World Journal of Pathology Volume No 6

Original Article Open Access

The Relationship of p16, Ki-67, Bcl-2, P53 and CK20 Immune Expressions with Recurrence in Superficial Bladder Tumors

Özben Yalçin, Yeşim Sağlican, Süleyman Özdemir, Naziye Özkan, Naşide Mangir and Funda Eren
World Journal of Pathology 2015, 4:8



Superficial urothelial carcinoma of the urinary bladder account for 70-80% of all newly diagnosed bladder cancer cases. Of these, approximately 50-75% will experience a recurrence in 12 months and 20 to 25 % will progress to invasive types during the person's lifetime.


In the present study, we investigated the relationship between the recurrence rate and the expressions of various genes via immunohistochemical analysis in order to assess their applicability as prognostic factors for clinical behavior and differential diagnosis.

Material and Methods

Methods The antibodies that were used in this study; tumor suppressor gene P53, apoptosis activity determinant bcl-2 cell proliferation marker Ki-67, CK20 cytokeratin isotope and tumor suppressor gene P16. Fifty eight cases diagnosed with primary superficial bladder cancer were investigated.


Recurrence was detected in 62.1% of the cases. Progression to a higher grade tumor was detected in 38.9% of the 36 cases that showed recurrence. A marked statistically significant relationship was found between recurrence and diffuse or no staining with CK20, more than 50% heterogeneous expression with P16, and more than 1% expression with bcl-2. Evaluation of the effect of the CK20, bcl-2 and P16 parameters with logistic regression analysis showed that the model was significant (p<0.05) and more than 1% staining with bcl-2 had an explanatory power of 8.057 times on the recurrence rate. A significant relationship was found between the pathological stage and histological grade of the cases and the CK 20 and Ki 67 expressions.


In conclusion, determining CK20, bcl–2, and p16 expressions with immunohistochemical methods can provide guidance in predicting the recurrence of superficial bladder tumors. Abnormal CK20 staining and Ki-67 expression is related to tumor grade and can be used to support the diagnosis in controversial cases.


superficial urinary bladder cancer, recurrence, immunohistochemical analysis

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