151
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Gore JL, du Plessis M, Zhang J, Dai D, Thompson DJ, Karsh L, Lane B, Franks M, Chen DY, Bianco FJ, Brown G, Clark W, Kibel AS, Kim H, Lowrance W, Manoharan M, Maroni P, Perrapato S, Sieber P, Trabulsi EJ, Waterhouse R, Spratt DE, Davicioni E, Lotan Y, Lin DW. Clinical Utility of a Genomic Classifier in Men Undergoing Radical Prostatectomy: The PRO-IMPACT Trial. Pract Radiat Oncol 2020; 10:e82-e90. [DOI: 10.1016/j.prro.2019.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
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Singla N, Lafin JT, Woldu SL, Lotan Y, Lewis C, Majmudar K, Savalyeva A, Kenigsberg AP, Kapur P, Margulis V, Strand D, Murray M, Amatruda JF, Bagrodia A. Serum microRNA-371a-3p levels to predict viable germ cell tumor in chemotherapy-naïve patients undergoing retroperitoneal lymph node dissection. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
417 Background: Serum microRNAs are candidate biomarkers for diagnosing and monitoring germ cell tumors (GCTs). The ability of miRNA to inform treatment in low-stage chemotherapy-naïve patients is unexplored. We sought to evaluate the performance characteristics of serum miRNA levels to predict viable GCT in chemotherapy-naïve patients undergoing primary retroperitoneal lymph node dissection (RPLND). Methods: We prospectively collected presurgical serum samples and clinicopathologic characteristics from consecutive chemotherapy-naïve GCT patients undergoing primary RPLND from 2016-2019. Serum miRNAs (-367-3p/-371a-3p/-372-3p/-373-3p/-375) were isolated and quantified. RPLND histopathology was categorized as benign, viable GCT, or teratoma; miRNA levels were compared among groups. Performance characteristics, including receiver operating characteristic (ROC) curves, assessed the discriminative ability of each miRNA signature to predict viable GCT. Results: 24 patients with stage I-II GCT underwent RPLND, revealing viable GCT in 11 (46%), teratoma in 3 (13%), and benign pathology in 10 (42%) patients. miR-371a-3p was the most discriminatory serum miRNA for viable GCT, exhibiting ~13,000-fold increase in expression over teratoma or benign pathology. On ROC analysis, miR-371a-3p had AUC = 0.965, with sensitivity and specificity of 100% and 92%, respectively. The AUC for other serum miRNAs in predicting viable GCT were 0.874 (miR-367-3p), 0.846 (miR-372-3p), and 0.720 (miR-373-3p). These serum miRNAs were not predictive of pure teratoma. Potential limitations include small cohort size and no post-RPLND sera for comparison. Conclusions: Serum miRNAs, particularly miR-371a-3p, can accurately differentiate small-volume viable GCT from benign processes or teratoma in patients with negative serum tumor markers undergoing primary RPLND. If validated, these data suggest a basis to implement precision medicine strategies in treating patients with early-stage GCT.
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Affiliation(s)
- Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | - John T. Lafin
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Cheryl Lewis
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Anna Savalyeva
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Payal Kapur
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Douglas Strand
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Matthew Murray
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Chen L, Gao A, Gannavarapu BS, Garant A, Desai NB, Folkert MR, Ahn C, Roehrborn CG, Lotan Y, Timmerman RD, Hannan R. Safety and outcome of stereotactic body radiation therapy (SBRT) with rectal hydrogel spacer for prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
76 Background: Ultra-hypofractionated radiotherapy delivered using stereotactic body radiotherapy (SBRT) is a cost-effective treatment for localized prostate cancer. Optimal dosing remains unclear, as commonly used 30-40Gy/5fx regimens appear to overestimate hypofractionation’s control benefits. Here, we report the largest experience of 45Gy/5Fx of SBRT for prostate cancer patients treated with hydrogel peri-rectal spacer (‘hydrogel’). Methods: An IRB-approved retrospective protocol was used to conduct a registry search identifying all patients with prostate cancer who received 45Gy/5Fx between 2015-2019 with hydrogel. Genitourinary (GU) and gastrointestinal (GI) toxicities were defined using the NCI Common Toxicity Criteria for Adverse Events (CTCAE) v.5.0. The ASTRO-Phoenix failure definition of Nadir+2 ng/mL was used for biochemical failure. Results: We analyzed 250 low (9.2%), intermediate (85.2%), and high-risk (5.6%) prostate cancer patients with a median follow-up of 9.9 months (range: 0-45.7 months). Acute GU and GI grade ≥ II toxicities were noted in 15.2% and 7.2% of patients, respectively. Late GU grade II and III toxicities occurred in 24.0% and 1.2% of patients, respectively, while late GI grade II and III toxicities occurred in 4.0% and 0.4% of patients, respectively. In patients (N=44) with follow-up >2 years, late GU and GI grade III toxicities occurred in 4.55% and 2.27% of patients, respectively. A significant correlation was noted for acute GI and GU toxicity predicting the respective late GI and GU toxicity (p-value < 0.001 for both). Physician-reported Grade ≥ II new onset erectile dysfunction was 17.2%. A gradual decline in prostate-specific antigen with a mean nadir of 0.04 (95% CI: [0.018, 0.067]) at 36 months was noted. The actuarial freedom from biochemical failure was 96.33% at 3 years. Overall survival was 94.09% at 3 years with no deaths attributed to prostate cancer. Conclusions: SBRT treatment of 45Gy/5Fx with hydrogel is well tolerated with GU/GI toxicities comparable to those reported for conventional fractionation. Although short, the 3-year biochemical control rate is encouraging. Longer follow-up and prospective evaluation are warranted.
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Affiliation(s)
- Lily Chen
- University of Texas Rio Grande Valley School of Medicine, Edinburg, TX
| | - Ang Gao
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Aurelie Garant
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Chul Ahn
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
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154
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Kenigsberg AP, Lafin JT, Meng X, Abe D, Savalyeva A, Singla N, Woldu SL, Lotan Y, Kapur P, Margulis V, Amatruda JF, Bagrodia A. Predictive capacity of miRNA-375 in identifying teratoma in post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
416 Background: Traditional tumor markers for testicular germ cell tumor (TGCT), lactate dehydrogenase (LDH), beta-human chorionic gonadotropin (hCG), and alpha-fetoprotein (AFP), have limited sensitivity in detecting residual tumor on PC-RPLND. Micro-RNAs (miRNA) have emerged as a promising serum markers to predict residual TGCT on RPLND. Previous reports have suggested high levels of miRNA-375 in teratoma. The purpose of this study was to evaluate serum miRNA-375 as a tumor marker for PC-RPLND teratoma. Methods: We prospectively collected pre-surgical serum samples from consecutive GCT patients undergoing PC-RPLND. Serum miRNA-375-3p and -5p expression was validated and quantified by qPCR. Receiver operating characteristic (ROC) analysis and logistic regression were utilized to evaluate test characteristics and predictors of teratoma. Results: 40 patients underwent PC-RPLND. 18 had benign pathology, 2 viable TGCT, 19 teratoma, and 1 embryonal rhabdomyosarcoma. 3 miRNA specimens were excluded as outliers. miRNA-375-5p was undetectable in all samples examined. ROC analysis of miRNA-375-3p revealed an area under the curve of 0.503. Of 19 patients with teratoma, 16 had elevated miRNA-375-3p (84.2% sensitivity). 6/17 with benign pathology had normal mi-RNA-375-3p (35.3% specificity). 16/27 with positive tests harbored teratoma (59.3% positive predictive value). 6/9 with negative miRNA-375-3p had benign disease (66.7% negative predictive value). Univariate analysis demonstrated that clinical stage, pre-RPLND LDH, AFP, hCG, N/L ratio, and miRNA-375-3p were not significant predictors of teratoma. Conclusions: miRNA-375 does not predict teratoma on PC-RPLND. Tissue expression of miRNA-375 did not translate to serum expression in our study. Reliable predictors of teratoma on PC-RPLND remain elusive.
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Affiliation(s)
| | - John T. Lafin
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Xiaosong Meng
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Dreaux Abe
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Anna Savalyeva
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Payal Kapur
- University of Texas Southwestern Medical Center, Dallas, TX
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155
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Meng X, Trivedi H, Kenigsberg AP, Ghandour R, Margulis V, Bagrodia A, Lotan Y, Woldu SL. Effect of increasing Medicaid coverage in Medicaid expansion states on stage at presentation for urologic malignancies. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
400 Background: Medicaid Expansion (ME) was introduced by the Affordable Care Act to improve access to care for low income individuals by increasing the annual income limits to 138% of the poverty line. However, not all states have elected to participate in ME. Using the National Cancer Database (NCDB), we sought to assess the effects of participation in ME on the four most common urologic malignancies. Methods: The NCDB was queried for bladder, prostate, kidney and testis cancer from 2012-2016, to span the time period two years before and two years after the main ME which took place in 2014. Trends in insurance status at time of diagnosis and effects on stage at presentation before and after ME were analyzed. Results: The percentage of patients with Medicaid coverage at the time of diagnosis for all four urologic malignancies increased significantly after 2014, with a commiserate decrease in the percentage of uninsured patients (Table). By 2016, significantly more patients had Medicaid coverage at diagnosis in ME states compared to those in Non-ME states (bladder 5.0% vs 2.5%, prostate 5.9% vs 2.2%, kidney 9.7% vs 4.1%, 19.5% vs 7.2%, all p < 0.01). However, the stage at presentation for all four urologic malignancies did not significantly differ for patients in ME versus non-ME states. Conclusions: Despite an increase in the proportion of patients with Medicaid coverage after 2014, surprisingly, there was not an associated change in stage at presentation for urologic malignancies in ME states. Further long-term analysis is necessary to evaluate if expanded Medicaid coverage impacts overall survival in this patient population.[Table: see text]
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Affiliation(s)
- Xiaosong Meng
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Hersh Trivedi
- University of Texas Southwestern School of Medicine, Dallas, TX
| | | | | | | | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
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156
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Chertack N, Ghandour R, Singla N, Freifeld YN, Hutchinson RC, Courtney KD, Moore JA, Aydin A, Margulis V, Lotan Y, Woldu SL, Bagrodia A. Overcoming sociodemographic factors in the care of testicular cancer patients at a safety net hospital. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
398 Background: Optimal treatment of GCT in underserved populations is subject to barriers that are associated with worse clinical outcomes. We determine whether standardized treatment of GCT can overcome such sociodemographic factors limiting patient care. Methods: The records of all patients undergoing primary treatment for GCT were analyzed from both a public safety net hospital and an academic tertiary care center in the same metropolitan area. Patients at both institutions were managed by the same group of physicians in the context of multidisciplinary cancer care. Patients were grouped by care center and clinicopathologic features, practice patterns, and outcomes were analyzed. Results: 106 and 95 patients underwent initial treatment for GCT between 2006 and 2018 in the safety net hospital and tertiary care center, respectively. Safety net patients were younger (29 vs 33 years, p=0.005), more likely to be Hispanic (79% vs 11%), more likely to be uninsured (80% vs 12%, p<0.001), and present via the emergency department (76% vs 8%, p<0.001). They were more likely to have metastatic (stage II/III) disease (42% vs 26%, p=0.025). On multivariable analysis, presence of lymphovascular invasion (OR=0.30, p=0.008) and embryonal carcinoma component (OR=0.36, p=0.02) were associated with surveillance vs adjuvant treatment for Stage I patients; hospital setting was not (OR=0.67, p=0.55). For patients with Stage II/III NSGCT, there was no difference in performance of PC-RPLND at the safety net hospital vs tertiary care center (52% vs 64%, p=0.53). No difference in recurrence rates between cohorts (5% vs 6%, p=0.76) was observed. Conclusions: Sociodemographic factors are often associated with adverse clinical outcomes in the treatment of GCT; this may be overcome with integrated, standardized management of testicular cancer.
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Affiliation(s)
| | | | - Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Ahmet Aydin
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
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157
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Lotan Y, Meng X. Critical treatment choices for patients with platinum-refractory urothelial carcinoma. Lancet Oncol 2020; 21:11-13. [PMID: 31753728 DOI: 10.1016/s1470-2045(19)30661-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Xiaosong Meng
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
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158
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Yeh HC, Margulis V, Singla N, Hernandez E, Panwar V, Woldu SL, Karam JA, Wood CG, Weizer AZ, Raman JD, Remzi M, Rioux-Leclercq N, Haitel A, Roscigno M, Bolenz C, Bensalah K, Li CC, Ke HL, Li WM, Lee HY, Rapoport LM, Lotan Y, Kapur P, Shariat SF, Hsieh JT, Wu WJ. PTRF independently predicts progression and survival in multiracial upper tract urothelial carcinoma following radical nephroureterectomy. Urol Oncol 2019; 38:496-505. [PMID: 31862213 DOI: 10.1016/j.urolonc.2019.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Polymerase I and transcript release factor (PTRF) has been implicated in cancer biology but its role in upper tract urothelial carcinoma (UTUC) is unknown. From a pilot transcriptome, we identified PTRF was significantly upregulated in high stage UTUC. Bladder cancer transcriptome from The Cancer Genome Atlas (TCGA) supported our finding and high PTRF level also predicted poor survival. We, therefore, investigated the correlation of PTRF with patients' clinicopathologic characteristics and outcomes in a multiracial UTUC cohort. MATERIALS AND METHODS By immunohistochemical staining, PTRF expression was determined using H-score. PTRF expression of 575 UTUCs from 8 institutions, including 118 Asians and 457 Caucasians, was compared with various clinicopathologic parameters. Human urothelial cancer cell lines were used to evaluate the level of PTRF protein and mRNA expression, and PTRF transcript level was assessed in fresh samples from 12 cases of the cohort. The impact of PTRF expression on disease progression, cancer-specific death and overall mortality was also examined. RESULTS High PTRF expression was significantly associated with multifocality (P = 0.023), high pathologic tumor stage (P < 0.00001), nonurothelial differentiation (P = 0.035), lymphovascular invasion (P = 0.003) and lymph node metastasis (P = 0.031). PTRF mRNA expression was also markedly increased in advanced stage UTUC (P = 0.0003). High PTRF expressing patients had consistently worse outcomes than patients with low PTRF expression regardless of demographic variation (all P < 0.005). In multivariate analysis, high PTRF expression was an independent predictor for progression-free survival (hazard ratio [HR] 1.70, 95% confidence interval [CI] 1.07-2.69, P = 0.025), cancer-specific survival (HR 2.09, 95% CI 1.28-3.42, P = 0.003), and overall survival (HR 2.04, 95% CI 1.33-3.14, P = 0.001). CONCLUSIONS Results indicate that PTRF is a predictive biomarker for progression and survival and an independent prognosticator of UTUC. Elevated PTRF could probably propel clinically aggressive disease and serve as a potential therapeutic target for UTUC.
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Affiliation(s)
- Hsin-Chih Yeh
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Elizabeth Hernandez
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vandana Panwar
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jose A Karam
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | | | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Jay D Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Andrea Haitel
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Marco Roscigno
- Department of Urology, Ospedali Riuniti of Bergamo, Bergamo, Italy
| | | | - Karim Bensalah
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Leonid M Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Payal Kapur
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jer-Tsong Hsieh
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.
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159
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Grivas P, Bismar TA, Alva AS, Huang HC, Liu Y, Seiler R, Alimohamed N, Cheng L, Hyndman ME, Dabbas B, Black PC, Davicioni E, Wright JL, Ornstein MC, Mian OY, Kaimakliotis HZ, Gibb EA, Lotan Y. Validation of a neuroendocrine-like classifier confirms poor outcomes in patients with bladder cancer treated with cisplatin-based neoadjuvant chemotherapy. Urol Oncol 2019; 38:262-268. [PMID: 31812633 DOI: 10.1016/j.urolonc.2019.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/08/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Neuroendocrine (NE)-like carcinoma is a newly recognized molecular subtype of conventional urothelial carcinoma of the bladder with transcriptomic profiles and clinical outcomes highly similar to histological NE carcinoma. The identification of NE-like tumors is challenging, as these tumors often appear histologically like urothelial carcinoma and can be missed by routine morphological criteria. We previously developed a single-sample classifier to identify NE-like tumors, which we aimed to validate in an independent cohort. MATERIALS AND METHODS A single-sample genomic classifier was performed on transurethral specimens from a retrospective multicenter cohort of 234 patients who underwent cisplatin-based neoadjuvant chemotherapy and subsequent radical cystectomy. Outcomes were compared for NE-like vs. non-NE-like. RESULTS We identified 10 patients with urothelial tumors of the NE-like subtype, all of which had robust gene expression of neuronal markers, but did not express markers associated with basal or luminal tumors. The cancer-specific mortality rates were significantly higher compared to non-NE-like tumors (P < 0.001), with 5 of the 10 patients dying within 12 months from surgery. CONCLUSIONS The single-sample classifier was able to identify urothelial carcinomas with NE-like subtype. These NE-like tumors have demonstrated transcriptomic profiles and clinical behavior similar to histological NE tumors across multiple patient cohorts. We propose that NE-like tumors should be managed similarly to histological NE tumors, and that standard treatments for small cell lung cancer as well as novel strategies may be evaluated in these patients.
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Affiliation(s)
- Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Tarek A Bismar
- Department of Pathology and Laboratory Medicine, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Aijai S Alva
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | | | - Yang Liu
- Decipher Biosciences, Inc., Vancouver, Canada
| | - Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | - Nimira Alimohamed
- Department of Medical Oncology, Tom Baker Cancer Center, University of Calgary, Calgary, AB, Canada
| | - Liang Cheng
- Department of Pathology, Indiana University, Indianapolis, IN
| | - M Eric Hyndman
- Department of Urology, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Moshe C Ornstein
- Department of Translational Hematology and Oncology Research, Cleveland Clinic, Cleveland, OH
| | - Omar Y Mian
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH
| | | | - Ewan A Gibb
- Decipher Biosciences, Inc., Vancouver, Canada
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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160
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Vantaku V, Donepudi SR, Ambati CR, Jin F, Putluri V, Nguyen K, Rajapakshe K, Coarfa C, Battula VL, Lotan Y, Putluri N. Correction: Expression of ganglioside GD2, reprogram the lipid metabolism and EMT phenotype in bladder cancer. Oncotarget 2019; 10:6843-6844. [PMID: 31827727 PMCID: PMC6887578 DOI: 10.18632/oncotarget.27311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Venkatrao Vantaku
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Sri Ramya Donepudi
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Chandrashekar R. Ambati
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Feng Jin
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Vasanta Putluri
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Khoa Nguyen
- Section of Molecular Hematology and Therapy, Department of Leukemia, and Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kimal Rajapakshe
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Cristian Coarfa
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Venkata Lokesh Battula
- Section of Molecular Hematology and Therapy, Department of Leukemia, and Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Nagireddy Putluri
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
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Vantaku V, Amara CS, Piyarathna DWB, Donepudi SR, Ambati CR, Putluri V, Tang W, Rajapakshe K, Estecio MR, Terris MK, Castro PD, Ittmann MM, Williams SB, Lerner SP, Sreekumar A, Bollag R, Coarfa C, Kornberg MD, Lotan Y, Ambs S, Putluri N. DNA methylation patterns in bladder tumors of African American patients point to distinct alterations in xenobiotic metabolism. Carcinogenesis 2019; 40:1332-1340. [PMID: 31284295 PMCID: PMC6875901 DOI: 10.1093/carcin/bgz128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/23/2019] [Accepted: 07/07/2019] [Indexed: 12/31/2022] Open
Abstract
Racial/ethnic disparities have a significant impact on bladder cancer outcomes with African American patients demonstrating inferior survival over European-American patients. We hypothesized that epigenetic difference in methylation of tumor DNA is an underlying cause of this survival health disparity. We analyzed bladder tumors from African American and European-American patients using reduced representation bisulfite sequencing (RRBS) to annotate differentially methylated DNA regions. Liquid chromatography-mass spectrometry (LC-MS/MS) based metabolomics and flux studies were performed to examine metabolic pathways that showed significant association to the discovered DNA methylation patterns. RRBS analysis showed frequent hypermethylated CpG islands in African American patients. Further analysis showed that these hypermethylated CpG islands in patients are commonly located in the promoter regions of xenobiotic enzymes that are involved in bladder cancer progression. On follow-up, LC-MS/MS revealed accumulation of glucuronic acid, S-adenosylhomocysteine, and a decrease in S-adenosylmethionine, corroborating findings from the RRBS and mRNA expression analysis indicating increased glucuronidation and methylation capacities in African American patients. Flux analysis experiments with 13C-labeled glucose in cultured African American bladder cancer cells confirmed these findings. Collectively, our studies revealed robust differences in methylation-related metabolism and expression of enzymes regulating xenobiotic metabolism in African American patients indicate that race/ethnic differences in tumor biology may exist in bladder cancer.
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Affiliation(s)
- Venkatrao Vantaku
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Chandra Sekhar Amara
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | | | - Sri Ramya Donepudi
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Chandrashekar R Ambati
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Vasanta Putluri
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Wei Tang
- Laboratory of Human Carcinogenesis, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, USA
| | - Kimal Rajapakshe
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Marcos Roberto Estecio
- Center for Cancer Epigenetics, Department of Epigenetics and Molecular Carcinogenesis, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Martha K Terris
- Department of Surgery: Urology, Augusta University, Augusta, GA, USA
| | - Patricia D Castro
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
- Human tissue acquisition and pathology shared source, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Michael M Ittmann
- Human tissue acquisition and pathology shared source, Baylor College of Medicine, Houston, TX, USA
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, TX, USA
| | - Stephen B Williams
- Division of Urology, Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Seth P Lerner
- Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Arun Sreekumar
- Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Roni Bollag
- Department of Pathology, Augusta University, Augusta, GA, USA
| | - Cristian Coarfa
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Michael D Kornberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, Center for Cancer Research (CCR), National Cancer Institute (NCI), National Institutes of Health, Bethesda, MD, USA
| | - Nagireddy Putluri
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
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162
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Singla N, Lotan Y. Challenging cases in urology: Hematuria in a man with prune belly syndrome. Urol Times 2019; 8:9-10. [PMID: 32801402 PMCID: PMC7424596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
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163
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Black AJ, Zargar H, Zargar-Shoshtari K, Fairey AS, Mertens LS, Dinney CP, Mir MC, Krabbe LM, Cookson MS, Jacobsen NE, Griffin J, Montgomery JS, Vasdev N, Yu EY, Xylinas E, Campain NJ, Kassouf W, Dall'Era MA, Seah JA, Ercole CE, Horenblas S, McGrath JS, Aning J, Shariat SF, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Bivalacqua TJ, North S, Barocas DA, Lotan Y, Grivas P, Stephenson AJ, Shah JB, van Rhijn BW, Spiess PE, Daneshmand S, Sridhar SS, Black PC. The prognostic value of the neutrophil-to-lymphocyte ratio in patients with muscle-invasive bladder cancer treated with neoadjuvant chemotherapy and radical cystectomy. Urol Oncol 2019; 38:3.e17-3.e27. [PMID: 31676278 DOI: 10.1016/j.urolonc.2019.09.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 09/02/2019] [Accepted: 09/25/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The neutrophil-to-lymphocyte ratio (NLR) is an attractive marker because it is derived from routine bloodwork. NLR has shown promise as a prognostic factor in muscle invasive bladder cancer (MIBC) but its value in patients receiving neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) is not yet established. Since NLR is related to an oncogenic environment and poor antitumor host response, we hypothesized that a high NLR would be associated with a poor response to NAC and would remain a poor prognostic indicator in patients receiving NAC. METHODS A retrospective analysis was performed on patients with nonmetastatic MIBC (cT2-4aN0M0) who received NAC prior to RC between 2000 and 2013 at 1 of 19 centers across Europe and North America. The pre-NAC NLR was used to split patients into a low (NLR ≤ 3) and high (NLR > 3) group. Demographic and clinical parameters were compared between the groups using Student's t test, chi-squared, or Fisher's exact test. Putative risk factors for disease-specific and overall survival were analyzed using Cox regression, while predictors of response to NAC (defined as absence of MIBC in RC specimen) were investigated using logistic regression. RESULTS Data were available for 340 patients (199 NLR ≤ 3, 141 NLR > 3). Other than age and rate of lymphovascular invasion, demographic and pretreatment characteristics did not differ significantly. More patients in the NLR > 3 group had residual MIBC after NAC than the NLR ≤ 3 group (70.8% vs. 58.3%, P = 0.049). NLR was the only significant predictor of response (odds ratio: 0.36, P = 0.003) in logistic regression. NLR was a significant risk factor for both disease-specific (hazard ratio (HR): 2.4, P = 0.006) and overall survival (HR:1.8, P = 0.02). CONCLUSION NLR > 3 was associated with a decreased response to NAC and shorter disease-specific and overall survival. This suggests that NLR is a simple tool that can aid in MIBC risk stratification in clinical practice.
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Affiliation(s)
- Anna J Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Homayoun Zargar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada; Western Health, Melbourne, Australia
| | - Kamran Zargar-Shoshtari
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL; University of Auckland, Auckland, New Zealand
| | | | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Colin P Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX
| | - Maria C Mir
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, University of Münster, Münster, Germany
| | - Michael S Cookson
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK
| | | | - Joshua Griffin
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | | | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, Stevenage, UK; Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Evan Y Yu
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Nicholas J Campain
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Wassim Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - Marc A Dall'Era
- Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, CA
| | - Jo-An Seah
- Princess Margaret Hospital, Toronto, ON, Canada
| | - Cesar E Ercole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - John S McGrath
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - Jonathan Aning
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY; Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | | | - Andrew C Thorpe
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Todd M Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | | | - Trinity J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Scott North
- Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, AB, Canada
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic
| | | | - Jay B Shah
- Department of Urology, MD Anderson Cancer Center, Houston, TX; Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Bas W van Rhijn
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa FL
| | - Siamak Daneshmand
- USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, CA
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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164
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de Jong JJ, Liu Y, Robertson AG, Seiler R, Groeneveld CS, van der Heijden MS, Wright JL, Douglas J, Dall'Era M, Crabb SJ, van Rhijn BWG, van Kessel KEM, Davicioni E, Castro MAA, Lotan Y, Zwarthoff EC, Black PC, Boormans JL, Gibb EA. Long non-coding RNAs identify a subset of luminal muscle-invasive bladder cancer patients with favorable prognosis. Genome Med 2019; 11:60. [PMID: 31619281 PMCID: PMC6796434 DOI: 10.1186/s13073-019-0669-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/29/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Muscle-invasive bladder cancer (MIBC) is a heterogeneous disease, and gene expression profiling has identified several molecular subtypes with distinct biological and clinicopathological characteristics. While MIBC subtyping has primarily been based on messenger RNA (mRNA), long non-coding RNAs (lncRNAs) may provide additional resolution. METHODS LncRNA expression was quantified from microarray data of a MIBC cohort treated with neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) (n = 223). Unsupervised consensus clustering of highly variant lncRNAs identified a four-cluster solution, which was characterized using a panel of MIBC biomarkers, regulon activity profiles, gene signatures, and survival analysis. The four-cluster solution was confirmed in The Cancer Genome Atlas (TCGA) cohort (n = 405). A single-sample genomic classifier (GC) was trained using ridge-penalized logistic regression and validated in two independent cohorts (n = 255 and n = 94). RESULTS NAC and TCGA cohorts both contained an lncRNA cluster (LC3) with favorable prognosis that was enriched with tumors of the luminal-papillary (LP) subtype. In both cohorts, patients with LP tumors in LC3 (LPL-C3) were younger and had organ-confined, node-negative disease. The LPL-C3 tumors had enhanced FGFR3, SHH, and wild-type p53 pathway activity. In the TCGA cohort, LPL-C3 tumors were enriched for FGFR3 mutations and depleted for TP53 and RB1 mutations. A GC trained to identify these LPL-C3 patients showed robust performance in two validation cohorts. CONCLUSIONS Using lncRNA expression profiles, we identified a biologically distinct subgroup of luminal-papillary MIBC with a favorable prognosis. These data suggest that lncRNAs provide additional information for higher-resolution subtyping, potentially improving precision patient management.
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Affiliation(s)
- Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Yang Liu
- Decipher Biosciences, Inc, Vancouver, British Columbia, Canada
| | - A Gordon Robertson
- Canada's Michael Smith Genome Sciences Center, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | - Clarice S Groeneveld
- Bioinformatics and Systems Biology Laboratory, Federal University of Paraná, Polytechnic Center, Curitiba, Brazil
| | | | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - James Douglas
- Department of Urology, University Hospital of Southampton, Hampshire, UK
| | - Marc Dall'Era
- UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Simon J Crabb
- Department of Medical Oncology, University Hospital of Southampton, Hampshire, UK
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Kim E M van Kessel
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Elai Davicioni
- Decipher Biosciences, Inc, Vancouver, British Columbia, Canada
| | - Mauro A A Castro
- Bioinformatics and Systems Biology Laboratory, Federal University of Paraná, Polytechnic Center, Curitiba, Brazil
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Ellen C Zwarthoff
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ewan A Gibb
- Decipher Biosciences, Inc, Vancouver, British Columbia, Canada
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165
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Kukreja J, Schroeck F, Ehlers M, Lotan Y, Gore J, Smith AB. Is Cystoscopy a Major Source of Discomfort and Anxiety for Bladder Cancer Patients? J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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166
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Kim J, Thompson B, Han S, Lotan Y, McDonald JG, Ye J. Uptake of HDL-cholesterol contributes to lipid accumulation in clear cell renal cell carcinoma. Biochim Biophys Acta Mol Cell Biol Lipids 2019; 1864:158525. [PMID: 31513923 DOI: 10.1016/j.bbalip.2019.158525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/03/2019] [Accepted: 09/05/2019] [Indexed: 01/06/2023]
Abstract
Clear cell renal cell carcinoma (ccRCC), which accounts for the majority of kidney cancer, is known to accumulate excess cholesterol. However, the mechanism and functional significance of the lipid accumulation for development of the cancer remains obscure. In this study, we analyzed 42 primary ccRCC samples, and determined that cholesterol levels of ~ 70% of the tumors were at least two-fold higher than that of benign kidney tissues. Compared to tumors without cholesterol accumulation, those containing excess cholesterol expressed higher levels of scavenger receptor BI (SR-B1), a receptor for uptake of HDL-associated cholesterol, but not genes involved in cholesterol synthesis and uptake of LDL-associated cholesterol. To further determine the roles of sterol accumulation for cancer development, we implanted ccRCC from patients into mouse kidneys using a mouse ccRCC xenograft model. Feeding mice with probucol, a compound lowing HDL-cholesterol, markedly reduced levels of cholesterol in tumors containing excess cholesterol. This treatment, however, did not affect growth of these tumors. Our study suggests that cholesterol overaccumulation in ccRCC is the consequence of increased uptake of HDL-cholesterol as a result of SR-B1 overexpression, but the lipid accumulation by itself may not play a significant role in progression of the cancer.
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Affiliation(s)
- JungYeon Kim
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Bonne Thompson
- Center for Human Nutrition, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Sungwon Han
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jeffrey G McDonald
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Center for Human Nutrition, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Jin Ye
- Department of Molecular Genetics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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167
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Piyarathna DWB, Rajendiran TM, Putluri V, Vantaku V, Soni T, von Rundstedt FC, Donepudi SR, Jin F, Maity S, Ambati CR, Dong J, Gödde D, Roth S, Störkel S, Degener S, Michailidis G, Lerner SP, Pennathur S, Lotan Y, Coarfa C, Sreekumar A, Putluri N. Erratum to "Distinct Lipidomic Landscapes Associated with Clinical Stages of Urothelial Cancer of the Bladder" [Eur Urol Focus 2018;4:907-915]. Eur Urol Focus 2019; 5:920. [PMID: 31474581 DOI: 10.1016/j.euf.2019.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Thekkelnaycke M Rajendiran
- Department of Pathology, Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA; Division of Bioinformatics, Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA
| | - Vasanta Putluri
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Venkatrao Vantaku
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Tanu Soni
- Division of Bioinformatics, Michigan Regional Comprehensive Metabolomics Resource Core, Ann Arbor, MI, USA
| | - Friedrich-Carl von Rundstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Urology, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Sri Ramya Donepudi
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Feng Jin
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Suman Maity
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Chandrashekar R Ambati
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Jianrong Dong
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - Daniel Gödde
- Department of Pathology, Witten-Herdecke University, Wuppertal, Germany
| | - Stephan Roth
- Department of Urology Helios Klinikum, Witten-Herdecke University, Wuppertal, Germany
| | - Stephan Störkel
- Department of Pathology, Witten-Herdecke University, Wuppertal, Germany
| | - Stephan Degener
- Department of Urology Helios Klinikum, Witten-Herdecke University, Wuppertal, Germany
| | | | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Medicine, University of Michigan, Ann Arbor, MI 48015, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Cristian Coarfa
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA; Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA
| | - Arun Sreekumar
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA; Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA; Verna and Marrs McLean Department of Biochemistry, Baylor College of Medicine, Houston, TX, USA
| | - Nagireddy Putluri
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA; Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, TX, USA.
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168
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Abstract
Background: Hematuria is the most common presenting symptom in bladder cancer, but many patients are not adequately evaluated. Objectives: To evaluate the type and frequency of hematuria evaluation in a large public health care system. Patients and Methods: Electronic medical records of adult patients with urinalysis positive for hematuria (≥3 RBCs/HPF) from January 2015 to April 2018 in an outpatient setting were reviewed. Logistic regression was performed to determine factors associated with urology referral and complete evaluation. Results: 11,422 patients met the inclusion criteria; the majority were females (72%) and white race (60%). There were an additional 3,221 patient’s with initial diagnosis of UTI. Median age was 49.0 years. Testing included repeat urinalysis (50%), imaging (26%), urology referral (11.4%), cystoscopy (4.4%) and complete evaluation defined as cystoscopy and US/CT/MRI (4%). In the multivariable analysis, factors independently associated with higher referral to urology were age >35, male gender, hypertension, RBCs ≥20. African American race was associated with less referral to urology. Smoking was a significant variable on univariable analysis only. 37 patients (0.25%) were diagnosed with urological malignancies, with bladder cancer in 33, 12 of whom are missed by excluding UTI patients. Conclusions: In the outpatient setting of a public health care system, the vast majority of patients with hematuria are not referred and evaluated properly across all age categories and regardless of smoking status. This might result in missed cancer diagnoses and requires quality improvement measures.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
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169
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Abstract
Introduction: The current first line therapy for high grade (HG) non-muscle invasive bladder cancer (NMIBC) is intravesical Bacillus Calmette-Guerin (BCG). Patients who recur or progress despite BCG are recommended to undergo radical cystectomy or participate in clinical trials. There is an urgent need for alternative therapies in the BCG-unresponsive NMIBC realm. Areas covered: We queried clinicaltrials.gov and pubmed.gov for current and recently completed early clinical trials pertaining to investigational agents used for the treatment of BCG-unresponsive NMIBC. These included intravesical chemotherapy, immunotherapy, vaccines, gene therapy, viruses, and agents used with novel drug delivery methods. In this article, we discuss the treatment guidelines for non-muscle invasive bladder cancer and therapeutic approaches under investigation in clinical trials. Expert opinion: The FDA is currently allowing single-arm studies as a pathway for approval in BCG-refractory patients with CIS. Although many agents are currently undergoing testing, none have been approved since Valrubicin. Hopefully, we will identify therapies sufficiently effective and durable to achieve FDA approval. Other considerations in this realm include the use of biomarkers in NMIBC to identify patients who will most likely respond to specific interventions. In addition, as systemic agents such as checkpoint inhibitors, are studied further, a multidisciplinary approach may be needed to treat this subset of patients.
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Affiliation(s)
- Jennifer Tse
- Department of Urology, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center , Dallas , TX , USA
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Moschini M, Zamboni S, Soria F, Mathieu R, Xylinas E, Tan WS, Kelly JD, Simone G, Meraney A, Krishna S, Konety B, Mattei A, Baumeister P, Mordasini L, Montorsi F, Briganti A, Gallina A, Stabile A, Sanchez-Salas R, Cathelineau X, Rink M, Necchi A, Karakiewicz PI, Rouprêt M, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Lotan Y, Sooriakumaran P, Shariat SF. Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes. J Clin Med 2019; 8:jcm8081192. [PMID: 31395826 PMCID: PMC6722857 DOI: 10.3390/jcm8081192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Stefania Zamboni
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, 10124 Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Rennes University Hospital, 35000 Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, 75877 Paris, France
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT 06106, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Philipp Baumeister
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Armando Stabile
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H4A 3J1, Canada
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC H4A3J1, Canada
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10038, USA
| | | | - Stephen A Boorjian
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Prasanna Sooriakumaran
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10021, USA.
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Lotan Y, Boorjian SA, Zhang J, Bivalacqua TJ, Porten SP, Wheeler T, Lerner SP, Hutchinson R, Francis F, Davicioni E, Svatek RS, Chen CL, Black PC, Gibb EA. Molecular Subtyping of Clinically Localized Urothelial Carcinoma Reveals Lower Rates of Pathological Upstaging at Radical Cystectomy Among Luminal Tumors. Eur Urol 2019; 76:200-206. [DOI: 10.1016/j.eururo.2019.04.036] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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172
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Konety B, Shore N, Kader AK, Porten S, Daneshmand S, Lough T, Lotan Y. Evaluation of Cxbladder and Adjudication of Atypical Cytology and Equivocal Cystoscopy. Eur Urol 2019; 76:238-243. [DOI: 10.1016/j.eururo.2019.04.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 04/24/2019] [Indexed: 01/03/2023]
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173
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Grivas P, Morgans AK, Lotan Y, Gregg J, Geynisman D, Friedlander T, Agarwal PK, Tesic-Schnell M, Bernstein A, Makari D, Meeks JJ. Abstract CT178: Prevalence of PD-L1 expression in 1st-line (1L) locally advanced/unresectable or metastatic urothelial carcinoma (UC). Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Treatments for 1L advanced, unresectable, or metastatic UC include platinum-based chemotherapy, immune checkpoint blockade, or clinical trial enrollment. Not all patients benefit from, or are eligible for, specific therapies due to comorbidities and performance status. There is an urgent need for biomarker-directed strategies to enable patient selection and improve outcomes. Currently the only clinically used molecular biomarker is programmed cell death ligand-1 (PD-L1) protein expression in tumor tissue. Although variably defined with different assays, higher PD-L1 expression generally correlates with increased response rates to immune checkpoint blockade. Improved understanding of the prevalence and potential prognostic role of PD-L1 testing can further enhance its clinical utility and guide novel clinical trial designs.
Methods: This observational study will enroll 250 patients diagnosed with advanced UC either prior to or during 1L therapy, as initiated at the discretion of participating clinicians from 60 US community sites. The primary endpoint is prevalence (with exact [Clopper-Pearson] 95% CI) of PD-L1 high expression by VENTANA SP263 Assay on pretreatment tumor tissue (classified as PD-L1 high if ≥25% of tumor cells [TCs] exhibit staining; or if immune cells [IC] present >1% and IC with staining ≥25%; or IC present =1% and IC with staining =100%). Secondary endpoints include the association of pretreatment PD-L1 expression with pretreatment tumor tissue mutational burden (tTMB), descriptions of treatment response and outcomes (objective response rate based on RECIST 1.1, progressive-free survival [PFS], and overall survival [OS]) and assessment of their correlations with PD-L1 expression. Exploratory endpoints include the association of pretreatment tumor tissue PD-L1 with pretreatment blood-based tumor mutational burden (bTMB), changes in circulating tumor DNA levels, the correlation between tTMB and bTMB values, and the association of those biomarkers with PFS and OS. Enrollment will take place over 24 months. Patients will be followed for up to 30 months after enrollment. With 250 patients, the 95% CI for 30%, 45%, and 60% observed prevalence of PD-L1 high expression are (24.4%, 36.1%), (38.9%, 51.2%), and (53.6%, 66.1%), respectively; the various secondary and exploratory analyses will be descriptive.
Citation Format: Petros Grivas, Alicia K. Morgans, Yair Lotan, Jeffrey Gregg, Daniel Geynisman, Terence Friedlander, Piyush K. Agarwal, Marija Tesic-Schnell, Andrew Bernstein, Doris Makari, Joshua J. Meeks. Prevalence of PD-L1 expression in 1st-line (1L) locally advanced/unresectable or metastatic urothelial carcinoma (UC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT178.
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Affiliation(s)
| | | | - Yair Lotan
- 3UT Southwestern Medical Center, Dallas, TX
| | - Jeffrey Gregg
- 4University of California, Davis Health, Sacramento, CA
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174
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Vantaku VR, Dong J, Ambati CR, Perera D, Donepudi SR, Amara CS, Putluri V, Shankar RS, Robertson MJ, Piyarathna DWB, Villanueva M, Rundstedt FCV, Karanam B, Ballester LY, Terris MK, Lerner SP, Andrea AB, Villanueva H, Sikora A, Lotan Y, Sreekumar A, Coarfa C, Putluri N. Abstract 5274: Multi-omics integration analysis robustly predicts high grade patient survival and identified altered fatty acid metabolism in high grade bladder cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-5274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Cancer metabolism varies depending on tumor grade. Currently, there is an absence of integration of multi-omics data to predict Bladder cancer (BLCA) survival. We aimed to identify a metabolic signature in high-grade BLCA by integration of unbiased metabolomics, lipidomics and transcriptomics to predict patient survival and to discover novel therapeutic targets. In the current study, using a robust mass spectrometry platform, we conducted global unbiased metabolic and lipid profiling analysis. We identified 518 differential metabolites and 19 lipids of various classes using the NIST MS metabolomics compendium and lipidblast MS/MS libraries, respectively, between low-grade and high-grade BLCA then mapped them to associated genes. Pathway analysis revealed a unique set of biochemical pathways highly deregulated in high-grade BLCA. Integromics analysis identified a molecular gene signature associated with patient poor survival. Importantly, low expression of fatty acid associated enzymes in high-grade tumors was associated with low fatty acid β- oxidation and acyl carnitines in high-grade BLCA and confirmed using tissue microarray. Our key finding is that impaired fatty acid β-oxidation (FAO) by downregulation of fatty acid associate enzymes suggests a crucial role in the progression of low grade to high grade BLCA. Using a metabolic-centered multi-omics based integrative analysis provided a system-level perspective of BLCA that would facilitate the development of novel therapeutics for high-grade BLCA.
Note: This abstract was not presented at the meeting.
Citation Format: Venkata Rao Vantaku, Jianrong Dong, Chandrashekar R Ambati, Dimuthu Perera, Sri Ramya Donepudi, Chandra Sekhar Amara, Vasanta Putluri, Ravi Shiva Shankar, Matthew J Robertson, Danthasinghe Waduge Badrajee Piyarathna, Mariana Villanueva, Friedrich-Carl von Rundstedt, Balasubramanyam Karanam, Leomar Y Ballester, Martha K. Terris, Seth P. Lerner, Apolo B Andrea, Hugo Villanueva, Andrew Sikora, Yair Lotan, Arun Sreekumar, Cristian Coarfa, Nagireddy Putluri. Multi-omics integration analysis robustly predicts high grade patient survival and identified altered fatty acid metabolism in high grade bladder cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5274.
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175
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Ghandour R, Ashbrook C, Freifeld Y, Singla N, El-Asmar JM, Lotan Y, Margulis V, Eggener S, Woldu S, Bagrodia A. Nationwide Patterns of Care for Stage II Nonseminomatous Germ Cell Tumor of the Testicle. Eur Urol Oncol 2019; 3:198-206. [PMID: 31272940 DOI: 10.1016/j.euo.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Management strategies for advanced testicular cancer published from a few, high-volume clinical centers may not be generalizable. OBJECTIVE To discern treatment patterns for stage II nonseminomatous germ cell tumor (NSGCT) in a nationwide cancer registry. DESIGN, SETTING, AND PARTICIPANTS The National Cancer Database was queried for patients with a stage II NSGCT from 2004 to 2014. Patients were stratified by clinical nodal status: cN1/stage IIA, cN2/stage IIB, and cN3/stage IIIC. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS Logistic regression was performed to determine factors independently associated with primary retroperitoneal lymph node dissection (RPLND), primary chemotherapy, and postchemotherapy RPLND (PC-RPLND). RESULTS AND LIMITATIONS A total of 2203 patients (stages IIA, n=1060; IIB, n=869; and IIC, n=274) met the inclusion criteria. Overall, 83% of patients underwent primary chemotherapy, while 17% underwent primary RPLND. Stratified by stage, use of primary chemotherapy was 78%, 88%, and 86% for stages IIA, IIB, and IIC, respectively. Overall, 24% of patients underwent PC-RPLND. Factors independently associated with a lower likelihood of undergoing primary RPLND were a more recent diagnosis and a higher clinical nodal stage. Conversely, patients treated at high-volume facilities were more likely to receive primary RPLND. Factors associated with a higher likelihood of undergoing PC-RPLND included a higher clinical nodal stage, treatment at a high-volume center, and a greater distance of patient travel. Associations based on serum tumor markers could not be assessed. CONCLUSIONS For clinical stage II NSGCT, nationwide utilization of primary chemotherapy is increasing compared with RPLND and is the preferred therapy for more advanced nodal disease. Primary RPLND may be underutilized in stage IIA disease. Utilization of PC-RPLND is driven by nodal stage as well as accessibility of a high-volume center. PATIENT SUMMARY The use of primary retroperitoneal lymph node dissection (RPLND) in early nodal disease is declining, while upfront chemotherapy is increasingly utilized. Primary RPLND may identify patients who are actually pN0 and would not benefit from systemic chemotherapy. Primary RPLND and postchemotherapy RPLND are performed more frequently at centers of excellence.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Caleb Ashbrook
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott Eggener
- Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Solomon Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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176
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Ghandour R, Singla N, Lotan Y. Treatment Options and Outcomes in Nonmetastatic Muscle Invasive Bladder Cancer. Trends Cancer 2019; 5:426-439. [PMID: 31311657 DOI: 10.1016/j.trecan.2019.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022]
Abstract
Muscle-invasive bladder cancer (MIBC) represents 25% of newly diagnosed bladder cancer. MIBC is aggressive and requires timely management. The current standard of care is neoadjuvant chemotherapy followed by radical cystectomy, an approach that could result in significant morbidities. Modifications in the chemotherapy regimens, as well as in perioperative care and surgical approach, have resulted in better overall toxicity profile and faster recovery. However, bladder-preservation in carefully selected patients can lead to acceptable oncological outcomes and better quality of life. Optimization of bladder-preservation protocols and proper identification of patients who tolerate and respond to various treatment modalities will significantly impact patient survival in the coming future.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
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177
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Lotan Y, Bivalacqua TJ, Downs T, Huang W, Jones J, Kamat AM, Konety B, Malmström PU, McKiernan J, O'Donnell M, Patel S, Pohar K, Resnick M, Sankin A, Smith A, Steinberg G, Trabulsi E, Woods M, Daneshmand S. Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA - update 2018. Nat Rev Urol 2019; 16:377-386. [PMID: 31019310 PMCID: PMC7136177 DOI: 10.1038/s41585-019-0184-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blue light cystoscopy (BLC) with hexaminolevulinate (HAL) during transurethral resection of bladder cancer improves detection of non-muscle-invasive bladder cancer (NMIBC) and reduces recurrence rates. Flexible BLC was approved by the FDA in 2018 for use in the surveillance setting and was demonstrated to improve detection. Results of a phase III prospective multicentre study of blue light flexible cystoscopy (BLFC) in surveillance of intermediate-risk and high-risk NMIBC showed that 20.6% of malignancies were identified only by BLFC. Improved detection rates in the surveillance setting are anticipated to lead to improved clinical outcomes by reducing future recurrences and earlier identification of tumours that are unresponsive to therapy. Thus, BLFC has a role in surveillance cystoscopy, and determining which patients will benefit from BLFC and optimal and cost-effective ways of incorporating this technology into surveillance cystoscopy must be developed.
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Affiliation(s)
- Yair Lotan
- UT Southwestern Medical Center, Dallas, TX, USA.
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tracy Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - William Huang
- Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Jeffrey Jones
- Genitourinary Surgery Section, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Per-Uno Malmström
- Department of Urology, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - James McKiernan
- Department of Urology, Columbia University Medical Center, New York City, NY, USA
| | | | - Sanjay Patel
- Department of Urology, University of Oklahoma, Oklahoma City, OK, USA
| | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Matthew Resnick
- Department of Urologic Surgery, Vanderbilt University, Nashville, TX, USA
| | - Alexander Sankin
- Department of Urology, Montefiore Medical Center, New York, NY, USA
| | - Angela Smith
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Gary Steinberg
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Edouard Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Woods
- Department of Urology, Loyola University Chicago, Chicago, IL, USA
| | - Siamak Daneshmand
- Department of Urology, University of Southern California, Los Angeles, CA, USA
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178
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Iroz A, Vecchio M, Lotan Y. FP131COST ANALYSIS OF INCREASED WATER INTAKE ON RECURRENT CYSTITIS BASED ON RESULTS FROM A RANDOMIZED CLINICAL TRIAL. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX, United States of America
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179
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Singla N, Woolford L, Stevens C, Tcheuyap V, Onabolu O, Xie Z, McKay R, Wang T, Christie A, Gahan J, Bagrodia A, Raj G, Sagalowsky AI, Lotan Y, Cadeddu JA, Margulis V, Kapur P, Brugarolas J. Leveraging a robust patient-derived xenograft platform to characterize predictors for engraftment and oncologic outcomes in renal cell carcinoma patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16100 Background: Patient-derived xenograft (PDX) models of renal cell carcinoma (RCC) preserve the biological features of patient tumors, providing a platform for biomarker identification and preclinical drug testing. We sought to identify predictors of successful tumor engraftment and evaluate the prognostic value of engraftment in patients with RCC using a robust murine PDX platform. Methods: 1,200 specimens derived from nephrectomy, thrombectomy, metastasectomy, or biopsy were orthotopically (renally) implanted into NOD/SCID mice between 2008-2018. Non-RCC pathology was excluded. Stable engraftment was defined by successful passage of tumor tissue at least twice with histologic confirmation. Clinicopathologic characteristics were stratified by engraftment status, and multivariate (MVA) logistic regression was used to identify predictors of engraftment. Kaplan-Meier and Cox regression analyses were used to assess the prognostic value of engraftment on patient overall (OS) and disease-free (DFS) survival. Results: 1,003 independent PDX lines derived from 770 RCC patients were included. 157 (15.6%) lines successfully engrafted and exhibited higher tumor grade, stage, size, and presence of sarcomatoid or rhabdoid components. 79.3% of all tumors were of clear cell histology, and histologic distribution did not vary by engraftment status. We have completed whole exome sequencing and RNAseq on 197 and 213 PDX lines, respectively, and downstream analyses will be reported. On MVA, sarcomatoid (OR 5.71, p < 0.001), rhabdoid (OR 2.79, p = 0.046), and advanced stage (OR 1.72, p = 0.049) were significant predictors for engraftment, while high grade and metastatic tumor source were significant only on UVA. Engraftment was associated with poor OS (HR 2.11, p < 0.001) and DFS (HR 1.85, p = 0.020) in patients after controlling for sarcomatoid, rhabdoid, grade, stage, and age on MVA. Conclusions: Aggressive RCC biology correlates with successful engraftment in PDX models. Engraftment remains independently predictive of OS and DFS even after controlling for adverse pathologic features. Engraftment in mice may illuminate aspects of tumor biology not captured by clinicopathologic variables and provide insight into novel determinants of tumor aggressiveness and metastasis.
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Affiliation(s)
- Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Zhiqun Xie
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Renee McKay
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Tao Wang
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Alana Christie
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ganesh Raj
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Vitaly Margulis
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Payal Kapur
- University of Texas Southwestern Medical Center, Dallas, TX
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180
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Kaludov N, Siddiqui MM, Kates M, Tripathi H, Salma AN, Lotan Y, Steinberg GD. Validation of an artificial intelligence algorithm applied to a metabolic substrate analysis of urine for detection of urothelial cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16008 Background: Urine tests such as urine cytology are commonly used for the diagnosis and monitoring of urothelial cancer. These tests are often limited by issues related to sensitivity or specificity. It is well known that derangement of cellular metabolism is one of the hallmarks of carcinogenesis. As urothelial cancer is in constant contact with urine, we hypothesize that metabolite composition in the urine may provide insight into possible urothelial cancer presence in the urinary tract. In this study, we evaluated a metabolomics based urine test for the detection of urothelial cancer. Methods: In this prospective, multi-institutional IRB approved study, urine samples were collected from a total of 57 urothelial cancer patients and non-urothelial cancer controls. Gas chromatography profiles of urine small molecule metabolites were generated to yield over 2400 data points of metabolite peaks and troughs for every urine sample. A machine-learning based algorithm (Abilis Life Sciences) was constructed to predict urothelial cancer versus non-cancer controls through analysis of peaks and trough patterns of urine metabolomics profiles. Predictions were made in a blinded fashion and descriptive statistics of test sensitivity and specificity were generated. Results: The urine metabolite composition of 57 patients were analyzed and urothelial cancer predictions were generated. The test demonstrated an overall accuracy of 89.5% (51 out of 57 cases correctly predicted). The sensitivity of the test was 97.1% (34 out of 35) and specificity was 77.3% (17 out of 22). The Positive Predictive Value is 87.2%, while the Negative Predictive Value is 94.4%. The area under the curve for the receiver operating characteristic curve was 0.87. Conclusions: Urine based metabolic profile analysis using artificial intelligence algorithms is a promising potential diagnostic test for detection of urothelial cancer. Further testing is ongoing to increase robustness of the validation.
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Affiliation(s)
| | | | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Gary D. Steinberg
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
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181
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Batista da Costa J, Gibb EA, Bivalacqua TJ, Liu Y, Oo HZ, Miyamoto DT, Alshalalfa M, Davicioni E, Wright J, Dall’Era MA, Douglas J, Boormans JL, Van der Heijden MS, Wu CL, van Rhijn BW, Gupta S, Grivas P, Mouw KW, Murugan P, Fazli L, Ra S, Konety BR, Seiler R, Daneshmand S, Mian OY, Efstathiou JA, Lotan Y, Black PC. Molecular Characterization of Neuroendocrine-like Bladder Cancer. Clin Cancer Res 2019; 25:3908-3920. [DOI: 10.1158/1078-0432.ccr-18-3558] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
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182
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Lotan Y, Margulis V. Predicting recurrence in patients with localised renal cell carcinoma after nephrectomy. Lancet Oncol 2019; 20:473-475. [PMID: 30880069 DOI: 10.1016/s1470-2045(19)30024-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/11/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Yair Lotan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA.
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX 75390-9110, USA
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183
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Grivas P, Morgans AK, Lotan Y, Gregg JP, Geynisman DM, Friedlander TW, Agarwal PK, Tesic-Schnell M, Bernstein A, Makari D, Meeks JJ. Prevalence of PD-L1 expression in first-line (1L) locally advanced/unresectable or metastatic urothelial carcinoma (UC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.8_suppl.tps67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS67 Background: Treatments for 1L advanced/metastatic UC include platinum-based chemotherapy, an immune checkpoint inhibitor (ICI) or clinical trial enrollment. Not all patients benefit from, or are eligible for, specific therapies due to comorbidities and performance status. There is an urgent need for biomarker-directed strategies to enable patient selection and improve outcomes. Currently the only clinically used molecular biomarker is PD-L1 protein expression in tumor tissue. Although inconsistent and variable among assays, higher PD-L1 expression generally correlates with increased ICI response rate. Improved understanding of the prevalence and potential prognostic and/or predictive role of PD-L1 can further enhance its clinical utility and guide novel clinical trial designs. Methods: This observational study will enroll 250 patients with advanced UC prior to starting or during 1L therapy, as initiated at the discretion of participating clinicians, from 60 US community sites. The primary endpoint is prevalence of PD-L1 expression by VENTANA SP263 Assay (exact [Clopper-Pearson] 95% CI) on pre-treatment tumor tissue. Secondary endpoints include the association of pre-treatment PD-L1 expression with pre-treatment tumor tissue mutational burden (tTMB), descriptions of treatment response and outcomes (ORR based on RECIST 1.1, PFS, OS) and assessment of their correlations with PD-L1 expression. Exploratory endpoints include the association of pre-treatment tumor tissue PD-L1 with pre-treatment blood-based tumor mutational burden (bTMB), changes in circulating tumor DNA (ctDNA) levels at various timepoints, the correlation between tTMB and bTMB values, and the association of those biomarkers for outcomes of PFS and OS. Enrollment will take place over 24 months with follow-up to 30 months from study enrollment. With 250 patients, the 95% CI for 30%, 45%, and 60% observed prevalence of PD-L1 high are (24.4%, 36.1%), (38.9%, 51.2%), and (53.6%, 66.1%), respectively; the various secondary and exploratory analyses will be descriptive.
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Affiliation(s)
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | - Piyush K. Agarwal
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
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184
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Vantaku V, Dong J, Ambati CR, Perera D, Donepudi SR, Amara CS, Putluri V, Ravi SS, Robertson MJ, Piyarathna DWB, Villanueva M, von Rundstedt FC, Karanam B, Ballester LY, Terris MK, Bollag RJ, Lerner SP, Apolo AB, Villanueva H, Lee M, Sikora AG, Lotan Y, Sreekumar A, Coarfa C, Putluri N. Multi-omics Integration Analysis Robustly Predicts High-Grade Patient Survival and Identifies CPT1B Effect on Fatty Acid Metabolism in Bladder Cancer. Clin Cancer Res 2019; 25:3689-3701. [PMID: 30846479 DOI: 10.1158/1078-0432.ccr-18-1515] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 11/09/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE The perturbation of metabolic pathways in high-grade bladder cancer has not been investigated. We aimed to identify a metabolic signature in high-grade bladder cancer by integrating unbiased metabolomics, lipidomics, and transcriptomics to predict patient survival and to discover novel therapeutic targets. EXPERIMENTAL DESIGN We performed high-resolution liquid chromatography mass spectrometry (LC-MS) and bioinformatic analysis to determine the global metabolome and lipidome in high-grade bladder cancer. We further investigated the effects of impaired metabolic pathways using in vitro and in vivo models. RESULTS We identified 519 differential metabolites and 19 lipids that were differentially expressed between low-grade and high-grade bladder cancer using the NIST MS metabolomics compendium and lipidblast MS/MS libraries, respectively. Pathway analysis revealed a unique set of biochemical pathways that are highly deregulated in high-grade bladder cancer. Integromics analysis identified a molecular gene signature associated with poor patient survival in bladder cancer. Low expression of CPT1B in high-grade tumors was associated with low FAO and low acyl carnitine levels in high-grade bladder cancer, which were confirmed using tissue microarrays. Ectopic expression of the CPT1B in high-grade bladder cancer cells led to reduced EMT in in vitro, and reduced cell proliferation, EMT, and metastasis in vivo. CONCLUSIONS Our study demonstrates a novel approach for the integration of metabolomics, lipidomics, and transcriptomics data, and identifies a common gene signature associated with poor survival in patients with bladder cancer. Our data also suggest that impairment of FAO due to downregulation of CPT1B plays an important role in the progression toward high-grade bladder cancer and provide potential targets for therapeutic intervention.
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Affiliation(s)
- Venkatrao Vantaku
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas
| | - Jianrong Dong
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas
| | - Chandrashekar R Ambati
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | - Dimuthu Perera
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | - Sri Ramya Donepudi
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | - Chandra Sekhar Amara
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas
| | - Vasanta Putluri
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | - Shiva Shankar Ravi
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas
| | - Matthew J Robertson
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | | | - Mariana Villanueva
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | | | - Balasubramanyam Karanam
- Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama
| | - Leomar Y Ballester
- Pathology & Laboratory Medicine, Neurosurgery, University of Texas Health Science Center, Houston, Texas
| | | | | | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | - Andrea B Apolo
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Hugo Villanueva
- Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas
| | - MinJae Lee
- Division of Clinical and Translational Sciences, Department of Internal Medicine, McGovern Medical School at The University of Texas Health Science Center, Houston, Texas
| | - Andrew G Sikora
- Department of Otolaryngology-Head & Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Arun Sreekumar
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas.,Verna and Marrs McLean Department of Biochemistry and Molecular Biology, Baylor College of Medicine, Houston, Texas
| | - Cristian Coarfa
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas.,Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery, Baylor College of Medicine, Houston, Texas.,Center for Precision Environmental Health, Baylor College of Medicine, Houston, Texas
| | - Nagireddy Putluri
- Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, Texas.
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185
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Hooton TM, Vecchio M, Lotan Y. Delivery of Bottled Water to Women With Recurrent Urinary Tract Infections: Why in Bulgaria?-Reply. JAMA Intern Med 2019; 179:449. [PMID: 30830193 DOI: 10.1001/jamainternmed.2018.7977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Thomas M Hooton
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
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186
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Singla N, Woolford L, Stevens C, Tcheuyap V, Onabolu O, Xie Z, McKay R, Wang T, Christie A, Gahan J, Bagrodia A, Raj G, Sagalowsky AI, Lotan Y, Cadeddu JA, Margulis V, Kapur P, Brugarolas J. Leveraging a robust patient-derived xenograft platform to characterize predictors for engraftment and oncologic outcomes in renal cell carcinoma patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
651 Background: Patient-derived xenograft (PDX) models of renal cell carcinoma (RCC) preserve the biological features of patient tumors, providing a platform for biomarker identification and preclinical drug testing. We sought to identify predictors of successful tumor engraftment and evaluate the prognostic value of engraftment in patients with RCC using a robust murine PDX platform. Methods: 1,200 specimens derived from nephrectomy, thrombectomy, metastasectomy, or biopsy were orthotopically (renally) implanted into NOD/SCID mice between 2008-2018. Non-RCC pathology was excluded. Stable engraftment was defined by successful passage of tumor tissue at least twice with histologic confirmation. Clinicopathologic characteristics were stratified by engraftment status, and multivariate (MVA) logistic regression was used to identify predictors of engraftment. Kaplan-Meier and Cox regression analyses were used to assess the prognostic value of engraftment on patient overall (OS) and disease-free (DFS) survival. Results: 1,003 independent PDX lines derived from 770 RCC patients were included. 157 (15.6%) lines successfully engrafted and exhibited higher tumor grade, stage, size, and presence of sarcomatoid or rhabdoid components. Whole exome sequencing was performed on 230 PDX lines. On MVA, sarcomatoid (OR 5.71, p < 0.001), rhabdoid (OR 2.79, p = 0.046), and advanced stage (OR 1.72, p = 0.049) were significant predictors for engraftment, while high grade and metastatic tumor source were significant only on UVA. Engraftment was associated with poor OS (HR 2.11, p < 0.001) and DFS (HR 1.85, p = 0.020) in patients after controlling for sarcomatoid, rhabdoid, grade, stage, and age on MVA. Conclusions: Aggressive RCC biology correlates with successful engraftment in PDX models. Engraftment remains independently predictive of OS and DFS even after controlling for adverse pathologic features. Engraftment in mice may illuminate aspects of tumor biology not captured by clinicopathologic variables and provide insight into novel determinants of tumor aggressiveness and metastasis. Efforts are underway to elucidate genomic drivers of engraftment.
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Affiliation(s)
- Nirmish Singla
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | | | | | - Zhiqun Xie
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Renee McKay
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Tao Wang
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Alana Christie
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeffrey Gahan
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ganesh Raj
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Yair Lotan
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Payal Kapur
- University of Texas Southwestern Medical Center, Dallas, TX
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187
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Abstract
INTRODUCTION Metabolomics is a chemical process, involving the characterization of metabolites and cellular metabolism. Recent studies indicate that numerous metabolic pathways are altered in bladder cancer (BLCA), providing potential targets for improved detection and possible therapeutic intervention. We review recent advances in metabolomics related to BLCA and identify various metabolites that may serve as potential biomarkers for BLCA. Areas covered: In this review, we describe the latest advances in defining the BLCA metabolome and discuss the possible clinical utility of metabolic alterations in BLCA tissues, serum, and urine. In addition, we focus on the metabolic alterations associated with tobacco smoke and racial disparity in BLCA. Expert commentary: Metabolomics is a powerful tool which can shed new light on BLCA development and behavior. Key metabolites may serve as possible markers of BLCA. However, prospective validation will be needed to incorporate these markers into clinical care.
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Affiliation(s)
- Chandra Sekhar Amara
- a Department of Molecular and Cell Biology , Baylor College of Medicine , Houston , TX , USA
| | - Venkatrao Vantaku
- a Department of Molecular and Cell Biology , Baylor College of Medicine , Houston , TX , USA
| | - Yair Lotan
- b Department of Urology , University of Texas Southwestern , Dallas , TX , USA
| | - Nagireddy Putluri
- a Department of Molecular and Cell Biology , Baylor College of Medicine , Houston , TX , USA.,c Dan L. Duncan Cancer Center, Advanced Technology Core, Alkek Center for Molecular Discovery , Baylor College of Medicine , Houston , TX , USA
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188
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Tse J, Ghandour R, Singla N, Lotan Y. Molecular Predictors of Complete Response Following Neoadjuvant Chemotherapy in Urothelial Carcinoma of the Bladder and Upper Tracts. Int J Mol Sci 2019; 20:E793. [PMID: 30781730 PMCID: PMC6413224 DOI: 10.3390/ijms20040793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 01/17/2023] Open
Abstract
Urothelial carcinoma of the bladder (UCB) and upper tracts (UTUC) is often regarded as one entity and is managed generally with similar principles. While neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) is an established standard of care in UCB, strong evidence for a similar approach is lacking in UTUC. The longest survival is seen in patients with complete response (pT0) on pathological examination of the RC specimen, but impact of delayed RC in nonresponders may be detrimental. The rate of pT0 following NAC in UTUC is considerably lower than that in UCB due to differences in access and instrumentation. Molecular markers have been evaluated to try to predict response to chemotherapy to reduce unnecessary treatment and expedite different treatment for nonresponders. A variety of potential biomarkers have been evaluated to predict response to cisplatin based chemotherapy including DNA repair genes (ATM, RB1, FANCC, ERCC2, BRCA1, and ERCC1), regulators of apoptosis (survivin, Bcl-xL, and emmprin), receptor tyrosine kinases (EGFR and erbB2), genes involved in cellular efflux (MDR1 and CTR1), in addition to molecular subtypes (Basal, luminal, and p53-like). The current state of the literature on the prediction of response to NAC based on the presence of these biomarkers is discussed in this review.
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Affiliation(s)
- Jennifer Tse
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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189
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Aydin AM, Singla N, Panwar V, Woldu SL, Freifeld Y, Wood CG, Karam JA, Weizer AZ, Raman JD, Remzi M, Rioux-Leclercq N, Haitel A, Roscigno M, Bolenz C, Bensalah K, Westerman ME, Sagalowsky AI, Shariat SF, Lotan Y, Bagrodia A, Kapur P, Margulis V, Krabbe LM. Prognostic significance of BAP1 expression in high-grade upper tract urothelial carcinoma: a multi-institutional study. World J Urol 2019; 37:2419-2427. [DOI: 10.1007/s00345-019-02678-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 02/06/2019] [Indexed: 01/21/2023] Open
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190
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Lotan Y. Progress toward a Nordic standard for the investigation of hematuria: 2019. Scand J Urol 2019; 53:8. [DOI: 10.1080/21681805.2019.1594581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yair Lotan
- Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, TX, USA
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191
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Smith AB, Daneshmand S, Patel S, Pohar K, Trabulsi E, Woods M, Downs T, Huang W, Taylor J, Jones J, O'Donnell M, Bivalacqua T, DeCastro J, Steinberg G, Kamat A, Resnick M, Konety B, Schoenberg M, Jones JS, Lotan Y. Patient-reported outcomes of blue-light flexible cystoscopy with hexaminolevulinate in the surveillance of bladder cancer: results from a prospective multicentre study. BJU Int 2019; 123:35-41. [PMID: 29979488 DOI: 10.1111/bju.14481] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate blue-light flexible cystoscopy (BLFC) with hexaminolevulinate in the office surveillance of patients with non-muscle-invasive bladder cancer with a high risk of recurrence by assessing its impact on pain, anxiety, subjective value of the test and patient willingness to pay. MATERIALS AND METHODS A prospective, multicentre, phase III study was conducted during which the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Pain and 'Was It Worth It' questionnaires were administered at baseline, after surveillance with BLFC and after resection for those referred to the operating room. Comparisons of scores were performed between groups. RESULTS A total of 304 patients were enrolled, of whom 103 were referred for surgical examination. Of these, 63 were found to have histologically confirmed malignancy. Pain levels were low throughout the study. Anxiety levels decreased after BLFC (∆ = -2.6), with a greater decrease among those with negative pathology results (P = 0.051). No differences in anxiety were noted based on gender, BLFC results, or test performance (true-positive/false-positive). Most patients found BLFC 'worthwhile' (94%), would 'do it again' (94%) and 'would recommend it to others' (91%), with no differences based on BLFC results or test performance. Most patients undergoing BLFC (76%) were willing to pay out of pocket. CONCLUSIONS Anxiety decreased after BLFC in patients with negative pathology, including patients with false-positive results. Most of the patients undergoing BLFC were willing to pay out of pocket, found the procedure worthwhile and would recommend it to others, irrespective of whether they had a positive BLFC result or whether this was false-positive after surgery.
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Affiliation(s)
| | | | | | | | - Edouard Trabulsi
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - William Huang
- New York University School of Medicine, New York, NY, USA
| | | | | | | | | | - Joel DeCastro
- Columbia University Medical Center, New York, NY, USA
| | | | - Ashish Kamat
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | | | | | - Mark Schoenberg
- Montefiore Medical Center, The Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX, USA
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192
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Valenberg FJPV, Hiar AM, Wallace E, Bridge JA, Mayne DJ, Beqaj S, Sexton WJ, Lotan Y, Weizer AZ, Jansz GK, Stenzl A, Danella JF, Shepard B, Cline KJ, Williams MB, Montgomery S, David RD, Harris R, Klein EW, Bradford TJ, Wolk FN, Westenfelder KR, Trainer AF, Richardson TA, Egerdie RB, Goldfarb B, Zadra JA, Ge S, Zhao S, Simon IM, Campbell SA, Rhees B, Bates MP, Higuchi RG, Witjes JA. Prospective Validation of an mRNA-based Urine Test for Surveillance of Patients with Bladder Cancer. Eur Urol 2018; 75:853-860. [PMID: 30553612 DOI: 10.1016/j.eururo.2018.11.055] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 11/30/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND A fast, noninvasive test with high sensitivity (SN) and a negative predictive value (NPV), which is able to detect recurrences in bladder cancer (BC) patients, is needed. A newly developed urine assay, Xpert Bladder Cancer Monitor (Xpert), measures five mRNA targets (ABL1, CRH, IGF2, UPK1B, and ANXA10) that are frequently overexpressed in BC. OBJECTIVE To validate Xpert characteristics in patients previously diagnosed with non-muscle-invasive BC. DESIGN, SETTING, AND PARTICIPANTS Voided precystoscopy urine samples were prospectively collected at 22 sites. Xpert, cytology, and UroVysion were performed. If cystoscopy was suspicious for BC, a histologic examination was performed. Additionally, technical validation was performed and specificity was determined in patients without a history or clinical evidence of BC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Test characteristics were calculated based on cystoscopy and histology results, and compared between Xpert, cytology, and UroVysion. RESULTS AND LIMITATIONS Of the eligible patients, 239 with a history of BC had results for all assays. The mean age was 71 yr; 190 patients were male, 53 never smoked, and 64% had previous intravesical immunotherapy (35%) or chemotherapy (29%). Forty-three cases of recurrences occurred. Xpert had overall SN of 74% (95% confidence interval [CI]: 60-85) and 83% (95% CI: 64-93) for high-grade (HG) tumors. The NPV was 93% (95% CI: 89-96) overall and 98% (95% CI: 94-99) for HG tumors. Specificity was 80% (95% CI: 73-85). Xpert SN and NPV were superior to those of cytology and UroVysion. Specificity in non-BC individuals (n=508) was 95% (95% CI: 93-97). CONCLUSIONS Xpert has an improved NPV compared with UroVysion and cytology in patients under follow-up for BC. It represents a promising tool for excluding BC in these patients, reducing the need for cystoscopy. PATIENT SUMMARY Xpert is an easy-to-perform urine test with good performance compared with standard urine tests. It should help optimize the follow-up of recurrent bladder cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Godfrey K Jansz
- Urology Office of G. Kenneth Jansz, Burlington, Ontario, Canada
| | - Arnulf Stenzl
- University Medical Clinic of Tuebingen, Tuebingen, Germany
| | | | - Barry Shepard
- Urological Surgeons of Long Island, PLLC, Garden City, NY, USA
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193
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Cumberbatch MGK, Jubber I, Black PC, Esperto F, Figueroa JD, Kamat AM, Kiemeney L, Lotan Y, Pang K, Silverman DT, Znaor A, Catto JWF. Epidemiology of Bladder Cancer: A Systematic Review and Contemporary Update of Risk Factors in 2018. Eur Urol 2018; 74:784-795. [PMID: 30268659 DOI: 10.1016/j.eururo.2018.09.001] [Citation(s) in RCA: 443] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/01/2018] [Indexed: 01/05/2023]
Abstract
CONTEXT Bladder cancer (BC) is a significant health problem, and understanding the risk factors for this disease could improve prevention and early detection. OBJECTIVE To provide a systematic review and summary of novel developments in epidemiology and risk factors for BC. EVIDENCE ACQUISITION A systematic review of original articles was performed by two pairs of reviewers (M.G.C., I.J., F.E., and K.P.) using PubMed/Medline in December 2017, updated in April 2018. To address our primary objective of reporting contemporary studies, we restricted our search to include studies from the last 5yr. We subdivided our review according to specific risk factors (PICO [Population Intervention Comparator Outcome]). EVIDENCE SYNTHESIS Our search found 2191 articles, of which 279 full-text manuscripts were included. We separated our manuscripts by the specific risk factor they addressed (PICO). According to GLOBOCAN estimates, there were 430000 new BC cases and 165000 deaths worldwide in 2012. Tobacco smoking and occupational exposure to carcinogens remain the factors with the highest attributable risk. The literature was limited by heterogeneity of data. CONCLUSIONS Evidence is emerging regarding gene-environment interactions, particularly for tobacco and occupational exposures. In some populations, incidence rates are declining, which may reflect a decrease in smoking. Standardisation of reporting may help improve epidemiologic evaluation of risk. PATIENT SUMMARY Bladder cancer is common worldwide, and the main risk factors are tobacco smoking and exposure to certain chemicals in the working and general environments. There is ongoing research to identify and reduce risk factors, as well as to understand the impact of genetics on bladder cancer risk.
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Affiliation(s)
| | - Ibrahim Jubber
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Jonine D Figueroa
- Usher Institute of Population Health Sciences and Informatics, CRUK Edinburgh Centre, University of Edinburgh, UK
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lambertus Kiemeney
- Department for Health Evidence, Radboud University Medical Center (Radboudumc), The Netherlands; Department of Urology, Radboud University Medical Center (Radboudumc), The Netherlands
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karl Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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194
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Woldu SL, Matulay JT, Clinton TN, Singla N, Freifeld Y, Sanli O, Krabbe LM, Hutchinson RC, Lotan Y, Hammers H, Hannan R, Brugarolas J, Bagrodia A, Margulis V. Incidence and Outcomes of Delayed Targeted Therapy After Cytoreductive Nephrectomy for Metastatic Renal-Cell Carcinoma: A Nationwide Cancer Registry Study. Clin Genitourin Cancer 2018; 16:e1221-e1235. [DOI: 10.1016/j.clgc.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 12/24/2022]
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195
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Soria F, Droller MJ, Lotan Y, Gontero P, D'Andrea D, Gust KM, Rouprêt M, Babjuk M, Palou J, Shariat SF. An up-to-date catalog of available urinary biomarkers for the surveillance of non-muscle invasive bladder cancer. World J Urol 2018; 36:1981-1995. [PMID: 29931526 PMCID: PMC6280823 DOI: 10.1007/s00345-018-2380-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/15/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES With the advent of novel genomic and transcriptomic technologies, new urinary biomarkers have been identified and tested for bladder cancer (BCa) surveillance. To summarize the current status of urinary biomarkers for the detection of recurrence and/or progression in the follow-up of non-muscle invasive BCa patients, and to assess the value of urinary biomarkers in predicting response to intravesical Bacillus Calmette-Guerin (BCG) therapy. METHODS AND MATERIALS A medline/pubmed© literature search was performed. The performance of commercially available and investigational biomarkers has been reviewed. End points were cancer detection (recurrence), cancer progression, and response to BCG therapy. RESULTS The performance requirements for biomarkers are variable according to the clinical scenario. The clinical role of urinary biomarkers in the follow-up of non-muscle invasive BCa patients remains undefined. The FDA-approved tests provide unsatisfactory sensitivity and specificity levels and their use is limited. Fluorescence in situ hybridization (FISH) has been shown to be useful in specific scenarios, mostly as a reflex test and in the setting of equivocal urinary cytology. FISH and immunocytology could conceivably be used to assess BCG response. Recently developed biomarkers have shown promising results; upcoming large trials will test their utility in specific clinical scenarios in a manner similar to a phased drug development strategy. CONCLUSIONS Current commercially available urinary biomarker-based tests are not sufficiently validated to be widely used in clinical practice. Several novel biomarkers are currently under investigation. Prospective multicenter analyses will be needed to establish their clinical relevance and value.
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Affiliation(s)
- Francesco Soria
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Michael J Droller
- Department of Urology, The Mount Sinai Medical Center, New York, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - David D'Andrea
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kilian M Gust
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Morgan Rouprêt
- Department of Urology, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris Sorbonne Université, Paris, France
| | - Marek Babjuk
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA.
- Department of Urology, Weill Cornell Medical College, New York, USA.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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196
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Freifeld Y, Woldu SL, Singla N, Clinton T, Bagrodia A, Hutchinson R, Lotan Y, Margulis V. Impact of Hospital Case Volume on Outcomes Following Radical Nephrectomy and Inferior Vena Cava Thrombectomy. Eur Urol Oncol 2018; 2:691-698. [PMID: 31411983 DOI: 10.1016/j.euo.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/19/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Radical nephrectomy with inferior vena cava thrombectomy (RN-IVCT) is a complicated procedure for which the impact of hospital case volume on overall survival (OS) is unknown. OBJECTIVE To assess the degree to which renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVC-TT) care is centralized and to evaluate the impact of hospital case volume on outcomes following RN-IVCT. DESIGN, SETTING, AND PARTICIPANTS The National Cancer Data Base was queried for patients with pT3b-c RCC treated with RN-IVCT. Hospitals were classified by case volume percentile as low (<75th percentile, <0.67 cases annually), intermediate (75th-95th percentile, 0.67-2.99 cases annually), or high (>95th percentile, >3 cases annually). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was OS. Secondary outcomes were short-term (30- and 90-d) mortality rates according to hospital case volume. Kaplan-Meier curves and Cox regression model were used to evaluate OS and the effect of covariables. RESULTS AND LIMITATIONS There were 2664 cases of RN-IVCT for pT3b-c tumors reported by 573 institutions, of which 435, 108, and 30 were classified as low, intermediate, and high volume, accounting for 28.5%, 34.5%, and 37% of cases, respectively. Treatment at high-volume institutions was associated with better OS: the median OS was 42, 53, and 60 months for low, intermediate and high-volume centers, respectively (p=0.009). After multivariable adjustment, treatment at a high-volume institution was associated with a 24% relative risk reduction for all-cause mortality compared to treatment at a low-volume institution (hazard ratio 0.76, 95% confidence interval 0.65-0.89; p=0.001). There was no significant difference in short-term mortality following RN-IVCT when stratified by hospital case volume. CONCLUSIONS Higher hospital case volume was associated with longer OS for patients undergoing RN-IVCT. These findings support efforts to centralize care for cases of advanced RCC. PATIENT SUMMARY In this study we looked at the impact of hospital case volume on survival following surgery for renal cell carcinoma and inferior vena cava thrombectomy. Survival was significantly better in high-volume hospitals performing three or more procedures per year.
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Affiliation(s)
- Yuval Freifeld
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ryan Hutchinson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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197
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Courtney KD, Bezwada D, Mashimo T, Pichumani K, Vemireddy V, Funk AM, Wimberly J, McNeil SS, Kapur P, Lotan Y, Margulis V, Cadeddu JA, Pedrosa I, DeBerardinis RJ, Malloy CR, Bachoo RM, Maher EA. Isotope Tracing of Human Clear Cell Renal Cell Carcinomas Demonstrates Suppressed Glucose Oxidation In Vivo. Cell Metab 2018; 28:793-800.e2. [PMID: 30146487 PMCID: PMC6221993 DOI: 10.1016/j.cmet.2018.07.020] [Citation(s) in RCA: 176] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/22/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
Clear cell renal cell carcinoma (ccRCC) is the most common form of human kidney cancer. Histological and molecular analyses suggest that ccRCCs have significantly altered metabolism. Recent human studies of lung cancer and intracranial malignancies demonstrated an unexpected preservation of carbohydrate oxidation in the tricarboxylic acid (TCA) cycle. To test the capacity of ccRCC to oxidize substrates in the TCA cycle, we infused 13C-labeled fuels in ccRCC patients and compared labeling patterns in tumors and adjacent kidney. After infusion with [U-13C]glucose, ccRCCs displayed enhanced glycolytic intermediate labeling, suppressed pyruvate dehydrogenase flow, and reduced TCA cycle labeling, consistent with the Warburg effect. Comparing 13C labeling among ccRCC, brain, and lung tumors revealed striking differences. Primary ccRCC tumors demonstrated the highest enrichment in glycolytic intermediates and lowest enrichment in TCA cycle intermediates. Among human tumors analyzed by intraoperative 13C infusions, ccRCC is the first to demonstrate a convincing shift toward glycolytic metabolism.
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Affiliation(s)
- Kevin D Courtney
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Kidney Cancer Program, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Divya Bezwada
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tomoyuki Mashimo
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kumar Pichumani
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vamsidhara Vemireddy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander M Funk
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jennifer Wimberly
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sarah S McNeil
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Payal Kapur
- Kidney Cancer Program, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ivan Pedrosa
- Kidney Cancer Program, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig R Malloy
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Veterans Affairs North Texas Healthcare System, Dallas, TX, USA
| | - Robert M Bachoo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elizabeth A Maher
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Annette G. Strauss Center for Neuro-Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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198
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Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, Lotan Y. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med 2018; 178:1509-1515. [PMID: 30285042 PMCID: PMC6584323 DOI: 10.1001/jamainternmed.2018.4204] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Increased hydration is often recommended as a preventive measure for women with recurrent cystitis, but supportive data are sparse. OBJECTIVE To assess the efficacy of increased daily water intake on the frequency of recurrent cystitis in premenopausal women. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label, controlled, 12-month trial at a clinical research center (years 2013-2016). Among 163 healthy women with recurrent cystitis (≥3 episodes in past year) drinking less than 1.5 L of fluid daily assessed for eligibility, 23 were excluded and 140 assigned to water or control group. Assessments of daily fluid intake, urinary hydration, and cystitis symptoms were performed at baseline, 6- and 12-month visits, and monthly telephone calls. INTERVENTIONS Participants were randomly assigned to drink, in addition to their usual fluid intake, 1.5 L of water daily (water group) or no additional fluids (control group) for 12 months. MAIN OUTCOMES AND MEASURES Primary outcome measure was frequency of recurrent cystitis over 12 months. Secondary outcomes were number of antimicrobial regimens used, mean time interval between cystitis episodes, and 24-hour urinary hydration measurements. RESULTS The mean (SD) age of the 140 participants was 35.7 (8.4) years, and the mean (SD) number of cystitis episodes in the previous year was 3.3 (0.6). During the 12-month study period, the mean (SD) number of cystitis episodes was 1.7 (95% CI, 1.5-1.8) in the water group compared with 3.2 (95% CI, 3.0-3.4) in the control group, with a difference in means of 1.5 (95% CI, 1.2-1.8; P < .001). Overall, there were 327 cystitis episodes, 111 in the water group and 216 in the control group. The mean number of antimicrobial regimens used to treat cystitis episodes was 1.9 (95% CI, 1.7-2.2) and 3.6 (95% CI, 3.3-4.0), respectively, with a difference in means of 1.7 (95% CI, 1.3-2.1; P < .001). The mean time interval between cystitis episodes was 142.8 (95% CI, 127.4-160.1) and 84.4 (95% CI, 75.4-94.5) days, respectively, with a difference in means of 58.4 (95% CI, 39.4-77.4; P < .001). Between baseline and 12 months, participants in the water group, compared with those in the control group, had increased mean (SD) urine volume (1.4 [0.04] vs 0.1 [0.04] L; P < .001) and voids (2.4 [0.2] vs -0.1 [0.2]; P < .001) and decreased urine osmolality (-402.8 [19.6] vs -24.0 [19.5] mOsm/kg; P < .001). CONCLUSIONS AND RELEVANCE Increased water intake is an effective antimicrobial-sparing strategy to prevent recurrent cystitis in premenopausal women at high risk for recurrence who drink low volumes of fluid daily. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02444975.
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Affiliation(s)
- Thomas M Hooton
- Department of Medicine, School of Medicine, University of Miami, Miami, Florida
| | | | | | - Ivan Tack
- Service des Explorations Fonctionnelles Physiologiques, CHU de Toulouse, Université Paul Sabatier, Toulouse, France
| | | | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas
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199
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Affiliation(s)
- Yuval Freifeld
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Yair Lotan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
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200
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Woldu SL, Sanli O, Clinton TN, Lotan Y. Validating the predictors of outcomes after radical cystectomy for bladder cancer. Cancer 2018; 125:223-231. [DOI: 10.1002/cncr.31799] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/21/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Solomon L. Woldu
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Oner Sanli
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
- Department of Urology; Istanbul University; Istanbul Turkey
| | - Timothy N. Clinton
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
| | - Yair Lotan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas Texas
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