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Helal DS, Darwish SA, Awad RA, Ali DA, El-Guindy DM. Immunohistochemical based molecular subtypes of muscle-invasive bladder cancer: association with HER2 and EGFR alterations, neoadjuvant chemotherapy response and survival. Diagn Pathol 2023; 18:11. [PMID: 36737799 PMCID: PMC9896690 DOI: 10.1186/s13000-023-01295-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Muscle-invasive bladder cancers (MIBCs) is a group of molecularly heterogonous diseases that could be stratified into subtypes with distinct clinical courses and sensitivities to chemotherapy. Clinical application of molecular subtypes could help in prediction of neoadjuvant chemotherapy (NAC) responders. Immunohistochemical (IHC) markers such as GATA3, cytokeratin (CK) 5/6, and p53 are associated with these subtypes and are widely available. Human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR) are mutated in multiple cancers including MIBC and are potential therapeutic targets. HER2/EGFR status of MIBC subtypes has not been investigated. Tissue microarrays (TMAs) were constructed from transurethral resection of the bladder tumor (TURB) specimens and stained with GATA3,CK5/6,p53 and HER2 in addition to Quantitative Reverse Transcription PCR for detection of EGFR gene. Of the total cases, 45% were luminal, 36.7% basal and 18.3% p53 wild subtype (p53-WT). Univariate analysis showed that overall survival (OS) and disease-free progression survival (DFS) were significantly longer for luminal subtype. In multivariate analysis, molecular subtype, HER2 status and LV invasion were independent prognostic factors for DFS and OS. Basal subtype showed a significantly better response to NAC. HER2 expression was significantly higher in luminal while EGFR expression was significantly higher in basal subtype. Kaplan-Meier survival curves revealed a significant longer OS and DFS for HER2 negative than positive cases. MIBC can be stratified using a simple IHC panel [GATA3,CK5/6,P53] into clinically relevant prognostic molecular subtypes. Basal tumors are aggressive and respond well to NAC while luminal have better OS. P53-WT tumors are chemoresistant and require further treatments. HER2 and EGFR are potential therapeutic targets for molecular subtypes of MIBC where luminal tumors are more likely to benefit from HER2 and basal from EGFR directed therapies.
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Affiliation(s)
- Duaa S. Helal
- grid.412258.80000 0000 9477 7793Pathology Department, Faculty of Medicine, Tanta University, Tanta, 31527 Egypt
| | - Sara A. Darwish
- grid.412258.80000 0000 9477 7793Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Radwa A. Awad
- grid.412258.80000 0000 9477 7793Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina A. Ali
- grid.412258.80000 0000 9477 7793Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina M. El-Guindy
- grid.412258.80000 0000 9477 7793Pathology Department, Faculty of Medicine, Tanta University, Tanta, 31527 Egypt
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Impact of COVID-19 on Uro-Oncological Patients: A Comprehensive Review of the Literature. Microorganisms 2023; 11:microorganisms11010176. [PMID: 36677468 PMCID: PMC9865028 DOI: 10.3390/microorganisms11010176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Background: The aim of this paper is to discuss the impact of COVID-19 on patients with urological malignancies (prostate cancer, bladder and upper tract urothelial cancer, kidney cancer, penile and testicular cancer) and to review the available recommendations reported in the literature. Methods: A review was performed, through the PubMed database, regarding available recommendations reported in the literature, to identify studies examining the impact of COVID-19 on treatment and clinical outcomes (including upstaging, recurrence, and mortality) for uro-oncological patients. Results: The COVID-19 pandemic dramatically changed the urological guidelines and patients' access to screening programs and follow-up visits. Great efforts were undertaken to guarantee treatments to high-risk patients although follow up was not always possible due to recurrent surges, and patients with lower risk cancers had to wait for therapies. Conclusions: Physically and mentally, uro-oncological patients paid a heavy price during the COVID-19 pandemic. Long term data on the "costs" of clinical decisions made during the COVID-19 pandemic are still to be revealed and analyzed.
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Chen H, Yang W, Xue X, Li Y, Jin Z, Ji Z. Neoadjuvant immunotherapy and chemoimmunotherapy for stage II-III muscle invasive bladder cancer. Front Immunol 2022; 13:986359. [PMID: 36059550 PMCID: PMC9428578 DOI: 10.3389/fimmu.2022.986359] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Considering the striking evidence revealed by immunotherapy in advanced or metastatic bladder cancer, investigators have explored neoadjuvant immunotherapy and chemoimmunotherapy in muscle-invasive bladder cancer (MIBC). Currently, there have been a large number of studies reporting varied efficacy and safety of these approaches. Herein, we pooled the available evidence in terms of oncological outcomes (pathological complete response [pCR] and pathological partial response [pPR]) and safety outcomes (immune-related adverse events [irAEs], treatment-related adverse events [TRAEs]), through a systematic review and meta-analysis. Method We searched PubMed, Embase, Cochrane Library, and American Society of Clinical Oncology meeting abstracts to identify relevant studies up to June 2022. Studies were included if they evaluated the neoadjuvant immunotherapy or chemoimmunotherapy in MIBC and reported at least the pCR. Results A total of 22 records involving 843 patients were included. For pCR of immunotherapy, the pooled rate of immune checkpoint inhibitor (ICI) monotherapy and dual-ICIs therapy was 24% (95% confidence interval [CI]: 15.3% - 32.8%) and 32.1% (95%CI: 20.6% - 43.7%), respectively. For pCR of chemoimmunotherapy, the overall pooled rate was 42.6% (95% CI: 34.9% - 50.2%). Subgroup of gemcitabine/cisplatin (GC) plus ICI had a pCR rate of 41.7% (95%CI: 35.8% - 47.5%). In terms of safety, the pooled rate of Grade≥3 irAEs was 11.7% (95% CI: 6.5%-16.9%). In subgroup analysis, the Grade≥3 irAEs rate of ICI monotherapy, dual-ICIs therapy, and GC plus ICI therapy was 7.4% (95% CI: 4.3%-10.5%), 30.3% (95% CI: 15.3%-45.3%), and 14.5% (95% CI: 3.5% - 25.4%), respectively. Besides, the pooled Grade≥3 TRAEs rate for chemoimmunotherapy was 32.4% (95% CI: 13.1% - 51.6%). Conclusion Neoadjuvant immunotherapy and chemoimmunotherapy were effective and safe in the treatment of MIBC. Compared to ICI monotherapy, dual-ICIs therapy or chemoimmunotherapy can improve the response rate, while increasing the morbidity of Grade≥ 3 irAEs or Grade≥ 3 TRAEs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD4202233771.
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Zhuang J, Yang X, Zheng Q, Li K, Cai L, Yu H, Lv J, Bai K, Cao Q, Li P, Yang H, Wang J, Lu Q. Metabolic Profiling of Bladder Cancer Patients' Serum Reveals Their Sensitivity to Neoadjuvant Chemotherapy. Metabolites 2022; 12:metabo12060558. [PMID: 35736490 PMCID: PMC9229374 DOI: 10.3390/metabo12060558] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Numerous patients with muscle-invasive bladder cancer develop low responsiveness to cisplatin. Our purpose was to explore differential metabolites derived from serum in bladder cancer patients treated with neoadjuvant chemotherapy (NAC). Data of patients diagnosed with cT2-4aNxM0 was collected. Blood samples were retained prospectively before the first chemotherapy for untargeted metabolomics by 1H-NMR and UPLC-MS. To identify characterized metabolites, multivariate statistical analyses were applied, and the intersection of the differential metabolites discovered by the two approaches was used to identify viable biomarkers. A total of 18 patients (6 NAC-sensitive patients and 12 NAC-resistant patients) were enrolled. There were 29 metabolites detected by 1H-NMR and 147 metabolites identified by UPLC-MS. Multivariate statistics demonstrated that in the sensitive group, glutamine and taurine were considerably increased compared to their levels in the resistant group, while glutamate and hypoxanthine were remarkably decreased. Pathway analysis and enrichment analysis showed significant alterations in amino acid pathways, suggesting that response to chemotherapy may be related to amino acid metabolism. In addition, hallmark analysis showed that DNA repair played a regulatory role. Overall, serum metabolic profiles of NAC sensitivity are significantly different in bladder cancer patients. Glycine, hypoxanthine, taurine and glutamine may be the potential biomarkers for clinical treatment. Amino acid metabolism has potential value in enhancing drug efficacy.
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Affiliation(s)
- Juntao Zhuang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Xiao Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Qi Zheng
- Center of Molecular Metabolism, Nanjing University of Science and Technology, Nanjing 210094, China;
| | - Kai Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Lingkai Cai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Hao Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Jiancheng Lv
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Kexin Bai
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Qiang Cao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Haiwei Yang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
| | - Junsong Wang
- Center of Molecular Metabolism, Nanjing University of Science and Technology, Nanjing 210094, China;
- Correspondence: (J.W.); (Q.L.)
| | - Qiang Lu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; (J.Z.); (X.Y.); (K.L.); (L.C.); (H.Y.); (J.L.); (K.B.); (Q.C.); (P.L.); (H.Y.)
- Correspondence: (J.W.); (Q.L.)
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Bai Y, Wang H, Wu X, Weng M, Han Q, Xu L, Zhang H, Chang C, Jin C, Chen M, Luo K, Teng X. Study on Molecular Information Intelligent Diagnosis and Treatment of Bladder Cancer on Pathological Tissue Image. Front Med (Lausanne) 2022; 9:838182. [PMID: 35755066 PMCID: PMC9215327 DOI: 10.3389/fmed.2022.838182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background Molecular information about bladder cancer is significant for treatment and prognosis. The immunohistochemistry (IHC) method is widely used to analyze the specific biomarkers to determine molecular subtypes. However, procedures in IHC and plenty of reagents are time and labor-consuming and expensive. This study established a computer-aid diagnosis system for predicting molecular subtypes, p53 status, and programmed death-ligand 1 (PD-L1) status of bladder cancer with pathological images. Materials and Methods We collected 119 muscle-invasive bladder cancer (MIBC) patients who underwent radical cystectomy from January 2016 to September 2018. All the pathological sections are scanned into digital whole slide images (WSIs), and the IHC results of adjacent sections were recorded as the label of the corresponding slide. The tumor areas are first segmented, then molecular subtypes, p53 status, and PD-L1 status of those tumor-positive areas would be identified by three independent convolutional neural networks (CNNs). We measured the performance of this system for predicting molecular subtypes, p53 status, and PD-L1 status of bladder cancer with accuracy, sensitivity, and specificity. Results For the recognition of molecular subtypes, the accuracy is 0.94, the sensitivity is 1.00, and the specificity is 0.909. For PD-L1 status recognition, the accuracy is 0.897, the sensitivity is 0.875, and the specificity is 0.913. For p53 status recognition, the accuracy is 0.846, the sensitivity is 0.857, and the specificity is 0.750. Conclusion Our computer-aided diagnosis system can provide a novel and simple assistant tool to obtain the molecular subtype, PD-L1 status, and p53 status. It can reduce the workload of pathologists and the medical cost.
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Affiliation(s)
- Yanfeng Bai
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huogen Wang
- Hithink RoyalFlush Information Network Co., Ltd., Hangzhou, China
- College of Computer Science and Technology, Zhejiang University, Hangzhou, China
| | - Xuesong Wu
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Menghan Weng
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qingmei Han
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liming Xu
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Han Zhang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengdong Chang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chaohui Jin
- Hithink RoyalFlush Information Network Co., Ltd., Hangzhou, China
| | - Ming Chen
- Hithink RoyalFlush Information Network Co., Ltd., Hangzhou, China
| | - Kunfeng Luo
- Hithink RoyalFlush Information Network Co., Ltd., Hangzhou, China
| | - Xiaodong Teng
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiaodong Teng,
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Abdullah O, Parashar D, Mustafa IJ, Young AM. Venous Thromboembolism Rate in Patients With Bladder Cancer According to the Type of Treatment: A Systematic Review. Cureus 2022; 14:e22945. [PMID: 35411272 PMCID: PMC8987908 DOI: 10.7759/cureus.22945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Bladder cancer (BC) is classified as a high-risk tumour type for venous thromboembolism (VTE). VTE presents an extra challenge in the management of patients with cancer, given the increase in morbidity and mortality on having both conditions. To summarise the contemporary evidence on the VTE rate in patients with BC according to the stage, type of anti-cancer treatment and highlight VTE rate in the UK and other countries. A systematic review was carried out, and an electronic search for publications between January 2000 and November 2021 was done. Studies recording VTE in BC patients were included, whilst paediatric patients, case reports, studies reporting on a mix of arterial and venous thrombosis, studies reporting DVT or PE only and recorded hospitalised VTE only were excluded. The rate of VTE, country of origin, risk factors and thromboprophylaxis duration for VTE in BC patients were identified. A total of 38 papers met the search criteria. All publications were original research papers (cohort studies). The overall VTE rate in patients with BC was estimated at 1.9% to 4.7%. For those patients undergoing cystectomy, the VTE rate ranged from 3% to 17.6%; however, the VTE rate in the metastatic stage of BC patients ranged from 3.1% to 5.1%. The rates of VTE in BC patients are high, further increased by interventions such as surgery and chemotherapy. Thromboprophylaxis measures should be optimised. This review highlighted the fact that the VTE rate in BC varies between studies due to the heterogeneity of risk factors reported.
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Lin CH, Chang HH, Lai CR, Wang HH, Tsai WC, Tsai YL, Changchien CY, Cheng YC, Wu ST, Chen Y. Fatty Acid Binding Protein 6 Inhibition Decreases Cell Cycle Progression, Migration and Autophagy in Bladder Cancers. Int J Mol Sci 2022; 23:ijms23042154. [PMID: 35216267 PMCID: PMC8878685 DOI: 10.3390/ijms23042154] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023] Open
Abstract
Bladder cancer (BC) has a high recurrence rate worldwide. The aim of this study was to evaluate the role of fatty acid binding protein 6 (FABP6) in proliferation and migration in human bladder cancer cells. Cell growth was confirmed by MTT and colony formation assay. Western blotting was used to explore protein expressions. Wound healing and Transwell assays were performed to evaluate the migration ability. A xenograft animal model with subcutaneous implantation of BC cells was generated to confirm the tumor progression. Knockdown of FABP6 reduced cell growth in low-grade TSGH-8301 and high-grade T24 cells. Cell cycle blockade was observed with the decrease of CDK2, CDK4, and Ki67 levels in FABP6-knockdown BC cells. Interestingly, knockdown of FBAP6 led to downregulation of autophagic markers and activation of AKT-mTOR signaling. The application of PI3K/AKT inhibitor decreased cell viability mediated by FABP6-knockdown additionally. Moreover, FABP6-knockdown reduced peroxisome proliferator-activated receptor γ and retinoid X receptor α levels but increased p-p65 expression. Knockdown of FABP6 also inhibited BC cell motility with focal adhesive complex reduction. Finally, shFABP6 combined with cisplatin suppressed tumor growth in vivo. These results provide evidence that FABP6 may be a potential target in BC cells progression.
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Affiliation(s)
- Chieh-Hsin Lin
- National Defense Medical Center, Department of Biology and Anatomy, Taipei 11490, Taiwan; (C.-H.L.); (H.-H.C.); (C.-R.L.); (C.-Y.C.); (Y.-C.C.)
| | - Hsin-Han Chang
- National Defense Medical Center, Department of Biology and Anatomy, Taipei 11490, Taiwan; (C.-H.L.); (H.-H.C.); (C.-R.L.); (C.-Y.C.); (Y.-C.C.)
| | - Chien-Rui Lai
- National Defense Medical Center, Department of Biology and Anatomy, Taipei 11490, Taiwan; (C.-H.L.); (H.-H.C.); (C.-R.L.); (C.-Y.C.); (Y.-C.C.)
| | - Hisao-Hsien Wang
- Department of Urology, Cheng Hsin General Hospital, Taipei 11490, Taiwan;
| | - Wen-Chiuan Tsai
- National Defense Medical Center, Department of Pathology, Tri-Service General Hospital, Taipei 11490, Taiwan; (W.-C.T.); (Y.-L.T.)
| | - Yu-Ling Tsai
- National Defense Medical Center, Department of Pathology, Tri-Service General Hospital, Taipei 11490, Taiwan; (W.-C.T.); (Y.-L.T.)
| | - Chih-Ying Changchien
- National Defense Medical Center, Department of Biology and Anatomy, Taipei 11490, Taiwan; (C.-H.L.); (H.-H.C.); (C.-R.L.); (C.-Y.C.); (Y.-C.C.)
- National Defense Medical Center, Department of Internal Medicine, Tri-Service General Hospital, Taipei 11490, Taiwan
| | - Yu-Chen Cheng
- National Defense Medical Center, Department of Biology and Anatomy, Taipei 11490, Taiwan; (C.-H.L.); (H.-H.C.); (C.-R.L.); (C.-Y.C.); (Y.-C.C.)
| | - Sheng-Tang Wu
- National Defense Medical Center, Division of Urology, Department of Surgery, Tri-Service General Hospital, Taipei 11490, Taiwan
- Correspondence: (S.-T.W.); (Y.C.); Tel.: +886-2-8792-3100 (ext. 18739) (Y.C.)
| | - Ying Chen
- National Defense Medical Center, Department of Biology and Anatomy, Taipei 11490, Taiwan; (C.-H.L.); (H.-H.C.); (C.-R.L.); (C.-Y.C.); (Y.-C.C.)
- Correspondence: (S.-T.W.); (Y.C.); Tel.: +886-2-8792-3100 (ext. 18739) (Y.C.)
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Wu T, Wu Y, Chen S, Wu J, Zhu W, Liu H, Chen M, Xu B. Curative Effect and Survival Assessment Comparing Gemcitabine and Cisplatin Versus Methotrexate, Vinblastine, Doxorubicin and Cisplatin as Neoadjuvant Therapy for Bladder Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:678896. [PMID: 34900663 PMCID: PMC8656312 DOI: 10.3389/fonc.2021.678896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Neoadjuvant chemotherapy has been accepted as an effective curative treatment for muscle-invasive bladder cancer patients and has resulted in better survival outcomes than radical cystectomy or a cisplatin-based regimen. In the present study, we aimed to compare the two most commonly used cisplatin-based neoadjuvant chemotherapies, gemcitabine plus cisplatin and methotrexate plus vinblastine plus doxorubicin plus cisplatin, by summarizing and analyzing clinical data and outcomes of published research. Methods We searched for qualified studies that compared these two types of neoadjuvant chemotherapy, including 4 randomized controlled trials and 14 retrospective studies. Data and information on pathological responses and long-term survival studies were extracted and analyzed separately. Results A total of 18 studies with 3116 patients were selected from 1188 studies, which contained data on pathological complete response, pathological partial response, and overall survival. In contrast to the results of previous studies, there was no significant difference in pathological complete response (odds ratio, 0.97; 95% confidence interval, 0.81-1.15), pathological partial response (odds ratio, 0.85; 95% confidence interval, 0.72-1.14), and overall survival (hazard ratio, 0.99; 95% confidence interval, 0.83-1.17) between GC and MVAC in this meta-analysis. Conclusion No significant differences were observed between GC and MVAC in the muscle-invasive bladder cancer treatment due to the similar curative effect and parallel long survival outcomes due to the similar curative effect and parallel long survival outcomes. The priority selection of GC or MVAC in the clinic should be guided by further investigation, and the clinical standard strategy still counts on the results of more randomized controlled trials in the future.
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Affiliation(s)
- Tiange Wu
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China.,Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Yuqing Wu
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China.,Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Shuqiu Chen
- Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Jianping Wu
- Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Weidong Zhu
- Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
| | - Hui Liu
- Department of Urology, Binhai County People's Hospital, Yancheng, China
| | - Ming Chen
- Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China.,Department of Urology, Zhongda Hospital Affiliated to Southeast University Lishui Branch, Nanjing, China
| | - Bin Xu
- Surgical Research Center, Institute of Urology, Medical School of Southeast University, Nanjing, China.,Department of Urology, Zhongda Hospital Affiliated to Southeast University, Nanjing, China
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Hansen TTD, Omland LH, von Heymann A, Johansen C, Clausen MB, Suetta C, Pappot H, Rafn BS. Development of Sarcopenia in Patients With Bladder Cancer: A Systematic Review. Semin Oncol Nurs 2021; 37:151108. [PMID: 33431235 DOI: 10.1016/j.soncn.2020.151108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Sarcopenia is known to influence cancer-related complications and overall survival. However, the effect of cancer treatment on the development or progression of sarcopenia is relatively unknown. The primary aim of this systematic review was to determine the prevalence and development of sarcopenia among people with bladder cancer. DATA SOURCES A systematic search was performed in PubMed, Web of Science, and EMBASE. Studies with ≥2 assessments of sarcopenia were eligible for inclusion. Five retrospective cohorts were included with a total of 438 participants. The baseline prevalence of sarcopenia across studies varied from 25% to 69% and post-treatment prevalence from 50% to 81%. The average loss of muscle mass was 2.2% to 10% during a time course of 3 to 12 months. CONCLUSION The prevalence of sarcopenia markedly increased during cancer treatment in patients with bladder cancer. Further research into the effect of different treatment regimens on the development of sarcopenia, and how these changes might affect functional capacity and survival is needed. IMPLICATIONS FOR NURSING PRACTICE The development of sarcopenia is important to understand because of its negative affect on quality of life, complications, and mortality. Further, understanding how sarcopenia develops during treatment could potentially strengthen nurses' future care plans for patients with bladder cancer.
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Affiliation(s)
- Tobias Tuse Dunk Hansen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Lise Høj Omland
- Department of Oncology, 5073, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Annika von Heymann
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Mikkel Bek Clausen
- Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy. University College Copenhagen, Faculty of Health, Copenhagen, Denmark
| | - Charlotte Suetta
- Geriatric Research Unit, Department of Geriatric and Palliative Medicine, Bispebjerg and Frederiksberg Hospital-Bispebjerg, Copenhagen, Denmark; Geriatric Research Unit, Department of Medicine, Herlev and Gentofte Hospitals, Herlev Denmark; CopenAge-Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - Helle Pappot
- Department of Oncology, 5073, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Bolette Skjødt Rafn
- Cancer Survivorship and Treatment Late Effects, Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
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Pederzoli F, Bandini M, Marandino L, Raggi D, Giannatempo P, Salonia A, Gallina A, Briganti A, Montorsi F, Necchi A. Neoadjuvant Chemotherapy or Immunotherapy for Clinical T2N0 Muscle-invasive Bladder Cancer: Time to Change the Paradigm? Eur Urol Oncol 2020; 4:1006-1010. [PMID: 32847746 DOI: 10.1016/j.euo.2020.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/03/2020] [Accepted: 07/21/2020] [Indexed: 12/31/2022]
Abstract
A 41-yr-old, otherwise healthy, premenopausal woman presented at our uro-oncology clinic with a diagnosis of muscle-invasive bladder cancer following a transurethral resection of the bladder performed at another center. After a thorough discussion with the patient, she was enrolled in the phase II PURE-01 trial (NCT02736266), testing three cycles of neoadjuvant pembrolizumab (200mg) every 3 wk before radical cystectomy. Before treatment, imaging studies were obtained as per the protocol using computed tomography (CT), [18F]fluorodeoxyglucose positron emission tomography/CT, and multiparametric magnetic resonance imaging of the bladder, defining a clinically localized T2N0M0 stage. As per the protocol, potential biomarkers were assessed, including PD-L1 expression (84% combined positive score), tumor mutational burden (16.67 mut/Mb), and genomic profiling (FoundationONE assay; somatic mutation in TP53, EZH2, APC, TERT, CDKN1A, CDKN1B, and ARID1A genes, and truncation in BRCA2 gene). After immunotherapy, the patient underwent a robot-assisted radical cystectomy with extended pelvic lymph node dissection. The final pathology report revealed absence of residual disease (ie, pathological complete response, ypT0ypN0). During follow-up, the only relevant and permanent immune-mediated adverse event was hypothyroidism secondary to an autoimmune thyroiditis. It appeared 2 mo after radical cystectomy and it was managed successfully with hormonal replacement therapy. Two years after treatment, the patient is asymptomatic and free from disease recurrence. PATIENT SUMMARY: Increasing evidence suggests that frontline neoadjuvant immunotherapy may be beneficial for patients diagnosed with non-locally advanced, muscle-invasive bladder cancer (cT2N0), with fewer drawbacks than traditional chemotherapy. Although further studies are needed in support, this vision opens the opportunity for future clinical trials testing the potential incremental benefits of immunotherapy and the utility of novel biomarker- and imaging-based strategies to assess response to therapy.
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Affiliation(s)
- Filippo Pederzoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy.
| | - Marco Bandini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Laura Marandino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Gallina
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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12
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Risk factors and reasons for reoperation after radical cystectomy. Urol Oncol 2020; 38:269-277. [DOI: 10.1016/j.urolonc.2019.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/25/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022]
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Sutton TL, Johnson N, Schlitt A, Gardiner SK, Garreau JR. Surgical timing following neoadjuvant chemotherapy for breast cancer affects postoperative complication rates. Am J Surg 2020; 219:741-745. [PMID: 32200974 DOI: 10.1016/j.amjsurg.2020.02.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/28/2020] [Accepted: 02/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is increasingly used in the treatment of breast cancer. The time interval from last dose of cytotoxic chemotherapy to surgery (TTS) can vary widely. We aimed to evaluate the effect of TTS on postoperative complications. METHODS A retrospective review for women treated with NAC at our institution between January 2011 through December 2016 was performed. Charts were reviewed for postoperative wound complications, and multivariate analysis was performed. RESULTS 455 patients were identified. Median TTS was 30 days (range 11-228). On multivariate analysis, TTS of less than 28 days was associated with 70% higher odds of any wound complication (p < 0.05). Increasing age had the strongest association with the presence of any wound complication (p < 0.0001). The majority of complications were treated in the outpatient setting (n = 80, 83%). CONCLUSION Following NAC for breast cancer, TTS less than 28 days is a risk factor for postoperative wound complications; however, the majority of complications are minor and treated in the outpatient setting. Additional data are needed to determine optimal TTS for oncologic outcomes.
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Affiliation(s)
- Thomas L Sutton
- Oregon Health & Science University, Department of Surgery, 3181 SW Sam Jackson Park Rd, Portland, 97239, OR, USA.
| | - Nathalie Johnson
- Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, 1040 NW 22nd Ave, Suite 560, Portland, 97227, OR, USA.
| | - Alexander Schlitt
- College of Osteopathic Medicine of the Pacific-Northwest, 200 Mullins Drive, 97355, OR, Lebanon.
| | - Stuart K Gardiner
- Devers Eye Institute, Legacy Research Institute, Legacy Health, 1225 NE 2nd Ave, Portland, 97232, OR, USA.
| | - Jennifer R Garreau
- Legacy Cancer Institute, Legacy Medical Group Surgical Oncology, 1040 NW 22nd Ave, Suite 560, Portland, 97227, OR, USA.
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Parikh N, Sharma P. Frailty as a prognostic indicator in the radical cystectomy population: a review. Int Urol Nephrol 2019; 51:1281-1290. [PMID: 31175538 DOI: 10.1007/s11255-019-02189-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022]
Abstract
Radical cystectomy and urinary diversion are the current gold standard of management for patients with muscle-invasive bladder cancer. While it is a common urologic procedure, it is associated with significant patient morbidity and mortality. Complications associated with the operation are often frequent, although minor, and significantly impact functional outcomes as well as patient quality of life. Frailty is emerging as a new preoperative prognostic indicator to help determine which patients are at greatest risk of poor outcomes and postoperative complications after treatment. In this review, we summarize the current known literature analyzing frailty as a significant prognostic risk factor of short-term and long-term outcomes after radical cystectomy and urinary diversion in the treatment of muscle-invasive bladder cancer.
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Affiliation(s)
- Niki Parikh
- Department of Urology, Texas Tech University Health Sciences Center, 3601 4th Street STOP 7260, Lubbock, TX, 79430, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, 3601 4th Street STOP 7260, Lubbock, TX, 79430, USA.
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