Five-alpha-reductase expression in benign and malignant urothelium: correlation with disease characteristics and outcome.
OBJECTIVE
To evaluate 5-alpha-reductase (5alphaR) expression in benign and malignant urothelium and to assess the relationship between 5alphaR expression and tumor stage, tumor grade, and clinical outcome in patients with urothelial carcinoma/transitional cell carcinoma.


METHODS
We performed immunohistochemistry for 5alphaR on 53 urothelial specimens from 36 patients with transitional cell carcinoma treated at our institution between June 2002 and July 2003. For each tumor and the adjacent nontumor urothelium, a semiquantitative staining score was calculated. We used t tests and analysis of variance to compare the staining score across groups. Kaplan-Meier and logistic regression analyses were performed to assess the relationship between 5alphaR expression and clinical outcome.


RESULTS
5alphaR was expressed throughout the non-neoplastic urothelium. Nontumor urothelium had greater mean staining scores than did tumor specimens (160.1 versus 105.5, P <0.01). Low staining scores were associated with high grade (P <0.05), Stage pT3, pT4, and pTis (P <0.05), and disease progression (P <0.05). A staining score less than the median was a risk factor for progression (odds ratio 6.2, P <0.01) on univariate regression analysis. Patients with a staining score less than the median had a greater likelihood of disease progression (log-rank P <0.05) and cause-specific mortality (log-rank P <0.05).


CONCLUSIONS
We demonstrated 5alphaR expression in human urothelium and found that expression is decreased in transitional cell carcinoma in relation to tumor grade and stage. Decreased 5alphaR expression was associated with disease progression and cause-specific mortality.
Barocas
Daniel A
DA
Department of Urology, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, New York 10021, USA.
Kawamoto
Hideki
H
Dreizin
David F
DF
Howard
Marion E
ME
Choi
Judy
J
Pitts
W Reid
WR
You
Xueke
X
Tickoo
Satish K
SK
Boorjian
Stephen A
SA
Scherr
Douglas S
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000175:diagnosis / Q000201:enzymology*; D042944:Cholestenone 5 alpha-Reductase / Q000096:biosynthesis*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014570:Urologic Diseases / Q000175:diagnosis / Q000201:enzymology*; D014571:Urologic Neoplasms / Q000175:diagnosis / Q000201:enzymology*; D019459:Urothelium / Q000201:enzymology*
D042944:Cholestenone 5 alpha-Reductase