Background: Clinical, pathologic, and molecular evidence indicate that bladder
cancer is heterogeneous with pathologic/molecular features that define distinct
subphenotypes with different prognoses. It is conceivable that specific patterns of
genetic susceptibility are associated with particular subphenotypes.
Objective: To ...»»»»
Background: Clinical, pathologic, and molecular evidence indicate that bladder
cancer is heterogeneous with pathologic/molecular features that define distinct
subphenotypes with different prognoses. It is conceivable that specific patterns of
genetic susceptibility are associated with particular subphenotypes.
Objective: To examine evidence for the contribution of germline genetic variation
to bladder cancer heterogeneity.
Design, setting, and participants: The Spanish Bladder Cancer/EPICURO Study is a
case-control study based in 18 hospitals located in five areas in Spain. Cases were
patients with a newly diagnosed, histologically confirmed, urothelial cell carcinoma
of the bladder from 1998 to 2001. Case diagnoses were reviewed and
uniformly classified by pathologists following the World Health Organisation/
International Society of Urological Pathology 1999 criteria. Controls were hospital-
matched patients (n = 1149).
Measurements: A total of 1526 candidate variants in 423 candidate genes were
analysed. Three distinct subphenotypes were defined according to stage and
grade: low-grade nonmuscle invasive (n = 586), high-grade nonmuscle invasive
(n = 219), and muscle invasive (n = 246). The association between each variant and subphenotype was assessed by polytomous risk models adjusting for potential
confounders. Heterogeneity in genetic susceptibility among subphenotypes was also
tested.
Results and limitations: Two established bladder cancer susceptibility genotypes, NAT2
slow-acetylation and GSTM1-null, exhibited similar associations among the subphenotypes,
as did VEGF-rs25648, which was previously identified in our study. Other
variants conferred risks for specific tumour subphenotypes such as PMS2-rs6463524
and CD4-rs3213427 (respective heterogeneity p values of 0.006 and 0.004), which were
associated with muscle-invasive tumours (per-allele odds ratios [95% confidence
interval] of 0.56 [0.41–0.77] and 0.71 [0.57–0.88], respectively) but not with non–
muscle-invasive tumours. Heterogeneity p values were not robust in multiple testing
according to their false-discovery rate.
Conclusions: These exploratory analyses suggest that genetic susceptibility loci might
be related to the molecular/pathologic diversity of bladder cancer. Validation through
large-scale replication studies and the study of additional genes and single nucleotide
polymorphisms are required.^^^^
