Upregulation of Twist2 in Non-Muscle Invasive Urothelial Carcinoma of the Bladder Correlate with Response to Treatment and Progression

• Published in: Open access Macedonian journal of medical sciences Vol. 6; no. 6; pp. 1017 - 1022
• Main Authors: Wishahi, Mohamed, Khalil, Heba, Badawy, Mohamed H, Elkholy, Amr, Eseily, Khaled, Anis, Shady, Eldahshan, Samir, Kamel, Noura, Romeih, Mahmoud
• Format: Journal Article
• Language: English
• Published: Macedonia Republic of Macedonia 20-06-2018
• Subjects: Clinical Science; Epithelial-mesenchymal transition; NMIBC; Bladder cancer; Twist2; BCG
• ISSN: 1857-9655; 1857-9655
• DOI: 10.3889/oamjms.2018.165

Twist2 is a transcription factor and an epithelial-to-mesenchymal transition that plays an important role in cell polarity, cell adhesion, and has a role in tumour invasion and metastases.
In this study, we examined the expression of Twist2 in non-muscle invasive bladder carcinoma (NMIBC) and correlated the expression with response to treatment and tumour progression.
Data of 305 patients with NMIBC of Ta, T1 were retrieved from hospitals archives. Twist2 expression was examined in tissue samples by immunohistochemistry at initial diagnosis and final follow-up, normal control was 10 normal urothelium, 10 patients with muscle-invasive bladder cancer (MIBC) were a positive control. Treatment of NMIBC was implemented according to the European Association of Urology guidelines on NMIBC. The descriptive statistical analysis included means, standard deviation, p-value; Univariate and multivariate Cox regression analyses.
Twist2 expression score was identified as negative, low (1-15%); medium (15-40%); and high (40-100%). Patients who had low or low medium scores at the initial diagnosis had a good response and a favourable prognosis. Expression of a high score of Twist2 in patients having high-grade T1 tumours showed non-responsiveness to repeated courses of intravesical bacillus Calmette Guerin (BCG) therapy and was upstaged to MIBC.
Twist2 expression in tissue samples of NMIBC would indicate the tumour response to therapy, upgrading and upstaging in the follow up after intravesical BCG therapy.