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Yılmaz H, Teke K, Süer E, İzol V, Akgül HM, Selvi İ. Does neo-adjuvant chemotherapy improve the negative effect of lymphovascular invasion in survival after radical cystectomy? Urol Oncol 2024; 42:30.e1-30.e7. [PMID: 37867054 DOI: 10.1016/j.urolonc.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/29/2023] [Accepted: 09/16/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE There is a lack of studies in the literature to evaluate the impact of the specific benefit of the use of neo-adjuvant chemotherapy (NAC) on the negative effect of lymphovascular invasion (LVI) on prognosis. We aimed to evaluate the survival differences of patients according to the presence of LVI with and without administration of NAC before radical cystectomy (RC). MATERIALS AND METHODS We retrospectively evaluated data of the patients who underwent RC with pelvic lymphadenectomy and urinary diversion for bladder cancer recorded in the bladder cancer database of the Turkish Uro-oncology Association between 2007 and 2021. Patient demographics, follow-up time and overall survival (OS) were noted. RESULTS A total of 633 subjects included in the analyses. Median follow-up time was 24 months (IQR 12-54). Five years OS of the whole cohort was 55.1%. This was 54.7% and 59.9% in NAC- and NAC+ groups (P = 0.683), respectively. It was also 35.7% and 65.7% in LVI+ and LVI- patients (P < 0.0001), respectively. There was a significant difference between LVI+ and LVI- patients (33.2% vs. 68.2%, P < 0.0001) in NAC- group, but similar 5-year OS was found (53.2% vs. 64.5%, P = 0.552) in NAC+ group. In multivariable analyses, female gender, pN stages, presence of variant histology and LVI were significant independent predictive factors for OS in the whole cohort and in the NAC- group. However, gender association, pN stages and LVI lost significance in NAC+ group. CONCLUSION Presence of LVI significantly reduced OS, and the NAC treatment improved the negative effects of LVI on OS. Our findings encourage the use of NAC before RC.
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Affiliation(s)
- Hasan Yılmaz
- Deparment of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey.
| | - Kerem Teke
- Deparment of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Evren Süer
- Deparment of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan İzol
- Deparment of Urology, Çukurova University School of Medicine, Adana, Turkey
| | - Hacı Murat Akgül
- Deparment of Urology, Tekirdağ Namık Kemal University School of Medicine, Tekirdağ, Turkey
| | - İsmail Selvi
- Department of Urology, Istanbul Faculty of Medicine, Istanbul, Turkey
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Kato M, Uchida J. Recent advances in immune checkpoint inhibitors in the treatment of urothelial carcinoma: A review. Int J Urol 2023; 30:1068-1077. [PMID: 37602512 DOI: 10.1111/iju.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023]
Abstract
Treatment options for urothelial carcinoma were limited until the emergence of immune checkpoint inhibitors, and even now, the prognosis of metastatic disease is poor compared with the other two major genitourinary cancers, renal cell carcinoma and prostate cancer. Despite the increasing use of immune checkpoint inhibitors in the sequential treatment of urothelial carcinoma, conflicting results from similar randomized clinical trials call into question the efficacy of this treatment. In addition, physicians must be aware of the clinical characteristics of immune checkpoint inhibitors, including immune-related adverse events, pseudo- and hyperprogression. This review summarizes the conflicting results of recent clinical trials and provides insights into the role of immune checkpoint inhibitors in the treatment of urothelial carcinoma.
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Affiliation(s)
- Minoru Kato
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Junji Uchida
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Fonteyne V, Dirix P, Van Praet C, Berghen C, Albersen M, Junius S, Liefhooghe N, Noé L, De Meerleer G, Ost P, Villeirs G, Verbeke S, De Maeseneer D, Rammant E, Verghote F, Elhaseen E, De Man K, Decaestecker K. Adjuvant Radiotherapy After Radical Cystectomy for Patients with High-risk Muscle-invasive Bladder Cancer: Results of a Multicentric Phase II Trial. Eur Urol Focus 2022; 8:1238-1245. [PMID: 34893458 DOI: 10.1016/j.euf.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/27/2021] [Accepted: 11/18/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND High-risk muscle-invasive bladder cancer (MIBC) has a poor prognosis. Old trials showed that external beam radiotherapy (EBRT) after radical cystectomy (RC) decreases the incidence of local recurrences but induces severe toxicity. OBJECTIVE To evaluate the toxicity and local control rate after adjuvant EBRT after RC delivered with volumetric arc radiotherapy. DESIGN, SETTING, AND PARTICIPANTS This is a multicentric phase 2 trial. From August 2014 till October 2020, we treated 72 high-risk MIBC patients with adjuvant EBRT after RC. High-risk MIBC is defined as ≥pT3-MIBC ± lymphovascular invasion, fewer than ten lymph nodes removed, pathological positive lymph nodes, or positive surgical margins. INTERVENTION Patients received 50 Gy in 25 fractions with intensity-modulated radiotherapy to the pelvic lymph nodes ± cystectomy bed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome is acute toxicity. We report on local relapse-free rate (LRFR), clinical relapse-free survival (CRFS), overall survival (OS), and bladder cancer-specific survival (BCSS). RESULTS AND LIMITATIONS The median follow-up is 18 mo. Forty-two patients (61%) developed acute grade 2 gastrointestinal (GI) toxicity. Four patients (6%) had acute grade 3 GI toxicity. One patient had grade 5 diarrhea and vomiting due to obstruction at 1 mo. Two-year probabilities of developing grade ≥3 and ≥2 GI toxicity were 17% and 76%, respectively. Urinary toxicity, assessed in 17 patients with a neobladder, was acceptable with acute grade 2 and 3 urinary toxicity reported in 53% (N = 9) and 18% (N = 3) of the patients, respectively. The 2-yr LRFR is 83% ± 5% and the 2-yr CRFS rate is 43% with a median CRFS time of 12 mo (95% confidence interval: 3-21 mo). Two-year OS and BCSS are 52% ± 7% and 62% ± 7%, respectively. Shortcomings are the nonrandomized study design and limited follow-up. CONCLUSIONS Adjuvant EBRT after RC can be administered without excessive severe toxicity. PATIENT SUMMARY In this report, we looked at the incidence of toxicity and local control after adjuvant external beam radiotherapy (EBRT) following radical cystectomy (RC) in high-risk muscle-invasive bladder cancer patients. We found that adjuvant EBRT was feasible and resulted in good local control. We conclude that these data support further enrollment of patients in ongoing trials to evaluate the place of adjuvant EBRT after RC.
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Affiliation(s)
- Valérie Fonteyne
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium.
| | - P Dirix
- Department of Radiation-Oncology, Iridium Network, Antwerp, Belgium
| | - C Van Praet
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - C Berghen
- Department of Radiotherapy-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - M Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - S Junius
- Department of Radiotherapy-Oncology, CH-M/AMPR, Mouscron, Belgium
| | - N Liefhooghe
- Department of Radiotherapy-Oncology, AZ Groeninge, Kortrijk, Belgium
| | - L Noé
- Department of Radiotherapy-Oncology, Limburg Oncology Center, Jessa Hospital, Hasselt, Belgium
| | - G De Meerleer
- Department of Radiotherapy-Oncology, University Hospitals Leuven, Leuven, Belgium
| | - P Ost
- Department of Human structure and Repair, Ghent University, Ghent, Belgium
| | - G Villeirs
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - S Verbeke
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - D De Maeseneer
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - E Rammant
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - F Verghote
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - E Elhaseen
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - K De Man
- Department of Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Bharadwaj M, Kaul S, Fleishman A, Korets R, Chang P, Wagner A, Kim S, Bellmunt J, Kaplan I, Olumi AF, Gershman B. Adjuvant chemotherapy versus observation following radical cystectomy for locally advanced urothelial carcinoma of the bladder. Urol Oncol 2022; 40:274.e15-274.e23. [DOI: 10.1016/j.urolonc.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/12/2022] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
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Dalla Volta A, Petrelli F, Luciani A, Caramella I, Grisanti S, Berruti A. Is adjuvant immunotherapy effective in patients with urothelial cancer? Minerva Urol Nephrol 2022; 74:252-254. [PMID: 35147389 DOI: 10.23736/s2724-6051.22.04841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alberto Dalla Volta
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Fausto Petrelli
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Andrea Luciani
- Medical Oncology Unit, ASST Bergamo Ovest, Treviglio, Bergamo, Italy
| | - Irene Caramella
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy -
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Tse RTH, Zhao H, Wong CYP, Kong AWY, Chan RCK, To KF, Ng CF, Teoh JYC. In vitro assessment of intra-operative and post-operative environment in reducing bladder cancer recurrence. Sci Rep 2022; 12:22. [PMID: 34997063 PMCID: PMC8741939 DOI: 10.1038/s41598-021-04035-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 01/11/2023] Open
Abstract
Urinary bladder cancer is a common cancer worldwide. Currently, the modality of treating and monitoring bladder cancer is wide. Nonetheless, the high recurrence rate of non-muscle-invasive bladder cancer after surgical resection is still unsatisfactory. Hereby, our study demonstrated whether the intra-operative and post-operative environments will affect bladder cancer recurrence utilizing in vitro cell line model. Bladder cancer cell lines were submerged in four different irrigating fluids for assessing their tumorigenic properties. Our results showed that sterile water performed the best in terms of the magnitude of cytotoxicity to cell lines. Besides, we also investigated cytotoxic effects of the four irrigating agents as well as mitomycin C (MMC) in normothermic and hyperthermic conditions. We observed that sterile water and MMC had an increased cytotoxic effect to bladder cancer cell lines in hyperthermic conditions. Altogether, our results could be translated into clinical practice in the future by manipulating the intra-operative and post-operative conditions in order to lower the chance of residual cancer cells reimplant onto the bladder, which in turns, reducing the recurrence rate of bladder cancers.
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Affiliation(s)
- Ryan Tsz-Hei Tse
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Hongda Zhao
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Christine Yim-Ping Wong
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Angel Wing-Yan Kong
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Ronald Cheong-Kin Chan
- grid.10784.3a0000 0004 1937 0482Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Fai To
- grid.10784.3a0000 0004 1937 0482Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China ,European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, The Netherlands
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Petrelli F, Perego G, Vavassori I, Luciani A. Neoadjuvant or adjuvant immunotherapy in bladder cancer: biological opportunity or clinical utility? TUMORI JOURNAL 2021; 108:510-511. [PMID: 34806495 DOI: 10.1177/03008916211061604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In urothelial cancer of the bladder, the introduction of immunotherapy with immune checkpoint inhibitors represents progress in the management of the disease's early and advanced stages. In particular, recent studies have implemented these drugs in the neoadjuvant and adjuvant phases to treat muscle-invasive bladder cancer. In some studies, patients received neoadjuvant immune checkpoint inhibitors alone (PURE and ABACUS) to treat muscle invasive bladder cancer, whereas other studies provided this therapy to cisplatin-ineligible patients. Furthermore, a large Phase III study (CheckMate 247) compared placebo with adjuvant nivolumab therapy in patients with high-risk urothelial cancer after neoadjuvant chemotherapy and surgery or surgery alone. Despite some uncertain niches (nonbladder, PD-L1-negative tumors, and node-negative resected cancers), certain biological opportunities (exploring new targets, evaluating in vivo pathologic response, focusing on biomarkers for response) and clinical uses (avoiding chemotherapy at all or in frail patients, attaining similar pathologic complete response rates as in cisplatin-based chemotherapy) are valid reasons for incorporating these agents into the therapeutic armamentarium of medical uro-oncologists.
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Affiliation(s)
| | | | | | - Andrea Luciani
- Oncology Unit, ASST Bergamo Ovest, Treviglio (BG), Italy
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Does perioperative systemic therapy represent the optimal therapeutic paradigm in organ-confined, muscle-invasive urothelial carcinoma? Future Sci OA 2021; 7:FSO770. [PMID: 34737893 PMCID: PMC8558855 DOI: 10.2144/fsoa-2021-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 01/11/2023] Open
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Wang W, Liu J, Liu L. Development and Validation of a Prognostic Model for Predicting Overall Survival in Patients With Bladder Cancer: A SEER-Based Study. Front Oncol 2021; 11:692728. [PMID: 34222021 PMCID: PMC8247910 DOI: 10.3389/fonc.2021.692728] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To establish a prognostic model for Bladder cancer (BLCA) based on demographic information, the American Joint Commission on Cancer (AJCC) 7th staging system, and additional treatment using the surveillance, epidemiology, and end results (SEER) database. METHODS Cases with BLCA diagnosed from 2010-2015 were collected from the SEER database, while patient records with incomplete information on pre-specified variables were excluded. All eligible cases were included in the full analysis set, which was then split into training set and test set with a 1:1 ratio. Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors for overall survival (OS) in BLCA patients. With selected independent prognosticators, a nomogram was mapped to predict OS for BLCA. The nomogram was evaluated using receiver operating characteristic (ROC) analysis and calibration plot in both the training and test sets. The area under curve [AUC] of the nomogram was calculated and compared with clinicopathological indicators using the full analysis set. Statistical analyses were conducted using the R software, where P-value <0.05 was considered significant. RESULTS The results indicated that age, race, sex, marital status, histology, tumor-node-metastasis (TNM) stages based on the AJCC 7th edition, and additional chemotherapy were independent prognostic factors for OS in patients with BLCA. Patients receiving chemotherapy tend to have better survival outcomes than those without. The proposed nomogram showed decent classification (AUCs >0.8) and prediction accuracy in both the training and test sets. Additionally, the AUC of the nomogram was observed to be better than that of conventional clinical indicators. CONCLUSIONS The proposed nomogram incorporated independent prognostic factors including age, race, sex, marital status, histology, tumor-node-metastasis (TNM) stages, and additional chemotherapy. Patients with BLCA benefit from chemotherapy on overall survival. The nomogram-based prognostic model could predict overall survival for patients with BLCA with accurate stratification, which is superior to clinicopathological factors.
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Affiliation(s)
- Wei Wang
- Institute of Military Hospital Management, The Chinese PLA General Hospital, Beijing, China
- Department of Rehabilitation Medicine, Qingdao Special Servicemen Recuperation Center of People’s Liberation Army (PLA) Navy, Qingdao, China
| | - Jianchao Liu
- Institute of Military Hospital Management, The Chinese PLA General Hospital, Beijing, China
| | - Lihua Liu
- Institute of Military Hospital Management, The Chinese PLA General Hospital, Beijing, China
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