Clinical Outcomes of Muscle-Invasive Bladder Cancer According to the BASQ Classification
23 Pages Posted: 29 Aug 2018More...
Background: We evaluated the clinical efficacy and prognosis of muscle-invasive bladder cancer according to the basal/squamous-like (BASQ) classification system based on immunohistochemical staining [CK5/6( ), CK14( ), GATA3(-), and FOXA1(-)].
Methods: One hundred patients diagnosed with muscle-invasive urothelial carcinoma of the urinary bladder were included in the study. All patients underwent radical cystectomy after transurethral removal of bladder tumor. Immunostaining was performed for CK5/6, CK514, FOXA1, and GATA3 antibodies on tissue microarray slides, and expression patterns were quantitatively analyzed using a scanning program.
Findings: The median follow-up time was 47.4 (interquartile range 6-89.9) months. The mean age of the patients was 65.1 ± 11.2 years. FOXA1 or CK14 expression greater than 1% was respectively positively and negatively correlated with overall survival (OS; P = 0.011 and P = 0.042, respectively), cancer-specific survival (CSS; P = 0.050 for both), and recurrence-free survival (RFS; P = 0.018 and P = 0.040, respectively). For CK5/6 and GATA3- or FOXA1- expression, 10% CK5/6 cells was negatively correlated with OS (P = 0.032 and P = 0.039, respectively) and with RFS in combination with FOXA1- only (P = 0.050).
Interpretation: FOXA1 and GATA3 were associated with a better prognosis, and CK14 and CK5/6 were associated with a poor prognosis in patients with muscle-invasive bladder carcinoma. Accordingly, basal types such as CK5/6 and GATA3-, or CK5/6 and FOXA1- were associated with a poor prognosis. A new classification system using molecular characteristics of bladder cancer can improve personalized treatment strategies and prediction of the therapeutic response.
Funding Statement: This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (Grant number: 2016R1A2B4011623). This study was supported by the Korean Urologic Oncology Society Grant (16-01).
Declaration of Interest: No conflict of interest.
Ethics Approval Statement: This study was approved by the Institutional Review Board (IRB No. H-1806-081-951).
Keywords: Basal Cell; Immunohistochemistry; Molecular Subtype; Neoplasm Metastasis; Squamous Cell; Urinary Bladder Neoplasms
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