Bladder cancer is the seventh cancer in males worldwide, approximately 25% of patients with urothelial bladder cancer (BC) present with muscle-invasive tumours, stages T2-T4, while 75% of patients present with non-muscle invasive bladder cancer (NMIBC)T1, Ta. There is a well-established relationship between schistosomiasis and urothelial carcinoma. Epithelial-mesenchymal transition Twist2 is responsible for tumor progression and metastasis when it is overexpressed in tumour tissue and detected by immunohistochemistry (IHC). The study included 123 patients with a urothelial carcinoma
of the bladder associated with or without schistosomiasis, patient's data and paraffin embedded tumour tissues were retrieved from different hospitals and archives, inclusion criteria were patients with muscle invasive bladder cancer (MIBC) of transitional cell carcinoma, exclusion criteria were squamous cell carcinoma, adenocarcinoma, and mixed variant histology, clinicopathological characteristics were: 93 patients were stage pT2-T3, No, Mo, 20 patients with NMIBC pT1, and 10 patients had pTa. The study included pre-cystectomy imaging and pathological diagnosis of 93 patients with
MIBC, post-operative pathological assessment of lymph node metastasis. IHC detection in tissue samples of Twist2 oncogene and schistosomal antigen reactivity (SAR) marker was done for the 123 patients. The results showed that MIBC harbour high expression of Twist2 indicated strong factor for lymph node metastasis. NMIBC of Ta had low Twist2 expression, while high grade T1 had medium expression. Schistosoma antigen reactivity was over expressed in MIBC associated with schistosomiasis, but was negative in NMIBC group and in non-schistosomal MIBC. Coexpression of Twist2 and SAR with high expression was in 73.8% patients with lymph node metastasis compared to 17.6% patients with negative expression in non-schistosomal MIBC and had negative lymph node metastasis. The results were significant (P=025). Clinical application indicated that detection of expression of twist2 and schistosomal antigen reactivity marker in tissue sample of trans-urethral resection of bladder tumours prior to surgery would indicate a positive lymph node metastasis in cystectomy operation showed extended lymphadenectomy and adjuvant chemotherapy, introducing imunohistochemistry in bladder cancer stratification would be of high impact on planning proper therapeutic regimen..