The role of p27 as a prognostic factor in association with grading and staging of urothelial bladder cancer

Abstract

Background: Bladder cancer (BC) is the tenth most common cancer worldwide with urothelial carcinoma (UC) being the main histological subtype. P27 is a cyclin-dependent kinase inhibitor that negatively regulates cell proliferation.Objective to analyze the clinical significance of p27 expression in Iraqi urothelial bladder cancer patients. Methods: This retrospective cross-sectional analysis of 53 formalin-fixed, paraffin-embedded bladder biopsy samples from December 2022 to July 2023, Teaching hospitals and private labs, these were transurethral biopsies. Clinicopathological parameters like age, sex, tumor morphology, muscle invasion, clinical stage, and histological grade were obtained from histopathological reports and clinical data. P27 expression was analyzed, and p27 expression was correlated with patients' clinical parameters. Results: In 31% of patients, nuclear p27 protein expression was positive. Loss of p27 expression was associated with higher tumour clinical stage (P=0.006) and muscle invasion (P=0.024). Reducing p27 expression score was associated with high grade (p<0.001), clinical stage (P=0.035), and older age > 69 (P=0.05). The link between p27 immunohistochemical expression and histological morphology and sex was not significant. Conclusion: This paper describes p27 expression in Iraqi bladder cancer patients and shows that p27 is involved in bladder carcinogenesis. p27 immunopostivity was inversely associated to bladder tumour muscle invasiveness and clinical stage, making it a prognostic marker. p27 low score is linked to high tumour stage and grade.