Combinatorial diagnostic value of DcR3, Bcl-2 and PCNA in bladder cancer tissues

Objective To explore the combinatorial diagnostic value of Decoy receptor 3 (DcR3),B-cell lymphoma-2 (Bcl-2) and proliferating cell nuclear antigen (PCNA) in bladder cancer tissues.Methods Immunohistochemistry (IHC) was performed to detect the expression of DcR3,Bcl-2 and PCNA in 224 cases bladder cancer tissues and 56 cases normal bladder tissues.Receiver operating characteristic (ROC) curve was applied to analyze the clinicopathological diagnostic value of the aforementioned 3 biomarkers individually or combinatorially.Results The expressions of DcR3,Bcl-2 and PCNA in bladder cancer were significantly higher than those in normal control (all P ＜ 0.05).The DcR3 level had positive correlations with pathological stages,invasion,lymphatic metastasis and recurrence (all P ＜ 0.05).The expression of Bcl-2 was related to lymphatic metastasis in bladder cancer (P ＜ 0.05).The expression of PCNA had a correlation with pathological stage and lymphatic metastasis (both P ＜ 0.05).DcR3 expression level was associated with that of Bcl-2 and PCNA,whereas Bcl-2 also had consistent correlation with PCNA (P ＜ 0.05).The areas under the curve (AUCs) of DcR3,Bcl-2 and PCNA were higher than the individual level of each marker.The combination of DcR3+PCNA,Bcl-2+PCNA and DcR3+Bcl-2+PCNA offered higher sensitive values than single marker.The highest sensitive value was 0.830,produced by the combination of DcR3+Bcl-2+PCNA.The combination of DcR3+PCNA (100％),Bcl-2+PCNA (96.2％) and DcR3+Bcl-2+PCNA (100％) had higher positive predictive values than single markers.Conclusion Combined detection by immunohistochemistry of DcR3,Bcl-2 and PCNA could noticeably improve the sensitivity and positive predictive values in the diagnosis of bladder cancer,which is superior to individual marker. Key words: Bladder cancer;  Decoy receptor 3;  B-cell lymphoma-2;  Proliferating cell nuclear antigen;  Immunohistochemistry;  Receiver operating characteristic curve