The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours

Life expectancy in rare histological prostate cancer subtypes

Survival differences in rare histological prostate cancer (PCa) subtypes relative to age-matched population-based controls are unknown. Within Surveillance, Epidemiology, and End Results database (2004-2020), newly diagnosed (2004-2015) PCa patients were identified. Relying on the Social Security Administration Life Tables (2004-2020) with 5 years of follow-up, age-matched population-based controls (Monte Carlo simulation) were simulated for each patient. Kaplan-Meier analyses addressed survival rates. Of 582,220 patients, 580,368 (99.68%) harbored acinar, 867 (0.15%) ductal, 534 (0.09%) neuroendocrine, 368 (0.07%) mucinous, and 83 (0.01%) signet ring cell carcinoma. The metastatic stage was most prevalent in neuroendocrine (62%). In the localized stage, the overall survival difference at 5 years of follow-up was greatest in neuroendocrine (22% vs. 72%), signet ring cell (78% vs. 84%), and ductal carcinoma (71% vs. 77%). In the locally advanced stage, overall survival difference was greatest in neuroendocrine (16% vs. 79%), signet ring cell (75% vs. 91%), ductal (78% vs. 84%), and mucinous carcinoma (84% vs. 90%). In the metastatic stage, the overall survival difference was greatest in neuroendocrine (3% vs. 81%), mucinous (26% vs. 84%), and acinar carcinoma (27% vs. 85%). Regardless of stage, neuroendocrine carcinoma patients exhibit the least favorable life expectancy compared with population-based controls. Conversely, all other rare histological PCa subtypes do not meaningfully affect life expectancy in localized or locally advanced stages, except for locally advanced signet ring cell adenocarcinoma.

Diagnostic and prognostic genomic aberrations in upper tract urothelial carcinoma can be identified in focal barbotage samples

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.

Diagnostic accuracy of Bladder EpiCheck for upper tract urothelial carcinoma: A meta-analysis

INTRODUCTION AND OBJECTIVE

Current upper tract urothelial carcinoma (UTUC) diagnosis and disease management rely on the combination of CT Urography (CTU), cytology and ureteroscopy (URS). The limited accuracy and complications associated with these tools have led to the search for non-invasive and reliable biomarkers. Our aim was to review and analyse the existing data on the use of Bladder EpiCheck® to assess its performance as a diagnostic tool for UTUC.

MATERIAL AND METHODS

A literature search on the diagnostic value of Bladder EpiCheck® as a urinary biomarker in UTUC was conducted through PubMed, Web of Science and Scopus until February 2024. Pooled sensitivity (Se), specificity (Sp), negative predictive value (NPV) and positive predictive value (PPV) of the biomarker were calculated. Diagnostic performance was assessed through the area under the curve (AUC).

RESULTS

Four studies, including 334 patients, were included in the quantitative analysis. Bladder EpiCheck® showed promising pooled diagnostic values with Se of 0.85 (95% CI 0.55-0.96), Sp of 0.93 (95% CI 0.56-0.99), PPV of 0.74 (95% CI 0.54-0.87) and NPV of 0.84 (95% CI 0.77-0.89). The exact AUC obtained was 0.912.

CONCLUSIONS

Bladder EpiCheck® is an effective diagnostic tool in UTUC, showing a promising diagnostic accuracy, with a Se and NPV of 85% and 84%, respectively. Its use in UTUC diagnosis and follow-up could reduce or postpone the need for more invasive procedures, such as URS, thereby reducing the procedure-associated risks and improving patients' quality of life. Although further research and large prospective studies are needed, the current results indicate that Bladder EpiCheck® is a promising tool in UTUC diagnosis, treatment decision-making, and follow-up.

Combined Molecular Subclass and Immune Phenotype Correlate to Atezolizumab Plus Radiation Therapy Response in Invasive Bladder Cancer: BPT-ART Phase 2 Study

PURPOSE

Bladder preservation therapy in combination with atezolizumab and radiation therapy trial, which was a multicenter, open-label, single-arm phase 2 study, showed a promisingly high interim clinical complete response (cCR) rate of 84.4% (38/45). In the present study, we aimed to identify potential tissue biomarkers for achieving cCR using bladder preservation therapy in combination with atezolizumab and radiation therapy.

METHODS AND MATERIALS

We used tumor tissue samples of the bladder and blood samples collected from patients at baseline to analyze the tumor immune microenvironment at baseline using an integrated approach of immunophenotyping, genomic, and tumor-infiltrating lymphocyte (TIL) profiling.

RESULTS

Immune phenotype analysis revealed that cCR rates of patients with the desert phenotype were as similarly high as patients with excluded/inflamed phenotypes (73.3% [11/15] vs 93.3% [14/15], P = .33) despite lower programmed death-ligand 1 expression levels in the desert phenotype. Genomic and TIL profiling then revealed that increased CD8+ and CD204+ TIL infiltration, high CD8:forkhead box protein P3 ratios in the stroma of the excluded/inflamed phenotypes, and gene alterations, such as CDK12, GNAS, NOTCH2, and AR1D1A, were associated with a high cCR rate (93.3%). Furthermore, the characteristics of these dual TILs, CD8-forkhead box protein P3 ratios, and gene alterations (especially FGFR3) bifurcated the desert phenotype into 2 subgroups with different cCR rates (100% [11/11] and 0% [0/4]).

CONCLUSIONS

These potential subgroups, defined by combined molecular subclass and immune phenotype, could lead to the identification of good responders to atezolizumab plus radiation therapy for invasive bladder cancer. However, given the small cohort size and limited number of tumor samples, these findings should be viewed as hypothesis-generating and require further validation in larger studies.

Multicenter Retrospective Registry Study on BCG Use in Non-Muscle Invasive Bladder Cancer in Latin America: BLATAM (Bladder Cancer in Latin America) Group

OBJECTIVES

This study, conducted by the Bladder Cancer in Latin America (BLATAM) group, aims to analyze epidemiological and therapeutic data on non-muscle invasive bladder cancer (NMIBC) in Latin American patients. It seeks to identify factors contributing to suboptimal responses to Bacillus Calmette-Guérin (BCG) therapy and assess areas for improvement in regional treatment practices.

MATERIALS AND METHODS

A multicenter retrospective study was carried out in collaboration with reference Urology Departments across Latin America. Data were collected using an electronic Case Report Form (CRF) from 2011 to 2021, capturing demographics, clinical presentation, treatment details, and follow-up of NMIBC patients treated with BCG. Statistical analyses included Kaplan-Meier survival analysis for relapse-free survival (RFS).

RESULTS

Data from 292 patients across five countries were analyzed, with a mean age of 70.3 years and a male prevalence of 74%. Smoking history was reported in 70.6% of patients. The mean time to the first BCG dose was 2.4 months post-TURBT, with 26.7% of patients exceeding the recommended 60-day window for induction initiation. While 84% of patients completed BCG induction, only 45.9% followed the recommended Lamm maintenance schedule. Delays in starting maintenance cycles were observed, with a median delay of over 36 days for the first cycle and 65 days for the second cycle. RFS at 1 year and 5 years for high-risk patients was 87.3% and 53.3%, respectively.

CONCLUSIONS

This study highlights critical deviations from recommended NMIBC management protocols in Latin America, including delayed BCG initiation and inconsistencies in maintenance therapy. These findings emphasize the need for standardized treatment protocols and improved adherence to international guidelines, which could enhance NMIBC patient outcomes in the region. Collaborative efforts are essential to develop region-specific strategies, improve data collection, and ultimately provide better care for bladder cancer patients in Latin America.

Concurrent occurrence of adenocarcinoma and urothelial carcinoma of the prostate: Coexistence mechanisms from multiple perspectives

This article discusses the coexistence of prostate adenocarcinoma and prostate urothelial carcinoma. Combining existing literature and research results, the potential mechanisms of the co-occurrence of these two cancers are explored, including the role of androgen receptor, gene mutations, and their complex interactions in cell signaling pathways, etc. Also, the hypothesis of prostate cancer transformation into urothelial carcinoma is explained from some perspectives, including tumor multipotent stem cell differentiation, epithelial-mesenchymal transition, mesenchymal-epithelial transition, and other mechanisms. Ultimately, the goal is to provide more accurate diagnoses and more personalized treatments in clinical practice, as well as to lay the foundation for improving patient prognoses in the future.

Valosin-Containing Protein (VCP/p97) Mediates Neuroendocrine Differentiation in Prostate Cancer Cells Through Pim1 Signaling Inducing Autophagy

BACKGROUND

Neuroendocrine Prostate Cancer (NEPC) is an aggressive type of androgen-independent prostate cancer (AIPC) associated with resistance to treatment. Valosin-containing protein (VCP/p97) has been found to be overexpressed in prostate cancer (PCa) cells undergoing neuroendocrine differentiation (NED) in response to interleukin-6 (IL-6). This study explores the molecular mechanisms through which VCP/p97 contributes to the progression of NEPC.

METHODS

To investigate the role of VCP/p97 in the NED of PCa, we overexpressed the VCP/p97 in PCa cells. The molecular mechanisms underlying VCP/p97 induced NED were assessed by using western blot analysis and RT-PCR. Morphological changes were analyzed by using both bright field and confocal microscope. Lysotracker staining was performed to identify autophagy in VCP positive PCa cells.

RESULTS

In the present study, we found that VCP/p97 expression was notably higher in neuroendocrine (NE) cells NCI-H660 and PC3 than in other PCa cells. IL-6 treatment led to significant VCP/p97 overexpression in LNCaP and VCaP cells, with a marked increase in NE markers NSE and CHR-A. Inhibition of VCP/p97 using NMS-873 attenuated NED features, suggesting that VCP/p97 is required for NED progression. Moreover, VCP's role in NED is linked to its regulation via Pim1 in differentiating cells. Exogenous expression of VCP/p97 enhanced Pim1 and c-Myc expression, which were diminished upon VCP/p97 inhibition which is corroborated by reduced NED markers. Pim1 inhibition using AZD1208 and c-Myc knockdown further supported Pim1's involvement in VCP mediated NED. To promote NED, VCP/p97 regulated autophagy, as evidenced by increased LC3B and decreased SQSTM1/p62 levels upon VCP overexpression. Inhibition of VCP/p97 or autophagy disrupted NED and autophagic flux, arresting NED of LNCaP cells. Lysotracker staining and autophagic flux assays confirmed VCP's role in enhancing lysosomal-mediated autophagy and autophagolysosome formation. Furthermore, we show that AMPK activation, via LKB1 is essential for VCP/p97 mediated NED and autophagy.

CONCLUSION

VCP drives NED in PCa cells through a complex interplay involving the Pim1 axis and autophagy pathways. These findings highlight the potential of targeting VCP/p97 and its associated mechanisms as therapeutic strategies to inhibit NED progression.

Trop-2 and Ephrin B2 expression in urothelial carcinoma with divergent differentiation and aggressive urothelial carcinoma subtypes

OBJECTIVES

Urothelial carcinomas (UCs) encompass a heterogeneous group of tumors. Several histopathologic features are associated with poor clinical outcomes and limited treatment options. With new rising therapeutic modalities, we aimed to determine the pattern of expression of Trop-2 and ephrin B2 in UC with aggressive subtype histology and/or divergent differentiation (SH/DD).

METHODS

We performed a retrospective analysis of 113 UC samples with SH/DD at our institution from 2011 to 2021. Immunohistochemical staining for Trop-2 and ephrin B2 expression was performed on all cases. Expression was determined by the percentage of samples with a moderate or strong H-score.

RESULTS

Our results show Trop-2 expression was the highest in squamous cell carcinoma and UC with squamous differentiation, adenocarcinoma and UC with glandular differentiation, and plasmacytoid subtype, while ephrin B2 expression was highest in adenocarcinoma, UC with glandular differentiation, and small cell carcinoma.

CONCLUSIONS

Expression of Trop-2 and ephrin B2 may demonstrate therapeutic possibilities for patients with SH/DD, who usually have limited treatment options, particularly in small cell carcinoma, in which few targets have been identified. Clinical trials to investigate the efficacy of these novel treatments are warranted.

Digital volumetric assessment of CIS and tumor mass compliments conventional histopathological assessment in muscle-invasive urothelial bladder cancer

Carcinoma in situ (CIS) of the bladder is a known parameter regarding the prognosis and recurrence tendency of urothelial carcinomas. Nevertheless, there is little evidence whether the amount of CIS or other precursor lesions, as well as the quantified tumor mass of muscle-invasive urothelial carcinoma, has an influence on the survival or recurrence rate of affected patients. From 80 patients with muscle invasive urothelial bladder cancer and radical cystectomy, 23 samples each were obtained as part of a whole organ mapping in a single institution study, in which the precursor lesions and tumor area were digitally measured and further correlated to pathological standard parameters, patient survival, molecular luminal and basal subtypes, and immune infiltration. Significant correlations were found between tumor mass and surface lining CIS amount for pT-stage, lymphovascular invasion, and perineural infiltration. Furthermore, an increased tumor mass as well as an increased amount of CIS combined with an increased tumor mass showed a significantly reduced survival rate in multivariable analysis (HR = 2.75; P = 0.019 vs. HR = 3.54; P = 0.002) as well as a significantly increased recurrence. No correlations could be found with molecular subtypes and immune infiltration. The exact measurement of the tumor mass with and without the CIS surface area, whether manually or, more specifically, digitally, could be incorporated into routine diagnostics and implemented as an independent predictor for patient post-surgical outcomes. It can therefore serve as an additional predictor for risk stratification and, if necessary, intensified follow-up care or therapy.

Nonfunctioning paraganglioma of the bladder mimicking nested variant of urothelial cancer: A case report and clinical management

INTRODUCTION AND IMPORTANCE

Non-functioning paraganglioma of the bladder is extremely rare disease. It is important to know the presence of paraganglioma of the bladder as the early and correct diagnosis affects the management and prognosis of the patient. Pathologists may misinterpret it as part of cystitis cystica/glandularis or nested variant urothelial carcinoma, or secondary bladder involvement by prostatic adenocarcinoma. This report will contribute to the existing literature and provide valuable insights into the clinical characteristics and treatment options for this rare tumor.

PRESENTATION OF CASE

35 years old female patient presented after incidental finding of bladder mass on abdominal ultrasound during routine antenatal follow up. Cystoscope showed 2 × 2 cm single solid bladder mass. Microscopic examination was suggestive of neuroendocrine tumor with paragangliom as a differential diagnosis. Imminohistochemical studies showed positive for synaptophysin, S100, GATA-3 and negative for panCK. The patient was managed with partial cystectomy.

CLINICAL DISCUSSION

Non-functioning paragnaglioma of the urinary bladder is a rare extra-adrenal pheochromocystoma. The diagnosis is usually challenging and it may mimic urothelial carcinoma. Histopathology and immunohistochemistry are almost always confirmatory.

CONCLUSION

Urinary bladder paraganglioma may mimic nested variant of the bladder tumor. High clinical suspicion is important. Confirmation is with histopathology and immunohistochemistry. Partial cystectomy is treatment of choice.

Prospective observational study on the relationships between genetic alterations and survival in Japanese patients with metastatic castration-sensitive prostate cancer: the impact of IDC-P

BACKGROUND

Intraductal Carcinoma of the Prostate (IDC-P) is a significant prognostic indicator for prostate cancer, which demonstrates significant associations with homologous recombination repair gene mutations (HRRm) and alterations in tumor suppressor genes. However, no study in Japan has investigated the association between IDC-P and genetic mutations in men with metastatic castration-sensitive prostate cancer (mCSPC).

METHODS

This prospective observational study enrolled 102 de novo mCSPC (LATITUDE high-risk) patients diagnosed between 2018 and 2021, with subsequent monitoring of survival outcomes. A single genitourinary pathologist evaluated all needle biopsy slides. Genetic analyses were performed using the Myriad myChoice HRD plus™. These genetic analyses covered 108 genetic loci, including 15 HRRm genes, with a success rate of 91%.

RESULTS

Genetic alterations were observed in 79 patients (77.5%), with 20 exhibiting HRRm (19.6%). Common genetic alterations included FOXA1 (29.4%) and TP53 (17.6%) mutations; BRCA (9.8%) mutations were the most frequent HRRm (BRCA1:2 cases, BRCA2:8 cases, including 6 biallelic). IDC-P-positive patients demonstrated a significantly higher frequency of genetic aberrations (82.6% vs. 50%, p = 0.0082). Patients with biallelic BRCA2, TP53, and PTEN mutations exhibited significantly poorer cancer-specific survival. Multivariate analysis identified lactate dehydrogenase (LDH) (HR 1.005, p = 0.035), TP53 mutations (HR 5.196, p < 0.001), biallelic BRCA2 mutations (HR 10.686, p = 0.005), and IDC-P as independent predictors of poor cancer-specific survival. No cancer-related deaths occurred in IDC-P-negative cases.

CONCLUSION

Our study emphasizes the significant association between IDC-P and an elevated incidence of genetic alterations in Japanese mCSPC patients, emphasizing the need for early genetic testing to guide therapeutic decision-making.

Analytical and Real-World Clinical Characterization of S2,3PSA% Test in MRI Fusion Targeted Prostate Biopsy Population

BACKGROUND

The α2,3-sialyl N-glycosylated free prostate-specific antigen ratio (S2,3PSA%) was approved in Japan as a prostate cancer (PCa) diagnostic test. We evaluated the analytical characterization and real-world diagnostic performance of S2,3PSA%.

METHODS

The precision testing, dilution linearity, measurement sensitivity, preanalytical stability, and interferences of S2,3PSA, α2,6-sialyl N-glycosylated free PSA (S2,6PSA), and S2,3PSA% were performed. The diagnostic accuracy detecting PCa of S2,3PSA% was prospectively evaluated in 253 men (Cohort 1, vs. PI-RADS) and in 145 men (Cohort 2, vs. PI-RADS, prostate health index, phi) who scheduled MRI-targeted biopsy by area under the receiver operating characteristics curve (AUC).

RESULTS

The precision of the S2,3PSA, S2,6PSA, and S2,3PSA% were all < 3.4% coefficient of variation. The dilution linearity of S2,3PSA had a correlation coefficient of 0.9949-0.9987. The detection limit of S2,3PSA and S2,6PSA was 0.044 and 0.029 ng/mL, respectively. Serum S2,3PSA and S2,6PSA concentrations were stable at 6°C for 24 h and -20°C for 90 days, while S2,3PSA% was unchanged at 6°C and -20°C for 90 days or under five freeze-thaw cycles. Serum S2,3PSA and S2,3PSA% were not affected by any interferences and drugs. In Cohort 1, AUC of S2,3PSA% (0.776, 95% CI 0.719-0.832) detecting PCa was comparable to that of PI-RADS (0.746, 0.685-0.807, p = 0.7996). In Cohort 2, AUC of S2,3PSA% detecting PCa (0.837, 0.774-0.901) was comparable to PI-RADS (0.779, 0.703-0.854, p = 0.3037), and phi (0.867, 0.809-0.926, p = 0.3000).

CONCLUSIONS

Analytical characteristics of S2,3PSA% perform well and the diagnostic performance of S2,3PSA% was comparable to phi and MRI.

Combination of MLo-1508 with sunitinib for the experimental treatment of papillary renal cell carcinoma

Renal cell carcinoma (RCC) is the 14th most incident cancer worldwide, and no curative therapeutic options are available for advanced and metastatic disease. Hence, new treatment alternatives are urgently needed to tackle disease management and drug resistance. Herein, we explored the use of MLo-1508 as an anti-tumoral agent in RCC and further assessed its combination with sunitinib for the treatment of papillary RCC. For that, different RCC cell lines were treated with both drugs, alone or in combination, and different phenotypic assays were performed. Moreover, global DNA methylation levels and specific DNMT3a activity were measured, and gene-specific CpG methylation and transcript levels were quantified after treatment. Finally, the combinatory potential of MLo-1508 and sunitinib were asses both in vitro and in vivo using the ACHN cell line. We found that MLo-1508 significantly decreased RCC cell viability while inducing apoptosis in a dose-dependent manner without cytotoxicity for non-malignant cells. Moreover, the treatment induced morphometric alterations and DNA damage in all RCC cell lines. MLo-1508 decreased DNMT1 and DNMT3A transcript levels in 786-O and ACHN cells, inhibited DNMT3A activity, and reduced the global DNA methylation content of ACHN cells. When combined with sunitinib, a reduction in ACHN cell viability, as well as cell cycle arrest at G2/M was observed. Importantly, MLo-1508 decreased the sunitinib effective anti-tumoral concentration against ACHN cell viability. In an in vivo ACHN CAM model, the combination induced cell necrosis. Thus, MLo-1508 might improve sensitivity to sunitinib treatment by decreasing the required concentration and delaying resistance acquisition.

Development and validation of a predictive model for postoperative metastasis of upper tract urothelial carcinoma after radical nephroureterectomy and analysis of risk factors for different metastatic sites: a multicenter study

PURPOSE

To develop a prediction model for assessing the risk of postoperative metastasis in upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU) and to analyze independent risk factors for metastasis at different sites.

METHODS

We retrospectively analyzed data from 555 UTUC patients who underwent RNU at 3 medical centers between January 2012 and August 2023. Patients were randomly divided into a training cohort (n = 388) and a validation cohort (n = 167) at a 7:3 ratio. Univariate and multivariate Cox regression analyses were performed in the training cohort to identify postoperative metastasis risk factors. A nomogram was developed based on these factors and validated. In addition, independent risk factors for metastasis at different sites were analyzed.

RESULTS

Among the 555 patients, 122 (22.0%) developed postoperative metastasis. Middle and lower ureteral tumors, T stage ≥ T3, high-grade tumors, lymphovascular invasion (LVI), and a prognostic nutritional index (PNI) < 48.75 were associated with poorer metastasis-free survival (MFS). The nomogram achieved C-indexes of 0.816 and 0.812 in the training and validation cohorts. Age < 65 years was a risk factor for lymph node metastasis, tumor size and necrosis predicted liver metastasis, and a higher preoperative platelet-to-lymphocyte ratio (PLR) was associated with bone metastasis. Median overall survival (OS) for lymph node, lung, liver, multiple sites, bone, and brain metastasis were 14, 10, 6, 5.5, 5, and 4.5 months, respectively.

CONCLUSION

The prediction model developed effectively assesses postoperative metastasis risk in UTUC patients' aids in guiding individualized treatment. The risk factors for different metastasis sites are generally similar, with slight variations, which may offer new directions for future research on site-specific therapeutic strategies.

Bladder cuff excision at radical nephroureterectomy improved survival in upper tract urothelial carcinoma

OBJECTIVE

To test for survival differences after radical nephroureterectomy (RNU) in pT1-T3N0 upper tract urothelial carcinoma (UTUC) patients according to bladder cuff excision (BCE) status.

METHODS

Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified RNU patients and documented BCE status. Prior and after propensity score matching (ratio 1:1), cumulative incidence plots and competing risk regression (CRR) models addressed cancer specific mortality (CSM) and other-cause mortality (OCM).

RESULTS

Of 4,426 RNU-treated patients, 3,186 (72%) patients underwent BCE and 1,240 (28%) did not. BCE rates significantly increased over time from 65.2 to 77.0% (EAPC: +1.0%, 95% CI +0.4 to +1.6%, P = 0.004) between 2004 and 2020. After 1:1 propensity score matching for T stage, 1,240 of 1,240 (100%) RNU patients without BCE and 1,240 of 3,186 (39%) RNU patients with BCE were included in subsequent analyses. Five-year CSM rates were 30% in RNU with BCE vs. 36% in RNU without BCE patients (Δ = 6%). In multivariable CRR, RNU with BCE independently predicted lower CSM (HR: 0.81, 95% CI: 0.70-0.93; P < 0.001). Conversely, BCE status did not affect OCM (P = 0.4).

CONCLUSION

The rate of guideline recommended BCE at RNU increased over time. Additionally, RNU with BCE is associated with significantly lower CSM than RNU without BCE in pT1-T3N0 UTUC patients. In consequence, BCE should represent an integral part of a comprehensive RNU.

Predicting variant histology in bladder cancer: the role of multiparametric MRI and vesical imaging-reporting and data system (VI-RADS)

OBJECTIVES

(1) To evaluate the diagnostic performance of the VI-RADS score in detecting muscle invasion in variant urothelial carcinomas (VUC). (2) To identify spesific MRI features that may serve as predicting for VUC.

METHODS

Two hundred four patients who underwent TUR-B and/or radical cystectomy and a bladder mpMRI scan within three months prior to the procedure were retrospectively enrolled. The tumors were divided into two histological cohorts: pure urothelial carcinoma (PUC) and VUC. Various MRI features, including largest tumor diameter, long-to-short axis ratio, morphology, heterogeneous signal intensity (SI), presence of necrosis, and normalized ADC (ADCn) value, were analyzed. The diagnostic performance of the VI-RADS score in predicting muscle invasion was calculated using a cut-off point of ≥ 4 in both cohorts. Univariate logistic regression were also performed to identify MRI features that predict VUC. Inter-reader agreement was assessed with the weighted kappa coefficient.

RESULTS

Our study identified several MRI features significantly associated with VUC, including heterogeneous SI on T2-weighted images (OR: 3.055; 95% CI: 1.312-7.112; p < 0.001), dynamic contrast enhancement images (OR: 2.935; 95% CI: 1.263-6.821; p < 0.001), and the presence of necrosis (OR: 3.575; 95% CI: 1.798-7.107; p < 0.001). Additionally, ADCn values were significantly lower in the VUC cohort (p = 0.003). The VI-RADS score demonstrated high diagnostic performance across both VUC and PUC cohorts, with sensitivity ranging from 94.4 to 86.8% (reader 1) and 94.2-82.2% (reader 2), specificity ranging from 100 to 94.6% (reader 1) and 100-94% (reader 2), and accuracy ranging from 96 to 90.6% (reader 1) and 96-88.2% (reader 2). The area under the curve (AUC) ranged between 0.972 and 0.972 (reader 1) and 0.838-0.781 (reader 2). No significant differences in diagnostic performance were observed between readers or cohorts (p > 0.05), and inter-reader agreement for VI-RADS scores was excellent for both cohorts.

CONCLUSION

VI-RADS score can be used with high performance to detect muscle invasion in VUC, regardless of reader experience. Additionally, specific MRI features such as heterogeneous SI, the presence of necrosis, and ADCn values can serve as potential predictors of VUC.

LAR, FAR, and PLR as prognostic factors in high-grade urothelial carcinoma of the bladder after surgery

Objective

We evaluated the prognostic significance of the Lactate Dehydrogenase-to-Serum Albumin Ratio (LAR), Fibrinogen-to-Albumin Ratio (FAR), and Platelet-to-Lymphocyte Ratio (PLR) in patients with high-grade urothelial carcinoma (HGUC) of the bladder who underwent radical cystectomy (RC). These markers have been reported to be associated with the prognosis of various cancers.

Methods

A retrospective analysis was conducted on HGUC patients who underwent RC at Guangxi Medical University Cancer Hospital between January 2013 and June 2021. Optimal cutoff values for LAR, FAR, and PLR were established. Kaplan-Meier survival analysis was used to evaluate survival outcomes, while univariate and multivariable Cox regression analyses identified independent prognostic factors. A nomogram was developed to predict survival, with validation through time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results

A total of 180 patients were included, with a follow-up period ranging from 2 to 127 months (49.28 ± 37.87 months). The optimal cutoff values for LAR, PLR, and FAR were 4.46, 139.68, and 0.13, respectively. Multivariable Cox regression identified tumor stage, LAR, PLR, and FAR as independent prognostic factors. Specifically, Stage III (HR = 25.44, 95% CI: 5.20-124.35, p < 0.001) and Stage IV (HR = 11.28, 95% CI: 3.18-40.05, p < 0.001) were independent risk factors for poor survival. A low PLR (HR = 0.45, 95% CI: 0.27-0.76, p = 0.003), low FAR (HR = 0.51, 95% CI: 0.29-0.89, p = 0.018), and low LAR (HR = 0.39, 95% CI: 0.23-0.67, p < 0.001) were independently associated with improved survival. The nomogram demonstrated high accuracy in predicting 1-, 3-, and 5-year overall survival (OS), with area under the curve (AUC) values of 0.866, 0.84, and 0.831, respectively. Further validation confirmed the model's stability and clinical applicability.

Conclusion

LAR, PLR, and FAR are promising prognostic factors for HGUC of the bladder following RC, showing substantial potential for prognostic evaluation.

Uncovering New Biomarkers for Prostate Cancer Through Proteomic and Network Analysis

BACKGROUND

Prostate cancer (PCa), is the second most prevalent solid tumor among men worldwide (7.3%), and the leading non-skin cancer in USA where it represents 14.9% of all new cancer cases diagnosed in 2024. This multifactorial disease exhibits substantial variation in incidence and mortality across different ethnic groups and geographic regions. Although prostate-specific antigen (PSA) remains widely used as a biomarker for PCa, its limitations reduce its effectiveness for accurate detection. Consequently, finding molecules that can either complement PSA and other biomarkers is a major goal in PCa research.

METHODS

Urine samples were collected from healthy donors (n = 5) and patients with low- and high-risk PCa (4 and 7 subjects, respectively) and were analyzed using proteomic data-derived systems and biology approaches. The most promising proteins were further investigated by means of The Cancer Genome Atlas (TCGA) database to assess their associations with clinical and histopathological characteristics in a larger in silico patient population.

RESULTS

By evaluating the variations in the urinary proteome as a mirror of the changes occurring in prostate tumor tissue, components of complement and coagulation cascades and glutathione metabolism emerged as hallmarks of low- and high-risk PCa patients, respectively. Moreover, our integrated approach highlighted new potential biomarkers, including CPM, KRT8, ITIH2, and RCN1.

CONCLUSIONS

The good overlap of our results with what is already reported in the literature supports the new findings in the perspective of improving the knowledge on PCa. Furthermore, they increase the panel of biomarkers that could enhance PCa management. Of course, further investigations on larger patient cohorts are required.

Contrast-enhanced ultrasound enables precision diagnosis of preoperative muscle invasion in bladder cancer: a prospective study

Bladder cancer's high mortality underscores the need for precise staging, especially to differentiate between nonmuscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) types. This prospective study evaluated the efficacy of contrast-enhanced ultrasound (CEUS) for preoperative staging, focusing on its ability to distinguish NMIBC from MIBC. Conducted from April 2020 to September 2021, the study involved 163 patients (median age: 64.0 years; 137 males, 26 females), with 133 NMIBC (81.6%) and 30 MIBC (18.4%). Each patient underwent CEUS followed by transurethral resection of bladder tumor or radical cystectomy. CEUS demonstrated high diagnostic accuracy in determining muscle invasion status (sensitivity 83.3%, specificity 92.5%, accuracy 90.8%, area under the receiver operating characteristic curve [AUC] 0.88). Comparative analyses against MRI (AUC 0.77) showed CEUS outperforming in muscle invasion detection. Combining CEUS with MRI improved diagnostic accuracy, particularly when MRI vesical imaging reporting and data system score was 3 points. The combined approach achieved an AUC of 0.73, with sensitivity, specificity, and accuracy of 76.2, 70.2, and 71.6%, respectively. Thus, CEUS emerges as a valuable diagnostic tool for preoperative staging of bladder cancer, particularly in its role in assessing muscle invasion status and thereby aiding in clinical decision-making and intervention outcomes.

Prognostic Significance of Ki67 Expression in Prostate Cancer in Nigerians: A Single-Center Study

Introduction Prostate cancer is one of the most common cancers occurring in men and one of the leading causes of cancer deaths globally. Associated risk factors include age, race, and positive family history. Older patients have an increased risk for more aggressive forms. Its incidence is particularly high in Black men. The Gleason grading and scoring system is an established prognostic factor for prostate cancer. Ki67, a nuclear protein, coded for by the MKi67 gene located on chromosome 10q26.2 and detected in all phases of the cell cycle, provides information on the proliferation index of cancer cells, including prostate cancer. This study is purposed to establish the significance of Ki67 expression as a prognostic marker of prostate cancer by correlating it with patients' age and Gleason scores, respectively, with the aim of understanding the molecular characteristics of prostate cancers in our environment, in order to assist in categorizing patients for treatment. Materials and methods This was a retrospective study carried out in Jos University Teaching Hospital (JUTH), Jos, Nigeria, involving histologically diagnosed prostate cancers over a five-year period. The surgical pathology reports and information on patients' biodata and clinical features were retrieved from departmental records and the hospital's electronic records. The appropriate archival hematoxylin and eosin (H&E)-stained slides and their respective formalin-fixed paraffin-embedded (FFPE) tissue blocks were retrieved and reviewed, with new sections made when necessary. Immunohistochemical analysis to assess the Ki67 proliferative index was carried out on sections made from representative blocks of each case using Ki67 monoclonal antibodies, according to the established protocol prescribed by the manufacturers. The Ki67 proliferative index was categorized as negative, low, and high. Data obtained were analyzed, and results were presented as percentages/frequencies and displayed as tables and charts. Results One hundred forty-two cases met the inclusion criteria. The age range was 30-90 years. The peak age group was 70-79 years with 38% (54/142). Majority, 81.7% (117/142), of cases occurred in patients above 60 years old. An overwhelming majority, 71.8% (102/142), of cases were poorly differentiated adenocarcinomas (Gleason scores 8-10), 21.1% (30/142) were moderately differentiated (Gleason score 7), and 7.0% (10/142) were well-differentiated (Gleason score 6). Among high Ki67 proliferative index cases, 81.4% (57/70) were aged above 60 years. Similarly, 85.1% (40/47) of low proliferative index cases were also aged above 60 years. Additionally, 92.5% (37/40) of well- and moderately differentiated cancers (Gleason scores 6 and 7) had negative or low Ki67 proliferative indices, while 65.7% (67/102) of the poorly differentiated (Gleason scores 8-10) had high indices. Conclusion Our study demonstrated a direct correlation of the Ki67 proliferative index with both histologic grade and aggressiveness of prostate carcinoma in a Nigerian population thereby confirming high Ki67 proliferative index as an adverse prognostic factor in prostate cancer. It, however, showed no direct relationship between age and Ki67 proliferative index. Determination of the Ki67 proliferative index is recommended for routine assessment of prostate cancer patients to help in risk stratification and instituting treatment plans.

Development and validation of a CT based radiomics nomogram for preoperative prediction of ISUP/WHO grading in renal clear cell carcinoma

BACKGROUND

Nuclear grading of clear cell renal cell carcinoma (ccRCC) is crucial for its diagnosis and treatment.

OBJECTIVE

To develop and validate a machine learning model for preoperative assessment of ccRCC nuclear grading using CT radiomics.

MATERIALS AND METHODS

This retrospective study analyzed 146 ccRCC patients who underwent surgery between June 2016 and January 2022 at two hospitals (the Quzhou Affiliated Hospital of Wenzhou Medical University with 117 cases and the Affiliated Cancer Hospital of University of Chinese Academy of Sciences with 29 cases). Radiomic features were extracted from preoperative abdominal CT images. Features reduction and selection were carried out using intraclass correlation efficient (ICCs), Spearman rank correlation coefficientsand and the Least Absolute Shrinkage and Selection Operator (LASSO) regression method. Radiomics and clinical models were developed utilizing Support Vector Machine (SVM), Extremely Randomized Trees (Extra Trees), Light Gradient Boosting Machine (LightGBM), Random Forest (RF) and K-Nearest Neighbors (KNN) algorithms. Subsequently, the radiomics nomogramwas developed incorporating independent clinical predictors and Rad_signature. Model performance was evaluated using the area under the curve (AUC), accuracy, sensitivity, and specificity, with decision curve analysis (DCA) assessing its clinical utility.

RESULTS

We extracted 1834 radiomic features from each CT sequence, with 1320 features passing through the ICCs screening process. 480 radiomics features were screened by Spearson correlation coefficient. Then, 15 radiomic features with non-zero coefficient values were determined by Lasso dimensionality reduction technique. The five machine learning methods effectively distinguished nuclear grades. The radiomics nomogram outperformed clinical radiological models and radiomics feature models in predictive performance, with an AUC of 0.936 (95% CI 0.885-0.986) for the training set and 0.896 (95% CI 0.716-1.000) for the external verification set. DCA indicated potential clinical applicability of the nomogram.

CONCLUSION

The radiomics nomogram, developed by integrating clinically independent risk factors and and Rad_signature, demonstrated robust performance in preoperative ccRCC grading. It offers a non-invasive tool that aids in ccRCC grading and clinical decision-making, with potential to enhance treatment strategies.

Evaluation of Diagnostic Accuracy of the Paris System (TPS 2.0) in Urine Cytology Specimens: An Institutional Experience From a Large Cohort of a Tertiary Care Centre

OBJECTIVE

The objective of this study is to evaluate the diagnostic performance of urine cytology using The Paris System (TPS 2.0) in comparison with TPS 1.0, and the Four-Tier Reporting System (FTRS) of our institute for identifying high-grade urothelial carcinoma (HGUC).

METHODOLOGY

A total of 789 urine cytology specimens from 240 patients including 12 UTUC cases with available histological and clinical details were included. Two hundred twenty-two cases were newly diagnosed, whereas 18 were recurrent tumours. Histopathological evaluation categorised the cases as non-neoplastic (33%, 13.7%), low-grade urothelial neoplasms (LGUNs) (94%, 39.2%), high-grade urothelial carcinoma (HGUCs) (110%, 45.8%) and other malignancies (3%, 1.3%).

RESULTS

TPS 2.0 categorised the cases as 14 (5.7%) non-diagnostic or ND/U, 99 (41.5%) NHGUC, 37 (15.4%) AUC, 24 (10%) SHGUC and 66 (27.5%) HGUC. TPS 1.0 had 14 (5.7%) ND/U, 72 (30%) NHGUC, 61 (24.5%) AUC, 3 (1.3%) LGUC, 24 (10%) SHGUC and 66 (27.5%) HGUC. FTRS classified them as 19 (7.5%) ND/UNS, 44 (18.3%) NEG, 88 (36.7%) INC and 89 (37.1%) POS. The ROHM for TPS 2.0 was 71.4% for ND/U, 12.1% for NHGUC, 29.7% for AUC, 79.2% for SHGUC and 89.4% for HGUC. TPS 1.0 showed a similar ROHM for ND/U, SHGUC and HGUC, whereas had 13.8% for NHGUC and 19.7% for AUCs. FTRS, had 78.9% for UNS, 6.8% for NEG, 35.2% for INC and 73.1% for POS. TPS demonstrated a sensitivity of 70.91% and specificity of 90.77% for identifying HGUC, whereas FTRS showed 59.09% sensitivity and 81.54% specificity. Also, TPS was found to be 75% accurate with 62.5% sensitivity and 100% specificity for UTCC cases separately.

CONCLUSION

TPS 2.0 exhibits diagnostic accuracy with better performance in comparison to FTRS, making it a more reliable system for clinical practice. Our findings endorse the utility of TPS 2.0 in improving the accuracy of urine cytology in predicting histological diagnosis of HGUC.

Risk-adapted scoring model to identify candidates benefiting from adjuvant chemotherapy after radical nephroureterectomy for localized upper urinary tract urothelial carcinoma: A multicenter study

PURPOSE

Adjuvant chemotherapy (AC) is recommended for muscle-invasive or lymph node-positive upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy (RNU). However, disease recurrences are frequently observed in pT1 disease, and AC may increase the risk of overtreatment in pT2 UTUC patients. This study aimed to validate a risk-adapted scoring model for selecting UTUC patients with ≤pT2 disease who would benefit from AC.

MATERIALS AND METHODS

We retrospectively analyzed 443 ≤pT2 UTUC patients who underwent RNU. A risk-adapted scoring model was applied, categorizing patients into low- or high-risk groups. Recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed according to risk group.

RESULTS

Overall, 355 patients (80.1%) and 88 patients (19.9%) were categorized into the low- and high-risk groups, respectively, with the latter having higher pathological stages, concurrent carcinoma in situ, and synchronous bladder tumors. Disease recurrence occurred in 45 patients (10.2%), among whom 19 (5.4%) and 26 (29.5%) belonged to the low- and high-risk groups, respectively (p<0.001). High-risk patients had significantly shorter RFS (64.3% vs. 93.6% at 60 months; hazard ratio [HR] 13.66; p<0.001) and worse CSS (80.7% vs. 91.5% at 60 months; HR 4.25; p=0.002). Multivariate analysis confirmed that pT2 stage and the high-risk group were independent predictors of recurrence and cancer-specific death (p<0.001). Decision curve analysis for RFS showed larger net benefits with our model than with the T stage model.

CONCLUSIONS

The risk-adapted scoring model effectively predicts recurrence and identifies optimal candidates for AC post RNU in non-metastatic UTUC.

The impact of age on BCG treatment response

INTRODUCTION

Bacillus Calmette-Guerin (BCG) is an immunologic treatment for patients with intermediate and high-risk Nonmuscle Invasive Bladder Cancer (NMIBC). It has been hypothesized that age related immune impairment might lead to decreased efficacy of BCG in older patients. One recent single-institution study found no association between age > 70 and worse oncologic outcomes in a cohort of 632 patients. We sought to validate these findings using a single institution database of NMIBC patients treated with BCG.

METHODS

We performed a retrospective analysis of patients diagnosed with NMIBC and treated with adequate BCG between 2000 and 2023 at our institution. Patients were divided into two cohorts based on age at NMIBC diagnosis: age ≤ 70 years and age > 70 years. Fine-Gray competing risk survival analysis was performed to assess for differences in the cumulative incidence of high-grade recurrence (HGR), progression (progression to muscle invasive bladder cancer or distant metastasis) and bladder cancer specific mortality (CSM) according to patient age.

RESULTS

We identified 473 patients treated with adequate BCG. 232 patients (49%) were aged ≤ 70 and 241 (51%) were aged > 70. Neither cohort differed significantly in terms of race, sex, or tumor characteristics. On competing risk analysis age > 70 was not significantly associated with increased HGR (HR 0.77; 95% CI 0.59-1.02, P = 0.06), progression (HR 1.17; 95% CI 0.62-2.18, P = 0.63), or CSM (HR 1.12; 95% CI 0.42-2.95, P = 0.82).

CONCLUSION

We did not observe an association between age > 70 and increased HG recurrence, bladder cancer progression, or CSM. Our results are consistent with other recent series and suggest that BCG efficacy in NMIBC is not negatively affected by increased patient age.

A Comprehensive Review of Current Approaches in Bladder Cancer Treatment

Bladder cancer is one of the most common malignant tumors of the urinary system globally. It is also one of the most expensive cancers to manage, due to the need for extensive treatment and follow-ups that often involve invasive and costly procedures. Although there have been some improvements in treatment options, the quality of life they offer has not improved at the same rate as other cancers. Therefore, there is an urgent need to find new alternatives to ease the burden of bladder cancer on patients. Recent discoveries have opened new avenues for the diagnosis and management of bladder cancer even though the clinical approach has largely remained the same for years. The decline in bladder cancer-specific mortality in regions that promote social awareness of risk factors and reduction of carcinogenic exposure demonstrates the effectiveness of such measures. New agents have been approved for patients who have undergone radical cystectomy after Bacillus Calmette-Guérin failure. Current best practices for diagnosing and treating bladder cancer are presented in this review. The review discusses radiation therapy, photodynamic therapy, gene therapy, chemotherapy, and nanomedicine in relation to non muscle-invasive cancers and muscle-invasive bladder cancers, as well as systemic treatments.

Multi-omics analysis reveals the impact of YAP/TEAD4-mediated EIF5A1 expression on mitochondrial apoptosis and bladder cancer progression

BACKGROUND

Eukaryotic Initiation Factor 5A1 (EIF5A1) is a translation factor, and its pro-tumorigenic role has been extensively documented across various cancer types. However, its specific function in bladder cancer (BLCA) remains unclear.

METHODS

We integrated proteomics and transcriptomics data with clinical data from BLCA patients to investigate the correlation between EIF5A1 expression and BLCA, as well as its potential clinical applications. Transcriptomic data were employed to explore the downstream signaling pathways regulated by EIF5A1. Furthermore, ChIP analysis and luciferase reporter assays were conducted to identify the upstream transcription factors regulating EIF5A1.

RESULTS

EIF5A1 expression is significantly upregulated in cancer tissues and cells and is strongly associated with poor prognosis. Silencing EIF5A1 in BLCA cells significantly reduced invasiveness, and proliferative capacity. Mechanistic studies identified YAP/TEAD4 as a transcription factor that regulates EIF5A1, influencing mitochondrial-mediated apoptosis by activating the JAK2/STAT3 signaling pathway, thereby promoting BLCA progression.

CONCLUSION

Our research demonstrates that EIF5A1 is upregulated in BLCA and associated with poor prognosis. We identified TEAD4 as a potential transcriptional regulator of EIF5A1 and showed that EIF5A1 expression is associated with changes in JAK2/STAT3 signaling and mitochondrial apoptosis in BLCA.

Sulfatase modifying factor 2 as a predictive biomarker for urothelial carcinoma

Sulfatases mediate the sulfation level of cell-surface heparan sulfates to regulate signal transduction, thereby promoting cancer progression. Sulfatase activation requires a sulfatase modifying factor (SUMF) for the modification of its catalytic domain. The role of the SUMF family in urothelial carcinoma (UC) has not been adequately evaluated. In this study, we used an online database and immunohistochemistry to assess genetic changes and the mRNA and protein expression of SUMFs and related candidate targets in UC. We found that SUMF1 and SUMF2 were amplified in UC tissues. High SUMF2 mRNA levels were associated with poor overall survival (OS) and disease-free survival (DFS) in bladder UC (BLCA) from The Cancer Genome Atlas (TCGA) dataset. High SUMF2 protein levels were associated with grade (P < 0.001), T status (P = 0.01), and stage (P = 0.006) in patients with BLCA. We also examined SUMF2 expression levels in upper tract UC (UTUC). SUMF2 expression was associated with stage (P = 0.046), poor OS (P = 0.0022), and DFS (P = 0.019) in patients with UTUC. Knockdown of SUMF2 significantly reduced the migration and invasion abilities of 5637 cells. Furthermore, SUMF2 mRNA levels negatively correlated with FBXW7 mRNA levels in BLCA. The SUMF2high/FBXW7low expression profile predicted the worst survival in BLCA. Taken together, SUMF2 expression is linked to unfavorable clinical outcomes in patients with UC and may serve as a useful prognostic biomarker for UC staging.

Penile Cancer: Innovations in Ultrastructural and Vibrational Markers

Penile cancer (PCa) is a disease that manifests predominantly as squamous cell carcinomas (SCCs), which, although rare, represents a significant public health problem, especially in regions with less socioeconomic development. One of the biggest challenges in managing this disease is the difficulty in differentiating tumor subtypes, making accurate diagnosis and treatment challenging. In this context, new characterization techniques are needed to investigate these tumors more completely. Atomic force microscopy (AFM) and Raman spectroscopy (RS) are valuable in this context, providing quantitative and qualitative ultrastructural data and vibrational signatures of the analyzed samples. In this study, AFM and RS techniques were employed to investigate subtypes of penile cancer, including the highly aggressive basaloid subtype, which is closely associated with human papillomavirus (HPV), and the sarcomatoid subtype, comparing them with nontumorous tissues. The AFM results revealed nanoscale changes in the ultrastructural properties of tumor samples, such as increased roughness in tumor tissues, with emphasis on the basaloid type associated with the HPV virus, and reduction in the surface area and volume of tumor tissues at the nanoscale, suggesting deeper tissue infiltration and greater deformability of tumor samples at the nanoscale. RS results detected significant spectral differences between normal and cancerous tissues and between tumor subtypes, particularly in vibrational modes related to proteins and lipids. Principal component analysis (PCA) confirmed a strong discriminative power between control and PCa groups. The data presented here offers new insights into the characteristics of penile tumors that, when integrated with clinical analyses, could improve the understanding of penile cancer behavior, contributing to more accurate diagnostic methods and targeted treatments.

Renal cell carcinoma with ALK-TPM3 gene fusion and ALK amplification: A case report and literature review

BACKGROUND

Anaplastic lymphoma kinase (ALK)-rearranged renal cell carcinoma (ALK-RCC) is a rare molecularly defined tumor entity included in the fifth edition of the World Health Organization Classification of Tumors. It is characterized by rearrangement of the ALK gene with various fusion partner genes, which most commonly results in oncogenic fusion proteins leading to ALK activation.

CASE PRESENTATION

A 30-year-old Chinese man underwent partial nephrectomy for a left renal tumor measuring 5 cm in diameter. Histologically, the tumor is pleomorphic and arranged in papillary, tubular, and solid patterns. At high magnification, abundant eosinophilic cytoplasm, obvious cytoplasmic vacuolation, and displaced nuclei were observed. Immunohistochemistry revealed diffuse positivity for PAX8,CK7,CAIX, and ALK(D5F3). Fluorescence in situ hybridization (FISH) showed ALK amplification and break-apart in tumor cells. ALK-TPM3 gene fusion and ALK amplification were detected by next-generation sequencing.

CONCLUSION

We report the first case of ALK-RCC with concurrent ALK amplification and fusion. This article presents the clinical data, morphology, immunohistochemistry, and molecular characteristics of this case, with the aim of enhancing the clinical and pathological understanding of ALK-RCC among clinicians and pathologists.

Enhanced Oxidative Phosphorylation Driven by TACO1 Mitochondrial Translocation Promotes Stemness and Cisplatin Resistance in Bladder Cancer

Chemoresistance poses a critical obstacle in bladder cancer (BCa) treatment, and effective interventions are currently limited. Elevated oxidative phosphorylation (OXPHOS) has been linked to cancer stemness, a determinant of chemoresistance. However, the mechanisms underlying increased OXPHOS during cancer cell chemoresistance remain unclear. This study revealed that the mitochondrial translational activator of cytochrome oxidase subunit 1 (TACO1) is linked to stemness and cisplatin resistance in BCa cells. Mechanistically, mitochondrial TACO1 enhances the translation of the mitochondrial cytochrome c oxidase I (MTCO1), promoting mitochondrial reactive oxygen species (mtROS) by upregulating OXPHOS, consequently driving cancer stemness and cisplatin resistance. Intriguingly, the mitochondrial translocation of TACO1 is mediated by the heat shock protein 90 β (HSP90β), a process that requires circFOXK2 as a scaffold for the TACO1-HSP90β interaction. The mutations at the binding sites of TACO1-circFOXK2-HSP90β disturb the ternary complex and inhibit cancer stemness and cisplatin resistance in BCa cells by suppressing the MTCO1/OXPHOS/mtROS axis. Clinically, BCa patients with increased mitochondrial TACO1 expression respond poorly to cisplatin treatment. This study elucidates the mechanisms by which TACO1 promotes BCa stemness and cisplatin resistance, providing a potential target for mitigating cisplatin resistance for BCa and a biomarker for predicting cisplatin response.

Assessing the predictive value of intraductal carcinoma of the prostate (IDC-P) in determining abiraterone efficacy for metastatic hormone-sensitive prostate cancer (mHSPC) patients

BACKGROUND

This study explored the value of intraductal carcinoma of the prostate (IDC-P) in predicting the efficacy of abiraterone treatment in metastatic hormone-sensitive prostate cancer (mHSPC) patients.

METHODS

A retrospective study of 925 patients who underwent prostate biopsies to detect IDC-P was conducted, with participants divided into two cohorts. The first cohort of 165 mHSPC patients receiving abiraterone treatment was analyzed to compare therapeutic effectiveness between IDC-P positive and negative cases. Utilizing propensity score matching (PSM) to reduce bias, outcomes such as PSA response, progression-free survival (PSA-PFS), radiographic progression-free survival (rPFS), and overall survival were assessed. Additionally, the second cohort of 760 mHSPC patients compared the efficacy of abiraterone with conventional hormone therapy, focusing on differences between IDC-P positive and negative individuals.

RESULTS

After PSM, our first cohort included 108 patients with similar baseline characteristics. Among them, 50% (54/108) were diagnosed with IDC-P, with 22.2% (12/54) having IDC-P pattern 1 and 77.8% (42/54) with IDC-P pattern 2. While no notable difference was seen in PSA responses between IDC-P positive and negative patients, IDC-P presence linked to worse clinical outcomes (PSA-PFS: 18.6 months vs. not reached [NR], p = 0.009; rPFS: 23.6 months vs. NR, p = 0.020). Further analysis showed comparable outcomes for IDC-P pattern 1 but significantly worse prognosis for IDC-P pattern 2 (PSA-PFS: 18.6 months vs. NR, p = 0.002; rPFS: 22.4 months vs. NR, p = 0.010). Subgroup analysis revealed IDC-P pattern 2 consistently predicted poorer outcomes across patient subgroups. Remarkably, both IDC-P positive and negative patients gained more from androgen deprivation therapy with abiraterone than conventional treatment, with IDC-P negative patients showing a more significant survival advantage, supported by better hazard ratios (0.47 and 0.66).

CONCLUSION

This study found that IDC-P, especially pattern 2, predicts poor prognosis in mHSPC patients on abiraterone therapy. Also, abiraterone's advantage over hormone therapy is reduced in cases with IDC-P compared to those without.

Proteomic profiling identifies muscle-invasive bladder cancers with distinct biology and responses to platinum-based chemotherapy

Platinum-based neoadjuvant chemotherapy prior to radical cystectomy is the preferred treatment for muscle-invasive bladder cancer despite modest survival benefit and significant associated toxicities. Here, we profile the global proteome of muscle-invasive bladder cancers pre- and post-neoadjuvant chemotherapy treatment using archival formalin-fixed paraffin-embedded tissue. We identify four pre-neoadjuvant chemotherapy proteomic clusters with distinct biology and response to therapy and integrate these with transcriptomic subtypes and immunohistochemistry. We observe proteomic plasticity post-neoadjuvant chemotherapy that is associated with increased extracellular matrix and reduced keratinisation compared to pre-neoadjuvant chemotherapy. Post-neoadjuvant chemotherapy clusters appear to be differentially enriched for druggable proteins. For example, MTOR and PARP are over-expressed at the protein level in tumours identified as neuronal-like. In addition, we determine that high intra-tumoural proteome heterogeneity in pre-neoadjuvant chemotherapy tissue is associated with worse prognosis. Our work highlights aspects of muscle-invasive bladder cancer biology associated with clinical outcomes and suggests biomarkers and therapeutic targets based on proteomic clusters.

Eighty-Nine Cases of Primary Prostatic Signet Ring Cell Carcinoma-Systematic Review

Signet ring cell adenocarcinoma is a rare subtype of mucinous adenocarcinoma that affects the gastrointestinal tract and the prostate. Prostatic signet ring cell carcinoma comprises 0.02% of all cases of prostate cancer and 0.4% of all signet ring cell cancers. The aim of this review was to summarize the existing literature on primary prostatic signet ring cell carcinoma by assessing patient demographics, clinical presentations, investigations, treatment methods, and survival outcomes. A systematic review was conducted in multiple databases, including 46 articles comprising 89 individual cases of primary prostatic signet ring cell carcinoma. Data was extracted and analyzed using descriptive statistics. The average age of patients with primary prostatic signet ring cell carcinoma was 68.5 years, and most cases were reported in Caucasian individuals. Clinical presentations varied, with lower urinary tract symptoms being the most common. Biochemical markers, such as prostate-specific antigen, were often elevated. Imaging modalities, including computed tomography and magnetic resonance imaging, were used for diagnosis, and it found that one-third had metastatic disease on diagnosis. Treatment options included radical prostatectomy, hormone therapy, radiation therapy, and chemotherapy. The prognosis for primary prostatic signet ring cell carcinoma was poor, with a 3-year survival rate of approximately 17%. Primary prostatic signet ring cell carcinoma is a rare and aggressive form of prostate cancer. The limited literature on this condition highlights the need for further research. These systematic review findings contribute to a better understanding of this disease and may guide future clinical management strategies.

Outcome Analysis of a Series of Mixed-Grade, Non-muscle Invasive, Papillary Carcinomas of the Bladder

INTRODUCTION

Papillary urothelial carcinomas are currently graded as either low- or high-grade tumors based on World Health Organization (WHO) 2022 guidelines for genitourinary tumors. However, a minority of tumors are mixed-grade tumors, composed predominantly of low-grade cancer with a minor high-grade component. In the 2022 WHO these cancers are recognized as having outcomes comparable to low-grade cancers, although data to date has been limited.

METHODS

The pathology records of a large academic institution were searched for mixed-grade, non-muscle invasive papillary carcinomas of the bladder and ureter in order to characterize prognosis of these cancers.

RESULTS

Of 136 cancers, the majority (n = 104, 76.5%) were solitary, mixed-grade tumors, while 21 (15.4%) had a concurrent low-grade cancer and 11 (8.1%) had multiple mixed-grade tumors at the time of diagnosis. At follow-up (median 48.3 months, range = 1.3 months-18.1 years), 71 cancers recurred (52.2%): 52 (38.2%) as low- or mixed-grade cancers and 18 (13.2%) as high-grade cancers. There were no instances of stage-progression to >pT2.

CONCLUSIONS

The clinical outcome of mixed-grade carcinomas was similar to what has been reported for low-grade carcinomas. Based on our results, and prior congruent studies of mixed-grade lesions, these lesions may be regarded as a distinct sub-category with a better prognosis than high-grade tumors.

A Comparative Study of the Paris System and Common Reporting System for Urine Cytology With Cyto-Histology Correlation: A Study of 829 Urine Cytology Specimens

BACKGROUND

The Paris System (TPS) diligently detects high-grade urothelial carcinoma (HGUC) and creates a uniform, standardized, reproducible reporting system for urine cytology. However, many centres might still use a common reporting system (CRS). The study aims to compare TPS and CRS for urine cytology with histology correlation.

METHOD

It was a cross-sectional study done from July 2016 to December 2022.

RESULTS

The study included 829 urine cytology samples (96% voided urine) from 478 patients. Histology correlation was available for 138 (16.6%) samples of 115 patients. The frequency of NHGUC, AUC, HGUC and SHGUC was 40.6%, 17.4%, 12.2% and 5.5%, respectively, in TPS. In contrast, in CRS, the frequency of NM, AUS, SM and PM was 69.2%, 13.3%, 4.5% and 13.0%, respectively. TPS and CRS had 64% agreement overall with the kappa test (κ-value 0.479, moderate strength). The agreement between TPS and CRS was 39.8% for NHGUC, 10.97% for AUC and 10.85% for HGUC. After combining a few TPS categories, the agreement increased to 87.7% (κ-value 0.7640, good strength). Histological concordance for AUC, HGUC and NHGUC was 75%, 31.8% and 31.3% in TPS, and it was 50% and 33.3% for AUS and PM, respectively, in CRS. The sensitivity and specificity of TPS and CRS against histology were 37.5% vs. 26.0%, p = 0.0005 and 76.5% vs. 85.3%, p = 0.0083, respectively.

CONCLUSION

TPS and CRS have moderate strength of agreement for urine cytology. TPS was more sensitive than CRS. It may be easy for institutes to transition to a newer TPS system if they still use a CRS.

High expression of ARPC1B promotes the proliferation and apoptosis of clear cell renal cell carcinoma cells, leading to a poor prognosis

BACKGROUND

ARPC1B has been identified as a key regulator of malignant biological behavior in various tumors. However, its specific role in clear cell renal cell carcinoma (ccRCC) remains poorly understood. This study aims to evaluate the influence of ARPC1B on the prognosis and disease progression in ccRCC patients.

METHODS

Multi-omics data and clinical information from public databases were analyzed to determine the associations between ARPC1B and prognosis, clinical features, immune microenvironment, and drug sensitivity in ccRCC. Co-expression and gene set enrichment analyses were conducted to elucidate the potential role of ARPC1B in ccRCC pathogenesis. Functional assays, including RT-qPCR, CCK8 assays, colony formation assays, immunofluorescence, immunohistochemistry, and xenograft tumor formation in nude mice, were performed to assess ARPC1B's impact on cell proliferation and apoptosis. Flow cytometry and Western blotting were further employed to investigate the underlying molecular mechanisms of ARPC1B in ccRCC.

RESULTS

ARPC1B expression was significantly elevated in ccRCC and associated with an unfavorable prognosis. Both independent and meta-analyses confirmed that ARPC1B is an independent prognostic risk factor in ccRCC. Furthermore, ARPC1B expression significantly correlated with the immune microenvironment and drug sensitivity. In vitro, experiments demonstrated that ARPC1B knockdown suppressed ccRCC cell proliferation and induced apoptosis through the BAX-Bcl-2/c-caspase3/c-PARP axis, which was further validated by in vivo studies.

CONCLUSION

ARPC1B overexpression is associated with poor prognosis, altered immune status, and drug sensitivity in ccRCC. Furthermore, ARPC1B promotes the malignant behavior of ccRCC cells and holds potential as a prognostic biomarker and therapeutic target for ccRCC.

Computed tomography-based nomogram for estimating progression-free survival probability in bladder cancer patients undergoing partial cystectomy

PURPOSE

To establish a prognostic model to estimate progression-free survival (PFS) probability in bladder cancer (BCa) patients undergoing partial cystectomy.

MATERIAL AND METHODS

Consecutive patients who underwent partial cystectomy between August 2012 and April 2021 were enrolled. The primary endpoint was PFS during the follow-up. The following features were assessed: tumor location, amount, size, tortuous blood vessels around or within the lesions, perivesical fat stranding, stalk, computed tomography (CT) enhancement, calcification, cystic degeneration, CT reported lymph nodes status, and presence of hydronephrosis. Univariate Cox regression and LASSO regression, followed by backward stepwise multivariable Cox, were used to construct the nomogram.

RESULTS

A total of 106 patients were enrolled. Gender, histology, tortuous blood vessels, and perivesical fat stranding were used to fit the nomogram. The overall Harrell's concordance index (C-index) was 0.752. The area under the receiver operator characteristic curves (AUC) at 1-year, 2-year and 3-year were 0.733, 0.789 and 0.833, respectively. The calibration curves showed remarkable consistency.

CONCLUSION

A nomogram model constructed based on the CT features and clinical risk factors is potentially feasible for predicting the PFS within 3 years after PC for BCa, which can assist in the choice of treatment and follow-up scheduling.

Predicting recurrence of non-muscle invasive bladder urothelial carcinoma: predictive value of the optimal cut-off value of Ki67

Objective

To investigate the optimal cut-off value of immunohistochemical marker Ki67 as a prognostic factor to predict the recurrence of non-muscle invasive bladder urothelial carcinoma (NMIBUC).

Methods

A total of 331 patients diagnosed with NMIBUC who underwent surgery in the Yongchuan Hospital and the Second Affiliated Hospital of Chongqing Medical University from January 2012 to January 2020 were finally included in this study. The optimal cut-off value of Ki67 for predicting recurrence of NMIBUC was calculated by ROC curve and Youden index. According to the cut-off value, the patients were divided into high ratio group and low ratio group, and the clinicopathological data of the two groups were compared. Univariate and multivariate regression analysis were used to analyze the relationship between the expression of Ki67 and postoperative recurrence of NMIBUC. The Kaplan-Meier curve was used for survival analysis.

Results

18% is the optimal cut-off value of Ki67 for predicting postoperative recurrence of NMIBUC. High Ki67 expression (Ki67>18%) was significantly correlated with tumor stage (P=0.001), tumor grade (P=0.014), immediate postoperative instillation (P=0.001), the expression of P53 (P=0.019) and CK20 (P=0.001). Ki67 expression greater than 18% was an independent risk factor for high recurrence rate of NMIBUC (P=0.001). Moreover, the 1-year and 3-year recurrence-free survival (RFS) of the high Ki67 group were 56.6% (95%CI 51.2%-62%) and 43.6% (95%CI 37.5%-49.7%) respectively, which were significantly lower than those in low Ki67 group which present as 92.9% (95%CI 89.0%-96.8%) and 88.3% (95%CI 82.4%-94.2%) respectively, and the difference was statistically significant (P<0.001).

Conclusions

18% is the optimal cut-off value of Ki67 for predicting recurrence of NMIBUC. Ki67>18% is an independent risk factor for high recurrence rate of NMIBUC. This cut-off value can more accurately predict the risk of recurrence and has the potential clinical value for guiding the postoperative adjuvant treatment and follow-up strategy of NMIBUC.

Intermediate risk prostate tumors contain lethal subtypes

In 2024, prostate cancer (PCa) remains the most common non-skin cancer in males within the United States, with an estimated 299,010 new cases, the highest increase incident trend rate (3.8%) of all cancers, and one of the eight deadliest. PCa cases are projected to double from 1.8 million to 2.9 million per year between 2020 and 2040. According to the National Comprehensive Cancer Network (NCCN) treatment guidelines, most cases (65%) are intermediate risk (Gleason sum score <7 [3 + 4, 4 + 3], prostate organ-confined, and PSA < 20) with treatment options limited to active surveillance, external beam radiation, and/or surgery to prevent metastasis in the long term (>10 years). It is increasingly recognized that the two most common subtypes of intermediate risk PCa are cribriform architecture (CA) and intraductal carcinoma of the prostate (IDC-P), which can occur together, and both are associated with increased metastatic risk, biochemical recurrence, and disease-specific mortality. Both subtypes display hypoxia, genomic instability, and are identified as Gleason 4 in pathology reports. However, since false negatives are common (up to 50%) in these subtypes on biopsy, more research is needed to reliably detect these subtypes that have an increased risk for invasive disease. We note that even with mpMRI-guided biopsies, the sensitivity is 54% for cribriform architecture and only 37% for IDC-P. The presence of these PCa subtypes in biopsy or radical prostatectomy (RP) tissue can exclude patients from active surveillance and from designation as intermediate risk disease, further underscoring the need for increased molecular understanding of these subtypes for diagnostic purposes. Understanding the heterogeneity of intermediate risk primary PCa phenotypes, using computational pathology approaches to evaluate the fixed biopsy specimen, or video microscopy of the surgical specimen with AI-driven analysis is now achievable. New research associating the resulting phenotypes with the different therapeutic choices and vulnerabilities will likely prevent extracapsular extension, the definition of high-risk disease, and upstaging of the final pathologic stage.

Differential Diagnosis of Urinary Cancers by Surface-Enhanced Raman Spectroscopy and Machine Learning

Bladder, kidney, and prostate cancers are prevalent urinary cancers, and developing efficient detection methods is of significance for the early diagnosis of them. However, noninvasive and sensitive detection of urinary cancers still challenges traditional techniques. In this study, we developed a SERS-based method to analyze serum samples from patients with urinary cancers. Rapid, label-free, and highly sensitive detection of human sera is achieved by cleaning and aggregating silver nanoparticles. Furthermore, a long short-term memory deep learning algorithm is used to distinguish serum spectra, and the performance of the model is evaluated by comparing the accuracy, sensitivity, specificity, and receiver operating characteristic curves. Taking advantage of SERS and machine learning in sensitivity and data processing, the three urinary cancers are clearly classified. This is the first attempt to exploit the SERS-machine learning strategy to discriminate multiple urinary cancers with clinical serum samples, and our results showed the potential application of this method in the early diagnosis and screening of cancers.

Gefitinib Reverses PD-L1-Mediated Immunosuppression Induced by Long-term Glutamine Blockade in Bladder Cancer

Glutamine is a major energy source for tumor cells, and blocking glutamine metabolism is being investigated as a promising strategy for cancer therapy. However, the antitumor effect of glutamine blockade in bladder cancer remains unclear, necessitating further investigation. In this study, we demonstrated that glutamine metabolism was involved in the malignant progression of bladder cancer. Treatment with the glutamine antagonist 6-diazo-5-oxo-L-norleucine (DON) inhibited the growth of bladder cancer cells in vitro in several ways. In addition, we observed inhibition of tumor growth in bladder cancer-bearing mice by using JHU083, a prodrug that was designed to prevent DON-induced toxicity. However, the antitumor immune effect of T cells changed from activation to inhibition as the administrated time extended. We found that both in vitro treatment with DON and in vivo prolonged administration of JHU083 led to the upregulation of PD-L1 in bladder cancer cells. Mechanistically, glutamine blockade upregulated PD-L1 expression in bladder cancer cells by accumulating reactive oxygen species, subsequently activating the EGFR/ERK/C-Jun signaling pathway. Combination treatment of JHU083 and gefitinib reversed the upregulation of PD-L1 in bladder cancer cells induced by prolonged glutamine blockade, resulting in the alleviation of T-cell immunosuppression and a significant improvement in therapeutic outcome. These preclinical findings show promise for glutamine metabolism targeting as a viable therapeutic strategy for bladder cancer, with the potential for further enhancement through combined treatment with gefitinib.

Diagnostic value of dual-layer spectral detector CT parameters for differentiating high- from low-grade bladder cancer

OBJECTIVES

This study aimed to investigate the diagnostic value of spectral parameters of dual-layer spectral detector computed tomography (DLCT) in distinguishing between low- and high-grade bladder cancer (BCa).

METHODS

This single-center retrospective study included pathologically confirmed BCa patients who underwent preoperative contrast-enhanced DLCT. Patients were divided into low- and high-grade groups based on pathology. We measured and calculated the following spectral CT parameters: iodine density (ID), normalized ID (NID), arterial enhancement fraction (AEF), extracellular volume (ECV) fraction, virtual non-contrast (VNC), slope of the attenuation curve, and Z effective (Zeff). Univariate and multivariable logistic regression analyses were used to determine the best predictive factors in differentiating between low- and high-grade BCa. We used receiver operating characteristic curve analysis to assess diagnostic performance and decision curve analysis to determine the net benefit.

RESULTS

The study included 64 patients (mean age, 64 ± 11.0 years; 46 men), of whom 42 had high-grade BCa and 22 had low-grade BCa. Univariate analysis revealed that differences in ID and NID in the corticomedullary phase, AEF, ECV, VNC, and Zeff images were statistically significant (p = 0.001-0.048). Multivariable analysis found that AEF was the best predictor of high-grade tumors (p = 0.006). With AEF higher in high-grade BCa, AEF results were as follows: area under the curve (AUC), 0.924 (95% confidence interval, 0.861-0.988); sensitivity, 95.5%; specificity, 81.0%; and accuracy, 85.9%. The cutoff valve of AEF for predicting high-grade BCa was 67.7%.

CONCLUSION

Using DLCT AEF could help distinguish high-grade from low-grade BCa.

CRITICAL RELEVANCE STATEMENT

This research demonstrates that the arterial enhancement fraction (AEF), a parameter derived from dual-layer spectral detector CT (DLCT), effectively distinguishes between high- and low-grade bladder cancer, thereby aiding in the selection of appropriate clinical treatment strategies.

KEY POINTS

This study investigated the value of dual-layer spectral detector CT in the assessment of bladder cancer (BCa) histological grade. The spectral parameter arterial enhancement fraction could help determine BCa grade. Our results can help clinicians formulate initial treatment strategies and improve prognostications.

A Predictive Nomogram for Development of Lymph Node Metastasis in Muscle-Invasive Bladder Cancer Following Neoadjuvant Therapy

Purpose

Pelvic lymph node metastases (ypN+) after multiagent neoadjuvant chemotherapy (NAC) is a poor prognostic sign in nonmetastatic muscle-invasive bladder cancer (nmMIBC). We sought to create a nomogram predicting probability of ypN+ after NAC for cN0 nmMIBC and determine association with overall survival (OS).

Methods and Materials

We reviewed the National Cancer Database for patients with cT2-4N0M0 urothelial carcinoma of the bladder receiving multiagent NAC and surgery from 2004 to 2020. Following a data split, univariate logistic regression identified variables associated with ypN+ at P < .05. Eligible variables were used for multivariate logistic regression and nomogram generation. A threshold for 95% sensitivity defined high- and low-risk groups for ypN+. Fine-Gray models assessed ypN+ risk group and OS, accounting for competing risks of surgical mortality.

Results

A total of 6194 patients were identified with a median follow-up of 39.5 months (interquartile range [IQR], 20.5-67.2 months). Most patients had high-grade (97.7%) cT2 disease (70.8%) with nonpapillary urothelial histology (67.3%) and initiated NAC at a median of 41.0 days after diagnosis (IQR, 28.0-59.0 days).The nomogram included age in decades (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.87-1.03; P = .172), weeks from diagnosis to NAC (OR, 1.02; 95% CI, 1.01-1.04; P = .004), nonpapillary histology (OR, 1.17; 95% CI, 0.99-1.39; P = .068), and clinical T-stage. Within the testing cohort, ypN+ was found in 392 (22.8%) high-risk and 12 (8.0%) low-risk patients (P < .001), with median OS of 36.1 and 74.0 months, respectively (P < .001). High-risk patients had worse OS despite competing risks of 30-day (subdistribution hazard ratio [SHR], 1.80; 95% CI, 1.49-2.18; P < .001) and 90-day surgical mortality (SHR, 1.68; 95% CI, 1.39-2.04; P < .001).

Conclusions

This is the first study to provide a tool for predicting ypN+ and prognosticate worse OS in primarily high-grade nmMIBC and could select patients for alternative neoadjuvant therapy and facilitate future study.

Next-Generation Sequencing: Key for Diagnosing Angiomyolipoma - A Case Report

Introduction

Renal angiomyolipomas (AMLs) are rare tumors categorized within the perivascular epithelioid cell tumor (PEComa) family, most of which are benign, except for epithelioid AMLs (EAML) with malignant potential. EAML develops sporadically or as part of the tuberous sclerosis complex (TSC), where mutations of the TSC1/2 genes result in increased activation of the mammalian target of the rapamycin (mTOR) signaling pathway.

Case Presentation

A 52-year-old female patient experienced dyspnea and abdominal pain, leading to the discovery of a retroperitoneal tumor confirmed by tomography. She was initially diagnosed with a retroperitoneal liposarcoma with lung metastasis. Following a first-line anthracycline-based chemotherapy, the patient achieved a complete clinical and tomographic response. Subsequent surgical resection of the primary tumor and a course of ifosfamide monotherapy yielded a 36-month progression-free survival to date. Comprehensive molecular profiling of the primary tumor by whole exome sequencing revealed pathogenic mutations in TSC2 and the absence of amplifications in MDM2 and CDK4, raising the need to consider a differential diagnosis in PEComas, and contemplate the potential use of AKT/Pi3K/mTOR pathway inhibitors. Pathological re-evaluation confirmed the diagnosis of a metastatic retroperitoneal AML with complete response and no evidence of disease.

Conclusion

This case underscores the invaluable role of next-generation sequencing testing in the differential diagnosis of retroperitoneal tumors, as well as the ability to identify precise therapeutic targets for the treatment of rare soft tissue cancer types within the realm of precision medicine.

Clear Cell Adenocarcinoma of the Urinary Tract Primary to the Renal Pelvis: A Multi-institutional Clinicopathologic and Molecular Study of Five Patients

Clear cell adenocarcinoma (CCA) of the urinary tract is a rare malignancy and tumors involving the renal pelvis are notably sparse in the literature, with only 5 other patients reported. We present 5 patients, 4 women, and 1 man, with CCA of the renal pelvis. The age at presentation ranged from 29 to 81 years. The tumor size ranged from 4.5 to 8.0 cm. Tumors exhibited shared morphologic and immunohistochemical features with CCA of the female genital tract and those originating in the bladder and urethra, including cells with large nuclei, prominent nucleoli, nuclear hobnailing, and scant clear cytoplasm. Common immunohistochemical findings included reactivity for PAX8, CK7, HNF1β, and Napsin-A. One of the tumors arose in the background of a mixed epithelial and stromal tumor. Another tumor occurred in a renal allograft and tumor cells were positive for the BK virus, demonstrated by SV40 immunohistochemistry. All tumors were negative for TFE3 and TFEB rearrangement and lacked TERT alterations. Follow-up was limited with no recurrence in 4 patients at a maximum of 20 months follow-up and 1 patient died of an unrelated cause at 25 months of follow-up. Next-generation sequencing analysis of all 5 CCAs revealed mutations within genes implicated in DNA damage repair and chromatin remodeling pathways, including ATM , BRCA1 , BRCA2, ARID1A, DICER1, SMAD4, NOTCH1 , and MYC amplification. These molecular findings underscore the dysregulation of fundamental cellular processes essential for genomic integrity maintenance.

Nomogram for the Pathological Complete Response After Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer Patients

BACKGROUND

No validated instrument currently exists to predict neoadjuvant chemotherapy (NAC) response in muscle-invasive bladder cancer (MIBC) patients. We aim to develop and validate a nomogram based on clinicopathological factors for predicting who would benefit most from NAC.

METHODS

Between January 2016 and April 2023, 361 consecutive MIBC patients treated with NAC were enrolled in the study. Two hundred sixty patients at the Hu Nan institution comprised the development cohort. The validation cohort (91 patients) was from the Xiang Hua center. Patient clinicopathologic information was documented. Using regression coefficients, a predictive model was constructed using multivariate logistic regression. The likelihood ratio test with Akaike's information criterion was then used as the ending rule for backward stepwise selection. This predictive model's efficacy was evaluated for discrimination, calibration, and clinical utility.

RESULTS

 Predictors of this model included the origin of MIBC, pathological tumor type, clinical tumor stage, and tumor size. In the validation cohort, the model demonstrated good discrimination with an AUROC of 0.7221 (P < 0.001) and calibration (Unreliability test, P = 0.580). In addition, decision curve analysis revealed that the model was clinically beneficial.

CONCLUSIONS

This study indicated that primary MIBC, pure UC pathological type, lower clinical tumor stage, and maximum tumor diameter <3 cm were significant predictors of ypCR in MIBC patients after NAC. This nomogram may contribute to the precious administration of NAC and the avoidance of chemotherapy toxicity and delayed RC.

Unveiling the molecular profile of a prostate carcinoma: implications for personalized medicine

BACKGROUND

Prostate cancer is the most common diagnosed tumor and the fifth cancer related death among men in Europe. Although several genetic alterations such as ERG-TMPRSS2 fusion, MYC amplification, PTEN deletion and mutations in p53 and BRCA2 genes play a key role in the pathogenesis of prostate cancer, specific gene alteration signature that could distinguish indolent from aggressive prostate cancer or may aid in patient stratification for prognosis and/or clinical management of patients with prostate cancer is still missing. Therefore, here, by a multi-omics approach we describe a prostate cancer carrying the fusion of TMPRSS2 with ERG gene and deletion of 16q chromosome arm.

RESULTS

We have observed deletion of KDM6A gene, which may represent an additional genomic alteration to be considered for patient stratification. The cancer hallmarks gene signatures highlight intriguing molecular aspects that characterize the biology of this tumor by both a high hypoxia and immune infiltration scores. Moreover, our analysis showed a slight increase in the Tumoral Mutational Burden, as well as an over-expression of the immune checkpoints. The omics profiling integrating hypoxia, ROS and the anti-cancer immune response, optimizes therapeutic strategies and advances personalized care for prostate cancer patients.

CONCLUSION

The here data reported can lay the foundation for predicting a poor prognosis for the studied prostate cancer, as well as the possibility of targeted therapies based on the modulation of hypoxia, ROS, and the anti-cancer immune response.

Exploring the value of arterial spin labeling and six diffusion MRI models in differentiating solid benign and malignant renal tumors

OBJECTIVE

To explore the value of three-dimensional arterial spin labeling (ASL) and six diffusion magnetic resonance imaging (MRI) models in differentiating solid benign and malignant renal tumors.

METHODS

This retrospective study included 89 patients with renal tumors. All patients underwent ASL and ZOOMit diffusion-weighted imaging (DWI) examinations and were divided into three groups: clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumors (BRT). The mean and peak renal blood flow (RBFmean and RBFpeak) from ASL and fourteen diffusion parameters from mono-exponential DWI (Mono_DWI), intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), stretched exponential model (SEM), fractional order calculus (FROC), and continuous-time random-walk (CTRW) model were analyzed. Binary logistic regression was used to determine the optimal parameter combinations. The diagnostic performance of various MRI-derived parameters and their combinations was compared.

RESULTS

Among the six diffusion models, the SEM model achieved the highest performance in differentiating ccRCC from non-ccRCC (area under the receiver operating characteristic curve [AUC] 0.880) and from BRT (AUC 0.891). IVIM model achieved the highest AUC (0.818) in differentiating non-ccRCC from BRT. Among all the MRI-derived parameters, RBFpeak combined with DKI_MK yielded the highest AUC (0.970) in differentiating ccRCC from non-ccRCC, and the combination of RBFpeak, SEM_DDC, and FROC_μ yielded the highest AUC (0.992) for differentiating ccRCC from BRT.

CONCLUSION

ASL and all diffusion models showed similar diagnostic performance in differentiating ccRCC from non-ccRCC or BRT, while the IVIM model performed better in distinguishing non-ccRCC from BRT. Combining ASL with diffusion models can provide additional value in predicting ccRCC.

RELEVANCE STATEMENT

Considering the increasing detection rate of incidental renal masses, accurate discrimination of benign and malignant renal tumors is crucial for decision-making. Combining ASL with diffusion MRI models offers a promising solution to this clinical issue.

KEY POINTS

All assessed models were effective for differentiating ccRCC from non-ccRCC or BRT. ASL and all diffusion models showed similar performance in differentiating ccRCC from non-ccRCC or BRT. Combining ASL with diffusion models significantly improved diagnostic efficacy in predicting ccRCC. IVIM model could better differentiate non-ccRCC from BRT.

Adult Prostate Sarcoma: Demographics, Treatment Patterns, and Survival

BACKGROUND

This study aimed to examine clinicopathologic characteristics, treatment patterns, and survival rates in a contemporary population-based cohort of adult prostate sarcoma patients.

METHODS

In the Surveillance, Epidemiology, and End Results database (2004-2020), adult patients with prostate sarcoma were identified. Descriptive statistics, Kaplan-Meier analyses, smoothed cumulative incidence plots, and Cox regression models were used.

RESULTS

Of 125 patients, 45 (36%) harbored leiomyosarcoma, 17 (14%) had rhabdomyosarcoma, 15 (12%) had stromal sarcoma, 17 (14%) had sarcoma not otherwise specified (NOS), and 31 (25%) had other sarcoma subtypes. Metastatic stage was most common in the rhabdomyosarcoma patients (44%) and least common in the leiomyosarcoma (21%) and stromal sarcoma (20%) patients. Most of the rhabdomyosarcoma patients received the combination of systemic and radiation therapy with (24%) or without radical surgery (35%), whereas most of the leiomyosarcoma and stromal sarcoma patients underwent radical surgery with (22 and 13%) or without (22 and 47%) radiation. In the overall population, the median overall survival was 27 months. The 5-years overall versus cancer-specific versus other-cause mortality rates were respectively 71 versus 58 versus 13%. In the multivariable Cox regression models, the highest overall mortality was exhibited by the patients with metastatic disease (hazard ratio [HR] 2.87; 95% confidence interval [CI] 1.55-5.31; p < 0.001) or unknown disease stage (HR 2.94; 95% CI 2.20-7.21; p = 0.019). Conversely, of all the histologic subtypes, only stromal sarcoma distinguished itself by lower overall mortality (HR 0.41; 95% CI 0.18-0.96; p = 0.039).

CONCLUSIONS

Four major histologic subtypes were identified. Among most adult sarcoma patients, treatment patterns vary according to histology, from multimodal therapy to radical prostatectomy alone. These treatment differences reflect equally important heterogeneity in survival patterns.

Impact of multi-parameter images obtained from dual-energy CT on radiomics to predict pathological grading of bladder urothelial carcinoma

OBJECTIVE

To investigate the effect of radiomics models obtained from dual-energy CT (DECT) material decomposition images and virtual monoenergetic images (VMIs) in predicting the pathological grading of bladder urothelial carcinoma (BUC).

MATERIALS AND METHODS

A retrospective analysis of preoperative DECT examination was conducted on 112 patients diagnosed with BUC. This cohort included 76 cases of high-grade urothelial carcinoma and 36 cases of low-grade urothelial carcinoma. DECT can provide material decomposition images of venous phase Iodine maps and Water maps based on the differences in attenuation of substances, as well as VMIs at 40 to 140 keV (interval 10 keV). A total of 13 image sets were obtained, and radiomics features were extracted and analyzed from each set to achieve preoperative prediction of BUC. The best features related to BUC were identified by recursive feature elimination (RFE), the Minimum Redundancy Maximum Relevance (mRMR), and the Least Absolute Shrinkage and Selection Operator (LASSO) in order. A five-fold cross-validation method was used to divide the samples into training and testing sets, and models for pathological prediction of BUC grading were constructed by a random forest (RF) classifier. Receiver operating curves (ROC) were plotted to evaluate the performance of 13 models obtained from each image set.

RESULTS

Despite the notable differences in the best radiomics features chosen from each image set, all the features selected from 40 to 100 keV VMIs included the Dependence Variance of the GLDM feature set. There were no statistically significant differences in the area under the curve (AUC) between the training set and the testing set for all 13 models. In the testing set, the AUCs of the models established through 40 keV to 140 keV (interval of 10 keV) image sets were 0.895, 0.874, 0.855, 0.889, 0.841, 0.868, 0.852, 0.847, 0.889, 0.887 and 0.863 respectively. The AUCs for the models established using the Iodine maps and Water maps image sets were 0.873 and 0.852, respectively.

CONCLUSION

Despite the differences in the selected radiomic features from DECT multi-parameter images, the performance of radiomics models in predicting the pathological grading of BUC was not affected by the variations in the types of images used for model training.