Original Paper Urol Int 2001;67:34–40 p53 and bcl-2 Overexpression as Associated Risk Factors in Patients 40 Years Old or Less with Transitional Cell Carcinoma of the Bladder Ramazan Asci a Levent Yildiz b Saban Sarikaya a Recep Buyukalpelli a Ali Faik Yilmaz a Bedri Kandemir b Department of a Urology and b Pathology, School of Medicine, Ondokuz Mayis University, Samsun, Turkey Received: July 7, 2000 Accepted: November 24, 2000 Dr. Ramazan Asci Department of Urology, School of Medicine Ondokuz Mayis University, TR–55139 Samsun (Turkey) Tel. +90 362 4576000, Fax +90 362 4576041 E-Mail rasci@superonline.com ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2001 S. Karger AG, Basel 0042–1138/01/0671–0034$17.50/0 Accessible online at: www.karger.com/journals/uin Key Words bcl-2 W p53 W Bladder cancer, immunohistochemistry W TCC, young patients Abstract Objectives: Transitional cell carcinoma (TCC) of the blad- der in younger patients has historically a favourable prognosis. bcl-2 and p53 genes are implicated in cell cycle regulation with roles on programmed cell death. Presence of nuclear accumulation of p53 and cytoplas- mic accumulation of bcl-2 were proposed to confer a growth advantage to tumour cells. In this study, we investigated the roles of p53 and bcl-2 as prognostic fac- tors in TCC of bladder in patients younger than 40 years. Patients and Methods: From 1986 to 1998, 25 patients younger than 40 years were treated for TCC of bladder in our hospital. Of the tumour specimens, 24 were ade- quate for evaluating p53 and bcl-2 oncoproteins (group I). As a control (group II), we randomly selected 30 patients older than 50 years treated for bladder cancer in this period. Two oncoproteins were detected by immu- nohistochemical analysis in paired tumour tissue speci- mens in both groups. Retrospectively obtained clinical follow-up data were available, with a mean follow-up of 44 and 25.5 months in groups I and II, respectively. Rela- tions between tumour recurrences and progression with positivity of bcl-2 and p53 were investigated. Results: Expression of bcl-2 was observed in 13 (54.1%) and 11 (36.7%) and nuclear p53 accumulation in 9 (37.5%) and 17 (56.7%) of groups I and II, respectively. In the pres- ence of p53 expression, tumours showed significantly more progression in group I (55 vs. 6.7%) and group II (41.1 vs. 0%). Recurrence rates were not significantly dif- ferent in tumours with and without nuclear p53 overex- pression in both groups. Also, recurrence and progres- sion rates were not significantly different in tumours with and without cytoplasmic bcl-2 overexpression in both groups. Grade (G) and stage appeared as important prognostic factors in both groups since 60% of GIII tumours showed progression in group I, but none of GI and GII tumours. Similarly, 75% of T3 tumours pro- gressed, while these rates were 25 and 25% for T1–T2 tumours in group I. In group II, 31.2, 25 and 0% of GIII, GII and GI tumours progressed, while 50, 41.6 and 0% of T3, T2 and T1 tumours progressed, respectively. Conclu- sions: Nuclear p53 expression in TCC appears to be asso- ciated with a poorer prognosis in both younger and older patients. Although cytoplasmic bcl-2 overexpression is found in the majority of tumours in the younger group, it is not associated with tumour progression and recur- rence. Copyright © 2001 S. Karger AG, Basel