Prognostic Markers of Intravesical Bacillus Calmette‐Guérin Therapy for Multiple, High‐Grade, Stage T1 Bladder Cancers

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Abstract
Background: Prediction of a response to intravesical bacillus Calmette‐Guérin (BCG) therapy for bladder cancer is clinically important. We determined whether several molecular markers have prognostic value in intravesical BCG therapy for multiple, high‐grade, stage T1 bladder cancers. Methods: The expressions of p53 (clone D07), bcl‐2 (100‐D5), cathepsin‐D (C5), c‐myc(9E11), c‐erbB‐2 (CB11) and Ki‐67 (MM1) were determined by immunohistochemistry in paraffin‐embedded tissues from 32 multiple, T1, grade II–III bladder cancer patients (1 5 BCG responders, 1 7 nonresponders) who had undergone a single course of BCG therapy (Pasteur strain, 5 × 108 CFU weekly for 6 weeks) after complete removal of the tumors. The association between the expression of these markers and the response to BCG was assessed by univariate and multivariate analyses. Results: There was no difference in patient and tumor characteristics between the 2 groups. Using multivariate analysis, the only useful marker was p53, with the overexpression of the p53 protein inversely related to the response to BCG therapy (P = 0.0182). Conclusion: Our results suggest that the status of p53 expression offers significant clinical information and may be a useful tool in the selection of suitable candidates for BCG therapy in multiple, high‐grade stage T1 bladder cancer patients.