Prospective comparison of molecular signatures in urothelial cancer of the bladder and the upper urinary tract: is there evidence for discordant biology?

abstract

Purpose

Upper tract urothelial carcinoma (UTUC) is rare and less well studied than bladder cancer (BC). It remains questionable if findings in BC can safely be extrapolated to UTUC. We prospectively evaluate molecular profiles of UTUC and BC using a cell cycle biomarker panel.

Materials and Methods

Immunohistochemical staining for p21, p27, p53, cyclin E and Ki-67 was prospectively performed on 96 UTUC and 159 BC patients with non-metastatic high-grade UC treated with extirpative surgery. Data was compared between two groups according to the pathological stage. Primary outcome was assessment of differences in marker expression. Secondary outcome was difference in survival according to marker status.

Results

Over a median follow up of 22.0 months, 31.2% of patients with UTUC and 28.3% of patients with BC recurred and 20.8% and 27.7% died of UTUC and BC, respectively. Number of altered markers was not significantly different between the study groups. 34 patients (35.4%) with UTUC and 62 patients (39.0%) with BC had an unfavorable marker score (MS) (>2 markers altered). There were no significant differences between UTUC and BC in alteration status of markers, number of altered markers and MS when sub-stratified by pathologic stage. There were no significant differences in survival outcomes between UTUC and BC patients, according to number of altered markers and MS.

Conclusions

Our results demonstrate molecular similarity of UTUC and BC regarding cell cycle and proliferative tissue markers. These findings have important implications and support further extrapolation of treatment paradigms established in BC to UTUC.

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