title: The p53 pathway and outcome among patients with T1G3 bladder tumors.
abstract: OBJECTIVE
  The aim was to analyze Tp53 and HDM2 in T1G3 bladder tumors and to determine the prognostic value of their alterations.
  
  
  METHODS
  Tumors (n = 119) were extracted from a prospective study of 1,356 bladder cancers. Tp53 mutations (exons 4-9) were assessed by sequencing of PCR products. HDM2 dose was assessed by quantitative PCR. p53, HDM2, and the products of p53 target genes were analyzed by immunohistochemistry. Cases were distributed in three categories. The association with prognosis was determined using Kaplan-Meier and Cox analyses.
  
  
  RESULTS
  Eighty-five percent of tumors harbored alterations in Tp53 or HDM2. In group 1 (n = 77), 69 tumors had inactivating Tp53 mutations (58%), and 8 had HDM2 gains (7%). Group 2 (n = 24) comprised tumors overexpressing p53 in the absence of mutations (20%). Group 3 tumors (n = 18) had no alterations. HDM2 gains were associated to HDM2 overexpression and to wild-type Tp53. Expression of type 1 insulin-like growth factor receptor, 14-3-3 sigma, and cyclooxygenase-2 was similar in groups 1 and 2 and significantly different from group 3. Survivin was expressed in the majority of tumors regardless of p53 pathway status. Taking group 3 as reference, the hazard ratios (HR) for recurrence, progression, and death were not significantly different in the other patient groups. HRs for recurrence were 1.13 for group 1 [95% confidence interval (95% CI), 0.25-5.03] and 1.40 for group 2 (95% CI, 0.27-7.20). HRs for progression were 0.50 for group 1 (95% CI, 0.18-1.40) and 0.25 for group 2 (95% CI, 0.05-1.29).
  
  
  CONCLUSIONS
  The p53 pathway is inactivated in most T1G3 bladder tumors. These genetic alterations do not independently predict patient's prognosis.
authors.affiliation: Institut Municipal d'Investigació Mèdica, Universitat Pompeu Fabra, and Hospital del Mar, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: López-Knowles
authors.forename: Silvia
authors.initials: S
authors.lastname: Hernández
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
authors.forename: Josep
authors.initials: J
authors.lastname: Lloreta
authors.forename: Alex
authors.initials: A
authors.lastname: Amorós
authors.forename: Adonina
authors.initials: A
authors.lastname: Tardón
authors.forename: Alfredo
authors.initials: A
authors.lastname: Carrato
authors.forename: Sirish
authors.initials: S
authors.lastname: Kishore
authors.forename: Consol
authors.initials: C
authors.lastname: Serra
authors.forename: Núria
authors.initials: N
authors.lastname: Malats
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
mesh_terms: D000328:Adult; D000368:Aged; D016158:Genes, p53; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D051736:Proto-Oncogene Proteins c-mdm2 / Q000235:genetics; D012189:Retrospective Studies; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000502:physiology*; D001749:Urinary Bladder Neoplasms / Q000235:genetics / Q000473:pathology / Q000503:physiopathology*
chemical_list: D016159:Tumor Suppressor Protein p53; C497206:MDM2 protein, human; D051736:Proto-Oncogene Proteins c-mdm2