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Association Between Positive iNOS mRNA Expression and Recurrence-free Survival Among Patients with Non-muscle-invasive Bladder Cancer

Chih-Ming Lu a, b, Allen W. Chiu c, Yu-Lun Huang d, Ying-Huei Lee e, Ying-Chin Ko a

aGraduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
bDepartment of Urology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
cDepartment of Health, Taipei City Government, Taipei, Taiwan
dDepartment of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
eDivision of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan

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Nitric oxide synthase is the key enzyme of the conversion of L-arginine to L-citrulline and nitric oxide. We conducted a study to investigate the association between positive inducible nitric oxide synthase (iNOS) mRNA expression and recurrence of bladder cancer.
Materials and Methods
Seventy-one patients with primary non-muscleinvasive bladder cancer were enrolled in this study. Tumor tissues were harvested during transurethral resection of bladder tumors. All operations were performed at the same hospital. Recurrence-free patients were followed up for at least 1 year unless tumors recurred during that time. The median intervals of follow-up were 34 months in the recurrence-free group and 12 months in the recurrence group. iNOS mRNA was detected using the RT-PCR-based method.
Bladder cancer patients with positive iNOS mRNA expression had a higher recurrence risk (18.7% vs. 2.6%; p = 0.04). After adjusting for other risk factors, a statistical significance remained (p = 0.04; hazards ratio = 13.27; 95% CI = 1.07–164.36). The patients also had reduced recurrence-free survival (p = 0.019).
The positive expression of iNOS mRNA may be a useful prognostic indicator of bladder cancer.


Bladder cancer; Inducible nitric oxide synthase; Messenger RNA; Recurrence; Reverse transcriptase polymerase chain reaction


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