A 5 Year Analysis of Different Types of Urothelial Malignancies with Special Reference to The Expression Of EGFR in These Tumours

Background: Urothelial neoplasms are a heterogenous group of neoplasms with high propensity for recurrence. EGFR is a novel and potential biological marker for predicting the prognosis of urothelial malignancies. This study highlights the diagnostic and prognostic usefulness of EGFR as a phenotypic marker in urothelial malignancies. Thus, it warrants for anti-tumour therapy and prevention of recurrence of urothelial cancers by anti-EGFR therapy. Methods: Current study includes 500 cases of urothelial tumours received in a major tertiary center in South Kerala. Based on the histopathological features these tumours were classified according to the WHO-2016 criteria.  Proportion in each class of urothelial tumours during the study period was calculated.  In addition to that, we also studied relation between EGFR expression and tumour grade and recurrence. Inclusion criteria: All consecutive cystoscopy biopsies, transurethral resection of bladder tumour (TURBT) and radical cystectomy specimens histologically diagnosed as urothelial malignancies of bladder. Exclusion criteria: All benign urothelial cases. Result: Out of the 500 cases of urothelial malignancies included in the study, the non-invasive papillary urothelial carcinoma, low grade constituted the major part, the second being invasive urothelial carcinoma, high grade, followed by noninvasive urothelial carcinoma, high grade. A strong expression of EGFR was found to be significantly associated with higher tumour grade (P = 0.001) and recurrence (P = 0.010). Conclusion: Histopathology supported by immunohistochemistry is a helpful tool in subtyping the various urothelial malignancies. EGFR can be considered as an adverse prognostic factor, the expression of which increases with tumour grade and stage. EGFR positivity may favor the use of targeted therapy in urothelial malignancies.