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Quinn C, Lerma LA, Zhu A, Monnat RJ, Wright JL, Lockwood CM, Tretiakova MS. Pilot study: Urine cell-free DNA with low-pass whole genome sequencing can detect and molecularly type upper tract urothelial carcinomas. Am J Clin Pathol 2025; 163:696-707. [PMID: 39923187 DOI: 10.1093/ajcp/aqae175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Accepted: 02/03/2025] [Indexed: 02/10/2025] Open
Abstract
OBJECTIVES Upper tract urothelial carcinoma (UTUC) is an aggressive disease that is challenging to biopsy and diagnose, frequently yielding nondiagnostic cytology and tissue specimens. Therefore, UTUC is often late stage when diagnosed, with poor outcomes. Cell-free tumor DNA (cfDNA) may improve UTUC early diagnosis and assessments of heterogeneity, treatment response, and recurrence but has not been studied in the urine from patients with UTUC. This study aimed to detect recurrent, diagnostic UTUC cytogenetic abnormalities by low-pass whole genome sequencing (LPWGS) and to compare urine-derived and plasma cfDNA against abnormalities identified in patient tumor tissue. METHODS Cell-free tumor DNA extracted from voided urine and plasma before nephroureterectomy in 4 patients with UTUC was compared with genomic DNA from formalin-fixed, paraffin-embedded tumor tissue after LPWGS. RESULTS Abnormal autosomal genomic regions were highest in tissue (n = 11,843), intermediate in urine (n = 5,072) and lowest in plasma (n = 763), with a high concordance of flagged regions identified in tissue and urine (r = 0.88). Pairwise analysis of whole chromosome gains/losses and subchromosomal alterations between tissue and urine showed nearly identical patterns in all 4 patients (r = 0.88-0.99) in contrast to plasma (r < 0.25). Abnormal genomic regions identified by LPWGS showed a high degree of overlap (100% for tumor tissue, 94% for urine cfDNA) with cBioPortal UTUC-associated genes. CONCLUSIONS We demonstrated the superiority of urine vs plasma cfDNA when LPWGS was used to identify UTUC-associated gene abnormalities. Voided urine cfDNA molecular signatures are highly concordant with matched tumor tissue on chromosomal and subchromosomal levels, emphasizing its feasibility as a noninvasive biomarker for UTUC detection and surveillance.
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Affiliation(s)
- Chaz Quinn
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, US
| | - L Angelica Lerma
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, US
| | - Alexander Zhu
- Department of Urology, University of Washington, Seattle, WA, US
| | - Raymond J Monnat
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, US
- Department of Genome Sciences, University of Washington, Seattle, WA, US
| | | | - Christina M Lockwood
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, US
| | - Maria S Tretiakova
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, WA, US
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Tomiyama E, Fujita K, Matsuzaki K, Narumi R, Matsushita M, Hayashi Y, Hashimoto M, Kato T, Hatano K, Kawashima A, Minami T, Takao T, Takada S, Uemura H, Adachi J, Tomonaga T, Nonomura N. EIF2S1 in Urinary Extracellular Vesicles as a Novel Diagnostic Marker for Bladder Cancer. Cancer Med 2025; 14:e70964. [PMID: 40365898 PMCID: PMC12076193 DOI: 10.1002/cam4.70964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 04/17/2025] [Accepted: 04/30/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Urinary extracellular vesicles (uEVs), directly secreted from bladder cancer (BCa) cells, harbor potential for biomarker discovery. METHODS We performed proteomic analysis to explore and validate uEV-based diagnostic markers for BCa, with a focus on cytoplasmic EV proteins. Among the 1960 proteins identified by shotgun proteomics (tandem mass tag-labeled liquid chromatography-tandem mass spectrometry [LC-MS/MS]) of uEVs from seven patients with BCa and four healthy individuals, 17 cytoplasmic EV proteins were significantly elevated in the patients' urine (fold change > 1.5; p < 0.05). These 17 proteins were subsequently validated using targeted proteomics (selected reaction monitoring/multiple reaction monitoring) using urine samples from 49 and 48 patients with and without BCa, respectively, including those with non-BCa hematuria. RESULTS Ten measurable EV proteins remained significantly elevated in the urine of patients with BCa, with EV-EIF2S1 demonstrating the best diagnostic performance (area under the receiver operating characteristic [ROC] curve [AUC] [ROCAUC]: 0.83). Additionally, EV-EIF2S1 distinguished patients with BCa from those without BCa and hematuria in a suitable manner (ROCAUC: 0.92). Functional analysis of EIF2S1 in the BCa cell lines (T24 and 5637) showed that EIF2S1 knockdown markedly inhibited cell proliferation and induced cell cycle arrest and apoptosis, suggesting its essentiality for BCa cell growth and survival. CONCLUSIONS This study identified EV-EIF2S1 as a novel, uEV-based BCa diagnostic marker and demonstrated its functional significance in BCa cell growth and survival.
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Affiliation(s)
- Eisuke Tomiyama
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Kazutoshi Fujita
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Kyosuke Matsuzaki
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Ryohei Narumi
- Laboratory of Proteomics for Drug Discovery, Center for Drug Design ResearchNational Institutes of Biomedical Innovation, Health and NutritionIbarakiOsakaJapan
| | - Makoto Matsushita
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yujiro Hayashi
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Mamoru Hashimoto
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Taigo Kato
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Koji Hatano
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Atsunari Kawashima
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Takafumi Minami
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Tetsuya Takao
- Department of UrologyOsaka General Medical CenterOsakaOsakaJapan
| | - Shingo Takada
- Department of UrologyOsaka Police HospitalOsakaOsakaJapan
| | - Hirotsugu Uemura
- Department of UrologyKindai University Faculty of MedicineOsaka‐SayamaOsakaJapan
| | - Jun Adachi
- Laboratory of Proteomics for Drug Discovery, Center for Drug Design ResearchNational Institutes of Biomedical Innovation, Health and NutritionIbarakiOsakaJapan
| | - Takeshi Tomonaga
- Laboratory of Proteomics for Drug Discovery, Center for Drug Design ResearchNational Institutes of Biomedical Innovation, Health and NutritionIbarakiOsakaJapan
| | - Norio Nonomura
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
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Axelsson TA, Sydén F, Eisfeldt J, Eriksson Y, Lundberg GG, Jaremko G, Gyllensten OC, Tham E, Brehmer M. Diagnostic and prognostic genomic aberrations in upper tract urothelial carcinoma can be identified in focal barbotage samples. BJU Int 2025; 135:792-801. [PMID: 39654327 PMCID: PMC11975159 DOI: 10.1111/bju.16620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2025]
Abstract
OBJECTIVES To investigate whether genetic analysis of focal barbotage samples obtained at ureterorenoscopy (URS) is possible, and to identify genetic aberrations that might add prognostic information. METHODS This prospective study included barbotage samples from 42 patients with upper urinary tract urothelial carcinoma (UTUC) confirmed at URS. At URS, focal barbotage specimens were collected for cytology and for gene sequencing. Tumour grades were determined from cytology and/or biopsy, or from radical nephroureterectomy samples. Next-generation sequencing using a 385-gene panel was performed and single nucleotide variants (SNVs), deletions/insertions (indels) and copy number aberrations (CNAs) were identified. Manual filtering of the SNVs/indels was performed to identify possible pathogenic mutations. RESULTS Of the 42 samples, two failed quality control, therefore, 40 focal barbotage samples were sequenced. We identified known and suspected pathogenic mutations and other genomic aberrations in 36 samples. The most common variants were in TERT (78%), FGFR3 (50%), KMT2D (42%), KDM6A (42%), ARID1A (39%), TP53 (19%) and deletion of 9q (50%). Known pathogenic mutations in FGFR3 were common in grade 1 and 2 tumours, but not present in any grade 3 tumour. No patients with an FGFR3 mutation died during follow-up. TP53 variants or deletions, as well as amplifications of MDM2, were only present in high-grade (HG) tumours or low-grade (LG) tumours in patients who had metastasis/died from urinary tract carcinoma. CNAs were detected in 36/40 barbotage samples, 91% of the HG samples and 69% of the LG samples, including those from all five patients with LG tumours with metastasis or who died from urinary tract cancer. CONCLUSION Focal barbotage samples enable identification of gene mutations and other genetic aberrations that may add important prognostic information to histopathology and cytology. Refined prognostication of UTUC patients already at diagnosis can guide treatment decisions and follow-up programmes.
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Affiliation(s)
| | - Filip Sydén
- Department of UrologyStockholm South General HospitalStockholmSweden
| | - Jesper Eisfeldt
- Department of Clinical Genetics and GenomicsKarolinska University HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | | | | | - Georg Jaremko
- Department of Pathology and Cancer DiagnosticsKarolinska University HospitalStockholmSweden
| | | | - Emma Tham
- Department of Clinical Genetics and GenomicsKarolinska University HospitalStockholmSweden
- Department of Molecular Medicine and SurgeryKarolinska InstitutetStockholmSweden
| | - Marianne Brehmer
- Department of UrologyStockholm South General HospitalStockholmSweden
- Department of Clinical Science and EducationKarolinska InstitutetStockholmSweden
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Klümper N, Cox A, Sjödahl G, Roghmann F, Bolenz C, Hartmann A, Grünwald V, Faltas BM, Hölzel M, Eckstein M. Pre-treatment metastatic biopsy: a step towards precision oncology for urothelial cancer. Nat Rev Urol 2025; 22:256-267. [PMID: 39472646 DOI: 10.1038/s41585-024-00951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 05/10/2025]
Abstract
Early metastatic spread and clonal expansion of individual mutations result in a heterogeneous tumour landscape in metastatic urothelial cancer (mUC). Substantial molecular heterogeneity of common drug targets, such as membranous NECTIN4, FGFR3 mutations, PDL1 or immune phenotypes, has been documented between primary and metastatic tumours. However, translational and clinical studies frequently do not account for such heterogeneity and often investigate primary tumour samples that might not be representative in patients with mUC. We propose this as a potential factor for why many biomarkers for mUC have failed to be integrated into clinical practice. Fresh pre-treatment metastatic biopsies enable the capturing of prevailing tumour biology in real time. The characterization of metastatic tumour samples can improve response prediction to immunotherapy, the anti-NECTIN4 antibody-drug conjugate enfortumab vedotin and the FGFR inhibitor erdafitinib. Routine metastatic biopsy can thus improve the precision of identifying driver druggable alterations, thus improving treatment selection for patients with mUC.
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Affiliation(s)
- Niklas Klümper
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany.
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany.
| | - Alexander Cox
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Gottfrid Sjödahl
- Department of Translational Medicine, Division of Urological Research, Lund University, Lund, Sweden
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Christian Bolenz
- Department of Urology and Paediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Viktor Grünwald
- Clinic for Internal Medicine (Tumour Research) and Clinic for Urology, Interdisciplinary Genitourinary Oncology at the West-German Cancer Center, Essen University Hospital, Essen, Germany
| | - Bishoy M Faltas
- Department of Hematology/Oncology, Weill-Cornell Medicine, New York, NY, USA
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Matsubara N, Osawa T, Abe T, Oya M, Nishimoto K, Iwahori T, Tsuchiya H, Murota M, Yoshida M, Tatematsu Y, Nakano Y, Eto M, Nonomura N. FGFR2/3 Gene Alterations and Clinical Outcomes in Advanced/Metastatic Urothelial Cancer in Japan: MONSTAR-SCREEN Database Study. Cancer Sci 2025; 116:1424-1432. [PMID: 39933925 PMCID: PMC12044656 DOI: 10.1111/cas.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 01/13/2025] [Accepted: 01/21/2025] [Indexed: 02/13/2025] Open
Abstract
Advanced/metastatic urothelial cancer (a/m UC) still has a poor prognosis despite the recent medical advances. Recent studies demonstrated that fibroblast growth factor receptor (FGFR) gene alterations (GAs) may be driver genes for UC; however, the proportion of UC genetic panel testing in Japan remains low. We clarified the proportion of patients with FGFR2/3 GAs, treatment patterns, and clinical outcomes in a/m UC patients in Japan. This study was a descriptive epidemiological study using the MONSTAR-SCREEN database, and 138 patients with a/m UC were evaluated. The primary endpoint was the proportion of patients with FGFR2/3 GAs. The secondary endpoints included treatment patterns, clinical outcomes, genomic status before and after treatment, etc. The proportion of FGFR GA-positive patients in a/m UC was 11.9%. The most common FGFR mutation variant and fusion gene were S249C (4.4%) and FGFR3-TACC3 fusion (3.7%), respectively. Fifty-one patients were tested two or more times; a few changes were observed in the FGFR GA status, regardless of the treatment regimen. Co-occurrence association was observed in FGFR1 with TET2, and in FGFR3 with CHEK2 or MLL2. During the first-, second-, and third-line treatment, median progression-free survival (PFS) of GA-positive patients was 7.3, 2.9, and 6.2 months, while for GA-negative patients, 6.9, 3.1, and 6.9 months, respectively. This study revealed that one in eight a/m UC patients had FGFR2/3 GAs, and a few changes were observed in FGFR GA status before and after treatment. Genetic testing will be beneficial for the selection of appropriate treatments after a diagnosis of a/m UC.
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Affiliation(s)
- Nobuaki Matsubara
- Department of Medical OncologyNational Cancer Center Hospital EastChibaJapan
| | - Takahiro Osawa
- Department of Renal and Genitourinary SurgeryHokkaido University Graduate School of MedicineSapporoJapan
| | - Takashige Abe
- Department of Renal and Genitourinary SurgeryHokkaido University Graduate School of MedicineSapporoJapan
| | - Mototsugu Oya
- Department of UrologyKeio University School of MedicineTokyoJapan
| | | | | | | | | | | | | | | | - Masatoshi Eto
- Department of UrologyKyushu University Graduate School of Medical SciencesFukuokaJapan
| | - Norio Nonomura
- Department of UrologyOsaka University Graduate School of MedicineOsakaJapan
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6
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Peng Y, Song Y, Qin C, Ding M, Huang Z, Wang F, HuangFu Y, Yu L, Du Y, Xu T. Genomic subtypes of non-muscle-invasive bladder cancer: guiding immunotherapy decision-making for patients exposed to aristolochic acid. Mol Med 2025; 31:140. [PMID: 40247187 PMCID: PMC12004710 DOI: 10.1186/s10020-025-01199-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 04/04/2025] [Indexed: 04/19/2025] Open
Abstract
BACKGROUND The limited genomic data on non-muscle-invasive bladder cancer (NMIBC) hampers our understanding of its carcinogenesis and development. Specifically, Aristolochic acid (AA), a potent human carcinogenic compound from aristolochia plants and commonly found in Chinese herbal medicine, has been extensively documented as being closely associated with the onset and progression of bladder cancer. However, the field of AA-induced NMIBC remains largely unexplored in terms of its genomic and molecular characteristics, as well as clinical therapeutic strategies. METHODS To bridge this knowledge gap, we conducted a comprehensive study using a cohort of 81 NMIBC samples. We performed whole-exome sequencing (WES) and RNA sequencing (RNA-seq) to obtain detailed genomic and transcriptomic data. We subjected these datasets to genomic analysis and subtype analysis to gain valuable insights into NMIBC. RESULTS By temporally dissecting mutations in NMIBC specimens, we identified a comprehensive mutational landscape of NMIBC and the associations of these mutations with recurrence-free survival. Additionally, we discerned four genomic subtypes of NMIBC: AA-like, FGFR3/HRAS, FGFR3 & chr9Del, and genome instability (GI). The AA-like subtype presented a high frequency of gene mutations along with a pronounced AA mutagenesis signature of SBS22 (Fisher test: P-value 3.5e-4, OR 25.25) even after temporal dissection. The FGFR3/HRAS subtype exhibited FGFR3 or HRAS mutations with few copy number alterations (CNAs). The FGFR3 & chr9Del subtype was characterized by the co-occurrence of chr9p and chr9q deletions as well as FGFR3 mutations, while the GI subtype showed a high frequency of CNAs. Notably, the AA-like and GI subtypes demonstrated better outcomes after immunotherapy, whereas the FGFR3/HRAS subtype showed poorer outcomes. CONCLUSIONS Our findings provide novel perspectives on the genomics of NMIBC, unveiling four prominent genomic subtypes, each showing different outcomes following immunotherapy. TRIAL REGISTRATION No. 2019PHB268-01 (retrospectively registered on February 14, 2020).
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Affiliation(s)
- Yun Peng
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Caipeng Qin
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Mengting Ding
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Zixiong Huang
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Fei Wang
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yuchao HuangFu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Luping Yu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yiqing Du
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
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7
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Yamamoto A, Kawashima A, Uemura T, Nakano K, Matsushita M, Ishizuya Y, Jingushi K, Hase H, Katayama K, Yamaguchi R, Sassi N, Motoyama Y, Nojima S, Mita M, Kimura T, Motooka D, Horibe Y, Okuda Y, Oka T, Yamamichi G, Tomiyama E, Koh Y, Yamamoto Y, Kato T, Hatano K, Uemura M, Imoto S, Wada H, Morii E, Tsujikawa K, Nonomura N. A novel mouse model of upper tract urothelial carcinoma highlights the impact of dietary intervention on gut microbiota and carcinogenesis prevention despite carcinogen exposure. Int J Cancer 2025; 156:1439-1456. [PMID: 39693209 PMCID: PMC11789449 DOI: 10.1002/ijc.35295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 11/19/2024] [Accepted: 11/28/2024] [Indexed: 12/20/2024]
Abstract
Animal models of N-butyl-N-(4-hydroxy butyl) nitrosamine (BBN)-induced urothelial carcinoma (UC), particularly bladder cancer (BC), have long been established. However, the rare incidence of BBN-induced upper urinary tract UC (UTUC), which originates from the same urothelium as BC, remains elusive. The scarcity of animal models of UTUC has made it challenging to study the biology of UTUC. To address this problem, we tried to establish a novel mouse model of UTUC by treating multiple mice strains and sexes with BBN. The molecular consistency between the UTUC mouse model and human UTUC was confirmed using multi-omics analyses, including whole-exome, whole-transcriptome, and spatial transcriptome sequencing. 16S ribosomal RNA metagenome sequencing, metabolome analysis, and dietary interventions were employed to assess changes in the gut microbiome, metabolome, and carcinogenesis of UTUC. Of all treated mice, only female BALB/c mice developed UTUC over BC. Multi-omics analyses confirmed that the UTUC model reflected the molecular characteristics and heterogeneity of human UTUC with poor prognosis. Furthermore, the model exhibited increased Tnf-related inflammatory gene expression in the upper urinary tract and a low relative abundance of Parabacteroides distasonis in the gut. Dietary intervention, mainly without alanine, led to P. distasonis upregulation and successfully prevented UTUC, as well as suppressed Tnf-related inflammatory gene expression in the upper urinary tract despite the exposure to BBN. This is the first report to demonstrate a higher incidence of UTUC than BC in a non-engineered mouse model using BBN. Overall, this model could serve as a useful tool for comprehensively investigating UTUC in future studies.
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Affiliation(s)
- Akinaru Yamamoto
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Atsunari Kawashima
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Toshihiro Uemura
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Kosuke Nakano
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Makoto Matsushita
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yu Ishizuya
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Kentaro Jingushi
- Laboratory of Molecular and Cellular Physiology, Graduate School of Pharmaceutical SciencesOsaka UniversitySuitaOsakaJapan
| | - Hiroaki Hase
- Laboratory of Molecular and Cellular Physiology, Graduate School of Pharmaceutical SciencesOsaka UniversitySuitaOsakaJapan
| | - Kotoe Katayama
- Laboratory of Sequence Analysis, Human Genome Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Rui Yamaguchi
- Division of Cancer Systems BiologyAichi Cancer Center Research InstituteNagoyaJapan
- Division of Cancer InformaticsNagoya University Graduate School of MedicineNagoyaJapan
| | - Nesrine Sassi
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yuichi Motoyama
- Department of Pathology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Satoshi Nojima
- Department of Pathology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | | | - Tomonori Kimura
- Department of Nephrology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Daisuke Motooka
- Department of Infection Metagenomics, Research Institute for Microbial DiseasesOsaka UniversitySuitaOsakaJapan
| | - Yuki Horibe
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yohei Okuda
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Toshiki Oka
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Gaku Yamamichi
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Eisuke Tomiyama
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yoko Koh
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Yoshiyuki Yamamoto
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Taigo Kato
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Koji Hatano
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Motohide Uemura
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Seiya Imoto
- Laboratory of Sequence Analysis, Human Genome Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
- Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Hisashi Wada
- Department of Clinical Research in Tumor Immunology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Eiichi Morii
- Department of Pathology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
| | - Kazutake Tsujikawa
- Laboratory of Molecular and Cellular Physiology, Graduate School of Pharmaceutical SciencesOsaka UniversitySuitaOsakaJapan
| | - Norio Nonomura
- Department of Urology, Graduate School of MedicineOsaka UniversitySuitaOsakaJapan
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8
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Li J, Song Y, Chen R, Gao H, Liu Y, Peng Y, Wu J, Lai S, Du Y, Qin C, Xu T. Improving Urothelial Carcinoma Outcomes: The Powerful Combination of Neoadjuvant and Adjuvant Chemotherapy in the Perioperative Period. Ann Surg Oncol 2025:10.1245/s10434-025-17154-7. [PMID: 40146492 DOI: 10.1245/s10434-025-17154-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 02/25/2025] [Indexed: 03/29/2025]
Abstract
INTRODUCTION To enhance urothelial carcinoma (UC) prognosis, clinicians combine surgery with intraoperative (ICT), neoadjuvant (NACT), or adjuvant chemotherapy (ACT); however, studies on their individual and combined effects vary. Furthermore, studies on the combined use of ACT and NACT are scarce. OBJECTIVE This study aimed to assess the impact of these chemotherapy regimens on UC prognosis, particularly the effectiveness of ACT + NACT, using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS We analyzed 45,211 UC cases from 2019 to 2021, focusing on renal, ureter, bladder, prostate, and urethra UC. Cox model-adjusted survival curves and multivariable Cox regression were performed using SPSS and R software. RESULTS Compared with ACT, NACT alone did not significantly impact survival (hazard ratio [HR] 0.834, 95% confidence interval [CI] 0.392-1.774, p = 0.638), whereas ACT + NACT (HR 0.389, 95% CI 0.169-0.895, p = 0.026) and ICT + ACT + NACT (HR 0.466, 95% CI 0.246-0.883, p = 0.019) positively affected UC prognosis. However, when compared with the combination of ACT + NACT, the combination of ICT + ACT + NACT did not show a statistically significant effect (HR 1.198, 95% CI 0.427-3.362, p = 0.731). Compared with no chemotherapy, ACT reduced renal UC survival (HR 1.430, 95% CI 1.105-1.850, p = 0.007) but improved ureter (HR 0.460, 95% CI 0.232-0.915, p = 0.027) and bladder UC survival (HR 0.605, 95% CI 0.466-0.785, p < 0.001). CONCLUSIONS Prognosis after chemotherapy varied depending on different tumor locations. ACT reduced the prognosis of renal UC patients but elevated the prognosis of ureter UC and bladder UC patients. Distinct chemotherapy protocols have also yielded varying prognostic outcomes. For UC patients, the combination of ACT + NACT merits consideration in order to achieve better prognostic outcomes than the use of ACT or NACT alone. The adoption of ICT for UC patients may not be necessary.
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Affiliation(s)
- Jincong Li
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Rui Chen
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Hanlin Gao
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yang Liu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yun Peng
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Jilin Wu
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Shicong Lai
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Yiqing Du
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Caipeng Qin
- Department of Urology, Peking University People's Hospital, Beijing, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, China.
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9
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Eva C, Johannes K, Shahrokh S, Gabriel W. Updates on Urothelial Carcinoma of the Upper Urinary Tract with a Focus on Molecular Findings. Surg Pathol Clin 2025; 18:53-61. [PMID: 39890309 DOI: 10.1016/j.path.2024.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Urothelial carcinoma (UC) of the upper urinary tract (UUT) is rare, constituting 5% to 10% of UCs, with a higher prevalence in males and older adults. It encompasses various subtypes and, unlike UC of the bladder, often presents as invasive disease. Molecular studies reveal frequent FGFR3 and TP53 mutations, guiding therapeutic strategies. Lynch Syndrome (LS), a hereditary condition, significantly contributes to UUT UC, especially in young patients. Current treatments emphasize platinum-based chemotherapy post-surgery, though immunotherapy shows promise, especially in LS cases. Further molecular insights are crucial for improving diagnosis and treatment.
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Affiliation(s)
- Compérat Eva
- Department of Pathology, Medical University Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.
| | - Kläger Johannes
- Department of Pathology, Medical University Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Shariat Shahrokh
- Department of Urology, Medical University Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
| | - Wasinger Gabriel
- Department of Pathology, Medical University Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria
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10
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St-Laurent MP, Nikkola J, Bahlburg H, Scurll JM, Black PC. Can a Molecular Classifier of Upper Tract Urothelial Carcinoma Inform Clinical Decision-making and Biological Stratification? Eur Urol 2025; 87:355-356. [PMID: 39616002 DOI: 10.1016/j.eururo.2024.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Revised: 11/10/2024] [Accepted: 11/19/2024] [Indexed: 02/21/2025]
Affiliation(s)
| | - Jussi Nikkola
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Henning Bahlburg
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Joshua M Scurll
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
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11
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Chen JF, Al-Ahmadie H. Molecular Classification of Urothelial Carcinoma. Surg Pathol Clin 2025; 18:41-51. [PMID: 39890308 DOI: 10.1016/j.path.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2025]
Abstract
Urothelial carcinoma exhibits a wide spectrum of morphologic and molecular heterogeneity. Advances in molecular testing have improved our understanding of the molecular biology of urothelial carcinoma, including recurrent genomic alterations and transcriptomic features, leading to the development of molecular classification schemes with potential therapeutic implications. This review summarizes the molecular characteristics of urothelial carcinoma, focusing on genomic and transcriptomic features, updates on variant histology, and novel biomarkers that may guide contemporary and future clinical management.
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Affiliation(s)
- Jie-Fu Chen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center.
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12
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Lyu T, Wu K, Zhou Y, Kong T, Li L, Wang K, Fu P, Wei P, Chen M, Zheng J. Single-Cell RNA Sequencing Reveals the Tumor Heterogeneity and Immunosuppressive Microenvironment in Urothelial Carcinoma. Cancer Sci 2025; 116:710-723. [PMID: 39726326 PMCID: PMC11875766 DOI: 10.1111/cas.16436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Revised: 11/24/2024] [Accepted: 12/09/2024] [Indexed: 12/28/2024] Open
Abstract
Urothelial carcinoma (UC) can arise from either the lower urinary tract or the upper tract; they represent different disease entities and require different clinical treatment strategies. A full understanding of the cellular characteristics in UC may guide the development of novel therapies. Here, we performed single-cell transcriptome analysis from four patients with UC of the bladder (UCB), five patients with UC of the ureter (UCU), and four patients with UC of the renal pelvis (UCRP) to develop a comprehensive cell atlas of UC. We found the rare epithelial cell subtype EP9 with epithelial-to-mesenchymal transition (EMT) and cancer stem cell (CSC) features, and specifically expressed SOX6, which was associated with poor prognosis. We also found that ACKR1+ endothelial cells and inflammatory cancer-associated fibroblasts (iCAFs) were more enriched in UCU, which may promote pathogenesis. While ESM1+ endothelial cells may more actively participate in UCB and UCRP tumorigenesis by promoting angiogenesis. Additionally, CD8 + effector T cells were more enriched in UCU and UCRP patients, while Tregs were mainly enriched in UCB tumors. C1QC+ macrophages and LAMP3+ dendritic cells were more enriched in UCB, which is closely related to the formation of the heterogeneous immunosuppressive microenvironment. Furthermore, we found strong interactions between iCAFs, EP9, and Endo_ESM1, and different degrees of activation of the FGF-FGFR3 axis and immune checkpoint pathway were observed in different UC subtypes. Our study elucidated the cellular heterogeneity and the components of the microenvironment in UC arising from the upper and lower urinary tracts and provided novel therapeutic targets.
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Affiliation(s)
- Tianqi Lyu
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
| | - Kerong Wu
- Department of Urology, Ningbo First HospitalSchool of Medicine Ningbo University, Zhejiang University Ningbo HospitalNingboChina
| | - Yincong Zhou
- Department of Bioinformatics, College of Life SciencesZhejiang UniversityHangzhouChina
| | - Tong Kong
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
| | - Lin Li
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
| | - Kaizhe Wang
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
| | - Pan Fu
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
| | - Pengyao Wei
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
| | - Ming Chen
- Department of Bioinformatics, College of Life SciencesZhejiang UniversityHangzhouChina
| | - Jianping Zheng
- Cixi Institute of Biomedical Engineering, Chinese Academy of Science (CAS)Ningbo Institute of Materials Technology and Engineering, CAS NingboNingboChina
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13
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Kim K, Alam SM, Kuo F, Chen Z, Yip W, Katims AB, Chu C, Lenis AT, Hu W, Gokturk Ozcan G, Chen JF, Firouzi S, Elhanati Y, Clinton TN, Aulitzky A, Almassi N, Fujii Y, Tracey AT, Reisz PA, Budhu S, Vuong L, Eichholz J, Woo HJ, Nogueira L, Gao SP, Scherz A, Aggen DH, Rosenberg JE, Pietzak EJ, Seshan V, Greenbaum B, Becker A, Akin O, Iyer G, Al-Ahmadie H, Hakimi AA, Merghoub T, Solit DB, Coleman JA. Molecular Heterogeneity and Immune Infiltration Drive Clinical Outcomes in Upper Tract Urothelial Carcinoma. Eur Urol 2025; 87:342-354. [PMID: 39550333 PMCID: PMC12092068 DOI: 10.1016/j.eururo.2024.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 09/25/2024] [Accepted: 10/22/2024] [Indexed: 11/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Molecular classification of upper tract urothelial carcinoma (UTUC) can provide insight into divergent clinical outcomes and provide a biological rationale for clinical decision-making. As such, we performed multi-omic analysis of UTUC tumors to identify molecular features associated with disease recurrence and response to immune checkpoint blockade (ICB). METHODS Targeted DNA and whole transcriptome RNA sequencing was performed on 100 UTUC tumors collected from patients undergoing nephroureterectomy. Consensus non-negative matrix factorization was used to identify molecular clusters associated with clinical outcomes. Gene set enrichment and immune deconvolution analyses were performed. Weighted gene co-expression network analysis was employed for unsupervised identification of gene networks in each cluster. KEY FINDINGS AND LIMITATIONS Five molecular clusters with distinct clinical outcomes were identified. Favorable subtypes (C1 and C2) were characterized by a luminal-like signature and an immunologically depleted tumor microenvironment (TME). Subtype C3 was characterized by FGFR3 alterations and a higher tumor mutational burden, and included all tumors with microsatellite instability. Despite higher rates of recurrence and inferior survival, subtypes C4 and C5 harbored an immunologically rich TME favoring response to ICB. Limitations include extrapolation of molecular features of tumors from the primary site to determine response to systemic immunotherapy and the limited resolution of bulk sequencing to distinguish gene expression in the tumor, stroma, and immune compartments. CONCLUSIONS AND CLINICAL IMPLICATIONS RNA sequencing identified previously underappreciated UTUC molecular heterogeneity and suggests that UTUC patients at the highest risk of metastatic recurrence following surgery include those most likely to benefit from perioperative ICB.
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Affiliation(s)
- Kwanghee Kim
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Syed M Alam
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fengshen Kuo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ziyu Chen
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wesley Yip
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew B Katims
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carissa Chu
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew T Lenis
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wenhuo Hu
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gamze Gokturk Ozcan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jie-Fu Chen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sanaz Firouzi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yuval Elhanati
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Timothy N Clinton
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas Aulitzky
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nima Almassi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yoich Fujii
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Andrew T Tracey
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter A Reisz
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sadna Budhu
- Ludwig Collaborative and Swim Across America Laboratory, Department of Pharmacology and Mayer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Lynda Vuong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jordan Eichholz
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hyung Jun Woo
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lucas Nogueira
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sizhi P Gao
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David H Aggen
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonathan E Rosenberg
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eugene J Pietzak
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Venkatraman Seshan
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Benjamin Greenbaum
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anton Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gopa Iyer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taha Merghoub
- Ludwig Collaborative and Swim Across America Laboratory, Department of Pharmacology and Mayer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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14
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Kobayashi K, Sakano S, Matsumoto H, Yamamoto M, Tsuchida M, Tei Y, Nagao K, Oba K, Kitahara S, Yano S, Yoshihiro S, Yamamoto Y, Ohmi C, Komatsu H, Misumi T, Akao J, Shiraishi K. Prognostic risk score and index including the platelet-to-lymphocyte ratio and lactate dehydrogenase in patients with metastatic or unresectable urothelial carcinoma treated with immune checkpoint inhibitors. Jpn J Clin Oncol 2025; 55:148-157. [PMID: 39373462 DOI: 10.1093/jjco/hyae137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 09/20/2024] [Indexed: 10/08/2024] Open
Abstract
BACKGROUND Avelumab and pembrolizumab are administered after platinum-based chemotherapy for the treatment of metastatic urothelial carcinoma. We explored the prognostic factors and risk scores for predicting the outcomes of metastatic or unresectable urothelial carcinoma at the start of treatment with immune checkpoint inhibitors. METHODS This retrospective study included patients with metastatic or unresectable urothelial carcinoma treated with avelumab or pembrolizumab after platinum-based chemotherapy between January 2017 and December 2022. Prognostic factors, including patient and tumor characteristics and blood data at the initiation of immune checkpoint inhibitor therapy, were examined. RESULTS This study included 36 and 207 patients treated with avelumab and pembrolizumab, respectively, for metastatic or unresectable urothelial carcinoma. Eastern Cooperative Oncology Group performance status, presence of visceral metastases, platelet-to-lymphocyte ratio and lactate dehydrogenase levels were independent prognostic factors for predicting overall survival. The median overall survival of patients in the risk-score model was 58.5 months (score zero), 27.9 months (one), 13.1 months (two) and 3.9 months (three or higher). The C-index for overall survival was 0.718 for the newly developed risk score compared with 0.679 for the Bellmunt score and 0.703 for the Bellmunt-C-reactive protein score. Additionally, the C-index for overall survival using the immune prognostic index derived from lactate dehydrogenase and the platelet-to-lymphocyte ratio was 0.646 compared with 0.615 for the Lung Immune Prognostic Index. CONCLUSIONS A risk score that includes the platelet-to-lymphocyte ratio and lactate dehydrogenase may serve as a useful model for predicting prognosis following the initiation of immune checkpoint inhibitors in patients with metastatic or unresectable urothelial carcinoma.
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Affiliation(s)
- Keita Kobayashi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Shigeru Sakano
- Department of Urology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroaki Matsumoto
- Department of Urology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Mitsutaka Yamamoto
- Department of Urology, Yamaguchi Prefectural Grand Medical Center, Hofu, Japan
| | - Masahiro Tsuchida
- Department of Urology and Nephrology, Tokuyama Central Hospital, Shunan, Japan
| | - Yasuhide Tei
- Department of Urology, Kanmon Medical Center, Shimonoseki, Japan
| | - Kazuhiro Nagao
- Department of Urology, Shuto General Hospital, Yanai, Japan
| | - Kazuo Oba
- Department of Urology, Saiseikai Yamaguchi General Hospital, Yamaguchi, Japan
| | - Seiji Kitahara
- Department of Urology, Nagato General Hospital, Nagato, Japan
| | - Seiji Yano
- Department of Urology, Masuda Red Cross Hospital, Masuda, Japan
| | - Satoru Yoshihiro
- Department of Urology, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Yoshiaki Yamamoto
- Department of Urology, Sanyo-Onoda Municipal Hospital, Sanyo-Onoda, Japan
| | - Chietaka Ohmi
- Department of Urology, Ube-kohsan Central Hospital Corp, Ube, Japan
| | - Hirotaka Komatsu
- Department of Urology, Shimonoseki Saiseikai Toyoura Hospital, Shimonoseki, Japan
| | - Taku Misumi
- Department of Urology, Ogori Daiichi General Hospital, Yamaguchi, Japan
| | - Jumpei Akao
- Department of Urology, Hikari Municipal Hikari General Hospital, Hikari, Japan
| | - Koji Shiraishi
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
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15
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Sekino Y, Nakahara H, Ikeda K, Kobatake K, Kohada Y, Tasaka R, Takemoto K, Miyamoto S, Kitano H, Goto K, Goriki A, Hieda K, Hinata N. The Gender-Biased Differential Effect of KDM6A Mutation on Immune Therapy in Urothelial Carcinoma: A Public Database Study. Cancers (Basel) 2025; 17:356. [PMID: 39941725 PMCID: PMC11816370 DOI: 10.3390/cancers17030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2024] [Revised: 01/16/2025] [Accepted: 01/19/2025] [Indexed: 02/16/2025] Open
Abstract
Background/Objectives: It is said that genes that escape from X chromosome inactivation (XCI) contribute to gender differences. We analyzed the prognostic role of these genes and identified a gender-biased difference in prognosis according to KDM6A mutation in the immune therapy cohort (IMvigor 210). We also investigate the gender-biased differential effect of KDM6A mutation in several public databases of urothelial carcinoma (UC). Methods: We used AACR GENIE, The Cancer Genome Atlas, International Cancer Genome Consortium, several public databases related to immune therapy, chemotherapy, and BCG treatment. We studied the gender-biased prognostic role of KDM6A mutation in several cohorts and the association between KDM6A mutation and immune-related fractions according to gender. Results: The expression of KDM6A was higher in females than in males in several cohorts. Mutation of KDM6A was observed in about 20-25% of the patients. The rate of KDM6A mutation was higher in females than in males in several cohorts. Kaplan-Meier analysis revealed a gender-biased difference in prognosis between patients with KDM6A mutations and those with the wild-type KDM6A in several cohorts, including the immune therapy cohort. The rate of immune-inflamed type was higher in males than in females in the patients with KDM6A mutation in the IMvigor 210 and UC-GENOME studies. Single-sample Gene Set Enrichment Analysis showed that CD8+ cells and type 1 IFN response fractions and APC co-inhibition fraction were higher in the male than female patients with KDM6A mutation. Similar findings were observed in other immune-related studies (UC-GENOME). Conclusions: The effect of KDM6A mutation on immune therapy varied according to gender, and the status of KDM6A mutation may be a promising biomarker in immune therapy in UC.
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Affiliation(s)
- Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Hikaru Nakahara
- Department of Clinical and Molecular Genetics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan;
| | - Kenichiro Ikeda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Kohei Kobatake
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Yuki Kohada
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Ryo Tasaka
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Kenshiro Takemoto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Shunsuke Miyamoto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Hiroyuki Kitano
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Akihiro Goriki
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Keisuke Hieda
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
| | - Nobuyuki Hinata
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.I.); (K.K.); (Y.K.); (R.T.); (K.T.); (S.M.); (H.K.); (K.G.); (A.G.); (K.H.); (N.H.)
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16
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Zeng Y, Lv W, Tao H, Li C, Jiang S, Liang Y, Chen C, Yu T, Li Y, Wu S, Cui X, Liang N, Wang P, Xu H, Dong J, Teng H, Chen K, Mu K, Fan T, Cen X, Xu Z, Zhu M, Wang W, Mi J, Xiang X, Dong W, Yang H, Bolund L, Lin L, Song J, Song X, Luo Y, Lin C, Han P. Mapping the chromothripsis landscape in urothelial carcinoma unravels great intratumoral and intertumoral heterogeneity. iScience 2025; 28:111510. [PMID: 39790556 PMCID: PMC11714673 DOI: 10.1016/j.isci.2024.111510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 08/24/2024] [Accepted: 11/28/2024] [Indexed: 01/12/2025] Open
Abstract
Chromothripsis, a hallmark of cancer, is characterized by extensive and localized DNA rearrangements involving one or a few chromosomes. However, its genome-wide frequency and characteristics in urothelial carcinoma (UC) remain largely unknown. Here, by analyzing single-regional and multi-regional whole-genome sequencing (WGS), we present the chromothripsis blueprint in 488 UC patients. Chromothripsis events exhibit significant intertumoral heterogeneity, being detected in 41% of UC patients, with an increase from 30% in non-muscle-invasive disease (Ta/1) to 53% in muscle-invasive disease (T2-4). The presence of chromothripsis correlates with an unstable cancer genome and poor clinical outcomes. Analysis of multi-regional WGS data from 52 patients revealed pronounced intratumoral heterogeneity with chromothripsis events detectable only in specific tumor regions rather than uniformly across all areas. Chromothripsis events evolve under positive selection and contribute to tumor dissemination. This study presents a comprehensive genome-wide chromothripsis landscape in UC, highlighting the significance of chromothripsis in UC development.
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Affiliation(s)
- Yuchen Zeng
- School of Life Sciences, Faculty of Medicine, Tianjin University, Tianjin 300072, China
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Wei Lv
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
- College of Life Sciences, University of Chinese Academy of Science, Beijing 100049, China
- Department of Biomedicine, Aarhus University, 8200 Aarhus, Denmark
| | - Huiying Tao
- The 2nd Medical College of Binzhou Medical University, Yantai, Shandong 264003, China
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Conghui Li
- Department of Biology, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Shiqi Jiang
- School of Life Sciences, Faculty of Medicine, Tianjin University, Tianjin 300072, China
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Yuan Liang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing 100101, China
| | - Chen Chen
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Tianxi Yu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Yue Li
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Shuang Wu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Xin Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Ning Liang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Ping Wang
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences and China National Center for Bioinformation, Beijing 100101, China
| | - Huixin Xu
- Department of Biomedicine, Aarhus University, 8200 Aarhus, Denmark
| | - Jingjing Dong
- Department of General Medicine, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Huajing Teng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ke Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Kai Mu
- The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong 250033, China
| | - Tianda Fan
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Xiaoping Cen
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
- College of Life Sciences, University of Chinese Academy of Science, Beijing 100049, China
| | - Zhe Xu
- College of Life Sciences, University of Chinese Academy of Science, Beijing 100049, China
| | - Ming Zhu
- Tsinghua-Peking Joint Center for Life Sciences, Tsinghua University, Beijing 100084, China
| | - Wenting Wang
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Jia Mi
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Binzhou Medical University, Yantai, Shandong 264003, China
| | - Xi Xiang
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518107, Guangdong, China
| | - Wei Dong
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Huanming Yang
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Lars Bolund
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Lin Lin
- Department of Biomedicine, Aarhus University, 8200 Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jinzhao Song
- HIM-BGI Omics Center, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Yonglun Luo
- Department of Biomedicine, Aarhus University, 8200 Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Chunhua Lin
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, China
| | - Peng Han
- Department of Biology, University of Copenhagen, 2100 Copenhagen, Denmark
- Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen 518107, Guangdong, China
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Jin K, Ding Y, Xu J, Liu Z, Zeng H, Su X, Zhang L, Sun J, Wu Y, Liu H, Chang Y, Zhu Y, Wang Z, Xu L, Zhang W, Xu J. Lethal clinical outcome and chemotherapy and immunotherapy resistance in patients with urothelial carcinoma with MDM2 amplification or overexpression. J Immunother Cancer 2025; 13:e010964. [PMID: 39762080 PMCID: PMC11749520 DOI: 10.1136/jitc-2024-010964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2024] [Accepted: 12/13/2024] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND The E3 ubiquitin ligase murine double minute 2 (MDM2) binds the p53 transcriptional activation domain and acts as a potent inhibitor of TP53 pathway, one of the three most crucial oncogenic pathways in urothelial carcinoma (UC). However, the clinical significance and impact on tumor immune contexture of MDM2 amplification in UC remain unclear. METHODS This study analyzed 240 patients with UC with matched clinical annotations from two local cohorts (ZSHS cohort and FUSCC cohort). We assessed the correlation between MDM2 status and clinical outcomes, therapeutic efficacy, and immunological characteristics by immunohistochemical analysis and targeted sequencing. Additionally, 2264 UC samples from five independent external cohorts, with genomic, transcriptomic, and clinical data, were used for validation. RESULTS MDM2 amplification (MDM2 Amp) or protein overexpression (MDM2OE) was associated with inferior overall survival (ZSHS cohort, Log-rank p<0.001; FUSCC cohort, Log-rank p=0.030) and reduced response to platinum-based chemotherapy (ZSHS cohort, Log-rank p<0.001) as well as anti-PD-1/PD-L1 immunotherapy (FUSCC cohort, Log-rank p=0.016) in patients with UC, irrespective of TP53/p53 status. MDM2 amplification or overexpression was further linked to high-grade UC tumors with dedifferentiated morphology. In addition, UC with MDM2 amplification or overexpression was associated with an immuno-evasive contexture characterized by lower proportion of tertiary lymphoid structure infiltration, lower abundance of CD8+ T cells, IFN-γ+ cells, GZMB+ cells, and decreased expression of immune checkpoint molecules including programmed death-ligand 1 (PD-L1), programmed death-1 (PD-1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). CONCLUSIONS MDM2 amplification or overexpression defines a lethal subset of patients with UC with inferior prognosis and resistance to both platinum-based chemotherapy and immunotherapy irrespective of TP53/p53 status. These tumors are characterized by dedifferentiated morphology and an immunosuppressive microenvironment. Accurate assessment of MDM2 status can improve risk stratification and enable personalized genomics-guided treatment for patients with UC.
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Affiliation(s)
- Kaifeng Jin
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yawei Ding
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jingtong Xu
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Zhaopei Liu
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Han Zeng
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiaohe Su
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Lingkai Zhang
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jiaxing Sun
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Yuzhen Wu
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Hailong Liu
- Department of Urology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Chang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yu Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zewei Wang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Le Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijuan Zhang
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Jiejie Xu
- NHC Key Laboratory of Glycoconjugate Research, Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Fudan University, Shanghai, China
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18
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Liu Z, Ma H, Guo Z, Su S, He X. Development of a machine learning-based predictive model for transitional cell carcinoma of the renal pelvis in White Americans: a SEER-based study. Transl Androl Urol 2024; 13:2681-2693. [PMID: 39816222 PMCID: PMC11732296 DOI: 10.21037/tau-24-385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 12/03/2024] [Indexed: 01/18/2025] Open
Abstract
Background Transitional cell carcinoma (TCC) of the renal pelvis is a rare cancer within the urinary system. However, the prognosis is not entirely satisfactory. This study aims to develop a clinical model for predicting cancer-specific survival (CSS) at 1-, 3-, and 5-year for White Americans with renal pelvic TCC. Methods Data of all White American patients diagnosed with TCC of the renal pelvis from 2010 to 2015 were extracted and analyzed from the Surveillance, Epidemiology, and End Results (SEER) database in this retrospective study. Subsequently, after excluding the metastatic group, a subgroup analysis was performed on the data of 1,715 White Americans with non-metastatic renal pelvic TCC. Patients included in this study were randomly divided into the training and validation sets in a ratio of 7:3. In addition, the features in the training set were extracted by the Boruta algorithm. The importance of these features was visualized using the eXtreme Gradient Boosting (XGBoost)-based SHapley Additive exPlanation (SHAP) tool. To improve predictive accuracy, a nomogram model with these identified independent prognostic variables was developed. Results A total of 1,887 White American patients with renal pelvic TCC were included in this study. In the training set, the area under the curve (AUC) for CSS nomograms at 1-, 3-, and 5-year were 0.813 [95% confidence interval (CI): 0.774-0.852], 0.738 (95% CI: 0.702-0.774), and 0.733 (95% CI: 0.698-0.768), respectively. Correspondingly, the AUCs for CSS nomograms at the above time points were 0.781 (95% CI: 0.732-0.830), 0.785 (95% CI: 0.741-0.829), and 0.775 (95% CI: 0.729-0.820) in the validation set, respectively. The subgroup analysis results revealed that the AUCs for CSS nomograms at 1-, 3-, and 5-year were 0.788, 0.725, and 0.726 in the training set, respectively, while the AUCs for CSS nomograms at 1-, 3-, and 5-year were 0.831, 0.786, and 0.754 in the training set, respectively. Conclusions In this study, a nomogram that predicts CSS in White American patients diagnosed with renal pelvic TCC was efficiently constructed. The application of the nomogram may enhance patient care and assist clinicians in choosing the optimal treatment strategies.
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Affiliation(s)
- Zhenyu Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Ma
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ziqi Guo
- Department of Urology, The First People Hospital of Lingbao, Lingbao, China
| | - Shuai Su
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangbiao He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Kobayashi G, Sekino Y, Nakahara H, Kobatake K, Goto K, Hayashi T, Sentani K, Hinata N. Distribution and clinicopathological characteristics of G-CSF expression in tumor cells and stromal cells in upper tract urothelial carcinoma. J Cancer Res Clin Oncol 2024; 151:18. [PMID: 39739128 PMCID: PMC11685250 DOI: 10.1007/s00432-024-06045-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 11/21/2024] [Indexed: 01/02/2025]
Abstract
BACKGROUND Urothelial carcinoma (UC) is a common type of malignant disease; however, the diagnostic and prognostic markers of upper urinary tract urothelial cancer (UTUC) remain poorly understood because of its rarity. METHODS To clarify the clinicopathological significance of granulocyte-colony stimulating factor (G-CSF) in UTUC, we analyzed the expression and distribution of G-CSF in 112 upper tract urothelial carcinoma (UTUC) samples with immunohistochemistry. RESULTS In normal urothelium, G-CSF expression was weak or absent, whereas high expression of G-CSF was observed in UTUC tissues, both in tumor cells (TCs) and stromal cells (SCs). G-CSF expression in the TCs and SCs was associated with nodular/flat morphology, high grade, advanced T stage, and lymphovascular invasion in UTUC. G-CSF expression in SCs was associated with poor prognosis and was an independent prognostic factor. Public data showed that G-CSF expression was also associated with decreased progression-free survival and disease-specific survival. A prognostic model was constructed by incorporating the presence or absence of G-CSF expression along with clinicopathologic factors, which allowed for a more accurate prediction of poor prognosis. We further showed that G-CSF expression was associated with a high Ki-67 labeling index and with PD-L1, HER2, and p53 expression in UTUC. CONCLUSION G-CSF expression in TCs and SCs may play a crucial role in UTUC tumor progression. Notably, stromal G-CSF expression showed significant prognostic value, even when compared to major clinicopathological factors, suggesting that the evaluation of G-CSF expression may contribute to clinical decision-making in patients with UTUC.
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Affiliation(s)
- Go Kobayashi
- Laboratory of Molecular Pathology, Department of Molecular Biosciences, Radiation Effects Research Foundation, Hiroshima, Japan
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yohei Sekino
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Hikaru Nakahara
- Department of Clinical and Molecular Genetics, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kohei Kobatake
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Keisuke Goto
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tetsutaro Hayashi
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuhiro Sentani
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Hamidi H, Senbabaoglu Y, Beig N, Roels J, Manuel C, Guan X, Koeppen H, Assaf ZJ, Nabet BY, Waddell A, Yuen K, Maund S, Sokol E, Giltnane JM, Schedlbauer A, Fuentes E, Cowan JD, Kadel EE, Degaonkar V, Andreev-Drakhlin A, Williams P, Carter C, Gupta S, Steinberg E, Loriot Y, Bellmunt J, Grivas P, Rosenberg J, van der Heijden MS, Galsky MD, Powles T, Mariathasan S, Banchereau R. Molecular heterogeneity in urothelial carcinoma and determinants of clinical benefit to PD-L1 blockade. Cancer Cell 2024; 42:2098-2112.e4. [PMID: 39577421 DOI: 10.1016/j.ccell.2024.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 08/15/2024] [Accepted: 10/29/2024] [Indexed: 11/24/2024]
Abstract
Checkpoint inhibitors targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) have revolutionized cancer therapy across many indications including urothelial carcinoma (UC). Because many patients do not benefit, a better understanding of the molecular mechanisms underlying response and resistance is needed to improve outcomes. We profiled tumors from 2,803 UC patients from four late-stage randomized clinical trials evaluating the PD-L1 inhibitor atezolizumab by RNA sequencing (RNA-seq), a targeted DNA panel, immunohistochemistry, and digital pathology. Machine learning identifies four transcriptional subtypes, representing luminal desert, stromal, immune, and basal tumors. Overall survival benefit from atezolizumab over standard-of-care is observed in immune and basal tumors, through different response mechanisms. A self-supervised digital pathology approach can classify molecular subtypes from H&E slides with high accuracy, which could accelerate tumor molecular profiling. This study represents a large integration of UC molecular and clinical data in randomized trials, paving the way for clinical studies tailoring treatment to specific molecular subtypes in UC and other indications.
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Affiliation(s)
| | | | - Niha Beig
- Genentech, South San Francisco CA, USA
| | | | | | | | | | | | | | | | - Kobe Yuen
- Genentech, South San Francisco CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Yohann Loriot
- Institut de Cancérologie Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Kazarian AG, Bhanvadia RR, Khene ZE, Gerald T, Brooks B, Lotan Y, Tachibana I, Gaston K, Woldu S, Margulis V. Landscape of Genomic Profiling and Circulating Tumor DNA Among Rare Genitourinary Cancers. Clin Genitourin Cancer 2024; 22:102245. [PMID: 39561633 DOI: 10.1016/j.clgc.2024.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 10/13/2024] [Indexed: 11/21/2024]
Affiliation(s)
| | - Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | | | - Thomas Gerald
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Bailey Brooks
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Isamu Tachibana
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Kris Gaston
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Sol Woldu
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern, Dallas, TX
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22
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Shigeta K, Matsumoto K, Kitaoka S, Omura M, Umeda K, Arita Y, Mikami S, Fukumoto K, Yasumizu Y, Tanaka N, Takeda T, Morita S, Kosaka T, Mizuno R, Hara S, Oya M. Profiling Fibroblast Growth Factor Receptor 3 Expression Based on the Immune Microenvironment in Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2024; 7:1338-1349. [PMID: 38320909 DOI: 10.1016/j.euo.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/10/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Although several studies have shown favorable outcomes in upper tract urothelial carcinoma (UTUC) with fibroblast growth factor receptor 3 (FGFR3) mutations and/or expression, the relationship between immune cell markers and FGFR3 expression remains unknown. OBJECTIVE To clarify the FGFR3-based immune microenvironment and investigate biomarkers to predict the treatment response to pembrolizumab (Pem) in patients with UTUC. DESIGN, SETTING, AND PARTICIPANTS We conducted immunohistochemical staining in 214 patients with UTUC. The expression levels of FGFR3, CD4, CD8, CD68, CD163, CD204, and programmed cell death ligand 1 (PD-L1) were examined. INTERVENTION All UTUC patients underwent radical nephroureterectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We assessed the relationship between these immune markers and patient prognosis. RESULTS AND LIMITATIONS A total of 109 (50.9%) patients showed high FGFR3 expressions and a favorable prognosis compared with the remaining patients. Among the six immune markers, CD8 high expression was an independent favorable factor, whereas CD204 expression was an independent prognostic factor for cancer death. From the FGFR3-based immune clustering, three immune clusters were identified. Cluster A showed low FGFR3 with tumor-associated macrophage-rich components (CD204+) followed by a poor prognosis due to a poor response to Pem. Cluster B showed low FGFR3 with an immune hot component (CD8+), followed by the most favorable prognosis owing to a good response to Pem. Cluster C showed high FGFR3 expression but an immune cold component, followed by a favorable prognosis due to the high FGFR3 expression, but a poor response was confirmed with Pem. CONCLUSIONS Although most patients exhibit a poor response to Pem, individuals with low FGFR3 expression and immune hot status may benefit clinically from Pem treatment. PATIENT SUMMARY We conducted immunohistochemical staining to evaluate fibroblast growth factor receptor 3 (FGFR3)-related immune microenvironment by evaluating the expressions of CD4, CD8, CD68, CD163, CD204, and PD-L1 in 214 upper tract urothelial carcinoma patients. We identified three distinct immune clusters based on FGFR3 expressions and found that patients with a low FGFR3 expression but immune hot status received the maximum benefit from an immune checkpoint inhibitor.
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MESH Headings
- Humans
- Tumor Microenvironment/immunology
- Female
- Male
- Aged
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Middle Aged
- Carcinoma, Transitional Cell/immunology
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Ureteral Neoplasms/metabolism
- Ureteral Neoplasms/immunology
- Ureteral Neoplasms/pathology
- Prognosis
- Kidney Neoplasms/immunology
- Kidney Neoplasms/pathology
- Kidney Neoplasms/metabolism
- Antibodies, Monoclonal, Humanized/therapeutic use
- Aged, 80 and over
- Antineoplastic Agents, Immunological/therapeutic use
- Biomarkers, Tumor/metabolism
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Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan; Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Sotaro Kitaoka
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Minami Omura
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Kota Umeda
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Yuki Arita
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Keishiro Fukumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Hara
- Department of Urology, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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23
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Head DJ, Raman JD. Kidney-Sparing Surgery for Upper Tract Urothelial Carcinoma-Modalities, Outcomes, and Limitations. J Clin Med 2024; 13:6593. [PMID: 39518735 PMCID: PMC11546368 DOI: 10.3390/jcm13216593] [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: 09/03/2024] [Revised: 10/23/2024] [Accepted: 10/28/2024] [Indexed: 11/16/2024] Open
Abstract
Upper tract urothelial carcinoma (UTUC) accounts for 5-10% of urothelial cancers and is associated with high morbidity and mortality. Increasing incidence of UTUC has been observed since the 1970's, alongside the evolution of advance imaging techniques, precision biopsy equipment, and risk stratification models. The high morbidity of radical nephroureterectomy (RNU) which is still the gold-standard treatment for high-risk UTUC, has driven the development of kidney-sparing surgery alternatives for low-risk UTUC. Now, several treatment approaches have outcomes comparable to RNU for low-risk UTUC and guidelines are recommending kidney-sparing surgery for favorable low-risk disease. The main categories of kidney-sparing surgery include segmental ureterectomy, endoscopic ablation, chemoablation, and vascular-targeted phototherapy. These treatments are highly nuanced making them difficult to compare, but for most cases of favorable low-grade disease, we recommend endoscopic laser ablation with optional adjuvant intracavitary therapy. Adverse events associated with kidney-sparing surgery include ureteral stricture, bleeding requiring transfusion, and bladder recurrence of UTUC. Limitations of kidney-sparing surgery include appropriate tissue sampling (contributing to under-grading and under-staging), higher rates of ipsilateral recurrence, and potential for grade and stage progression. Collectively, these may subsequently necessitate RNU. Here, we review the technical variations and evidence behind kidney-sparing therapies as well as their practicality in the real world.
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Affiliation(s)
| | - Jay D. Raman
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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24
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Hoseini ZS, Zeinalilathori S, Fathi-karkan S, Zeinali S, Rahdar A, Siddiqui B, Kharaba Z, Pandey S. Cell-targeting nanomedicine for bladder cancer: A cellular bioengineering approach for precise drug delivery. J Drug Deliv Sci Technol 2024; 101:106220. [DOI: 10.1016/j.jddst.2024.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Gabriel PE, Cancel-Tassin G, Audenet F, Masson-Lecomte A, Allory Y, Roumiguié M, Pradère B, Loriot Y, Léon P, Traxer O, Xylinas E, Rouprêt M, Neuzillet Y, Seisen T. A collaborative review of the microsatellite instability/deficient mismatch repair phenotype in patients with upper tract urothelial carcinoma. BJU Int 2024; 134:723-735. [PMID: 38813615 DOI: 10.1111/bju.16405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To perform a collaborative review of the literature exploring the microsatellite instability/deficient mismatch repair (MSI/dMMR) phenotype in patients with upper tract urothelial carcinoma (UTUC). METHOD A collaborative review of the literature available on Medline was conducted by the Cancer Committee of the French Association of Urology to report studies describing the genetic mechanisms, investigation, prevalence and impact of the MSI/dMMR phenotype in UTUC patients. RESULTS The predominant genetic mechanism leading to the MSI/dMMR phenotype in UTUC patients is related to the constitutional mutation of one allele of the MMR genes MLH1, MSH2, MSH6 and PMS2 within Lynch syndrome. Indications for its investigation currently remain limited to patients with a clinical suspicion for sporadic UTUC to refer only those with a positive testing for germline DNA sequencing to screen for this syndrome. With regard to technical aspects, despite the interest of MSIsensor, only PCR and immunohistochemistry are routinely used to somatically investigate the MSI and dMMR phenotypes, respectively. The prevalence of the MSI/dMMR phenotype in UTUC patients ranges from 1.7% to 57%, depending on the study population, investigation method and definition of a positive test. Younger age and a more balanced male to female ratio at initial diagnosis are the main specific clinical characteristics of UTUC patients with an MSI/dMMR phenotype. Despite the conflicting results available in the literature, these patients may have a better prognosis, potentially related to more favourable pathological features. Finally, they may also have lower sensitivity to chemotherapy but greater sensitivity to immunotherapy. CONCLUSION Our collaborative review summarises the available data from published studies exploring the MSI/dMMR phenotype in UTUC patients, the majority of which are limited by a low level of evidence.
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Affiliation(s)
- Pierre-Etienne Gabriel
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
| | | | - François Audenet
- Department of urology, Georges Pompidou European Hospital, APHP, Centre, Université Paris Cité, Paris, France
| | | | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, Paris, France
| | | | - Benjamin Pradère
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Yohann Loriot
- Department of Oncology, Gustave Roussy, Villejuif, France
| | | | - Olivier Traxer
- Department of Urology, Tenon Hospital, AP-HP, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Université Paris-Saclay, Suresnes, France
| | - Thomas Seisen
- GRC 5 Predictive Onco-Uro, Sorbonne University, AP-HP, Urology, Pitie-Salpetriere Hospital, Paris, France
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Yoshida S, Maezawa Y, Ishihara K, Inoue N, Tanabe K, Izumi K, Fujiwara M, Toide M, Yamamoto T, Uehara S, Araki S, Inoue M, Takazawa R, Numao N, Ohtsuka Y, Tanaka H, Fujii Y. Outcomes and prognostic factors in patients with synchronous and metachronous oligometastatic urothelial carcinoma with visceral metastases. Int J Urol 2024; 31:1234-1240. [PMID: 39010666 DOI: 10.1111/iju.15542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES To evaluate the clinical characteristics of oligometastatic disease (OMD) in metastatic urothelial carcinoma (mUC) with visceral metastases when classified into synchronous and metachronous metastases. METHODS Of 957 cases of de novo mUC treated between 2008 and 2023, 374 with visceral metastases were analyzed. Cases were classified into OMD with up to three metastatic lesions and polymetastatic disease (PMD), and into synchronous and metachronous metastases. The clinical characteristics and overall survival (OS) for each group were analyzed. RESULTS Overall, 196 (52.4%) had synchronous metastasis and 178 (47.6%) had metachronous metastasis. Median OS for synchronous metastases was significantly shorter than for metachronous metastases (12.1 months vs. 15.3 months, p = 0.011). Among the synchronous metastases, 48 (24.5%) were OMD and 148 (75.6%) were PMD. There was no significant difference in OS between the OMDs and PMDs (median 14.9 months vs. 11.7 months, p = 0.32), and only decreased albumin level was identified as a significant predictor of poor OS. Among the metachronous metastases, 64 (36.0%) were OMD and 114 (64.0%) were PMD. There was no significant difference in OS between the OMD and PMD (median 21.2 months vs. 15.0 months, p = 0.35), and no significant predictors of poor OS were identified. CONCLUSIONS For mUC with visceral metastases, the timing of metastasis appearance was associated with prognosis, with synchronous metastases being a poorer prognostic factor compared to metachronous metastases. There was no prognostic difference between OMD and PMD with visceral metastases when classified into synchronous or metachronous metastases.
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Affiliation(s)
- Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yuya Maezawa
- Department of Urology, Tsuchiura Kyodo General Hospital, Tsuchiura-shi, Ibaraki, Japan
| | - Kensaku Ishihara
- Department of Urology, Soka Municipal Hospital, Soka-shi, Saitama, Japan
| | - Naoki Inoue
- Department of Urology, JA Toride Medical Hospital, Toride-shi, Ibaraki, Japan
| | - Kenji Tanabe
- Department of Urology, Saitama Red Cross Hospital, Saitama, Japan
| | - Keita Izumi
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya-shi, Saitama, Japan
| | - Motohiro Fujiwara
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takanobu Yamamoto
- Department of Urology, Tokyo Metropolitan Tama-Nambu Chiiki Hospital, Tama-shi, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Showa General Hospital, Kodaira-shi, Tokyo, Japan
| | - Saori Araki
- Department of Urology, Kohnodai Hospital, Ichikawa-shi, Chiba, Japan
| | - Masaharu Inoue
- Department of Urology, Saitama Prefectural Cancer Center, Kitaadachi-gun-Ina-machi, Saitama, Japan
| | - Ryoji Takazawa
- Department of Urology, Tokyo Metropolitan Ohtsuka Hospital, Toshima-ku, Tokyo, Japan
| | - Noboru Numao
- Department of Urology, Cancer Institute Hospital, Koto-ku, Tokyo, Japan
| | - Yukihiro Ohtsuka
- Department of Urology, Japanese Red Cross Omori Hospital, Ota-ku, Tokyo, Japan
| | - Hajime Tanaka
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
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Jaime-Casas S, Tripathi A, Pal SK, Yip W. Clinical Implications of the Molecular and Genomic Landscape of Upper Tract Urothelial Carcinoma. Curr Urol Rep 2024; 26:11. [PMID: 39379745 PMCID: PMC11461588 DOI: 10.1007/s11934-024-01245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2024] [Indexed: 10/10/2024]
Abstract
PURPOSE OF REVIEW Upper tract urothelial carcinoma (UTUC) is an aggressive entity with treatment strategies mirroring bladder cancer. Genomic and molecular profiling allows for a better characterization of this disease and allows for patient-tailored approaches. We aim to describe the genomic and molecular implications of this disease. RECENT FINDINGS Technological advances have the potential for early diagnosis and precise molecular analysis in patients with UTUC. Genomic profile clustering, specific mRNA signatures, and pathway-specific protein abundance tools have oncologic and clinical implications. We describe their utility in the context of this disease. In the era of precision medicine, designing clinical trials that explore the diagnostic and prognostic implications of biomolecular signatures in the context of UTUC is of utmost importance. Promising advances in this arena provide tools for physicians to avoid overtreatment in this patient population.
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Affiliation(s)
- Salvador Jaime-Casas
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Abhishek Tripathi
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Sumanta K Pal
- Department of Medical Oncology & Experimental Therapeutics, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Wesley Yip
- Division of Urology and Urologic Oncology, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA.
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Nagata Y, Minato A, Aono H, Kimuro R, Higashijima K, Tomisaki I, Harada K, Miyamoto H, Fujimoto N. Immunohistochemical Expression of p53 and FGFR3 Predicts Response to Enfortumab Vedotin in Metastatic Urothelial Carcinoma. Int J Mol Sci 2024; 25:10348. [PMID: 39408678 PMCID: PMC11477066 DOI: 10.3390/ijms251910348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 09/23/2024] [Accepted: 09/23/2024] [Indexed: 10/20/2024] Open
Abstract
Locally advanced or metastatic urothelial carcinoma is a genomically and molecularly heterogeneous disease associated with various clinical outcomes. We aimed to evaluate the association between the status of p53/FGFR3 expression and the efficacy of enfortumab vedotin (EV) in metastatic urothelial carcinoma. We evaluated the association between p53 (abnormal vs. wild-type) or FGFR3 (high vs. low) expression determined by immunohistochemistry and response to EV in 28 patients with metastatic urothelial carcinoma. Overall, 60.7% showed abnormal p53, and 17.9% had high FGFR3 expression. The rates of objective response to EV were statistically higher in patients with abnormal p53 than in those with wild-type p53 (p = 0.038). Patients with pure urothelial carcinoma (n = 18) and low FGFR3 showed significantly better response to EV than those with high FGFR3. When the statuses of p53 and FGFR3 were combined, abnormal p53/low FGFR3 (vs. wild-type p53/high FGFR3) was strongly associated with favorable outcomes in both the entire cohort (p = 0.002) and in cases of pure urothelial carcinoma only (p = 0.023). Immunohistochemically abnormal p53 tumors were found to respond well to EV, while high FGFR3 tumors had a poorer response. Thus, p53 and FGFR3 are potential biomarkers for predicting response to EV treatment in patients with urothelial carcinoma.
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MESH Headings
- Humans
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Receptor, Fibroblast Growth Factor, Type 3/genetics
- Tumor Suppressor Protein p53/metabolism
- Tumor Suppressor Protein p53/genetics
- Male
- Female
- Aged
- Middle Aged
- Antibodies, Monoclonal/therapeutic use
- Immunohistochemistry
- Aged, 80 and over
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/genetics
- Biomarkers, Tumor/metabolism
- Biomarkers, Tumor/genetics
- Neoplasm Metastasis
- Treatment Outcome
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/genetics
- Carcinoma, Transitional Cell/pathology
- Prognosis
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Affiliation(s)
- Yujiro Nagata
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Akinori Minato
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Hisami Aono
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Rieko Kimuro
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Katsuyoshi Higashijima
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Ikko Tomisaki
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Kenichi Harada
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Hiroshi Miyamoto
- Departments of Pathology & Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Naohiro Fujimoto
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
- Department of Urology, Kurate Hospital, Kurate 807-1311, Japan
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29
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Meireles S, Dias C, Martins D, Marques A, Dias N, Pacheco-Figueiredo L, Silva J, Silva CM, Barbosa M, Costa L, Lopes JM, Soares P. Biomarker Profiling of Upper Tract Urothelial Carcinoma Only and with Synchronous or Metachronous Bladder Cancer. Biomedicines 2024; 12:2154. [PMID: 39335667 PMCID: PMC11429062 DOI: 10.3390/biomedicines12092154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Molecular profiling in upper tract urothelial carcinoma (UTUC) with synchronous or metachronous urothelial bladder cancer (UBC) is scarce. We intended to assess immunohistochemical (IHC) and genetic differences between UTUC-only and UTUC with synchronous or metachronous UBC (UTUC + UBC) and evaluate the effect of subsequent UBC on the outcome of UTUC patients stratified by luminal-basal subtypes. METHODS A retrospective cohort of UTUC was divided into UTUC-only (n = 71) and UTUC + UBC (n = 43). IHC expression of cytokeratin 5/6 (CK5/6), CK20, GATA3, and p53 was evaluated to assess relevant subtypes. Genetic characterization comprised TERTp, FGFR3, RAS, and TP53 status. Kaplan-Meier and Cox regression analyses estimated the effect of clinicopathological variables and molecular profiles on progression-free survival (PFS) and overall survival (OS) of UTUC patients. RESULTS No meaningful differences were detected among both subgroups according to luminal-basal stratification and genetic analysis. UTUC + UBC was independently associated with a worse PFS when stratified by luminal-basal phenotype (HR 3.570, CI 95% 1.508-8.453, p = 0.004) but with no impact in OS (HR 1.279, CI 95% 0.513-3.190, p = 0.597). CONCLUSIONS This study reveals that both subgroups exhibited equivalent genomic features and luminal-basal subtypes. The involvement of the bladder relates to shorter PFS but does not seem to influence the survival outcome of UTUC, independently of the IHC phenotype.
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Affiliation(s)
- Sara Meireles
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Medical Oncology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carolina Dias
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Diana Martins
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Ana Marques
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Nuno Dias
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luís Pacheco-Figueiredo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- Department of Urology, Trofa Saúde Private Hospitals, 4785-409 Trofa, Portugal
| | - João Silva
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carlos Martins Silva
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Urology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Miguel Barbosa
- Medical Oncology Department, Centro Hospitalar Universitário de São João (CHUSJ), Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luís Costa
- Medical Oncology Department, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz MB, 1649-028 Lisboa, Portugal
- Institute of Molecular Medicine-João Lobo Antunes, Faculty of Medicine, University of Lisbon, Avenida Professor Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - José Manuel Lopes
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- Pathology Department, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Paula Soares
- Institute for Research and Innovation in Health (i3S), University of Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
- Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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30
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Fukumoto K, Kanatani S, Jaremko G, West Z, Li Y, Takamatsu K, Al Rayyes I, Mikami S, Niwa N, Axelsson TA, Tanaka N, Oya M, Miyakawa A, Brehmer M, Uhlén P. Three-dimensional imaging of upper tract urothelial carcinoma improves diagnostic yield and accuracy. JCI Insight 2024; 9:e175751. [PMID: 39133649 PMCID: PMC11383588 DOI: 10.1172/jci.insight.175751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Upper tract urothelial carcinoma (UTUC) is a rare form of urothelial cancer with a high incidence of recurrence and a low survival rate. Almost two-thirds of UTUCs are invasive at the time of diagnosis; therefore, improving diagnostic methods is key to increasing survival rates. Histopathological analysis of UTUC is essential for diagnosis and typically requires endoscopy biopsy, tissue sectioning, and labeling. However, endoscopy biopsies are minute, and it is challenging to cut into thin sections for conventional histopathology; this complicates diagnosis. Here, we used volumetric 3-dimensional (3D) imaging to explore the inner landscape of clinical UTUC biopsies, without sectioning, revealing that 3D analysis of phosphorylated ribosomal protein S6 (pS6) could predict tumor grade and prognosis with improved accuracy. By visualizing the tumor vasculature, we discovered that pS6+ cells were localized near blood vessels at significantly higher levels in high-grade tumors than in low-grade tumors. Furthermore, the clustering of pS6+ cells was associated with shorter relapse-free survival. Our results demonstrate that 3D volume imaging of the structural niches of pS6 cells deep inside the UTUC samples improved diagnostic yield, grading, and prognosis prediction.
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Affiliation(s)
- Keishiro Fukumoto
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shigeaki Kanatani
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Georg Jaremko
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Zoe West
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Yue Li
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Kimiharu Takamatsu
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Ibrahim Al Rayyes
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Shuji Mikami
- Department of Diagnostic Pathology, National Hospital Organization Saitama Hospital, Saitama, Japan
| | - Naoya Niwa
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | | | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Miyakawa
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
- Division of Urology, Department of Molecular Medicine and Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Brehmer
- Department of Urology and Department of Clinical Science and Education, Stockholm South General Hospital, Sweden
| | - Per Uhlén
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
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31
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Sirohi D. Histologic and molecular landscape of genitourinary tumors and clinical implications. Urol Oncol 2024; 42:191-192. [PMID: 38670817 DOI: 10.1016/j.urolonc.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
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32
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Zhang Q, Wang C, Qin M, Ye Y, Mo Y, Meng Q, Yang G, Feng G, Lin R, Xian S, Wei J, Chen S, Wang S, Mo Z. Investigating cellular similarities and differences between upper tract urothelial carcinoma and bladder urothelial carcinoma using single-cell sequencing. Front Immunol 2024; 15:1298087. [PMID: 38903524 PMCID: PMC11187293 DOI: 10.3389/fimmu.2024.1298087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
Background Upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BLCA) both originate from uroepithelial tissue, sharing remarkably similar clinical manifestations and therapeutic modalities. However, emerging evidence suggests that identical treatment regimens may lead to less favorable outcomes in UTUC compared to BLCA. Therefore, it is imperative to explore molecular processes of UTUC and identify biological differences between UTUC and BLCA. Methods In this study, we performed a comprehensive analysis using single-cell RNA sequencing (scRNA-seq) on three UTUC cases and four normal ureteral tissues. These data were combined with publicly available datasets from previous BLCA studies and RNA sequencing (RNA-seq) data for both cancer types. This pooled analysis allowed us to delineate the transcriptional differences among distinct cell subsets within the microenvironment, thus identifying critical factors contributing to UTUC progression and phenotypic differences between UTUC and BLCA. Results scRNA-seq analysis revealed seemingly similar but transcriptionally distinct cellular identities within the UTUC and BLCA ecosystems. Notably, we observed striking differences in acquired immunological landscapes and varied cellular functional phenotypes between these two cancers. In addition, we uncovered the immunomodulatory functions of vein endothelial cells (ECs) in UTUC, and intercellular network analysis demonstrated that fibroblasts play important roles in the microenvironment. Further intersection analysis showed that MARCKS promote UTUC progression, and immunohistochemistry (IHC) staining revealed that the diverse expression patterns of MARCKS in UTUC, BLCA and normal ureter tissues. Conclusion This study expands our multidimensional understanding of the similarities and distinctions between UTUC and BLCA. Our findings lay the foundation for further investigations to develop diagnostic and therapeutic targets for UTUC.
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Affiliation(s)
- Qingyun Zhang
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Chengbang Wang
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Min Qin
- Human Sperm Bank, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yu Ye
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yingxi Mo
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Qinggui Meng
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Guanglin Yang
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Guanzheng Feng
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Rui Lin
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Shinan Xian
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Jueling Wei
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Shaohua Chen
- Department of Urology, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Shan Wang
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Key Laboratory for Genomic and Personalized Medicine, Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China
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Matin SF, Adibi M, Shah AY, Alhalabi O, Corn P, Guo C, Amirtharaj R, Xiao L, Lange S, Duose DY, Wang S, Pal S, Campbell MT. Phase 1b Trial Evaluating Tolerability and Activity of Targeted Fibroblast Growth Factor Receptor Inhibition in Localized Upper Tract Urothelial Carcinoma. J Urol 2024; 211:784-793. [PMID: 38573872 PMCID: PMC11251863 DOI: 10.1097/ju.0000000000003928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE We initiated a biomarker-informed preoperative study of infigratinib, a fibroblast growth factor receptor (FGFR) inhibitor, in patients with localized upper tract urothelial carcinoma (UTUC), a population with high unmet needs and tumor with a high frequency of FGFR3 alterations. MATERIALS AND METHODS Patients with localized UTUC undergoing ureteroscopy or nephroureterectomy/ureterectomy were enrolled on a phase 1b trial (NCT04228042). Once-daily infigratinib 125 mg by mouth × 21 days (28-day cycle) was given for 2 cycles. Tolerability was monitored by Bayesian design and predefined stopping boundaries. The primary endpoint was tolerability, and the secondary endpoint was objective response based on tumor mapping, done after endoscopic biopsy and post-trial surgery. Total planned enrollment: 20 patients. Targeted sequencing performed using a NovaSeq 6000 solid tumor panel. RESULTS From May 2021 to November 2022, 14 patients were enrolled, at which point the trial was closed due to termination of all infigratinib oncology trials. Two patients (14.3%) had treatment-terminating toxicities, well below the stopping threshold. Responses occurred in 6 (66.7%) of 9 patients with FGFR3 alterations. Responders had median tumor size reduction of 67%, with 3 of 5 patients initially planned for nephroureterectomy/ureterectomy converted to ureteroscopy. Median follow-up in responders was 24.7 months (14.9-28.9). CONCLUSIONS In this first trial of targeted therapy for localized UTUC, FGFR inhibition was well tolerated and had significant activity in FGFR3 altered tumors. Renal preservation was enabled in a substantial proportion of participants. These data support the design of a biomarker-driven phase 2 trial of FGFR3 inhibition in this population with significant unmet clinical needs.
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Affiliation(s)
- Surena F. Matin
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | - Mehrad Adibi
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | - Amishi Y. Shah
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Omar Alhalabi
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Paul Corn
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Charles Guo
- Department of Pathology, MD Anderson Cancer Center, Houston, Texas
| | | | - Lianchun Xiao
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Suzanne Lange
- Department of Urology, MD Anderson Cancer Center, Houston, Texas
| | - Dzifa Y. Duose
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, Texas
| | - Shufang Wang
- Department of Translational Molecular Pathology, MD Anderson Cancer Center, Houston, Texas
| | - Sumanta Pal
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, California
| | - Matthew T. Campbell
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Center, Houston, Texas
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Yamashita R, Nakamura M, Notsu A, Asakura K, Usui K, Sakura Y, Shinsaka H, Matsuzaki M, Sugino T, Mizuno R, Niwakawa M, Oya M. Cumulative incidence and risk factors for recurrence of upper tract urothelial carcinoma in patients undergoing radical cystectomy. BJUI COMPASS 2024; 5:483-489. [PMID: 38751952 PMCID: PMC11090764 DOI: 10.1002/bco2.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/31/2023] [Accepted: 01/31/2024] [Indexed: 05/18/2024] Open
Abstract
Objectives This study aimed to evaluate the cumulative incidence of upper tract urothelial carcinoma (UTUC) recurrence and identify its risk factors in patients who underwent radical cystectomy (RC). Patients and methods We performed RC on 385 patients between September 2002 and February 2020. After excluding 20 patients-13 with simultaneous nephroureterectomy, 6 with distal ureteral stump positivity and 1 with urachal cancer-365 patients were included in the analysis. To predict UTUC recurrence, we examined the cancer extension pattern in cystectomy specimens and categorized them into three types: cancer located only in the bladder (bladder-only type), cancer extending to the urethra or distal ureter (one-extension type) and cancer extending to both the urethra and distal ureter (both-extension type). We determined hazard ratios for UTUC recurrence for each covariate, including this cancer extension pattern. Results Of the 365 patients, 60% had the bladder-only type, 30% had the one-extension type and 10% had the both-extension type. During a median follow-up period of 72 months for survivors, UTUC recurred in 25 of the 365 patients, with cumulative incidences of 3.7% at 5 years and 8.3% at 10 years. The median interval from cystectomy to recurrence was 65 months (interquartile range: 36-92 months). In the multivariate analysis, the extension pattern was a significant predictor of UTUC recurrence. The hazard ratios for UTUC recurrence were 3.12 (95% confidence interval [CI] = 1.15-8.43, p = 0.025) for the one-extension type and 5.96 (95% CI = 1.98-17.91, p = 0.001) for the both-extension type compared with the bladder-only type. Conclusions The cancer extension pattern in cystectomy specimens is predictive of UTUC recurrence. A more extensive cancer extension in cystectomy specimens elevates the risk of subsequent UTUC recurrence. Intensive long-term monitoring is essential, particularly for patients with the both-extension type.
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Affiliation(s)
- Ryo Yamashita
- Division of UrologyShizuoka Cancer CenterShizuokaJapan
- Department of UrologyKeio UniversityTokyoJapan
| | | | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer CenterShizuokaJapan
| | - Koiku Asakura
- Division of Diagnostic RadiologyShizuoka Cancer CenterShizuokaJapan
| | | | - Yuma Sakura
- Division of UrologyShizuoka Cancer CenterShizuokaJapan
| | | | | | - Takashi Sugino
- Division of PathologyShizuoka Cancer CenterShizuokaJapan
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Li J, Song Y, Peng Y, Lin J, Du Y, Qin C, Xu T. The role of histological subtype and chemotherapy on prognosis of ureteral cancer. J Cancer Res Clin Oncol 2024; 150:192. [PMID: 38613698 PMCID: PMC11015994 DOI: 10.1007/s00432-024-05684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To date, there have been few studies examining the prognostic implications of histological subtypes in ureteral cancer. And chemotherapy plays a crucial role in the treatment of ureteral cancer, while many factors influence the efficacy of chemotherapy. This study aimed to utilize the Surveillance, Epidemiology and End Results database to assess the impact of histological type on ureteral cancer prognostic outcomes and discovered how histological type and T-stage influence the efficacy of chemotherapy. METHODS Based on Surveillance, Epidemiology, and End Results Program, we reviewed 8915 records of patients with primary ureteral cancer from 18 centers between 2000 and 2018. We focused on the overall survival and cancer-specific survival of the records and used Kaplan‒Meier method to calculate survival curves. RESULTS In the comparison of prognostic outcomes, atypical subtypes exhibited a less favorable prognosis compared to typical ureteral carcinoma. Notably, patients diagnosed with papillary urothelial carcinoma demonstrated the most favorable overall survival (p = 0.005). Statistically significant benefits were observed in the prognosis of patients with non-papillary urothelial carcinoma who received chemotherapy (HR = 0.860, 95% CI 0.764-0.966, p = 0.011), while chemotherapy did not yield a statistically significant effect on the prognosis of patients with papillary urothelial carcinoma (HR = 1.055, 95% CI 0.906-1.228, p = 0.493). Chemotherapy had an adverse impact on the prognosis of patients with T1 ureteral cancer (HR = 1.235, 95% CI 1.016-1.502, p = 0.034), whereas it exhibited a positive prognostic effect for T3/T4 cases (HR = 0.739, 95% CI 0.654-0.835, p < 0.001). CONCLUSIONS Histological type affects the prognosis of ureteral cancer. And evaluation of cancer histological type and T stage in ureteral cancer patients prior to chemotherapy is mandatory.
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Affiliation(s)
- Jincong Li
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yuxuan Song
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yun Peng
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Jiaxing Lin
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Yiqing Du
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China
| | - Caipeng Qin
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing, 100044, China.
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Jakus D, Šolić I, Borovac JA, Šitum M. The influence of the initial clinical presentation of upper tract urothelial carcinoma on histopathological tumor features. Int Urol Nephrol 2024; 56:1335-1341. [PMID: 38015383 DOI: 10.1007/s11255-023-03883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To investigate the influence of the initial clinical presentation (symptomatic vs. asymptomatic) on histopathological tumor features in patients with upper tract urothelial carcinoma (UTUC). METHODS We conducted a single-center, cross-sectional, and retrospective study that enrolled 72 adults with primary UTUC who underwent radical nephroureterectomy at our institution over a period of 4 years (April 2019-April 2023). RESULTS Symptomatic patients exhibited significantly higher frequencies of high-grade UTUC (73.6% vs. 36.8%, p = 0.006), ≥ T2 stage UTUC (60.4% vs. 26.3%, p = 0.007), and larger tumor sizes (median 5 vs. 4 cm, p = 0.015) compared to asymptomatic patients. Multiple regression analyses demonstrated significant associations between symptomatic presentation and the presence of high-grade UTUC (OR 6.35, 95% CI 1.81-22.27, p = 0.004), ≥ T2 stage UTUC (OR 5.98, 95% CI 1.62-22.08, p = 0.007), and larger tumor size (B 3.14, 95% CI 0.62-5.66, p = 0.015). A subset of patients with hematuria was separately analyzed to assess the influence of hematuria severity (gross vs. microscopic) on UTUC characteristics. Patients with gross hematuria exhibited significantly higher frequencies of high-grade UTUC (72.9% vs. 33.3%, p = 0.048) and ≥ T2 stage UTUC (58.3% vs. 22.2%, p = 0.001). Multiple regression analyses showed significant associations between gross hematuria and the presence of high-grade UTUC (OR 6.34, 95% CI 1.15-34.95, p = 0.034) and ≥ T2 stage UTUC (OR 6.54, 95% CI 1.11-38.93, p = 0.039). CONCLUSION Initial symptomatic presentation was independently associated with adverse histopathological UTUC characteristics, potentially attributed to earlier detection of UTUC in asymptomatic patients, before the onset of symptoms.
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Affiliation(s)
- Dora Jakus
- Department of Urology, University Hospital of Split, Šoltanska 1, Split, Croatia.
| | - Ivana Šolić
- Department of Urology, University Hospital of Split, Šoltanska 1, Split, Croatia
| | - Josip Anđelo Borovac
- Cardiovascular Diseases Department, University Hospital of Split, Split, Croatia
| | - Marijan Šitum
- Department of Urology, University Hospital of Split, Šoltanska 1, Split, Croatia
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Palermo M, D'Elia C, Trenti E, Comploj E, Mian C, Schwienbacher C, Heidegger I, Clauser S, Pycha A, Vjaters E. Prospective evaluation of the RT-PCR based urinary marker Bladder Epicheck® as a diagnostic tool in upper urinary tract tumor. Minerva Urol Nephrol 2024; 76:195-202. [PMID: 38498297 DOI: 10.23736/s2724-6051.23.05488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Upper-tract-urothelial-carcinoma (UTUC) represents 5-10% of all urothelial-neoplasms with increasing incidence in the last decades. Current standard tools for diagnosis of UTUC include cytology, computed tomography (CT) urography and ureterorenoscopy (URS). The aim of this study was to evaluate the impact of Bladder Epicheck® Test as diagnostic tool for UTUC diagnosis and recurrence. METHODS Overall, 136 urine samples, selective collected from upper-urinary-tract before URS for suspicion of UTUC were analyzed with cytology and Bladder Epicheck® Test. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of both markers were calculated and compared to URS and/or histology as reference. RESULTS UTUC was detected in 40 cases (33.3%), among them 30 were classified as low-grade (LG) and 10 as high-grade (HG). Overall sensitivity of Bladder Epicheck® for UTUC detection was 65% compared to 42.5% for cytology, increasing to 100% for Bladder Epicheck® and 90% for cytology if considering only HG tumors. Overall specificity of Bladder Epicheck® was 81.2% and of cytology 93.7%. PPV and NPV were 63.4% and 82.2% for Bladder Epicheck® and 77.2% and 76.5% for cytology. Considering an EpiScore cut-off >75, instead of 60, specificity of Bladder Epicheck® improves to 89% and PPV to 74.2%. Limitations include the use of a marker validated only for bladder-cancer and the relatively small number of cases. CONCLUSIONS Due to its high sensitivity for HG tumors, the Bladder Epicheck® Test can be used in diagnosis and treatment decision-making of UTUC. Furthermore, it could be very useful in follow-up of UTUC, after endoscopic treatment to postpone or avoid unnecessary endoscopic exploration. Even if further studies are needed to validate these findings, Bladder Epicheck® could be a promising clinical tool for detection of UTUC.
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Affiliation(s)
| | - Carolina D'Elia
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | - Emanuela Trenti
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy -
| | - Evi Comploj
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | - Christine Mian
- Department of Pathology, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Isabel Heidegger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvia Clauser
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
- Medical School, Sigmund Freud Private University, Vienna, Austria
| | - Egils Vjaters
- Department of Urology, Riga Stradins University Hospital, Riga, Latvia
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Uchida N, Urabe F, Suhara Y, Goto Y, Yoshihara K, Sadakane I, Yata Y, Kurawaki S, Miyajima K, Ishikawa M, Takahashi K, Iwatani K, Imai Y, Sakanaka K, Nakazono M, Hisakane A, Kurauchi T, Kayano S, Onuma H, Mori K, Aikawa K, Yanagisawa T, Tashiro K, Tsuzuki S, Miki J, Furuta A, Sato S, Takahashi H, Kimura T. Effect of a variant histology on the oncological outcomes of Japanese patients with upper tract urothelial carcinomas after radical nephroureterectomy: a multicenter retrospective study. Transl Androl Urol 2024; 13:414-422. [PMID: 38590954 PMCID: PMC10999016 DOI: 10.21037/tau-23-561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
Background An earlier systematic review and meta-analysis found that patients with a certain histological variant of upper tract urothelial carcinoma (UTUC) exhibited more advanced disease and poorer survival than those with pure UTUC. A difference in the clinicopathological UTUC characteristics of Caucasian and Japanese patients has been reported, but few studies have investigated the clinical impact of the variant histology in Japanese UTUC patients. Methods We retrospectively enrolled 824 Japanese patients with pTa-4N0-1M0 UTUCs who underwent radical nephroureterectomy without neoadjuvant chemotherapy. Subsequently, we explored the effects of the variant histology on disease aggressiveness and the oncological outcomes. We used Cox's proportional hazards models to identify significant predictors of oncological outcomes, specifically intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results Of the 824 UTUC patients, 32 (3.9%) exhibited a variant histology that correlated significantly with a higher pathological T stage and lymphovascular invasion (LVI). Univariate analysis revealed that the variant histology was an independent risk factor for suboptimal RFS, CSS, and OS. However, significance was lost on multivariate analyses. Conclusions The variant histology does not add to the prognostic information imparted by the pathological findings after radical nephroureterectomy, particularly in Japanese UTUC patients.
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Affiliation(s)
- Naoki Uchida
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yushi Suhara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuma Goto
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yoshihara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Ibuki Sadakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shiro Kurawaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mimu Ishikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Hisakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kurauchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hajime Onuma
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Akira Furuta
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Padullés B, Carrasco R, Ingelmo-Torres M, Roldán FL, Gómez A, Vélez E, Alfambra H, Figueras M, Carrion A, Gil-Vernet J, Mengual L, Izquierdo L, Alcaraz A. Prognostic Value of Liquid-Biopsy-Based Biomarkers in Upper Tract Urothelial Carcinoma. Int J Mol Sci 2024; 25:3695. [PMID: 38612507 PMCID: PMC11012136 DOI: 10.3390/ijms25073695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Currently, there are no reliable prognostic factors to determine which upper tract urothelial carcinoma (UTUC) patients will progress after radical nephroureterectomy (RNU). We aim to evaluate whether liquid-biopsy-based biomarkers (circulating tumor cells (CTCs), cell-free DNA (cfDNA), and circulating tumor DNA (ctDNA)) were able to predict clinical outcomes in localized UTUC patients undergoing RNU. Twenty patients were prospectively enrolled between 2021 and 2023. Two blood samples were collected before RNU and three months later. CTCs and cfDNA were isolated and evaluated using the IsoFlux system and Quant-iT PicoGreen dsDNA kit, respectively. Droplet digital PCR was performed to determine ctDNA status. Cox regression analysis was performed on CTCs, cfDNA, and ctDNA at two different follow-up time points to examine their influence on tumor progression and cancer-specific survival (CSS). During a median follow-up of 18 months, seven (35%) patients progressed and three (15%) died. Multivariate analysis demonstrated that cfDNA levels three months after RNU are a significant predictor of tumor progression (HR = 1.085; p = 0.006) and CSS (HR = 1.168; p = 0.029). No associations were found between CTC enumeration and ctDNA status with any of the clinical outcomes evaluated. The evaluation of cfDNA levels in clinical practice could improve the disease management of UTUC patients.
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Affiliation(s)
- Bernat Padullés
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Departament de Biomedicina, Facultat de Medicina I Ciències de la Salut, Universitat de Barcelona (UB), 08036 Barcelona, Spain
| | - Raquel Carrasco
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Mercedes Ingelmo-Torres
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Fiorella L. Roldán
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Ascensión Gómez
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
| | - Elena Vélez
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
| | - Héctor Alfambra
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
| | - Marcel Figueras
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Albert Carrion
- Department of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Jordi Gil-Vernet
- Department of Urology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
| | - Lourdes Mengual
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Departament de Biomedicina, Facultat de Medicina I Ciències de la Salut, Universitat de Barcelona (UB), 08036 Barcelona, Spain
| | - Laura Izquierdo
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08036 Barcelona, Spain
| | - Antonio Alcaraz
- Laboratori i Servei d’Urologia, Hospital Clínic de Barcelona, 08036 Barcelona, Spain; (B.P.); (L.M.)
- Genètica i Tumors Urològics, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08036 Barcelona, Spain
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Taguchi S, Kawai T, Nakagawa T, Kume H. Latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the era of immune checkpoint inhibitors: a narrative review. Jpn J Clin Oncol 2024; 54:254-264. [PMID: 38109484 DOI: 10.1093/jjco/hyad172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023] Open
Abstract
The management of advanced (locally advanced or metastatic) urothelial carcinoma has been revolutionized since pembrolizumab was introduced in 2017. Several prognostic factors for advanced urothelial carcinoma treated with pembrolizumab have been reported, including conventional parameters such as performance status and visceral (especially liver) metastasis, laboratory markers such as the neutrophil-to-lymphocyte ratio, sarcopenia, histological/genomic markers such as programmed cell death ligand 1 immunohistochemistry and tumor mutational burden, variant histology, immune-related adverse events, concomitant medications in relation to the gut microbiome, primary tumor site (bladder cancer versus upper tract urothelial carcinoma) and history/combination of radiotherapy. The survival time of advanced urothelial carcinoma has been significantly prolonged (or 'doubled' from 1 to 2 years) after the advent of pembrolizumab, which will be further improved with novel agents such as avelumab and enfortumab vedotin. This review summarizes the latest evidence on clinical outcomes and prognostic factors of advanced urothelial carcinoma in the contemporary era of immune checkpoint inhibitors.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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41
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Abstract
Upper urinary tract urothelial carcinoma (UTUC) is an uncommon malignancy involving the renal pelvis and ureter. Careful pathologic analysis plays a critical role in the diagnosis and clinical management of UTUC. In combination with clinical and radiologic evaluation, pathologic features can be used to stratify patients into low-risk and high-risk groups. This risk stratification can help clinicians select the optimal treatment for patients with UTUC, such as kidney-sparing (conservative) treatment, radical nephroureterectomy or ureterectomy, and perioperative systemic therapy. However, due to the technical difficulty of obtaining sufficient tissue from the upper urinary tract, it is often challenging for pathologists to accurately grade the tumor and assess tumor invasion in small biopsy specimens. Although the majority of UTUCs are pure urothelial carcinoma, a considerable subset of UTUCs show histologic subtypes or divergent differentiation. Recent studies have identified genetically distinct molecular subtypes of UTUC by examining DNA, RNA, and protein expression profiles. The prognosis of pT3 UTUC, particularly renal pelvic UC, remains controversial, and several studies have proposed subclassification of pT3 UTUC. Lynch syndrome is a significant risk factor for UTUC, and screening tests may be considered in young patients and those with familial histories of the disease. Despite significant progress in recent years, several issues remain to be addressed in the pathologic diagnosis, molecular classification, and treatment of UTUC.
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Affiliation(s)
- Jianping Zhao
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C. Guo
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Priya Rao
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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42
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Okuda Y, Kato T, Fujita K, Fushimi H, Miyamoto H, Netto GJ, Nonomura N. Association of Androgen Receptor and PD-L1 Expression in Upper Urinary Tract Urothelial Carcinoma. Cancer Genomics Proteomics 2024; 21:137-143. [PMID: 38423597 PMCID: PMC10905274 DOI: 10.21873/cgp.20435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND/AIM The response to immune checkpoint inhibitors (ICIs) or enfortumab vedotin is limited in patients with upper urinary tract urothelial carcinoma (UTUC), and the development of new targeted therapy for UTUC is eagerly needed. Several biomarkers, including programmed cell death-ligand 1 (PD-L1), have already been reported as predictors of response to ICIs therapy for UTUC. Recently, several studies have shown that steroid hormone receptors, including the androgen receptor (AR), are associated with progression of urothelial carcinoma. MATERIALS AND METHODS We prepared tissue microarrays (TMA) from paraffin blocks of UTUC specimens in 99 non-metastatic UTUC patients who underwent radical nephroureterectomy. With these TMA sections, we performed immunohistochemical staining for PD-L1 and AR and examined PD-L1 and AR expression levels in tumor cells. In addition, we analyzed the correlation between these markers and clinical prognosis in UTUC cases. RESULTS PD-L1 was positive in 24 (24%) of the 99 samples, whereas AR was positive in 20 (20%) patients. AR-negative samples had significantly higher PD-L1 expression level than that the AR-positive samples (mean value 4.70% versus 2.55%, p=0.0324). Among AR-positive cases, patients with absence of PD-L1 expression had significantly lower cancer-specific survival (CSS) than that in PD-L1 expression-positive cases (p=0.049), although PD-L1 expression had no significant impact on CSS in AR-negative cases (p=0.920). CONCLUSION Our findings suggest that AR is the promising target for UTUC treatment, especially in PD-L1-negative cases.
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Affiliation(s)
- Yohei Okuda
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan;
| | - Kazutoshi Fujita
- Department of Urology, Kindai University Faculty of Medicine, Sayama, Japan
| | - Hiroaki Fushimi
- Department of Pathology, Osaka General Medical Center, Osaka, Japan
| | - Hiroshi Miyamoto
- Departments of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, U.S.A
- Urology, University of Rochester Medical Center, Rochester, NY, U.S.A
| | - George J Netto
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, U.S.A
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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43
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Mori K, Hatakeyama S, Enokida H, Miyake H, Kikuchi E, Nishiyama H, Ichikawa T, Kamai T, Kaji Y, Kume H, Kondo T, Matsuyama H, Masumori N, Kawauchi A, Takenaka A, Uemura H, Eto M, Nonomura N, Fujii Y, Hinotsu S, Ohyama C. Summary of the Clinical Practice Guidelines for Upper Tract Urothelial Carcinoma 2023 by the Japanese Urological Association. Int J Urol 2024; 31:194-207. [PMID: 38113344 PMCID: PMC11524111 DOI: 10.1111/iju.15362] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
This article is an English translation of the Clinical Practice Guidelines for Upper Tract Urothelial Carcinoma (2nd edition) published in June 2023. The Japanese Urological Association's (JUA) Guidelines Committee on Upper Tract Urothelial Carcinoma (UTUC) created a 2023 update guideline to support clinicians' current evidence-based management of UTUC and to incorporate its recommendations into clinical practice. The new guideline adhered as closely as possible to the Minds Manual for Guideline Development 2020 ver. 3.0. Findings related to epidemiological, pathological, diagnosis, treatment, and follow-up were reviewed. In addition, seven clinical questions (CQs) were set to determine the grade of recommendation and level of evidence. Preconceptions and biases were removed from the preparation process, the overall evidence was evaluated appropriately, and recommendations were made after fully considering the balance between benefits and harms. Although the evidence is still insufficient to be taken up as a CQ, the latest important information is described in seven columns, and clinical issues that should be resolved in the future related to the CQ are described as recommendations for tomorrow. We hope that these guidelines will help medical professionals, patients, and their families involved in the treatment of UTUC in their decision-making, and hope that a critical review of these guidelines will lead to further refinements in the next edition.
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Affiliation(s)
- Kazuyuki Mori
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Shingo Hatakeyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
| | - Hideki Enokida
- Department of UrologyGraduate School of Medical and Dental Sciences, Kagoshima UniversityKagoshimaKagoshimaJapan
| | - Hideaki Miyake
- Department of UrologyHamamatsu University School of MedicineHamamatsuShizuokaJapan
| | - Eiji Kikuchi
- Department of UrologySt. Marianna University School of MedicineKawasakiKanagawaJapan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Tomohiko Ichikawa
- Department of UrologyGraduate School of Medicine, Chiba UniversityChibaChibaJapan
| | - Takao Kamai
- Department of UrologyDokkyo Medical UniversityMibuTochigiJapan
| | - Yasushi Kaji
- Department of RadiologyShimane University Faculty of MedicineIzumoShimaneJapan
| | - Haruki Kume
- Department of Urology, Graduate School of MedicineThe University of TokyoBunkyoTokyoJapan
| | - Tsunenori Kondo
- Department of UrologyTokyo Women's Medical University, Adachi Medical CenterAdachiTokyoJapan
| | - Hideyasu Matsuyama
- Department of UrologyJA Yamaguchi Kouseiren Nagato General HospitalNagatoYamaguchiJapan
| | - Naoya Masumori
- Department of UrologySapporo Medical UniversitySapporoHokkaidoJapan
| | | | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of MedicineTottori UniversityYonagoTottoriJapan
| | - Hirotsugu Uemura
- Department of UrologyKindai University Faculty of MedicineOsakasayamaOsakaJapan
| | - Masatoshi Eto
- Department of UrologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaFukuokaJapan
| | - Norio Nonomura
- Department of UrologyOsaka University Graduate School of MedicineSuitaOsakaJapan
| | - Yasuhisa Fujii
- Department of UrologyTokyo Medical and Dental UniversityBunkyoTokyoJapan
| | - Shiro Hinotsu
- Department of Biostatistics and Data ManagementSapporo Medical UniversitySapporoHokkaidoJapan
| | - Chikara Ohyama
- Department of UrologyHirosaki University Graduate School of MedicineHirosakiAomoriJapan
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44
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Angeloni M, van Doeveren T, Lindner S, Volland P, Schmelmer J, Foersch S, Matek C, Stoehr R, Geppert CI, Heers H, Wach S, Taubert H, Sikic D, Wullich B, van Leenders GJLH, Zaburdaev V, Eckstein M, Hartmann A, Boormans JL, Ferrazzi F, Bahlinger V. A deep-learning workflow to predict upper tract urothelial carcinoma protein-based subtypes from H&E slides supporting the prioritization of patients for molecular testing. J Pathol Clin Res 2024; 10:e12369. [PMID: 38504364 PMCID: PMC10951050 DOI: 10.1002/2056-4538.12369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
Upper tract urothelial carcinoma (UTUC) is a rare and aggressive, yet understudied, urothelial carcinoma (UC). The more frequent UC of the bladder comprises several molecular subtypes, associated with different targeted therapies and overlapping with protein-based subtypes. However, if and how these findings extend to UTUC remains unclear. Artificial intelligence-based approaches could help elucidate UTUC's biology and extend access to targeted treatments to a wider patient audience. Here, UTUC protein-based subtypes were identified, and a deep-learning (DL) workflow was developed to predict them directly from routine histopathological H&E slides. Protein-based subtypes in a retrospective cohort of 163 invasive tumors were assigned by hierarchical clustering of the immunohistochemical expression of three luminal (FOXA1, GATA3, and CK20) and three basal (CD44, CK5, and CK14) markers. Cluster analysis identified distinctive luminal (N = 80) and basal (N = 42) subtypes. The luminal subtype mostly included pushing, papillary tumors, whereas the basal subtype diffusely infiltrating, non-papillary tumors. DL model building relied on a transfer-learning approach by fine-tuning a pre-trained ResNet50. Classification performance was measured via three-fold repeated cross-validation. A mean area under the receiver operating characteristic curve of 0.83 (95% CI: 0.67-0.99), 0.8 (95% CI: 0.62-0.99), and 0.81 (95% CI: 0.65-0.96) was reached in the three repetitions. High-confidence DL-based predicted subtypes showed significant associations (p < 0.001) with morphological features, i.e. tumor type, histological subtypes, and infiltration type. Furthermore, a significant association was found with programmed cell death ligand 1 (PD-L1) combined positive score (p < 0.001) and FGFR3 mutational status (p = 0.002), with high-confidence basal predictions containing a higher proportion of PD-L1 positive samples and high-confidence luminal predictions a higher proportion of FGFR3-mutated samples. Testing of the DL model on an independent cohort highlighted the importance to accommodate histological subtypes. Taken together, our DL workflow can predict protein-based UTUC subtypes, associated with the presence of targetable alterations, directly from H&E slides.
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Affiliation(s)
- Miriam Angeloni
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Thomas van Doeveren
- Department of UrologyErasmus MC Urothelial Cancer Research GroupRotterdamThe Netherlands
| | - Sebastian Lindner
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Patrick Volland
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Jorina Schmelmer
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | | | - Christian Matek
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Robert Stoehr
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Carol I Geppert
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Hendrik Heers
- Department of UrologyPhilipps‐Universität MarburgMarburgGermany
| | - Sven Wach
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
- Department of Urology and Pediatric UrologyUniversity Hospital Erlangen, Friedrich‐Alexander Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Helge Taubert
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
- Department of Urology and Pediatric UrologyUniversity Hospital Erlangen, Friedrich‐Alexander Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Danijel Sikic
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
- Department of Urology and Pediatric UrologyUniversity Hospital Erlangen, Friedrich‐Alexander Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Bernd Wullich
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
- Department of Urology and Pediatric UrologyUniversity Hospital Erlangen, Friedrich‐Alexander Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Geert JLH van Leenders
- Department of PathologyErasmus MC Cancer Institute, University Medical CentreRotterdamthe Netherlands
| | - Vasily Zaburdaev
- Department of BiologyFriedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Max‐Planck‐Zentrum für Physik und MedizinErlangenGermany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
| | - Joost L Boormans
- Department of UrologyErasmus MC Urothelial Cancer Research GroupRotterdamThe Netherlands
| | - Fulvia Ferrazzi
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
- Department of NephropathologyInstitute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
| | - Veronika Bahlinger
- Institute of Pathology, University Hospital Erlangen‐Nürnberg, Friedrich‐Alexander‐Universität Erlangen‐Nürnberg (FAU)ErlangenGermany
- Comprehensive Cancer Center Erlangen‐EMN (CCC ER‐EMN)ErlangenGermany
- Bavarian Cancer Research Center (BZKF)ErlangenGermany
- Department of Pathology and NeuropathologyUniversity Hospital and Comprehensive Cancer Center TübingenTübingenGermany
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45
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Huelster HL, Gould B, Schiftan EA, Camperlengo L, Davaro F, Rose KM, Soupir AC, Jia S, Zheng T, Sexton WJ, Pow-Sang J, Spiess PE, Daniel Grass G, Wang L, Wang X, Vosoughi A, Necchi A, Meeks JJ, Faltas BM, Du P, Li R. Novel Use of Circulating Tumor DNA to Identify Muscle-invasive and Non-organ-confined Upper Tract Urothelial Carcinoma. Eur Urol 2024; 85:283-292. [PMID: 37802683 DOI: 10.1016/j.eururo.2023.09.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/28/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Optimal patient selection for neoadjuvant chemotherapy prior to surgical extirpation is limited by the inaccuracy of contemporary clinical staging methods in high-risk upper tract urothelial carcinoma (UTUC). OBJECTIVE To investigate whether the detection of plasma circulating tumor DNA (ctDNA) can predict muscle-invasive (MI) and non-organ-confined (NOC) UTUC. DESIGN, SETTING, AND PARTICIPANTS Plasma cell-free DNA was prospectively collected from chemotherapy-naïve, high-risk UTUC patients undergoing surgical extirpation and sequenced using a 152-gene panel and low-pass whole-genome sequencing. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS To test for concordance, whole-exome sequencing was performed on matching tumor samples. The performance of ctDNA for predicting MI/NOC UTUC was summarized using the area under a receiver-operating curve, and a variant count threshold for predicting MI/NOC disease was determined by maximizing Youden's J statistic. Kaplan-Meier methods estimated survival, and Mantel-Cox log-rank testing assessed the association between preoperative ctDNA positivity and clinical outcomes. RESULTS AND LIMITATIONS Of 30 patients enrolled prospectively, 14 were found to have MI/NOC UTUC. At least one ctDNA variant was detected from 21/30 (70%) patients, with 52% concordance with matching tumor samples. Detection of at least two panel-based molecular alterations yielded 71% sensitivity at 94% specificity to predict MI/NOC UTUC. Imposing this threshold in combination with a plasma copy number burden score of >6.5 increased sensitivity to 79% at 94% specificity. Furthermore, the presence of ctDNA was strongly prognostic for progression-free survival (PFS; 1-yr PFS 69% vs 100%, p < 0.001) and cancer-specific survival (CSS; 1-yr CSS 56% vs 100%, p = 0.016). CONCLUSIONS The detection of plasma ctDNA prior to extirpative surgery was highly predictive of MI/NOC UTUC and strongly prognostic of PFS and CSS. Preoperative ctDNA demonstrates promise as a biomarker for selecting patients to undergo neoadjuvant chemotherapy prior to nephroureterectomy. PATIENT SUMMARY Here, we show that DNA from upper tract urothelial tumors can be detected in the blood prior to surgical removal of the kidney or ureter. This circulating tumor DNA can be used to predict that upper tract urothelial carcinoma is invasive into the muscular lining of the urinary tract and may help identify those patients who could benefit from chemotherapy prior to surgery.
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Affiliation(s)
- Heather L Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Elizabeth A Schiftan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lucia Camperlengo
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Facundo Davaro
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kyle M Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Alex C Soupir
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | | | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Liang Wang
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Aram Vosoughi
- Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Department of GU Medical Oncology, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Joshua J Meeks
- Departments of Urology and Biochemistry, Northwestern University, Chicago, IL, USA
| | - Bishoy M Faltas
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Pan Du
- Predicine Inc., Hayward, CA, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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46
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Tamura D, Abe M, Hiraki H, Sasaki N, Yashima‐Abo A, Ikarashi D, Kato R, Kato Y, Maekawa S, Kanehira M, Takata R, Maejima K, Sasagawa S, Fujita M, Suzuki Y, Nakagawa H, Iwaya T, Nishizuka SS, Obara W. Postoperative recurrence detection using individualized circulating tumor DNA in upper tract urothelial carcinoma. Cancer Sci 2024; 115:529-539. [PMID: 38083992 PMCID: PMC10859621 DOI: 10.1111/cas.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/13/2023] [Accepted: 11/06/2023] [Indexed: 02/13/2024] Open
Abstract
Biomarkers that could detect the postoperative recurrence of upper tract urothelial carcinoma (UTUC) have not been established. In this prospective study, we aim to evaluate the utility of individualized circulating tumor DNA (ctDNA) monitoring using digital PCR (dPCR) as a tumor recurrence biomarker for UTUC in the perioperative period. Twenty-three patients who underwent radical nephroureterectomy (RNU) were included. In each patient, whole exome sequencing by next-generation sequencing and TERT promoter sequencing of tumor DNA were carried out. Case-specific gene mutations were selected from sequencing analysis to examine ctDNA by dPCR analysis. We also prospectively collected plasma and urine ctDNA from each patient. The longitudinal variant allele frequencies of ctDNA during the perioperative period were plotted. Case-specific gene mutations were detected in 22 cases (96%) from ctDNA in the preoperative samples. Frequently detected genes were TERT (39%), FGFR3 (26%), TP53 (22%), and HRAS (13%). In all cases, we obtained plasma and urine samples for 241 time points and undertook individualized ctDNA monitoring for 2 years after RNU. Ten patients with intravesical recurrence had case-specific ctDNA detected in urine at the time of recurrence. The mean lead time of urinary ctDNA in intravesical recurrence was 60 days (range, 0-202 days). Two patients with distal metastasis had case-specific ctDNA in plasma at the time of metastasis. In UTUC, tumor-specific gene mutations can be monitored postoperatively as ctDNA in plasma and urine. Individualized ctDNA might be a minimally invasive biomarker for the early detection of postoperative recurrence.
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Affiliation(s)
- Daichi Tamura
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Masakazu Abe
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
- Division of Biomedical Research and DevelopmentIwate Medical University Institute for Biomedical SciencesYahabaJapan
| | - Hayato Hiraki
- Division of Biomedical Research and DevelopmentIwate Medical University Institute for Biomedical SciencesYahabaJapan
| | - Noriyuki Sasaki
- Division of Biomedical Research and DevelopmentIwate Medical University Institute for Biomedical SciencesYahabaJapan
| | - Akiko Yashima‐Abo
- Division of Biomedical Research and DevelopmentIwate Medical University Institute for Biomedical SciencesYahabaJapan
| | - Daiki Ikarashi
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Renpei Kato
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Yoichiro Kato
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Shigekatsu Maekawa
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Mitsugu Kanehira
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Ryo Takata
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Kazuhiro Maejima
- Laboratory for Cancer GenomicsRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Shota Sasagawa
- Laboratory for Cancer GenomicsRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Masashi Fujita
- Laboratory for Cancer GenomicsRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Yutaka Suzuki
- Department of Computational Biology and Medical SciencesThe University of TokyoKashiwaJapan
| | - Hidewaki Nakagawa
- Laboratory for Cancer GenomicsRIKEN Center for Integrative Medical SciencesYokohamaJapan
| | - Takeshi Iwaya
- Department of Clinical OncologyIwate Medical University School of MedicineYahabaJapan
| | - Satoshi S. Nishizuka
- Division of Biomedical Research and DevelopmentIwate Medical University Institute for Biomedical SciencesYahabaJapan
| | - Wataru Obara
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
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47
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Radvanyi F, Real FX, McConkey D. What is a Bladder Cancer Molecular Subtype? - Counterpoint. Bladder Cancer 2023; 9:299-304. [PMID: 38994248 PMCID: PMC11165934 DOI: 10.3233/blc-230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/09/2023] [Indexed: 07/13/2024]
Abstract
In an accompanying paper, Mattias Höglund discusses on what is a bladder cancer molecular subtype. He emphasizes the need to consider the aim of tumor classification, which is obviously critical to the approach. He also focuses on considering primarily the identity features of the neoplastic cells. Here, we provide a counterpoint. While largely agreeing with his views, we underline that other parameters that may vary in a spatial or temporal scale, and the tumor microenvironment, can also provide relevant information to render tumor classifications clinically useful. Furthermore, tumor heterogeneity and evolution during the disease course - natural or under therapeutic pressure - should be considered.
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Affiliation(s)
- François Radvanyi
- Equipe Oncologie Moléculaire, Equipe Labellisée Ligue Contre le Cancer, CNRS, UMR144, Institut Curie, PSL Research University, Paris, France
| | - Francisco X. Real
- Epithelial Carcinogenesis Group, Spanish National Cancer Research Centre-CNIO, Madrid, Spain
- CIBERONC, Madrid, Spain
- Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - David McConkey
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Greenberg Bladder Cancer Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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48
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Kato M, Uchida J. Recent advances in immune checkpoint inhibitors in the treatment of urothelial carcinoma: A review. Int J Urol 2023; 30:1068-1077. [PMID: 37602512 DOI: 10.1111/iju.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
Treatment options for urothelial carcinoma were limited until the emergence of immune checkpoint inhibitors, and even now, the prognosis of metastatic disease is poor compared with the other two major genitourinary cancers, renal cell carcinoma and prostate cancer. Despite the increasing use of immune checkpoint inhibitors in the sequential treatment of urothelial carcinoma, conflicting results from similar randomized clinical trials call into question the efficacy of this treatment. In addition, physicians must be aware of the clinical characteristics of immune checkpoint inhibitors, including immune-related adverse events, pseudo- and hyperprogression. This review summarizes the conflicting results of recent clinical trials and provides insights into the role of immune checkpoint inhibitors in the treatment of urothelial carcinoma.
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Affiliation(s)
- Minoru Kato
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Junji Uchida
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Grahn A, Coleman JA, Eriksson Y, Gabrielsson S, Madsen JS, Tham E, Thomas K, Turney B, Uhlén P, Vollmer T, Zieger K, Osther PJS, Brehmer M. Consultation on UTUC II Stockholm 2022: diagnostic and prognostic methods-what's around the corner? World J Urol 2023; 41:3405-3411. [PMID: 37725130 PMCID: PMC10693501 DOI: 10.1007/s00345-023-04597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/23/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE To map current literature and provide an overview of upcoming future diagnostic and prognostic methods for upper tract urothelial carcinoma (UTUC), including translational medical science. METHODS A scoping review approach was applied to search the literature. Based on the published literature, and the experts own experience and opinions consensus was reached through discussions at the meeting Consultation on UTUC II in Stockholm, September 2022. RESULTS The gene mutational profile of UTUC correlates with stage, grade, prognosis, and response to different therapeutic strategies. Analysis of pathway proteins downstream of known pathogenic mutations might be an alternative approach. Liquid biopsies of cell-free DNA may detect UTUC with a higher sensitivity and specificity than urinary cytology. Extracellular vesicles from tumour cells can be detected in urine and may be used to identify the location of the urothelial carcinoma in the urinary tract. 3D microscopy of UTUC samples may add information in the analysis of tumour stage. Chemokines and chemokine receptors were linked to overall survival and responsiveness to neoadjuvant chemotherapy in muscle-invasive bladder cancer, which is potentially also of interest in UTUC. CONCLUSION Current diagnostic methods for UTUC have shortcomings, especially concerning prognostication, which is important for personalized treatment decisions. There are several upcoming methods that may be of interest for UTUC. Most have been studied for urothelial carcinoma of the bladder, and it is important to keep in mind that UTUC is a different entity and not all methods are adaptable or applicable to UTUC.
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Affiliation(s)
- Alexandra Grahn
- Division of Urology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonathan A Coleman
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, Weill-Cornell University Medical College, New York, USA
| | | | - Susanne Gabrielsson
- Division of Immunology and Allergy, Departments of Medicine, and Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonna Skov Madsen
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Kay Thomas
- Guy's Stone Unit, Guy's and St Thomas' Hospital, London, UK
| | - Ben Turney
- Department of Urology, Churchill Hospital, Oxford, UK
| | - Per Uhlén
- Deptartment of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Tino Vollmer
- Department of Hematology and Oncology, Medical Center-University of Freiburg, Freiburg, Germany
| | - Karsten Zieger
- Department of Urology, Lillebælt Hospital, Vejle, Denmark
| | - Palle Jörn Sloth Osther
- Department of Urology, Urological Research Center, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Marianne Brehmer
- Departments of Urology and Clinical Sciences, Stockholm South General Hospital Stockholm, Karolinska Institutet, Stockholm, Sweden.
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50
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Mu N, Jylhä C, Axelsson T, Sydén F, Brehmer M, Tham E. Patient-specific targeted analysis of circulating tumour DNA in plasma is feasible and may be a potential biomarker in UTUC. World J Urol 2023; 41:3421-3427. [PMID: 37721600 PMCID: PMC10693512 DOI: 10.1007/s00345-023-04583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
PURPOSE The prognosis of upper urinary tract urothelial carcinoma (UTUC) is associated with tumour grade (G) and stage. Despite preoperative risk stratification and radical treatment, recurrence and progression are common. Thus, prognostic and monitoring biomarkers are needed. This feasibility study aimed to investigate if targeted analyses on circulating tumour DNA (ctDNA) in plasma could identify tumour-specific gene variants, and thus have potential for further evaluation as a biomarker in UTUC. METHODS Nine UTUC patients with genetically characterised tumours were included in this prospective pilot study. Two tumour-specific variants were chosen for targeted analyses with multiplex droplet digital PCR on cell-free DNA (cfDNA) from plasma at diagnosis or from recurrence. RESULTS Of six patients with diagnostic plasma samples, ctDNA was detected in four with G2 or G3 tumours and tumours > 300m2 in size. Three of these patients progressed in their disease and the fourth had the largest G3 tumour at sampling. In contrast, the two patients with undetectable ctDNA in diagnostic plasma had a G1 tumour and G3 carcinoma in situ (CIS), respectively. The patient with G3 CIS had detectable ctDNA later during follow-up and progressed thereafter with aggressive intravesical recurrence and CT-scan-verified CIS progression in the upper urinary tract. In three patients with small recurrent G1 or G2 tumours, none had detectable ctDNA in plasma and all were progression free. CONCLUSION Our early findings demonstrate that ctDNA in plasma can be detected by targeted analysis in patients with UTUC. However, further studies are needed to determine its role as a potential biomarker.
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Affiliation(s)
- Ninni Mu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Jylhä
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Tomas Axelsson
- Division of Urology, Danderyd Hospital, Stockholm, Sweden
| | - Filip Sydén
- Department of Urology, Stockholm South General Hospital, Stockholm, Sweden
| | - Marianne Brehmer
- Department of Urology, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emma Tham
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
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