT nucleolar expression by immunohistochemistry.

Results: Post-BCG hTERT expression was statistically significantly lower than pre-BCG hTERT expression. Pre-BCG hTERT nucleolar staining in more than 75% of cells was associated with worse RFS (9 months vs. not yet reached, P = 0.05), while post-BCG hTERT nucleolar staining in more than 50% of the cells was associated with worse RFS (6 months vs. not yet reached, P = 0.001) and development of invasive disease. In multivariate analysis, post-BCG hTERT expression was independently associated with RFS and development of invasive disease.

Conclusions: Immunohistochemical evaluation of hTERT may help define a subset of high risk SBC patients that will eventually fail BCG and may therefore benefit from early salvage cystectomy.

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Figures

Fig. 1
Fig. 1
hTERT positive (a) and negative (b) samples obtained from the same patient pre- and post-BCG, respectively
Fig. 2
Fig. 2
Association between pre-BCG hTERT positivity (based on a cut-off of 75%) and recurrence free survival: pre-BCG hTERT positive patients had a worse recurrence free survival compared to patients with tumors that hTERT negative (median recurrence free survival 9 months vs. not yet reached respectively, log rank P = 0.05)
Fig. 3
Fig. 3
Association between post-BCG hTERT positivity and recurrence free survival: post-BCG hTERT positive patients had a worse recurrence free survival compared to patients with tumors that hTERT negative (median recurrence free survival 6 months vs. not yet reached respectively, log rank P = 0.001)
See this image and copyright information in PMC

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