Oct-4: a prognostic biomarker of urinary bladder cancer in North India.

Background: The objective of this study was to evaluate Octamer-binding transcription factor 4 (Oct-4), neutrophil to lymphocyte ratio (NLR) and body mass index (BMI) as independent prognostic biomarkers for prediction of urinary bladder cancer (UBC) outcomes. With the advancement in prognostic biomarker discovery, tumor recurrence is difficult to accurately predict in UBC. UBC is costly to treat due to the requirement of frequent invasive follow-up sessions. Therefore, it is of utmost importance to evaluate good prognostic biomarkers for UBC surveillance.

Methods: We studied 39 UBC tissue samples. Oct-4 protein expression was evaluated semiquantitatively by immunohistochemistry (IHC). Complete blood count data and body weight as well as the height of the patients were retrieved and recorded before the date of the first transurethral resection of bladder tumor (TURBT). The follow-up period was 48 months for recurrence-free survival (RFS), progression-free survival (PFS), and overall survival (OS).

Results: Oct-4 expression profile was found to be significantly associated with gender ( = 0.028), tumor grade ( = 0.038), tumor stage ( = 0.003), lymph node status ( = 0.029), recurrence ( = 0.004), progression ( = 0.011), and treatment modality ( = 0.016). Tumor grade and progression were found significant with NLR values (tumor grade,  = 0.006; progression,  = 0.038) and BMI (tumor grade,  = 0.036; progression,  = 0.014). Moreover, BMI was also significantly associated with UBC recurrence ( = 0.014). Kaplan-Meier survival analysis showed poor prognosis with both high Oct-4 expression (RFS,  = 0.001; PFS,  = 0.004; OS,  = 0.014) and high NLR values (RFS,  = 0.049; PFS,  = 0.004; OS,  = 0.005). Patients with high BMI too had poor RFS ( = 0.025) and poor PFS ( = 0.032). Furthermore, multivariate Cox regression analysis, indicated Oct-4 as an independent prognostic biomarker for RFS (HR = 0.240, 95% CI, 0.072-0.804,  = 0.021).

Conclusions: We conclude that the expression profile of Oct-4 will be beneficial in prediction of UBC recurrence, and could have profound implications on the development of new therapeutic targets for UBC treatment.