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Zhu C, Shi T, Jiang C, Liu B, Baldassarre LA, Zarich S. Racial and Ethnic Disparities in All-Cause and Cardiovascular Mortality Among Cancer Patients in the U.S. JACC CardioOncol 2023; 5:55-66. [PMID: 36875907 PMCID: PMC9982284 DOI: 10.1016/j.jaccao.2022.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 02/24/2023] Open
Abstract
Background With improved cancer survival, death from noncancer etiologies, especially cardiovascular disease (CVD) mortality, has come more into focus. Little is known about the racial and ethnic disparities in all-cause and CVD mortality among U.S. cancer patients. Objectives This study sought to investigate racial and ethnic disparities in all-cause and CVD mortality among adults with cancer in the United States. Methods Using the Surveillance, Epidemiology, and End Results (SEER) database from years 2000 to 2018, all-cause and CVD mortality among patients ≥18 years of age at the time of initial malignancy diagnosis were compared by race and ethnicity groups. The 10 most prevalent cancers were included. Cox regression models were used to estimate adjusted HRs for all-cause and CVD mortality using Fine and Gray's method for competing risks, as applicable. Results Among a total of 3,674,511 participants included in our study, 1,644,067 (44.7%) died, with 231,386 (6.3%) deaths as a result of CVD. After adjusting for sociodemographic and clinical characteristics, non-Hispanic (NH) Black individuals had both higher all-cause (HR: 1.13; 95% CI: 1.13-1.14) and CVD (HR: 1.25; 95% CI: 1.24-1.27) mortality, whereas Hispanic and NH Asian/Pacific Islander had lower mortality than NH White patients. Racial and ethnic disparities were more prominent among patients 18 to 54 years of age and those with localized cancer. Conclusions Significant racial and ethnic differences exist in both all-cause and CVD mortality among U.S. cancer patients. Our findings underscore the vital roles of accessible cardiovascular interventions and strategies to identify high-risk cancer populations who may benefit most from early and long-term survivorship care.
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Affiliation(s)
- Cenjing Zhu
- Department of Chronic Disease Epidemiology, Yale University, New Haven, Connecticut, USA
| | - Tiantian Shi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Changchuan Jiang
- Department of Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Baoqiong Liu
- Division of Cardiology, Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lauren A. Baldassarre
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stuart Zarich
- Division of Cardiovascular Medicine, Bridgeport Hospital, Yale New Haven Health System, Bridgeport, Connecticut, USA
- Address for correspondence: Dr Stuart Zarich, Division of Cardiovascular Medicine, Bridgeport Hospital, Yale New Haven Health System, 267 Grant Street, Bridgeport, Connecticut 06610, USA.
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Goodrich JA, Walker D, Lin X, Wang H, Lim T, McConnell R, Conti DV, Chatzi L, Setiawan VW. Exposure to perfluoroalkyl substances and risk of hepatocellular carcinoma in a multiethnic cohort. JHEP Rep 2022; 4:100550. [PMID: 36111068 PMCID: PMC9468464 DOI: 10.1016/j.jhepr.2022.100550] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/12/2022] [Indexed: 01/09/2023] Open
Abstract
Background & Aims Exposure to poly- and perfluoroalkyl substances (PFAS), a class of persistent organic pollutants, is ubiquitous. Animal studies suggest that PFAS may increase risk of fatty liver and hepatocellular carcinoma (HCC) via impacts on hepatic lipid, amino acid, and glucose metabolism, but human data is lacking. We examined associations between PFAS exposure, altered metabolic pathways, and risk of non-viral HCC. Methods In this nested case-control study, pre-diagnostic plasma PFAS and metabolomics were measured in 50 incident HCC cases and 50 individually matched controls from the Multiethnic Cohort (MEC) study. Cases/controls were matched by age, sex, race, and study area. PFAS exposure and risk of HCC were examined using conditional logistic regression. A metabolome-wide association study and pathway enrichment analysis was performed for PFAS exposure and HCC risk, and key metabolites/metabolic pathways were identified using a meet in the middle approach. Results High perfluorooctane sulfonic acid (PFOS) levels (90th percentile from NHANES; >55 μg/L) were associated with 4.5-fold increased risk of HCC (odds ratio 4.5, 95% CI 1.2-16.0). Pathway enrichment analysis showed that PFOS exposure was associated with alterations in amino acid and glycan biosynthesis pathways, which were also associated with HCC risk. We identified 4 metabolites linking PFOS exposure with HCC, including glucose, butyric acid (a short-chain fatty acid), α-ketoisovaleric acid (a branched-chain α-keto acid), and 7α-hydroxy-3-oxo-4-cholestenoate (a bile acid), each of which was positively associated with PFOS exposure and risk of HCC. Conclusion This proof-of-concept analysis shows that exposure to high PFOS levels was associated with increased risk of non-viral HCC, likely via alterations in glucose, amino acid, and bile acid metabolism. Larger studies are needed to confirm these findings. Lay summary Per- and polyfluoroalkyl substances (PFAS), often referred to as “forever chemicals” because they are difficult to break down and stay in the human body for years, are extremely common and can cause liver damage. In a first of its kind study, we found that exposure to high levels of perfluorooctanesulfonic acid, one of the most common PFAS chemicals, was linked to increased risk of hepatocellular carcinoma in humans. Hepatocellular carcinoma is difficult to treat and is one of the most common forms of liver cancer, and these findings may provide new avenues for helping to prevent this disease. Associations of PFAS and risk of hepatocellular carcinoma were tested in humans. PFAS and untargeted metabolomics were assessed in pre-diagnostic samples. Exposure to high PFOS levels was linked to increased hepatocellular carcinoma risk. The likely mechanisms were via alterations in glucose, amino acid, and bile acid metabolism.
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Key Words
- Chemical exposure
- HCC, hepatocellular carcinoma
- HILIC, hydrophilic interaction chromatography
- HRMS, high-resolution mass spectrometry
- LC, liquid chromatography
- MEC, Multiethnic Cohort
- MWAS, metabolome-wide association
- NAFLD, non-alcoholic fatty liver disease
- PFAS, perfluoroalkyl substances
- PFDA, perfluorodecanoate
- PFHxS, perfluorohexane sulfonate
- PFNA, perfluorononanoate
- PFOA, perfluorooctanoate
- PFOS, perfluorooctane sulfonate
- PFUnDA, perfluoroundecanoic acid
- RP, reverse phase
- SEER, Surveillance, Epidemiology, and End Results
- bile acid
- exposome
- hepatocellular carcinoma
- metabolic pathway
- metabolome
- perfluorinated alkyl substance
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Affiliation(s)
- Jesse A Goodrich
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Douglas Walker
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Xiangping Lin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Hongxu Wang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tiffany Lim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David V Conti
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Lida Chatzi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Veronica Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Paterson DI, Wiebe N, Cheung WY, Mackey JR, Pituskin E, Reiman A, Tonelli M. Incident Cardiovascular Disease Among Adults With Cancer: A Population-Based Cohort Study. JACC CardioOncol 2022; 4:85-94. [PMID: 35492824 PMCID: PMC9040097 DOI: 10.1016/j.jaccao.2022.01.100] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [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: 09/14/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/13/2022] Open
Abstract
Background Patients with cancer and cancer survivors are at increased risk for incident heart failure, but there are conflicting data on the long-term risk for other cardiovascular events and how such risk may vary by cancer site. Objectives The aim of this study was to determine the impact of a new cancer diagnosis on the risk for fatal and nonfatal cardiovascular events. Methods Using administrative health care databases, a population-based retrospective cohort study was conducted among 4,519,243 adults residing in Alberta, Canada, from April 2007 to December 2018. Participants with new cancer diagnoses during the study period were compared with those without cancer with respect to risk for subsequent cardiovascular events (cardiovascular mortality, myocardial infarction, stroke, heart failure, and pulmonary embolism) using time-to-event survival models after adjusting for sociodemographic data and comorbidities. Results A total of 224,016 participants with new cancer diagnoses were identified, as well as 73,360 cardiovascular deaths and 470,481 nonfatal cardiovascular events during a median follow-up period of 11.8 years. After adjustment, participants with cancer had HRs of 1.33 (95% CI: 1.29-1.37) for cardiovascular mortality, 1.01 (95% CI: 0.97-1.05) for myocardial infarction, 1.44 (95% CI: 1.41-1.47) for stroke, 1.62 (95% CI: 1.59-1.65) for heart failure, and 3.43 (95% CI: 3.37-3.50) for pulmonary embolism, compared with participants without cancer. Cardiovascular risk was highest for patients with genitourinary, gastrointestinal, thoracic, nervous system and hematologic malignancies. Conclusions A new cancer diagnosis is independently associated with a significantly increased risk for cardiovascular death and nonfatal morbidity regardless of cancer site. These findings highlight the need for a collaborative approach to health care for patients with cancer and cancer survivors.
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Affiliation(s)
- D. Ian Paterson
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Winson Y. Cheung
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - John R. Mackey
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Edith Pituskin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Anthony Reiman
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Address for correspondence: Dr Marcello Tonelli, University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada. @cellotonelli
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Tanenbaum HC, Xu L, Hahn EE, Wolfson J, Bhatia S, Cannavale K, Cooper R, Chao C. Preventive health service use among survivors of adolescent and young adult cancer. Prev Med Rep. 2020;20:101278. [PMID: 33384914 PMCID: PMC7770961 DOI: 10.1016/j.pmedr.2020.101278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/09/2020] [Accepted: 11/21/2020] [Indexed: 12/16/2022] Open
Abstract
Preventive health screenings are essential for survivors of adolescent and young adult (AYA) cancer survivors, who are at greater risk for non-cancer related death compared to individuals without a history of cancer. However, little research exists examining their use of screening services. In order to identify potential areas for targeted improvements in AYA survivorship care, we examined adherence to United States Preventive Services Task Force (USPSTF) screening recommendations among members of Kaiser Permanente Southern California. The study population included individuals diagnosed with cancer between ages 15-39 from 2000 to 2012 who survived at least two years post-diagnosis (n = 6779) and a matched cohort of non-cancer comparisons (n = 25640). To assess adherence to screening services, we calculated a Prevention Index (PI, proportion of person-time covered by receipt of recommended clinical preventive services relative to the time eligible) for every individual and the distributions for each service. We also evaluated predictors for adherence using logistic regression. Adherence was significantly (p-value < 0.05) higher among survivors than non-cancer subjects for screenings for dyslipidemia (71.16% and 65.94, respectively), hypertension (97.43% and 89.11%), cervical cancer (87.36% and 84.45%), colorectal cancer (83.23% and 58.27%), and influenza vaccination (36.79% and 33.21%). The logistic regression showed that survivors were significantly more likely to adhere to guidelines compared to non-cancer peers for all screenings except breast cancer, with the greatest difference found for colorectal cancer (odds ratio: 5.04, p-value: <0.01). While AYA survivors appear to use preventive screenings more than comparisons, there is room for improvement for certain services, most notably for influenza vaccination.
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Papakonstantinou E, Stamatopoulos A, I Athanasiadis D, Kenanidis E, Potoupnis M, Haidich AB, Tsiridis E. Limb-salvage surgery offers better five-year survival rate than amputation in patients with limb osteosarcoma treated with neoadjuvant chemotherapy. A systematic review and meta-analysis. J Bone Oncol 2020; 25:100319. [PMID: 33088699 DOI: 10.1016/j.jbo.2020.100319] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 09/09/2020] [Indexed: 02/04/2023] Open
Abstract
Background Osteosarcoma is the most common primary bone sarcoma. Currently, the main treatment option for high-grade osteosarcomas is neoadjuvant chemotherapy, followed by surgical resection of the lesion and adjuvant chemotherapy. Limb salvage surgery (LSS) and amputation are the main surgical techniques; however, controversy still exists concerning the best surgical method. Our meta-analysis compared the effectiveness of LSS and amputation combined with neoadjuvant chemotherapy in patients with limb osteosarcoma, in terms of 5-year overall survival (OS), 5-year disease-free survival (DFS) and local recurrence rate. Methods Following the established methodology of PRISMA guidelines, a literature search was conducted in PubMed, Cochrane, Google Scholar from 1975 until January 2020. Two independent reviewers evaluated the study quality based on the Newcastle-Ottawa scale. Odds ratio and 95% confidence interval of the OS, DFS and local recurrence rate were calculated. Results Thirteen studies were finally included with a total of 2884 patients; 1986 patients undergone LSS and 898 amputations. Five-year overall survival was almost 2-fold in patients treated with LSS than those treated with amputation (OR: 1.99; 95% CI: 1.35-2.93; I2 = 74%, p < 0.001). No difference was found in 5-year DFS between LSS patients and amputees (OR: 1.24; 95% CI: 0.55-2.79; I2 = 67%, p = 0.01). The odds of local recurrence was numerically higher in LSS compared to amputation but not statistically significant (OR: 2.29; 95% CI: 0.95-5.53; I2 = 47%, p = 0.05). However, the included studies did not clearly define differences in the stages of patients of the two groups. Conclusion Our study demonstrated that in patients with limb osteosarcoma treated with neoadjuvant chemotherapy, LSS is associated with a higher 5-year overall survival and the odds of local recurrence may be increased but these results should be interpreted with caution due to high heterogeneity.
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Key Words
- AJCC, American Joint Cancer Committee
- ASCO, American Society of Clinical Oncology
- Amputation
- CATS, Computed Assisted Tumor Surgery
- CCG, Children’s Cancer Group
- CI, Confidence Interval
- COSS, Cooperative Osteosarcoma Study Group
- CT, Computed Tomography
- DFS, Disease Free Survival
- FNA, Fine Needle Aspiration
- LSS, Limb Salvage Surgery
- Limb-salvage surgery
- MAP, MTX, Adriamycin, Cisplatin
- MRI, Magnetic Resonance Imaging
- MSKCC, Memorial Sloan Kattering Cancer Center
- MSTS, Musculoskeletal Tumor Society
- NCCN, National Comprehensive Cancer Network
- NOS, Newcastle–Ottawa scale
- NPCR, National Program of Cancer Registries
- Neoadjuvant chemotherapy
- OR, Odds Ratio
- OS, Overall Survival
- Osteosarcoma
- PET, Positron Emission Tomography
- POG, Pediatric Oncology Group
- RCT, Randomized Controlled Trials
- Rev-Man, Review Manager
- SEER, Surveillance, Epidemiology, and End Results
- SIOP, International Society of Paediatric Oncology
- Tc-MDP, Methylene diphosphonate with technetium-99m
- VICC, Vanderbilt-Ingram Cancer Center
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Lee KW, Zang DY, Ryu MH, Kim KH, Kim MJ, Han HS, Koh SA, Park JH, Kim JW, Nam BH, Choi IS. Comparison of efficacy and tolerance between combination therapy and monotherapy as first-line chemotherapy in elderly patients with advanced gastric cancer: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2017; 8:55-61. [PMID: 29696197 PMCID: PMC5898575 DOI: 10.1016/j.conctc.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/24/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The combination of a fluoropyrimidine [5-fluorouracil (5-FU), capecitabine, or S-1] with a platinum analog (cisplatin or oxaliplatin) is the most widely accepted first-line chemotherapy regimen for metastatic or recurrent advanced gastric cancer (AGC), based on the results of clinical trials. However, there is little evidence to guide chemotherapy for elderly patients with AGC because of under-representation of this age group in clinical trials. Thus, the aim of this study is to determine the optimal chemotherapy regimen for elderly patients with AGC by comparing the efficacies and safeties of combination therapy versus monotherapy as first-line chemotherapy. METHODS This study is a randomized, controlled, multicenter, phase III trial. A total of 246 elderly patients (≥70 years old) with metastatic or recurrent AGC who have not received previous palliative chemotherapy will be randomly allocated to a combination therapy group or a monotherapy group. Patients randomized to the combination therapy group will receive fluoropyrimidine plus platinum combination chemotherapy (capecitabine/cisplatin, S-1/cisplatin, capecitabine/oxaliplatin, or 5-FU/oxaliplatin), and those randomized to the monotherapy group will receive fluoropyrimidine monotherapy (capecitabine, S-1, or 5-FU). The primary outcome is the overall survival of patients in each treatment group. The secondary outcomes include progression-free survival, response rate, quality of life, and safety. DISCUSSION We are conducting this pragmatic trial to determine whether elderly patients with AGC will obtain the same benefit from chemotherapy as younger patients. We expect that this study will help guide decision-making for the optimal treatment of elderly patients with AGC.
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Key Words
- 5-FU, 5-fluorouracil
- ADL, activities of daily living
- AGC, advanced gastric cancer
- AST/ALT, aspartate aminotransferase/alanine aminotransferase
- CCr, creatinine clearance
- CGA, comprehensive geriatric assessment
- CI, confidence interval
- CRF, case report form
- CT, computed tomography
- Chemotherapy
- DSMB, data safety monitoring board
- ECOG, Eastern Cooperative Oncology Group
- EORTC QLQ-C30, European Organization for Research and Treatment of Cancer core quality of life questionnaire
- EORTC QLQ-STO22, European Organization for Research and Treatment of Cancer quality of life questionnaire-gastric
- Elderly
- FAS, full analysis set
- Gastric cancer
- HER-2, human epidermal growth factor receptor-2
- HR, hazard ratio
- IADL, independent activities of daily living
- IIT, intent to treat
- KCSG, Korean Cancer Study Group
- KG-7, Korean Cancer Study Group geriatric tool
- KPS, Karnofsky performance status
- NCI CTCAE, National Cancer Institute Common Terminology Criteria for Adverse Events
- OS, overall survival
- PFS, progression-free survival
- PPS, per-protocol set
- PS, performance status
- QoL, quality of life
- RCT, randomized controlled trial
- RECIST, Response Evaluation Criteria in Solid Tumors
- RR, response rate
- Randomized controlled trial
- SAE, serious adverse event
- SEER, Surveillance, Epidemiology, and End Results
- UNL, upper normal limit
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Affiliation(s)
- Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Hyang Kim
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, South Korea
| | - Mi-Jung Kim
- Center for Gastric Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Hye Sook Han
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea
| | - Sung Ae Koh
- Department of Internal Medicine, Yeungnam University Medical Center, Daegu, South Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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Martin JW, Carballido EM, Ahmed A, Farhan B, Dutta R, Smith C, Youssef RF. Squamous cell carcinoma of the urinary bladder: Systematic review of clinical characteristics and therapeutic approaches. Arab J Urol 2016; 14:183-91. [PMID: 27547458 PMCID: PMC4983161 DOI: 10.1016/j.aju.2016.07.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/24/2016] [Accepted: 07/03/2016] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To highlight the current understanding of the epidemiology, clinicopathological characteristics, and management of squamous cell carcinoma (SCC) of the bladder, as it accounts for 2-5% of bladder tumours, with a focus on non-bilharzial-associated SCC (NB-SCC). The standard treatment for bladder SCC remains radical cystectomy (RC). We present an updated clinical profile of bladder SCC and a review of NB-SCC therapeutic approaches, including RC, neoadjuvant and adjuvant treatments, radiotherapy, chemotherapy, and immunotherapy. METHODS Using search terms relating to SCC, urinary bladder, and treatment modalities, we performed a search of the PubMed and Embase databases to identify NB-SCC treatment approaches and outcomes. Peer-reviewed English language reports from 1975 to present assessing SCC management were included. Two authors independently screened and extracted the data. RESULTS Of the 806 articles screened, 10 met the pre-defined inclusion criteria. RC was performed in seven of the 10 studies. Although radiotherapy alone yielded poor outcomes, preoperative radiotherapy and RC were associated with improved survival. There is little evidence supporting the use of chemotherapy in NB-SCC, and its efficacy in relation to RC is not known. CONCLUSION Based on current literature, there is insufficient evidence to provide a treatment recommendation for NB-SCC. Whilst RC is the standard of care, the role of preoperative radiotherapy should be revisited and compared to RC alone. Additional studies incorporating multimodal approaches, contemporary radiation techniques, and systemic therapies are warranted. Immunotherapy as a treatment for bladder SCC has yet to be investigated.
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Key Words
- B-SCC, bilharzial-associated SCC
- Bilharzial
- Bladder
- CISC, clean intermittent self-catheterisation
- COX-2, cyclooxygenase 2
- DFS, disease-free survival
- FGF-2, fibroblast growth factor 2
- HER-2, human epidermal growth factor receptor 2
- HPV, human papilloma virus
- LN, lymph node
- LVI, lymphovascular invasion
- NAC, neoadjuvant chemotherapy
- NB-SCC, non-bilharzial SCC
- OS, overall survival
- PD-1, programmed cell death 1
- PD-L1, programmed death-ligand 1
- RC, radical cystectomy
- Radical cystectomy
- Radiotherapy
- SCC, squamous cell carcinoma
- SCI, spinal cord injury
- SEER, Surveillance, Epidemiology, and End Results
- Squamous cell carcinoma (SCC)
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Affiliation(s)
- Jeremy W Martin
- Department of Urology, University of California - Irvine, Orange, CA, USA
| | - Estrella M Carballido
- Division of Hematology and Medical Oncology, Mayo Clinic Cancer Center, Scottsdale, AZ, USA
| | - Ahmed Ahmed
- Department of Urology, University of California - Irvine, Orange, CA, USA; Department of Urology, Faculty of Medicine, Aswan University, Aswan, Egypt
| | - Bilal Farhan
- Department of Urology, University of California - Irvine, Orange, CA, USA
| | - Rahul Dutta
- Department of Urology, University of California - Irvine, Orange, CA, USA
| | - Cody Smith
- Department of Urology, University of California - Irvine, Orange, CA, USA
| | - Ramy F Youssef
- Department of Urology, University of California - Irvine, Orange, CA, USA
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