1
|
Ramos P, Mateus A, Manso M, Botelho F, Silva A, Silva J, Silva C, Pacheco-Figueiredo L. Prognostic impact of variant histology in bladder cancer: Would early and aggressive treatment shift the paradigm? Urol Oncol 2024; 42:161.e1-161.e8. [PMID: 38267300 DOI: 10.1016/j.urolonc.2024.01.009] [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: 10/15/2023] [Revised: 12/22/2023] [Accepted: 01/07/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Bladder cancer (BC) is an increasingly frequent malignancy worldwide. Several variant histologies (VH) have been described in BC with a distinct clinical behavior. OBJECTIVES This study aims to assess the prognostic impact of VH in BC, comparing its outcomes to pure urothelial carcinoma PUC in both non-muscle invasive (NMIBC) and muscle-invasive (MIBC) settings. METHODS We included patients with primary BC, comparing those with VH with those with PUC, with an age and sex-matched proportion of 1:3, considering stage at diagnosis, recurrence-free, progression-free, and overall survival (OS). A total of 616 patients were included in the study, (460 UC and 151 VH). RESULTS After first TURBT, MIBC was present in 99 (64.1%) of patients with VH, and 95 (20.6%) with UC (p<0.001). Concerning NMIBC, we observed higher rates of progression to MIBC amid patients with VH (p=0.009). Nodal involvement (p=0.020) and metastatic disease (p<0.001) were significantly higher within the VH group. A higher OS was observed among patients with NMIBC of PUC (p<0.001). There were no statistically significant differences of metastasis-free survival and OS between VH and UC groups within the MIBC setting. CONCLUSION We confirmed that VH presents a more aggressive clinical course compared to PUC. An earlier radical treatment within the NMIBC setting could increase the oncological outcomes of the VH patients.
Collapse
Affiliation(s)
- Pedros Ramos
- School of Medicine, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Department of Urology, Centro Hosspitalar São João, Porto, Portugal.
| | - André Mateus
- School of Medicine, University of Minho, Braga, Portugal
| | - Margarida Manso
- Department of Urology, Centro Hosspitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisco Botelho
- School of Medicine, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; Department of Urology, Centro Hosspitalar São João, Porto, Portugal
| | - André Silva
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Trofa Saúde Private Hospitals, Portugal
| | - João Silva
- Department of Urology, Centro Hosspitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Silva
- Department of Urology, Centro Hosspitalar São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luis Pacheco-Figueiredo
- School of Medicine, University of Minho, Braga, Portugal; Department of Urology, Trofa Saúde Private Hospitals, Portugal
| |
Collapse
|
2
|
Yu TY, Wang HJ, Sung MT, Chuang YC, Chen YT, Cheng YT, Kang CH, Liu HY, Chang YL, Luo HL. Variant histology is associated with more non-urothelial tract recurrence but less intravesical recurrence for upper tract urothelial carcinoma after radical nephroureterectomy. Int J Urol 2024; 31:410-418. [PMID: 38169055 DOI: 10.1111/iju.15376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE To investigate the prognostic impact of variant histology (VH) on oncological outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone radical nephroureterectomy (RNU). PATIENTS AND METHODS A total of 1239 patients with clinically localized UTUC who underwent RNU at a single institution between January 2005 and June 2020 were included. The VH was reviewed by a uro-pathologist at our institution. The Cox regression model was used to perform multivariate analysis, including VH and other established prognostic factors for post-RNU oncological outcomes (intravesical recurrence [IVR], non-urothelial recurrence, and cancer-specific death). RESULTS Of the 1239 patients with UTUC, 384 patients (31%) were found to have VH. Advanced tumor stage, lymph node metastasis, high tumor grade, lymphovascular invasion, open surgery, and renal pelvis had a significantly larger proportion of UTUC with VH compared to pure UTUC (all p < 0.05). VH was an independent prognostic factor associated with less IVR identified by multivariate analysis, more non-urothelial recurrence, and more cancer-specific mortality. CONCLUSION Patients with VH account for 31% with UTUC treated with RNU in this cohort. VH was an independent prognostic factor associated with more non-urothelial recurrence and cancer-specific mortality but less IVR.
Collapse
Affiliation(s)
- Tsung Yu Yu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Hung Jen Wang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Min Tse Sung
- Department of Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yao Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen Ta Chen
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Yuan Tso Cheng
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Chih Hsiung Kang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Hui Ying Liu
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Yin Lun Chang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Hao Lun Luo
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University and College of Medicine, Kaohsiung, Taiwan
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
3
|
de Angelis M, Baudo A, Siech C, Jannello LMI, Di Bello F, Goyal JA, Tian Z, Longo N, de Cobelli O, Chun FKH, Saad F, Shariat SF, Carmignani L, Gandaglia G, Moschini M, Montorsi F, Briganti A, Karakiewicz PI. Trimodal therapy effect on survival in urothelial vs non-urothelial bladder cancer. BJU Int 2024. [PMID: 38494989 DOI: 10.1111/bju.16333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To address cancer-specific mortality free-survival (CSM-FS) differences in patients with urothelial carcinoma of the urinary bladder (UCUB) vs non-UCUB who underwent trimodal therapy (TMT), according to organ confined (OC: T2N0M0) vs non-organ confined (NOC: T3-4NanyM0 or TanyN1-3M0) clinical stages. PATIENTS AND METHODS Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified patients with cT2-T4N0-N3M0 bladder cancer treated with TMT, defined as the combination of transurethral resection of bladder tumour, chemotherapy, and radiotherapy. Temporal trends described TMT use over time. Kaplan-Meier plots and multivariable Cox regression (MCR) models addressed CSM in UCUB vs non-UCUB according to OC vs NOC stages. RESULTS Of 5130 assessable TMT-treated patients, 425 (8%) harboured non-UCUB vs 4705 (92%) who had UCUB. The TMT rates increased for patients with OC UCUB from 92.4% to 96.8% (estimated annual percentage change of 0.4%, P < 0.001), but not in the NOC stages (P = 0.3). In the OC stage, the median CSM-FS was 36 months in patients with non-UCUB vs 60 months in those with UCUB, respectively (P = 0.01). Conversely, in the NOC stage, the median CSM-FS was 23 months both in UCUB and non-UCUB (P = 0.9). In the MCR models addressing OC stage, non-UCUB histology independently predicted higher CSM (hazard ratio 1.45, P = 0.004), but not in the NOC stage (P = 0.9). CONCLUSION In OC UCUB, TMT rates have increased over time in a guideline-consistent fashion. Patients with OC non-UCUB treated with TMT showed a CSM disadvantage relative to OC UCUB. In the NOC stage, use of TMT resulted in dismal CSM, regardless of UCUB vs non-UCUB histology.
Collapse
Affiliation(s)
- Mario de Angelis
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Division of Experimental Oncology/Unit of Urology, URI, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Baudo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Carolin Siech
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Letizia Maria Ippolita Jannello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Francesco Di Bello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Nicola Longo
- Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Felix K H Chun
- Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Luca Carmignani
- Department of Urology, IRCCS Policlinico San Donato, Milan, Italy
| | - Giorgio Gandaglia
- Division of Experimental Oncology/Unit of Urology, URI, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Experimental Oncology/Unit of Urology, URI, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Milan, Italy
- IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| |
Collapse
|
4
|
Ran S, Yang J, Hu J, Fang L, He W. Identifying Optimal Candidates for Trimodality Therapy among Nonmetastatic Muscle-Invasive Bladder Cancer Patients. Curr Oncol 2023; 30:10166-10178. [PMID: 38132374 PMCID: PMC10742539 DOI: 10.3390/curroncol30120740] [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: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
(1) Background: This research aims to identify candidates for trimodality therapy (TMT) or radical cystectomy (RC) by using a predictive model. (2) Methods: Patients with nonmetastatic muscle-invasive bladder cancer (MIBC) in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled. The clinical data of 2174 eligible patients were extracted and separated into RC and TMT groups. To control for confounding bias, propensity score matching (PSM) was carried out. A nomogram was established via multivariable logistic regression. The area under the receiver operating characteristic curve (AUC) and calibration curves were used to assess the nomogram's prediction capacity. Decision curve analysis (DCA) was carried out to determine the nomogram's clinical applicability. (3) Results: After being processed with PSM, the OS of the RC group was significantly longer compared with the TMT group (p < 0.001). This remarkable capacity for discrimination was exhibited in the training (AUC: 0.717) and validation (AUC: 0.774) sets. The calibration curves suggested acceptable uniformity. Excellent clinical utility was shown in the DCA curve. The RC and RC-Beneficial group survived significantly longer than the RC and TMT-Beneficial group (p < 0.001) or the TMT group (p < 0.001). However, no significant difference was found between the RC and TMT-Beneficial group and the TMT group (p = 0.321). (4) Conclusions: A predictive model with excellent discrimination and clinical application value was established to identify the optimal patients for TMT among nonmetastatic MIBC patients.
Collapse
Affiliation(s)
- Shengming Ran
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (S.R.); (J.H.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Jingtian Yang
- Department of Urology, The Third People’s Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen 518116, China;
| | - Jintao Hu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (S.R.); (J.H.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| | - Liekui Fang
- Department of Urology, The Third People’s Hospital of Shenzhen, Southern University of Science and Technology, Shenzhen 518116, China;
| | - Wang He
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China; (S.R.); (J.H.)
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, China
- Guangdong Clinical Research Center for Urological Diseases, Guangzhou 510289, China
| |
Collapse
|
5
|
Douglawi A, Ghoreifi A, Carbonara U, Yip W, Uzzo RG, Margulis V, Ferro M, Cobelli OD, Wu Z, Simone G, Mastroianni R, Rha KH, Eun DD, Reese AC, Porter JR, Derweesh I, Mehrazin R, Rosiello G, Tellini R, Jamil M, Kenigsberg A, Farrow JM, Schrock WP, Cacciamani G, Srivastava A, Bhattu AS, Mottrie A, Gonzalgo ML, Sundaram CP, Abdollah F, Minervini A, Autorino R, Djaladat H. Impact of Variant Histology on Oncological Outcomes in Upper Tract Urothelial Carcinoma: Results From the ROBUUST Collaborative Group. Clin Genitourin Cancer 2023; 21:563-568. [PMID: 37301663 DOI: 10.1016/j.clgc.2023.05.011] [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: 08/29/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Oncologic implications of variant histology (VH) have been extensively studied in bladder cancer; however, further investigation is needed in upper tract urothelial carcinoma (UTUC). Our study aims to evaluate the impact of VH on oncological outcomes in UTUC patients treated with radical nephroureterectomy (RNU). METHODS A retrospective analysis was performed on patients who underwent a robotic or laparoscopic RNU for UTUC using the ROBUUST database, a multi-institutional collaborative including 17 centers worldwide. Logistic regression was used to assess the effect of VH on urothelial recurrence (bladder, contralateral upper tract), metastasis, and survival following RNU. RESULTS A total of 687 patients were included in this study. Median (IQR) age was 71 (64-78) years and 470 (68%) had organ confined disease. VH was present in 70 (10.2%) patients. In a median follow-up of 16 months, the incidence of urothelial recurrence, metastasis, and mortality was 26.8%, 15.3%, and 11.8%, respectively. VH was associated with increased risk of metastasis (HR 4.3, P <.0001) and death (HR 2.0, P =.046). In multivariable analysis, VH was noted to be an independent risk factor for metastasis (HR 1.8, P =.03) but not for urothelial recurrence (HR 0.99, P =.97) or death (HR 1.4, P =.2). CONCLUSION Variant histology can be found in 10% of patients with UTUC and is an independent risk factor for metastasis following RNU. Overall survival rates and the risk of urothelial recurrence in the bladder or contralateral kidney are not affected by the presence of VH.
Collapse
Affiliation(s)
- Antoin Douglawi
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Alireza Ghoreifi
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Umberto Carbonara
- Division of Urology, Virginia Commonwealth University, Richmond, Virginia
| | - Wesley Yip
- Institute of Urology, University of Southern California, Los Angeles, CA
| | - Robert G Uzzo
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Matteo Ferro
- Department of Urology, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, Istituto Europeo di Oncologia (IEO), Milan, Italy
| | - Zhenjie Wu
- Department of Urology, Shanghai Hospital, Naval Medical University Shanghai, China
| | - Giuseppe Simone
- Istituto Regina Elena (IRE), Department of Urology, Rome, Italy
| | | | - Koon H Rha
- Department of Urology, Yonsei University, Seoul, Republic of Korea
| | - Daniel D Eun
- Department of Urology, Temple University, Philadelphia, PA
| | - Adam C Reese
- Department of Urology, Temple University, Philadelphia, PA
| | | | - Ithaar Derweesh
- Department of Urology, University of California San Diego, San Diego, CA
| | - Reza Mehrazin
- Icahn School of Medicine at Mount Sinai, Department of Urology, New York, NY
| | - Giuseppe Rosiello
- Onze Lieve Vrouwziekenhuis (OLV), Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Riccardo Tellini
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | - Marcus Jamil
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Alexander Kenigsberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jason M Farrow
- Department of Urology, Indiana University, Indianapolis, IN
| | | | | | | | - Amit S Bhattu
- Department of Urology, University of Miami, Miami, FL
| | - Alexandre Mottrie
- Onze Lieve Vrouwziekenhuis (OLV), Aalst, Belgium; ORSI Academy, Melle, Belgium
| | | | | | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Careggi Hospital, Florence, Italy
| | | | - Hooman Djaladat
- Institute of Urology, University of Southern California, Los Angeles, CA.
| |
Collapse
|
6
|
Prijovic N, Acimovic M, Santric V, Stankovic B, Nikic P, Vukovic I, Radovanovic M, Kovacevic L, Nale P, Babic U. The Impact of Variant Histology in Patients with Urothelial Carcinoma Treated with Radical Cystectomy: Can We Predict the Presence of Variant Histology? Curr Oncol 2023; 30:8841-8852. [PMID: 37887538 PMCID: PMC10605515 DOI: 10.3390/curroncol30100638] [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: 08/12/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/28/2023] Open
Abstract
Considering the divergent biological behaviors of certain histological subtypes of urothelial carcinoma, it would be of great importance to examine the impact of variant histology and to predict its presence in patients with bladder cancer. A single-center cohort study included 459 patients who underwent radical cystectomy for urothelial carcinoma between 2017 and 2021. Patients were followed up with until July 2022. We compared clinical, laboratory, and histopathologic characteristics and the overall survival between patients with pure urothelial carcinoma and variant histologies. Our results showed that the patients with variant histology were older and preoperatively more frequently had hydronephrosis and higher values of leukocytes and neutrophils. Also, we found a significant association between variant histology and an advanced stage of tumor disease, the presence of lymphovascular invasion, positive surgical margins, and metastases in surgically resected lymph nodes. The number of neutrophils was identified as an independent preoperative predictor of the presence of variant histology after a radical cystectomy. The overall survival of the patients with variant histology was significantly lower compared to the patients with pure urothelial carcinoma. According to our results, the presence of variant histology represents a more aggressive form of the disease. Preoperative neutrophil counts may indicate the presence of variant histology of urothelial carcinoma in patients with bladder cancer.
Collapse
Affiliation(s)
- Nebojsa Prijovic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
| | - Miodrag Acimovic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
- Faculty of Medicine, University of Belgrade, Dr Subotica Str. 8, 11000 Belgrade, Serbia
| | - Veljko Santric
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
- Faculty of Medicine, University of Belgrade, Dr Subotica Str. 8, 11000 Belgrade, Serbia
| | - Branko Stankovic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
| | - Predrag Nikic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
- Faculty of Medicine, University of Belgrade, Dr Subotica Str. 8, 11000 Belgrade, Serbia
| | - Ivan Vukovic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
- Faculty of Medicine, University of Belgrade, Dr Subotica Str. 8, 11000 Belgrade, Serbia
| | - Milan Radovanovic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
- Faculty of Medicine, University of Belgrade, Dr Subotica Str. 8, 11000 Belgrade, Serbia
| | - Luka Kovacevic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
| | - Petar Nale
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
| | - Uros Babic
- Clinic of Urology, University Clinical Center of Serbia, Resavska Str. 51, 11000 Belgrade, Serbia; (N.P.); (M.A.); (V.S.); (B.S.); (P.N.); (I.V.); (M.R.); (L.K.); (P.N.)
- Faculty of Medicine, University of Belgrade, Dr Subotica Str. 8, 11000 Belgrade, Serbia
| |
Collapse
|
7
|
Tsai TH, Su PJ, Huang SY, Kuo MC, Lin CT, Wu CC, Luo HL, Chen CH, Chou CC, Liu TT, Huang CC, Tsai KL, Su YL. The prognostic significance of histologic variant on survival outcomes in patients with metastatic urothelial carcinoma receiving immune checkpoint inhibitor therapy. BMC Cancer 2023; 23:871. [PMID: 37715113 PMCID: PMC10504763 DOI: 10.1186/s12885-023-11398-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND While the treatment guidelines have been established for pure urothelial carcinoma (pUC), patients with variant type urothelial carcinoma (vUC) face limited effective treatment options. The effectiveness of immune checkpoint inhibitors (ICI) in patients with vUC remains uncertain and necessitates additional research. METHOD We conducted a retrospective, multicenter study to explore the effectiveness of ICI in patients with pUC or vUC in Taiwan. We evaluated the overall response rate (ORR) through univariate logistic regression analysis and examined the overall survival (OS) and progression-free survival (PFS) using Kaplan-Meier analysis. Additionally, we employed univariate and multivariate Cox proportional hazards models to analyze the data. RESULT A total of 142 patients (116 pUC, 26 vUC) were included in our final analysis. The ORR was marginally higher in patients with pUC compared to those with vUC (34.5% vs. 23.1%, p = 0.26). Among all patients, 12.9% with pUC achieved a complete response (CR) after ICI treatment, while no vUC cases achieved CR (p = 0.05). There were no significant differences in PFS (median 3.6 months vs. 4.1 months, p = 0.34) or OS (median 16.3 months vs. 11.0 months, p = 0.24) when comparing patients with pUC or vUC. In the subgroup analysis, patients with pUC who underwent first-line ICI treatment exhibited significantly improved OS compared to those with vUC (24.6 months vs. 9.1 months, p = 0.004). CONCLUSION The use of ICI as monotherapy is a feasible and effective treatment approach for patients with metastatic vUC.
Collapse
Affiliation(s)
- Tsung-Han Tsai
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan
| | - Po-Jung Su
- Division of Hematology Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Tao-Yuan, Kaohsiung City, Taiwan
| | - Shih-Yu Huang
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan
| | - Ming-Chun Kuo
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan
| | - Chang-Ting Lin
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan
| | - Chia-Che Wu
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan
| | - Hao-Lun Luo
- Department of Urology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung City, Taiwan
| | - Chien-Hsu Chen
- Department of Urology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung City, Taiwan
| | - Chih-Chi Chou
- Department of Pathology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Ting-Ting Liu
- Department of Pathology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung City, Taiwan
| | - Chun-Chieh Huang
- Department of Radiation Oncology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung City, Taiwan
| | - Kai-Lung Tsai
- Department of Colorectal Surgery, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung City, Taiwan
| | - Yu-Li Su
- Division of Hematology Oncology, Department of Internal Medicine, College of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University, No.123, Dapi Rd., Niaosong Dist, Kaohsiung City, 833, Taiwan.
- Genomic & Proteomic Core Laboratory, Department of Medical Research, Kaohsiung, Taiwan.
| |
Collapse
|
8
|
Yin N, Zhao W, He T, Li T, Lei X, He H, Long Z, Wang Y. Partial cystectomy for bladder squamous cell carcinoma with a 10-year follow-up: a case report. Front Oncol 2023; 13:1237228. [PMID: 37621677 PMCID: PMC10446963 DOI: 10.3389/fonc.2023.1237228] [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: 06/09/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
Squamous cell carcinoma (SCC) of the bladder is a rare malignancy of the urinary system. It is prone to invasion and metastasis in the early stage and has a poor prognosis. This case reports a 65-year-old female patient with SCC of the bladder who was free of disease recurrence and metastasis 10 years after partial cystectomy (PC) combined with left ureteral reimplantation. The treatment plan and admission of this patient were retrospectively analyzed in order to provide some reference significance for the treatment plan for the SCC of the bladder.
Collapse
Affiliation(s)
- Na Yin
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Wei Zhao
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Tao He
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Tingchao Li
- Department of Pathology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Xu Lei
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Hao He
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Zongmin Long
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| | - Yan Wang
- Department of Urology, The Third Affiliated Hospital of Zunyi Medical University (The First People’s Hospital of Zunyi), Zunyi, China
| |
Collapse
|
9
|
Claps F, van de Kamp MW, Mayr R, Bostrom PJ, Shariat SF, Hippe K, Bertz S, Neuzillet Y, Sanders J, Otto W, van der Heijden MS, Jewett MAS, Stöhr R, Zlotta AR, Trombetta C, Eckstein M, Mertens LS, Burger M, Soorojebally Y, Wullich B, Bartoletti R, Radvanyi F, Pavan N, Sirab N, Mir MC, Pouessel D, van der Kwast TH, Hartmann A, Lotan Y, Bussani R, Allory Y, van Rhijn BWG. Prognostic impact of variant histologies in urothelial bladder cancer treated with radical cystectomy. BJU Int 2023; 132:170-180. [PMID: 36748180 DOI: 10.1111/bju.15984] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate variant histologies (VHs) for disease-specific survival (DSS) in patients with invasive urothelial bladder cancer (BCa) undergoing radical cystectomy (RC). MATERIALS AND METHODS We analysed a multi-institutional cohort of 1082 patients treated with upfront RC for cT1-4aN0M0 urothelial BCa at eight centres. Univariable and multivariable Cox' regression analyses were used to assess the effect of different VHs on DSS in overall cohort and three stage-based analyses. The stages were defined as 'organ-confined' (≤pT2N0), 'locally advanced' (pT3-4N0) and 'node-positive' (pTanyN1-3). RESULTS Overall, 784 patients (72.5%) had pure urothelial carcinoma (UC), while the remaining 298 (27.5%) harboured a VH. Squamous differentiation was the most common VH, observed in 166 patients (15.3%), followed by micropapillary (40 patients [3.7%]), sarcomatoid (29 patients [2.7%]), glandular (18 patients [1.7%]), lymphoepithelioma-like (14 patients [1.3%]), small-cell (13 patients [1.2%]), clear-cell (eight patients [0.7%]), nested (seven patients [0.6%]) and plasmacytoid VH (three patients [0.3%]). The median follow-up was 2.3 years. Overall, 534 (49.4%) disease-related deaths occurred. In uni- and multivariable analyses, plasmacytoid and small-cell VHs were associated with worse DSS in the overall cohort (both P = 0.04). In univariable analyses, sarcomatoid VH was significantly associated with worse DSS, while lymphoepithelioma-like VH had favourable DSS compared to pure UC. Clear-cell (P = 0.015) and small-cell (P = 0.011) VH were associated with worse DSS in the organ-confined and node-positive cohorts, respectively. CONCLUSIONS More than 25% of patients harboured a VH at time of RC. Compared to pure UC, clear-cell, plasmacytoid, small-cell and sarcomatoid VHs were associated with worse DSS, while lymphoepithelioma-like VH was characterized by a DSS benefit. Accurate pathological diagnosis of VHs may ensure tailored counselling to identify patients who require more intensive management.
Collapse
Affiliation(s)
- Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Maaike W van de Kamp
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Roman Mayr
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Peter J Bostrom
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Shahrokh F Shariat
- Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katrin Hippe
- Department of Pathology, University Medical Center - Regensburg, Regensburg, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yann Neuzillet
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Joyce Sanders
- Core Facility Molecular Pathology & Biobank, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Wolfgang Otto
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Michiel S van der Heijden
- Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael A S Jewett
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Robert Stöhr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Alexandre R Zlotta
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Maximilian Burger
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Yanish Soorojebally
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Bernd Wullich
- Department of Urology & Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Riccardo Bartoletti
- Unit of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - François Radvanyi
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - Nicola Pavan
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Nanour Sirab
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
| | - M Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Damien Pouessel
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
- Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France
| | - Theo H van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen/Nurnberg, Erlangen, Germany
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical center, Dallas, TX, USA
| | - Rossana Bussani
- Department of Pathology, University of Trieste, Trieste, Italy
| | - Yves Allory
- Institut Curie, CNRS, UMR144, Molecular Oncology Team, PSL Research University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
10
|
Tappero S, Barletta F, Piccinelli ML, Cano Garcia C, Incesu RB, Morra S, Scheipner L, Tian Z, Parodi S, Dell'Oglio P, Briganti A, de Cobelli O, Chun FKH, Graefen M, Mirone V, Ahyai S, Saad F, Shariat SF, Suardi N, Borghesi M, Terrone C, Karakiewicz PI. Adenocarcinoma of the Bladder: Assessment of Survival Advantage Associated With Radical Cystectomy and Comparison With Urothelial Bladder Cancer. Urol Oncol 2023; 41:326.e9-326.e16. [PMID: 36882338 DOI: 10.1016/j.urolonc.2023.01.015] [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: 11/10/2022] [Revised: 12/16/2022] [Accepted: 01/16/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To evaluate the association between radical cystectomy (RC) and cancer-specific mortality (CSM) in patients diagnosed with adenocarcinoma of the bladder (ACB). Moreover, to directly compare the survival advantage of RC between ACB vs. urothelial bladder cancer (UBC). MATERIALS AND METHODS Non-metastatic muscle-invasive ACB and UBC patients were identified within Surveillance, Epidemiology, and End Results database (SEER 2000-2018). All analyses were stratified between RC vs. no-RC, in either organ-confined (OC: T2N0M0) or non-organ-confined (NOC: T3-4N0M0 or TanyN1-3M0) stages. Propensity score matching (PSM), cumulative incidence plots, competing risks regression (CRR) analyses, and 3 months' landmark analyses were performed. RESULTS Overall, 1,005 ACB and 47,741 UBC patients were identified, of whom 475 (47%) and 19,499 (41%) were treated with RC, respectively. After PSM, comparison between RC vs. no-RC applied to 127 vs. 127 OC-ACB, 7,611 vs. 7,611 OC-UBC, 143 vs. 143 NOC-ACB, and 4,664 vs. 4,664 NOC-UBC patients. 36-month CSM rates in RC vs. no-RC patients were 14 vs. 44% in OC-ACB, 18 vs. 39% in OC-UBC, 49 vs. 66% in NOC-ACB, and 44 vs. 56% in NOC-UBC patients. In CRR analyses, the effect of RC on CSM yielded a hazard ratio of 0.37 in OC-ACB, of 0.45 in OC-UBC, of 0.65 in NOC-ACB and of 0.68 in NOC-UBC patients (all P values<0.001). Landmark analyses virtually perfectly replicated the results. CONCLUSIONS In ACB, regardless of stage, RC is associated with lower CSM. The magnitude of this survival advantage was greater in ACB than in UBC, even after control for immortal time bias.
Collapse
Affiliation(s)
- Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy.
| | - Francesco Barletta
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Luca Piccinelli
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Cristina Cano Garcia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Reha-Baris Incesu
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Morra
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Lukas Scheipner
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Medical University of Graz, Graz, Austria
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Stefano Parodi
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Vincenzo Mirone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, Graz, Austria
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Nazareno Suardi
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Borghesi
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| |
Collapse
|
11
|
Flammia RS, Tufano A, Chierigo F, Würnschimmel C, Hoeh B, Sorce G, Tian Z, Anceschi U, Leonardo C, Del Giudice F, Terrone C, Giordano A, Morrione A, Saad F, Shariat SF, Briganti A, Montorsi F, Chun FKH, Gallucci M, Karakiewicz PI. The Effect of Sex on Disease Stage and Survival after Radical Cystectomy in Non-Urothelial Variant-Histology Bladder Cancer. J Clin Med 2023; 12:jcm12051776. [PMID: 36902562 PMCID: PMC10003431 DOI: 10.3390/jcm12051776] [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: 01/08/2023] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Female sex in patients treated by radical cystectomy (RC) is associated with more advanced stage and worse survival. However, studies supporting these findings mostly or exclusively relied on urothelial carcinoma of the urinary bladder (UCUB) and did not address non-urothelial variant-histology bladder cancer (VH BCa). We hypothesized that female sex is associated with a more advanced stage and worse survival in VH BCa, similarly to that of UCUB. MATERIALS AND METHODS Within the SEER database (2004-2016), we identified patients aged ≥18 years, with histologically confirmed VH BCa, and treated with comprehensive RC. Logistic regression addressing the non-organ-confined (NOC) stage, as well as cumulative incidence plots and competing risks regression addressing CSM for females vs. males, were fitted. All analyses were repeated in stage-specific and VH-specific subgroups. RESULTS Overall, 1623 VH BCa patients treated with RC were identified. Of those, 38% were female. Adenocarcinoma (n = 331, 33%), neuroendocrine tumor (n = 304, 18%), and other VH (n = 317, 37%) were less frequent in females but not squamous cell carcinoma (n = 671, 51%). Across all VH subgroups, female patients had higher NOC rates than males did (68 vs. 58%, p < 0.001), and female sex was an independent predictor of NOC VH BCa (OR = 1.55, p = 0.0001). Overall, five-year cancer-specific mortality (CSM) were 43% for females vs. 34% for males (HR = 1.25, p = 0.02). CONCLUSION In VH BC patients treated with comprehensive RC, female sex is associated with a more advanced stage. Independently of stage, female sex also predisposes to higher CSM.
Collapse
Affiliation(s)
- Rocco Simone Flammia
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
- Correspondence:
| | - Antonio Tufano
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16146 Genova, Italy
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60596 Frankfurt am Main, Germany
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Zhen Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
| | - Umberto Anceschi
- Department of Urology, Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, 16146 Genova, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
- Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy
| | - Andrea Morrione
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
| | - Shahrokh F. Shariat
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, 128 08 Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman 11942, Jordan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60596 Frankfurt am Main, Germany
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Rome, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H4A 3J1, Canada
| |
Collapse
|
12
|
Duwe G, Fischer ND, Haack M, Höfner T, Haferkamp A, Brandt MP. Solitary cardiac metastasis of urothelial carcinoma of the urinary bladder with squamous cell differentiation - a rare manifestation. Urol Case Rep 2023; 46:102318. [PMID: 36632283 PMCID: PMC9827352 DOI: 10.1016/j.eucr.2023.102318] [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: 11/28/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
We present a case of bladder cancer with a singular cardiac metastasis. A 51-year-old female patient was referred to our department for painless macrohematuria. We confirmed the diagnosis of muscle-invasive urothelial carcinoma of the urinary bladder with partial squamous cell differentiation. Computed tomography (CT) staging demonstrated a singular cardiac metastasis. Two months after receiving six cycles of chemotherapy control CT scan revealed massive tumour progression. The singular cardiac metastasis size increased to approximately two thirds of right ventricle size. Singular cardiac metastases of urothelial carcinoma are extremely rare and show rapid progression, hence introduction to therapy should not be delayed.
Collapse
Affiliation(s)
- Gregor Duwe
- Corresponding author. Department of Urology and Pediatric Urology, Johannes-Gutenberg University Medical Center, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | | | | | | | | | | |
Collapse
|
13
|
Cai J, Xie Z, Yan Y, Huang Z, Tang P, Cao X, Wang Z, Yang C, Tan M, Zhang F, Shen B. Establishment of an optimized orthotopic bladder cancer model in mice. BMC Urol 2022; 22:142. [PMID: 36057655 PMCID: PMC9441054 DOI: 10.1186/s12894-022-01093-6] [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: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bladder cancer (BC) is one of the most common malignancies of the genitourinary system. Animal models offer an important tool to explore tumour initiation, progression, and therapeutic mechanisms. Our aim is to construct an optimized orthotopic BC model which is predictable, reproducible, and convenient. METHODS The optimized orthotopic BC model was constructed in male C57BL/6 mice utilizing microsyringes to inoculate them with a murine BC cell line (MB49). Anesthetised mice were inoculated with an MB49 cell suspension (10 µL) at approximately 5 × 106/mL. The whole process of modelling was observed and monitored every 3 days for 21 days utilizing HE staining and transabdominal ultrasonography (TUS). RESULTS In this study, the model showed excellent success rates for tumour formation (96.67%) and metastatic rate (89.66%). Compared to the control group (sham operation), mice in the modelling group had serous cachexia, visible haematuresis and weight loss (all P < 0.05). The lungs, liver, ureter and kidneys were found to have tumour metastasis. Moreover, the average survival time (19.73 ± 1.69 d) of modelling mice was significantly shorter than that of the control mice (P < 0.05), which remained alive. CONCLUSION Our study established a method using microsyringes to inject murine BC cells into the bladder wall, creating a stable transplantable BC model in mice.
Collapse
Affiliation(s)
- Jinming Cai
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Zhiwen Xie
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Yilin Yan
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Zhengnan Huang
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Pengfei Tang
- Department of Urology, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai, 200080, China
| | - Xiangqian Cao
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Zeyi Wang
- Department of Urology, Shanghai General Hospital Affiliated to Nanjing Medical University, Shanghai, 200080, China
| | - Chenkai Yang
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China
| | - Mingyue Tan
- Department of Urology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200021, China.
| | - Fang Zhang
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China.
| | - Bing Shen
- Department of Urology, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, No. 85 Wujin Road, Hongkou District, Shanghai, 200080, China.
| |
Collapse
|
14
|
Benidir T, Lone Z, Zhang A, Nowacki AS, Munoz-Lopez C, Hegde P, Fung K, Fajnzylber J, Abouassaly R, Berglund R, Klein EA, Eltemamy M, Kaouk J, Weight CJ, Almassi N, Pascal-Haber G, Lee BH. Comparing Pathologic and Survival Outcomes Between Primary and Secondary Muscle Invasive Bladder Cancer when treated by Radical Cystectomy With or Without Neoadjuvant Chemotherapy. Urology 2022; 168:137-142. [PMID: 35772481 DOI: 10.1016/j.urology.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To compare pathologic and survival outcomes between primary muscle invasive (pMIBC) and secondary muscle invasive (sMIBC) bladder cancer patients who were treated with or without cisplatin-based neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). METHODS We reviewed cT2-T4/N0 MIBC patients at our institution between 2010-2019. pMIBC was defined as presenting with > cT2 disease on initial or restaging TURBT with no prior history of bladder cancer. sMIBC was defined as prior history of NMIBC that was treated with at least one induction course of BCG that progressed to MIBC. Outcomes analyzed included pathologic downstaging rates defined as <pT2/N0, pathologic complete response rates (pT0/N0), and survival outcomes (RFS, CSS, OS). Survival outcomes were analyzed using the Kaplan-Meier Method or Gray's test with log rank. Cox Proportional Hazards and semiparametric hazards models proposed by Fine and Gray were constructed to identify predictors of oncologic outcomes. RESULTS 333 patients were included in the analysis (sMIBC: 48 vs pMIBC: 285). There were no differences in pathologic downstaging (sMIBC: 54% vs. pMIBC: 51%, p=0.67) or pathologic complete response (sMIBC: 33% vs. pMIBC: 28, p=0.46). Survival analysis showed no differences when patients were treated with NAC+RC in oncologic outcomes. On regression analysis, only >pT2 and N+ disease were predictors of poorer CSS and OS. Separate analysis of sMIBC patients whom underwent RC only (N=61), demonstrated inferior oncologic outcomes to other cohorts (p<0.01). CONCLUSION There were no differences in pathologic response or survival between pMIBC and sMIBC patients when managed with NAC and RC.
Collapse
Affiliation(s)
- Tarik Benidir
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Zaeem Lone
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Ao Zhang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Amy S Nowacki
- Cleveland Clinic Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland, Ohio
| | | | - Pranay Hegde
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - Kevin Fung
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | | | - Robert Abouassaly
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ryan Berglund
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Mohammed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Nima Almassi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | | | - Byron H Lee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
15
|
Sorce G, Flammia RS, Hoeh B, Chierigo F, Horlemann B, Würnschimmel C, Tian Z, Graefen M, Terrone C, Gallucci M, Chun FKH, Saad F, Shariat SF, Montorsi F, Briganti A, Karakiewicz PI. Plasmacytoid variant urothelial carcinoma of the bladder: effect of radical cystectomy and chemotherapy in non-metastatic and metastatic patients. World J Urol 2022; 40:1481-1488. [PMID: 35084543 DOI: 10.1007/s00345-022-03940-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/09/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Data about optimal management of plasmacytoid (PCV) bladder cancer patients are extremely scarce and limited by sample size. We focused on PCV bladder cancer patients to explore the effect of radical cystectomy (RC) and chemotherapy in non-metastatic (T 2-4N0-3M0), as well as in metastatic (TanyNanyM1) subgroups. METHODS Using the Surveillance, Epidemiology and End Results database (2000-2016), we identified 332 PCV patients with muscle-invasive disease or higher (≥ T2N0M0). Kaplan-Meier plots and Cox regression models addressed cancer-specific mortality (CSM). RESULTS In 332 PCV patients, median age was 68 years (Interquartile range [IQR]:58-76). Of those, 252 were non-metastatic patients (76%) vs 80 were metastatic patients (24%), at presentation. Of non-metastatic patients, 142 (56%) underwent RC and 131 (52%) underwent chemotherapy. Chemotherapy did not improve CSM in non-metastatic PCV. Conversely, RC was associated with lower CSM (hazard ratio [HR]: 0.51, p = 0.002). Median CSM-free survival was 48 vs 38 months for RC treated vs RC not treated. Of metastatic patients, 22 (28%) underwent RC and 42 (52%) underwent chemotherapy. Both chemotherapy and RC improved CSM in metastatic PCV. Median CSM-free survival was 12 vs 7 months for RC treated vs RC not treated (HR: 0.27, p < 0.001). Median CSM-free survival was 11 vs 4 months for chemotherapy exposed vs chemotherapy naïve (HR: 0.32, p = 0.002). CONCLUSIONS Although RC resulted in lower CSM, chemotherapy failed to show that effect in non-metastatic PCV patients. Conversely, both chemotherapy and RC resulted in statistically significantly lower CSM in metastatic PCV patients.
Collapse
Affiliation(s)
- Gabriele Sorce
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy. .,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Rocco Simone Flammia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Benedikt Horlemann
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Christoph Würnschimmel
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Departments of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| |
Collapse
|
16
|
Oswald D, Pallauf M, Herrmann TRW, Netsch C, Becker B, Lehrich K, Miernik A, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L, Deininger S. [Transurethral resection of bladder tumors (TURBT)]. Urologe A 2022; 61:71-82. [PMID: 34982181 PMCID: PMC8763753 DOI: 10.1007/s00120-021-01741-z] [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] [Accepted: 11/29/2021] [Indexed: 10/28/2022]
Abstract
Transurethral resection of bladder tumors (TURBT) is the standard of care for the diagnostics and primary treatment of bladder tumors. These are removed by fragmentation using loop diathermy. The resection area is coagulated for hemostasis. An important aspect is always a complete resection with an adequate amount of detrusor muscle in the specimen. Postoperative intravesical instillation of single-shot chemotherapy has been proven to reduce recurrence rates. Methods for improved tumor visualization (particularly photodynamic diagnostics) are used to enhance tumor detection rates particularly in multifocal tumors or carcinoma in situ (CIS). Thus, recurrence and progression rates can be reduced. Depending on the histological examination of the TURBT specimen, follow-up treatment for non-muscle invasive bladder tumors are adjuvant instillation treatment using chemotherapy or Bacillus Calmette-Guérin (BCG), second look TURBT and early cystectomy or for muscle invasive bladder tumors, radical cystectomy or (oncologically subordinate) trimodal treatment with renewed TURBT, radiotherapy and chemotherapy are indicated. Possible complications of TURBT include bleeding with bladder tamponade, extraperitoneal or intraperitoneal bladder perforation and infections of the urogenital tract.
Collapse
Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - M Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Universitätsklinik für Urologie und Andrologie der PMU, Salzburger Landeskliniken, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| |
Collapse
|
17
|
Laymon M, Mosbah A, Hashem A, Mahmoud O, Harraz AM, Elsawy AA, Abol-Enein H. Oncologic Outcomes of Squamous Cell Carcinoma Versus Urothelial Carcinoma With Squamous Differentiation After Radical Cystectomy for Bladder Carcinoma. Clin Genitourin Cancer 2021; 20:148-154. [PMID: 34998698 DOI: 10.1016/j.clgc.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In this study we aim to compare clinicopathological characteristics and cancer specific survival between patients treated with radical cystectomy for pure squamous cell carcinoma (SCC) and urothelial carcinoma with squamous differentiation (SqD). PATIENTS AND METHODS We reviewed data of 1737 consecutive patients treated with radical cystectomy and urinary diversion between January 2004 and February 2014. Only patients with pure SCC or SqD were included in the analysis. Squamous differentiation was defined as intercellular bridges or keratinization in the tumor. Clinicopathological data and recurrence free survival (RFS) were compared between patients diagnosed with SCC and SqD. RESULTS SCC and SqD were found in 318 and 223 patients, respectively. Mean age was 57 ± 8.3 years in SCC and 58.8 ± 7.8 in SqD (P = .008). A higher proportion of female patients was observed in SCC group compared to SqD (31.8% vs. 22% P < .0001). Patients with SqD were more likely to have extravesical (58.3% vs. 46.2%: P = .006) and nodal positive disease (34.5% vs. 14.5%: P < .0001) than pure SCC patients. Bilharzial eggs were found in 61% of SCC vs. 46% of SqD (P = .001).; The median (IQR) follow up period for SCC and SqD was 63 (12-112) months and 23 months (9-74.7), respectively. The 5-year RFS for SCC and SqD were 77% and 59.8 %, respectively (P < .0001).; Multivariate cox regression analysis identified advanced pT stage (OR: 1.9, 95% CI: 1.3-2.86, P = .0001), nodal positive disease (OR: 1.6, 95% CI: 1.1-2.48, P = .01) and SqD histology (OR: 1.6, 95% CI: 1.14-2.31, P = .007 as independent predictors of 5-year RFS. CONCLUSION Patient with SCC had significantly higher 5-year RFS in comparison to SqD. The higher rate of extravesical disease and lymph node metastasis in SqD patients is indicative of aggressive behavior of this histologic type.
Collapse
Affiliation(s)
- Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed Mosbah
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Abdelwahab Hashem
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Osama Mahmoud
- Urology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed M Harraz
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr A Elsawy
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
18
|
Alvarez-Maestro M, Chierigo F, Mantica G, Quesada-Olarte JM, Carrion DM, Gomez-Rivas J, Pinto-Marin A, Aguilera Bazan A, Martinez-Piñeiro L. The effect of neoadjuvant chemotherapy among patients undergoing radical cystectomy for variant histology bladder cancer: A systematic review. Arab J Urol 2021; 20:1-13. [PMID: 35223104 PMCID: PMC8881059 DOI: 10.1080/2090598x.2021.1994230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To systematically review the evidence about the effect of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) with pure urothelial carcinoma (pUC) in radical cystectomy (RC) candidates affected by variant histology (VH) bladder cancer. Methods A review of the current literature was conducted through the Medline and National Center for Biotechnology Information (NCBI) PubMed, Scopus databases in May 2020. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this systematic review. Keywords used were ‘bladder cancer’, ‘bladder carcinoma’, ‘bladder tumour’ and ‘bladder cancer variants’ and ‘neoadjuvant chemotherapy’. Only original articles in English published after 2000 and reporting oncological outcomes a series of more than five patients with VH were included. We excluded series in which the oncological outcomes of patients with pUC and VH were undistinguishable. Results The literature search identified 2231 articles. A total of 51 full-text articles were assessed for eligibility, with 17 eventually considered for systematic review, for a cohort of 450,367 patients, of which 5010 underwent NAC + RC. The median age at initial diagnosis ranged from 61 to 71 years. Most patients received cisplatin-gemcitabine, methotrexate-vinblastine-adriamycin-cisplatin, or carboplatin-based chemotherapy. Only one study reported results of neoadjuvant immunotherapy. The median follow-up ranged from 1 to 120 months. The results showed that squamous cell carcinoma (SCC) is less sensitive to NAC than pUC and that SCC predicts poorer prognosis. NAC was found to be a valid approach in treating small cell carcinoma and may have potential benefit in micropapillary carcinoma. Conclusions NAC showed the best oncological outcomes in small cell variants and micropapillary carcinoma, while NAC survival benefit for SCC and adenocarcinoma variants needs further studies. Drawing definite considerations on the efficacy of NAC in VH is complicated due to the heterogeneity of present literature. Present results need to be confirmed in randomised controlled trials.
Collapse
Affiliation(s)
| | - Francesco Chierigo
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genoa, Italy
| | | | - D. M. Carrion
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Juan Gomez-Rivas
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | |
Collapse
|
19
|
Rosiello G, Palumbo C, Deuker M, Stolzenbach LF, Martin T, Tian Z, Gallina A, Montorsi F, Black P, Kassouf W, Shariat SF, Saad F, Briganti A, Karakiewicz PI. Sex- and age-related differences in the distribution of bladder cancer metastases. Jpn J Clin Oncol 2021; 51:976-983. [PMID: 33558890 DOI: 10.1093/jjco/hyaa273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Our objective was to investigate age- and sex-related differences in the distribution of metastases in patients with metastatic bladder cancer. METHODS Within the National Inpatient Sample database (2008-2015), we identified 7040 patients with metastatic bladder cancer. Trend test and Chi-square test analyses were used to evaluate the relationship between age and site of metastases, according to sex. RESULTS Of 7040 patients with metastatic bladder cancer, 5226 (74.2%) were men and 1814 (25.8%) were women. Thoracic, abdominal, bone and brain metastases were present in 19.5 vs. 23.0%, 43.6 vs. 46.9%, 23.9 vs. 18.7% and 2.4 vs. 2.9% of men vs. women, respectively. Bone was the most common metastatic site in men (23.9%) vs. lung in women (22.4%). Increasing age was associated with decreasing rates of abdominal (from 44.9 to 40.2%) and brain (from 3.2 to 1.4%) metastases in men vs. decreasing rates of bone (from 21.0 to 13.3%) and brain (from 5.1 to 2.0%) metastases in women (all P < 0.05). Finally, rates of metastases in multiple organs also decreased with age, in both men and women. CONCLUSIONS The distribution of metastases in bladder cancer varies according to sex. Moreover, differences exist according to patient age and these differences are also sex-specific. In consequence, patient age and sex should be considered in the interpretation of imaging, especially when findings are indeterminate.
Collapse
Affiliation(s)
- Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lara Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Martin
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Peter Black
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| |
Collapse
|
20
|
Hsieh JJ. The 2021 COVID-19 Artificial Intelligence Issue. Clin Genitourin Cancer 2021; 19:1-2. [PMID: 33610279 PMCID: PMC7889475 DOI: 10.1016/j.clgc.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|