A Proposed Score for Assessing Progression in pT1 High-grade Urothelial Carcinoma of the Bladder

Abstract We tested a selected series of patients with single urothelial high-grade pT1 stage (pT1 HG) or urothelial carcinoma in situ (CIS) with a set of immunohistochemical markers to elaborate a risk score for progression. We retrospectively reviewed all first diagnoses of single, <3 cm, urothelial papillary carcinoma pT1 HG or isolated CIS between 2006 and 2009. Galectin-3, CD44, E-cadherin, CD138, p16, survivin, HYAL-1, and topoisomerase-II α were used. A grading score 0 or 1 for each immunohistochemical staining was assigned to obtain a total score for assessing the progression. The median "progression score" was selected as cutoff value for statistical analysis. Overall, 23 patients (19 pT1 HG and 4 CIS) were included in the study. After a median follow-up of 21 months (range, 12 to 34 mo), 9 patients (39.1%) showed disease recurrence whereas 4 patients (17.4%) showed tumor progression. Topoisomerase-II α, p16, survivin, galectin-3, and CD138 were significantly associated with progression. Progression score ranged from 0 (best prognosis) to 7 (worst prognosis). Using a score ≥5 as a threshold, specificity was 78.9%, sensitivity 100%, positive predictive value 50%, and negative predictive value 100%. ROC area (a 95% confidence interval, 0.807-1.000; P<0.001). This immunohistochemistry-based progression score using a threshold ≥5, might help the clinician to focus on patients with HG pT1 or extended CIS at high risk for disease progression. These patients might benefit from a more intensive follow-up program or early cystectomy.