Our results showed that Twist expresse in human BT tissues was significantly correlated to the tumor stage, grade and progression (P = 0.000, P = 0.000 and P = 0.021, respectively);Snail was significantly correlated to nodal CFTRinh-172 in vivo involvement (P = 0.000), but Snail was not involved in bladder tumor differentiation, stage, grade and progression;Slug was only significantly correlated to nodal involvement (P = 0.012). It would seem unnecessary to evaluate new progression marker in the very aggressive group of invasive BT of which the prognosis is pejorative, but the comparison of the molecular profile between superficial and

invasive BT could allow individualizing a molecular marker of interest in order to treat earlier and more efficiently Selleckchem DMXAA the high-risk of progression superficial bladder tumor. However, it has been demonstrated Trichostatin A in human tumor cell lines that the forced expression of E-cadherin was not sufficient to reverse the process in Slug, Snail or Twist-expressing cells, and this result supports

that Slug, Snail or Twist might modulate other important signaling pathways involved in tumor progression and metastasis development independently of E-cadherin expression[38–42]. Then, it strengthens the argument to justify both Slug or Snail or Twist expression and potential downstream targets as E-cadherin expression evaluation. It has already been demonstrated that Slug, Snail or Twist overexpression was associated with poor outcome and shorter survival in patients with solid tumors [31–34]. Our findings support this hypothesis as E-cadherin and Twist expression were associated with poor survival both in univariate and multivariate

analyses of all factors Branched chain aminotransferase that influenced survival. Franck Bruyere et al.[43]have found that high expression of Snail in superficial bladder tumors significantly predicts tumor recurrence in these patients. But we did not find any relationship between the expression of Snail and tumor recurrence. That we had a different way to evaluate the immunohistochemistry results may be the reasons. The univariate analysis showed that high Snail expression, histologic grading, CIS and E-cadherin(P = 0.005)were statistically significant risk factors. The backward stepwise multivariate analysis showed that high Snail and Slug expression and E-cadherin were statistically significant independent risk factors. One mechanism of the link between Slug, Snail or Twist expression and poor prognosis may be the reducing of E-cadherin expression allowing cancer cells to migrate but it is probably not the only one[38–42]. Moreover, in our study, we noticed that some patients with high-risk superficial bladder tumors that High expressed Slug, Snail or Twist displayed distant metastasis within 2 years after initial diagnosis even if a cystectomy was performed.