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Cox A, Klümper N, Stein J, Sikic D, Breyer J, Bolenz C, Roghmann F, Erben P, Wirtz RM, Wullich B, Ritter M, Hölzel M, Schwamborn K, Horn T, Gschwend J, Hartmann A, Weichert W, Erlmeier F, Eckstein M. Molecular Urothelial Tumor Cell Subtypes Remain Stable During Metastatic Evolution. Eur Urol 2024; 85:328-332. [PMID: 37031005 DOI: 10.1016/j.eururo.2023.03.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/23/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
Urothelial cancer (UC) care is moving toward precision oncology. For tumor biology-driven treatment of metastatic UC (mUC), molecular subtypes play a crucial role. However, it is not known whether subtypes change during metastatic evolution. To address this, we analyzed a UC progression cohort (N = 154 patients) with 138 matched primary tumors (PRIM) and synchronous or metachronous distant metastasis (MET) by immunohistochemistry, and mRNA sequencing in a subgroup of 20 matched pairs. Protein-based tumor cell subtypes and histomorphology remained stable during metastatic progression (concordance: 94%, 95% confidence interval [CI] 88-97%). In comparison, transcriptome-based molecular consensus subtypes exhibited higher heterogeneity between PRIM and MET (concordance: 45%, 95% CI 23-69%), with switches particularly occurring between luminal and stroma-rich tumors. Of note, all tumors classified as stroma rich showed luminal tumor cell differentiation. By an in-depth analysis, we found a negative correlation of luminal gene and protein expression with increasing desmoplastic stroma content, suggesting that luminal tumor cell differentiation of "stroma-rich tumors" is superimposed by gene expression signals stemming from the stromal compartment. Immunohistochemistry allows tumor cell subtyping into luminal, basal, or neuroendocrine classes that remain stable during metastatic progression. These findings expand our biological understanding of UC MET and have implications for future subtype-stratified clinical trials in patients with mUC. PATIENT SUMMARY: Urothelial carcinomas (UCs) occur in different appearances, the so-called molecular subtypes. These molecular subtypes will gain importance for the therapy of metastatic UCs in the future. We could demonstrate that the subtype remains stable during metastasis, which is highly relevant for future studies.
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Affiliation(s)
- Alexander Cox
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Düsseldorf, Germany
| | - Niklas Klümper
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Düsseldorf, Germany; Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany
| | - Johannes Stein
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Düsseldorf, Germany
| | - Danijel Sikic
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bavarian Center for Cancer Research (BZKF), Bavaria, Germany
| | - Johannes Breyer
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Department of Urology, St.-Caritas Hospital Regensburg, Regensburg, Germany; University of Regensburg, Regensburg, Germany
| | - Christian Bolenz
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Florian Roghmann
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Philipp Erben
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralph M Wirtz
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; STRATIFYER Molecular Pathology, Cologne, Germany
| | - Bernd Wullich
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bavarian Center for Cancer Research (BZKF), Bavaria, Germany
| | - Manuel Ritter
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Düsseldorf, Germany
| | - Michael Hölzel
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Düsseldorf, Germany; Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany
| | - Kristina Schwamborn
- Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Institute of Pathology, Technische Universität München, Munich, Germany
| | - Thomas Horn
- Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Department of Urology, Technische Universität München, Munich, Germany
| | - Jürgen Gschwend
- Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Department of Urology, Technische Universität München, Munich, Germany
| | - Arndt Hartmann
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Wilko Weichert
- Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Institute of Pathology, Technische Universität München, Munich, Germany
| | - Franziska Erlmeier
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Institute of Pathology, Technische Universität München, Munich, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus Eckstein
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bavarian Center for Cancer Research (BZKF), Bavaria, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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2
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Reike MJ, Reicherz A, Tully KH, Bahlburg H, Maas M, Bach P, Klümper N, Eckstein M, Hartmann A, Breyer J, Erben P, Bolenz C, Noldus J, Berg S, Roghmann F. An empirical survey on the adaption of neoadjuvant chemotherapy in bladder cancer. Urol Int 2024:000536321. [PMID: 38246156 DOI: 10.1159/000536321] [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] [Received: 10/18/2023] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To determine the adaption of neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC) in Germany, Austria and Switzerland and especially underlying reasons for potential low adherence to guidelines. METHODS We conducted a non-validated survey amongst 336 urologic departments in Germany, Austria and Switzerland. RedCap questionnaires were electronically distributed and included 23 items concerning the general NAC administration standards and guideline compliance in patient counselling regarding actual treatment. RESULTS Return rate of the questionnaire was 19.1% (63/336). Although 45 departments (71.4%) claim to perform NAC as standard-of-care, only 49% of eligible patients actually receive NAC. An advanced disease stage (≥cT3) and a high tumor-volume were mentioned to support application of NAC, whereas 35% of responders worry a deterioration of patients' preoperative status due to NAC. Furthermore, 26.7% of respondents are concerned about the low extent of survival benefit. CONCLUSION Application of NAC in eligible MIBC-patients in Germany, Austria and Switzerland remains low. Although the majority of urologic departments discusses NAC and acknowledges the need for intensified treatment in advanced disease stages, not all eligible patients will actually receive NAC before radical cystectomy.
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3
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Klümper N, Wüst L, Saal J, Ralser DJ, Zarbl R, Jarczyk J, Breyer J, Sikic D, Wullich B, Bolenz C, Roghmann F, Hölzel M, Ritter M, Strieth S, Hartmann A, Erben P, Wirtz RM, Landsberg J, Dietrich D, Eckstein M. PD-L1 ( CD274) promoter hypomethylation predicts immunotherapy response in metastatic urothelial carcinoma. Oncoimmunology 2023; 12:2267744. [PMID: 37868689 PMCID: PMC10588513 DOI: 10.1080/2162402x.2023.2267744] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
PD-L1 status assessed by immunohistochemistry (IHC) has failed to reliably predict outcomes for patients with metastatic urothelial carcinoma (mUC) on immune checkpoint blockade (ICB). PD-L1 promoter methylation is an epigenetic mechanism that has been shown to regulate PD-L1 mRNA expression in various malignancies. The aim of our present study was to evaluate the predictive potential of PD-L1 promoter methylation status (mPD-L1) in ICB-treated mUC compared to conventional IHC-based PD-L1 assessment. We quantified mPD-L1 in formalin-fixed and paraffin-embedded tissue sections using an established quantitative methylation-specific PCR assay (qMSP) in a well-characterized multicenter ICB-treated cohort comprising N = 107 patients with mUC. Additionally, PD-L1 protein expression in tumor tissues was assessed using regulatory approved IHC protocols. The effect of pharmacological hypomethylation by the DNA methyltransferase inhibitor decitabine in combination with interferon-γ stimulation in urothelial carcinoma cell lines was investigated by IHC and FACS. mPD-L1 hypomethylation predicted objective response rate at the first staging on ICB. Patients with tumors categorized as PD-L1 hypomethylated (lower quartile) showed significantly prolonged progression-free (PFS) and overall survival (OS) after ICB initiation. In contrast, PD-L1 protein expression status neither correlated with response nor survival. In multivariable Cox regression analyses, PD-L1 promoter hypermethylation remained an independent predictor of unfavorable PFS and OS. In urothelial carcinoma cell lines, pharmacological demethylation led to an upregulation of membranous PD-L1 expression and an enhanced inducibility of PD-L1 expression by interferon γ. Hypomethylation of the PD-L1 promoter is a promising predictive biomarker for response to ICB in patients with mUC.
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Affiliation(s)
- Niklas Klümper
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Lennert Wüst
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Jonas Saal
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Damian J. Ralser
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Department of Gynaecology and Gynaecological Oncology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Romina Zarbl
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Breyer
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
- Center for Integrated Oncology, Bavarian Center for Cancer Research (Bayerisches Zentrum für Krebsforschung, BZKF), Erlangen, Germany
| | - Danijel Sikic
- Center for Integrated Oncology, Bavarian Center for Cancer Research (Bayerisches Zentrum für Krebsforschung, BZKF), Erlangen, Germany
- Center for Integrated Oncology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Bernd Wullich
- Center for Integrated Oncology, Bavarian Center for Cancer Research (Bayerisches Zentrum für Krebsforschung, BZKF), Erlangen, Germany
- Center for Integrated Oncology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Michael Hölzel
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Manuel Ritter
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Sebastian Strieth
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Arndt Hartmann
- Center for Integrated Oncology, Bavarian Center for Cancer Research (Bayerisches Zentrum für Krebsforschung, BZKF), Erlangen, Germany
- Center for Integrated Oncology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralph M. Wirtz
- Center for Integrated Oncology, STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Jennifer Landsberg
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Department of Dermatology and Allergy, University Medical Center Bonn (UKB), Bonn, Germany
| | - Dimo Dietrich
- Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
- Department of Otorhinolaryngology, University Medical Center Bonn (UKB), Bonn, Germany
| | - Markus Eckstein
- Center for Integrated Oncology, Bavarian Center for Cancer Research (Bayerisches Zentrum für Krebsforschung, BZKF), Erlangen, Germany
- Center for Integrated Oncology, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Breyer J, Eckstein M, Sikic D, Wezel F, Roghmann F, Brehmer M, Wirtz RM, Jarczyk J, Erben P, Bahlinger V, Goldschmidt F, Fechner G, Chen J, Paxinos E, Bates M, Haas M, Zengerling F, Bolenz C, Burger M, Hartmann A, Kriegmair MC. Xpert bladder cancer monitor to predict the need for a second TURB (MoniTURB trial). Sci Rep 2023; 13:15437. [PMID: 37723173 PMCID: PMC10507065 DOI: 10.1038/s41598-023-42088-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
To determine whether Xpert bladder cancer monitor, a noninvasive PCR-based biomarker test, can predict the need for 2nd transurethral resection of the bladder (TURB) better than clinical assessment. Patients scheduled for TURB were prospectively screened. After initial TURB, patients were assigned to 2nd TURB or follow-up cystoscopy at 3 months (FU) by clinicians' discretion. Central urine cytology and Xpert monitor tests were performed prior to the 1st TURB and 2nd TURB or FU, respectively. Statistical analysis to compare clinical assessment and Xpert monitor comprised sensitivity (SENS), specificity (SPEC), NPV and PPV. Of 756 screened patients, 171 were included (114 with 2nd TURB, 57 with FU). Residual tumors were detected in 34 patients who underwent 2nd TURB, and recurrent tumors were detected in 2 patients with FU. SENS and SPEC of Xpert monitor were 83.3% and 53.0%, respectively, PPV was 32.6% and NPV was 92.1%. Clinical risk assessment outperformed Xpert monitor. In patients with pTa disease at initial TURB, Xpert monitor revealed a NPV of 96%. Xpert monitor was not superior than clinical assessment in predicting the need for 2nd TURB. It might be an option to omit 2nd TURB for selected patients with pTa disease.
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Affiliation(s)
- Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany.
| | - Markus Eckstein
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Felix Wezel
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Mirco Brehmer
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
- Institute of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Veronika Bahlinger
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Franziska Goldschmidt
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Guido Fechner
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Jack Chen
- Biostatistics, Cepheid Inc., Sunnyvale, CA, USA
| | - Ellen Paxinos
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Friedemann Zengerling
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Arndt Hartmann
- Institute of Pathology, Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Hospital Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- BRIDGE (Bladder Cancer Research Initiative for Drug Targets Germany) Consortium E.V., Mannheim, Germany
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5
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Koch J, Neuberger M, Schmidt-Dengler M, Xu J, Carneiro VC, Ellinger J, Kriegmair MC, Nuhn P, Erben P, Michel MS, Helm M, Rodríguez-Paredes M, Nientiedt M, Lyko F. Reinvestigating the clinical relevance of the m 6A writer METTL3 in urothelial carcinoma of the bladder. iScience 2023; 26:107300. [PMID: 37554463 PMCID: PMC10405067 DOI: 10.1016/j.isci.2023.107300] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/13/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
METTL3 is the major writer of N6-Methyladenosine (m6A) and has been associated with controversial roles in cancer. This is best illustrated in urothelial carcinoma of the bladder (UCB), where METTL3 was described to have both oncogenic and tumor-suppressive functions. Here, we reinvestigated the role of METTL3 in UCB. METTL3 knockout reduced the oncogenic phenotype and m6A levels of UCB cell lines. However, complete depletion of METTL3/m6A was not achieved due to selection of cells expressing alternative METTL3 isoforms. Systematic vulnerability and inhibitor response analyses suggested that uroepithelial cells depend on METTL3 for viability. Furthermore, expression and survival analyses of clinical data revealed a complex role for METTL3 in UCB, with decreased m6A mRNA levels in UCB tumors. Our results suggest that METTL3 expression may be a suitable diagnostic UCB biomarker, as the enzyme promotes UCB formation. However, the suitability of the enzyme as a therapeutic target should be evaluated carefully.
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Affiliation(s)
- Jonas Koch
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Manuel Neuberger
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Martina Schmidt-Dengler
- Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg-Universität, 55128 Mainz, Germany
| | - Jinyun Xu
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Vitor Coutinho Carneiro
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Jörg Ellinger
- Department of Urology, University Hospital Bonn, 53127 Bonn, Germany
| | - Maximilian C. Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Mark Helm
- Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg-Universität, 55128 Mainz, Germany
| | - Manuel Rodríguez-Paredes
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Malin Nientiedt
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Frank Lyko
- Division of Epigenetics, DKFZ-ZMBH Alliance, German Cancer Research Center, 69120 Heidelberg, Germany
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6
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Waldbillig F, Bormann F, Neuberger M, Ellinger J, Erben P, Kriegmair MC, Michel MS, Nuhn P, Nientiedt M. An m6A-Driven Prognostic Marker Panel for Renal Cell Carcinoma Based on the First Transcriptome-Wide m6A-seq. Diagnostics (Basel) 2023; 13:diagnostics13050823. [PMID: 36899967 PMCID: PMC10001021 DOI: 10.3390/diagnostics13050823] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
To date, only a single transcriptome-wide m6A sequencing study of clear cell renal cell carcinoma (ccRCC) has been reported, with no validation so far. Herein, by TCGA analysis of the KIRC cohort (n = 530 ccRCC; n = 72 normal), an external expression validation of 35 preidentified m6A targets was performed. Further in-depth expression stratification enabled assessment of m6A-driven key targets. Overall survival (OS) analysis and gene set enrichment analyses (GSEA) were conducted to assess their clinical and functional impact on ccRCC. In the hyper-up cluster significant upregulation was confirmed for NDUFA4L2, NXPH4, SAA1, and PLOD2 (40%) and in the hypo-up cluster for FCHSD1 (10%). Significant downregulation was observed for UMOD, ANK3, and CNTFR (27.3%) in the hypo-down cluster and for CHDH (25%) in the hyper-down cluster. In-depth expression stratification showed consistent dysregulation in ccRCC only for 11.67%: NDUFA4L2, NXPH4, and UMOD (NNU-panel). Patients with strong NNU panel dysregulation had significantly poorer OS (p = 0.0075). GSEA identified 13 associated and significantly upregulated gene sets (all p-values < 0.5; FDR < 0.25). External validation of the only available m6A sequencing in ccRCC consistently reduced dysregulated m6A-driven targets on the NNU panel with highly significant effects on OS. Epitranscriptomics are a promising target for developing novel therapies and for identifying prognostic markers for daily clinical practice.
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Affiliation(s)
- Frank Waldbillig
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | | | - Manuel Neuberger
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Jörg Ellinger
- Department of Urology & Pediatric Urology, University Medical Centre Bonn, University of Bonn, 53127 Bonn, Germany
| | - Philipp Erben
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Maximilian C. Kriegmair
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Malin Nientiedt
- Department of Urology & Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany
- Correspondence: ; Tel.: +49-(0)621-383-2201
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7
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Erlmeier F, Klümper N, Strissel P, Strick R, Sikic D, Bahlinger V, Breyer J, Ritter M, Bolenz C, Roghmann F, Erben P, Schwamborn K, Wirtz RM, Horn T, Wullich B, Hölzel M, Hartmann A, Gschwend JE, Weichert W, Eckstein M. Spatial immunophenotypes of distant metastases and response to immune checkpoint inhibition. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
538 Background: The value of PD-L1 to predict durable responses to immune checkpoint inhibition (ICI) in metastatic urothelial carcinoma (mUC) is inconsistent. We hypothesize that the use of archived primary tumor material (PRIM) for PD-L1 testing in clinical trials not properly reflecting the metastatic disease status (MET) contributes to this clinical issue. Objective: To analyze the predictive and prognostic value of PD-L1, spatial immunephenotypes and MHC-I determined in patient-matched PRIM/MET. Methods: PD-L1 (Ventana IC-Score, combined positivity score), spatial immunephenotypes (midi-plex digital spatial immuneprofiling) and MHC-I were examined in 154 mUC patients with at least one available pretreatment MET (138 patient-matched PRIM/MET pairs). 119 patients received first-line platinum-based chemotherapy, and 50 patients received second-line immunecheckpoint inhibition. PD-L1 expression, spatial immunephenotypes and MHC-I status of (patient-matched PRIM and) pretreatment MET were correlated to chemotherapy and ICI response and outcomes. Results: Discordance rates in patient-matched PRIM/MET amounted 25/30%, 36% and 49% for PD-L1 (CPS10/IC5%), immunephenotypes and MHC-I (loss versus preserved), respectively. Correlations with chemotherapy and ICI responses were observed for immunephenotypes and MHC-I status determined in MET (not for PD-L1 alone), but not in PRIM. In case of ICI, patients with cytotoxic tumor immune microenvironments (TIME) showed durable responses with disease control rates of 90% and a hazard ratio for disease progression/death of 0.05 (95%-CI:0.01-0.65) versus patients with immunedepleted MET (DCR 29%). MET MHC-I status added incremental value to predict durable ICI responses: Combination of MHC-I based (auto-)antigen expression of tumor cells with spatial immunepehnotypes in pre-treatment MET improved predictive and prognostic impact for response and outcome prediction of mUC patients undergoing first-line platinum-based chemotherapy and second-line immunecheckpoint inhibition. Limitations include the partly retrospective design and the lack of MET multisampling on individual patient level. Conclusions: The TIME is subject to substantial dynamics during metastatic evolution. MET immunephenotypes and MHC-I statuses show promising potential to predict chemotherapy and durable ICI responses, while the PRIM TIME does not. Thus, future clinical trials should rather rely on pre-treatment MET-biopsies reflecting the current immunological disease state than on PRIM.
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Affiliation(s)
| | - Niklas Klümper
- Department of Urology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Pamela Strissel
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Reiner Strick
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Danijel Sikic
- Department of Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Veronika Bahlinger
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Manuel Ritter
- Department of Urology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Christian Bolenz
- Department of Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Florian Roghmann
- Department of Urology, University Hospital of Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - Philipp Erben
- Department of Urology, University Hospital Mannheim, Mannheim, Germany
| | | | | | - Thomas Horn
- Technical University Munich Department of Urology, Munich, Germany
| | - Bernd Wullich
- Department of Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Arndt Hartmann
- Institute of Pathology, Universitatsklinikum Erlangen, Friedrich-Alexander-Universitat Erlangen-Nürnberg, Erlangen, Germany
| | | | - Wilko Weichert
- Institute of Pathology, Technical University of Munich (TUM), Munich, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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8
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Erlmeier F, Klümper N, Landgraf L, Strissel PL, Strick R, Sikic D, Taubert H, Wach S, Geppert CI, Bahlinger V, Breyer J, Ritter M, Bolenz C, Roghmann F, Erben P, Schwamborn K, Wirtz RM, Horn T, Wullich B, Hölzel M, Hartmann A, Gschwend JE, Weichert W, Eckstein M. Spatial Immunephenotypes of Distant Metastases but not Matched Primary Urothelial Carcinomas Predict Response to Immune Checkpoint Inhibition. Eur Urol 2023; 83:133-142. [PMID: 36372626 DOI: 10.1016/j.eururo.2022.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/11/2022] [Revised: 10/03/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The value of programmed cell death ligand-1 (PD-L1) to predict durable responses to immune checkpoint inhibitors (ICIs) in metastatic urothelial carcinoma (mUC) is inconsistent. We hypothesize that the use of archived primary tumor material (PRIM) for PD-L1 testing in clinical trials not properly reflecting the metastatic disease status (MET) contributes to this clinical issue. OBJECTIVE To analyze the predictive and prognostic value of PD-L1, spatial immunephenotypes, and major histocompatibility complex class I (MHC-I) determined in patient-matched PRIM/MET. DESIGN, SETTING, AND PARTICIPANTS PD-L1, spatial immunephenotypes, and MHC-I were examined in 154 mUC patients with at least one available pretreatment MET (138 patient-matched PRIM/MET pairs). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS PD-L1, spatial immunephenotype, and MHC-I status of (patient-matched PRIM and) pretreatment MET were correlated with chemotherapy and ICI response and outcomes. RESULTS AND LIMITATIONS Discordance rates in patient-matched PRIM/MET were 25/30%, 36%, and 49% for PD-L1 (CPS10/IC5%), immunephenotypes, and MHC-I (loss vs preserved), respectively. Correlations with chemotherapy and ICI responses were observed for immunephenotypes and MHC-I status determined in MET (not for PD-L1 alone), but not in PRIM. In case of ICIs, patients with cytotoxic tumor immune microenvironment (TIME) showed durable responses with disease control rates of 90% and a hazard ratio for disease progression/death of 0.05 (95% confidence interval: 0.01-0.65) versus patients with immunedepleted MET (disease control rate 29%). MET MHC-I status added an incremental value to predict durable ICI responses. Limitations include the partly retrospective design and the lack of MET multisampling on individual patient level. CONCLUSIONS The TIME is subject to substantial dynamics during metastatic evolution. MET immunephenotypes and MHC-I statuses show promising potential to predict chemotherapy and durable ICI responses, while the PRIM TIME does not. Thus, future clinical trials should rather rely on pretreatment MET biopsies reflecting the current immunological disease state than on PRIM. PATIENT SUMMARY Prediction of chemotherapy and responses to immune checkpoint inhibitors might be possible using representative pretreatment metastatic biopsies.
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Affiliation(s)
- Franziska Erlmeier
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Institute of Pathology, Technical University Munich, Munich, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Niklas Klümper
- Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany; Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Laura Landgraf
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Pamela L Strissel
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Reiner Strick
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Danijel Sikic
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Helge Taubert
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Wach
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carol I Geppert
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Veronika Bahlinger
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Johannes Breyer
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology, University of Regensburg, Caritas St. Josef, Regensburg, Germany
| | - Manuel Ritter
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology and Pediatric Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Christian Bolenz
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Florian Roghmann
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Philipp Erben
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; Department of Urology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kristina Schwamborn
- Institute of Pathology, Technical University Munich, Munich, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Ralph M Wirtz
- BRIDGE-Consortium Germany e.V, Mannheim, Germany; STRATIFYER Molecular Pathology, Cologne, Germany
| | - Thomas Horn
- Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology, Technical University Munich, Munich, Germany
| | - Bernd Wullich
- Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology, Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Jürgen E Gschwend
- Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany; Department of Urology, Technical University Munich, Munich, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich, Munich, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; BRIDGE-Consortium Germany e.V, Mannheim, Germany; Bayerisches Zentrum für Krebsforschung (BZKF), Bavaria, Germany.
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Erlmeier F, Klümper N, Landgraf L, Strissel P, Strick R, Sikic D, Taubert H, Wach S, Geppert C, Bahlinger V, Breyer J, Ritter M, Bolenz C, Roghmann F, Erben P, Schwamborn K, Wirtz R, Horn T, Wullich B, Hölzel M, Hartmann A, Gschwend J, Weichert W, Eckstein M. Spatial immunephenotypes of distant metastases but not matched primary urothelial carcinomas predict response to immune checkpoint inhibition. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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10
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Cox A, Klümper N, Stein J, Sikic D, Breyer J, Bolenz C, Roghmann F, Erben P, Wirtz R, Wullich B, Ritter M, Hölzel M, Schwamborn K, Horn T, Gschwend J, Hartmann A, Weichert W, Erlmeier F, Eckstein M. Intrinsic molecular urothelial cancer subtypes remain stable during metastatic evolution. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Neuberger M, Frey L, Nitschke K, Wessels F, Westhoff N, Waldbillig F, Nientiedt M, Hartung F, VON Hardenberg J, Michel MS, Erben P, Nuhn P, Worst TS. Integrin Expression in Localized Prostate Cancer: A TCGA and MSKCC Cohort-based Exploratory In Silico Analysis. Anticancer Res 2023; 43:417-428. [PMID: 36585191 DOI: 10.21873/anticanres.16177] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/05/2022] [Accepted: 11/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Diagnostic and prognostic biomarkers in localized prostate cancer (PC) are insufficient. Treatment stratification relies on prostate-specific antigen, clinical tumor staging and International Society of Urological Pathology (ISUP) grading, whereas molecular profiling remains unused. Integrins (ITG) have an important function in bidirectional signaling and are associated with progression, proliferation, perineural invasion, angiogenesis, metastasis, neuroendocrine differentiation, and a more aggressive disease phenotype in PC. However, ITG subunit expression in localized PC and their utility as prognostic biomarkers has not yet been analyzed. This study aimed to fill this gap and provide a comprehensive overview of ITG expression as well as ITG utility as biomarkers. PATIENTS AND METHODS The Cancer Genome Atlas (TCGA) and the Memorial Sloan Kettering Cancer Center (MSKCC) prostate adenocarcinoma cohorts were analyzed regarding ITG expression in correlation to ISUP, N- and American Joint Committee on Cancer (AJCC) stage and were correlated with disease-free survival (DFS). Statistical tests used included the Mann-Whitney U-test, logrank test and uni- and multivariable cox regression analyses. RESULTS After grouping for ISUP (1 and 2 vs. 3-5), N0 vs. N1 and AJCC stage (≤2 vs. ≥3), multiple ITGs showed significant expression differences. The most consistent results were observed for ITGα4, ITGαX, ITGα11, ITGβ2 and ITGα2. In multivariable cox regression, ITGα2, ITGα10, ITGαD, ITGαB2 (TCGA), ITGα11 and ITGβ4 (MSKCC) were independent predictors of DFS. CONCLUSION The utility of ITGs as PC biomarkers was herein shown.
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Affiliation(s)
- Manuel Neuberger
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany;
| | - Lisa Frey
- Department of Urology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Katja Nitschke
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Frederik Wessels
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Malin Nientiedt
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Friedrich Hartung
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Jost VON Hardenberg
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
| | - Thomas Stefan Worst
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of the University of Heidelberg, University Medical Center Mannheim, Mannheim, Germany
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12
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Klümper N, Ralser DJ, Ellinger J, Roghmann F, Albrecht J, Below E, Alajati A, Sikic D, Breyer J, Bolenz C, Zengerling F, Erben P, Schwamborn K, Wirtz RM, Horn T, Nagy D, Toma M, Kristiansen G, Büttner T, Hahn O, Grünwald V, Darr C, Erne E, Rausch S, Bedke J, Schlack K, Abbas M, Zschäbitz S, Schwab C, Mustea A, Adam P, Manseck A, Wullich B, Ritter M, Hartmann A, Gschwend J, Weichert W, Erlmeier F, Hölzel M, Eckstein M. Membranous NECTIN-4 expression frequently decreases during metastatic spread of urothelial carcinoma and is associated with enfortumab vedotin resistance. Clin Cancer Res 2022; 29:1496-1505. [PMID: 36534531 PMCID: PMC10102834 DOI: 10.1158/1078-0432.ccr-22-1764] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/06/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Background: The antibody-drug conjugate enfortumab vedotin (EV) releases a cytotoxic agent into tumor cells via binding to the membrane receptor NECTIN-4. EV has been recently approved for patients with metastatic urothelial carcinoma (mUC) without prior assessment of the tumor receptor status as ubiquitous NECTIN-4 expression is assumed. Objective: To determine the prevalence of membranous NECTIN-4 protein expression in primary tumors (PRIM) and patient-matched distant metastases (MET). Main Outcomes and Measures: Membranous NECTIN-4 protein expression was measured (H-score) by immunohistochemistry (IHC) in PRIM and corresponding MET (N=137) and in a multicenter EV-treated cohort (N=47). Progression-free survival (PFS) after initiation of EV treatment was assessed for the NECTIN-4 negative/weak (H-score 0-99) versus moderate/strong (H-score 100-300) subgroup. The specificity of the NECTIN-4 IHC staining protocol was validated by establishing CRISPR-Cas9-induced polyclonal NECTIN-4 knockouts. Results: In our cohort, membranous NECTIN-4 expression significantly decreased during metastatic spread (Wilcoxon matched pairs P<0.001, median H-score=40, interquartile range (IQR): 0-140), with 39.4% of MET lacking membranous NECTIN-4 expression. In our multicenter EV cohort, absence or weak membranous NECTIN-4 expression (34.0% of the cohort) was associated with a significantly shortened PFS on EV (Log-rank P<0.001). Conclusion: Membranous NECTIN-4 expression is frequently decreased or absent in mUC tissue. Of note, the clinical benefit of EV strongly depends on membranous NECTIN-4 expression. Thus, our results are of highest clinical relevance and argue for a critical reconsideration of the current practice and suggest that the NECTIN-4 receptor status should be determined (ideally in a metastatic/ progressive lesion) before initiation of EV.
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Affiliation(s)
| | | | | | | | | | | | | | - Danijel Sikic
- Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Breyer
- Caritas Hospital St. Josef, University of Regensburg, Regensburg, Bavaria, Germany
| | | | | | - Philipp Erben
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | - Thomas Horn
- Technische Universität München, Munich, Germany
| | - Dora Nagy
- University Medical Center Bonn (UKB), Bonn, Germany
| | | | | | | | - Oliver Hahn
- Universitätsmedizin Göttingen, Göttingen, Germany
| | | | | | - Eva Erne
- Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | | | - Jens Bedke
- University Hospital Tuebingen, Tuebingen, Germany
| | | | | | | | - Constantin Schwab
- Heidelberg University Hospital, Heidelberg, Baden-Wuerttemberg, Germany
| | | | | | | | - Bernd Wullich
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangern, Germany
| | | | - Arndt Hartmann
- Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | | | | | | | - Markus Eckstein
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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13
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Klümper N, Sikic D, Saal J, Büttner T, Goldschmidt F, Jarczyk J, Becker P, Zeuschner P, Weinke M, Kalogirou C, Breyer J, Burger M, Nuhn P, Tully K, Roghmann F, Bolenz C, Zengerling F, Wirtz RM, Muders M, Kristiansen G, Bald T, Ellinger J, Wullich B, Hölzel M, Hartmann A, Erben P, Ritter M, Eckstein M. C-reactive protein flare predicts response to anti-PD-(L)1 immune checkpoint blockade in metastatic urothelial carcinoma. Eur J Cancer 2022; 167:13-22. [PMID: 35366569 DOI: 10.1016/j.ejca.2022.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/29/2021] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Robust biomarkers to predict response to immune checkpoint blockade (ICB) in metastatic urothelial carcinoma (mUC) are still in demand. Recently, early C-reactive protein (CRP) kinetics and especially the novel CRP flare-response phenomenon has been associated with immunotherapy response. METHODS We conducted a multicentre observational study comprising 154 patients with mUC treated with ICB to evaluate the predictive value of a previously described on-treatment CRP kinetics: CRP flare responders (at least doubling of baseline CRP within the first month after initiation of ICB followed by a decline below baseline within three months), CRP responders (decline in baseline CRP by ≥ 30% within three months without a prior flare) and the remaining patients as CRP non-responders. CRP kinetics groups were correlated with baseline parameters, PD-L1 status, progression-free survival (PFS) and overall survival (OS). RESULTS Objective response was observed in 57.1% of CRP responders, 45.8% of CRP flare responders and 17.9% of CRP non-responders (P < 0.001). CRP flare response was associated with prolonged PFS and OS (P < 0.001). In multivariable Cox regression analysis, CRP flare responders showed a risk reduction of ∼70% for tumour progression and death compared to CRP non-responders. Subgroup analysis of CRP flare responders revealed that patients with a long-flare response (completed flare-response kinetics ≥6 weeks on-treatment) showed even more favourable outcomes following ICB (HR = 0.18, 95%-CI: 0.07-0.48, P < 0.001). CONCLUSION CRP (flare)response robustly predicts immunotherapy response and outcomes in mUC independent of PD-L1 status. Thus, early on-treatment CRP kinetics is a promising low-cost and easy-to-implement biomarker to optimise therapy monitoring in patients with mUC treated with ICB.
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Affiliation(s)
- Niklas Klümper
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany, Erlangen.
| | - Jonas Saal
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Medical Clinic III for Oncology, Hematology, Immune-Oncology and Rheumatology, University Medical Center Bonn (UKB), Germany.
| | - Thomas Büttner
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Franziska Goldschmidt
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Philippe Becker
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany.
| | - Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany.
| | - Maximilian Weinke
- Department of Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany.
| | - Charis Kalogirou
- Department of Urology, Julius Maximilians University Medical Center of Würzburg, Würzburg, Germany.
| | - Johannes Breyer
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany.
| | - Maximilian Burger
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany.
| | - Philipp Nuhn
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Karl Tully
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany.
| | - Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany.
| | | | | | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany.
| | - Michael Muders
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Institute of Pathology, University Medical Center Bonn (UKB), Bonn, Germany.
| | - Glen Kristiansen
- Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany; Institute of Pathology, University Medical Center Bonn (UKB), Bonn, Germany.
| | - Tobias Bald
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Jörg Ellinger
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany, Erlangen.
| | - Michael Hölzel
- Institute of Experimental Oncology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany, Erlangen; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Manuel Ritter
- Department of Urology, University Medical Center Bonn (UKB), Bonn, Germany; Center for Integrated Oncology Aachen/Bonn/Cologne/Düsseldorf (CIO-ABCD), Germany.
| | - Markus Eckstein
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany, Erlangen; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
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14
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Neuberger M, Skladny J, Goly N, Wessels F, WEIß C, Egen L, Erben P, GROß-Weege M, Grüne B, Hartung F, Herrmann J, Honeck P, Jarczyk J, Kowalewski KF, Mühlbauer J, Nitschke K, Nientiedt M, Walach MT, Waldbillig F, Westhoff N, VON Hardenberg J, Kriegmair M, Worst TS, Nuhn P. Baseline Modified Glasgow Prognostic Score (mGPS) Predicts Radiologic Response and Overall Survival in Metastatic Hormone-sensitive Prostate Cancer Treated With Docetaxel Chemotherapy. Anticancer Res 2022; 42:1911-1918. [PMID: 35347010 DOI: 10.21873/anticanres.15668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/18/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To assess the baseline inflammatory markers modified Glasgow Prognostic Score (mGPS), systemic immune-inflammation index (SII), and neutrophile-to-lymphocyte ratio (NLR) as pragmatic tools for predicting response to chemohormonal therapy (docetaxel plus ADT) and prognosis in men with metastatic hormone-sensitive prostate cancer (mHSPC). PATIENTS AND METHODS Male patients who received docetaxel at a tertiary university care center between 2014 and 2019 were screened for completion of 6 cycles. NLR, SII, mGPS, overall survival (OS), three-year survival, and radiologic response were assessed. Complete response (CR), partial response (PR), and stable disease (SD) were analyzed alone and in combination. RESULTS Thirty-six mHSPC-patients were included. In thirty patients, baseline mGPS was assessed and was either 0 (n=22) or 2 (n=8). In Cochran-Armitage Trend Test, mGPS showed significant association with the combined radiologic endpoint of "CR, PR, or SD" (p=0.01), three-year survival (p=0.02), and OS (p<0.01). Next to prostate-specific antigen (PSA) (HR per 100 units 1.16, 95%CI=1.04-1.30, p<0.01), NLR (HR=1.31, 95%CI=1.03-1.66, p=0.03), and mGPS (2 vs. 0, HR=6.53, 95%CI=1.6-27.0, p<0.01) at baseline showed significant association with OS in univariable cox regression. However, mGPS remained the only independent predictor for OS in multivariable cox regression (p<0.01) and for the combined radiologic endpoint of "CR, PR or SD" (p=0.01) in multivariable logistic regression. SII showed no statistical relevance. CONCLUSION Baseline mGPS seems to be a pragmatic tool for clinical decision-making in patients with mHSPC in daily routine.
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Affiliation(s)
- Manuel Neuberger
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
| | - Janina Skladny
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nora Goly
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wessels
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel WEIß
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Luisa Egen
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Matthias GROß-Weege
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Britta Grüne
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Friedrich Hartung
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Herrmann
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Patrick Honeck
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jonas Jarczyk
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julia Mühlbauer
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katja Nitschke
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Malin Nientiedt
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Margarete Theresa Walach
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost VON Hardenberg
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian Kriegmair
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas S Worst
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urologic Surgery, University Medical Center Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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15
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Mayr R, Eckstein M, Wirtz RM, Santiago-Walker A, Baig M, Sundaram R, Carcione JC, Stoehr R, Hartmann A, Bolenz C, Burger M, Otto W, Erben P, Breyer J. Prognostic and Predictive Value of Fibroblast Growth Factor Receptor Alterations in High-grade Non–muscle-invasive Bladder Cancer Treated with and Without Bacillus Calmette-Guérin Immunotherapy. Eur Urol 2022; 81:606-614. [DOI: 10.1016/j.eururo.2022.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/26/2022] [Accepted: 02/25/2022] [Indexed: 11/29/2022]
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16
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Nientiedt M, Waldbillig F, Stroop F, Nuhn P, Erben P, Popovic ZV, Weis CA, Michel MS, Kriegmair MC. Upper Tract Urinary Cancer Recurrence after Radical Cystectomy: Risk Assessment of Intraoperative Frozen Section. Urol Int 2022; 106:816-824. [DOI: 10.1159/000521804] [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] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Upper tract urinary cancer recurrence (UTUCR) after radical cystectomy (RC) is outcome-limiting. Surgical recommendations on intraoperative performance of frozen section analysis (FSA) and management of positive ureteral margin (PUM) are lacking. <b><i>Methods:</i></b> 634 RC cases were identified (2010–2018). In patients with PUM, sequential ureteral resections up to a negative margin were performed. We investigated the accuracy of FSA, significance of PUM, and identified risk factors (RFs) to stratify patients for UTUCR. <b><i>Results:</i></b> FSA was performed in 355 patients, including a total of 693 ureters. FSA sensitivity was 0.93 and specificity 0.99. PUM conversion was possible in 52 (91.2%) cases. UTUCR occurred in 17 (4.8%) patients. Identified UTUCR RFs are non-muscle invasive bladder carcinoma (NMIBC) (OR 3.8, 95% confidence intervals [CI] 1.4–10.2, <i>p</i> = 0.008), multifocal bladder cancer in cystectomy specimen (OR 4.7, CI 1.1–20.8, <i>p</i> = 0.042), and recurrent NMIBC (OR 4.1, CI 1.5–10.9, <i>p</i> = 0.006). Risk-group stratification showed a six-fold increase in UTUCR risk (low-to high-risk). <b><i>Conclusion:</i></b> FSA is a sensitive and specific method to identify PUM. UTUCR occurs significantly more often in patients with recurrent, multifocal NMIBC at the time of RC. Patients can be risk stratified for UTUCR. In case of NMIBC-PUM, surgeons can safely opt for a kidney preserving strategy.
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17
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Hammerl JA, Barac A, Erben P, Fuhrmann J, Gadicherla A, Kumsteller F, Lauckner A, Müller F, Hertwig S. Properties of Two Broad Host Range Phages of Yersinia enterocolitica Isolated from Wild Animals. Int J Mol Sci 2021; 22:11381. [PMID: 34768812 PMCID: PMC8583763 DOI: 10.3390/ijms222111381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022] Open
Abstract
Yersinia (Y.) enterocolitica and Y. pseudotuberculosis are important zoonotic agents which can infect both humans and animals. To combat these pathogens, the application of strictly lytic phages may be a promising tool. Since only few Yersinia phages have been described yet, some of which demonstrated a high specificity for certain serotypes, we isolated two phages from game animals and characterized them in terms of their morphology, host specificity, lytic activity on two bio-/serotypes and genome composition. The T7-related podovirus vB_YenP_Rambo and the myovirus vB_YenM_P281, which is very similar to a previously described phage PY100, showed a broad host range. Together, they lysed all the 62 tested pathogenic Y. enterocolitica strains belonging to the most important bio-/serotypes in Europe. A cocktail containing these two phages strongly reduced cultures of a bio-/serotype B4/O:3 and a B2/O:9 strain, even at very low MOIs (multiplicity of infection) and different temperatures, though, lysis of bio-/serotype B2/O:9 by vB_YenM_P281 and also by the related phage PY100 only occurred at 37 °C. Both phages were additionally able to lyse various Y. pseudotuberculosis strains at 28 °C and 37 °C, but only when the growth medium was supplemented with calcium and magnesium cations.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stefan Hertwig
- Department of Biological Safety, German Federal Institute for Risk Assessment, Max-Dohrn Str. 8-10, D-10589 Berlin, Germany; (J.A.H.); (A.B.); (P.E.); (J.F.); (A.G.); (F.K.); (A.L.); (F.M.)
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18
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Sikic D, Taubert H, Breyer J, Eckstein M, Weyerer V, Keck B, Kubon J, Otto W, Worst TS, Kriegmair MC, Erben P, Hartmann A, Wullich B, Wirtz RM, Wach S. The Prognostic Value of FGFR3 Expression in Patients with T1 Non-Muscle Invasive Bladder Cancer. Cancer Manag Res 2021; 13:6567-6578. [PMID: 34447272 PMCID: PMC8384147 DOI: 10.2147/cmar.s318893] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 05/06/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose Fibroblast growth factor receptor 3 (FGFR3) alterations are frequent in non-muscle-invasive bladder cancer (NMIBC), although current data regarding the prognostic and therapeutic relevance are inconsistent. We analyzed the prognostic role of FGFR3 mRNA expression in stage T1 NMIBC. Patients and Methods The mRNA expression of FGFR3 and cyclin-dependent kinase inhibitor 2A (CDKN2A) was measured by RT-qPCR in 80 patients with stage T1 NMIBC treated with transurethral resection of the bladder and correlated with clinical data and KRT5 and KRT20 expression, used as surrogate markers for basal and luminal subtypes, respectively. Results FGFR3 and CDKN2A transcript levels were not correlated. FGFR3 expression was associated with the expression of KRT5 (p=0.002) and KRT20 (p < 0.001). CDKN2A expression was negatively correlated with KRT5 (p=0.030). In Kaplan–Meier analysis and univariable Cox regression analysis, high FGFR3 expression was associated with significantly reduced recurrence-free survival (RFS) (HR=3.78; p < 0.001) and improved overall survival (OS) (HR=0.50; p=0.043), while high CDKN2A expression was associated with reduced OS (HR=2.34; p=0.034). Patient age was the only clinicopathological parameter associated with reduced OS (HR=2.29; p=0.022). No parameter was an independent prognostic factor in multivariable analysis. Next, we stratified the patients depending on their lineage differentiation. In univariable analysis, the prognostic effect of FGFR3 and CDKN2A was observed primarily in patients demonstrating high expression of KRT5 or KRT20, whereas high FGFR3 expression was associated with significantly reduced RFS, irrespective of instillation therapy. Conclusion Stage T1 NMIBC patients with high FGFR3 expression show shorter RFS but better OS than patients with low FGFR3 expression.
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Affiliation(s)
- Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Markus Eckstein
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.,Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Veronika Weyerer
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.,Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Bastian Keck
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Jennifer Kubon
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Thomas S Worst
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.,Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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19
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Eckstein M, Strissel P, Strick R, Weyerer V, Wirtz R, Pfannstiel C, Wullweber A, Lange F, Erben P, Stoehr R, Bertz S, Geppert CI, Fuhrich N, Taubert H, Wach S, Breyer J, Otto W, Burger M, Bolenz C, Keck B, Wullich B, Hartmann A, Sikic D. Cytotoxic T-cell-related gene expression signature predicts improved survival in muscle-invasive urothelial bladder cancer patients after radical cystectomy and adjuvant chemotherapy. J Immunother Cancer 2021; 8:jitc-2019-000162. [PMID: 32448798 PMCID: PMC7253053 DOI: 10.1136/jitc-2019-000162] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [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] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background Assessment of the immune status of muscle-invasive bladder cancer (MIBC) has previously shown to be prognostically relevant after treatment with curative intent. We conducted this study to develop a clinically applicable immune gene expression assay to predict prognosis and adjuvant chemotherapy benefit. Patients and methods Gene expression of CD3Z, CD8A and CXCL9, immune cell (IC) populations including stromal tumor infiltrating lymphocytes (sTILs), T-cells, natural killer cells (NK-cells), macrophages, Programmed cell death protein 1 positive (PD-1) IC and tumor subtypes (MD Anderson Cancer Center/MDACC-approach) were assessed in 187 MIBC patients (Comprehensive Cancer Center Erlangen-EMN/CCC-EMN-cohort). A gene expression signature was derived by hierarchical-clustering and validated in The Cancer Genome Atlas (TCGA)-cohort. IC populations in the TCGA cohort were assessed via CIBERSORT. Benefit of platinum-containing adjuvant chemotherapy was assessed in a pooled cohort of 125 patients. Outcome measurements were disease specific survival, disease-free survival and overall survival. Results The gene expression signature of CXCL9, CD3Z and CD8A correlates with quantitative amounts of specific IC populations and sTILs (CCC-EMN: ρ-range: 0.44–0.74; TCGA: ρ-range: 0.56–0.82) and allows stratification of three different inflammation levels (inflamed high, inflamed low, uninflamed). Highly inflamed tumors are preferentially basal subtype and show favorable 5-year survival rates of 67.3% (HR=0.27; CCC-EMN) and 55% (HR=0.41; TCGA). Uninflamed tumors are predominantly luminal subtypes and show low 5-year survival rates of 28% (CCC-EMN) and 36% (TCGA). Inflamed tumors exhibit higher levels of PD-1 and Programmed cell death 1 ligand 1 (PD-L1). Patients undergoing adjuvant platinum-based chemotherapy with ‘inflamed high’ tumors showed a favorable 5-year survival rate of 64% (HR=0.27; merged CCC-EMN and TCGA cohort). Conclusion The gene expression signature of CD3Z, CD8A and CXCL9 can assess the immune status of MIBC and stratify the survival of MIBC patients undergoing surgery and adjuvant platinum-based chemotherapy. Furthermore, the assay can identify patients with immunological hot tumors with particular high expression of PD-L1 potentially suitable for immunotherapy.
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Affiliation(s)
- Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Pamela Strissel
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Reiner Strick
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology, Cologne, Germany
| | - Carolin Pfannstiel
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Adrian Wullweber
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Fabienne Lange
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Erben
- Department of Urology, Ruprecht-Karls-Universität Heidelberg Medizinische Fakultät Mannheim, Mannheim, Germany
| | - Robert Stoehr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carol Imanuel Geppert
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nicole Fuhrich
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, Universitätsklinikum Regensburg, Universität Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology, Universitätsklinikum Regensburg, Universität Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Universitätsklinikum Regensburg, Universität Regensburg, Regensburg, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, Universitätsklinikum Ulm, Universität Ulm, Ulm, Germany
| | - Bastian Keck
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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20
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Sikic D, Eckstein M, Weyerer V, Kubon J, Breyer J, Roghmann F, Kunath F, Keck B, Erben P, Hartmann A, Wirtz RM, Wullich B, Taubert H, Wach S. High expression of ERBB2 is an independent risk factor for reduced recurrence-free survival in patients with stage T1 non-muscle-invasive bladder cancer. Urol Oncol 2021; 40:63.e9-63.e18. [PMID: 34330652 DOI: 10.1016/j.urolonc.2021.06.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/26/2021] [Revised: 06/13/2021] [Accepted: 06/25/2021] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Molecular markers associated with breast cancer are assumed to be associated with outcome in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS We retrospectively investigated the association of the mRNA expression of estrogen receptor 1 (ESR1) and 2 (ESR2), progesterone receptor (PGR), MKI67, and HER2 (ERBB2) with recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS) in 80 patients with stage T1 NMIBC. RESULTS High expression of ESR2 (P = 0.003), ERBB2 (P < 0.001), and MKI67 (P = 0.029) was associated with shorter RFS. Only high ERBB2 was an independent prognostic factor for reduced RFS (HR = 2.98; P = 0.009). When sub stratifying the cohort, high ESR2 was associated with reduced RFS (P < 0.001), CSS (P = 0.037) and OS (P = 0.006) in patients without instillation therapy. High ESR2 was associated with reduced CSS (P = 0.018) and OS (P = 0.029) in females and with shorter RFS in both sexes (males: P = 0.035; females: P = 0.010). Patients with high ERBB2 showed reduced CSS (P = 0.011) and OS (P = 0.042) in females and reduced CSS (P = 0.012) in those without instillation, while RFS was significantly reduced irrespective of sex or instillation. CONCLUSION High mRNA expression of ERBB2 is an independent predictor of reduced RFS in patients with stage T1 NMIBC. High ERBB2 and ESR2 are associated with reduced outcomes, especially in females and patients without instillation therapy.
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Affiliation(s)
- Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Markus Eckstein
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Veronika Weyerer
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Jennifer Kubon
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Regensburg, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr University Bochum, Herne, Germany
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Bastian Keck
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Philipp Erben
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany; Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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21
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Tully KH, Jütte H, Wirtz RM, Jarczyk J, Santiago-Walker A, Zengerling F, Breyer J, Sikic D, Kriegmair MC, von Hardenberg J, Wullich B, Taubert H, Weyerer V, Stoehr R, Bolenz C, Burger M, Porubsky S, Hartmann A, Roghmann F, Erben P, Eckstein M. Prognostic Role of FGFR Alterations and FGFR mRNA Expression in Metastatic Urothelial Cancer Undergoing Checkpoint Inhibitor Therapy. Urology 2021; 157:93-101. [PMID: 34153367 DOI: 10.1016/j.urology.2021.05.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/23/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the disease-specific survival(DSS) after checkpoint inhibitor(CPI) therapy based on FGFR alterations and FGFR mRNA expression levels in patients with metastatic urothelial cancer(mUCa) within a multi-center cohort. METHODS Within a cohort of 72 patients with mUCa from five academic centers in Germany FGFR alterations, as well as FGFR1-4 mRNA expression levels in tumor samples from the primary tumor or metastatic sites. Spearman rank correlations, logistic regression, as well as Kaplan-Meier survival analyses and univariate Cox proportional hazards regression models were employed to examine the impact of different FGFR patterns on the DSS after CPI treatment. RESULTS FGFR3 mutations or gene fusions (gene alterations) were detected in 16.9% of all samples. Patients with or without FGFR3 gene alterations did not show different oncological outcomes undergoing CPI treatment. Low expression of FGFR2 mRNA alone, as well as the combination of either low FGFR2mRNA expression and FGFR3 gene alteration or high FGFR3mRNA expression (P = 0.027), identified a subgroup of patients with unfavorable outcomes, comprising 40% of the total cohort. This trend was also observed in univariate Cox proportional hazards regression analysis(FGFR3 gene alteration: Hazard ratio(HR) 5.33, 95%Confidence interval(CI)1.76-15.0, P = 0.004; FGFR3mRNA expression:HR 3.04, 95%CI 1.40-7.13, P = 0.005). CONCLUSION Assessment of FGFR mRNA expression identified a high-risk subgroup of patients with mUCa. These patients showing overexpression of FGFR3 mRNA were found to have unfavorable DSS after CPI treatment. Using this approach may be suitable for identifying a patient population with poor response to CPI treatment, which may benefit from early FGFR inhibition.
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Affiliation(s)
- Karl H Tully
- Department of Urology, Marien-Hospital Herne, University Hospital Bochum, Ruhr-University, Bochum.
| | - Hendrik Jütte
- Department of Pathology, University Hospital Bochum, University of Bochum, Bochum
| | | | - Jonas Jarczyk
- Department of Urology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim
| | | | | | - Johannes Breyer
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Maximilian C Kriegmair
- Department of Urology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim
| | - Jost von Hardenberg
- Department of Urology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Robert Stoehr
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Christian Bolenz
- Department of Urology, University Hospital Ulm, University of Ulm, Ulm
| | - Maximilian Burger
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg
| | - Stefan Porubsky
- Department of Pathology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
| | - Florian Roghmann
- Department of Urology, Marien-Hospital Herne, University Hospital Bochum, Ruhr-University, Bochum
| | - Philipp Erben
- Department of Urology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen
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Nitschke K, Worst TS, von Rhade SM, Thaqi B, Neuberger M, Wessels F, Weis CA, Porubsky S, Gaiser T, Kriegmair M, von Hardenberg J, Weidenbusch M, Erben P, Nuhn P. High IL-22RA1 gene expression is associated with poor outcome in muscle invasive bladder cancer. Urol Oncol 2021; 39:499.e1-499.e8. [PMID: 34134925 DOI: 10.1016/j.urolonc.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/09/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND The cell surface interleukin 22 (IL-22) receptor complex is mainly expressed in epithelial and tissue cells like pancreatitis cells. Recent studies described that IL-22R was overexpressed in malignant diseases and was associated with a poor overall survival (OS). The role of IL-22RA1 gene expression in muscle invasive bladder cancer (MIBC) has not been investigated, yet. OBJECTIVES The aim of this study was to analyze the role of IL-22RA1 gene expression in patients with MIBC. METHODS In a cohort of 114 patients with MIBC who underwent radical cystectomy, IL-22RA1 gene expression was analyzed with qRT-PCR and correlated with clinical parameters. Furthermore, Kaplan-Meier and Cox regression analysis were performed. For validation, an in silico dataset (TCGA 2017, n=407) was reanalyzed. RESULTS IL-22RA1 gene expression was independent of clinicopathological parameters like age (P=0.2681), T stage (P=0.2130), nodal status (P=0.3238) and lymph vascular invasion (LVI, P=0.5860) in patients with MIBC. A high expression of IL-22RA1 was associated with a shorter OS (P=0.0040) and disease-specific survival (P=0.0385). Furthermore, a shorter disease-free survival (DFS) was also associated with a high expression of IL-22RA1 (P=0.0102). In the multivariable analysis, IL-22RA1 expression was an independent prognostic predictors regarding OS (P=0.0096, HR=0.48). In the TCGA cohort, IL-22RA1 expression was independent regarding to OS and DFS. CONCLUSION A high IL-22RA1 gene expression was associated with worse outcome. Furthermore, IL-22RA1 represented an independent predictor regarding OS in our cohort and therefore might be used for risk stratification in patients with MIBC.
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Affiliation(s)
- Katja Nitschke
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany.
| | - Thomas S Worst
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Sophie Madeleine von Rhade
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Blerta Thaqi
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Manuel Neuberger
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Frederik Wessels
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Cleo-Aron Weis
- Pathologisches Institut, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Stefan Porubsky
- Institut für Pathologie, Universitätsmedizin, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Timo Gaiser
- Pathologisches Institut, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Maximilian Kriegmair
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Marc Weidenbusch
- Nephrologisches Zentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Philipp Erben
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Philipp Nuhn
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
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23
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Porubsky S, Nientiedt M, Kriegmair MC, Siemoneit JHH, Sandhoff R, Jennemann R, Borgmann H, Gaiser T, Weis CA, Erben P, Hielscher T, Popovic ZV. The prognostic value of galactosylceramide-sulfotransferase (Gal3ST1) in human renal cell carcinoma. Sci Rep 2021; 11:10926. [PMID: 34035403 PMCID: PMC8149814 DOI: 10.1038/s41598-021-90381-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 05/11/2021] [Indexed: 12/30/2022] Open
Abstract
Renal cell carcinoma (RCC) is the deadliest primary genitourinary malignancy typically associated with asymptomatic initial presentation and poorly predictable survival. Next to established risk factors, tumor microenvironment may alter metastatic capacity and immune landscape. Due to their high concentrations, sulfoglycolipids (sulfatides) were among the first well-described antigens in RCC that are associated with worse prognosis. As sulfatide detection in routine diagnostics is not possible, we aimed to test the prognostic value of its protein counterpart, sulfatide-producing enzyme Gal3ST1. We performed retrospective long-term follow up analysis of Gal3ST1 expression as prognostic risk factor in a representative RCC patient cohort. We observed differentially regulated Gal3ST1 expression in all RCC types, being significantly more associated with clear cell RCC than to chromophobe RCC (p = 0.001). Surprisingly, in contrast to published observations from in vitro models, we could not confirm an association between Gal3ST1 expression and a malignant clinical behaviour of the RCC. In our cohort, Gal3ST1 did not significantly influence progression-free survival (Hazard Ratio (HR): 1.7 95% CI (0.6–4.9), p = 0.327). Particularly after adjusting for histology, T-stage, N-status and M-status at baseline, we observed no independent prognostic effect (HR = 1.0 95% CI (0.3–3.3), p = 0.96). The analysis of Gal3ST1 mRNA expression in a TCGA dataset supported the results of our cohort. Thus, Gal3ST1 might help to differentiate between chromophobe RCC and other frequent RCC entities but—despite previously published data from cell culture models—does not qualify as a prognostic marker for RCC. Further investigation of regulatory mechanisms of sulfatide metabolism in human RCC microenvironment is necessary to understand the role of this quantitatively prominent glycosphingolipid in RCC progression.
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Affiliation(s)
- Stefan Porubsky
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Institute of Pathology, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Malin Nientiedt
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jörn-Helge Heinrich Siemoneit
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Roger Sandhoff
- Lipid Pathobiochemistry Group, German Cancer Research Center, Heidelberg, Germany
| | - Richard Jennemann
- Lipid Pathobiochemistry Group, German Cancer Research Center, Heidelberg, Germany
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes-Gutenberg University, Mainz, Germany
| | - Timo Gaiser
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Hielscher
- Department of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Zoran V Popovic
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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24
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Herrmann J, Schmidt H, Nitschke K, Weis CA, Nuhn P, von Hardenberg J, Michel MS, Erben P, Worst TS. RNA Expression of DNA Damage Response Genes in Muscle-Invasive Bladder Cancer: Influence on Outcome and Response to Adjuvant Cisplatin-Based Chemotherapy. Int J Mol Sci 2021; 22:4188. [PMID: 33919527 PMCID: PMC8073847 DOI: 10.3390/ijms22084188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Perioperative cisplatin-based chemotherapy (CBC) can improve the outcome of patients with muscle-invasive bladder cancer (MIBC), but it is still to be defined which patients benefit. Mutations in DNA damage response genes (DDRG) can predict the response to CBC. The value of DDRG expression as a marker of CBC treatment effect remains unclear. MATERIAL AND METHODS RNA expression of the nine key DDRG (BCL2, BRCA1, BRCA2, ERCC2, ERCC6, FOXM1, RAD50, RAD51, and RAD52) was assessed by qRT-PCR in a cohort of 61 MICB patients (median age 66 y, 48 males, 13 females) who underwent radical cystectomy in a tertiary care center. The results were validated in the The Cancer Genome Atlas (TCGA) cohort of MIBC (n = 383). Gene expression was correlated with disease-free survival (DFS) and overall survival (OS). Subgroup analyses were performed in patients who received adjuvant cisplatin-based chemotherapy (ACBC) (Mannheim n = 20 and TCGA n = 75). RESULTS Low expression of RAD52 was associated with low DFS in both the Mannheim and the TCGA cohorts (Mannheim: p = 0.039; TCGA: p = 0.017). This was especially apparent in subgroups treated with ACBC (Mannheim: p = 0.0059; TCGA: p = 0.012). Several other genes showed an influence on DFS in the Mannheim cohort (BRCA2, ERCC2, FOXM1) where low expression was associated with poor DFS (p < 0.05 for all). This finding was not fully supported by the data in the TCGA cohort, where high expression of FOXM1 and BRCA2 correlated with poor DFS. CONCLUSION Low expression of RAD52 correlated with decreased DFS in the Mannheim and the TCGA cohort. This effect was especially pronounced in the subset of patients who received ACBC, making it a promising indicator for response to ACBC on the level of gene expression.
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Affiliation(s)
- Jonas Herrmann
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Helena Schmidt
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Katja Nitschke
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Cleo-Aron Weis
- Institute for Pathology, University Medical Centre Mannheim, 68167 Mannheim, Germany;
| | - Philipp Nuhn
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Jost von Hardenberg
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Maurice Stephan Michel
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Philipp Erben
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
| | - Thomas Stefan Worst
- Department of Urology, University Medical Centre Mannheim, 68167 Mannheim, Germany; (H.S.); (K.N.); (P.N.); (J.v.H.); (M.S.M.); (P.E.); (T.S.W.)
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25
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Neuberger M, Weiß C, Worst TS, Westhoff N, Erben P, Michel MS, von Hardenberg J. Factors to improve academic publishing success of physicians engaged in scientific research. Z Evid Fortbild Qual Gesundhwes 2021; 162:63-69. [PMID: 33824094 DOI: 10.1016/j.zefq.2021.02.001] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Scientific evidence in medicine is based on data generated from research. Recently, the number of scientifically active physicians has decreased, which has led to the development of the Clinician Scientist Programs. To better structure and focus the research of young physicians, we aimed to investigate the impact of collaborations and other factors on the quality and output of scientific publications. METHODS The abstracts of three annual congresses of the German Society of Urology were systematically analysed regarding content, collaborations, and study design. Full-text publications and journals were identified through a MEDLINE® search. Impact factors (IFs) were identified using Journal Citation Reports™. To identify factors which predict publication and IFs, χ2 and Wilcoxon rank-sum tests were used. Uni- and multivariable logistic regression analyses were performed to assess the best model for publication success for an abstract as well as the achievement of a high IF. RESULTS 1,074 abstracts were reviewed. The publication rate of subsequent peer-reviewed full-text publications was 52.5%. Collaborations with at least one institution (odds ratio (OR) 2.02, 95% confidence interval (CI) 1.48-2.76, p <0.0001), statistical analysis (OR 1.92, 95% CI 1.41-2.60, p <0.0001), study design (prospective vs. retrospective: OR 1.43, 95% CI 1.06-1.93, p=0.021), and national collaborations (OR 1.43, 95% CI 1.04-1.98, p=0.029) increased the likelihood of publication in a peer-reviewed journal in a multivariable logistic regression analysis. Experimental design (OR 2.77, 95% CI 1.32-5.84, p=0.007), international collaborations (OR 2.26, 95% CI 1.23-4.15, p=0.009), oncologic topics (OR 1.94, 95% CI 1.23-3.07, p=0.005), prostate disease (OR 1.75, 95% CI 1.08-2.84, p=0.023), and statistical analysis (OR 1.68, 95% CI 1.06-2.64, p=0.026) were associated with a higher IF. CONCLUSION Abstracts resulting from collaborative research projects had a higher likelihood of subsequent full-text publication and a higher IF. More full-text publications were reported when abstracts included a statistical analysis. Hence, intensive networking (e. g. at congresses and workshops) of researching physicians as well as statistical/biometrical classes could be key factors to improve academic success.
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Affiliation(s)
- Manuel Neuberger
- Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christel Weiß
- Department of Biometry and Statistics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Stefan Worst
- Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urological Surgery, University Medical Centre Mannheim (UMM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Uysal D, Kowalewski KF, Kriegmair MC, Wirtz R, Popovic ZV, Erben P. A comprehensive molecular characterization of the 8q22.2 region reveals the prognostic relevance of OSR2 mRNA in muscle invasive bladder cancer. PLoS One 2021; 16:e0248342. [PMID: 33711044 PMCID: PMC7954304 DOI: 10.1371/journal.pone.0248342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/25/2021] [Indexed: 12/27/2022] Open
Abstract
Technological advances in molecular profiling have enabled the comprehensive identification of common regions of gene amplification on chromosomes (amplicons) in muscle invasive bladder cancer (MIBC). One such region is 8q22.2, which is largely unexplored in MIBC and could harbor genes with potential for outcome prediction or targeted therapy. To investigate the prognostic role of 8q22.2 and to compare different amplicon definitions, an in-silico analysis of 357 patients from The Cancer Genome Atlas, who underwent radical cystectomy for MIBC, was performed. Amplicons were generated using the GISTIC2.0 algorithm for copy number alterations (DNA_Amplicon) and z-score normalization for mRNA gene overexpression (RNA_Amplicon). Kaplan-Meier survival analysis, univariable, and multivariable Cox proportional hazard ratios were used to relate amplicons, genes, and clinical parameters to overall (OS) and disease-free survival (DFS). Analyses of the biological functions of 8q22.2 genes and genomic events in MIBC were performed to identify potential targets. Genes with prognostic significance from the in silico analysis were validated using RT-qPCR of MIBC tumor samples (n = 46). High 8q22.2 mRNA expression (RNA-AMP) was associated with lymph node metastases. Furthermore, 8q22.2 DNA and RNA amplified patients were more likely to show a luminal subtype (DNA_Amplicon_core: p = 0.029; RNA_Amplicon_core: p = 0.01). Overexpression of the 8q22.2 gene OSR2 predicted shortened DFS in univariable (HR [CI] 1.97 [1.2; 3.22]; p = 0.01) and multivariable in silico analysis (HR [CI] 1.91 [1.15; 3.16]; p = 0.01) and decreased OS (HR [CI] 6.25 [1.37; 28.38]; p = 0.0177) in RT-qPCR data analysis. Alterations in different levels of the 8q22.2 region are associated with manifestation of different clinical characteristics in MIBC. An in-depth comprehensive molecular characterization of genomic regions involved in cancer should include multiple genetic levels, such as DNA copy number alterations and mRNA gene expression, and could lead to a better molecular understanding. In this study, OSR2 is identified as a potential biomarker for survival prognosis.
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Affiliation(s)
- Daniel Uysal
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Karl-Friedrich Kowalewski
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Köln, Germany
| | - Zoran V. Popovic
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- * E-mail:
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Wu S, Nitschke K, Worst TS, Fierek A, Weis CA, Eckstein M, Porubsky S, Kriegmair M, Erben P. Long noncoding RNA MIR31HG and its splice variants regulate proliferation and migration: prognostic implications for muscle invasive bladder cancer. J Exp Clin Cancer Res 2020; 39:288. [PMID: 33334367 PMCID: PMC7745499 DOI: 10.1186/s13046-020-01795-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
Background Growing evidence supports the pivotal role of long non-coding RNAs (lncRNAs) in the regulation of cancer development and progression. Their expression patterns and biological function in muscle invasive bladder cancer (MIBC) remain elusive. Methods Transcript levels of lncRNA miR-31 host gene (MIR31HG) and its splice variants were measured in our MIBC cohort (n = 102) by qRT-PCR, and validated in silico by the TCGA cohort (n = 370). Kaplan-Meier and multiple Cox regression analysis were conducted to evaluate the survival significance of MIR31HG and its splice variants. Functional experiments were performed to examine the proliferation and migration abilities of MIR31HG and its splice variants by knockdown approaches. Results In this study, a decreased expression of MIR31HG was found in bladder cancer cells and tissues, except in the basal subtype. Survival analysis showed that high expression of MIR31HG was associated with poor overall survival (OS) and disease-free survival (DFS) in patients with MIBC of basal subtype. Two splice variants of MIR31HG lacking exon 1 (MIR31HGΔE1) and exon 3 (MIR31HGΔE3) were identified to have specific expression patterns in different molecular subtypes of our MIBC cohort. MIR31HGΔE3 was highly expressed in basal subtype tumors. A high expression of MIR31HGΔE1 and MIR31HGΔE3 was associated with worse OS and DFS in our cohort. In vitro experiments revealed that knockdown of MIR31HG inhibits cell proliferation, colony formation, and migration in bladder cancer. Cell proliferation and migration assays after knockdown of splice variants of MIR31HG showed corresponding roles for the full-length transcript. Conclusions Our study demonstrates that MIR31HG and its splice variants could serve as biomarkers for the classification and prognosis prediction of patients with MIBC. Supplementary Information The online version contains supplementary material available at 10.1186/s13046-020-01795-5.
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Affiliation(s)
- Sheng Wu
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.,Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Katja Nitschke
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Thomas Stefan Worst
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Alexander Fierek
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91052, Erlangen, Germany
| | - Stefan Porubsky
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Maximilian Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167, Mannheim, Germany.
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Weyerer V, Geppert CI, Bertz S, Taubert H, Breyer J, Bolenz C, Erben P, Wach S, Sikic D, Kunath F, Wullich B, Hartmann A, Eckstein M. Divergent immunobiological correlates of FDA-/EMA-approved PD-L1 assays and scoring algorithms in muscle-invasive bladder cancer. Urol Oncol 2020. [DOI: 10.1016/j.urolonc.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Advanced and metastatic stages of bladder cancer are associated with a poor prognosis. Therapy options are currently limited to systemic therapy with chemo- and immunotherapeutics. In order to improve individual therapy and especially to achieve a more favorable prognosis for these patients, intrinsic molecular subtypes have recently been identified in urothelial carcinoma of the bladder. This review article presents the latest developments, background, and clinical relevance of molecular subtypes in urothelial carcinoma of the bladder. The existing literature and current study data were analyzed to present and evaluate the different molecular classification systems. A focus was placed on the possible therapeutic implications of these molecular subtypes. Although promising progress has been made in the molecular subtyping of urothelial carcinoma, this classification has not yet found its way into clinical application. Multicenter prospective studies with standardized study protocols are still lacking. Previous studies differ in molecular markers, sample collection and preparation procedures, and analytical protocols. Standardization is urgently needed before guidelines can be established and targeted treatment regimens implemented. In principle, the aim should be to develop a stable and as simple as possible methodology, enabling personalized treatment based on molecular subtypes to be broadly applied, and not just in specialized expert centers.
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Affiliation(s)
- Philipp Erben
- Klinik für Urologie und Urochirurgie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland
| | - Christoph Becker
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland. .,Forschungskoordination, Deutsche Gesellschaft für Urologie (DGU) e. V., Uerdinger Straße 64, 40474, Düsseldorf, Deutschland.
| | - Igor Tsaur
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland.,Klinik für Urologie und Kinderurologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Matthias B Stope
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland.,Klinik für Gynäkologie und Gynäkologische Onkologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Tilman Todenhöfer
- Fachgruppe Molekulare Urologie der Arbeitsgruppe urologische Forschung (AuF) der Deutschen Gesellschaft für Urologie, Berlin, Deutschland.,Studienpraxis Urologie, Nürtingen, Deutschland
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Nientiedt M, Müller K, Nitschke K, Erben P, Steidler A, Porubsky S, Popovic ZV, Waldbillig F, Mühlbauer J, Kriegmair MC. B-MYB-p53-related relevant regulator for the progression of clear cell renal cell carcinoma. J Cancer Res Clin Oncol 2020; 147:129-138. [PMID: 32951068 DOI: 10.1007/s00432-020-03392-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/07/2020] [Accepted: 09/10/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To investigate the mRNA expression of B-MYB and MDM2 together with their p53 relatedness in clear cell renal cell carcinoma (ccRCC). METHODS Genes were screened for their mRNA expression from 529 patients in a publicly available ccRCC cohort (TCGA). A cohort of 101 patients with ccRCC served as validation by qRT-PCR mRNA tissue expression analysis. RESULTS Expression: B-MYB expression was significantly higher in high-grade tumours (p < 0.0001 and p = 0.048) and in advanced stages (p = 0.005 and p = 0.037) in both cohorts. Correlation: p53-B-MYB as well as MDM2-B-MYB showed significant correlations in local and low-grade ccRCCs, but not in high grade tumours or advanced stages (r < 0.3 and/or p > 0.05). Survival: Multivariable Cox regression of the TCGA cohort revealed B-MYB upregulation and low MDM2 expression as predictors for an impaired overall survival (OS) (HR 1.97; p = 0.0003; HR 2.94, p < 0.0001) and progression-free survival (PFS) (HR 2.86; p = 0.0005; HR 1.58, p = 0.046). In the validation cohort, the results were confirmed for OS by univariable, but not multivariable regression: high B-MYB expression (HR = 3.05, p = 0.035) and low MDM2 expression (HR 3.81, p value 0.036). CONCLUSION In ccRCC patients with high-grade tumours and advanced stages, high B-MYB expression is common and is associated with poorer OS and PFS. These patients show a loss of their physiological B-MYB-p53 network correlation, suggesting an additional, alternative regulatory, oncogenic mechanism. Assuming further characterization of its signalling pathways, B-MYB could be a potential therapy target for ccRCC.
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Affiliation(s)
- M Nientiedt
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - K Müller
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - K Nitschke
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Steidler
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - S Porubsky
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Z V Popovic
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - F Waldbillig
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - J Mühlbauer
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M C Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Breyer J, Monga M, Mayr R, Otto W, Burger M, Eckstein M, Stöhr R, Erben P, Bolenz C, Eidt S, Sundaram R, Baig M, Galluzzi A, Wirtz R, Hartmann A, Santiago-Walker A. 758P Assessment of prognostic and predictive value of FGFR alterations (FGFRa) in a real-world cohort of patients (pts) with high-risk pT1 non-muscle-invasive bladder cancer (NMIBC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Eckstein M, Pfannstiel C, Chiappinelli KB, Sikic D, Wach S, Wirtz RM, Wullweber A, Taubert H, Breyer J, Otto W, Worst T, Burger M, Wullich B, Bolenz C, Fuhrich N, Geppert C, Weyerer V, Stoehr R, Bertz S, Keck B, Erlmeier F, Erben P, Hartmann A, Strissel P, Strick R. Abstract PR04: Tumor immune microenvironment drives prognostic relevance correlating with bladder cancer subtypes. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.bladder19-pr04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Muscle-invasive bladder cancer (MIBC) represents approximately two thirds of invasive urothelial bladder cancers (UBC) and has high morbidity and mortality. Despite intensive efforts to improve patient treatment and outcome, two thirds of patients with UBC will have a recurrence or disease progression within 5 years. We conducted this study to gain further insights in the immunologic tumor microenvironment (TIME).
Material and Methods: Stromal tumor-infiltrating lymphocytes (sTILs) were scored continuously on HE slides in a cohort of 135 patients with MIBC treated by radical cystectomy (adjuvant chemotherapy n= 34) according to current recommendations (Salgado et al., 2015). In parallel, we assessed intrinsic subtypes by 21-gene Nanostring signature adapted from the MDACC-subtyping approach. Tertiary lymph structures were assessed by whole slide immunohistochemistry of CD3, CD8, CD68, and CD79a. Spatial immune profiling was carried out on regionally (tumor center, invasive margin) designed TMAs by CD3, CD8, CD56 (NK-cells), CD68, PD-1, and PD-L1 and revealed spatial organized immune phenotypes. Results were validated in 407 MIBC of the TCGA cohort by hierarchical clustering analysis, immune cell population analysis via CIBERSORT, and sTIL-scoring on digitalized HE-slides. Furthermore, tumor mutational burden, neoantigen load, and mutational patterns as well as mutational signatures were correlated with immune phenotypes in the TCGA cohort.
Results: We demonstrate that quantity and spatial distribution of sTILs within the tumor immune microenvironment (TIME) predict stages of tumor inflammation, subtypes, and patient survival and correlate with expression of immune checkpoints in an analysis of 542 MIBC. High sTILs indicate an inflamed subtype with 80% 5-year disease-specific survival. A lack of immune infiltrates identifies an uninflamed subtype with a survival rate of less than 25%. A separate immune-evading phenotype with upregulated immune checkpoints was associated with poor survival. Within the TIME are tertiary lymph node structures (TLS), which can mediate antitumor activity via active immune cells. High TLS amounts and close tumor distance correlated significantly with an inflamed phenotype and favorable survival. The uninflamed and evasion phenotypes showed lowest TLS numbers and farthest tumor distances and shortest survival. High inflammation also correlated with increased neoantigen load, high TMB, and specific mutational patterns (TCGA-MSig1, TCGA-MSig3/4). Patients treated with adjuvant chemotherapy showed a favorable prognosis dependent on high sTILs.
Conclusion: Determination of sTILs and tumor subtypes may stratify therapy success and patient survival. Considering sTILs can easily be quantified using simple morphologic parameters such as hematoxylin-eosin, sTILs can be implemented for predicting patient survival and outcome after adjuvant platinum-containing chemotherapy in a routine manner.
This abstract is also being presented as Poster A03.
Citation Format: Markus Eckstein, Carolin Pfannstiel, Katherine B. Chiappinelli, Danijel Sikic, Sven Wach, Ralph M. Wirtz, Adrian Wullweber, Helge Taubert, Johannes Breyer, Wolfgang Otto, Thomas Worst, Maximilian Burger, Bernd Wullich, Christian Bolenz, Nicole Fuhrich, Carol Geppert, Veronika Weyerer, Robert Stoehr, Simone Bertz, Bastian Keck, Franziska Erlmeier, Philipp Erben, Arndt Hartmann, Pamela Strissel, Reiner Strick. Tumor immune microenvironment drives prognostic relevance correlating with bladder cancer subtypes [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr PR04.
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Affiliation(s)
- Markus Eckstein
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Carolin Pfannstiel
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Katherine B. Chiappinelli
- 2Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC,
| | - Danijel Sikic
- 3Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Sven Wach
- 3Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | | | - Adrian Wullweber
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Helge Taubert
- 3Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Johannes Breyer
- 5Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Erlangen, Germany,
| | - Wolfgang Otto
- 5Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Erlangen, Germany,
| | - Thomas Worst
- 6Department of Urology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany,
| | - Maximilian Burger
- 5Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Erlangen, Germany,
| | - Bernd Wullich
- 3Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | | | - Nicole Fuhrich
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Carol Geppert
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Veronika Weyerer
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Robert Stoehr
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Simone Bertz
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Bastian Keck
- 3Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Franziska Erlmeier
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Philipp Erben
- 6Department of Urology, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany,
| | - Arndt Hartmann
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Pamela Strissel
- 8Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Reiner Strick
- 8Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
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Weyerer V, Stoehr R, Strissel P, Strick R, Bolenz C, Hartmann A, Erben P, Eckstein M. Abstract A15: Uninflamed immunologic microenvironment of muscle-invasive bladder cancer associates with activating FGFR3 gene alterations. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.bladder19-a15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background and Objective: Muscle-invasive bladder cancer (MIBC) is a complex disease for which perioperative chemotherapy followed by radical cystectomy is a standard treatment. In recent years new therapy options for advanced urothelial tumors have emerged, representing a personalized medicine approach for patients. For example, targeting fibroblast growth factor receptors (FGFR) as well as restoring antitumor activity using PD-1/PD-L1 inhibitors are currently being evaluated in clinical trials and show promising results. Our present goal in this study was to assess the relationship of FGFR3-gene alterations, immune cell types, gene expression of checkpoint inhibitors like PD-L1/PD-1, and immune-related genes in MIBC to gain insight into significant differential expression.
Materials and Methods: We analyzed the TCGA cohort (n=407). Tumors were identified with activating FGFR3-gene alterations (FGFR3-altered: mutation, amplification, fusion, gain). A comparison was performed between tumors with FGFR3-altered or wild-type tumors and tumor mutational burden (TMB), neoantigen load, immune checkpoint, and immune-related gene expression as well as specific immune cell populations using the CIBERSORT-algorithm.
Results: Activating FGFR3-altered tumors showed significantly less TMB and neoantigen load compared to wild-type cases (p=0.037 and p=0.04). Tumors with high expression of PD-1, PD-L1, CTLA4, and IDO1 were predominately not FGFR3-altered (p<0.0001). Additionally, expression of immune-related genes like CD3Z, CD8A, FOXP3 and amounts of specific immune cell populations were significantly inversely associated with an FGFR3-altered status.
Conclusion: Strikingly, our analysis demonstrates that activating FGFR3 gene alterations in MIBC show low immune checkpoint and immune-related gene expression as well as low amounts of immune cells, demonstrating association with an uninflamed tumor microenvironment. Therefore, combination therapies targeting FGFR3 and, e.g., PD-1/PD-L1 might not be effective. It will be essential to validate these results in another MIBC cohort as well as unravel the role of aberrant signaling of FGFR3.
Citation Format: Veronika Weyerer, Robert Stoehr, Pamela Strissel, Reiner Strick, Christian Bolenz, Arndt Hartmann, Philipp Erben, Markus Eckstein. Uninflamed immunologic microenvironment of muscle-invasive bladder cancer associates with activating FGFR3 gene alterations [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr A15.
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Affiliation(s)
- Veronika Weyerer
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Robert Stoehr
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Pamela Strissel
- 2Department of Gynecology and Obstetrics, Laboratory for Molecular Medicine, University-Hospital Erlangen, Erlangen, Germany,
| | - Reiner Strick
- 2Department of Gynecology and Obstetrics, Laboratory for Molecular Medicine, University-Hospital Erlangen, Erlangen, Germany,
| | | | - Arndt Hartmann
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
| | - Philipp Erben
- 4Department of Urology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Mannheim, Germany
| | - Markus Eckstein
- 1Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany,
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Waldbillig F, Nitschke K, Abdelhadi A, von Hardenberg J, Nuhn P, Nientiedt M, Weis CA, Michel MS, Erben P, Worst TS. Phosphodiesterase SMPDL3B Gene Expression as Independent Outcome Prediction Marker in Localized Prostate Cancer. Int J Mol Sci 2020; 21:ijms21124373. [PMID: 32575490 PMCID: PMC7352472 DOI: 10.3390/ijms21124373] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 12/31/2022] Open
Abstract
Current outcome prediction markers for localized prostate cancer (PCa) are insufficient. The impact of the lipid-modifying Sphingomyelin Phosphodiesterase Acid Like 3B (SMPDL3B) in PCa is unknown. Two cohorts of patients with PCa who underwent radical prostatectomy (n = 40, n = 56) and benign prostate hyperplasia (BPH) controls (n = 8, n = 11) were profiled for SMPDL3B expression with qRT-PCR. Publicly available PCa cohorts (Memorial Sloane Kettering Cancer Centre (MSKCC; n = 131, n = 29 controls) and The Cancer Genome Atlas (TCGA; n = 497, n = 53 controls)) served for validation. SMPDL3B's impact on proliferation and migration was analyzed in PC3 cells by siRNA knockdown. In both cohorts, a Gleason score and T stage independent significant overexpression of SMPDL3B was seen in PCa compared to BPH (p < 0.001 each). A lower expression of SMPDL3B was associated with a shorter overall survival (OS) (p = 0.005) in long term follow-up. A SMPDL3B overexpression in PCa tissue was confirmed in the validation cohorts (p < 0.001 each). In the TCGA patients with low SMPDL3B expression, biochemical recurrence-free survival (p = 0.011) and progression-free interval (p < 0.001) were shorter. Knockdown of SMPDL3B impaired PC3 cell migration but not proliferation (p = 0.0081). In summary, SMPLD3B is highly overexpressed in PCa tissue, is inversely associated with localized PCa prognosis, and impairs PCa cell migration.
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Affiliation(s)
- Frank Waldbillig
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
- Correspondence: ; Tel.: +49-621-383-2201
| | - Katja Nitschke
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Abdallah Abdelhadi
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Philipp Nuhn
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Malin Nientiedt
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Philipp Erben
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
| | - Thomas Stefan Worst
- Department of Urology and Urosurgery, University Medical Centre Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (K.N.); (A.A.); (J.v.H.); (P.N.); (M.N.); (M.S.M.); (P.E.); (T.S.W.)
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Sikic D, Eckstein M, Wirtz RM, Jarczyk J, Worst TS, Porubsky S, Keck B, Kunath F, Weyerer V, Breyer J, Otto W, Rinaldetti S, Bolenz C, Hartmann A, Wullich B, Erben P. FOXA1 Gene Expression for Defining Molecular Subtypes of Muscle-Invasive Bladder Cancer after Radical Cystectomy. J Clin Med 2020; 9:jcm9040994. [PMID: 32252315 PMCID: PMC7230662 DOI: 10.3390/jcm9040994] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/04/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/25/2022] Open
Abstract
It remains unclear how to implement the recently revealed basal and luminal subtypes of muscle-invasive bladder cancer (MIBC) into daily clinical routine and whether molecular marker panels can be reduced. The mRNA expression of basal (KRT5) and luminal (FOXA1, GATA3, KRT20) markers was measured by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) and correlated to clinicopathological features, recurrence-free survival (RFS), disease-free survival (DFS), and overall survival (OS) in 80 patients with MIBC who underwent radical cystectomy. Additionally, the correlation of single markers with the basal and non-basal subtypes defined by a 36-gene panel was examined and then validated in the TCGA (The Cancer Genome Atlas) cohort. High expression of FOXA1 (p = 0.0048) and KRT20 (p = 0.0317) was associated with reduced RFS. In the multivariable analysis, only FOXA1 remained an independent prognostic marker for DFS (p = 0.0333) and RFS (p = 0.0310). FOXA1 expression (AUC = 0.79; p = 0.0007) was closest to the combined marker expression (AUC = 0.79; p = 0.0015) in resembling the non-basal subtype defined by the 36-gene panel. FOXA1 in combination with KRT5 may be used to distinguish the basal and non-basal subtypes of MIBC.
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Affiliation(s)
- Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (B.K.); (F.K.); (B.W.)
- Correspondence: ; Tel.: +49-9131-822-3178
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (M.E.); (V.W.); (A.H.)
| | - Ralph M. Wirtz
- STRATIFYER Molecular Pathology GmbH, 50935 Cologne, Germany;
| | - Jonas Jarczyk
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (J.J.); (T.S.W.); (P.E.)
| | - Thomas S. Worst
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (J.J.); (T.S.W.); (P.E.)
| | - Stefan Porubsky
- Institute of Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Bastian Keck
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (B.K.); (F.K.); (B.W.)
| | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (B.K.); (F.K.); (B.W.)
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (M.E.); (V.W.); (A.H.)
| | - Johannes Breyer
- Department of Urology, University of Regensburg, 93053 Regensburg, Germany; (J.B.); (W.O.)
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, 93053 Regensburg, Germany; (J.B.); (W.O.)
| | - Sebastien Rinaldetti
- Department of Hematology and Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany;
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, 89081 Ulm, Germany;
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (M.E.); (V.W.); (A.H.)
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, 91054 Erlangen, Germany; (B.K.); (F.K.); (B.W.)
| | - Philipp Erben
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (J.J.); (T.S.W.); (P.E.)
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Roghmann F, Reike M, Wirtz R, Kriegmair M, Erben P, Tully K, Weyerer V, Eckstein M, Hartmann A, Wezel F, Bolenz C, Tannapfel A, Noldus J, Juette H. Association of KRT20 and KRT5 with response to neoadjuvant chemotherapy in patients diagnosed with muscle invasive bladder cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
562 Background: Patients with muscle-invasive bladder cancer (MIBC) that underwent neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) show improved overall survival. Those with a pathological complete response (pCR) usually have the best prognosis. In the literature, improved response to NAC has been associated with basal tumor characteristics in MIBC so far. The aim of the present study was to examine the association of luminal (KRT20) and basal (KRT5) mRNA expression patterns at transurethral resection (TUR) with pCR at RC after NAC in a contemporary cohort of consecutive MIBC patients. Methods: Clinical Data and formalin fixed paraffin embedded tumor tissue samples from TUR and RC of 49 patients with MIBC were retrospectively analyzed. Using RT-PCR KRT20 and KRT5 mRNA expression were measured in 40-∆Ct values and normalized against the control gene CALM2. Statistical analyses comprised nonparametric and chi2 testing, partition models and spearman correlation analyses. Results: The study cohort had a median age of 63 years and consisted of 38/49 (78%) males. After NAC, 17/49 (35%) patients had cPR. Using partition models, we found that patients with high-KRT20 (≥39.5 ∆Ct) had a higher chance of pCR (57% vs. 26%, p=0.04). Using a cutoff for KRT5 at <38.1 ∆Ct within the subgroup of patients with low-KRT20 (<39.5 ∆Ct, n=35), we found poorest response among low-KRT20/low-KRT5 compared to low-KRT20/high-KRT5 and high-KRT20 (13% vs. 37% vs. 57%, p=0.29), respectively. For low-KRT20/low-KRT5, low-KRT20/high-KRT5 and high-KRT20 median KRT5 was 34.8 vs. 39.5 vs. 34.1 ∆Ct ( p=0.001) and median KRT20 was 37.9 vs. 32.9 vs. 40.1 ∆Ct,( p=0.001), respectively. Conclusions: Patients with MIBC showing high expression of KRT20 were more likely to show pCR at RC after NAC. Moreover, we were able to identify a high risk group of patients with lowKRT20/lowKRT5 that was less likely to achieve pCR at RC after NAC. Our findings are contradicting previous studies and need further verification in larger cohorts. However, our results might be useful for treatment stratification in MIBC patients.
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Affiliation(s)
- Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - Moritz Reike
- Department of Urology, Marien-Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Maximilian Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany, Mannheim, Germany
| | - Karl Tully
- Department of Urology, Marien-Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Wezel
- Department of Urology, University of Ulm, Ulm, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Germany, Bochum, Germany
| | - Joachim Noldus
- Department of Urology, Ruhr-University Bochum, Marien-Hospital, Herne, Germany
| | - Hendrik Juette
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
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Kim WY, Rose TL, Roghmann F, Eckstein M, Jarczyk J, Zengerling F, Sikic D, Breyer J, Bolenz C, Hartmann A, Mayhew G, Shibata Y, Uronis JM, Galluzzi A, Sundaram R, Xia Q, Wu K, Santiago-Walker AE, Erben P, Wirtz R. Predictive value of fibroblast growth factor receptor (FGFR) alterations on anti-PD-(L)1 treatment outcomes in patients (Pts) with advanced urothelial cancer (UC): Pooled analysis of real-world data. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
493 Background: The tumor microenvironment in UC harboring FGFR gene alterations is characterized by decreased T-cell infiltration and low immune marker expression, potentially implicating suboptimal response to immune checkpoint inhibitors. The association between FGFR gene mutations/fusions and anti-PD-(L)1 treatment outcomes in advanced UC was assessed using real-world pt data. Methods: A pooled dataset of matched clinical and genomic data for advanced UC pts treated with anti-PD-(L)1 in any line from the Bladder Cancer Research Initiative for Drug Targets in Germany (BRIDGE) Consortium and UNC-CH was assessed. FGFR status was defined by a prespecified panel of FGFR2/3 mutations and fusions. Overall survival (OS) was analyzed using Kaplan-Meier estimates and Cox proportional hazards models. Multivariate analyses were performed using potential prognostic covariates (sex, age, baseline tumor stage, urothelial histology, smoking history, primary tumor location, and ECOG) in a Cox regression model for OS to assess their impact on the effect of FGFR alterations. Results: Median OS for FGFR+ pts (n=28) who received any line of anti-PD-(L)1 therapy was 9.5 mo vs 7.5 mo for FGFR− pts (n=139) (HR: 1.03, 95% CI: 0.60-1.76, p=0.93). Median OS for pts treated with first-line anti-PD-(L)1 was 5.42 mo in FGFR+ pts (n=10) and was not reached for FGFR− pts (n=31) (HR: 2.06, 95% CI: 0.68-6.24, p=0.19); median OS in second-line anti-PD-(L)1 was 6.5 mo (FGFR+; n=14) vs 5.7 mo (FGFR−; n=86) (HR: 0.89, 95% CI: 0.44-1.81, p=0.74). The multivariate analyses showed a significant trend of poorer OS in FGFR+ pts with first-line anti-PD-(L)1 (HR: 10.42, 95% CI: 1.45-74.97, p=0.02); wide CI may be attributed to small sample size for some categories in several covariates. Conclusions: Treatment with first-line anti-PD-(L)1 in FGFR+ pts may be associated with poorer OS outcomes in FGFR+ pts; however, this trend was not observed in FGFR+ pts treated with any line and second-line anti-PD-(L)1. Investigation of the predictive value of FGFR alterations to immunotherapy outcomes in larger real-world pt datasets is warranted.
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Affiliation(s)
- William Y. Kim
- The University of North Carolina at Chapel Hill (UNC-CH) School of Medicine and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Tracy L. Rose
- The University of North Carolina at Chapel Hill (UNC-CH) School of Medicine and UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Mannheim, Germany
| | - Friedemann Zengerling
- Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Gregory Mayhew
- GeneCentric Therapeutics, Inc., Research Triangle Park, NC
| | | | | | | | | | - Qi Xia
- Janssen Research & Development, Philadelphia, PA
| | - Kathy Wu
- Janssen Research & Development, LLC, Skillman, NJ
| | | | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
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Reike M, Juette H, Wirtz R, Erben P, Tully K, Eckstein M, Weyerer V, Hartmann A, Kriegmair M, Wezel F, Bolenz C, Tannapfel A, Noldus J, Roghmann F. Smoking status and PD-L1 mRNA-expression as a predictor of response to neoadjuvant chemotherapy in patients diagnosed with muscle invasive bladder cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
530 Background: Patients with muscle-invasive bladder cancer (MIBC) that underwent neoadjuvant chemotherapy (NAC) prior to radical cystectomy (RC) show improved overall survival. Patients with a pathological complete response (pCR) usually have the best prognosis. In the literature, impaired response to immune checkpoint therapy has been reported in active smokers. The aim of our study was to examine the association of smoking status with pCR at RC after NAC. Moreover, we investigated the interaction of smoking status and Programmed Death Ligand 1 (PD-L1) mRNA expression at transurethral resection (TUR) and pCR prediction at RC after NAC. Methods: Clinical Data and formalin fixed paraffin embedded tumor tissue samples from TUR and RC of 49 patients with MIBC were retrospectively analyzed. Using RT-PCR PD-L1 mRNA expression was measured in 40-∆Ct values and normalized against the control gene CALM2. Smoking status was defined as never, former and active. After NAC, RC was performed and the specimens were evaluated for pCR, defined as ypT0N0M0. Statistical analyses comprised nonparametric and chi2 testing, partition models and spearman correlation analyses. Results: The study cohort had a median age of 63 years and consisted of 38/49 (78%) males. Regarding smoking status 11/49 (22%) were never, 17/49 (35%) were former and 21/49 (43%) were active smokers. After NAC, 17/49 patients (35%) had a pCR. Never/former smokers did not show a higher rate of pCR compared to active smokers (43%vs.24%, p=0.16). Comparing smoking status (never/former vs. active smokers) within the subgroup showing high PD-L1 expression (≥32.1∆Ct), a higher rate of pCR was found in never/former smokers (58% vs. 25%, p=0.047). Conclusions: Never and former smokers with MIBC that show high PD-L1 mRNA expression patterns are more likely to show pCR at RC after NAC. Smoking cessation is important for the management of MIBC patients undergoing NAC and RC.
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Affiliation(s)
- Moritz Reike
- Department of Urology, Marien-Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Hendrik Juette
- Institute of Pathology, Ruhr-University Bochum, Bochum, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany, Mannheim, Germany
| | - Karl Tully
- Department of Urology, Marien-Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Veronika Weyerer
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Maximilian Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Felix Wezel
- Department of Urology, University of Ulm, Ulm, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, University of Ulm, Ulm, Germany
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-University Bochum, Germany, Bochum, Germany
| | - Joachim Noldus
- Department of Urology, Ruhr-University Bochum, Marien-Hospital, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
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Wu S, Nitschke K, Heinkele J, Weis CA, Worst TS, Eckstein M, Porubsky S, Erben P. ANLN and TLE2 in Muscle Invasive Bladder Cancer: A Functional and Clinical Evaluation Based on In Silico and In Vitro Data. Cancers (Basel) 2019; 11:cancers11121840. [PMID: 31766561 PMCID: PMC6966660 DOI: 10.3390/cancers11121840] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 10/15/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023] Open
Abstract
Anilin actin binding protein (ANLN) and transducing-like enhancer protein 2 (TLE2) are associated with cancer patient survival and progression. The impact of their gene expression on progression-free survival (PFS) of patients with muscle invasive bladder cancer (MIBC) treated with radical cystectomy (RC) and subtype association has not yet been investigated. qRT-PCR was used to measure the transcript levels of ANLN and TLE2 in the Mannheim cohort, and validated in silico by The Cancer Genome Atlas (TCGA) cohort. Uni- and multivariate Cox regression analyses identified predictors for disease-specific survival (DSS) and overall survival (OS). In the Mannheim cohort, tumors with high ANLN expression were associated with lower OS and DSS, while high TLE2 expression was associated with a favorable OS. The TCGA cohort confirmed that high ANLN and low TLE2 expression was associated with shorter OS and disease-free survival (DFS). In both cohorts, multivariate analyses showed ANLN and TLE2 expression as independent outcome predictors. Furthermore, ANLN was more highly expressed in cell lines and patients with the basal subtype, while TLE2 expression was higher in cell lines and patients with the luminal subtype. ANLN and TLE2 are promising biomarkers for individualized bladder cancer therapy including cancer subclassification and informed MIBC prognosis.
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Affiliation(s)
- Sheng Wu
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (S.W.); (K.N.); (J.H.); (T.S.W.)
| | - Katja Nitschke
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (S.W.); (K.N.); (J.H.); (T.S.W.)
| | - Jakob Heinkele
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (S.W.); (K.N.); (J.H.); (T.S.W.)
| | - Cleo-Aron Weis
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.-A.W.); (S.P.)
| | - Thomas Stefan Worst
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (S.W.); (K.N.); (J.H.); (T.S.W.)
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, 91052 Erlangen, Germany;
| | - Stefan Porubsky
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (C.-A.W.); (S.P.)
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany; (S.W.); (K.N.); (J.H.); (T.S.W.)
- Correspondence: ; Tel.: +49-621-383-1610
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Weyerer V, Stoehr R, Juette H, Wirtz R, Eckstein M, Roghmann F, Breyer J, Porubsky S, Sikic D, Bolenz C, Kriegmair M, Hartmann A, Erben P. Evaluation of different diagnostic methods for identification of FGFR alteration in advanced urothelial carcinomas: Proficiency results based on multiple RNA extraction kits and mutation detection methods. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Roghmann F, Wirtz R, Jarczyk J, Kriegmair M, Worst T, Sikic D, Wach S, Taubert H, Wullich B, Weyerer V, Stoehr R, Zengerling F, Bolenz C, Breyer J, Burger M, Porubsky S, Hartmann A, Erben P, Eckstein M, Juette H. Prognostic role of FGFR Mutations and FGFR mRNA expression in metastatic urothelial cancer treated with anti-PD(L1) inhibitors in first and second-line setting. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Jarczyk J, Wirtz R, Roghmann F, Juette H, Kriegmair M, Worst T, Sikic D, Wach S, Taubert H, Wullich B, Weyerer V, Stoehr R, Zengerling F, Bolenz C, Breyer J, Burger M, Porubsky S, Hartmann A, Erben P, Eckstein M. Efficacy of anti-PD(L)1 treatment in patients with metastatic urothelial cancer based on mRNA- and protein- based PD-L1 determination: Results from the multicentric, retrospective FOsMIC trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pfannstiel C, Strissel PL, Chiappinelli KB, Sikic D, Wach S, Wirtz RM, Wullweber A, Taubert H, Breyer J, Otto W, Worst T, Burger M, Wullich B, Bolenz C, Fuhrich N, Geppert CI, Weyerer V, Stoehr R, Bertz S, Keck B, Erlmeier F, Erben P, Hartmann A, Strick R, Eckstein M. The Tumor Immune Microenvironment Drives a Prognostic Relevance That Correlates with Bladder Cancer Subtypes. Cancer Immunol Res 2019; 7:923-938. [DOI: 10.1158/2326-6066.cir-18-0758] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/09/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
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von Hardenberg J, Hartmann S, Nitschke K, Worst TS, Ting S, Reis H, Nuhn P, Weis CA, Erben P. Programmed Death Ligand 1 (PD-L1) Status and Tumor-Infiltrating Lymphocytes in Hot Spots of Primary and Liver Metastases in Prostate Cancer With Neuroendocrine Differentiation. Clin Genitourin Cancer 2019; 17:145-153.e5. [DOI: 10.1016/j.clgc.2018.12.007] [Citation(s) in RCA: 10] [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: 08/07/2018] [Revised: 11/24/2018] [Accepted: 12/15/2018] [Indexed: 11/28/2022]
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Sikic D, Wirtz RM, Wach S, Dyrskjøt L, Erben P, Bolenz C, Breyer J, Otto W, Hoadley KA, Lerner SP, Eckstein M, Hartmann A, Keck B. Androgen Receptor mRNA Expression in Urothelial Carcinoma of the Bladder: A Retrospective Analysis of Two Independent Cohorts. Transl Oncol 2019; 12:661-668. [PMID: 30831560 PMCID: PMC6403442 DOI: 10.1016/j.tranon.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION: Gender-specific differences have led to the androgen receptor (AR) being considered a possible factor in the pathophysiology of urothelial carcinoma of the bladder (UCB), but the exact role remains unclear. MATERIALS AND METHODS: The association of AR mRNA expression with clinicopathological features was retrospectively analyzed in two previously described cohorts. The first cohort consisted of 41 patients with all stages of UCB treated at Aarhus University Hospital, Denmark. The second cohort consisted of 323 patients with muscle-invasive bladder cancer (MIBC) accumulated by the Cancer Genome Atlas (TCGA) Research Network. RESULTS: AR mRNA expression is significantly higher in non-muscle-invasive bladder cancer (NMIBC) when compared to MIBC (P = .0004), with no relevant changes within the different stages of MIBC. AR mRNA expression was significantly associated with TCGA molecular subtypes (P < .0001). In the total cohort, there was no association between AR expression and gender (P = .23). When analyzed separately, females showed a significantly worse disease-free (P = .03) and overall survival (P = .02) when expressing AR mRNA above median level, while the same was not observed for men. Multivariable Cox's regression analyses revealed AR mRNA expression to be an independent prognostic marker for disease-free survival in women (P = .007). CONCLUSIONS: AR mRNA expression is significantly higher in NMIBC than in MIBC, while high AR mRNA expression is associated with worse survival in females with MIBC. Further studies need to investigate the gender-specific role of AR in UCB.
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Affiliation(s)
- Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany.
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Philipp Erben
- Department of Urology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University Hospital Ulm, Ulm, Germany.
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Regensburg, Germany.
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Regensburg, Germany.
| | - Katherine A Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Seth P Lerner
- Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
| | - Bastian Keck
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Wessels F, Kriegmair MC, Oehme A, Rassweiler-Seyfried MC, Erben P, Oberneder R, Kriegmair M, Ritter M, Michel MS, Honeck P. Radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid. Eur J Surg Oncol 2019; 45:1260-1265. [PMID: 30827801 DOI: 10.1016/j.ejso.2019.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/06/2018] [Revised: 01/08/2019] [Accepted: 02/17/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Aim of this study was to analyse the perioperative outcome of patients undergoing radical cystectomy under continuous antiplatelet therapy with acetylsalicylic acid. MATERIALS AND METHODS Using prospectively maintained databases of two departments of urology, we identified 461 consecutive patients who underwent radical cystectomy for bladder cancer (2011-2017). Patients were divided into three groups: 1) on-going antiplatelet therapy with acetylsalicylic acid (n = 50), 2) discontinuing antiplatelet therapy (n = 65) and 3) no antiplatelet therapy (n = 346). Perioperative outcome was compared between the three groups using ANOVA, likelihood ratio or Kruskal Wallis test with post-hoc testing. Uni- and multivariate analyses were performed to identify predictor for perioperative complications and transfusion. RESULTS Group 1 showed an average estimated blood loss of 732 ± 424, group 2 752 ± 488 and group 3 810 ± 544 ml (p = 0.51). There was no significant difference in transfusion rate (44% in group 1, 45% and 39% in groups 2 and 3, p = 0.63). Severe complications occurred in 26%, 15% and 15% in groups 1-3 (p = 0.19). Ischemic complications were more often observed in group 1 (n = 4, 8%) and 2 (n = 5, 8%) than group 3 (n = 7, 2%), p = 0.02. 90-day readmission (n = 99, 22%) and mortality rate (n = 10, 2.2%) were low and did not show any significant differences between the groups. In uni- and multivariate analysis ongoing therapy with acetylsalicylic acid was no independent risk factor for transfusion or severe complications. CONCLUSION Perioperative continuation of therapy with acetylsalicylic acid in radical cystectomy is safe with no difference in intraoperative blood loss, transfusion rate, complications or mortality.
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Affiliation(s)
- F Wessels
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - M C Kriegmair
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - A Oehme
- Clinic for Urology, Munich-Planegg, Germeringer Strasse, Germany
| | - M C Rassweiler-Seyfried
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Erben
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - R Oberneder
- Clinic for Urology, Munich-Planegg, Germeringer Strasse, Germany
| | - M Kriegmair
- Clinic for Urology, Munich-Planegg, Germeringer Strasse, Germany
| | - M Ritter
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - M S Michel
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - P Honeck
- University Medical Centre Mannheim, Urology, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Martini T, Heinkele J, Mayr R, Weis CA, Wezel F, Wahby S, Eckstein M, Schnöller T, Breyer J, Wirtz R, Ritter M, Bolenz C, Erben P. Erratum to 'Predictive value of lymphangiogenesis and proliferation markers on mRNA level in urothelial carcinoma of the bladder after radical cystectomy' [Urologic Oncology: Seminars and Original Investigations 36/12 (2018) 505-534]. Urol Oncol 2019; 37:227. [PMID: 30595464 DOI: 10.1016/j.urolonc.2018.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Jakob Heinkele
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Roman Mayr
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Felix Wezel
- Department of Urology, University of Ulm, Ulm, Germany
| | - Sarah Wahby
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Markus Eckstein
- Institute of Pathology, University of Erlangen-Nüremberg, Erlangen, Germany
| | | | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; Institute of Pathology, The St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Manuel Ritter
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Philipp Erben
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Eckstein M, Erben P, Kriegmair MC, Worst TS, Weiß CA, Wirtz RM, Wach S, Stoehr R, Sikic D, Geppert CI, Weyerer V, Bertz S, Breyer J, Otto W, Keck B, Burger M, Taubert H, Weichert W, Wullich B, Bolenz C, Hartmann A, Erlmeier F. Performance of the Food and Drug Administration/EMA-approved programmed cell death ligand-1 assays in urothelial carcinoma with emphasis on therapy stratification for first-line use of atezolizumab and pembrolizumab. Eur J Cancer 2019; 106:234-243. [DOI: 10.1016/j.ejca.2018.11.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/04/2018] [Accepted: 11/06/2018] [Indexed: 11/16/2022]
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Erben P, Sikic D, Wirtz RM, Martini T, Weis CA, Breyer J, Otto W, Keck B, Hartmann A, Bolenz C. Analysis of the prognostic relevance of sex-steroid hormonal receptor mRNA expression in muscle-invasive urothelial carcinoma of the urinary bladder. Virchows Arch 2018; 474:209-217. [PMID: 30483954 DOI: 10.1007/s00428-018-2496-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 01/08/2018] [Revised: 10/10/2018] [Accepted: 11/19/2018] [Indexed: 12/20/2022]
Abstract
Muscle-invasive urothelial carcinoma of the urinary bladder (UCB) often recurs following radical cystectomy (RC). An altered expression of sex-steroid hormone receptors has been associated with oncological outcomes of UCB and may represent therapeutic targets. Here the expression of different hormone receptors was measured on mRNA levels in patients treated by RC and associated with outcomes. Androgen receptor (AR), estrogen receptor 1 (ESR1), and progesterone receptor (PGR) mRNA expression was assessed by quantitative reverse transcription polymerase chain reaction (RT-qPCR) in RC samples of 87 patients with a median age of 66 (39-88) years. Univariate and multivariate analyses were performed to test associations with pathological and clinical characteristics as well as recurrence-free (RFS) and disease-specific survival (DSS). AR mRNA expression was lower in comparison with ESR1 and PGR expression (p < 0.0001). In univariate analysis, high expression levels of AR were associated with reduced RFS (HR 2.8, p = 0.015) and DSS (HR 2.8, p = 0.010). High AR mRNA expression and a positive lymph node status were independent predictors for reduced RFS (HR 2.5, p = 0.0049) and DSS (HR 3.4, p = 0.009). In patients with low AR mRNA expression, an increased ESR1 and PGR mRNA expression were associated with reduced RFS and DSS. High expression levels of AR are significantly associated with adverse outcome in patients with muscle-invasive UCB following RC. ESR1 and PGR expression status can further stratify patients with low AR expression into subgroups with significantly reduced RFS and DSS. Therapeutic targeting of AR may influence outcomes in patients with UCB.
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Affiliation(s)
- Philipp Erben
- Department of Urology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
| | - Thomas Martini
- Department of Urology and Pediatric Urology, University of Ulm, Ulm, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Johannes Breyer
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Bastian Keck
- Department of Urology and Pediatric Urology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Bolenz
- Department of Urology and Pediatric Urology, University of Ulm, Ulm, Germany
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Martini T, Heinkele J, Mayr R, Weis CA, Wezel F, Wahby S, Eckstein M, Schnöller T, Breyer J, Wirtz R, Ritter M, Bolenz C, Erben P. Predictive value of lymphangiogenesis and proliferation markers on mRNA level in urothelial carcinoma of the bladder after radical cystectomy. Urol Oncol 2018; 36:530.e19-530.e27. [PMID: 30446441 DOI: 10.1016/j.urolonc.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/14/2018] [Revised: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the mRNA expression of lymphangiogenesis and proliferation markers and to examine its association with histopathological characteristics and clinical outcome in patients with urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). PATIENTS AND METHODS Gene expression analysis of the vascular endothelial growth -C and -D (VEGF-C/-D), its receptor VEGF receptor-3 (VEGFR-3), MKI67, and RACGAP1 was performed in 108 patients after radical cystectomy and their correlation with clinical-pathological parameters was investigated. Uni- and multivariate regression analyses were used to identify predictors for cancer-specific survival (CSS), recurrence-free survival (RFS) and overall survival (OS) after RC. RESULTS The expression of RACGAP1 and VEGFR-3 showed an association with a higher pT stage (P = 0.049; P = 0.009). MKI67 showed an association with a high-grade urothelial carcinoma of the bladder (P = 0.021). VEGFR-3 expression was significantly associated with the presence of lymphovascular invasion (LVI) (P = 0.016) and lymph node metastases (pN+) (P = 0.028). With the univariate analysis, overexpression of VEGFR-3 (P = 0.029) and the clinical-pathological parameters pT stage (P < 0.0001), pN+ (P = 0.0004), LVI (P < 0.0001) and female gender (P = 0.021) were significantly associated with a reduced CSS. Multivariate analysis identified a higher pT stage (P = 0.017) and LVI (P = 0.008) as independent predictors for reduced CSS. Independent predictors for reduced OS were a higher pT stage (P = 0.0007) and LVI (P = 0.0021), while overexpression of VEGF-D was associated with better OS (P < 0.0001). CONCLUSIONS The mRNA expression of the investigated markers showed associations with common histopathological parameters. Increased expression of VEGF-D is independently associated with better overall survival.
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Affiliation(s)
| | - Jakob Heinkele
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Roman Mayr
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Felix Wezel
- Department of Urology, University of Ulm, Ulm, Germany
| | - Sarah Wahby
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Markus Eckstein
- Institute of Pathology, University of Erlangen-Nüremberg, Erlangen, Germany
| | | | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; Institute of Pathology, The St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Manuel Ritter
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Philipp Erben
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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