Low immunohistochemical expression of e-cadherin is associated with better survival in high-grade urothelial cancer

Introduction: Urothelial carcinoma (UC) is the most common type of bladder cancer (BC). Approximately 75% of all BCs are restricted to the mucosa. Ten to 30% of superficial tumors will progress to invasive disease with worse prognosis. The epithelial to mesenchymal transition (EMT) is associated with the acquisition of tumor invasiveness and aggressive phenotypes. E-cadherin (E-CA) and vimentin are two proteins related to the EMT phenomenon. Materials and Methods: This study evaluated immunohistochemical (IHC) expression of E-CA and vimentinin 34 patients with high-grade UC who underwent radical cystectomy. Sections of paraffin embedded tumors were stained with E-CA or vimentin specific antibodies. The IHC results were quantified by digital image analysis, using the color deconvolution method and related to patients’ survival rates. Disease-specific survival was demonstrated by Kaplan-Meier curves considering P<0.05. Results: The cut-off points utilizing ROC curves for E-CA and vimentin were 57.2% and 25.6% of stained areas, respectively. Patients with E-CA’s expression less than 57.2%had better disease-specific survival (HR 13.7, CI 1.52 to 123, P=0.02). Vimentin expression was not associated with survival (P=0.838). Conclusion: Low E-CA’s IHC expression in high-grade bladder UC is associated with better cancer survival in patients submitted to radical cystectomy.