title: Predictive value of telomerase reverse transcriptase expression in patients with high risk superficial bladder cancer treated with adjuvant BCG immunotherapy.
abstract: OBJECTIVE
  We conducted a prospective study to determine whether expression of telomerase reverse transcriptase (hTERT) is associated with recurrence-free-survival (RFS) or development of invasive disease in patients with high risk superficial bladder cancer (SBC) that received adjuvant BCG immunotherapy.
  
  
  METHODS
  Thirty patients with high-grade T1 tumors were evaluated. Pre-BCG TURBT and post-BCG specimens were analyzed for hTERT nucleolar expression by immunohistochemistry.
  
  
  RESULTS
  Post-BCG hTERT expression was statistically significantly lower than pre-BCG hTERT expression. Pre-BCG hTERT nucleolar staining in more than 75% of cells was associated with worse RFS (9 months vs. not yet reached, P = 0.05), while post-BCG hTERT nucleolar staining in more than 50% of the cells was associated with worse RFS (6 months vs. not yet reached, P = 0.001) and development of invasive disease. In multivariate analysis, post-BCG hTERT expression was independently associated with RFS and development of invasive disease.
  
  
  CONCLUSIONS
  Immunohistochemical evaluation of hTERT may help define a subset of high risk SBC patients that will eventually fail BCG and may therefore benefit from early salvage cystectomy.
authors.affiliation: Department of Urology, University of Thessalia, Larissa, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Zachos
authors.forename: Panagiotis A
authors.initials: PA
authors.lastname: Konstantinopoulos
authors.forename: Gerasimos P
authors.initials: GP
authors.lastname: Vandoros
authors.forename: Michalis V
authors.initials: MV
authors.lastname: Karamouzis
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Papatsoris
authors.forename: Thomas
authors.initials: T
authors.lastname: Podimatas
authors.forename: Antonios
authors.initials: A
authors.lastname: Papachristodoulou
authors.forename: Michael
authors.initials: M
authors.lastname: Chrisofos
authors.forename: Charalambos
authors.initials: C
authors.lastname: Deliveliotis
authors.forename: Athanasios G
authors.initials: AG
authors.lastname: Papavassiliou
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D001500:BCG Vaccine / Q000008:administration & dosage*; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007167:Immunotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D019098:Telomerase / Q000235:genetics*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology
chemical_list: D000276:Adjuvants, Immunologic; D001500:BCG Vaccine; C509186:TERT protein, human; D019098:Telomerase