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Manini C, López-Fernández E, López JI, Angulo JC. Advances in Urological Cancer in 2022, from Basic Approaches to Clinical Management. Cancers (Basel) 2023; 15:cancers15051422. [PMID: 36900214 PMCID: PMC10000370 DOI: 10.3390/cancers15051422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 02/26/2023] Open
Abstract
This Special Issue includes 12 articles and 3 reviews dealing with several basic and clinical aspects of prostate, renal, and urinary tract cancer published during 2022 in Cancers, and intends to serve as a multidisciplinary chance to share the last advances in urological neoplasms [...].
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Affiliation(s)
- Claudia Manini
- Department of Pathology, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy
- Correspondence:
| | - Estíbaliz López-Fernández
- FISABIO Foundation, 46020 Valencia, Spain
- Faculty of Health Sciences, European University of Valencia, 46023 Valencia, Spain
| | - José I. López
- Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain
| | - Javier C. Angulo
- Clinical Department, Faculty of Medical Sciences, European University of Madrid, 28005 Madrid, Spain
- Department of Urology, University Hospital of Getafe, 28907 Madrid, Spain
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Larrinaga G, Calvete-Candenas J, Solano-Iturri JD, Martín AM, Pueyo A, Nunes-Xavier CE, Pulido R, Dorado JF, López JI, Angulo JC. (Pro)renin Receptor Is a Novel Independent Prognostic Marker in Invasive Urothelial Carcinoma of the Bladder. Cancers (Basel) 2021; 13:cancers13225642. [PMID: 34830803 PMCID: PMC8616163 DOI: 10.3390/cancers13225642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 01/01/2023] Open
Abstract
Simple Summary This is a novel description of (Pro)renin receptor (PRR) protein and its prognostic role in invasive urothelial cancer of the bladder. Using a tissue microarray, we investigated PRR expression and other immunohistochemical markers including p53, immune-checkpoint inhibition, and basal and luminal phenotypes in a series of patients with invasive urothelial carcinoma of the bladder treated with radical cystectomy. PRR expression is an independent prognostic marker and could be a potential target in urothelial carcinoma that should be further investigated. Abstract (Pro)renin receptor (PRR) is being investigated in several malignancies as it activates pathogenic pathways that contribute to cell proliferation, immunosuppressive microenvironments, and acquisition of aggressive neoplastic phenotypes. Its implication in urothelial cancer (UC) has not been evaluated so far. We retrospectively evaluate the prognostic role of PRR expression in a series of patients with invasive UC treated with radical cystectomy and other clinical and histopathological parameters including p53, markers of immune-checkpoint inhibition, and basal and luminal phenotypes evaluated by tissue microarray. Cox regression analyses using stepwise selection evaluated candidate prognostic factors and disease-specific survival. PRR was expressed in 77.3% of the primary tumors and in 70% of positive lymph nodes. PRR expression correlated with age (p = 0.006) and was associated with lower preoperatively hemoglobin levels. No other statistical association was evidenced with clinical and pathological variables (gender, ASA score, Charlson comorbidity index, grade, pT, pN) or immunohistochemical expressions evaluated (CK20, GA-TA3, CK5/6, CD44, PD-L1, PD-1, B7-H3, VISTA, and p53). PRR expression in primary tumors was associated with worse survival (log-rank, p = 0.008). Cox regression revealed that PRR expression (HR 1.85, 95% CI 1.22–2.8), pT (HR 7.02, 95% CI 2.68–18.39), pN (HR 2.3, 95% CI 1.27–4.19), and p53 expression (HR 1.95, 95% CI 1.1–3.45) were independent prognostic factors in this series. In conclusion, we describe PRR protein and its prognostic role in invasive UC for the first time. Likely mechanisms involved are MAPK/ERK activation, Wnt/β-catenin signaling, and v-ATPAse function.
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Affiliation(s)
- Gorka Larrinaga
- Department of Nursing, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, 48903 Barakaldo, Spain; (J.D.S.-I.); (C.E.N.-X.); (R.P.); (J.I.L.)
- Correspondence:
| | | | - Jon Danel Solano-Iturri
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, 48903 Barakaldo, Spain; (J.D.S.-I.); (C.E.N.-X.); (R.P.); (J.I.L.)
- Service of Pathology, Donostia University Hospital, 20014 San Sebastian, Spain
| | - Ana M. Martín
- Service of Pathology, University Hospital of Getafe, 28905 Madrid, Spain;
| | - Angel Pueyo
- Foundation for Biomedical Research and Innovation of University Hospitals Infanta Leonor and South-East, 28003 Madrid, Spain;
- Heath Science PhD Program, UCAM Universidad Católica San Antonio de Murcia, Guadalupe de Maciascoque, 30107 Murcia, Spain
| | - Caroline E. Nunes-Xavier
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, 48903 Barakaldo, Spain; (J.D.S.-I.); (C.E.N.-X.); (R.P.); (J.I.L.)
- Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, 0310 Oslo, Norway
| | - Rafael Pulido
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, 48903 Barakaldo, Spain; (J.D.S.-I.); (C.E.N.-X.); (R.P.); (J.I.L.)
- Ikerbasque, The Basque Foundation for Science, 48011 Bilbao, Spain
| | | | - José I. López
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, 48903 Barakaldo, Spain; (J.D.S.-I.); (C.E.N.-X.); (R.P.); (J.I.L.)
- Department of Pathology, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Javier C. Angulo
- Clinical Department, Faculty of Medical Sciences, European University of Madrid, 28005 Madrid, Spain;
- Department of Urology, University Hospital of Getafe, 28907 Madrid, Spain
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Plata A, Guerrero-Ramos F, Garcia C, González-Díaz A, Gonzalez-Valcárcel I, de la Morena JM, Díaz-Goizueta FJ, del Álamo JF, Gonzalo V, Montero J, Sousa-Escandón A, León J, Pontones JL, Delgado F, Adriazola M, Pascual Á, Calleja J, Ruano A, Martínez-Piñeiro L, Angulo JC. Long-Term Experience with Hyperthermic Chemotherapy (HIVEC) Using Mitomycin-C in Patients with Non-Muscle Invasive Bladder Cancer in Spain. J Clin Med 2021; 10:jcm10215105. [PMID: 34768625 PMCID: PMC8584886 DOI: 10.3390/jcm10215105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Intravesical mitomycin-C (MMC) combined with hyperthermia is increasingly used in non-muscle invasive bladder cancer (NMIBC), especially in the context of a relative BCG shortage. We aim to determine real-world data on the long-term treatment outcomes of adjunct hyperthermic intravesical chemotherapy (HIVEC) with MMC and a COMBAT® bladder recirculation system (BRS); (2) Methods: A prospective observational trial was performed on patients with NMIBC treated with HIVEC using BRS in nine academic institutions in Spain between 2012–2020 (HIVEC-E). Treatment effectiveness (recurrence, progression and overall mortality) was evaluated in patients treated with HIVEC MMC 40mg in the adjuvant setting, with baseline data and a clinical follow-up, that comprise the Full Analysis Set (FAS). Safety, according to the number and severity of adverse effects (AEs), was evaluated in the safety (SAF) population, composed by patients with at least one adjunct HIVEC MMC instillation; (3) Results: The FAS population (n = 502) received a median number of 8.78 ± 3.28 (range 1–20) HIVEC MMC instillations. The median follow-up duration was 24.5 ± 16.5 (range 1–81) months. Its distribution, based on EAU risk stratification, was 297 (59.2%) for intermediate and 205 (40.8%) for high-risk. The figures for five-year recurrence-free and progression-free survival were 50.37% (53.3% for intermediate and 47.14% for high-risk) and 89.83% (94.02% for intermediate and 84.23% for high-risk), respectively. A multivariate analysis identified recurrent tumors (HR 1.83), the duration of adjuvant HIVEC therapy <4 months (HR 1.72) and that high-risk group (HR 1.47) were at an increased risk of recurrence. Independent factors of progression were high-risk (HR 3.89), recurrent tumors (HR 3.32) and the induction of HIVEC therapy without maintenance (HR 2.37). The overall survival was determined by patient age at diagnosis (HR 3.36) and the treatment duration (HR 1.82). The SAF population (n = 592) revealed 406 (68.58%) patients without AEs and 186 (31.42%) with at least one AE: 170 (28.72%) of grade 1–2 and 16 (2.7%) of grade 3–4. The most frequent AEs were dysuria (10%), pain (7.1%), urgency (5.7%), skin rash (4.9%), spasms (3.7%) and hematuria (3.6%); (4) Conclusions: HIVEC using BRS is efficacious and well tolerated. A longer treatment duration, its use in naïve patients and the intermediate-risk disease are independent determinants of success. Furthermore, a monthly maintenance of adjunct MMC HIVEC diminishes the progression rate of NMIBC.
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Affiliation(s)
- Ana Plata
- Urology Department, Hospital Universitario de Canarias, Carretera Ofra s/n, 38320 San Cristóbal de La Laguna, Spain; (A.P.); (C.G.)
| | - Félix Guerrero-Ramos
- Urology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain; (F.G.-R.); (A.G.-D.)
| | - Carlos Garcia
- Urology Department, Hospital Universitario de Canarias, Carretera Ofra s/n, 38320 San Cristóbal de La Laguna, Spain; (A.P.); (C.G.)
| | - Alejandro González-Díaz
- Urology Department, Hospital Universitario 12 de Octubre, Avenida de Córdoba s/n, 28041 Madrid, Spain; (F.G.-R.); (A.G.-D.)
| | - Ignacio Gonzalez-Valcárcel
- Urology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain; (I.G.-V.); (J.M.d.l.M.)
| | - José Manuel de la Morena
- Urology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, San Sebastián de los Reyes, 28702 Madrid, Spain; (I.G.-V.); (J.M.d.l.M.)
| | | | - Julio Fernández del Álamo
- Urology Department, Hospital Universitario de Torrejón, Mateo Inurria, s/n, Torrejón de Ardoz, 28850 Madrid, Spain;
| | - Victoria Gonzalo
- Urology Department, Hospital Universitario de Burgos, Avenida Islas Baleares 3, 09006 Burgos, Spain; (V.G.); (J.M.)
| | - Javier Montero
- Urology Department, Hospital Universitario de Burgos, Avenida Islas Baleares 3, 09006 Burgos, Spain; (V.G.); (J.M.)
| | - Alejandro Sousa-Escandón
- Urology Department, Hospital Comarcal de Monforte, Rúa Corredoira s/n, 27400 Monforte de Lemos, Spain; (A.S.-E.); (J.L.)
| | - Juan León
- Urology Department, Hospital Comarcal de Monforte, Rúa Corredoira s/n, 27400 Monforte de Lemos, Spain; (A.S.-E.); (J.L.)
| | - Jose Luis Pontones
- Urology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain; (J.L.P.); (F.D.)
| | - Francisco Delgado
- Urology Department, Hospital Universitario La Fe, Avinguda de Fernando Abril Martorell 106, 46026 Valencia, Spain; (J.L.P.); (F.D.)
| | - Miguel Adriazola
- Urology Department, Hospital General Rio Carrión, Avenida Donantes de Sangre s/n, 34005 Palencia, Spain; (M.A.); (Á.P.)
| | - Ángela Pascual
- Urology Department, Hospital General Rio Carrión, Avenida Donantes de Sangre s/n, 34005 Palencia, Spain; (M.A.); (Á.P.)
| | - Jesús Calleja
- Urology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003 Valladolid, Spain; (J.C.); (A.R.)
| | - Ana Ruano
- Urology Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal 3, 47003 Valladolid, Spain; (J.C.); (A.R.)
| | - Luis Martínez-Piñeiro
- Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain;
| | - Javier C. Angulo
- Urology Department, Hospital Universitario Getafe, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain;
- Clinical Department, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Carretera de Toledo, Km 12.500, Getafe, 28905 Madrid, Spain
- Correspondence: ; Tel.: +34-699497569
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Manini C, López JI. Insights into Urological Cancer. Cancers (Basel) 2021; 13:E204. [PMID: 33429960 PMCID: PMC7827315 DOI: 10.3390/cancers13020204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
The year the Covid-19 pandemic appeared has been quite prolific in urological cancer research, and the collection of articles, perspectives, and reviews on renal, prostate, and urinary tract tumors merged in this Urological Cancer 2020 issue is just a representative sample of this assertion [...].
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Affiliation(s)
- Claudia Manini
- Department of Pathology, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - José I. López
- Department of Pathology, Cruces University Hospital, Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain
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Differences in Pathologic Results of Repeat Transurethral Resection of Bladder Tumor (TURBT) according to Institution Performing the Initial TURBT: Comparative Analyses between Referred and Nonreferred Group. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9432606. [PMID: 30271788 PMCID: PMC6146742 DOI: 10.1155/2018/9432606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 12/22/2022]
Abstract
Objective Although transurethral resection of bladder tumor (TURBT) is a standard treatment and determines staging for nonmuscle invasive bladder cancer, many deficiencies persist. There is a risk of upstaging and residual cancer when repeat TURBT is performed. Authors compared the results of repeat TURBT by institution performing the initial TURBT. Methods We retrospectively reviewed the medical records of 289 patients who underwent repeat TURBT within 2-6 weeks after initial TURBT between 1998 and 2013. The patients were divided into the referred group and the nonreferred group by institution performing the initial TURBT. And we analyzed the intergroup differences in residual tumor and upstaging rate and the factors significantly correlated with residual tumor. Results The mean age was 69.6 ± 11.1 years and the mean follow-up was 49.7 (range: 0–191) months. The referred group included 69 patients, while the nonreferred group included 220 patients. The referred group included 57 (82.6%) patients with residual tumor after repeat TURBT. Overall upstaging occurred in 15 (21.7%), and upstaging to T2 occurred in 11 (15.9%) of the initial Ta and T1 patients. In the nonreferred group, there were 123 (55.9%) patients with residual tumor. Overall upstaging occurred in 10 (4.5%) and upstaging to T2 occurred in 7 (3.2%) patients. Conclusions Gross hematuria, grade, and tumor quantity and size were significantly associated with residual cancer on multivariate analysis. In the referred group, repeat TURBT and restaging are necessary.
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Esquinas C, Alonso J, Mateo E, Dotor A, Martín A, Dorado J, Arance I, Angulo J. Prospective study comparing laparoscopic and open radical cystectomy: Surgical and oncological results. Actas Urol Esp 2018. [PMID: 28624175 DOI: 10.1016/j.acuro.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Laparoscopic radical cystectomy with lymphadenectomy and urinary diversion is an increasingly widespread operation. Studies are needed to support the oncological effectiveness and safety of this minimally invasive approach. PATIENTS AND METHODS A nonrandomised, comparative prospective study between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) was conducted in a university hospital. The main objective was to compare cancer-specific survival. The secondary objective was to compare the surgical results and complications according to the Clavien-Dindo scale. RESULTS We treated 156 patients with high-grade invasive bladder cancer with either ORC (n=70) or LRC (n=86). The mean follow-up was 33.5±23.8 (range 12-96) months. The mean age was 66.9+9.4 years, and the male to female ratio was 19:1. Both groups were equivalent in age, stage, positive lymph nodes, in situ carcinoma, preoperative obstructive uropathy, adjuvant chemotherapy and type of urinary diversion. There were no differences between the groups in terms of cancer-specific survival (log-rank; P=.71). The histopathology stage was the only independent variable that predicted the prognosis. The hospital stay (P=.01) and operative transfusion rates (P=.002) were less for LRC. The duration of the surgery was greater for LRC (P<.001). There were no differences in the total complications rate (p=.62) or major complications (P=.69). The risk of evisceration (P=.02), surgical wound infection (P=.005) and pneumonia (P=.017) was greater for ORC. The risk of rectal lesion (P=.017) and urethrorectal fistulae (P=.065) was greater for LRC. CONCLUSION LRC is an equivalent treatment to ORC in terms of oncological efficacy and is advantageous in terms of transfusion rates and hospital stays but not in terms of operating room time and overall safety. Studies are needed to better define the specific safety profile for each approach.
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Angulo JC, López JI, Ropero S. DNA Methylation and Urological Cancer, a Step Towards Personalized Medicine: Current and Future Prospects. Mol Diagn Ther 2017; 20:531-549. [PMID: 27501813 DOI: 10.1007/s40291-016-0231-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Urologic malignancies are some of the commonest tumors often curable when diagnosed at early stage. However, accurate diagnostic markers and faithful predictors of prognosis are needed to avoid over-diagnosis leading to overtreatment. Many promising exploratory studies have identified epigenetic markers in urinary malignancies based on DNA methylation, histone modification and non-coding ribonucleic acid (ncRNA) expression that epigenetically regulate gene expression. We review and discuss the current state of development and the future potential of epigenetic biomarkers for more accurate and less invasive detection of urological cancer, tumor recurrence and progression of disease serving to establish diagnosis and monitor treatment efficacies. The specific clinical implications of such methylation tests on therapeutic decisions and patient outcome and current limitations are also discussed.
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Affiliation(s)
- Javier C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Hospital Universitario de Getafe, Carretera de Toledo Km 12.5, Getafe, 28905, Madrid, Spain.
| | - Jose I López
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Instituto BioCruces,Universidad del País Vasco (UPV-EHU), Bilbao, Spain
| | - Santiago Ropero
- Departamento de Biología de Sistemas, Unidad Docente de Bioquímica y Biología Molecular, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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Cortés JM, de Petris G, López JI. Detection of Intratumor Heterogeneity in Modern Pathology: A Multisite Tumor Sampling Perspective. Front Med (Lausanne) 2017; 4:25. [PMID: 28321395 PMCID: PMC5337957 DOI: 10.3389/fmed.2017.00025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/20/2017] [Indexed: 12/30/2022] Open
Abstract
Current sampling protocols of neoplasms along the digestive tract and in the urinary bladder have to be updated, as they do not respond to the necessities of modern personalized medicine. We show here that an adapted version of multisite tumor sampling (MSTS) is a sustainable model to overcome current deficiencies in digestive and bladder tumors when they are large enough so as to make unaffordable a total sampling. The new method is based on the divide-and-conquer algorithm and includes a slight modification of the MSTS, which proved to be useful very recently in clear cell renal cell carcinoma. This in silico analysis confirms the usefulness of MSTS for detecting intratumor heterogeneity (ITH) in tumors arising in hollow viscera. However, MSTS does not seem to improve routine traditional sampling in detecting tumor budding, extramural venous invasion, and perineural invasion. We conclude that (1) MSTS is the best method for tumor sampling to detect ITH balancing high performance and sustainable cost, (2) MSTS must be adapted to tumor shape and tumor location for an optimal performance.
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Affiliation(s)
- Jesús M Cortés
- Quantitative Biomedicine Unit, Biocruces Research Institute, Barakaldo, Spain; Ikerbasque: The Basque Foundation for Science, Bilbao, Spain; Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Giovanni de Petris
- Department of Pathology and Laboratory Medicine, Penrose St Francis Hospital , Colorado Springs, CO , USA
| | - José I López
- Department of Pathology, Cruces University Hospital, Barakaldo, Spain; Biomarkers in Cancer Unit, Biocruces Research Institute, Barakaldo, Spain; University of the Basque Country (UPV/EHU), Leioa, Spain
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Franco R, Zappavigna S, Gigantino V, Luce A, Cantile M, Cerrone M, Facchini G, Perdonà S, Pignata S, Di Lorenzo G, Chieffi S, Vitale G, De Sio M, Sgambato A, Botti G, Yousif AM, Novellino E, Grieco P, Caraglia M. Urotensin II receptor determines prognosis of bladder cancer regulating cell motility/invasion. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2014; 33:48. [PMID: 24893613 PMCID: PMC4061920 DOI: 10.1186/1756-9966-33-48] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/19/2014] [Indexed: 12/22/2022]
Abstract
Background Non Muscle Invasive Bladder Transitional Cancer (NMIBC) and Muscle Invasive Bladder Transitional Cancer (MIBC)/invasive have different gene profile and clinical course. NMIBC prognosis is not completely predictable, since the relapse rate is higher than 20%, even in the form of MIBC. The aim of this study is to evaluate if UTR expression can discriminate between NMIBC and MIBC and predict the risk of relapses in NMIBCs. Methods We have investigated upon urotensin-II (UII) receptor (UTR) expression in vivo in 159 patients affected by NMIBC. The biological role of UTR was also investigated in vitro. UTR expression was evaluated in a tissue-micro-array, consisting of normal, NMIBC and invasive bTCC samples. Results UTR discriminated between NMIBC and MIBC and showed a significant correlation between low UTR expression and shorter disease free survival in NMIBC. The superagonist UPG84 induced growth suppression at nM concentrations on 3/4 cell lines. Bladder cancer cell treatment with the antagonist urantide or the knock-down of UTR with a specific shRNA significantly blocked both the motility and invasion of bladder cancer cells. Conclusions The evaluation of UTR expression can discriminate between NMIBC at high and low risk of relapse. Moreover, our data suggest that UTR is involved in the regulation of motility, invasion and proliferation of bladder cancer cells. High UTR expression is an independent prognostic factor of good prognosis for NMIBC regulating motility and invasion of bladder cancer cells.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michele Caraglia
- Department of Biochemistry, Biophysics and General Pathology, Second University of Naples, Naples, Italy.
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The role of matrix metalloproteinase MMP-9 and TIMP-2 tissue inhibitor of metalloproteinasas as serum markers of bladder cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.acuroe.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ramón de Fata F, Ferruelo A, Andrés G, Gimbernat H, Sánchez-Chapado M, Angulo JC. The role of matrix metalloproteinase MMP-9 and TIMP-2 tissue inhibitor of metalloproteinases as serum markers of bladder cancer. Actas Urol Esp 2013; 37:480-8. [PMID: 23916137 DOI: 10.1016/j.acuro.2013.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 05/29/2013] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The diagnosis and molecular staging of bladder cancer based on the detection of gelatinases mRNA (MMP-2 and MMP-9) in peripheral blood circulating and mononuclear cells have shown promising results. We analyze if the determination of the corresponding protein synthesis products makes it possible to diagnose and characterize patients with bladder cancer. MATERIAL AND METHOD Quantification of the serum levels of MMP-2, MMP-9 and TIMP-2 in a series of 42 individuals (31 patients with bladder cancer in different stages and 11 healthy controls) using the ELISA technique was carried out. The determinations were compared between cases and controls (Mann-Whitney U) and between different groups of tumors (Mann-Whitney U or Kruskal-Wallis), according to the clinical-pathological characteristics (age, gender, T category, M category or grade). Diagnostic yield of these markers was evaluated by analysis of the ROC curves. RESULTS There is a correlation between the determinations of MMP-2 and TIMP-2 (R=.699; P>.0001) and MMP-9 and TIMP-2 (R=.305; P=.049). Patients with bladder cancer have higher levels of MMP-9 (p<0.0001) and TIMP-2 (P=.047) than the controls. Furthermore, the MMP-9/TIMP-2 ratio is also superior in cancer patients (P<.001). Differences were not detected between cancer and controls regarding age (P=.64) or gender (P=.64). Differences were also not detected regarding MMP-2 (P=.35) or MMP-2/TIMP-2 rate (P=.45). Within the cancer patient population, the MMP-2 and MMP-9 values differ according to T category (P=.022 and P=.038, respectively) and those of the TIMP-2 according to M category (P=.036). ROC curve analysis showed that both MMP-9 and the MMP-9/TIMP-2 ratio discriminate patients with cancer and controls, with equivalent diagnostic accuracy (ABC 0.953) and cut offs of 3.93 ng/mL (S 90%; Sp 81%) and 0.053 ng/mL (S 96%; Sp 84%), respectively. CONCLUSIONS The results obtained suggest that both serum MMP-9 and TIMP-2 would have an application in the prediction of the development and progression of bladder cancer, and a potential utility as clinical markers of the disease. Multicenter, prospective studies that confirm their preliminary results are necessary.
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Affiliation(s)
- F Ramón de Fata
- Servicio de Urología, Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Universidad Europea de Madrid, Madrid, España.
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Urothelial carcinoma in patients with advanced kidney disease: a 12-year retrospective cohort survey. Am J Med Sci 2011; 342:148-52. [PMID: 21747280 DOI: 10.1097/maj.0b013e318223e800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The goal of this study was to compare the clinical and pathological features of urothelial carcinoma (UC) identified in patients with end-stage renal disease (ESRD) and advanced-stage chronic kidney disease (CKD). The predictive value of CKD on patient mortality in these UC patients was also analyzed. METHODS From January 1997 to December 2008, 141 patients with pathologically proven UC with stage 4/5 CKD (predialysis) and patients with ESRD receiving long-term dialysis were identified under an institutional review board approval protocol. The medical records and survival outcome of these patients were reviewed. RESULTS A total of 141 UC patients with renal diseases (n = 97, 68.8%, of stage 4/5 CKD; n = 44, 31.2%, at dialysis) were enrolled. Patients with stage 4/5 CKD were significantly older, male gender, less anemic and more likely to have higher prevalence of diabetes mellitus (P < 0.05). We noticed a more significant increase in the frequency of high-stage UC (24.7% and 6.8%) and a larger tumor size (50.5% and 27.3%) in patients with stage 4/5 CKD, compared with patients with ESRD (P < 0.05). Old age at the time of dialysis initiation in patients with ESRD [hazard ratio (HR) = 1.121, P = 0.039], male gender (HR = 6.822, P = 0.016) and high-stage tumors (HR = 5.012, P = 0.008) in patients with stage 4/5 CKD were independent predictors of mortality from UC. CONCLUSIONS Patients with stage 4/5 CKD had more aggressive histological UC patterns than did patients with ESRD.
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You D, Kim SC, Jeong IG, Hong JH, Ro JY, Ahn H, Kim CS. Urothelial carcinoma of the bladder with seminal vesicle invasion: prognostic significance. BJU Int 2010; 106:1657-61. [DOI: 10.1111/j.1464-410x.2010.09494.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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López JI, Angulo JC. Growth pattern in superficial urothelial bladder carcinomas. Histological review and clinical relevance. Int Urol Nephrol 2009; 41:847-54. [PMID: 19283508 DOI: 10.1007/s11255-009-9537-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/29/2009] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The question of when an intraepithelial urothelial carcinoma becomes invasive into the lamina propria of the urinary bladder is an unresolved issue. Our objective was to analyse a series of consecutive superficial carcinomas to assess the importance of growth pattern in tumour recurrence and progression. MATERIALS AND METHODS The pathological staging of 200 superficial (pTa/pT1) bladder carcinomas was reviewed. Non-invasive lesions and tumours invading the lamina propria were distinguished. Both infiltrating and pushing patterns of growth were regarded as lamina propria invasion. RESULTS A total of 35 (17.5%) pTa and 165 (82.5%) pT1 tumours were identified. Among pT1 tumours, 39 (23.6%) displayed the infiltrating pattern of invasion and 126 (76.4%) the pushing pattern. Differences in five-year recurrence-free (P = 0.01) and progression-free (P = 0.001) survival were demonstrated between pTa and pT1 tumours, and between pT1 infiltrating and pT1 pushing subcategories. Invasive growth pattern has a 1.86 times higher risk of tumour recurrence and 3.01 times higher risk of progression. CONCLUSIONS The pT1 category of bladder carcinoma should include a group of tumours defined by its pushing pattern of growth. Some cases may have been previously considered pTa, but follow an intermediate clinical course between pTa and pT1 tumours with infiltrating growth pattern.
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Affiliation(s)
- José I López
- Department of Anatomic Pathology, Hospital Universitario de Cruces, Basque Country University, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain.
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Vakar-Lopez F, Shen SS, Zhang S, Tamboli P, Ayala AG, Ro JY. Muscularis mucosae of the urinary bladder revisited with emphasis on its hyperplastic patterns: a study of a large series of cystectomy specimens. Ann Diagn Pathol 2007; 11:395-401. [DOI: 10.1016/j.anndiagpath.2006.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Türkölmez K, Tokgöz H, Reşorlu B, Köse K, Bedük Y. Muscle-Invasive Bladder Cancer: Predictive Factors and Prognostic Difference Between Primary and Progressive Tumors. Urology 2007; 70:477-81. [PMID: 17905100 DOI: 10.1016/j.urology.2007.05.008] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 03/14/2007] [Accepted: 05/14/2007] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To establish whether a difference in the clinical outcomes of patients with progressive and primary muscle-invasive bladder cancer exists. METHODS The records of patients who had undergone radical cystectomy for bladder urothelial carcinoma from 1990 to 2005 were reviewed. According to our inclusion criteria, 109 patients with primary muscle-invasive tumor (group 1) and 45 patients with progressive tumors were selected (group 2). The correlation of clinical and pathologic variables with survival was investigated using the Cox proportional hazards test. The Kaplan-Meier method was used to estimate progression rates. Multivariate analysis was performed using the Cox regression survival method to investigate possible predictive factors. RESULTS The 2, 3, and 5-year cancer-specific survival rate was 72%, 61%, and 43% for patients with progressive tumor and 75%, 62%, and 54% for patients with primary tumor, respectively (P >0.05). For lymph node-negative tumors (pN0), the corresponding rates were 77%, 64%, and 56% in group 1 and 73%, 60%, and 39% in group 2 (P >0.05). On multivariate analysis, lymphovascular invasion and pT stage of the primary tumor remained significant independent prognostic factors for cancer-specific survival. The detection of local and/or distant metastasis during follow-up significantly shortened the cancer-specific survival of patients with muscle-invasive bladder cancer. CONCLUSIONS The results of our study have shown that patients with progressive muscle-invasive urothelial tumors do not have a worse prognosis than do those with primary tumors. During the early postoperative years, even patients with progressive tumors had better disease-specific survival rates. For both groups, pT stage and lymphovascular invasion seemed to be independent predictors of decreased cancer-specific survival.
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Affiliation(s)
- Kadir Türkölmez
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Jimenez RE, Gheiler E, Oskanian P, Tiguert R, Sakr W, Wood DP, Pontes JE, Grignon DJ. Grading the invasive component of urothelial carcinoma of the bladder and its relationship with progression-free survival. Am J Surg Pathol 2000; 24:980-7. [PMID: 10895820 DOI: 10.1097/00000478-200007000-00009] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although grading is valuable prognostically in pTa and pT1 papillary urothelial carcinoma, it is unclear whether it provides any prognostic information when applied to the invasive component in muscle-invasive carcinoma. The authors analyzed 93 cases of muscle-invasive urothelial carcinoma of the bladder treated with radical cystectomy for which follow-up information was available. Each case was graded using the Malmström grading system for urothelial carcinoma, applied to the invasive component. Pathologic stage, lymph node status, and histologic invasion pattern were also recorded and correlated with progression-free survival. Thirty-four cases (37%) were pT2, 40 (43%) were pT3, and 19 (20%) were pT4. Of the 77 patients who had a lymph node dissection at the time of cystectomy, 34 (44%) had metastatic carcinoma to one or more lymph nodes. The median survival for pT2, pT3, and pT4 stages was 85, 24, and 29 months, respectively (p = 0.0001). Lymph node-negative and lymph node-positive patients had a median survival of 63 and 23 months, respectively (p = 0.0001). Fifteen patients (16%) were graded as 2b and 78 patients (84%) were graded as 3. Median survival of patients graded as 2b was 34 months compared with 31 months for patients graded as 3 (p value not significant). Three invasive patterns were recognized: nodular (n = 13, 14%), trabecular (n = 39, 42%), and infiltrative (n = 41, 44%). The presence of any infiltrative pattern in the tumor was associated with a median survival of 29 months, compared with 85 months in tumors without an infiltrative pattern (p = 0.06). Pathologic T stage and lymph node status remain the most powerful predictors of progression in muscle-invasive urothelial carcinoma. In this group of patients histologic grade, as defined by the Malmström system and as applied to the invasive component, provided no additional prognostic information. An infiltrative growth pattern may be associated with a more dismal prognosis.
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Affiliation(s)
- R E Jimenez
- Department of Pathology, Harper Hospital, the Barbara Ann Karmanos Cancer Institute, and Wayne State University, Detroit, Michigan 48201, USA
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López JI, Elorriaga K, Imaz I, Bilbao FJ. Micropapillary transitional cell carcinoma of the urinary bladder. Histopathology 1999; 34:561-2. [PMID: 10383706 DOI: 10.1111/j.1365-2559.1999.0696f.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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BASSI PIERFRANCESCO, FERRANTE GIANLUCADRAGO, PIAZZA NICOLA, SPINADIN RENATO, CARANDO ROBERTO, PAPPAGALLO GIANLUIGI, PAGANO FRANCESCO. PROGNOSTIC FACTORS OF OUTCOME AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER: A RETROSPECTIVE STUDY OF A HOMOGENEOUS PATIENT COHORT. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68936-7] [Citation(s) in RCA: 127] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Harnden P, Parkinson M. Transitional cell carcinoma of the bladder: diagnosis and prognosis. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/s0968-6053(96)80014-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Angulo JC, Sanchez-Chapado M, Lopez JI, Flores N. Primary Cisplatin, Methotrexate and Vinblastine Aiming at Bladder Preservation in Invasive Bladder Cancer: Multivariate Analysis on Prognostic Factors. J Urol 1996. [DOI: 10.1016/s0022-5347(01)66041-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Javier C. Angulo
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
| | - Manuel Sanchez-Chapado
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
| | - Jose I. Lopez
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
| | - Nicolas Flores
- From the Departments of Urology and Pathology, Hospital de Basurto, Bilbao, Universidad del Pais Vasco and Universidad de Alcala de Henares, Madrid, Spain
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Abstract
Transurethral resection specimens from 170 T1 bladder carcinomas were reviewed for the presence of vascular (blood vessel and/or lymphatic) invasion by tumour cells. Such a finding was noted in 17 cases (10%), and occurred most frequently in high grade tumours. Tumour recurrence was documented in 11 of these cases (65%), including seven patients who showed progression to more invasive disease (T2-T4) and six patients (55%) who died of disease. Five-year survival for cases without vascular invasion was 81% versus 44% for those with. This was a statistically significant difference (log-rank, P = 0.004). Neoplasms of high grade (grades 2 to 3), without a papillary configuration, and exceeding 5 cm were associated with vascular invasion (chi-squared; P < 0.001, P = 0.043, and P = 0.061 respectively). In multivariate analysis vascular invasion proved to be an independent prognostic factor (Cox's regression, P = 0.015). We therefore stress the clinical relevance of a thorough evaluation of the state of vascular invasion in stage T1 bladder cancer.
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Affiliation(s)
- J I Lopez
- Department of Pathology, Hospital de Basurto, Basque Country University, Bilbao, Spain
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Lopez JI, Angulo JC, Flores N, Toledo JD. Small cell carcinoma of the urinary bladder. A clinicopathological study of six cases. BRITISH JOURNAL OF UROLOGY 1994; 73:43-9. [PMID: 7507782 DOI: 10.1111/j.1464-410x.1994.tb07454.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study the clinical, histological, and immunohistochemical findings of small cell carcinoma (SCC) of the urinary bladder, and also to delineate its behaviour in comparison with transitional cell carcinomas of the bladder. MATERIALS AND METHODS A retrospective review of 552 patients with bladder cancer yielded six cases (1%) of small cell carcinoma which were histologically identical to pulmonary small cell anaplastic carcinoma. Clinical data and follow-up were collected. Aside from the conventional histological parameters, an immunohistochemical study with AE1-AE3 and Cam 5.2 keratins, epithelial membrane antigen, neuron-specific enolase, chromogranin, synaptophysin, ACTH, calcitonin, and prostatic specific antigen was performed. RESULTS The clinical presentation did not differ from conventional transitional cell carcinoma, haematuria being the most frequent complaint (four cases). All the cases presented as flat tumours. On light microscopy, there were oat cell (four cases), intermediate (one case) and mixed oat-cell/intermediate (one case) variants. Three cases were associated with transitional cell carcinoma. Dysplastic changes were observed in the adjacent urothelium in one case only. At the time of diagnosis, all tumours were deeply invasive (pT3). Three cases were Stage III and three Stage IV, with involvement of regional lymph nodes and metastases to the liver (two cases) and lung (one case). Immunohistochemically, epithelial markers were variably expressed as AE1-AE3 keratin (5/6), Cam 5.2 keratin (2/6) and epithelial membrane antigen (3/6). Neuron specific enolase was demonstrated in every case. Chromogranin, however, was expressed in only one case. Synaptophysin, ACTH, calcitonin, and prostatic specific antigen all gave negative results. All the patients died of the disease and the overall length of survival was very poor (range 5-25 months, mean 13.3). CONCLUSION Small cell carcinomas show the same histological patterns as their pulmonary counterpart. Immunohistochemistry reveals a wide spectrum of activity, enolase and keratins being the most constant. The present study confirms that the overall prognosis of this tumour is very poor.
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Affiliation(s)
- J I Lopez
- Department of Pathology, Hospital de Basurto, Faculty of Medicine, Basque Country University/EHU, Bilbao, Spain
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