Introduction: Human epidermal growth factor receptor type 2 (HER2) overexpression is a prognostic factor and a therapeutic target for breast cancer; however, anti-HER2 therapies are ineffective in patients with bladder cancer. The authors investigated the effect of HER2 overexpression (HER2⁺) on the prognosis of muscle-invasive bladder cancer (MIBC). Materials and methods: This retrospective cohort study included patients who underwent initial transurethral resection of bladder tumors between 2005 and 2013 and were registered in the Korea National Health Insurance Database, which provides data on overall survival (OS). Sixty-one patients with clinically nonmetastatic de novo MIBC were included in this study. As a subgroup, 33 patients who underwent immediate radical cystectomy (RC) were analyzed. Univariate and multivariate Cox proportional hazards models were used to identify prognostic factors for survival. A multivariable binary logistic regression model was used to identify the favorable T stage. Results: Among the 61 patients with d-MIBC, 14 were HER2⁺ and 47 HER2^-. Age less than 70 years [hazard ratio (HR): 0.312, CI: 0.16–0.59, P<0.001] and HER2⁺ status (HR: 0.40, CI: 0.19–0.85, P=0.02) were favorable prognostic factors for OS after adjusting for clinical variables. In the RC subgroup, HER2⁺ status was a significant predictive factor for the pT2 stage (HR): 36.8, CI: 4.83–797.41, P<0.01). Age less than 70 years (HR: 0.15, CI: 0.05–0.42, P<0.001) and HER2⁺ status (HR: 0.11, CI: 0.02–0.54, P=0.01) were favorable prognostic factors for OS after adjusting for RC pathological variables. Conclusions: HER2⁺ status could be a marker for an indolent subset of MIBC and could predict favorable survival regardless of RC status. Moreover, HER2⁺ status not only consistently predicted a favorable T stage after RC, but also predicted better survival than pathological outcomes.

Seong KT, et al. Korean J Urol. 2013 Jul;54(7):433-436. http://dx.doi.org/10.4111/kju.2013.54.7.433

Lim JH, et al. Korean J Urol. 2015 Jun;56(6):443-448. http://dx.doi.org/10.4111/kju.2015.56.6.443

Often, a diagnosis of pT3 is made on the basis of radical retropubic prostatectomy specimens, despite a Gleason score of 6 on the preoperative prostate biopsy. Thus, we investigated the preoperative variables in patients displaying these characteristics. Study subjects comprised patients at our institute from 1996 to July 2010 who had exhibited a Gleason score of 6 on their prostate biopsies and had undergone a radical retropubic prostatectomy. Through univariate and multivariate analysis, we investigated pT3 predictive factors including age, preoperative prostate-specific antigen (PSA) levels, transrectal ultrasonography (TRUS)-weighted prostate volume, digital rectal examination findings, bilaterality via prostate biopsy, prostatic cancer in prostate base cores via prostate biopsy, maximum length and percent of prostatic cancer, and number of cores detected in prostatic cancer via prostate biopsy. In the univariate logistic regression mode, a PSA value of 7.4 ng/ml or higher, TRUS-weighted PSA density of 0.2 ng/ml/cc or higher, prostate cancer detected in the basal core, and prostate cancer detected in 2 or more cores out of 12 were predictive factors for extraprostatic extension. Independent predictive factors for stage pT3 were a PSA of 7.4 ng/ml or higher and prostate cancer detected in 2 or more cores out of 12. In the case of patients with the foregoing risk factors, it is advisable not to perform nerve-sparing surgery but to prepare for the possibility of a pT3 stage.