title: The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic infiltration and COX-2 expression and survival in patients with transitional cell carcinoma of the urinary bladder.
abstract: The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic infiltration, and COX-2 expression and survival was examined in patients with transitional cell carcinoma of the urinary bladder (n=103). Sixty-one patients had superficial disease and 42 patients had invasive disease. Cancer-specific survival was shorter in those patients with invasive compared with superficial bladder cancer (P<0.001). On univariate analysis, stratified by stage, increased Ki-67 labelling index (P<0.05), increased COX-2 expression (P<0.05), C-reactive protein (P<0.05) and adjuvant therapy (P<0.01) were associated with poorer cancer-specific survival. On multivariate analysis of these significant factors, stratified by stage, only C-reactive protein (HR 2.89, 95% CI 1.42-5.91, P=0.004) and adjuvant therapy (HR 0.29, 95% CI 0.14-0.62, P=0.001) were independently associated with poorer cancer-specific survival. These results would suggest that tumour-based factors such as grade, COX-2 expression or T-lymphocytic infiltration are subordinate to systemic factors such as C-reactive protein in determining survival in patients with transitional cell carcinoma of the urinary bladder.
authors.affiliation: Department of Surgery, Royal Infirmary University, Glasgow G31 2ER, UK. m.hilmy@doctors.net.uk
authors.forename: M
authors.initials: M
authors.lastname: Hilmy
authors.forename: R
authors.initials: R
authors.lastname: Campbell
authors.forename: J M S
authors.initials: JM
authors.lastname: Bartlett
authors.forename: A-M
authors.initials: AM
authors.lastname: McNicol
authors.forename: M A
authors.initials: MA
authors.lastname: Underwood
authors.forename: D C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism / Q000473:pathology; D002295:Carcinoma, Transitional Cell / Q000097:blood / Q000201:enzymology / Q000473:pathology*; D049109:Cell Proliferation; D003430:Cross-Sectional Studies; D051546:Cyclooxygenase 2 / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000097:blood*; D019394:Ki-67 Antigen / Q000032:analysis; D016246:Lymphocytes, Tumor-Infiltrating / Q000378:metabolism / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D001749:Urinary Bladder Neoplasms / Q000097:blood / Q000201:enzymology / Q000473:pathology*
chemical_list: D019394:Ki-67 Antigen; D002097:C-Reactive Protein; D051546:Cyclooxygenase 2