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A non-diploid DNA status is linked to poor prognosis in renal cell cancer. World J Urol 2020; 39:829-837. [PMID: 32361874 PMCID: PMC7969487 DOI: 10.1007/s00345-020-03226-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/24/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose DNA ploidy measurement has earlier been suggested as a potentially powerful prognostic tool in many cancer types, but the role in renal tumors is still unclear. Methods To clarify its prognostic impact, we analyzed the DNA content of 1320 kidney tumors, including clear cell, papillary and chromophobe renal cell carcinoma (RCC) as well as renal oncocytoma and compared these data with clinico-pathological parameters and patient prognosis. Results A non-diploid DNA content was seen in 37% of 1276 analyzable renal tumors with a striking predominance in chromophobe carcinoma (74.3% of 70 cases). In clear cell carcinoma, a non-diploid DNA content was significantly linked to high-grade (ISUP, Fuhrman, Thoenes; p < 0.0001 each), advanced tumor stage (p = 0.0011), distant metastasis (p < 0.0001), shortened overall survival (p = 0.0010), and earlier recurrence (p < 0.0001). In papillary carcinoma, an aberrant DNA content was significantly linked to high Fuhrman grade (p = 0.0063), distant metastasis (p = 0.0138), shortened overall survival (p = 0.0010), and earlier recurrence (p = 0.0003). Conclusion In summary, the results of our study identify a non-diploid DNA content as a predictor of an unfavorable prognosis in clear cell and papillary carcinoma. Electronic supplementary material The online version of this article (10.1007/s00345-020-03226-8) contains supplementary material, which is available to authorized users.
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Kao YT, Wu CH, Wu SY, Lan SH, Liu HS, Tseng YS. Arsenic treatment increase Aurora-A overexpression through E2F1 activation in bladder cells. BMC Cancer 2017; 17:277. [PMID: 28420331 PMCID: PMC5394624 DOI: 10.1186/s12885-017-3253-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/01/2017] [Indexed: 12/17/2022] Open
Abstract
Background Arsenic is a widely distributed metalloid compound that has biphasic effects on cultured cells. In large doses, arsenic can be toxic enough to trigger cell death. In smaller amounts, non-toxic doses may promote cell proliferation and induces carcinogenesis. Aberration of chromosome is frequently detected in epithelial cells and lymphocytes of individuals from arsenic contaminated areas. Overexpression of Aurora-A, a mitotic kinase, results in chromosomal instability and cell transformation. We have reported that low concentration (≦1 μM) of arsenic treatment increases Aurora-A expression in immortalized bladder urothelial E7 cells. However, how arsenic induces carcinogenesis through Aurora-A activation remaining unclear. Methods Bromodeoxyuridine (BrdU) staining, MTT assay, and flow cytometry assay were conducted to determine cell proliferation. Messenger RNA and protein expression levels of Aurora-A were detected by reverse transcriptional-PCR and Western blotting, respectively. Centrosome of cells was observed by immunofluorescent staining. The transcription factor of Aurora-A was investigated by promoter activity, chromosome immunoprecipitation (ChIP), and small interfering RNA (shRNA) assays. Mouse model was utilized to confirm the relationship between arsenic and Aurora-A. Results We reveal that low dosage of arsenic treatment increased cell proliferation is associated with accumulated cell population at S phase. We also detected increased Aurora-A expression at mRNA and protein levels in immortalized bladder urothelial E7 cells exposed to low doses of arsenic. Arsenic-treated cells displayed increased multiple centrosome which is resulted from overexpressed Aurora-A. Furthermore, the transcription factor, E2F1, is responsible for Aurora-A overexpression after arsenic treatment. We further disclosed that Aurora-A expression and cell proliferation were increased in bladder and uterus tissues of the BALB/c mice after long-term arsenic (1 mg/L) exposure for 2 months. Conclusion We reveal that low dose of arsenic induced cell proliferation is through Aurora-A overexpression, which is transcriptionally regulated by E2F1 both in vitro and in vivo. Our findings disclose a new possibility that arsenic at low concentration activates Aurora-A to induce carcinogenesis.
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Affiliation(s)
- Yu-Ting Kao
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin-Han Wu
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shan-Ying Wu
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Sheng-Hui Lan
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Sheng Liu
- Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Ya-Shih Tseng
- Department of Medical Laboratory Science and Biotechnology, College of Medicine and Life Science, Chung Hwa University of Medical technology, Tainan, Taiwan.
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Chen WT, Hung WC, Kang WY, Huang YC, Chai CY. Urothelial carcinomas arising in arsenic-contaminated areas are associated with hypermethylation of the gene promoter of the death-associated protein kinase. Histopathology 2007; 51:785-92. [DOI: 10.1111/j.1365-2559.2007.02871.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Tseng YS, Tzeng CC, Huang CYF, Chen PH, Chiu AWH, Hsu PY, Huang GC, Wang YC, Liu HS. Aurora-A overexpression associates with Ha-ras codon-12 mutation and blackfoot disease endemic area in bladder cancer. Cancer Lett 2005; 241:93-101. [PMID: 16338065 DOI: 10.1016/j.canlet.2005.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 09/27/2005] [Accepted: 10/07/2005] [Indexed: 11/23/2022]
Abstract
Our data revealed that 59.4% of the bladder cancer specimens showed Aurora-A overexpression, of which 31.8% also had Ha-ras codon-12 mutation; 45.5% were from blackfoot-disease endemic areas in which arsenic exposure is a major environment factor associated with various cancer formation. We further demonstrated that arsenic treatment of the immortalized bladder cell line, E7, increased Aurora-A expression. All together, co-existence of Aurora-A overexpression and Ha-ras mutation suggests a possible additively effect on the tumorigenesis of bladder cancer. In addition, Aurora-A overexpression and up-regulated by arsenic exposure opens a new direction for exploring the occurrence of bladder cancer occurrence in Taiwan.
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Affiliation(s)
- Ya-Shih Tseng
- College of Medicine, Institute of Basic Medical Sciences, National Cheng Kung University, Tainan, Taiwan, ROC
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Lu SN, Chow NH, Wu WC, Chang TT, Huang WS, Chen SC, Lin CH, Carr BI. Characteristics of Hepatocellular Carcinoma in a High Arsenicism Area in Taiwan: A Case???Control Study. J Occup Environ Med 2004; 46:437-41. [PMID: 15167390 DOI: 10.1097/01.jom.0000126023.32772.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Arsenic contamination of drinking water is noticeably linked to the occurrence of skin, bladder, lung cancers, and hepatocellular carcinoma (HCC). Blackfoot disease (BFD) caused by arsenicosis is endemic in southwestern Taiwan, where artesian well water contains high concentrations of arsenic, and mortality from HCC shows a dose-response increase by concentration of arsenic in the well water. This case-control study was conducted to examine the clinical characteristics of HCC patients of BFD-endemic area. A total of 65 HCC cases (54 men and 11 women) were recruited from the BFD-endemic areas. The clinicopathological features were compared with 130 age- and sex-matched HCC control patients from non-BFD-endemic areas. Characteristics analyzed included hepatitis viral infection status, hepatitis activity, liver function, histological findings, computed tomography scan characteristics, and patient survival. No differences were observed between HCC patients or their tumors, from study and control areas.
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Affiliation(s)
- Sheng-Nan Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Kang CH, Yu TJ, Hsieh HH, Yang JW, Shu K, Huang CC, Chiang PH, Shiue YL. The development of bladder tumors and contralateral upper urinary tract tumors after primary transitional cell carcinoma of the upper urinary tract. Cancer 2003; 98:1620-6. [PMID: 14534877 DOI: 10.1002/cncr.11691] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contralateral, metachronous upper urinary tract (UUT) tumors after primary transitional cell carcinoma (TCC) of the UUT are reported rarely, and to the authors' knowledge the risk factors have not been determined to date. In addition, few reports have described the characteristics of recurrent bladder tumors and contralateral UUT tumors and any relation between theses tumor types. METHODS Statistical analysis of data from 223 patients with documented primary UUT-TCC was undertaken. After excluding bilateral involvement and distant metastases, 12 variables were analyzed by multivariate analysis in 189 patients to determine the risk factors for recurrent urothelial tumors. RESULTS The incidence rates of recurrent bladder tumors and contralateral UUT tumors were 31.2% and 5.8%, respectively. Multiplicity was determined as a risk factor for recurrent bladder tumors. Renal insufficiency, uremia, and concurrent bladder tumors significantly predisposed patients to develop contralateral UUT tumors after primary UUT-TCC. The time intervals and stage distributions differed significantly between recurrent bladder tumors and contralateral UTT tumors. Patients who had recurrent bladder tumors had earlier stage tumors and had a shorter time to recur compared with patients who had contralateral, metachronous UUT tumors. CONCLUSIONS For patients with primary UUT-TCC, regular follow-up by cystoscopy is necessary to detect recurrent bladder tumors. Intravenous urography or retrograde pyelography should be performed for patients who have a high risk of developing contralateral UUT tumors.
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Affiliation(s)
- Chih-Hsiung Kang
- Department of Urology and Pathology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Lee YL, Huang SP, Shih MC, Chou YH, Huang CH. Correlation Between Filling Defect Patterns on Urography and Pathologic Staging of Ureteral Transitional Cell Carcinomas. Kaohsiung J Med Sci 2003; 19:447-52. [PMID: 14604319 DOI: 10.1016/s1607-551x(09)70489-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Although a filling defect within the ureter is the most common finding with ureteral transitional cell carcinomas (TCCs), little is known about the correlation between filling defect patterns and pathologic findings. This study was conducted to address this. Between January 1995 and January 2003, 126 pathologically confirmed TCCs of the ureter were included in our study. We classified urographic filling defects into four patterns: ovoid, polypoid, infiltrating, and plaque-like. The correlation between different filling defect patterns and pathologic findings was assessed using Pearson's Chi-squared and logistic regression methods. There were 28 (22%) ovoid filling defects, 42 (33%) polypoid filling defects, 37 (29%) infiltrating filling defects, and 19 (15%) plaque-like filling defects. Infiltrating and plaque-like filling defects were significantly associated with more advanced disease compared to ovoid and polypoid filling defects (odds ratio, 6.75; 95% confidence interval, 3.04-14.98; p < 0.0001). Our results suggest that filling defect presentations may signify different invasive behavior among TCCs. The distribution of ovoid, polypoid, infiltrating, and plaque-like filling defect patterns is significantly different between superficial and advanced ureteral TCCs. We suggest that classifying the filling defect patterns of ureteral TCCs may provide important preoperative information for planning treatment and predicting outcome.
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Affiliation(s)
- Yi-Lun Lee
- Department of Urology, Chi-Shan Hospital, Kaohsiung, Taiwan
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Yang MH, Chen KK, Yen CC, Wang WS, Chang YH, Huang WJS, Fan FS, Chiou TJ, Liu JH, Chen PM. Unusually high incidence of upper urinary tract urothelial carcinoma in Taiwan. Urology 2002; 59:681-7. [PMID: 11992840 DOI: 10.1016/s0090-4295(02)01529-7] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Unusually high incidences of upper urinary tract urothelial carcinoma (UUT-UC) have been reported from the endemic area for "blackfoot disease" of southern Taiwan, and the arsenic-contaminated water was considered to be the reason for this prevalence. In this study, we determined the ratio of UC in different locations, the difference in clinical profiles for UUT-UC and urinary-bladder urothelial carcinoma (UB-UC), and the influence of tumor location on survival in a medical center of northern Taiwan. METHODS A total of 535 patients with pathologically proven UC were reviewed retrospectively in this study, and clinical data were recorded from pathologic and chart reviews. Statistical analyses to determine the association between tumor location and clinical variables, and stratified survival analyses to determine the effect of tumor location on survival were performed. RESULTS The incidence of UUT-UC was relatively high (the ratio of renal pelvis/ureter/urinary bladder was 1:2.08:6.72), even though most of the patients did not reside in the endemic "blackfoot disease" area. Young age, female sex, higher T stage, and elevated pretreatment serum lactate dehydrogenase and creatinine level were significantly associated with UUT-UC after multivariate logistic regression analysis. Tumor location influenced survival in patients with early-stage disease or favorable prognostic factors. CONCLUSIONS Factors other than arsenic water contamination may contribute to the unusually high incidence of UUT-UC in the non-"blackfoot disease" area in Taiwan. UUT-UC carried a more aggressively clinical behavior than UB-UC; tumor location influences patient survival markedly in patients with early-stage disease or favorable prognostic factors.
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Affiliation(s)
- Muh-Hwa Yang
- Division of Medical Oncology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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Ozsahin M, Zouhair A, Villà S, Storme G, Chauvet B, Taussky D, Gouders D, Ries G, Bontemps P, Coucke PA, Mirimanoff RO. Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study. Eur J Cancer 1999; 35:738-43. [PMID: 10505034 DOI: 10.1016/s0959-8049(99)00012-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To assess the prognostic factors in patients with transitional-cell carcinoma of the renal pelvis and/or ureter, a series of 138 patients with transitional-cell carcinoma of the renal pelvis and/or ureter was collected in a retrospective multicentre study. 12 patients with distant metastases were excluded from the statistical evaluation. All but 3 patients underwent radical surgery: nephroureterectomy (n = 71), nephroureterectomy and lymphadenectomy (n = 20), nephroureterectomy and partial bladder resection or transurethral resection (n = 20), nephrectomy (n = 10), and ureterectomy (n = 5). Sixty-one per cent (n = 77) of the tumours were located in the renal pelvis, and 21% (n = 27) in the ureter (both in 22 [17%]). Following surgery, residual tumour was still present in 33 patients (16 microscopic and 17 macroscopic). Postoperative radiotherapy was given to 45 (36%) patients. The median follow-up period was 39 months. In a median period of 9 months, 66% of the patients relapsed (34 local, 7 locoregional, 16 regional, and 24 distant). The 5- and 10-year survival were 29% and 19%, respectively, in all patients. In univariate analyses, statistically significant factors influencing the outcome were Karnofsky index, pT-classification, pN-classification, tumour localisation, grade, and residual tumour after surgery. Multivariate analysis revealed that independent prognostic factors influencing outcome were pT-classification, the existence of residual tumour, and tumour localisation. In patients with urothelial renal pelvis and/or ureter tumours, a radical surgical attitude is mandatory; and the presence of tumour in the ureter is associated with a poorer prognosis.
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Affiliation(s)
- M Ozsahin
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Affiliation(s)
- A Borkowski
- University Clinic of Urology, Warsaw, Poland
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Minimo C, Tawfiek ER, Bagley DH, McCue PA, Bibbo M. Grading of upper urinary tract transitional cell carcinoma by computed DNA content and p53 expression. Urology 1997; 50:869-74. [PMID: 9426716 DOI: 10.1016/s0090-4295(97)00404-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Transitional cell carcinomas of upper urinary tract (uttTCC) constitute 5% to 6% of all urothelial tumors. Ureteropyeloscopy has become the standard for clinical evaluation of uutTCC. Moreover, endoscopic treatments have been advocated as a conservative approach for low grade tumors or patients with intermediate grade tumors whose renal function is compromised. Therefore, grading has become the most predictive variable in defining therapeutic approach. In addition to morphologic evaluation, a series of biologic markers may be used to increase the accuracy of grading such as DNA analysis and p53 protein expression. In this study, we have evaluated these markers by means of cell image analysis with the SAMBA 400 system. METHODS Thirteen cases of uttTCC were studied with cytologic smear, cell block, and histologic confirmation. DNA analysis was performed on cytologic smear. Immunostaining was performed on cell blocks. A grade was assigned on the basis of DNA evaluation and p53 expression quantitation. These grades were combined for each case and compared with the initial cytologic grading and the final histologic grading. RESULTS Cytology alone diagnosed TCC in all but 1 case that was diagnosed atypical. Discrepancies were found in primary grading: cytologic grading concurred with histologic grading in 6 of the 13 cases. CONCLUSIONS These results, although in a limited but selected number of cases, show the potential of computerized evaluation of biologic markers as parameters for a more objective grading of tumors.
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Affiliation(s)
- C Minimo
- Department of Pathology/Cell Biology, Thomas Jefferson University, Philadelphia 19107-5244, USA
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Affiliation(s)
- P H Chiang
- Department of Urology and Surgery, Kaohsiung Medical College, Taiwan, Republic of China
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Rey A, Lara PC, Redondo E, Valdés E, Apolinario R. Overexpression of p53 in transitional cell carcinoma of the renal pelvis and ureter. Relation to tumor proliferation and survival. Cancer 1997; 79:2178-85. [PMID: 9179065 DOI: 10.1002/(sici)1097-0142(19970601)79:11<2178::aid-cncr16>3.0.co;2-t] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical management of patients with tumors of the upper urinary tract is based mainly on histologic grade and stage of the tumors. In recent years, tumor proliferation has also proved to be an important factor in determining the prognosis of these and other transitional cell tumors. The aim of this study was to assess the role of p53 in regulating cell proliferation and tumor progression and to define its value in predicting the long term survival of patients with these tumors. Such information could be of use in selecting treatment in individual cases. METHODS Eighty-three patients with urothelial tumors of the renal pelvis and ureter diagnosed and treated between 1975 and 1993 were included in this study. p53 immunostaining was performed on paraffin embedded tissue. Tumor location, histologic grade, histologic pattern, tumor proliferation by Ki-67, local (T classification), lymph node (N classification), vascular and perineural invasion, and clinical stage (TNM) were assessed in relation to p53 overexpression (Mann-Whitney U test and analysis of variance comparisons) and as prognostic factors for survival in both univariate analysis (log rank test) and multivariate analysis (Cox proportional hazards model). RESULTS Overexpression of p53 was related to tumor proliferation as assessed by Ki-67 (P < 0.01), T classification (Ta vs. T1-4; P < 0.01), N classification (P < 0.054), and TNM staging (Stage 0 vs. I-IV; P < 0.01). There was also a statistically significant relation to vascular (P < 0.002) and perineural invasion (P < 0.04). Fifteen-year actuarial survival for the whole group was 75%. Patients having tumors with low p53 overexpression (< 30% of stained nuclei) had a better survival rate (88%) than those having tumors with high (> 30%) p53 overexpression (65%) (P < 0.02), and this effect reached statistical significance with high grade (P < 0.02) and infiltrating tumors (P < 0.04). Patients with low p53 and Ki-67 expression had a 15-year survival rate of 100%; in contrast, patients with overexpression of both markers had a 15-year survival rate of 61% (P < 0.003). In a multivariate analysis, only T classification (P < 0.001) and p53-Ki-67 expression (P < 0.026) were statistically significant. CONCLUSIONS Overexpression of p53 is related to increased tumor proliferation and disease progression and is of value in determining the long term survival of patients with tumors of the renal pelvis and ureter. p53 immunostaining can be used to distinguish low risk patients in the theoretically unfavorable high grade, high stage group, and when used together with Ki-67 index, it is a predictive factor for survival.
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Affiliation(s)
- A Rey
- Department of Pathology, Hospital Nuestra Señlora del Pino, Las Palmas de Gran Canaria, Spain
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