cefoxitin and Urinary-Bladder-Neoplasms

Topics: Age Factors; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cefoxitin; Cystectomy; Female; Fosfomycin; Humans; Male; Postoperative Complications; Prospective Studies; Treatment Outcome; Urethra; Urinary Bladder Neoplasms; Urinary Tract Infections

To study the effectiveness of combining DNA ploidy and the blood-group related membrane antigen Tn as bladder tumour markers which have been individually associated with high tumour grade and poor prognosis. In particular to (i) determine whether use of these two markers would improve tumour detection compared with either alone, particularly of high grade disease and (ii) determine whether intermediate rates of marker expression would occur in bladder cancer patients with no current tumour compared with those with a tumour and a control group with benign prostatic hypertrophy.. A total of 102 patients undergoing cystoscopic monitoring for either benign prostatic hyperplasia (BPH) or for transitional cell carcinoma (TCC) at the Repatriation Hospital and Flinders Medical Centre were included in the study. The patients comprised three study groups, those with BPH (n = 37), with TCC but no tumour present (n = 38) and those with TCC and a tumour present at cystoscopy (n = 27). Exfoliated cells obtained from bladder washings at cystoscopy were double-labelled using a monoclonal antibody to the Tn antigen and a DNA stain, propidium iodide and examined by flow cytometry.. Rates of marker expression in 27 patients with tumours were 30% for Tn antigen, 30% for aneuploidy and 48% for either marker. Marker expression was strongly associated with tumour grade, with no expression at grade 1, 38% (3/8) tumours at grade 2 and 90% (9/10) at grade 3. In patients with a history of bladder tumours but no current tumour, rates were intermediate (30%) compared with patients with current transitional cell carcinoma (42%) and control patients (19%).. The use of Tn antigen combined with DNA flow cytometry can increase tumour detection, particularly of high grade, aggressive disease. Gradation of expression of these markers across patient groups at increasing risk of a tumour, with intermediate expression in patients with no current tumour, suggests that marker expression may be detecting a preneoplastic stage of the disease, which is not possible with cytology. Given two parallel disease processes for superficial papillary and for high grade disease with invasive potential, the expression of high grade tumour markers in cells from cystoscopically normal bladders may represent a pre-clinical stage of aggressive disease. The identification of patients at risk of invasive disease using combinations of tumour markers may offer advantages in clinical management, particularly when no tumour is present and therefore no histopathological assessment is made.

Topics: Aged; Antigens, Tumor-Associated, Carbohydrate; Biomarkers, Tumor; Carcinoma, Transitional Cell; Female; Flow Cytometry; Genetic Markers; Humans; Male; Ploidies; Urinary Bladder Neoplasms

The T-antigen system and the mean nuclear volume have been proposed as risk variables in bladder tumors. This study includes 34 patients with initially noninvasive (Ta) transitional cell carcinomas who experienced different courses of disease. Tissue specimens of primary tumors were analyzed for the expression of T-antigen, Tn-antigen, and sialosyl-Tn-antigen using monoclonal antibodies (MoAb) and the lectin peanut agglutinin (PNA) in an indirect immunoperoxidase method. In addition, the mean nuclear volume was estimated by morphometry. Tissue from 7 of 13 patients (54%) who had invasive disease during a follow-up period of 5 years expressed T-antigen, as defined by MoAb HH8 in the primary tumor, whereas tissue of only 3 of 21 patients who did not have invasive disease expressed the antigen (P less than 0.02). No association was found between tumor progression to invasion and the expression of Tn-antigen or sialosyl-Tn-antigen. Tn-antigen expression was partially lost in invasive tumors (P less than 0.03) when compared with the expression in primary noninvasive tumors. A high mean nuclear volume in tissue specimens of primary tumors correlated with a progression to invasive disease (P less than 0.01). A significantly (P less than 0.003) higher mean nuclear volume was found in tumor areas that were positive for PNA compared with areas that were negative for PNA in primary tumors. A significantly lower mean nuclear volume was found in Tn-antigen-positive invasive Grade 3 tumor areas than in Tn-antigen-negative areas (P less than 0.005). The combined use of T-antigen expression and mean nuclear volume is of potential clinical interest for determining patients who are at high risk of disease progression.

Topics: Aged; Aged, 80 and over; Antibodies, Monoclonal; Antigens, Neoplasm; Antigens, Tumor-Associated, Carbohydrate; Carcinoma, Transitional Cell; Cell Nucleus; Disaccharides; Humans; Immunoenzyme Techniques; Middle Aged; Neoplasm Recurrence, Local; Predictive Value of Tests; Urinary Bladder Neoplasms

Recently, several investigators have demonstrated that the MN blood group precursor antigens Thomsen-Friedenreich antigen (T-Ag) and Tn-antigen (Tn-Ag) are expressed on the cell surfaces of several cancers, including urinary bladder cancer. T-Ag is composed of a specific carbohydrate chain, galactose-beta-1-3-N-acetylgalactosamine (GalNAc), which is specifically detectable through the immunohistochemical binding of peanut agglutinin (PNA). In normal cells, T-Ag is cryptic (cT-Ag) and can be unmasked by treatment with neuraminidase. Tn-Ag is composed of another carbohydrate chain, alpha-GalNAc-serine/threonine, and binds specifically to Vicia villosa agglutinin (VVA). With the use of both these lectins, VVA and PNA, the presence or absence of Tn-Ag and T-Ag was examined in 24 specimens of normal bladder epithelium and specimens from 53 cases of human urinary bladder transitional cell carcinoma of various histologic grades by staining paraffin sections by means of the avidin-biotin-immunoperoxidase technique. The correlation between the expression of these antigens and the patient's clinical course was then estimated. Out of 21 patients in whom the tumors expressed the phenotype Tn-Ag(+), T-Ag(+), or cT-Ag(-), 17 suffered from invasive recurrence. Although patients with tumors expressing the phenotypes T-Ag(-) and cT-Ag(+) have been reported to show a good clinical course, in our studies some of them showed a switch to invasive recurrence. Thus it was not possible to estimate the patient's clinical course only by the presence or absence of T-Ag and cT-Ag. The expression of Tn-Ag was then examined with the use of VVA. Of 38 cases expressing the phenotypes T-Ag(-) and cT-Ag(+), 6 had tumors that carried Tn-Ag; 5 of them suffered from invasive recurrence. These results indicated that the detection of Tn-Ag with the use of VVA in combination with the examination of T-Ag and cT-Ag is useful for estimating the degree of malignancy of bladder cancer and the patient's clinical course.

Topics: Antigens, Neoplasm; Antigens, Tumor-Associated, Carbohydrate; Cross Reactions; Humans; Immunoenzyme Techniques; Lectins; Plant Lectins; Urinary Bladder Neoplasms