Prognostication of Bladder Carcinoma by Immunohistochemistry: Refined and Combined Analysis of Staining for MCA and CA50

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Abstract
The immunohistochemical reactivity of tumour markers MCA and CA50 was determined in transitional cell carcinoma of the bladder of WHO grades I–III. The material consisted of paraffin-embedded biopsies from bladder tumors in 83 patients. Mean follow-up time was 13 years (range 9.6–22 years). Staining indexes for the whole section and for the area with maximal staining intensity were calculated (for MCA; IMCAtot, IMCAmax, for CA 50: ICA50tot, ICA50max). Also two combination indexes were created (Itot, Imax). The relations between histological grade on one hand, and IMCAtot (p < 0.001), IMCAmax (p = 0.007), ICA50tot (p < 0.001), and ICA50max (p < 0.001) on the other were statistically significant. IMCAtot (p = 0.008) and ICA50max (p 0.040) had a statistically significant relation to clinical stage. IMCAtot (p = 0.004) and IMCAmax (p = 0.001) also predicted node involvement with statistical significance. Metastasizing behavior could be predicted with all four indexes with statistical significance (IMCAtot p = 0.021; IMCAmax, p = 0.001; ICA50tot, p = 0.021; ICA50max, p = 0.050), but best with IMCAmax. Bladder cancer survival was related to IMCAtot (p = 0.044) and to ICA50tot (p = 0.0009) with statistical significance. The higher the MCA positivity and the lower the CA50 positivity, the worse was the prognosis. The combination index (Itot) predicted survival (p = 0.0004) better than IMCAtot or ICA50tot separately. Itot and Imax did not offer any advantages over other indexes in predicting node involvement or metastasis. Grade II tumors were divided into two prognostic groups using Itot, but the difference between survival was not statistically significant. The results suggest that the combination of MCA and CA50 staining data in bladder cancer offers substantial prognostic information, especially in terms of survival.

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