High Immunohistochemical Expression of Runt-Related Transcription Factor 2 (RUNX2) Is Associated With High Tumor Grade, Muscle Invasion, Lymph Node Metastasis, and Advanced Stage in Urinary Bladder Cancer

Introduction Urinary bladder cancer is a common malignancy worldwide and remains a significant contributor to cancer-related morbidity and mortality. The recent shift towards personalized oncology has led to the investigation and adoption of various biomarkers as therapeutic targets. However, validated biomarkers predicting tumor behavior and progression in bladder cancer remain limited. The Runt-related transcription factor (RUNX) proteins are transcription factors playing key roles in signaling pathways associated with cancer development. There are limited studies in the literature addressing the role of RUNX2 in urinary bladder cancers. Therefore, we have attempted to analyze the immunohistochemical expression of RUNX2 in urinary bladder cancer in this study and to evaluate the significance of its immunoexpression in relation to clinicopathological parameters such as age and gender of patient, tumor size and site, tumor grade, histological subtype, muscle invasion, lymph node metastasis, and pTNM stage. Materials and methods This observational study was carried out in the Pathology department of our institute. Sixty histopathologically confirmed consecutive cases of urinary bladder carcinoma over a period from 1st January 2022 to 31st March 2025 were included. Immunohistochemistry was performed on these cases using archival paraffin blocks and the RUNX2 antibody. The final immunohistochemical results were analyzed in relation to clinicopathological variables. Result The data were analyzed using SPSS (version 23.0, IBM Corp., Armonk, New York, USA). To assess statistical significance (p-value) and correlations, the chi-square test and Fisher's exact test were used. For establishing statistical significance, a p-value of less than 0.05 was considered. High immunohistochemical expression of RUNX2 exhibited a significant association (p < 0.05) with high tumor grade, muscle invasion, lymph node metastasis, and advanced stage (pTNM) of the tumor. Conclusions This study documents that there exists a statistically significant association between immunoexpression of RUNX2 and grade of tumor, muscle invasion, advanced stage, and lymph node metastasis in urinary bladder cancers, which can guide further management and treatment and can be utilized in the near future for the development of targeted therapy for urinary bladder cancer patients.