P53 as a prognostic marker for bladder cancer: a meta-analysis and review.
BACKGROUND
P53 is the most widely investigated molecular marker in bladder cancer. We aimed to review comprehensively the evidence for use of changes in P53 to predict bladder-cancer recurrence, progression, and mortality.


METHODS
We reviewed 168 publications from 117 studies. Estimates of significance were extracted from association tests, and hazard ratios with 95% CI from actuarial curves and Cox regression analyses. A meta-analysis was done on the studies that applied Cox models.


RESULTS
The methods used to assess significance varied widely between studies. 27% (nine of 34) of studies that assessed the prognostic value of P53 overexpression in recurrence by use of multivariate tests showed a significant association. The corresponding values for progression and mortality were 50% (12 of 24) and 29% (ten of 35), respectively. In the studies that used Cox models, the overall risk of recurrence was 1.6 (95% CI 1.2-2.1), of progression was 3.1 (1.9-4.9), and of mortality was 1.4 (1.2-1.7). These findings could be overestimates because of publication and reporting bias.


CONCLUSIONS
After 10 years of research, evidence is not sufficient to conclude whether changes in P53 act as markers of outcome in patients with bladder cancer.
Malats
Núria
N
Municipal Institute of Medical Investigation, Barcelona, Spain. nuria@imim.es
Bustos
Aurelia
A
Nascimento
Cristiane M
CM
Fernandez
Francisco
F
Rivas
Manuel
M
Puente
Diana
D
Kogevinas
Manolis
M
Real
Francisco X
FX
D014408:Biomarkers, Tumor / Q000378:metabolism*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D016159:Tumor Suppressor Protein p53 / Q000378:metabolism*; D001749:Urinary Bladder Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology*
D014408:Biomarkers, Tumor; D016159:Tumor Suppressor Protein p53