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Open Access Research

Lower cyclooxygenase-2 expression is associated with recurrence of solitary non-muscle invasive bladder carcinoma

Tomislav Tadin14*, Kristian Krpina2, Sanja Štifter3, Emina Babarović3, Željko Fučkar2 and Nives Jonjić3

Author affiliations

1 Ultrasound Diagnostic Service, Health Centre Rijeka, Martina Kontuša 18, Rijeka, 51000, Croatia

2 Department of Urology, University Hospital Centre Rijeka, Tome Strižića 3, Rijeka, 51000, Croatia

3 Department of Pathology, Faculty of Medicine, University of Rijeka, B. Branchetta 20, Rijeka, 51000, Croatia

4 Tomislav Tadin, MD M.Sc., Ultrasound Diagnostic Service, Martina Kontuša 18, Rijeka, 51000, Croatia

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Citation and License

Diagnostic Pathology 2012, 7:152  doi:10.1186/1746-1596-7-152

Published: 5 November 2012

Abstract

Background

A new modality is necessary to prevent recurrence of superficial bladder cancer after complete transurethral resection because of the high recurrence rate even with current prophylaxis protocols.

Methods

In order to analyze the predictive value of cyclooxygenase-2 (COX-2) expression and tumor infiltrating lymphocytes (TILs) in recurrence of this disease tumor specimens from 127 patients with solitary papillary non-muscle invasive bladder cancer (NMIBC), 78 with recurrent disease and 49 without recurrence during follow up of minimum 5 years, were retrieved for tissue microarrays construction and immunohistochemical analysis. COX-2 expression was scored according to Allred’s scoring protocol, while presence of TILs was categorized as absent (no) or present (yes) on whole tissue sections.

Results

COX-2 immunoreactivity was presented in 70 (71%), weak in 16% and strong in 55% of cases, while 29 (29%) tumors were negative. TILs were present in 64 (58%) NMIBC, while 44 cases (41%) did not reveal mononuclear infiltration in tumoral stroma. Statistical analysis demonstrated a higher proportion of patients with recurrence in the group with the COX-2 score 0, and lower in the group with score 2 (p=0.0001, p=0.0101, respectively). In addition, a higher proportion of recurrent patients in the group with no TILs, and lower proportion in the group with TILs were found (p=0.009, p=0.009, respectively). Univariate and multivariate analysis revealed overexpression of COX-2 and presence of TILs as negative predictors.

Conclusion

Patients with lower COX-2 expression and absence of TILs in NMIBC need to be followed up more vigorously and probably selected for adjuvant therapy.

Virtual slide

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1411318819790406 webcite

Keywords:
Non-muscle invasive bladder cancer; Recurrence; Cyclooxygenase-2; Tumor infiltrating lymphocytes