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Cao C, Fu Z, Liu Y, Zhou A, Wang J, Shou J. A Muscle-Invasive Bladder Cancer Patient With High Tumor Mutational Burden and RB1 Mutation Achieved Bladder Preservation Following Chemotherapy Combined With Immunotherapy: A Case Report. Front Immunol 2021; 12:684879. [PMID: 34177933 PMCID: PMC8222973 DOI: 10.3389/fimmu.2021.684879] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for patients diagnosed with muscle-invasive bladder cancer (MIBC). However, urinary diversion following radical cystectomy significantly reduces patient quality of life. In addition, patients who significantly respond to neoadjuvant chemotherapy have a strong will to preserve the bladder. Bladder-sparing therapy has become a research focus worldwide. Although the bladder-sparing regimen, referred to as trimodality therapy (TMT), has been accepted, the efficacy of immunotherapy combined with chemotherapy for bladder preservation in patients with MIBC has not yet been published. We describe the case of a 50-year-old male presented intermittent macrohematuria and was diagnosed with bladder urothelial carcinoma by diagnostic transurethral resection of bladder tumor (TURBt) with clinical stage IIIA (cT3bN0M0). A complete response was achieved after four courses of neoadjuvant chemotherapy combined with pembrolizumab. Then, we performed a second TURBt plus randomized biopsy by cystoscopy. The pathology indicated no tumor in the bladder. Adjuvant chemoradiotherapy and immunotherapy were subsequently performed. Imaging examinations, cystoscopy and urine tumor DNA (utDNA) levels were used for surveillance after treatment. Finally, the patient achieved bladder preservation and had remained cancer-free for 19 months at the last follow-up on February 20, 2021. This is the first published case study to describe neoadjuvant chemotherapy plus pembrolizumab followed by concurrent chemoradiotherapy as a novel bladder-sparing regimen and successfully achieved a promising outcome.
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Affiliation(s)
- Chuanzhen Cao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhichao Fu
- Research Institute, GloriousMed Clinical Laboratory (Shanghai) Co., Ltd., Shanghai, China
| | - Yueping Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aiping Zhou
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianfei Wang
- Research Institute, GloriousMed Clinical Laboratory (Shanghai) Co., Ltd., Shanghai, China
| | - Jianzhong Shou
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhu H, Wang Y, Wei T, Zhao X, Li F, Li Y, Wang F, Cai Y, Jin J. KAT8/MOF-Mediated Anti-Cancer Mechanism of Gemcitabine in Human Bladder Cancer Cells. Biomol Ther (Seoul) 2021; 29:184-194. [PMID: 33041265 PMCID: PMC7921864 DOI: 10.4062/biomolther.2020.111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 01/18/2023] Open
Abstract
Histone acetylation is a well-characterized epigenetic modification controlled by histone acetyltransferases (HATs) and histone deacetylases (HDACs). Imbalanced histone acetylation has been observed in many primary cancers. Therefore, efforts have been made to find drugs or small molecules such as HDAC inhibitors that can revert acetylation levels to normal in cancer cells. We observed dose-dependent reduction in the endogenous and exogenous protein expression levels of KAT8 (also known as human MOF), a member of the MYST family of HATs, and its corresponding histone acetylation at H4K5, H4K8, and H4K16 in chemotherapy drug gemcitabine (GEM)-exposed T24 bladder cancer (BLCA) cells. Interestingly, the reduction in MOF and histone H4 acetylation was inversely proportional to GEM-induced γH2AX, an indicator of chemotherapy drug effectiveness. Furthermore, pGL4-MOF-Luc reporter activities were significantly inhibited by GEM, thereby suggesting that GEM utilizes an MOF-mediated anti-BLCA mechanism of action. In the CCK-8, wound healing assays and Transwell® experiments, the additive effects on cell proliferation and migration were observed in the presence of exogenous MOF and GEM. In addition, the promoted cell sensitivity to GEM by exogenous MOF in BLCA cells was confirmed using an Annexin V-FITC/PI assay. Taken together, our results provide the theoretical basis for elucidating the anti-BLCA mechanism of GEM.
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Affiliation(s)
- Huihui Zhu
- School of Life Sciences, Jilin University, Jilin 130012, China
| | - Yong Wang
- Urology Department, Jilin Province People's Hospital, Jilin 130021, China
| | - Tao Wei
- School of Life Sciences, Jilin University, Jilin 130012, China
| | - Xiaoming Zhao
- Central laboratory, China-Japan Union Hospital of Jilin University, Jilin 130031, China
| | - Fuqiang Li
- School of Pharmacy, Changchun University of Chinese Medicine, Jilin 130117, China
| | - Yana Li
- School of Life Sciences, Jilin University, Jilin 130012, China.,Department of Ophthalmology and Otorhinolaryngology, Changchun Children's Hospital, Jilin 130061, China
| | - Fei Wang
- School of Life Sciences, Jilin University, Jilin 130012, China
| | - Yong Cai
- School of Life Sciences, Jilin University, Jilin 130012, China.,School of Pharmacy, Changchun University of Chinese Medicine, Jilin 130117, China
| | - Jingji Jin
- School of Life Sciences, Jilin University, Jilin 130012, China.,School of Pharmacy, Changchun University of Chinese Medicine, Jilin 130117, China
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Neighborhood context and non-small cell lung cancer outcomes in Florida non-elderly patients by race/ethnicity. Lung Cancer 2020; 142:20-27. [PMID: 32062478 DOI: 10.1016/j.lungcan.2020.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/19/2019] [Accepted: 01/11/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the relationship between neighborhood environment and lung cancer outcomes among Florida residents younger than 65 years of age. METHODS AND MATERIALS This was a retrospective cohort study that included patients diagnosed with non-small cell lung cancer (NSCLC) in Florida from January 2005 to December 2014 (n = 22,750). Multi-level, mixed-effect logistic regression models were used for two outcomes: receipt of treatment and receipt of surgery. Survival analyses, using proportional subdistribution hazard models, were conducted to examine the impact of neighborhood characteristics on risk of death due to lung cancer with adjustment for individual-level variables. Neighborhood exposures of interest were census tract level black and Hispanic segregation combined with economic deprivation. RESULTS White patients who lived in low black segregation/high deprivation areas had 15 % lower odds of receiving surgery (95 % CI: 0.76-0.93). However, the likelihood of receiving surgery for black patients who lived in high black segregation/low deprivation and high black segregation/high deprivation was lower than for black patients who lived in low black segregation/low deprivation neighborhoods (level 3 AOR = 0.56 [0.38-0.85]; level 4 AOR = 0.69 [0.54-0.88]). Living in suburban and rural areas increased the risk of lung cancer death for white patients by 14 % (95 % CI: 1.05-1.24) and 26 % (95 % CI: 1.08-1.46), respectively. Living in rural areas increased the risk of death for black patients by 54 % r (SHR = 1.54 [1.19-2.0]). Black patients who live in high Hispanic segregation/high deprivation had 36 % increased risk of death compared to black patients who lived in low Hispanic segregation/low deprivation areas. CONCLUSION This study suggests that when investigating cancer disparities, merely adjusting for race/ethnicity does not provide sufficient explanation to understand survival and treatment variations. Lung cancer outcomes are impacted by neighborhood environments that are formed based on the distribution of race, ethnicity and class.
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Mathes J, Rausch S, Todenhöfer T, Stenzl A. Trimodal therapy for muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2018; 18:1219-1229. [DOI: 10.1080/14737140.2018.1535314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joachim Mathes
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University of Tübingen, Tübingen, Germany
| | | | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
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Van Every MJ, Dancik G, Paramesh V, Gurda GT, Meier DR, Cash SE, Richmond CS, Guin S. Genomic case report of a low grade bladder tumor metastasis to lung. BMC Urol 2018; 18:74. [PMID: 30176882 PMCID: PMC6122771 DOI: 10.1186/s12894-018-0386-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/16/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND We present a rare case where distant metastasis of a low grade bladder tumor was observed. We carried out detailed genomic analysis and cell based experiments on patient tumor samples to study tumor evolution, possible cause of disease and provide personalized treatment strategies. CASE PRESENTATION A man with a smoking history was diagnosed with a low-grade urothelial carcinoma of the bladder and a concurrent high-grade upper urinary tract tumor. Seven years later he had a lung metastasis. We carried out exome sequencing on all the patient's tumors and peripheral blood (germline) to identify somatic variants. We constructed a phylogenetic tree to capture how the tumors are related and to identify somatic changes important for metastasis. Although distant metastasis of low-grade bladder tumor is rare, the somatic variants in the tumors and the phylogenetic tree showed that the metastasized tumor had a mutational profile most similar to the low grade urothelial carcinoma. The primary and the metastatic tumors shared several important mutations, including in the KMT2D and the RXRA genes. The metastatic tumor also had an activating MTOR mutation, which may be important for tumor metastasis. We developed a mutational signature to understand the biologic processes responsible for tumor development. The mutational signature suggests that the tumor mutations are associated with tobacco carcinogen exposure, which is concordant with the patient's smoking history. We cultured cells from the lung metastasis to examine proliferation and signaling mechanisms in response to treatment. The mTOR inhibitor Everolimus inhibited downstream mTOR signaling and induced cytotoxicity in the metastatic tumor cells. CONCLUSION We used genomic analysis to examine a rare case of low grade bladder tumor metastasis to distant organ (lung). Our analysis also revealed exposure to carcinogens found is tobacco as a possible cause in tumor development. We further validated that the patient might benefit from mTOR inhibition as a potential salvage therapy in an adjuvant or recurrent disease setting.
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Affiliation(s)
- Marvin J. Van Every
- Department of Urology, Gundersen Health System, 1900 South Ave, La Crosse, WI 54601 USA
| | - Garrett Dancik
- Department of Mathematics and Computer Science, Eastern Connecticut State University, 83 Windham Street, Willimantic, CT 06226 USA
| | - Venki Paramesh
- Department of Cardiothoracic Surgery, Gundersen Health System, 1900 South Ave, La Crosse, WI 54601 USA
| | - Grzegorz T. Gurda
- Department of Pathology, Gundersen Health System, 1900 South Ave, La Crosse, WI 54601 USA
- Gundersen Medical Foundation, 1300 Badger Street, La Crosse, WI 54601 USA
| | - David R. Meier
- Gundersen Medical Foundation, 1300 Badger Street, La Crosse, WI 54601 USA
| | - Steven E. Cash
- Gundersen Medical Foundation, 1300 Badger Street, La Crosse, WI 54601 USA
| | - Craig S. Richmond
- Gundersen Medical Foundation, 1300 Badger Street, La Crosse, WI 54601 USA
| | - Sunny Guin
- Gundersen Medical Foundation, 1300 Badger Street, La Crosse, WI 54601 USA
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Park J, Shin DW, Kim TH, Jung SI, Nam JK, Park SC, Hong S, Jung JH, Kim H, Kim WT. Development and Validation of the Korean Version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Patients with Non-muscle Invasive Bladder Cancer: EORTC QLQ-NMIBC24. Cancer Res Treat 2017; 50:40-49. [PMID: 28279061 PMCID: PMC5784644 DOI: 10.4143/crt.2016.594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 02/15/2017] [Indexed: 12/20/2022] Open
Abstract
Purpose We aimed to evaluate psychometric properties of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-NMIBC24 when applied to Korean non-muscle invasive bladder cancer (NMIBC) patients. Materials and Methods A total of 249 patients who underwent curative transurethral resection of bladder tumor (TURBT) for primary or recurrent NMIBC were asked to complete the Korean version of EORTC QLQ-C30 and -NMIBC24 questionnaires three times (preoperative, post-TURBT 3 months and 6 months). Linguistic validation and psychometric evaluation of the questionnaire was conducted. Results Multitrait scaling analysis confirmed satisfactory construct validity in five scales except the malaise scale. Internal consistency was good (Cronbach’s alpha ≥ 0.70) for the five scales except the malaise scale at the all three time points. Known-group comparison analyses showed better quality-of-life (QOL) scores in patients with higher performance status as expected, and better sexual function in men than women (p < 0.05). Most of the scales had low correlations (< 0.40) with the scales in QLQ-C30 showing divergent validity, except for malaise scale which showed higher correlations (0.42 to 0.60). Responsiveness to change was consistent with clinical implications over time after TURBT. Conclusion The Korean version of the EORTC QLQ-NMIBC24 has good reliability and cross-cultural validity for measuring various QOL aspects that can be self-administered to Korean NMIBC patients undergoing TURBT.
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Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Chol Park
- Department of Urology, Wonkwang University School of Medicine, Iksan, Korea
| | - Sungwoo Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hongwook Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, Korea
| | - Won Tae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
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Lee MS, Lee J, Kim JH, Kim WT, Kim WJ, Ahn H, Park J. Overexpression of caldesmon is associated with tumor progression in patients with primary non-muscle-invasive bladder cancer. Oncotarget 2016; 6:40370-84. [PMID: 26430961 PMCID: PMC4741901 DOI: 10.18632/oncotarget.5458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/15/2015] [Indexed: 12/15/2022] Open
Abstract
The expression and function of caldesmon (CAD) in urothelial bladder carcinoma (BC) have not been reported. Here, we investigated the expression, prognostic value, and potential functional mechanism of CAD in primary non-muscle-invasive bladder cancer (NMIBC). Protein profiling of tissue samples using antibody microarrays showed significantly higher CAD expression in muscle-invasive BC tissues compared with NMIBC tissues. We then validated the CAD expression in BC cells by immunohistochemistry analysis using paraffin-embedded tissue blocks and western blots using BC cell lines. In addition, we examined the expression of CAD variants by reverse transcription-polymerase chain reaction, and confirmed the expression of low-molecular-weight isoforms (L-CAD), specifically encoded by WI-38 L-CAD II (transcript variant 2), in BC cells. Survival analysis in an independent primary NMIBC cohort comprising 132 patients showed that positive CAD expression was significantly associated with poorer prognosis than no CAD expression with regard to recurrence- and progression-free survival (p = 0.001 and 0.014, respectively). Multivariate analyses further indicated that positive CAD expression was an independent predictor of progression-free survival (p = 0.032; HR = 5.983). Data obtained from in vitro silencing and overexpression studies indicated that L-CAD promotes migration and invasiveness of BC cells. Immunofluorescence assays showed dramatic structural changes in the actin cytoskeleton of BC cells after L-CAD overexpression. Our findings collectively suggest that L-CAD overexpression in primary NMIBC is significantly associated with tumor progression and that a possible mechanism for L-CAD's activity is implicated in increased cell motility and invasive characteristics through morphological changes in BC cells.
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Affiliation(s)
- Myung-Shin Lee
- Department of Microbiology and Immunology, Eulji University School of Medicine, Daejeon, South Korea
| | - Jisu Lee
- Department of Microbiology and Immunology, Eulji University School of Medicine, Daejeon, South Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, South Korea
| | - Won Tae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Wun-Jae Kim
- Department of Urology, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, South Korea
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Li J, Zhuang C, Liu Y, Chen M, Chen Y, Chen Z, He A, Lin J, Zhan Y, Liu L, Xu W, Zhao G, Guo Y, Wu H, Cai Z, Huang W. Synthetic tetracycline-controllable shRNA targeting long non-coding RNA HOXD-AS1 inhibits the progression of bladder cancer. J Exp Clin Cancer Res 2016; 35:99. [PMID: 27328915 PMCID: PMC4915162 DOI: 10.1186/s13046-016-0372-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/08/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long non-coding RNAs (lncRNAs) have been proved to act as key molecules in cancer development and progression. Dysregulation of lncRNAs is discovered in various tumor tissues and cancer cells where they can serve as oncogenes or tumor suppressors. Long non-coding RNA HOXD-AS (HOXD cluster antisense RNA 1) has recently been identified to be involved in the development of several cancers including neuroblastoma, adenocarcinomas and breast cancer. However, the role of HOXD-AS1 in bladder cancer remains unknown. METHODS The synthetic tetracycline-controllable shRNA was used to modulate the level of HOXD-AS1 by adding different concentrations of doxycycline (dox). RT-qPCR was used to detect the expression level of HOXD-AS1. Cell proliferation was determined by CCK-8 assay and EdU incorporation experiment when HOXD-AS1 was knocked down. We used wound-healing assay for detecting the effect of HOXD-AS1 on cell migration. Eventually, cell apoptosis was determined by caspase 3 ELISA assay and flow cytometry assay. RESULTS In this study, we found that the expression level of HOXD-AS1 was significantly increased in bladder cancer tissues and cells. Furthermore, high expression of HOXD-AS1 was significantly related to tumor size, histological grade and TNM stage. In vitro assays confirmed that knockdown of HOXD-AS1 suppressed cell proliferation/migration and increased the rate of apoptotic cell in bladder cancer cells. At last, we used the important element of synthetic biology, tetracycline(tet)-controllable switch, to construct tet-controllable shRNA vectors which can modulate the expression of HOXD-AS1 in a dosage-dependent manner. CONCLUSIONS Our research suggested that high expression of HOXD-AS1 may be involved in the bladder cancer carcinogenesis through inhibiting the phenotypes and activating endogenous cancer-related molecular pathways. Therefore, HOXD-AS1 may act as an oncogene and provide a potential attractive therapeutic target for bladder cancer. In addition, the synthetic tetracycline-controllable shRNA may provide a novel method for cancer research in vitro assays.
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Affiliation(s)
- Jianfa Li
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Chengle Zhuang
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
- Guangdong and Shenzhen Key Laboratory of Male Reproductive Medicine and Genetics, Institute of Urology, Peking University Shenzhen Hospital, Shenzhen PKU-HKUST Medical Center, Shenzhen, 518036, People's Republic of China
| | - Yuchen Liu
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
| | - Mingwei Chen
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Anhui Medical University, Hefei, 230000, Anhui Province, People's Republic of China
| | - Yincong Chen
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Zhicong Chen
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Anbang He
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Anhui Medical University, Hefei, 230000, Anhui Province, People's Republic of China
| | - Junhao Lin
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Yonghao Zhan
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Li Liu
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China
| | - Wen Xu
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
| | - Guoping Zhao
- Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Centerat Shanghai, Shanghai, 200000, People's Republic of China
| | - Yinglu Guo
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China
| | - Hanwei Wu
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China
| | - Zhiming Cai
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China.
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China.
- Anhui Medical University, Hefei, 230000, Anhui Province, People's Republic of China.
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China.
| | - Weiren Huang
- Key Laboratory of Medical Reprogramming Technology, Shenzhen Second People's Hospital, Clinical Institute of Shantou University Medical College, First Affiliated Hospital of Shenzhen University, Shenzhen, 518039, Guangdong Province, People's Republic of China.
- Shantou University Medical College, Shantou, 515041, Guangdong Province, People's Republic of China.
- Anhui Medical University, Hefei, 230000, Anhui Province, People's Republic of China.
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China.
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Cui J, Wang W, Chen S, Chen P, Yang Y, Guo Y, Zhu Y, Chen F, Shi B. Combination of Intravesical Chemotherapy and Bacillus Calmette-Guerin Versus Bacillus Calmette-Guerin Monotherapy in Intermediate- and High-risk Nonmuscle Invasive Bladder Cancer: A Systematic Review and Meta-analysis. Medicine (Baltimore) 2016; 95:e2572. [PMID: 26817914 PMCID: PMC4998288 DOI: 10.1097/md.0000000000002572] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Urothelial carcinoma of the bladder has become a major cause of morbidity, mortality, and health-related costs. There is still no standard instillation therapy against bladder cancer. A meta-analysis was conducted to evaluate the efficacy and toxicity of adding chemotherapy to Bacillus Calmette-Guerin (BCG) in intermediate- and high-risk nonmuscle invasive bladder cancer (NMIBC).All randomized controlled trials (RCTs) that evaluated the efficacy of combination therapy and BCG monotherapy for intermediate- and high-risk NMIBC were comprehensively searched. Relevant databases, including PubMed, Embase, Cochrane Central Register of Controlled trials databases, and American Society of Clinical Oncology (http://www.asco.org/ASCO), the clinical trial registration website (ClinicalTrials.gov), and relevant trials from the references of selected studies were searched from initial state up to June 6, 2015. Random-effects model was used to estimate hazard ratios (HRs) statistics. All statistical analyses were performed by STATA (version 13.0, College Station, TX).Seven studies, including 1373 patients with intermediate- and high-risk NMIBC, were identified. For disease-free survival, the pooled HRs from all studies was 0.69 (95% confidence interval [CI], 0.48-1.00; P = 0.048). The disease-free survival benefit was more apparent among patients with intermediate-risk NMIBC (P = 0.002) or Ta/T1 with/without carcinoma in situ (P < 0.01). In subgroup analysis, a significant reduction in recurrence was found in studies that explored the influence of a perioperative single dose instillation compared with delayed BCG monotherapy (HR = 0.60; 95% CI, 0.38-0.92; P = 0.021). No significant difference was found for progression-free survival (HR = 0.78; 95% CI, 0.43-1.44; P = 0.435).Patients with intermediate- and high-risk NMIBC who underwent combination therapy achieved lower rates of recurrence than those who underwent BCG therapy alone. No difference in progression-free survival was found between the 2 different therapy schedules. Better efficacy for a perioperative single dose instillation compared with delayed BCG monotherapy was found in this meta-analysis.
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Affiliation(s)
- Jianfeng Cui
- From the Department of Urology, Qilu Hospital of Shandong University (JC, SC, YY, YZ, FC, BS); Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University (WW); Department of Radiation Oncology, Qilu Hospital of Shandong University (PC); and Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, People's Republic of China (YG)
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Bladder Cancer Mortality in the United States: A Geographic and Temporal Analysis of Socioeconomic and Environmental Factors. J Urol 2015; 195:290-6. [PMID: 26235377 DOI: 10.1016/j.juro.2015.07.091] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We assessed the association of temporal, socioeconomic and environmental factors with bladder cancer mortality in the United States. Our hypothesis was that bladder cancer mortality is associated with distinct environmental and socioeconomic factors with effects varying by region, race and gender. MATERIALS AND METHODS NCI (National Cancer Institute) age adjusted, county level bladder cancer mortality data from 1950 to 2007 were analyzed to identify clusters of increased bladder cancer death using the Getis-Ord Gi* statistic. Socioeconomic, clinical and environmental data were assessed using geographically weighted spatial regression analysis adjusting for spatial autocorrelation. County level socioeconomic, clinical and environmental data were obtained from national databases, including the United States Census, CDC (Centers for Disease Control and Prevention), NCHS (National Center for Health Statistics) and County Health Rankings. RESULTS Bladder cancer mortality hot spots and risk factors for bladder cancer death differed significantly by gender, race and geographic region. From 1996 to 2007 smoking, unemployment, physically unhealthy days, air pollution ozone days, percent of houses with well water, employment in the mining industry and urban residences were associated with increased rates of bladder cancer mortality (p <0.05). Model fit was significantly improved in hot spots compared to all American counties (R(2) = 0.20 vs 0.05). CONCLUSIONS Environmental and socioeconomic factors affect bladder cancer mortality and effects appear to vary by gender and race. Additionally there were temporal trends of bladder cancer hot spots which, when persistent, should be the focus of individual level studies of occupational and environmental factors.
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DeSantis CE, Lin CC, Mariotto AB, Siegel RL, Stein KD, Kramer JL, Alteri R, Robbins AS, Jemal A. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014; 64:252-71. [PMID: 24890451 DOI: 10.3322/caac.21235] [Citation(s) in RCA: 2120] [Impact Index Per Article: 212.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022] Open
Abstract
The number of cancer survivors continues to increase due to the aging and growth of the population and improvements in early detection and treatment. In order for the public health community to better serve these survivors, the American Cancer Society and the National Cancer Institute collaborated to estimate the number of current and future cancer survivors using data from the Surveillance, Epidemiology, and End Results (SEER) program registries. In addition, current treatment patterns for the most common cancer types are described based on information in the National Cancer Data Base and the SEER and SEER-Medicare linked databases; treatment-related side effects are also briefly described. Nearly 14.5 million Americans with a history of cancer were alive on January 1, 2014; by January 1, 2024, that number will increase to nearly 19 million. The 3 most common prevalent cancers among males are prostate cancer (43%), colorectal cancer (9%), and melanoma (8%), and those among females are cancers of the breast (41%), uterine corpus (8%), and colon and rectum (8%). The age distribution of survivors varies substantially by cancer type. For example, the majority of prostate cancer survivors (62%) are aged 70 years or older, whereas less than one-third (32%) of melanoma survivors are in this older age group. It is important for clinicians to understand the unique medical and psychosocial needs of cancer survivors and to proactively assess and manage these issues. There are a growing number of resources that can assist patients, caregivers, and health care providers in navigating the various phases of cancer survivorship.
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Affiliation(s)
- Carol E DeSantis
- Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Ravi P, Bianchi M, Hansen J, Trinh QD, Tian Z, Meskawi M, Abdollah F, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI, Sun M. Benefit in regionalisation of care for patients treated with radical cystectomy: a nationwide inpatient sample analysis. BJU Int 2013; 113:733-40. [DOI: 10.1111/bju.12288] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Praful Ravi
- West Middlesex University Hospital; London UK
| | - Marco Bianchi
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal QC Canada
- Department of Urology; Urologic Research Institute; Vita-Salute San Raffaele University; Milan Italy
| | - Jens Hansen
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal QC Canada
- Martini-Klinic; Prostate Cancer Center Hamburg-Eppendorf; Hamburg Germany
| | - Quoc-Dien Trinh
- Division of Urology; Brigham and Women's Hospital/Dana Farber Cancer Institute; Harvard Medical School; Boston MA USA
- Center for Surgery and Public Health; Brigham and Women's Hospital and Harvard School of Public Health; Boston MA USA
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal QC Canada
| | - Malek Meskawi
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal QC Canada
| | - Firas Abdollah
- Department of Urology; Urologic Research Institute; Vita-Salute San Raffaele University; Milan Italy
| | - Alberto Briganti
- Department of Urology; Urologic Research Institute; Vita-Salute San Raffaele University; Milan Italy
| | - Shahrokh F. Shariat
- Department of Urology; Weill Medical College of Cornell University; New York NY USA
| | - Paul Perrotte
- Department of Urology; University of Montreal Health Center; Montreal QC Canada
| | - Francesco Montorsi
- Department of Urology; Urologic Research Institute; Vita-Salute San Raffaele University; Milan Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal QC Canada
- Department of Urology; University of Montreal Health Center; Montreal QC Canada
| | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Center; Montreal QC Canada
- Department of Public Health; Faculty of Medicine; University of Montreal; Montreal QC Canada
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Parsons JK, Pierce JP, Natarajan L, Newman VA, Barbier L, Mohler J, Rock CL, Heath DD, Guru K, Jameson MB, Li H, Mirheydar H, Holmes MA, Marshall J. A randomized pilot trial of dietary modification for the chemoprevention of noninvasive bladder cancer: the dietary intervention in bladder cancer study. Cancer Prev Res (Phila) 2013; 6:971-8. [PMID: 23867158 PMCID: PMC3857028 DOI: 10.1158/1940-6207.capr-13-0050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Epidemiological data suggest robust associations of high vegetable intake with decreased risks of bladder cancer incidence and mortality, but translational prevention studies have yet to be conducted. We designed and tested a novel intervention to increase vegetable intake in patients with noninvasive bladder cancer. We randomized 48 patients aged 50 to 80 years with biopsy-proven noninvasive (Ta, T1, or carcinoma in situ) urothelial cell carcinoma to telephone- and Skype-based dietary counseling or a control condition that provided print materials only. The intervention behavioral goals promoted seven daily vegetable servings, with at least two of these as cruciferous vegetables. Outcome variables were self-reported diet and plasma carotenoid and 24-hour urinary isothiocyanate (ITC) concentrations. We used two-sample t tests to assess between-group differences at 6-month follow-up. After 6 months, intervention patients had higher daily intakes of vegetable juice (P = 0.02), total vegetables (P = 0.02), and cruciferous vegetables (P = 0.07); lower daily intakes of energy (P = 0.007), fat (P = 0.002) and energy from fat (P = 0.06); and higher plasma α-carotene concentrations (P = 0.03). Self-reported cruciferous vegetable intake correlated with urinary ITC concentrations at baseline (P < 0.001) and at 6 months (P = 0.03). Although urinary ITC concentrations increased in the intervention group and decreased in the control group, these changes did not attain between-group significance (P = 0.32). In patients with noninvasive bladder cancer, our novel intervention induced diet changes associated with protective effects against bladder cancer. These data show the feasibility of implementing therapeutic dietary modifications to prevent recurrent and progressive bladder cancer.
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Affiliation(s)
- J Kellogg Parsons
- Division of Urologic Oncology, Moores UCSD Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093-0987, USA.
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Abdollah F, Gandaglia G, Thuret R, Schmitges J, Tian Z, Jeldres C, Passoni NM, Briganti A, Shariat SF, Perrotte P, Montorsi F, Karakiewicz PI, Sun M. Incidence, survival and mortality rates of stage-specific bladder cancer in United States: A trend analysis. Cancer Epidemiol 2013; 37:219-25. [DOI: 10.1016/j.canep.2013.02.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 10/27/2022]
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Gray PJ, Fedewa SA, Shipley WU, Efstathiou JA, Lin CC, Zietman AL, Virgo KS. Use of potentially curative therapies for muscle-invasive bladder cancer in the United States: results from the National Cancer Data Base. Eur Urol 2012. [PMID: 23200811 DOI: 10.1016/j.eururo.2012.11.015] [Citation(s) in RCA: 183] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Despite its lethal potential, many patients with muscle-invasive bladder cancer (MIBC) do not receive aggressive, potentially curative therapy consistent with established practice standards. OBJECTIVE To characterize the treatments received by patients with MIBC and analyze their use according to sociodemographic, clinical, pathologic, and facility measures. DESIGN, SETTING, AND PARTICIPANTS Using the National Cancer Data Base, we analyzed 28 691 patients with MIBC (stages II-IV) treated between 2004 and 2008, excluding those with cT4b tumors or distant metastases. Treatments included radical or partial cystectomy with or without chemotherapy (CT), chemoradiotherapy (CRT), radiation therapy (RT), or CT alone and observation following biopsy. Aggressive therapy (AT) was defined as radical or partial cystectomy or definitive RT/CRT (total dose ≥ 50 Gy). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS AT use and correlating variables were assessed by multivariable, generalized estimating equation models adjusted for facility clustering. RESULTS AND LIMITATIONS According to the database, 52.5% of patients received AT; 44.9% were treated surgically, 7.6% received definitive CRT or RT, and 25.9% of patients received observation only. AT use decreased with advancing age (odds ratio [OR]: 0.34 for age 81-90 yr vs ≤ 50 yr; p<0.001). AT use was also lower in racial minorities (OR: 0.74 for black race; p<0.001), the uninsured (OR: 0.73; p<0.001), Medicaid-insured patients (OR: 0.81; p=0.01), and at low-volume centers (OR: 0.64 vs high-volume centers; p<0.001). Use of AT was higher with increasing tumor stage (OR: 2.23 for T3/T4a vs T2; p<0.001) and nonurothelial histology (OR: 1.25 and 1.43 for squamous and adenocarcinoma, respectively; p<0.001). Study limitations include retrospective design and lack of information about patient and provider motivations regarding therapy selection. CONCLUSIONS AT for MIBC appears underused, especially in the elderly and in groups with poor socioeconomic status. These data point to a significant unmet need to inform policy makers, payers, and physicians regarding appropriate therapies for MIBC.
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Affiliation(s)
- Phillip J Gray
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
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Schned AR, Lenz P, Moore LE, Johnson A, Jones M, Kida M, Silverman DT, Schwenn M, Kelsey KT, Andrew AS, Baris D, Karagas MR. Analysis of the Distribution and Temporal Trends of Grade and Stage in Urothelial Bladder Cancer in Northern New England from 1994 to 2004. ACTA ACUST UNITED AC 2012; 2012. [PMID: 24683496 DOI: 10.5402/2012/283670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We investigate the distribution of bladder tumor category and stage in Northern New England by geographic region, smoking status and over time. 1091 incident bladder cancer cases from the New England Bladder Cancer Study (NEBCS), a large population-based case-control study carried out in Maine, New Hampshire and Vermont (2001-2004), and 680 bladder cancer cases from previous case-control studies in New Hampshire (1994-2000) were used in the analysis. Of 1091 incident bladder cancer cases from the NEBCS, 26.7% of tumors were papillary urothelial neoplasms of low malignant potential (PUNLMP), 26.8% low-grade papillary urothelial carcinomas (PUC-LG), 31.3% high-grade papillary urothelial carcinomas (PUC-HG), 9.1% non-papillary urothelial carcinomas (non-PUC), and 4.3% carcinoma in situ (CIS). Approximately 70% of cases were non-invasive (Tis/Ta), and all PUNLMP cases were of the Ta category. By contrast, half of all PUC-HG carcinomas were invasive. Short-term time trend analysis within the NEBCS (2001-2004) indicated an increase in the percentage of PUNLMP (p-trend<0.0001) paralleled by a decrease in PUC-LG (p-trend=0.02), and for PUC-LG an increase in the percentage of non-invasive tumors (p-trend 0.04). Our findings suggest possible short-term trends with an increase in the percentage of PUNLMP and a change in the percentage of PUC-LG towards non-invasive disease.
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Affiliation(s)
- Alan R Schned
- Department of Pathology, Dartmouth Medical School, Hanover, New Hampshire USA
| | - Petra Lenz
- Division of Cancer Epidemiology and Genetics, Science Applications International Corporation-Frederick, Inc., National Cancer Institute-Frederick, Frederick, MD 21702
| | - Lee E Moore
- Occupational and Environmental Epidemiology Branch, Epidemiology and Biostatistics Program, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | | | - Michael Jones
- Department of Pathology and Laboratory Medicine, Maine Medical Center Portland, Maine, USA
| | - Masatoshi Kida
- Department of Pathology, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Epidemiology and Biostatistics Program, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | | | - Karl T Kelsey
- Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island, USA
| | - Angeline S Andrew
- Section of Biostatistics and Epidemiology, Dartmouth Medical School, Hanover, New Hampshire USA
| | - Dalsu Baris
- Occupational and Environmental Epidemiology Branch, Epidemiology and Biostatistics Program, National Cancer Institute, NIH, DHHS, Bethesda, Maryland, USA
| | - Margaret R Karagas
- Section of Biostatistics and Epidemiology, Dartmouth Medical School, Hanover, New Hampshire USA
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Kiriluk KJ, Prasad SM, Patel AR, Steinberg GD, Smith ND. Bladder cancer risk from occupational and environmental exposures. Urol Oncol 2012; 30:199-211. [DOI: 10.1016/j.urolonc.2011.10.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 10/21/2011] [Accepted: 10/23/2011] [Indexed: 12/20/2022]
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Hispanic ethnicity and fatal fall risk: do age, gender, and community modify the relationship? J Surg Res 2011; 175:113-7. [PMID: 21529828 DOI: 10.1016/j.jss.2011.02.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 02/04/2011] [Accepted: 02/18/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hispanic ethnicity is associated with a reduced risk of fatal falls in the elderly despite lower socioeconomic standing. The factors responsible for this "Hispanic paradox" are unknown. We hypothesized that age and gender would modify this relationship and that the association would be accentuated in a community with prominent Hispanic culture. MATERIALS AND METHODS The number of fatal falls in a 3-year period in the United States (US) and in Miami-Dade County, Florida (MDC) were obtained through the CDC's WISQARS database and the Florida Office of Vital Statistics. US Census Bureau data were used to define the total at-risk populations by age group and gender. Age group- and gender-specific ratios of the risk of fatal fall in Hispanic to white non-Hispanic individuals were calculated. RESULTS In the US and MDC, Hispanic ethnicity was associated with a reduced risk of fatal fall across all age and gender subgroups. In the US, the risk reduction associated with Hispanic ethnicity grew from 11% and 23% in 65- to 74-year-old men and women, respectively, to 43% for both men and women over 84-years-old. This relationship was stronger in MDC than nationally in five of the six age and gender subgroups examined. CONCLUSIONS Older individuals, women, and residents of communities with prominent Hispanic culture have the greatest reduction in fatal fall risk associated with Hispanic ethnicity.
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Fedeli U, Fedewa SA, Ward EM. Treatment of Muscle Invasive Bladder Cancer: Evidence From the National Cancer Database, 2003 to 2007. J Urol 2011; 185:72-8. [DOI: 10.1016/j.juro.2010.09.015] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Ugo Fedeli
- Epidemiological Department, Veneto Region, Castelfranco Veneto, Italy
| | - Stacey A. Fedewa
- Department of Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia
| | - Elizabeth M. Ward
- Department of Surveillance and Health Policy Research, American Cancer Society, Atlanta, Georgia
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Resnick MJ, Bergey M, Magerfleisch L, Tomaszewski JE, Malkowicz SB, Guzzo TJ. Longitudinal evaluation of the concordance and prognostic value of lymphovascular invasion in transurethral resection and radical cystectomy specimens. BJU Int 2010; 107:46-52. [DOI: 10.1111/j.1464-410x.2010.09635.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brookfield KF, Cheung MC, Gomez C, Yang R, Nieder AM, Lee DJ, Koniaris LG. Survival disparities among African American women with invasive bladder cancer in Florida. Cancer 2009; 115:4196-209. [DOI: 10.1002/cncr.24497] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bladder Cancer Clusters in Florida: Identifying Populations at Risk. J Urol 2009; 182:46-50; discussion 51. [DOI: 10.1016/j.juro.2009.02.149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 11/19/2022]
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David KA, Mallin K, Milowsky MI, Ritchey J, Carroll PR, Nanus DM. Surveillance of urothelial carcinoma: stage and grade migration, 1993-2005 and survival trends, 1993-2000. Cancer 2009; 115:1435-47. [PMID: 19215030 DOI: 10.1002/cncr.24147] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous investigators have detected shifts to lower stages at diagnosis for renal cell carcinoma and prostate cancer. The authors investigated whether a similar pattern is seen for urothelial carcinomas of the bladder, ureter, and renal pelvis and sought to identify changes in cancer grade and survival trends from 1993 to 2005. METHODS The National Cancer Data Base (NCDB) collects data on approximately 75% of all newly diagnosed cancer cases annually. The authors queried the database for cases of urothelial carcinomas diagnosed in 1993-2005 in patients aged 18 years and older. All cancer stage data were forward converted to the sixth edition of the American Joint Committee on Cancer staging definitions. RESULTS A total of 334,480 bladder cancer cases, 15,105 renal pelvis cancer cases, and 10,128 ureteral carcinoma cases were identified. Stage data were available for 84% of bladder cases, 83% of renal pelvis cases, and 82% of ureter cases. With the classification of early stage tumors as stage 0a, 0is, and I and late stage tumors as II, III, and IV, the percentage of early stage renal pelvis and ureter tumors increased slightly from 1993 to 2005, whereas no stage migration was seen in bladder tumors. In looking specifically at early stage tumors, a significant increase in the proportion of stage 0a and a significant decrease in the proportion of stage I tumors for each cancer site was seen between 1993 and 2005. The proportion of high grade tumors in each disease site significantly increased from 1993 to 2005. For cases diagnosed in 1993-1996 and 1997-2000, a significant decrease in 5-year relative survival was observed for patients with stage I and stage II bladder cancer. The absolute change, however, was relatively small, and for bladder cases was not significantly different when adjusted for low or high grade tumors. CONCLUSIONS When differentiating between early and late stage tumors, a slight stage migration was seen in renal pelvis and ureteral carcinomas, whereas no stage migration was seen in bladder tumors. Within early stage tumors of all sites, a stage shift was seen, most notably with the proportion of stage 0a tumors increasing and stage I tumors decreasing. The proportion of high grade tumors in all sites increased. No change in overall survival was observed, underscoring the need for new therapeutic advances.
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Affiliation(s)
- Kevin A David
- Department of Medicine, Weill Cornell Medical College of Cornell University, New York, New York, USA
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Canter D, Guzzo TJ, Resnick MJ, Bergey MR, Sonnad SS, Tomaszewski J, VanArsdalen K, Malkowicz SB. A thorough pelvic lymph node dissection in presence of positive margins associated with better clinical outcomes in radical cystectomy patients. Urology 2009; 74:161-5. [PMID: 19371932 DOI: 10.1016/j.urology.2009.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 12/08/2008] [Accepted: 01/04/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the effect of positive surgical margins in patients with muscle-invasive transitional cell carcinoma of the bladder on survival. METHODS A retrospective evaluation of a prospectively maintained radical cystectomy database consisting of the data from 344 patients was performed. Cox regression analysis was done, and Kaplan-Meier tables were developed to evaluate the contribution of this finding to clinical outcomes. RESULTS A total of 304 (88.4%) patients had negative surgical margins in the radical cystectomy specimen, and 40 (11.6%) had positive surgical margins. On univariate analysis, positive surgical margins conferred a significant risk of poorer clinical outcomes. The 5-year overall (OS) and disease-specific survival (DSS) rate was 9% and 18% for patients with positive margins compared with 48% and 65% for patients with negative margins, respectively. The multivariate analysis demonstrated a significant independent risk of decreased recurrence-free survival, DSS, and OS for patients with positive surgical margins. The corresponding hazard ratios were 2.29 (95% confidence interval 1.54-3.41, P < .001), 1.71 (95% confidence interval 1.15-2.56, P < .009), and 1.70 (95% confidence interval 1.23-2.34, P < .001). Despite these findings, patients with positive margins and node-negative disease experienced improved DSS and recurrence-free survival (P = .001 P and = .009, respectively) if >15 lymph nodes were removed during surgery. CONCLUSIONS The presence of positive surgical margins in the pathologic specimen confers a significant independent risk of reduced recurrence-free survival, DSS, and overall survival. Nevertheless, patients with positive surgical margins will still benefit from a meticulous pelvic lymph node dissection.
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Affiliation(s)
- Daniel Canter
- Department of Surgery, Division of Urology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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Canter D, Guzzo T, Resnick M, Magerfleisch L, Sonnad S, Bergey M, Tomazewski J, Vaughn D, Van Arsdalen K, Malkowicz B. The presence of lymphovascular invasion in radical cystectomy specimens from patients with urothelial carcinoma portends a poor clinical prognosis. BJU Int 2008; 102:952-7. [DOI: 10.1111/j.1464-410x.2008.07732.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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