Journal of Cancer Research and Clinical Oncology

, Volume 135, Issue 9, pp 1169–1175

Predictive value of telomerase reverse transcriptase expression in patients with high risk superficial bladder cancer treated with adjuvant BCG immunotherapy

  • Ioannis Zachos
  • Panagiotis A. Konstantinopoulos
  • Gerasimos P. Vandoros
  • Michalis V. Karamouzis
  • Athanasios G. Papatsoris
  • Thomas Podimatas
  • Antonios Papachristodoulou
  • Michael Chrisofos
  • Charalambos Deliveliotis
  • Athanasios G. Papavassiliou
Original Paper



We conducted a prospective study to determine whether expression of telomerase reverse transcriptase (hTERT) is associated with recurrence-free-survival (RFS) or development of invasive disease in patients with high risk superficial bladder cancer (SBC) that received adjuvant BCG immunotherapy.


Thirty patients with high-grade T1 tumors were evaluated. Pre-BCG TURBT and post-BCG specimens were analyzed for hTERT nucleolar expression by immunohistochemistry.


Post-BCG hTERT expression was statistically significantly lower than pre-BCG hTERT expression. Pre-BCG hTERT nucleolar staining in more than 75% of cells was associated with worse RFS (9 months vs. not yet reached, P = 0.05), while post-BCG hTERT nucleolar staining in more than 50% of the cells was associated with worse RFS (6 months vs. not yet reached, P = 0.001) and development of invasive disease. In multivariate analysis, post-BCG hTERT expression was independently associated with RFS and development of invasive disease.


Immunohistochemical evaluation of hTERT may help define a subset of high risk SBC patients that will eventually fail BCG and may therefore benefit from early salvage cystectomy.


Superficial bladder cancer Telomerase reverse transcriptase BCG Recurrence Multivariate analysis 


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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ioannis Zachos
    • 1
  • Panagiotis A. Konstantinopoulos
    • 2
    • 3
  • Gerasimos P. Vandoros
    • 4
  • Michalis V. Karamouzis
    • 2
  • Athanasios G. Papatsoris
    • 2
    • 5
  • Thomas Podimatas
    • 6
  • Antonios Papachristodoulou
    • 7
  • Michael Chrisofos
    • 5
  • Charalambos Deliveliotis
    • 5
  • Athanasios G. Papavassiliou
    • 2
  1. 1.Department of UrologyUniversity of ThessaliaLarissaGreece
  2. 2.Department of Biological Chemistry, Medical SchoolUniversity of AthensAthensGreece
  3. 3.Division of Hematology, OncologyBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  4. 4.Department of Pathology‘Agios Andreas’ HospitalPatrasGreece
  5. 5.Second Department of Urology, ‘Sismanoglio’ General HospitalUniversity of AthensAthensGreece
  6. 6.Department of Urology‘Agios Andreas’ HospitalPatrasGreece
  7. 7.Department of General Surgery, ‘Laiko’ General Hospital, Medical School University of AthensAthensGreece

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