Expression of squamous cell carcinoma-associated antigen in grade 3 pT1 transitional cell carcinoma of the bladder and prediction of its progression and intravesical recurrence

Background. Among superficial transitional cell carcinomas (TCC) of the bladder, Grade 3 pT1 disease is associated with a higher risk of progression and intravesical recurrence. The authors determined whether or not squamous cell carcinoma-associated antigen (SCC antigen) could predict clinical behavior of Grade 3 pT1 disease. Methods. SCC antigen was immunohistochemically stained in Grade 3 pT1 TCC of the bladder that had been fixed in formaldehyde solution and embedded in paraffin. Patients were followed up, and disease progression and recurrence were identified. Disease progression was defined as histologically verified muscle invasion or clinically detectable distant metastasis, including pelvic lymph node metastasis. Results. SCC antigen in the cytoplasm was positively identified with immunohistochemical staining in 21 of 55 patients with the disease. Of 21 patients with positive SCC antigen in the cytoplasm, 8 experienced disease progression, whereas there was progression in 5 of 34 patients with negative antigen. The nonprogression rate of Grade 3 pT1 carcinomas with positive antigen in the cytoplasm was significantly lower than that for those with negative antigen. The disease-free rate also was clearly lower in the positive carcinoma than in the negative. Multivariate analysis confirmed that SCC antigen in the cytoplasm was the only significant variable independently affecting progression and intravesical recurrence of the disease. Conclusions. The results suggested that immunohistochemical expression of SCC antigen in the cytoplasm is closely linked with a higher risk for progression and intravesical recurrence of Grade 3 pT1 disease. Detection of the antigen can help to more accurately predict the clinical course of the disease.