p53 immunohistochemistry as a prognostic marker in bladder cancer. Playground for urology scientists?

OBJECTIVES: Anomalies of the p53 tumor suppressor gene have been reported for a variety of different tumor types. Also in urothelial cancer accumulation of the P53 protein has been linked with an unfavorable prognosis of the patients. Despite the growing number of publications confusion remains because key questions regarding p53 accumulation in bladder cancer are still unanswered. The objective of this manuscript was to review all published literature on the association of p53 accumulation and prognosis of patients with bladder cancer. Furthermore, putative reasons for the conflicting results should be defined as a basis for future research.
METHODS: The entry criteria for the analysis were met by 43 trials comprising 3,764 patients out of 138 publications found through Medline search.
RESULTS: Comparison between the trials yielded considerable differences obviously due to technical aspects, e.g. the selection of the antibody and the use of different cut-off values, study design and patient selection.
CONCLUSIONS: From this analysis it becomes evident that further retrospective investigations will not contribute to the solution of the problem and thus are obsolete. There is an obvious need for standardization of the assay procedure and the assessment of the specimens as well as for the initiation of a prospective multicenter trial to provide definite answers.