title: Early metastatic progression of bladder carcinoma: molecular profile of primary tumor and sentinel lymph node.
abstract: OBJECTIVE
  We characterized early metastatic progression of bladder carcinoma from the primary tumor, separated in the central part and invasive front, to the first lymphatic metastasis.
  
  
  METHODS
  Included in this study were 8 patients undergoing sentinel lymph node detection for invasive bladder cancer, of whom 4 had metastasis in the sentinel lymph node and 4 were randomly chosen without metastases. After microdissection p53 genomic structure and immunohistochemical expression of p53, pRB, Ki67 and E-cadherin were analyzed. Microvessel density and apoptosis were also assessed.
  
  
  RESULTS
  In 5 patients there were p53 gene mutations in the primary tumor, while 3 had the wild-type gene. The genotypes were identical in the central part and invasive front. All sentinel lymph node metastases harbored p53 mutations, in contrast to all nonmetastatic sentinel lymph nodes. Two patients had the same mutation as the primary tumor and 1 had an additional mutation. In a patient with a wild-type gene in each compartment of the primary tumor a mutation appeared in the corresponding sentinel lymph node metastasis. There was poor concordance of p53 mutation with protein status. The expression of p53, pRB, Ki67, E-cadherin, and the evaluation of apoptosis and angiogenesis showed in most cases only slight variations in tumor compartments and the sentinel lymph node.
  
  
  CONCLUSIONS
  In this study invasive bladder carcinoma involved monoclonal proliferations with a mainly homogenous biomarker profile. The first metastases in sentinel lymph nodes had a similar molecular profile but in half of the cases signs of clonal evolution appeared.
authors.affiliation: Department of Urology, University Hospital, Uppsala, Sweden.
authors.forename: Per-Uno
authors.initials: PU
authors.lastname: Malmström
authors.forename: Zhi-Ping
authors.initials: ZP
authors.lastname: Ren
authors.forename: Amir
authors.initials: A
authors.lastname: Sherif
authors.forename: Manuel
authors.initials: M
authors.lastname: de la Torre
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wester
authors.forename: Magnus
authors.initials: M
authors.lastname: Thörn
mesh_terms: D017209:Apoptosis / Q000235:genetics; D014408:Biomarkers, Tumor / Q000235:genetics*; D015820:Cadherins / Q000235:genetics; D002455:Cell Division / Q000235:genetics; D004252:DNA Mutational Analysis; D018450:Disease Progression; D015972:Gene Expression Regulation, Neoplastic / Q000502:physiology; D006801:Humans; D019394:Ki-67 Antigen / Q000235:genetics; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000235:genetics* / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016160:Retinoblastoma Protein / Q000235:genetics; D021701:Sentinel Lymph Node Biopsy; D016159:Tumor Suppressor Protein p53 / Q000235:genetics; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000235:genetics* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D015820:Cadherins; D019394:Ki-67 Antigen; D016160:Retinoblastoma Protein; D016159:Tumor Suppressor Protein p53