Can p53 help select patients with invasive bladder cancer for bladder preservation?
OBJECTIVE
We evaluated whether the p53 status of invasive bladder cancer may help to select patients for treatment strategies aimed at bladder preservation.


METHODS
A total of 111 patients with muscle invasive (T2 to 3N0M0) transitional cell carcinoma of the bladder received neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy. Of these patients 60 (54%) had a complete clinical response (TO) to M-VAC. We report the 10-year outcome for these 60 patients, stratified by p53 status (positive versus negative) and stage (T2 versus T3) of the primary bladder neoplasm, and type of surgery (bladder sparing versus cystectomy) after M-VAC.


RESULTS
All 19 patients with T2 (organ confined) p53 negative tumors survived (16 after bladder sparing surgery and 3 after cystectomy) compared with 47% of 19 with T2 p53 positive tumors, 67% of 12 with T3 (extravesical) p53 negative tumors and 60% of 10 with T3 p53 positive tumors.


CONCLUSIONS
Our study suggests that the bladder may be preserved for up to 10 years in patients with tumors confined to the bladder (stage T2) who lack detectable p53 if they respond completely to neoadjuvant chemotherapy. Patients with T3 bladder tumors or T2 p53 positive tumors are best treated currently with cystectomy.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, Cornell University Medical College, New York, New York, USA.
H W
HW
Herr
D F
DF
Bajorin
H I
HI
Scher
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C
Cordon-Cardo
V E
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Reuter
D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002295:Carcinoma, Transitional Cell / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality; D016158:Genes, p53 / Q000235:genetics*; D006801:Humans; D008875:Middle Aged; D015996:Survival Rate; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality
D000970:Antineoplastic Agents