World J Nephrol Urol

World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Nephrol Urol and Elmer Press Inc

Journal website http://www.wjnu.org

Original Article

Volume 3, Number 3, September 2014, pages 118-123

Snail Is an Independent Prognostic Indicator for Predicting Recurrence and Progression in Non-Muscle Invasive Bladder Cancer

Figure 1. Expression and location of Snail in human bladder cancer. (A) Negative immunostaining for Snail, low grade. (B) Positive Snail immunostaining in cytoplasm, low grade. (C) Positive Snail immunostaining in cytoplasm and nucleus, high grade. (D-F) are part of (A-C) in the rectangle respectively (× 400, scale bar: 50 µm).

Figure 2. Kaplan-Meier curves show that recurrence-free (A) and progression-free (B) survival rates were significantly higher in high vs. low Snail group (log-rank test P < 0.010 and P < 0.001, respectively).

**Table 1.** Association of Snail Expression (Negative vs. Positive) in NMIBC Specimens With Clinical and Pathological Characteristics of 332 Patients Treated With TUR
Variable	N	Snail expression status	P
Total	332	228 (68.7%)	104 (31.3%)	-
Age (years)
≤ 65	171 (51.5%)	119 (75.3%)	39 (24.7%)	0.013
> 65	161 (48.5%)	109 (62.6%)	65 (37.4%)
Gender
Female	59 (17.8%)	42 (71.2%)	17 (28.8%)	0.646
Male	273 (82.2%)	186 (68.1%)	87 (31.9%)
Tumor size
< 3 cm	221 (66.6%)	159 (71.9%)	62 (28.1%)	0.070
≥ 3 cm	111 (33.4%)	69 (62.2%)	42 (37.8%)
Number of tumors
Single	205 (61.7%)	154 (75.1%)	51 (24.9%)	0.001
Multiple	127 (38.3%)	74 (58.3%)	53 (41.7%)
Tumor stage
Ta	204 (61.4%)	164 (79.2%)	43 (20.8%)	< 0.0001
T1	128 (38.6%)	64 (51.2%)	61 (48.8%)
Tumor grade
G1	114 (34.3%)	99 (86.8%)	15 (13.2%)	< 0.0001
G2	168 (50.6%)	110 (65.7%)	58 (43.3%)
G3	50 (15.1%)	18 (36.7%)	31 (63.3%)
Concomitant CIS
No	309 (93.1%)	217 (70.7%)	90 (29.3%)	0.006
Yes	23 (6.9%)	11 (44.0%)	14 (56.0%)
Recurrence
No	213 (64.2%)	165 (77.5%)	48 (22.5%)	< 0.0001
Yes	119 (35.8%)	63 (52.9%)	56 (47.1%)
Progression
No	292 (88.0%)	211 (72.3%)	81 (27.7%)	< 0.0001
Yes	40 (12.0%)	17 (42.5%)	23 (57.5%)

Table 1. Association of Snail Expression (Negative vs. Positive) in NMIBC Specimens With Clinical and Pathological Characteristics of 332 Patients Treated With TUR

Variable

Snail expression status

Negative

Positive

Total

332

228 (68.7%)

104 (31.3%)

Age (years)

≤ 65

171 (51.5%)

119 (75.3%)

39 (24.7%)

0.013

> 65

161 (48.5%)

109 (62.6%)

65 (37.4%)

Gender

Female

59 (17.8%)

42 (71.2%)

17 (28.8%)

0.646

Male

273 (82.2%)

186 (68.1%)

87 (31.9%)

Tumor size

< 3 cm

221 (66.6%)

159 (71.9%)

62 (28.1%)

0.070

≥ 3 cm

111 (33.4%)

69 (62.2%)

42 (37.8%)

Number of tumors

Single

205 (61.7%)

154 (75.1%)

51 (24.9%)

0.001

Multiple

127 (38.3%)

74 (58.3%)

53 (41.7%)

Tumor stage

204 (61.4%)

164 (79.2%)

43 (20.8%)

< 0.0001

128 (38.6%)

64 (51.2%)

61 (48.8%)

Tumor grade

114 (34.3%)

99 (86.8%)

15 (13.2%)

< 0.0001

168 (50.6%)

110 (65.7%)

58 (43.3%)

50 (15.1%)

18 (36.7%)

31 (63.3%)

Concomitant CIS

309 (93.1%)

217 (70.7%)

90 (29.3%)

0.006

Yes

23 (6.9%)

11 (44.0%)

14 (56.0%)

Recurrence

213 (64.2%)

165 (77.5%)

48 (22.5%)

< 0.0001

Yes

119 (35.8%)

63 (52.9%)

56 (47.1%)

Progression

292 (88.0%)

211 (72.3%)

81 (27.7%)

< 0.0001

Yes

40 (12.0%)

17 (42.5%)

23 (57.5%)

**Table 2.** Univariate Cox Regression Model of Clinical and Pathological Variables Predicting Recurrence and Progression in 332 Patients in Our Cohort
Variable	Recurrence	Progression
Age: ≤ 65 years, > 65 years	1.160	0.420	0.792	0.469
Gender: male, female	1.102	0.682	1.327	0.456
Number of tumors: single, multiple	2.609	< 0.0001	1.840	0.055
Tumor size: < 3 cm, ≥ 3 cm	2.760	< 0.0001	4.657	0.0001
T category: Ta, T1	3.079	< 0.0001	7.953	< 0.0001
Grade: G1, G2 vs. G3	3.566	< 0.0001	8.624	< 0.0001
Carcinoma in situ: no, yes	2.391	0.002	5.989	< 0.0001
Snail: negative, positive	2.976	< 0.0001	4.713	< 0.0001

Table 2. Univariate Cox Regression Model of Clinical and Pathological Variables Predicting Recurrence and Progression in 332 Patients in Our Cohort

Variable

Recurrence

Progression

P value

Age: ≤ 65 years, > 65 years

1.160

0.420

0.792

0.469

Gender: male, female

1.102

0.682

1.327

0.456

Number of tumors: single, multiple

2.609

< 0.0001

1.840

0.055

Tumor size: < 3 cm, ≥ 3 cm

2.760

< 0.0001

4.657

0.0001

T category: Ta, T1

3.079

< 0.0001

7.953

< 0.0001

Grade: G1, G2 vs. G3

3.566

< 0.0001

8.624

< 0.0001

Carcinoma in situ: no, yes

2.391

0.002

5.989

< 0.0001

Snail: negative, positive

2.976

< 0.0001

4.713

< 0.0001

**Table 3.** Multivariable Cox Regression Model of Clinical and Pathological Variables Predicting Recurrence and Progression in 332 Patients in Our Cohort
Variable	Recurrence	Progression
Number of tumors: single, multiple	1.91 (1.31, 2.79)	0.001	1.33 (0.69, 2.58)	0.394
Tumor size: < 3 cm, ≥ 3 cm	2.11 (1.45, 3.06)	< 0.0001	2.92 (1.48, 5.76)	0.002
T category: Ta, T1	1.64 (1.09, 2.48)	0.018	2.61 (1.18, 5.73)	0.017
Grade: G1, G2 vs. G3	1.63 (1.03, 2.58)	0.037	2.36 (1.11, 5.05)	0.026
Carcinoma in situ: no, yes	1.63 (0.91, 2.91)	0.098	2.51 (1.08, 5.84)	0.033
Snail: negative, positive	1.95 (1.33, 2.88)	0.001	2.34 (1.19, 4.62)	0.014

Table 3. Multivariable Cox Regression Model of Clinical and Pathological Variables Predicting Recurrence and Progression in 332 Patients in Our Cohort

Variable

Recurrence

Progression

P value

Number of tumors: single, multiple

1.91 (1.31, 2.79)

0.001

1.33 (0.69, 2.58)

0.394

Tumor size: < 3 cm, ≥ 3 cm

2.11 (1.45, 3.06)

< 0.0001

2.92 (1.48, 5.76)

0.002

T category: Ta, T1

1.64 (1.09, 2.48)

0.018

2.61 (1.18, 5.73)

0.017

Grade: G1, G2 vs. G3

1.63 (1.03, 2.58)

0.037

2.36 (1.11, 5.05)

0.026

Carcinoma in situ: no, yes

1.63 (0.91, 2.91)

0.098

2.51 (1.08, 5.84)

0.033

Snail: negative, positive

1.95 (1.33, 2.88)

0.001

2.34 (1.19, 4.62)

0.014