title: Bilharzial vs non-bilharzial related bladder cancer: pathological characteristics and value of cyclooxygenase-2 expression.
abstract: OBJECTIVE
  • To assess the expression pattern of cyclooxygenase-2 (COX-2) in bilharzial and non-bilharzial related bladder cancer (BBC and NBBC) and its association with clinical outcome after radical cystectomy (RC). We also determined the clinico-pathological differences between BBC and NBBC.
  
  
  METHODS
  • Immunohistochemical (IHC) staining for COX-2 was performed on archival bladder specimens from 315 patients treated with RC between 1997 and 2003. • Patients were divided into 2 groups: Group 1 comprised 205 patients (65%) with BBC and group 2 comprised 110 patients (35%) with NBBC. • Clinico-pathological differences were compared and altered IHC expression of COX-2 was correlated with clinical outcome in both groups.
  
  
  RESULTS
  • The study included 315 patients (239 males and 76 females) with median age 54 y (range 31-79) and median follow up of 63.2 months after RC. • There was significant difference in histological types, tumor stage, grade, and architecture and COX-2 alterations between both groups (P < 0.05). • BBC presented with lower grade, higher stage, and non-papillary non-urothelial carcinoma. COX-2 overexpression was associated with pathological T stage (P= 0.01), grade (P < 0.001) and lymphovascular invasion (LVI) (P= 0.041). • COX-2 expression was an independent predictor of disease recurrence (HR 1.9, CI 0.99-3.626 and P= 0.05) and cancer specific mortality (HR 2.8, CI 1.155-6.73 and P= 0.023) only in BBC but not in NBBC (HR 1.6, CI 0.598-4.364, P= 0.344 and HR 0.349, CI 0.076-1.595, P= 0.175, respectively).
  
  
  CONCLUSIONS
  • BBC differs pathologically and biologically from NBBC. BBCs present more frequently as low-grade, high stage non-papillary and non-urothelial cancers. BBCs with COX-2 alterations are associated with worse outcome after RC. • Our findings support the need for further evaluation of COX-2 and inflammatory signaling pathways as well as COX-2-targeted prevention and therapies in BC.
authors.affiliation: Urology and Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Ramy
authors.initials: R
authors.lastname: Youssef
authors.forename: Payal
authors.initials: P
authors.lastname: Kapur
authors.forename: Wareef
authors.initials: W
authors.lastname: Kabbani
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mosbah
authors.forename: Hassan
authors.initials: H
authors.lastname: Abol-Enein
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ghoniem
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000201:enzymology / Q000469:parasitology* / Q000473:pathology; D051546:Cyclooxygenase 2 / Q000378:metabolism*; D015653:Cystectomy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012548:Schistosoma haematobium; D012553:Schistosomiasis haematobia / Q000150:complications*; D046888:Tissue Array Analysis; D001749:Urinary Bladder Neoplasms / Q000201:enzymology / Q000469:parasitology* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor; D051546:Cyclooxygenase 2