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Systematic review on oncologic outcomes on adjuvant endovesical treatment for non-muscle invasive bladder cancer in patients with solid organ transplant. World J Urol 2022; 40:2901-2910. [PMID: 36367586 DOI: 10.1007/s00345-022-04188-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/06/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Urothelial carcinoma has a higher incidence in renal transplanted patients according to several registries (relative risk × 3), and the global prognosis is inferior to the general population. The potential impact of immunosuppressive therapy on the feasibility, efficacy, and complications of endovesical treatment, especially Bacillus Calmette-Guerin, has a low level of evidence. We performed a systematic review that aimed to assess the morbidity and oncological outcomes of adjuvant endovesical treatment in solid organ transplanted patients. METHODS Medline was searched up to December 2021 for all relevant publications reporting oncologic outcomes of endovesical treatment in solid organ transplanted patients with NMIBC. Data were synthesized in light of methodological and clinical heterogeneity. RESULTS Twenty-three retrospective studies enrolling 238 patients were included: 206 (96%) kidney transplants, 5 (2%) liver transplants, and 2 (1%) heart transplants. Concerning staging: 25% were pTa, 62% were pT1, and 22% were CIS. 140/238 (59%) patients did not receive adjuvant treatment, 50/238 (21%) received mitomycin C, 4/238 (2%) received epirubicin, and 46/238 (19%) received BCG. Disease-free survival reached 35% with TURBT only vs. 47% with endovesical treatment (Chi-square test p = 0.08 OR 1.2 [0.98-1.53]). The complication rate of endovesical treatment was 12% and was all minor (Clavien-Dindo I). CONCLUSION In solid organ transplanted patients under immunosuppressive treatment, both endovesical chemotherapy and BCG are safe, but the level of evidence concerning efficacy in comparison with the general population is low. According to these results, adjuvant treatment should be proposed for NMIC in transplanted patients as in the general population.
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Kohada Y, Hayashi T, Hsi RS, Yukihiro K, Sentani K, Goto K, Inoue S, Ohara S, Teishima J, Kajiwara M, Nishisaka T, Yasui W, Black PC, Matsubara A. Recurrence- and progression-free survival in intermediate-risk non-muscle-invasive bladder cancer: the impact of conditional evaluation and subclassification. BJU Int 2020; 127:473-485. [PMID: 32805763 DOI: 10.1111/bju.15209] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To assess the change in rates of recurrence-free survival (RFS) and progression-free survival (PFS) based on the duration of survival without recurrence or progression among patients with intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC), and to examine the predictive factors for recurrence at different time points by assessing conditional RFS and PFS. PARTICIPANTS AND METHODS A cohort of 602 patients treated with transurethral resection of bladder tumour and histopathologically diagnosed with IR NMIBC was included in this retrospective study. RESULTS The conditional RFS rate at 1, 2, 3, 4 and 5 years improved with increased duration of RFS; however, the conditional PFS rate did not improve over time. Multivariable analyses showed that recurrent tumour, multiple tumours, tumour size (>3 cm), immediate postoperative instillation of chemotherapy, and administration of BCG were independent predictive factors for recurrence at baseline. The predictive ability of these factors disappeared with increasing recurrence-free survivorship. Subclassification of these patients with IR NMIBC into three groups using clinicopathological factors (recurrent tumour, multiple tumours, tumour size) demonstrated that the high IR group (two factors) had significantly worse RFS than the intermediate (one factor, P < 0.001) and low IR groups (no factor, P = 0.005) at baseline. This subclassification stratified conditional risk of RFS also at 1, 3 and 5 years, which provides the basis for distinct surveillance protocols among patients with IR NMIBC. CONCLUSION Conditional survival analyses of patients with IR NMIBC demonstrate that RFS changes over time, while PFS does not change. These data support distinct surveillance protocols based on the subclassification of IR NMIBC.
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Affiliation(s)
- Yuki Kohada
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan.,Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kazuma Yukihiro
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shogo Inoue
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shinya Ohara
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Nishisaka
- Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Wataru Yasui
- Department of Molecular Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Peter C Black
- Vancouver Prostate Centre and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Akio Matsubara
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Lucca I, Hofbauer SL, Haitel A, Susani M, Shariat SF, Klatte T, De Martino M. Urinary expression of genes involved in DNA methylation and histone modification for diagnosis of bladder cancer in patients with asymptomatic microscopic haematuria. Oncol Lett 2019; 18:57-62. [PMID: 31289472 DOI: 10.3892/ol.2019.10330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 04/25/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of the present study was to identify and test a urine marker panel of genes involved in DNA methylation and histone modification for the detection of urothelial carcinoma of the bladder (UCB). RNA samples obtained from the voided urine of 227 patients with asymptomatic microscopic haematuria (AMH) were analysed. Gene array analysis was performed on 18 randomly selected cDNA samples, which revealed that histone deacetylase 9 (HDAC9), HDAC3, tRNA (cytosine-5-)-methyltransferase1 and DNA methyltransferase 1 were differentially expressed between patients with UCB and control subjects. Subsequently, reverse transcription-quantitative polymerase chain reaction analysis was employed to test the performance of the identified four-gene panel on the remaining 209 cDNA samples. In this targeted discovery cohort, all four genes were significantly associated with UCB on univariable analyses [each odds ratio (OR) >2, P<0.05], but only HDAC3 was significant following multivariable analysis (OR=2.8, P=0.011). The addition of HDAC3 to a base risk factor model improved its accuracy by 1.4%. These data suggest that urinary HDAC3 is associated with the presence of UCB in patients with AMH; however, HDAC3 improved the accuracy of the established risk factors only to a marginal extent.
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Affiliation(s)
- Ilaria Lucca
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.,Department of Urology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | | | - Andrea Haitel
- Department of Pathology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Martin Susani
- Department of Pathology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.,Karl Landsteiner Society, Urology and Andrology, A-1090 Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, NY 10011, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria
| | - Michela De Martino
- Department of Urology, Medical University of Vienna, A-1090 Vienna, Austria
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Benoni H, Eloranta S, Ekbom A, Wilczek H, Smedby KE. Survival among solid organ transplant recipients diagnosed with cancer compared to nontransplanted cancer patients-A nationwide study. Int J Cancer 2019; 146:682-691. [PMID: 30919451 DOI: 10.1002/ijc.32299] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
Solid organ transplant recipients (OTRs) have an increased cancer risk but their survival once diagnosed with cancer has seldom been assessed. We therefore investigated cancer-specific survival among OTRs with a wide range of cancer forms nationally in Sweden. The study included 2,143 OTRs with cancer, and 946,089 nontransplanted cancer patients diagnosed 1992-2013. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox regression models adjusted for age, sex and calendar year. Median follow-up was 3.1 (range 0-22) years. Overall, OTRs diagnosed with any cancer had a 35% higher rate of cancer death compared to nontransplanted cancer patients (HR: 1.35, 95% CI: 1.24-1.47). Specifically, higher rates of cancer-specific death were observed among OTRs diagnosed with Hodgkin lymphoma (HR: 15.0, 95% CI: 5.56-40.6), high-grade non-Hodgkin lymphoma (HR: 2.68, 95% CI: 1.90-3.77), malignant melanoma (HR: 2.80, 95% CI: 1.74-4.52) and urothelial (HR: 2.56, 95% CI: 1.65-3.97), breast (HR: 2.12, 95% CI: 1.38-3.25), head/neck (HR: 1.55, 95% CI: 1.02-2.36) and colorectal (HR: 1.42, 95% CI: 1.07-1.88) cancer. The worse outcomes were not explained by differences in distribution of cancer stage or histologic subtypes. For other common cancer forms such as prostate, lung and kidney cancer, the prognosis was similar to that in nontransplanted cancer patients. In conclusion, several but not all types of posttransplantation cancer diagnoses are associated with worse outcomes than in the general population. Reasons for this should be further explored to optimize posttransplantation cancer management.
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Affiliation(s)
- Henrik Benoni
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Akademiska University Hospital, Uppsala, Sweden
| | - Sandra Eloranta
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ekbom
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Henryk Wilczek
- Division of Transplantation Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karin E Smedby
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Center for Hematology, Karolinska University Hospital, Stockholm, Sweden
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Mbeutcha A, Shariat SF, Rieken M, Rink M, Xylinas E, Seitz C, Lucca I, Mathieu R, Rouprêt M, Briganti A, Karakiewicz PI, Klatte T. Prognostic significance of markers of systemic inflammatory response in patients with non–muscle-invasive bladder cancer. Urol Oncol 2016; 34:483.e17-483.e24. [DOI: 10.1016/j.urolonc.2016.05.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/23/2016] [Accepted: 05/12/2016] [Indexed: 12/14/2022]
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Leitner CV, Ederer IA, de Martino M, Hofbauer SL, Lucca I, Mbeutcha A, Mathieu R, Haitel A, Susani M, Shariat SF, Klatte T. Dynamic Prognostication Using Conditional Recurrence and Progression Estimates for Patients with Nonmuscle Invasive Bladder Cancer. J Urol 2016; 196:46-51. [DOI: 10.1016/j.juro.2016.01.102] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Carmen V. Leitner
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ines A. Ederer
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Michela de Martino
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Sebastian L. Hofbauer
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Ilaria Lucca
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Aurélie Mbeutcha
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Romain Mathieu
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Haitel
- Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Martin Susani
- Clinical Institute of Pathology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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Gordetsky J, Gennaro KH, Selph JP, Rais-Bahrami S. Nephrogenic Adenoma: Clinical Features, Management, and Diagnostic Pitfalls. Urology 2016; 95:29-33. [PMID: 27138263 DOI: 10.1016/j.urology.2016.04.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 04/20/2016] [Accepted: 04/26/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To review the diagnosis and management of nephrogenic adenoma (NA), an uncommon benign lesion found in the urinary tract. This lesion arises from a proliferation of implanted renal tubular cells. Although more common in adults, it can occur in all ages. NAs can recur and cause significant morbidity in patients. NAs are also a potential diagnostic pitfall as they can clinically and histologically mimic malignancy in the urinary tract. MATERIALS AND METHODS We performed an Institutional Board Review approved search of our surgical pathology database from 2005 to 2015 for cases of NA. A retrospective chart review was performed with a focus on the clinical, pathologic, and radiographic findings in these patients. RESULTS We identified 32 cases of NA in 31 patients. Lesions were most common in Caucasian males (male-to-female ratio of 2:1) with an average age at diagnosis of 55 years (range 25-77). Bladder was the most common site of occurrence (81.2%), followed by ureter (9.4%), urethra (6.3%), and intrarenal collecting system (3.1%). Most patients (72%) were symptomatic and presented with hematuria (41%), lower urinary tract symptoms (28%), pelvic or flank pain (6%), hydronephrosis (19%), or urinary incontinence (13%). NA was asymptomatic and identified incidentally in 9 (28%) patients. One patient (3%) had a renal transplant and 8 (26%) patients had diabetes mellitus. Twenty-six (84%) patients were managed with endoscopic resection of their tumors. CONCLUSION NAs are benign lesions that may cause significant morbidity and mimic malignant tumors. There should be increased suspicion in patients with predisposing factors.
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Affiliation(s)
- Jennifer Gordetsky
- University of Alabama at Birmingham, Department of Pathology, Birmingham, AL; University of Alabama at Birmingham, Department of Urology, Birmingham, AL.
| | - Kyle H Gennaro
- University of Alabama, School of Medicine, Birmingham, AL
| | - John P Selph
- University of Alabama at Birmingham, Department of Urology, Birmingham, AL
| | - Soroush Rais-Bahrami
- University of Alabama at Birmingham, Department of Urology, Birmingham, AL; University of Alabama at Birmingham, Department of Radiology, Birmingham, AL
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