An Investigation Into the Prognostic Significance of Necrosis and Hypoxia in High Grade and Invasive Bladder Cancer

Purpose: We investigated hypoxia and necrosis in high grade and invasive bladder cancer, and related this to prognosis.Materials and Methods: We performed a retrospective observational study of 98 primary cystectomy specimens scored for necrosis, and the hypoxia associated markers carbonic anhydrase IX, hypoxia-inducible factor 1 alpha and 2 alpha, and Bcl2/adenovirus EIB 19 kDa interacting protein 3. Tumor tissue array was used with cores taken from representative and perinecrotic tumor regions. Necrosis was scored on whole sections as absent, less than 5 mm (comedo) or more than 5 mm (gross).Results: Of the 98 cases analyzed followup data were available on 91. Median followup was 22 months (IQR 8–35). Stage was T0/1 to T4 in 18, 20, 41 and 12 cases, respectively. The prevalence of necrosis in bladder cancer was high and it increased with stage (17%, 30%, 70% and 71% at stages T0/1 to T4, respectively). Necrosis was significantly associated with stage (p = 0.0001) and nodal status (p = 0.016). Hypoxia-in...