Smoking intensity and a panel of nine cancer biomarkers can be used to predict prognosis for patients with primary bladder tumors, according to research published online in Cancer.

Anirban P. Mitra, MD, PhD, of the University of Southern California in Los Angeles, and colleagues studied the prognostic value of smoking intensity and molecular alterations, including Bax, caspase-3, apoptotic protease-activating factor 1 (Apaf-1), Bcl-2, p53, p21, cyclooxygenase-2, vascular endothelial growth factor, and E-cadherin alterations, on the outcome for 212 patients with urothelial carcinoma of the bladder (UCB). Participants were followed for a median of 13.2 years.

The researchers identified significant associations for age, pathologic stage, surgical modality, and adjuvant therapy administration with survival. There was an independent correlation for increasing smoking intensity with worse outcome. Individually, Apaf-1, E-cadherin, and p53 were significantly prognostic for outcome. In univariable and multivariable analysis, combining all nine biomarkers was significantly prognostic. Compared with models composed of standard clinicopathological variables with or without smoking intensity, significantly greater accuracy for predicting prognosis was noted with a multivariable model that included all nine biomarkers and smoking intensity.

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“These findings can potentially affect UCB management across all stages,” according to the researchers. “Although validation of this panel is needed, this study clearly demonstrates that a multipathway-based approach to constructing rational marker panels holds potential for future UCB management.”

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