Can p53 help select patients with invasive bladder cancer for bladder preservation?

Purpose: We evaluated whether the p53 status of invasive bladder cancer may help to select patients for treatment strategies aimed at bladder preservation. Materials and Methods: A total of 111 patients with muscle invasive (T2 to 3N0M0) transitional cell carcinoma of the bladder received neoadjuvant methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy. Of these patients 60 (54%) had a complete clinical response (TO) to M-VAC. We report the 10-year outcome for these 60 patients, stratified by p53 status (positive versus negative) and stage (T2 versus T3) of the primary bladder neoplasm, and type of surgery (bladder sparing versus cystectomy) after M-VAC. Results: All 19 patients with T2 (organ confined) p53 negative tumors survived (16 after bladder sparing surgery and 3 att;er cystectomy) compared with 47% of 19 with T2 p53 positive tumors, 67% of 12 with T3 (extravesical) p53 negative tumors and 60% of 10 with T3 p53 positive tumors. Conclusions: Our study suggests that the bladder may be preserved for up to 10 years in patients with tumors confined to the bladder (stage T2) who lack detectable p53 if they respond completely to neoadjuvant chemotherapy Patients with T3 bladder tumors or T2 p53 positive tumors are best treated currently with cystectomy.