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Abstract
PURPOSE OF REVIEW To review the epidemiology, diagnosis, and management of all stages of bladder cancer with an emphasis on studies published within the last year. RECENT FINDINGS Smoking continues to be the most important risk factor for the development of bladder cancer, and this risk has increased over time. Although a number of urinary markers for bladder cancer are now approved by the Food and Drug Administration, there is not enough evidence that any marker can replace surveillance cystoscopy. Management of high-risk patients with nonmuscle-invasive cancer remains a challenge, with continued controversy over which patients may safely be treated with bladder-sparing regimens. Efforts toward developing agents for bacillus Calmette-Guerin-refractory superficial bladder cancer continue, however, none to date have shown high rates of long-term success. In patients undergoing cystectomy, reports using more standardized measures of complications have demonstrated high rates of postoperative morbidity and mortality, particularly in elderly individuals. Robot-assisted radical cystectomy is being more widely studied as a potential approach to decrease operative blood loss and shorten recovery. Although more expensive, increasing evidence suggests that it is well tolerated, does not increase the risk of positive surgical margins, and can achieve similar lymph node counts as open cystectomy in experienced hands and with careful patient selection. Despite level I evidence supporting the use of neoadjuvant chemotherapy, there remains disagreement regarding its use vs. selective adjuvant therapy, given the modest benefits seen with current regimens. SUMMARY Progress continues in bladder cancer diagnosis and management, and we anticipate that future work will further advance the care of patients with this disease.
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Abstract
In the last few years, angiogenesis has confirmed its critical role in the development of malignant neoplasms. Antiangiogenic drugs, mainly bevacizumab, sorafenib, or sunitinib, are currently approved in a wide number of tumor types, such as breast, colorectal, liver, or kidney cancer, and have changed dramatically the evolution of our patients. Unfortunately, in urothelial carcinoma, which is a very common neoplasm, antiangiogenic agents are still in a very preliminary phase of clinical research. In this study, we focus on the biological basis of angiogenesis in urothelial tumors, its influence in the prognosis of these malignancies, and the available evidence about the use of antiangiogenic drugs in urothelial carcinoma.
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Tickoo SK, Milowsky MI, Dhar N, Dudas ME, Gallagher DJ, Al-Ahmadie H, Gopalan A, Fine SW, Ishill N, Bajorin DF, Reuter VE. Hypoxia-inducible factor and mammalian target of rapamycin pathway markers in urothelial carcinoma of the bladder: possible therapeutic implications. BJU Int 2010; 107:844-849. [PMID: 20707797 DOI: 10.1111/j.1464-410x.2010.09517.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the rationale for using targeted therapies against hypoxia-inducible factor (HIF) and mammalian target of rapamycin (mTOR) pathways in urothelial carcinoma of the bladder, by studying the immunohistochemical expression of molecules of these pathways in urothelial carcinoma, as recent pre-clinical studies and clinical trials have shown the potential utility of such targeted therapies. PATIENTS AND METHODS Immunohistochemical stains were performed on a tissue microarray prepared from 92 cases of ≥ pT2 urothelial (transitional cell) carcinoma of bladder, using antibodies against HIF-1α and VEGF-R2, and phospho-S6 and phospho-4E BP1, molecules of HIF and activated mTOR pathways, respectively. Immunoreactivity was graded from 0 to 3+ (0, 0-5%; 1+, 6-25%; 2+, 26-50%; 3+, > 50% tumour cells positive). RESULTS In all, 58, 34, 35 and 17% of the tumours showed grade 2-3+ expression of phospho-4E BP1, phospho-S6, HIF-1α and VEGF-R2, respectively. Moderate correlation for immunoreactivity was observed between molecules within the same pathway [(phospho-4E BP1 with phospho-S6 (rho = 0.411), and HIF-1α with VEGF-R2 (rho = 0.265)], but not between molecules across pathways. CONCLUSIONS Urothelial carcinomas of the bladder express molecules of the HIF and mTOR pathways, providing a rationale for clinical trials evaluating agents targeting these pathways. Correlation between molecules within the same pathway, and not across pathways, suggests that investigating the usefulness of a specific targeted agent might benefit from pre-treatment evaluation of pathway marker expression.
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Affiliation(s)
- Satish K Tickoo
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Matthew I Milowsky
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Nitin Dhar
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Maria E Dudas
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - David J Gallagher
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Hikmat Al-Ahmadie
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Anuradha Gopalan
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Samson W Fine
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Nicole Ishill
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Dean F Bajorin
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
| | - Victor E Reuter
- Department of PathologyGenitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer CenterWeill Cornell Medical College of Cornell UniversityDepartment of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer, Center, New York, NY, USA
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Amsellem-Ouazana D, Theodore C, Irani J, Bernardini S, Bonnal JL, Chauvet B, Colombel M, Davin JL, Laurent G, Lebret T, Maidenberg M, Mazerolles C, Pfister C, Roupret M, Roy C, Rozet F, Saint F, Soulié M, Guillotreau J. Avancées et synthèse des derniers congrès : ASCO-GU, EAU, AUA, ASCO concernant la prise en charge médicale des cancers urothéliaux. Prog Urol 2010; 20 Suppl 1:S38-40. [DOI: 10.1016/s1166-7087(10)70024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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