WORLD JOURNAL OF ADVANCE
HEALTHCARE RESEARCH

Dr. Ronas Hayder Talib and Professor Dr. Khitam Razzak Kadhim Al-Khafaji

ABSTRACT

Background: Urothelial carcinoma (UC), also known as transitional cell carcinoma, is the predominant type of bladder cancer, making up over 90% of cases in the United States. It originates in the urothelial cells lining the urinary tract and contributes significantly to global morbidity and mortality. The current study, highlight that bladder cancer is the seventh most common cancer among Iraqi men, with an incidence rate of 8.5 per 100,000 men. Globally, bladder cancer ranks as the seventh most common cancer in men. The study aims to evaluate P53 protein expression in both normal bladder epithelium and transitional cell carcinoma (TCC) of the urinary bladder using immunohistochemical analysis and to correlate P53 expression with various clinicopathological parameters in urothelial carcinoma. Method: This cross-sectional study was conducted at Gazi AL-Hariri Hospital and private labs from January to December 2024, with ethical approval from the Scientific Council of Pathology of the Iraqi Board of Medical Specializations. A convenient sampling method was used to enroll 50 patients (40 patients diagnosed with Urothelial Carcinoma and 10 patients diagnosed with cystitis) during 2023, using paraffin-embedded blocks from patient records. The study included patients newly diagnosed with bladder cancer & those with hematuria without bladder mass. With patient known case of bladder carcinoma previously treated as exclusion criteria. Data collected included patient age, sex, histological type, TNM staging (excluding metastasis), tumor grade, muscularis propria invasion, and lympho-vascular invasion. Results: The study analyzed patients with predominantly older age (54% aged ≥60 years) and a majority being male (82%). It focused on cystitis (benign lesion) and two types of malignant urothelial carcinomas. Among the findings, 80% had malignant lesions, with papillary type urothelial carcinoma being the most common. The P53 scoring system revealed a significant correlation with histopathological outcomes. High-grade tumors were frequent (77.5%), with most patients in stage T1 (75%). Associations between histopathological findings and factors like lymphovascular invasion and muscularis propria invasion were explored, revealing notable differences between genders and tumor types. 50% of P53 scoring system (+3), 18% (+2), and 6% (+1). Patients with negative P53 scores were 26%. Histological type is associated with P53 score (P-value 0.0001). 100% of negative-scoring patients developed cystitis. All patients with solid urothelial carcinoma had P53 score (+3), whereas 60.5% of papillary patients had it. The supplied P-values show that high-grade and T1 stage tumors have higher P53 scores (+2 and +3), however the connections are not statistically significant. Conclusion: This study highlights bladder cancer trends, with older males most affected and papillary urothelial carcinoma as the most common type. Solid-type carcinoma is linked to aggressive features like high-grade tumors, lymphovascular invasion, and advanced stages. P53 scoring shows significant utility in distinguishing benign (cystitis) from malignant lesions, with (+3) scores strongly associated with papillary type (60.5%) and solid type (100%) carcinoma. Higher P53 scores (+2, +3) correlate with high-grade and T1 tumors, though statistical significance varies. These findings emphasize the importance of early detection, accurate staging, and tailored treatments for improved outcomes.