الفهرس 
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Abstract
Bladder cancer continues to be one of the most common cancers among men in Egypt. The histopathological profile of bladder cancer in Egypt has changed significantly over the past 26 years as there was significant rise of urothelial carcinoma from 16% to 65.8%, becoming at present the most common tumour type.
The most important predictive parameter for the biological behaviour of urothelial carcinoma, except depth of invasion, is the histological grade of tumour, Tumour grade and stage have been shown to have a strong correlation with tumour recurrence and progression to invasive bladder cancer. A large number of markers have been extensively investigated as potential predictors of bladder tumour recurrence, progression, or response to therapy.
P63, a member of the p53 gene family and is a transcription factor that bind directly to DNA as tetramers, interact with other transcription factors and the transcription machinery, and together control the expression of thousands of genes involved in all aspects of life. P63 and p73 are involved in a broad spectrum of biological activities, including cell proliferation, survival, apoptosis, development, differentiation, senescence, and aging. P63 is crucial for the development and maintenance of stem cells in stratified epithelia.
P63 is expressed at high levels in the basal layers of different epithelial tissues, including the urothelium and plays a key role in regulating epithelial proliferation and differentiation programs and play a critical role in the normal development and maintenance of the human urothelium
P63 expression is a prognostic marker along with the well established prognostic factors, such asTNM stage, indicating that impaired p63 characterizes biological aggressiveness of urothelial neoplasms.
The purpose of this study was:
• To study the expression of p63 in cases of urothelial carcinoma.
• To detect the role of using p63 expression as a prognostic marker in urothelial carcinoma.
The fifty studied cases were obtained from specimens referred to the Pathology Department from Urology Department, Sohag University Hospitals at the period between 2012 to 2016.
All specimens were examined histopathologically by routine H&E stain to evaluate the diagnosis, grading according to WHO/ISUP grading criteria into 17 cases low-grade UC, 33 cases high-grade UC, 12 non invasive UC and 38 invasive UC.
The age range of the 50 studied patients with UC of the urinary bladder was 20-80 years, mean age was 57.2 years, and median age was 56 years. 42/50 (84%) were males and 8/50 (16%) were females with male: female 5:1.
The cases were immunostained with p63 antibody and revealed that p63 was expressed in 28/38 cases of invasive UC (73.7%) with variation in its expression as it was strongly expressed in 12/38 (31.6%), moderately expressed in 8/38 (21%), mildly expressed in 8/38 (21%) and didn’t expressed in 10/38 (26.3%) of cases. And was expressed in all cases of non-invasive UC as it was strongly expressed in 7/12 (58.33%), moderately expressed in 2/12 (16.6%), mildly expressed in 3/12 (25%) of cases.
P63 showed variation in its expression in high grade UC as it was strongly expressed in 8/33(24.2%), moderately expressed in 7/33 (21.2%), mildly expressed in 9/33 (27.3%) and didn’t expressed in 9/33 (27.3%) of cases. Expression of p63 in low grade UC was; strong in 11/17 (64.7%), moderate in 3/17 (17.65%), mild in 2/17 (11.76%) and not expressed in 1/17 (5.88%) of cases
There was significant correlation between p63 expression and tumour grade, P value = (0.034). There was decrease in p63 expression with increasing grade of UC. There was also significant correlation between p63 expression and invasion, p value = (0.047). There was decrease in its expression with invasion. There was no significant correlation between p63 expression and the following variables; age, sex and bilharziasis.
Conclusion:
1. Expression of p63 decreases with increasing grades of the tumour and also it showed decrease in expression by presence of invasion
2. Although the histopathology of the tumour cells remains the standard method in the diagnosis of bladder cancer, the expression of p63 might have a role in assessing the prognosis and progression of bladder cancer.
3. P63 might be a helpful biomarker in predicting the biological behaviour of tumours.
4. P63 identifies patients at low risk for progression who could benefit from conservative therapy.
Recommendation
• Studying the expression of p63 on a large number of cases of urothelial carcinoma of the bladder and different histological types.
• Further studies on different isoforms of p63 are recommended to elucidate more clearly its role as a prognostic indicator and its utility as a tumour marker.
• The diagnostic value of using p63 as a part of the routine follow-up of patients after complete resection of high-risk non-muscle-invasive urothelial carcinoma needs to be accurately addressed.
• Follow up of patients to emphasize the correlation between p63 expression with the patient survival and disease outcome.