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Mori K, Matsumoto K, Ikeda M, Koguchi D, Shimizu Y, Tsumura H, Ishii D, Tsuji S, Sato Y, Iwamura M. Membranous Expression of Heart Development Protein with EGF-like Domain 1 Is Associated with a Good Prognosis in Patients with Bladder Cancer. Diagnostics (Basel) 2023; 13:3067. [PMID: 37835810 PMCID: PMC10572329 DOI: 10.3390/diagnostics13193067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVE To investigate the correlation between total protein expression of heart development protein with EGF-like domain 1 (HEG1) and clinicopathological characteristics in patients with bladder cancer (BC) after radical cystectomy (RC). PATIENTS AND METHODS We retrospectively analyzed data from 110 patients who underwent RC at Kitasato University Hospital. And we prepared an anti-HEG1 monoclonal antibody W10B9, which can detect total HEG1 protein. HEG1 protein expression in tumor cells was evaluated separately for membrane and cytoplasmic staining using immunohistochemistry. RESULTS Membranous HEG1 expression was associated with absent lymphovascular invasion (p < 0.01) and low pT stage (p < 0.01). Kaplan-Meier analysis revealed that the membranous HEG1-positive group had significantly long recurrence-free survival (RFS) (p < 0.01) and cancer-specific survival (p = 0.01). Expression of membranous HEG1 was identified as an independent prognostic factor for RFS (p = 0.04). There were no significant differences between cytoplasmic HEG1 expression and clinicopathologic factors including prognosis. CONCLUSION The expression of membranous HEG1 could serve as a favorable prognostic indicator in patients with BC treated with RC.
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Affiliation(s)
- Kohei Mori
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Yuriko Shimizu
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Hideyasu Tsumura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Daisuke Ishii
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
| | - Shoutaro Tsuji
- Department of Medical Technology & Clinical Engineering, Gunma University of Health and Welfare, 191-1 Kawamagari-machi, Maebashi-shi 371-0823, Gunma, Japan;
| | - Yuichi Sato
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
- KITASATO-OTSUKA Biomedical Assay Laboratories Co., Ltd., 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Kanagawa, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (K.M.); (M.I.); (D.K.); (Y.S.); (H.T.); (D.I.); (Y.S.); (M.I.)
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Katsumata H, Matsumoto K, Yanagita K, Shimizu Y, Hirano S, Kitajima K, Koguchi D, Ikeda M, Sato Y, Iwamura M. Expression of S100A16 Is Associated with Biological Aggressiveness and Poor Prognosis in Patients with Bladder Cancer Who Underwent Radical Cystectomy. Int J Mol Sci 2023; 24:14536. [PMID: 37833982 PMCID: PMC10572706 DOI: 10.3390/ijms241914536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/22/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
S100 calcium binding protein A16 (S100A16) is expressed in various cancers; however, there are few reports on S100A16 in bladder cancer (BC). We retrospectively investigated clinical data including clinicopathological features in 121 patients with BC who underwent radical cystectomy (RC). Immunohistochemical staining was performed to evaluate S100A16 expression in archived specimens. Cases with >5% expression and more than moderate staining intensity on cancer cells were considered positive. S100A16 expression was observed in 54 patients (44.6%). Univariate analysis showed that S100A16 expression was significantly associated with age, pT stage, recurrence, and cancer-specific death. Kaplan-Meier analyses showed that patients with S100A16 expression had shorter overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) than those without S100A16 expression. In multivariate analysis, pT stage was an independent prognostic factor for OS and lymph node metastasis for CSS and RFS. S100A16 expression may be a biomarker of a biologically aggressive phenotype and poor prognosis in patients with BC who underwent RC. The PI3k/Akt signaling pathway is probably associated with S100A16 and may be a therapeutic target.
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Affiliation(s)
- Hiroki Katsumata
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Kengo Yanagita
- Biofluid Biomarker Center, Niigata University, 8050 ikarashi 2-no-cho, Nishi-ku, Niigata 950-2181, Niigata, Japan;
| | - Yuriko Shimizu
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Shuhei Hirano
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Kazuki Kitajima
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Dai Koguchi
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Masaomi Ikeda
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
| | - Yuichi Sato
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
- KITASATO-OTSUKA Biomedical Assay Laboratories Co., Ltd., 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0329, Kanagawa, Japan
| | - Masatsugu Iwamura
- Department of Urology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara 252-0374, Kanagawa, Japan; (H.K.); (Y.S.); (S.H.); (K.K.); (D.K.); (M.I.); (Y.S.); (M.I.)
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Sarrió-Sanz P, Martinez-Cayuelas L, Lumbreras B, Sánchez-Caballero L, Palazón-Bru A, Gil-Guillén VF, Gómez-Pérez L. Mortality prediction models after radical cystectomy for bladder tumour: A systematic review and critical appraisal. Eur J Clin Invest 2022; 52:e13822. [PMID: 35642331 DOI: 10.1111/eci.13822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/18/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To identify risk-predictive models for bladder-specific cancer mortality in patients undergoing radical cystectomy and assess their clinical utility and risk of bias. METHODS Systematic review (CRD42021224626:PROSPERO) in Medline and EMBASE (from their creation until 31/10/2021) was screened to include articles focused on the development and internal validation of a predictive model of specific cancer mortality in patients undergoing radical cystectomy. CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) and Prediction model Risk Of Bias ASsessment Tool (PROBAST) were applied. RESULTS Nineteen observational studies were included. The main predictors were sociodemographic variables, such as age (18 studies, 94.7%) and sex (17, 89.5% studies), tumour characteristics (TNM stage (18 studies, 94.7%), histological subtype/grade (15 studies, 78.9%), lymphovascular invasion (10 studies, 52.6%) and treatment with chemotherapy (13 studies, 68.4%). C-index values were presented in 14 studies. The overall risk of bias assessed using PROBAST led to 100% of studies being classified as high risk (the analysis domain was rated to be at high risk of bias in all the studies), and 52.6% showed low applicability. Only 5 studies (26.3%) included an external validation and 2 (10.5%) included a prospective study design. CONCLUSIONS Using clinical predictors to assess the risk of bladder-specific cancer mortality is a feasibility alternative. However, the studies showed a high risk of bias and their applicability is uncertain. Studies should improve the conducting and reporting, and subsequent external validation studies should be developed.
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Affiliation(s)
- Pau Sarrió-Sanz
- Urology Services, University Hospital of San Juan de Alicante, Alicante, Spain
| | | | - Blanca Lumbreras
- Department of Public Health, History of Science and Gynecology, Miguel Hernández University, and CIBER en Epidemiología y Salud Pública, Alicante, Spain
| | | | - Antonio Palazón-Bru
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | | | - Luis Gómez-Pérez
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
- Urology Services, University General Hospital of Elx, Alicante, Spain
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Mori K, Matsumoto K, Amano N, Koguchi D, Shimura S, Hagiwara M, Shimizu Y, Ikeda M, Sato Y, Iwamura M. Expression of Membranous CD155 Is Associated with Aggressive Phenotypes and a Poor Prognosis in Patients with Bladder Cancer. Cancers (Basel) 2022; 14:cancers14061576. [PMID: 35326727 PMCID: PMC8946612 DOI: 10.3390/cancers14061576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/12/2022] [Accepted: 03/18/2022] [Indexed: 12/24/2022] Open
Abstract
Objective: To investigate the relationship between clinicopathological findings and membranous CD155 (mCD155) or cytoplasmic CD155 (cCD155) expression in bladder cancer (BC). Methods: We retrospectively analyzed 103 patients with BC who underwent radical cystectomy between 1990 to 2015 at Kitasato University Hospital. Immunohistochemical staining was performed to evaluate CD155 expression in tumor cells. Cases with > 10% expression on the membrane or cytoplasm of tumor cells were positive. The Fisher′s exact test was used for categorical variables and the Kaplan−Meier method was used for survival outcomes. Univariate and multivariate Cox regression hazard models were used to evaluate the survival risk factors. Results: Cases that were mCD155-positive were associated with high-grade tumors (p = 0.02), nodal status (p < 0.01), and pT stage (p = 0.04). No association with any clinicopathological factor was observed in the cCD155 cases. Kaplan−Meier analysis showed that mCD155-positive cases had shorter periods of recurrence-free survival (p = 0.015) and cancer-specific survival (p = 0.005). Only nodal status was an independent predictor for both cancer-specific survival and recurrence-free survival in multivariate analysis (p = 0.02 and p < 0.01, respectively). Conclusion: mCD155 expression may be a marker of an aggressive phenotype and a poor prognosis in patients with BC.
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Amano N, Matsumoto K, Shimizu Y, Nakamura M, Tsumura H, Ishii D, Sato Y, Iwamura M. High HNRNPA3 expression is associated with lymph node metastasis and poor prognosis in patients treated with radical cystectomy. Urol Oncol 2020; 39:196.e1-196.e7. [PMID: 33160845 DOI: 10.1016/j.urolonc.2020.10.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/25/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We sought to identify heterogeneous nuclear ribonucleoprotein A3 (HNRNPA3) expression in bladder cancer and its relationship to clinicopathological findings and prognosis. METHODS Immunohistochemical staining for HNRNPA3 was performed on 122 archived radical cystectomy specimens, with immunoreactivity being stratified on a 0 to 3 scale. The percentage of HNRNPA3 expressing tumor cells was calculated and multiplied by the staining score over an average of 5 areas to obtain a semiquantitative H-score (maximum value: 300). HNRNPA3 expression was categorized as high (≥80) or low (<80). RESULTS The patients' median age was 70 years, and the median follow-up period was 39.4 months. High HNRNPA3 expression was significantly associated with lymph node metastasis (P= 0.014) and S100A8, S100A9 and uroplakin III expression (P= 0.028, 0.002, and 0.047, respectively). Log-rank tests indicated that high HNRNPA3 expression was significantly associated with disease progression and cancer-specific death (P= 0.013 and 0.006, respectively). In the Cox proportional hazards regression analysis, only lymph node metastasis was associated with disease progression and cancer-specific survival. CONCLUSION HNRNPA3 may be a new biomarker to predict biologically aggressive cancers and determine the appropriate treatment modality in patients after radical cystectomy.
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Affiliation(s)
- Noriyuki Amano
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Kazumasa Matsumoto
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan.
| | - Yuriko Shimizu
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Marie Nakamura
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Hideyasu Tsumura
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Daisuke Ishii
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Yuichi Sato
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
| | - Masatsugu Iwamura
- Department of Urology, School of Medicine, Kitasato University, Sagamihara, Japan
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Mir MC, Marchioni M, Zargar H, Zargar-Shoshtari K, Fairey AS, Mertens LS, Dinney CP, Krabbe LM, Cookson MS, Jacobsen NE, Griffin J, Montgomery JS, Vasdev N, Yu EY, Xylinas E, McGrath JS, Kassouf W, Dall'Era MA, Sridhar SS, Aning J, Shariat SF, Wright JL, Thorpe AC, Morgan TM, Holzbeierlein JM, Bivalacqua TJ, North S, Barocas DA, Lotan Y, Grivas P, Stephenson AJ, Shah JB, van Rhijn BW, Spiess PE, Daneshmand D, Black PC. Nomogram Predicting Bladder Cancer-specific Mortality After Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle-invasive Bladder Cancer: Results of an International Consortium. Eur Urol Focus 2020; 7:1347-1354. [PMID: 32771446 DOI: 10.1016/j.euf.2020.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/25/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) is associated with improved overall and cancer-specific survival. The post-NAC pathological stage has previously been reported to be a major determinant of outcome. OBJECTIVE To develop a postoperative nomogram for survival based on pathological and clinical parameters from an international consortium. DESIGN, SETTING, AND PARTICIPANTS Between 2000 and 2015, 1866 patients with MIBC were treated at 19 institutions in the USA, Canada, and Europe. Analysis was limited to 640 patients with adequate follow-up who had received three or more cycles of NAC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A nomogram for bladder cancer-specific mortality (BCSM) was developed by multivariable Cox regression analysis. Decision curve analysis was used to assess the model's clinical utility. RESULTS AND LIMITATIONS A total of 640 patients were identified. Downstaging to non-MIBC (ypT1, ypTa, and ypTis) occurred in 271 patients (42 %), and 113 (17 %) achieved a complete response (ypT0N0). The 5-yr BCSM was 47.2 % (95 % confidence interval [CI]: 41.2-52.6 %). On multivariable analysis, covariates with a statistically significant association with BCSM were lymph node metastasis (hazard ratio [HR] 1.90 [95% CI: 1.4-2.6]; p < 0.001), positive surgical margins (HR 2.01 [95 % CI: 1.3-2.9]; p < 0.001), and pathological stage (with ypT0/Tis/Ta/T1 as reference: ypT2 [HR 2.77 {95 % CI: 1.7-4.6}; p < 0.001] and ypT3-4 [HR 5.9 {95 % CI: 3.8-9.3}; p < 0.001]). The area under the curve of the model predicting 5-yr BCSM after cross validation with 300 bootstraps was 75.4 % (95 % CI: 68.1-82.6 %). Decision curve analyses showed a modest net benefit for the use of the BCSM nomogram in the current cohort compared with the use of American Joint Committee on Cancer staging alone. Limitations include the retrospective study design and the lack of central pathology. CONCLUSIONS We have developed and internally validated a nomogram predicting BCSM after NAC and radical cystectomy for MIBC. The nomogram will be useful for patient counseling and in the identification of patients at high risk for BCSM suitable for enrollment in clinical trials of adjuvant therapy. PATIENT SUMMARY In this report, we looked at the outcomes of patients with muscle-invasive bladder cancer in a large multi-institutional population. We found that we can accurately predict death after radical surgical treatment in patients treated with chemotherapy before surgery. We conclude that the pathological report provides key factors for determining survival probability.
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Affiliation(s)
- Maria Carmen Mir
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Fundacion Instituto Valenciano Oncologia, Valencia, Spain.
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, Urology Unit, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Homi Zargar
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
| | - K Zargar-Shoshtari
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - A S Fairey
- University of Alberta, Edmonton, Alberta, Canada
| | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - C P Dinney
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - L M Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Münster, Münster, Germany
| | - M S Cookson
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma City, OK, USA
| | - N E Jacobsen
- University of Alberta, Edmonton, Alberta, Canada
| | - J Griffin
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - J S Montgomery
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - N Vasdev
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - E Y Yu
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - E Xylinas
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - J S McGrath
- Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - W Kassouf
- Department of Surgery (Division of Urology), McGill University Health Center, Montreal, Canada
| | - M A Dall'Era
- Department of Urology, University of California at Davis, Davis Medical Center, Sacramento, CA, USA
| | - S S Sridhar
- Princess Margaret Hospital, Toronto, Ontario, Canada
| | - J Aning
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK; Department of Surgery, Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Trust, Exeter, UK
| | - S F Shariat
- Department of Urology, Weill Cornell Medical College, Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; UT Southwestern, Dallas, TX, USA; Charles University, Prag, Czech Republic; University of Jordan, Amman, Jordan
| | - J L Wright
- Department of Urology, University of Washington, Seattle, WA, USA
| | - A C Thorpe
- Department of Urology, Freeman Hospital, Newcastle Upon Tyne, UK
| | - T M Morgan
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - J M Holzbeierlein
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - T J Bivalacqua
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - S North
- Cross Cancer Institute, Edmonton, AB, Canada; Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - D A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Y Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - P Grivas
- Department of Medicine, Division of Oncology, University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A J Stephenson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Urology, RUSH University, Chicago, IL, USA
| | - J B Shah
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - B W van Rhijn
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - P E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - D Daneshmand
- USC/Norris Comprehensive Cancer Center, Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - P C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada
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del Pozo Jiménez G, Herranz Amo F, Subirá Ríos D, Rodríguez Fernández E, Bueno Chomón G, Moralejo Gárate M, Durán Merino R, Escribano Patiño G, Carballido Rodríguez J, Hernández Fernández C. Mortality prediction model for patients with bladder urothelial tumor after radical cystectomy. Actas Urol Esp 2020; 44:215-223. [PMID: 32035808 DOI: 10.1016/j.acuro.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 07/02/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. MATERIAL AND METHODS Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986-2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer-Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). RESULTS BC was the cause of death in 225 patients (45%). One, three and five-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65-77%, p=.000) for the 1st year, 73.9% (CI95% 69.2-78.6%, p=.000) for the third and 73.2% (CI% 68.5-77.9%, p=.000) for the 5th. CONCLUSIONS The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8, 73.9 and 73.2%, respectively.
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Chen FV, Koru-Sengul T, Miao F, Jue JS, Alameddine M, Dave DJ, Punnen S, Parekh DJ, Ritch CR, Gonzalgo ML. Propensity-matched analysis of stage-specific efficacy of adjuvant chemotherapy for bladder cancer. Urol Oncol 2019; 37:877-85. [PMID: 31420159 DOI: 10.1016/j.urolonc.2019.06.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/12/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Contemporary randomized controlled trials exploring adjuvant chemotherapy (AC) for bladder cancer (BCa) have yielded inconsistent results due to premature termination and/or poor patient accrual. OBJECTIVE To compare efficacy of AC vs. observation after radical cystectomy stratified by disease stage in a propensity-matched cohort. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective study that included patients who underwent radical cystectomy for any pT, N0-1, M0 BCa from the National Cancer Data Base (2004-2014). Patients who underwent AC were 1:1 propensity matched with patients who received observation only. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival was assessed with multivariable Cox regression models where adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated. RESULTS AND LIMITATIONS After coarsened exact 1:1 propensity matching, 3,066 patients (AC 1,533; observation 1,533) were included in the analysis. There were no significant differences in patient-, facility-, or tumor-level characteristics among cohorts. Compared with patients who underwent observation, recipients of AC had improved overall survival (aHR 0.67; 95% CI 0.61-0.74). Patients with pT2-4, pN1 disease significantly benefited from AC. Among the pN0 cohort, improved survival from AC was observed only in stages pT3 (aHR 0.67; 95% CI 0.55-0.83) and pT4 (aHR 0.70; 95% CI 0.50-0.98). CONCLUSIONS AC was associated with improved survival in locally advanced (pT3-4, pN0) and regionally advanced (pT2-4, pN1) chemotherapy-naive BCa.
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9
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Necchi A, Pond GR, Moschini M, Plimack ER, Niegisch G, Yu EY, Bamias A, Agarwal N, Vaishampayan U, Theodore C, Sridhar SS, Rosenberg JE, Bellmunt J, Gallina A, Colombo R, Montorsi F, Briganti A, Galsky MD. Development of a Prediction Tool for Exclusive Locoregional Recurrence After Radical Cystectomy in Patients With Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer 2018; 17:7-14.e3. [PMID: 30292628 DOI: 10.1016/j.clgc.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/30/2018] [Accepted: 09/07/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Limited information is available about the pattern of relapse after perioperative chemotherapy with radical cystectomy (RC) vs. RC alone in muscle-invasive bladder cancer. PATIENTS AND METHODS Data from 1082 patients of the Retrospective International Study of Invasive/Advanced Cancer of the Urothelium database, treated from February 1990 to December 2013 at 27 centers in the United States, Europe, Israel, and Canada, were collected. Locoregional relapse was defined as any pelvic lymph node or soft tissue-only recurrences. Cumulative incidence methods were used to estimate time to locoregional relapse (TTRL). Cox regression analyses were performed and a nomogram for 12-month locoregional relapse-free survival (RFS) was developed. The nomogram was applied to an external data set (n = 1021). RESULTS A total of 517 patients (47.8%) developed a relapse: 177 (16.4%) exclusive locoregional relapse. In multivariable analyses, perioperative chemotherapy was associated with longer TTRL (P < .001). Other factors were nonurothelial histology (P = .013), pT-stage (P < .001), and surgical margins (P < .001). The concordance index of the model was 0.681 (95% bootstrapped confidence interval, 0.666-0.716). Risk group categories were obtained according to nomogram tertiles. Despite, overall, observed locoregional RFS in the validation cohort exceeding predicted results, for high-risk patients (80 points or less, lowest nomogram tertile) observed 12-month RFS was similar between development and validation cohorts (60.1% and 66.6%). The study is limited by its retrospective nature. CONCLUSION In the largest study, to our knowledge, that analyzed locoregional recurrences after RC, we propose a risk prediction tool for exclusive locoregional failures that might be suitable for clinical studies. Patients best suited for adjuvant radiotherapy might be those within the lowest nomogram tertile. Prospective trials are needed to validate findings.
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Affiliation(s)
- Andrea Necchi
- Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
| | | | - Marco Moschini
- Vita Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milano, Italy
| | | | - Gunter Niegisch
- Heinrich-Heine-University, Medical faculty, Department of Urology, Düsseldorf, Germany
| | - Evan Y Yu
- University of Washington, Seattle, WA
| | | | | | | | | | - Srikala S Sridhar
- Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | | | | | - Andrea Gallina
- Vita Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milano, Italy
| | - Renzo Colombo
- Vita Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milano, Italy
| | - Francesco Montorsi
- Vita Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milano, Italy
| | - Alberto Briganti
- Vita Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milano, Italy
| | - Matthew D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY
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Bandini M, Briganti A, Plimack ER, Niegisch G, Yu EY, Bamias A, Agarwal N, Sridhar SS, Sternberg CN, Vaishampayan U, Théodore C, Rosenberg JE, Bellmunt J, Galsky MD, Montorsi F, Necchi A. Modeling 1-year Relapse-free Survival After Neoadjuvant Chemotherapy and Radical Cystectomy in Patients with Clinical T2-4N0M0 Urothelial Bladder Carcinoma: Endpoints for Phase 2 Trials. Eur Urol Oncol 2018; 2:248-256. [PMID: 31200838 DOI: 10.1016/j.euo.2018.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several ongoing phase 2 trials are evaluating new neoadjuvant therapy regimens in patients with muscle-invasive bladder cancer (MIBC). The 1-yr recurrence-free survival (RFS) after radical cystectomy (RC), with or without perioperative chemotherapy, can be used to model statistical assumptions and interpret outcomes from these studies. OBJECTIVE To provide a benchmark for predicting 1-yr RFS in patients with cT2-4N0 MIBC. DESIGN, SETTING, AND PARTICIPANTS We identified 950 patients with clinical stage T2-4N0 MIBC undergoing RC at 27 centers between 1990 and 2016. We assessed 1-yr RFS rates for patients managed with no perioperative chemotherapy, neoadjuvant chemotherapy (NAC), adjuvant chemotherapy (AC), or NAC followed by AC. Cox regression analyses tested for 1-yr postsurgical RFS predictors. A Cox-based nomogram was developed to estimate 1-yr RFS and its accuracy was assessed in terms of Harrell's c-index, a calibration plot, and decision curve analysis. We report 1-yr RFS rates across the nomogram tertiles. RESULTS AND LIMITATIONS The 1-yr RFS rates were 67.9% (95% confidence interval [CI] 64-72) after no perioperative chemotherapy, 76.9% (95% CI 72-83%) after NAC, 77.8% (95% CI 71-85%) after AC, and 57% (95% CI 37-87) after NAC+AC. On multivariable analysis, positive surgical margins (p=0.002), pT stage (p<0.0001), and pN stage (p<.0001) were significantly associated with RFS, while NAC was not (p=0.6). The model including all these factors yielded a c-index of 0.76 (95% CI 0.72-0.79), good calibration, and a high net benefit. The 1-yr RFS rates across nomogram tertiles were 90.5% (95% CI 87-94%), 73.4% (95% CI 68-79%), and 51.1% (95% CI 45-58%), respectively. The results lack external validation. CONCLUSIONS Benchmark 1-yr RFS estimates for phase 2 design of new neoadjuvant trials are proposed and can be used for statistical assumptions, pending external validation. PATIENT SUMMARY Our prognostic model predicting 1-yr survival free from recurrence of bladder cancer after radical cystectomy, with or without standard chemotherapy, could provide an improvement to the quality of phase 2 clinical trial designs and interpretation of their results.
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Affiliation(s)
- Marco Bandini
- Vita-Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Alberto Briganti
- Vita-Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Günter Niegisch
- Department of Urology, Heinrich-Heine University, Düsseldorf, Germany
| | - Evan Y Yu
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | | | - Neeraj Agarwal
- Huntsman Cancer Institute (HCI), University of Utah, Salt Lake City, UT, USA
| | - Srikala S Sridhar
- Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Joaquim Bellmunt
- Bladder Cancer Center, Medicine, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Matthew D Galsky
- Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA
| | - Francesco Montorsi
- Vita-Salute San Raffaele University and Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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11
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Mari A, Kimura S, Foerster B, Abufaraj M, D'Andrea D, Gust KM, Shariat SF. A systematic review and meta-analysis of lymphovascular invasion in patients treated with radical cystectomy for bladder cancer. Urol Oncol 2018; 36:293-305. [PMID: 29685374 DOI: 10.1016/j.urolonc.2018.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/06/2018] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Lymphovascular invasion (LVI) is an important step in bladder cancer cell dissemination. We aimed to perform a systematic review and meta-analysis of the literature to assess the prognostic value of LVI in radical cystectomy (RC) specimens. PATIENTS AND METHODS A systematic review and meta-analysis of the last 10 years was performed using the MEDLINE, EMBASE, and the Cochrane libraries in July 2017. The analyses were performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. RESULTS We retrieved 65 studies (including 78,107 patients) evaluating the effect of LVI on oncologic outcomes in patients treated with RC. LVI was reported in 35.4% of patients. LVI was associated with disease recurrence (pooled hazard ratio [HR] = 1.57; 95% CI: 1.45-1.70) and cancer-specific mortality (CSM) (pooled HR = 1.59; 95% CI: 1.48-1.73) in all studies regardless of tumor stage and node status (pT1-4 pN0-2). LVI was associated with recurrence and CSM in patients with node-negative bladder cancer (BC). In patients with node-negative BC, LVI rate increased and was associated with worse oncologic outcome. LVI had a lower but still significant association with disease recurrence and CSM in node-positive BC. CONCLUSIONS LVI is a strong prognostic factor of worse prognosis in patients treated with RC for bladder cancer. This association is strongest in node-negative BC, but it is also in node-positive BC. LVI should be part of all pathological reporting and could provide additional information for treatment-decision making regarding adjuvant therapy after RC.
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Affiliation(s)
- Andrea Mari
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Beat Foerster
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Special Surgery, Jordan University hospital, The University of Jordan, Amman, Jordan
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kilian M Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.
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12
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Moschini M, Shariat SF, Abufaraj M, Foerster B, D′Andrea D, Soria F, Dell′Oglio P, Mattei A, Montorsi F, Colombo R, Briganti A, Gallina A. Predicting local failure after radical cystectomy in patients with bladder cancer: Implications for the selection of candidates at adjuvant radiation therapy. Urol Oncol 2017; 35:672.e1-672.e6. [DOI: 10.1016/j.urolonc.2017.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/26/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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13
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Mari A, Campi R, Tellini R, Gandaglia G, Albisinni S, Abufaraj M, Hatzichristodoulou G, Montorsi F, van Velthoven R, Carini M, Minervini A, Shariat SF. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol 2017; 36:157-170. [PMID: 29147759 PMCID: PMC5799348 DOI: 10.1007/s00345-017-2115-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To review the currently available literature reporting the patterns of recurrence and their predictive factors after open radical cystectomy (RC) for bladder cancer. Methods A review of the literature was performed using the MEDLINE, Scopus and Web of Sciences databases from January 1997 to May 2017. The PRISMA guidelines were followed for the conduct of the study. Results Local recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%. The mean follow-up of studies included in the analysis ranged from 18 to 350 months. Details on the most important demographic and epidemiological, clinical, histologic and pathologic predictors of recurrence after radical cystectomy are provided through an evidence-based approach. The impact of the extension of lymph node dissection on recurrence after RC is investigated. Conclusions A correct prognostic assessment is essential for patients undergoing radical cystectomy for bladder cancer, thereby potentially improving their oncologic outcomes. Electronic supplementary material The online version of this article (10.1007/s00345-017-2115-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Simone Albisinni
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Roland van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria. .,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. .,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA. .,Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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14
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Dabi Y, Rouscoff Y, Delongchamps NB, Sibony M, Saighi D, Zerbib M, Peyraumore M, Xylinas E. [Negative prognostic impact of female gender on oncological outcomes following radical cystectomy]. Prog Urol 2016; 26:83-8. [PMID: 26796347 DOI: 10.1016/j.purol.2015.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/25/2015] [Accepted: 12/11/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To confirm gender specific differences in pathologic factors and survival rates of urothelial bladder cancer patients treated with radical cystectomy. PATIENTS AND METHODS We conducted a retrospective monocentric study on 701 patients treated with radical cystectomy and pelvic lymphadenectomy for muscle invasive bladder cancer. Impact of gender on recurrence rate, specific and non-specific mortality rate were evaluated using Cox regression models in univariate and multivariate analysis. RESULTS We collected data on 553 males (78.9%) and 148 females (21.1%) between 1998 and 2011. Both groups were comparable at inclusion regarding age, pathologic stage, nodal status and lymphovascular invasion. Mean follow-up time was 45 months (interquartile 23-73) and by that time, 163 patients (23.3%) had recurrence of their tumor and 127 (18.1%) died from their disease. In multivariable Cox regression analyses, female gender was independently associated with disease recurrence (RR: 1.73; 95% CI 1.22-2.47; P=0.02) and cancer-specific mortality (RR=2.50, 95% CI=1.71-3.68; P<0.001). CONCLUSION We confirmed female gender to be an independent negative prognosis factor for patients following a radical cystectomy and lymphadenectomy for an invasive muscle bladder cancer.
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Affiliation(s)
- Y Dabi
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - Y Rouscoff
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - N B Delongchamps
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Sibony
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - D Saighi
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Zerbib
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - M Peyraumore
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - E Xylinas
- Service d'urologie, hôpital Cochin, université Paris Descartes, Assistance publique-Hôpitaux de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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15
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Lucca I, Jichlinski P, Shariat SF, Rouprêt M, Rieken M, Kluth LA, Rink M, Mathieu R, Mbeutcha A, Maj-Hes A, Fajkovic H, Briganti A, Seitz C, Karakiewicz PI, de Martino M, Lotan Y, Babjuk M, Klatte T. The Neutrophil-to-lymphocyte Ratio as a Prognostic Factor for Patients with Urothelial Carcinoma of the Bladder Following Radical Cystectomy: Validation and Meta-analysis. Eur Urol Focus 2015; 2:79-85. [PMID: 28723455 DOI: 10.1016/j.euf.2015.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/16/2015] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic inflammatory response has been proposed as a prognostic factor for patients with urothelial carcinoma of the bladder (UCB) following radical cystectomy (RC). OBJECTIVE To validate NLR as a prognostic biomarker and to perform a pooled meta-analysis. DESIGN, SETTING, AND PARTICIPANTS The NLR was assessed in 4061 patients within 30 days before RC. A systematic review of the literature was undertaken using electronic databases. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Associations with overall survival (OS) and cancer-specific survival (CSS) were evaluated using Cox models. Hazard ratios (HRs) were pooled in a meta-analysis using random-effects modeling. RESULTS AND LIMITATIONS A high NLR (≥2.7) was associated with advanced pathological tumor stages (p<0.001), lymph node involvement (p<0.001), lymphovascular invasion (p=0.008), and positive soft0tissue surgical margins (p=0.001). In multivariate analyses, a high NLR was independently associated with both OS (HR 1.11, 95% confidence interval [CI] 1.01-1.22; p=0.029) and cancer-specific survival (CSS) (HR 1.21, 95% CI 1.07-1.37, p=0.003). The discrimination of the multivariate models increased by 0.2% on inclusion of NLR. Five studies were included in the meta-analysis. The HR for NLR greater than the cutoff was 1.46 (95% CI 1.01-1.92) for OS and 1.51 (95% CI 1.17-1.85) for CSS. Limitations include the retrospective study design and the lack of standardized follow-up. CONCLUSION In patients with UCB treated with RC, a high preoperative NLR is associated with more advanced tumor stage, lymph node metastasis, and worse prognosis. The NLR may be a readily available and useful biomarker for preoperative prognostic stratification. PATIENT SUMMARY We investigated the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in patients with bladder cancer treated with radical cystectomy. We found that a high NLR is associated with worse oncologic outcomes, suggesting it could play a role in risk stratification.
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Affiliation(s)
- Ilaria Lucca
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrice Jichlinski
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
| | - Morgan Rouprêt
- Department of Urology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique Hopitaux de Paris, Faculty of Medicine Pierre et Marie Curie, University Paris 6, Paris, France
| | - Malte Rieken
- Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Luis A Kluth
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France
| | - Aurelie Mbeutcha
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Agnes Maj-Hes
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Alberto Briganti
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Christian Seitz
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QB, Canada
| | - Michela de Martino
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marko Babjuk
- Department of Urology, Hospital Motol, Second Faculty of Medicine, Prague, Czech Republic
| | - Tobias Klatte
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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16
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Engel O, Soave A, Peine S, Kluth LA, Schmid M, Shariat SF, Dahlem R, Fisch M, Rink M. The impact of the AB0 and the Rhesus blood group system on outcomes in bladder cancer patients treated with radical cystectomy. World J Urol 2015; 33:1769-76. [DOI: 10.1007/s00345-015-1531-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 03/05/2015] [Indexed: 11/25/2022] Open
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17
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Kluth LA, Black PC, Bochner BH, Catto J, Lerner SP, Stenzl A, Sylvester R, Vickers AJ, Xylinas E, Shariat SF. Prognostic and Prediction Tools in Bladder Cancer: A Comprehensive Review of the Literature. Eur Urol 2015; 68:238-53. [PMID: 25709027 DOI: 10.1016/j.eururo.2015.01.032] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
Abstract
CONTEXT This review focuses on risk assessment and prediction tools for bladder cancer (BCa). OBJECTIVE To review the current knowledge on risk assessment and prediction tools to enhance clinical decision making and counseling of patients with BCa. EVIDENCE ACQUISITION A literature search in English was performed using PubMed in July 2013. Relevant risk assessment and prediction tools for BCa were selected. More than 1600 publications were retrieved. Special attention was given to studies that investigated the clinical benefit of a prediction tool. EVIDENCE SYNTHESIS Most prediction tools for BCa focus on the prediction of disease recurrence and progression in non-muscle-invasive bladder cancer or disease recurrence and survival after radical cystectomy. Although these tools are helpful, recent prediction tools aim to address a specific clinical problem, such as the prediction of organ-confined disease and lymph node metastasis to help identify patients who might benefit from neoadjuvant chemotherapy. Although a large number of prediction tools have been reported in recent years, many of them lack external validation. Few studies have investigated the clinical utility of any given model as measured by its ability to improve clinical decision making. There is a need for novel biomarkers to improve the accuracy and utility of prediction tools for BCa. CONCLUSIONS Decision tools hold the promise of facilitating the shared decision process, potentially improving clinical outcomes for BCa patients. Prediction models need external validation and assessment of clinical utility before they can be incorporated into routine clinical care. PATIENT SUMMARY We looked at models that aim to predict outcomes for patients with bladder cancer (BCa). We found a large number of prediction models that hold the promise of facilitating treatment decisions for patients with BCa. However, many models are missing confirmation in a different patient cohort, and only a few studies have tested the clinical utility of any given model as measured by its ability to improve clinical decision making.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernard H Bochner
- Department of Urology, Memorial Sloan-Kettering Cancer Center, Kimmel Center for Prostate and Urologic Tumors, New York, NY, USA
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | | | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, UT Southwestern, Dallas, TX, USA; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
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Lucca I, Rouprêt M, Kluth L, Rink M, Tilki D, Fajkovic H, Kassouf W, Hofbauer SL, de Martino M, Karakiewicz PI, Briganti A, Trinh QD, Seitz C, Fritsche HM, Burger M, Lotan Y, Kramer G, Shariat SF, Klatte T. Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of >1500 patients. BJU Int 2015; 115:722-7. [DOI: 10.1111/bju.12829] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ilaria Lucca
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
- Department of Urology; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Morgan Rouprêt
- Department of Urology; Groupe Hospitalier Pitié - Salpêtrière; Assistance Publique Hopitaux de Paris; Faculty of Medicine Pierre et Marie Curie; Institut Universitaire de Cancérologie GRC5; University Paris 6; Paris France
| | - Luis Kluth
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Michael Rink
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Department of Urology; University of California; Davis CA USA
| | - Harun Fajkovic
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Wassim Kassouf
- Department of Urology; McGill University; Montreal QC Canada
| | - Sebastian L. Hofbauer
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Michela de Martino
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Centre; Montreal QC Canada
| | - Alberto Briganti
- San Raffaele Scientific Institute; Urological Research Institute; Department of Urology; Milan Italy
| | - Quoc-dien Trinh
- School of Medicine; Sacramento CA USA
- Department of Surgery; Division of Urology; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | - Christian Seitz
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Hans-Martin Fritsche
- Department of Urology; Caritas St. Josef Medical Center; University of Regensburg; Regensburg Germany
| | - Maximilian Burger
- Department of Urology; Caritas St. Josef Medical Center; University of Regensburg; Regensburg Germany
| | - Yair Lotan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Gero Kramer
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Shahrokh F. Shariat
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
- Department of Urology; Weill Cornell Medical College; New York-Presbyterian Hospital; New York NY USA
| | - Tobias Klatte
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
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Kramer MW, Heinisch A, Wegener G, Abbas M, von Klot C, Peters I, Tezval H, Herrmann TR, Kuczyk MA, Merseburger AS. [C-reactive protein prior to radical cystectomy: preoperative determination of CRP]. Urologe A 2014; 53:222-7. [PMID: 23955283 DOI: 10.1007/s00120-013-3299-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Numerous studies have shown a positive correlation between elevated C-reactive protein (CRP) and systemic spread of malignancies. The goal of the current study was to assess the predictive significance of preoperative CRP in patients undergoing radical cystectomy (RC). MATERIAL AND METHODS Preoperative CRP values were measured in 194 patients undergoing RC because of urothelial carcinoma between 1996 and 2005. Elevated CRP level was defined as ≥ 5 mg/l. RESULTS Preoperative increased CRP values were detected in 89 (45.9%) patients and these patients were more likely to have advanced tumor stages (pT3-4), positive resection margins and positive lymph nodes. Advanced urinary diversions were more common in patients with normal CRP values. In multivariate analysis, CRP was identified as an independent prognostic indicator for poor cancer-specific survival. CONCLUSION The results confirm previous reports that showed a prognostic significance of preoperative CRP elevation.
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Affiliation(s)
- M W Kramer
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
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Masson-lecomte A, Xylinas E, Bouquot M, Sibony M, Allory Y, Comperat E, Zerbib M, de la Taille A, Rouprêt M. Oncological outcomes of advanced muscle-invasive bladder cancer with a micropapillary variant after radical cystectomy and adjuvant platinum-based chemotherapy. World J Urol 2015; 33:1087-93. [DOI: 10.1007/s00345-014-1387-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022] Open
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21
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Lee DJ, Xylinas E, Rieken M, Khani F, Klatte T, Wood CG, Karam JA, Weizer AZ, Raman JD, Remzi M, Guo CC, Rioux-Leclercq N, Haitel A, Bolenz C, Bensalah K, Sagalowsky AI, Montorsi F, Lotan Y, Shariat SF, Robinson BD, Margulis V. Insulin-like Growth Factor Messenger RNA-binding Protein 3 Expression Helps Prognostication in Patients with Upper Tract Urothelial Carcinoma. Eur Urol 2014; 66:379-85. [DOI: 10.1016/j.eururo.2013.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/08/2013] [Indexed: 12/27/2022]
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Kwon T, Jeong IG, You D, Hong B, Hong JH, Ahn H, Kim CS. Long-term oncologic outcomes after radical cystectomy for bladder cancer at a single institution. J Korean Med Sci 2014; 29:669-75. [PMID: 24851023 PMCID: PMC4024950 DOI: 10.3346/jkms.2014.29.5.669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/03/2014] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to evaluate our experience using radical cystectomy to treat patients with bladder cancer and to describe the associations between pathologic features and clinical outcomes. All 701 patients who underwent radical cystectomy for bladder cancer were evaluated. The patient population consisted of 623 men and 78 women. The overall 5 and 10 yr recurrence-free survival (RFS) rates were 61.8% and 57.7%, respectively, and the 5 and 10 yr cancer-specific survival (CSS) rates were 70.8% and 65.1%, respectively. Multivariate analysis showed that factors significantly predictive of RFS and CSS included extravesical extension (P = 0.001), lymph node metastasis (P = 0.001), and lymphovascular invasion (P < 0.001 and P = 0.007). The 5 and 10 yr RFS rates for patients with lymph node metastasis were 25.6% and 20.8%, respectively, and the 5 and 10 yr CSS rates were 38.6% and 30.9%, respectively. Adjuvant chemotherapy significantly improved RFS (P = 0.002) and CSS (P = 0.001) in patients with lymph node metastasis. Radical cystectomy provides good survival results in patients with invasive bladder cancer. Pathologic features significantly associated with prognosis include extravesical extension, node metastasis, and lymphovascular invasion. Adjuvant chemotherapy improves survival in patients with advanced stage disease.
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Affiliation(s)
- Taekmin Kwon
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Eisenberg MS, Boorjian SA, Cheville JC, Thompson RH, Thapa P, Kaushik D, Frank I. The SPARC Score: A Multifactorial Outcome Prediction Model for Patients Undergoing Radical Cystectomy for Bladder Cancer. J Urol 2013; 190:2005-10. [DOI: 10.1016/j.juro.2013.06.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2013] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | | | - Prabin Thapa
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Dharam Kaushik
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota
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Xylinas E, Cha EK, Khani F, Kluth LA, Rieken M, Volkmer BG, Hautmann R, Küfer R, Chen YT, Zerbib M, Rubin MA, Scherr DS, Shariat SF, Robinson BD. Association of oncofetal protein expression with clinical outcomes in patients with urothelial carcinoma of the bladder. J Urol 2014; 191:830-41. [PMID: 23994370 DOI: 10.1016/j.juro.2013.08.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE Oncofetal proteins are expressed in the developing embryo. Oncofetal protein expression correlates with the clinical outcome of nonmuscle invasive bladder urothelial carcinoma. IMP3, MAGE-A, glypican-3 and TPBG are oncofetal proteins that have not been well characterized in urothelial carcinoma of the bladder. MATERIALS AND METHODS We investigated the expression of these 4 proteins and their association with clinical outcomes using tissue microarrays from 384 consecutive patients treated with radical cystectomy between 1988 and 2003 at 1 academic center. We stained for IMP3, MAGE-A, glypican-3 and TPBG. Univariable and multivariable Cox regression analyses were done to evaluate the association of oncofetal protein expression with disease recurrence and cancer specific mortality. RESULTS IMP3, MAGE-A, glypican-3 and TPBG were expressed in 39.5%, 45%, 6% and 85% of urothelial bladder carcinomas, respectively. Expression was tumor specific and did not correlate with pathological features except for TPBG. At a median followup of 128 months 176 patients (46%) experienced disease recurrence, 175 (45.5%) had died of the disease and 96 (27.5%) had died of another cause. On univariable analysis IMP3 and MAGE-A expression was associated with an increased risk of disease recurrence (p <0.001 and 0.03) and cancer specific mortality (p = 0.004 and 0.03, respectively). On multivariable Cox regression analysis adjusted for the effects of standard clinicopathological features IMP3 and MAGE-A expression was independently associated with disease recurrence (p = 0.004, HR 1.55, 95% CI 1.15-2.11 and p = 0.02, HR 1.44, 95% CI 1.05-1.99, respectively) but not with cancer specific mortality. CONCLUSIONS Oncofetal proteins are commonly and differentially expressed in urothelial carcinoma of the bladder compared to normal urothelium. IMP3 and MAGE-A expression was associated with disease recurrence and cancer specific mortality but glypican-3 and TPBG expression was not.
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Thissen AK, Pfister D, Heidenreich A. [Muscle invasive bladder cancer after radical cystectomy. Prognostic factors of adjuvant chemotherapy]. Urologe A 2013; 52:1233-41. [PMID: 23975218 DOI: 10.1007/s00120-013-3311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The indications to administer adjuvant systemic chemotherapy to patients with urothelial carcinoma of the bladder who underwent radical cystectomy is discussed controversially and all international guidelines are very restrictive with regard to its recommendation for routine daily practice due to the low scientific evidence concerning its therapeutic benefit. Currently, adjuvant systemic chemotherapy should be preferably administered within clinical trials. In the daily routine adjuvant treatment might be given in patients with lymph node positive disease. Clinical, pathohistological and molecular biomarkers which might be associated with a positive or negative treatment response have been evaluated sparsely in the past. RESULTS The presence of hemangiosis/lymphangiosis carcinomatosa and/or extranodal expansion in patients with lymph node metastases appears to be associated with a poor outcome. The markers ERCC-1, XAF and anti-apoptotic proteins of the Bcl-2 family seem to represent the most promising biomarkers associated with response to adjuvant cisplatin-based chemotherapy.
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