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Russell B, Leech P, Wylie H, Moss CL, Haire A, Enting D, Amery S, Chatterton K, Khan MS, Thurairaja R, Nair R, Malde S, Smith K, Gillett C, Josephs D, Pintus E, Rudman S, Hughes S, Relton C, Van Hemelrijck M. A cohort profile of the Graham Roberts study cohort. Front Oncol 2024; 13:1334183. [PMID: 38264755 PMCID: PMC10803459 DOI: 10.3389/fonc.2023.1334183] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] Open
Abstract
Purpose The Graham Roberts Study was initiated in 2018 and is the first Trials Within Cohorts (TwiCs) study for bladder cancer. Its purpose is to provide an infrastructure for answering a breadth of research questions, including clinical, mechanistic, and supportive care centred questions for bladder cancer patients. Participants All consented patients are those aged 18 or older, able to provide signed informedconsent and have a diagnosis of new or recurrent bladder cancer. All patients are required to have completed a series of baseline questionnaires. The questionnaires are then sent out every 12 months and include information on demographics and medical history as well as questionnaires to collect information on quality of life, fatigue, depression, overall health, physical activity, and dietary habits. Clinical information such as tumor stage, grade and treatment has also been extracted for each patient. Findings to date To date, a total of 125 bladder cancer patients have been consented onto the study with 106 filling in the baseline questionnaire. The cohort is made up of 75% newly diagnosed bladder cancer patients and 66% non-muscle invasive bladder cancer cases. At present, there is 1-year follow-up information for 70 patients, 2-year follow-up for 57 patients, 3-year follow-up for 47 patients and 4-year follow-up for 19 patients. Future plans We plan to continue recruiting further patients into the cohort study. Using the data collected within the study, we hope to carry out independent research studies with a focus on quality of life. We are also committed to utilizing the Roberts Study Cohort to set up and commence an intervention. The future studies and trials carried out using the Roberts Cohort have the potential to identify and develop interventions that could improve the prevention, diagnosis, and treatment of bladder cancer.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Poppy Leech
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Harriet Wylie
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Charlotte Louise Moss
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Anna Haire
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Deborah Enting
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Suzanne Amery
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kathryn Chatterton
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Ramesh Thurairaja
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rajesh Nair
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sachin Malde
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Kate Smith
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Cheryl Gillett
- King’s Health Partners Cancer Biobank, King’s College London, London, United Kingdom
| | - Debra Josephs
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Elias Pintus
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Sarah Rudman
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Hughes
- Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Clare Relton
- Wolfson Institute of Population Health, Queen Mary University of London, London Sheffield, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
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Bazargan S, Bunch B, Ojwang‘ AME, Blauvelt J, Landin A, Ali J, Abrahams D, Cox C, Hall AM, Beatty MS, Poch M, Rejniak KA, Pilon-Thomas S. Targeting myeloid-derived suppressor cells with gemcitabine to enhance efficacy of adoptive cell therapy in bladder cancer. Front Immunol 2023; 14:1275375. [PMID: 37901214 PMCID: PMC10602731 DOI: 10.3389/fimmu.2023.1275375] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Background New therapeutics in development for bladder cancer need to address the recalcitrant nature of the disease. Intravesical adoptive cell therapy (ACT) with tumor infiltrating lymphocytes (TIL) can potentially induce durable responses in bladder cancer while maximizing T cells at the tumor site. T cells infused into the bladder directly encounter immunosuppressive populations, such as myeloid derived suppressor cells (MDSCs), that can attenuate T cell responses. Intravesical instillation of gemcitabine can be used as a lymphodepleting agent to precondition the bladder microenvironment for infused T cell products. Methods Urine samples from bladder cancer patients and healthy donors were analyzed by flow cytometry and cytometric bead array for immune profiling and cytokine quantification. MDSCs were isolated from the urine and cocultured with stimulated T cells to assess effects on proliferation. An orthotopic murine model of bladder cancer was established using the MB49-OVA cell line and immune profiling was performed. MDSCs from tumor-bearing mice were cocultured with OT-I splenocytes to assess T cell proliferation. Mice received intravesical instillation of gemcitabine and depletion of immune cells was measured via flow cytometry. Bladder tumor growth of mice treated with intravesical gemcitabine, OT-I transgenic T cells, or combination was monitored via ultrasound measurement. Results In comparison to healthy donors, urine specimen from bladder cancer patients show high levels of MDSCs and cytokines associated with myeloid chemotaxis, T cell chemotaxis, and inflammation. T cells isolated from healthy donors were less proliferative when cocultured with MDSCs from the urine. Orthotopic murine bladder tumors also presented with high levels of MDSCs along with enrichment of cytokines found in the patient urine samples. MDSCs isolated from spleens of tumor-bearing mice exerted suppressive effects on the proliferation of OT-I T cells. Intravesical instillation of gemcitabine reduced overall immune cells, MDSCs, and T cells in orthotopic bladder tumors. Combination treatment with gemcitabine and OT-I T cells resulted in sustained anti-tumor responses in comparison to monotherapy treatments. Conclusion MDSCs are enriched within the microenvironment of bladder tumors and are suppressive to T cells. Gemcitabine can be used to lymphodeplete bladder tumors and precondition the microenvironment for intravesical ACT.
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Affiliation(s)
- Sarah Bazargan
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | - Brittany Bunch
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | | | - Jamie Blauvelt
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | - Annick Landin
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | - Johannes Ali
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | - Dominique Abrahams
- Comparative Medicine, University of South Florida, Tampa, FL, United States
| | - Cheryl Cox
- Cell Therapy Facility, Moffitt Cancer Center, Tampa, FL, United States
| | - Amy M. Hall
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | - Matthew S. Beatty
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
| | - Michael Poch
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Katarzyna A. Rejniak
- Department of Integrated Mathematical Oncology, Moffitt Cancer Center, Tampa, FL, United States
| | - Shari Pilon-Thomas
- Department of Immunology, Moffitt Cancer Center, Tampa, FL, United States
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, United States
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Kadhum T, Selinski S, Blaszkewicz M, Reinders J, Roth E, Volkert F, Ovsiannikov D, Moormann O, Gerullis H, Barski D, Otto T, Höhne S, Hengstler JG, Golka K. Bladder cancer course, four genetic high-risk variants, and histopathological findings. EXCLI J 2023; 22:867-879. [PMID: 37720238 PMCID: PMC10502201 DOI: 10.17179/excli2023-5862] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/07/2023] [Indexed: 09/19/2023]
Abstract
Urinary bladder cancer, a smoking and occupation related disease, was subject of several genome-wide association studies (GWAS). However, studies on the course of the disease based on GWAS findings differentiating between muscle invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC) are rare. Thus we investigated 4 single nucleotide polymorphisms (SNPs) detected in GWAS, related to the genes coding for TACC3 (transforming, acidic coiled-coil containing protein 3), for FGFR3 (fibroblast growth factor receptor 3), for PSCA (prostate stem cell antigen) and the genes coding for CBX6 (chromobox homolog 6) and APOBEC3A (apolipoprotein B mRNA editing enzyme, catalytic polypeptide-like 3A). This study is based on 712 bladder cancer patients and 875 controls from 3 different case control studies in Germany. The 4 SNPs of interest (PSCA rs2294008 and rs2978974, FGFR3-TACC3 rs798766, and CBX6-APOBEC3A rs1014971) were determined by real-time polymerase chain reaction. The distribution of the 4 SNPs does not vary significantly between cases and controls in the entire study group and in the 3 local subgroups, including two former highly industrialized areas and a region without such history. Also, no significant differences in the bladder cancer subgroups of MIBC and NMIBC were observed. The 4 investigated SNPs do not noticeably contribute differently to the bladder cancer risk for the bladder cancer subgroups of MIBC and NMIBC.
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Affiliation(s)
- Thura Kadhum
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
- Specialist Clinic for Psychosomatic Rehabilitation, Mittelrhein-Klinik, Boppard - Bad Salzig, Germany
| | - Silvia Selinski
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Meinolf Blaszkewicz
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Jörg Reinders
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Emanuel Roth
- Department of Urology, Evangelic Hospital, Paul-Gerhardt Foundation, Lutherstadt Wittenberg, Germany
| | - Frank Volkert
- Department of Urology, Evangelic Hospital, Paul-Gerhardt Foundation, Lutherstadt Wittenberg, Germany
| | | | | | | | - Dimitri Barski
- Rheinland Klinikum Lukaskrankenhaus Neuss, Neuss, Germany
| | - Thomas Otto
- Rheinland Klinikum Lukaskrankenhaus Neuss, Neuss, Germany
| | - Svetlana Höhne
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Jan G. Hengstler
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
| | - Klaus Golka
- Leibniz Research Centre for Working Environment and Human Factors at TU Dortmund (IfADo), Dortmund, Germany
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Nishikawa R, Miyake M, Morizane S, Shimizu R, Teraoka S, Honda M, Iida K, Nishimura N, Sazuka T, Kimura T, Ito A, Shiga K, Taoka R, Kojima T, Kobayashi T, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Takenaka A. C-reactive protein as a prognostic predictor for non-muscle invasive bladder cancer after intravesical bacillus Calmette-Guérin therapy: A Japan Urological Oncology Group study analysis. Int J Urol 2023; 30:299-307. [PMID: 36448522 DOI: 10.1111/iju.15106] [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: 02/04/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To investigate the involvement of pretreatment C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in the prognosis of patients who underwent intravesical bacillus Calmette-Guérin (BCG) therapy for non-muscle invasive bladder cancer (NMIBC). METHODS The clinicopathological data of 1709 patients with NMIBC who underwent initial intravesical BCG therapy after transurethral resection of bladder tumor were retrospectively analyzed to evaluate the outcome of intravesical BCG therapy in a multicenter study conducted by the Japan Urological Oncology Group. The prognoses of these patients were analyzed to determine whether the biomarkers (CRP and NLR) could predict the efficacy of intravesical BCG therapy. Patients were divided into two groups according to the pretreatment CRP and NLR, with cutoff values defined as CRP ≥ 0.5 mg/dl and NLR ≥ 2.5, based on several previous reports. RESULTS In the univariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence, cancer-specific survival, and bladder cancer (BC) progression, while NLR ≥ 2.5 was not significantly associated with patient prognosis. In the multivariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence and BC progression. The concordance index was used to examine the accuracy in predicting recurrence and progression events. While CRP was slightly, though not statistically significant, inferior to the European Association of Urology risk classification, the combination of them showed improved predictive accuracy. CONCLUSION This study suggests that CRP can be a prognostic factor after intravesical BCG therapy and may provide useful data for determining treatment and follow-up strategies for patients with NMIBC.
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Affiliation(s)
- Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Kota Iida
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Tomokazu Sazuka
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Chiba City, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Minato-ku, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduates School of Medicine, Miyagi, Sendai, Japan
| | - Kenichiro Shiga
- Department of Urology, Harasanshin Hospital, Fukuoka City, Fukuoka, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center, Nagoya City, Aichi, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
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Zhang Y, Wang W, Zhou H, Cui Y. Urinary Eubacterium sp. CAG:581 Promotes Non-Muscle Invasive Bladder Cancer (NMIBC) Development through the ECM1/MMP9 Pathway. Cancers (Basel) 2023; 15. [PMID: 36765767 DOI: 10.3390/cancers15030809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Increasing evidence points to the urinary microbiota as a possible key susceptibility factor for early-stage bladder cancer (BCa) progression. However, the interpretation of its underlying mechanism is often insufficient, given that various environmental conditions have affected the composition of urinary microbiota. Herein, we sought to rule out confounding factors and clarify how urinary Eubacterium sp. CAG:581 promoted non-muscle invasive bladder cancer (NMIBC) development. METHODS Differentially abundant urinary microbiota of 51 NMIBC patients and 47 healthy controls (as Cohort 1) were first determined by metagenomics analysis. Then, we modeled the coculture of NMIBC organoids with candidate urinary Eubacterium sp. CAG:581 in anaerobic conditions and explored differentially expressed genes of these NMIBC tissues by RNA-Seq. Furthermore, we dissected the mechanisms involved into Eubacterium sp. CAG:581 by inducing extracellular matrix protein 1 (ECM1) and matrix metalloproteinase 9 (MMP9) upregulation. Finally, we used multivariate Cox modeling to investigate the clinical relevance of urinary Eubacterium sp. CAG:581 16S ribosomal RNA (16SrRNA) levels to the prognosis of 406 NMIBC patients (as Cohort 2). RESULTS Eubacterium sp. CAG:581 infection accelerated the proliferation of NMIBC organoids (p < 0.01); ECM1 and MMP9 were the most upregulated genes induced by the increased colony forming units (CFU) gradient of Eubacterium sp. CAG:581 infection via phosphorylating ERK1/2 in NMIBC organoids of Cohort 1. Excluding the favorable impact of potential contributing factors, the ROC curve of Cohort 2 manifested its 3-year AUC value as 0.79 and the cut-off point of Eubacterium sp. CAG:581 16SrRNA as 10.3 (delta CT value). CONCLUSION Our evidence suggests that urinary Eubacterium sp. CAG:581 promoted NMIBC progression through the ECM1/MMP9 pathway, which may serve as the promising noninvasive diagnostic biomarker for NMIBC.
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Sun X, Dai T, Xu L. Transurethral resection of bladder tumor-based bladder preservation therapy for refractory high risk non-muscle invasive bladder cancer: Current landscape and future directions. Front Surg 2023; 10:1143219. [PMID: 37123545 PMCID: PMC10130525 DOI: 10.3389/fsurg.2023.1143219] [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: 01/12/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
Bladder cancer is the most common malignant tumor of urinary system worldwide. Approximately 75% of patients with bladder cancer present with non-muscle-invasive bladder cancer (NMIBC), which is effectively managed with transurethral resection of bladder tumor (TURBT). For refractory high risk NMIBC, patients are typically treated by radical cystectomy (RC). TURBT deserves further evaluation. Growing evidence suggests that repeated TURBT-based bladder-sparing approaches may improve oncological outcomes and quality of life in highly selected patients. Novel imaging techniques and biomarkers may aid in patients selection and postoperative surveillance. With growing interest in adding immunotherapy to refractory bladder cancer, TURBT based approaches enable the bladder preservation therapy for high risk NMIBC. Here we summarize the current landscape, biomarkers for surveillance, and future directions for applying TURBT-based bladder preservation therapy.
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Affiliation(s)
- Xinghui Sun
- Department of Urology, Mengchao Hepatobiliary Hospital, Fuzhou, China
- Correspondence: Xinghui Sun
| | - Tianzeng Dai
- Department of Urology, Mengchao Hepatobiliary Hospital, Fuzhou, China
| | - Lihui Xu
- Department of Urology, Mengchao Hepatobiliary Hospital, Fuzhou, China
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Kumarasegaram V, Drejer D, Jensen JB. Detection rate of CIS during TURBT following shift from PDD to NBI in a single University Hospital. Urology 2021; 161:83-86. [PMID: 34890685 DOI: 10.1016/j.urology.2021.11.025] [Citation(s) in RCA: 2] [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: 08/25/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To examine whether or not the detection rate of CIS was significantly higher after switching from PDD guided TURBT to NBI guided TURBT. MATERIALS AND METHODS Pathological outcome regarding CIS detection was reviewed in all TURBT procedures in a 2 year period. A total number of 1,132 TURBT procedures were reviewed. In period 1, starting from January 2018 to December 2018, 487 TURBTs were performed and in period 2, from January 2019 to December 2019, 645 TURBTs were performed. PDD was used as assistance to detect CIS in period 1 and NBI was introduced as assistance instead of PDD in all TURBT in period 2. RESULTS A significantly higher detection rate of CIS was found in period 2 compared to period 1 (8.7% versus 4.9%, p=0.02). In primary tumours, CIS was detected in 8.4% in period 2 versus 5.4% in period 1 (not significant) whereas in TURBs for recurrent tumour, CIS was detected in 8.6% in period 2 versus 4.6% in period 1 (p=0.04). There was no difference in CIS detection in patients investigated following BCG treatment for CIS (18,1% vs 21,4%). CONCLUSION The overall detecting of CIS is significantly higher in period 2 but not not in the recurrent tumour group, neither in the control after BCG group. These data suggest that PDD is not superior to NBI. The reduced cost and the convenient logistics of NBI can most likely improve the overall CIS detection rate.
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Affiliation(s)
| | - Ditte Drejer
- Department of Urology, Hospital of Western Jutland, Holstebro, Denmark.
| | - Jørgen Bjerggaard Jensen
- Department of Clinical Medicine-Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
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Nayak A, Cresswell J, Mariappan P. Quality of life in patients undergoing surveillance for non-muscle invasive bladder cancer-a systematic review. Transl Androl Urol 2021; 10:2737-2749. [PMID: 34295759 PMCID: PMC8261437 DOI: 10.21037/tau-20-1333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/11/2020] [Accepted: 02/04/2021] [Indexed: 11/06/2022] Open
Abstract
Background The main objective of this study was to evaluate the various instruments available to evaluate the quality of life (QoL) in patients diagnosed with non-muscle invasive bladder cancer (NMIBC) undergoing surveillance. Methods A PubMed literature review was carried out with query terms (“Urinary Bladder Neoplasms” [Mesh] OR “Bladder malignancy”) AND (“quality of life”) including all studies up to June 2020. This resulted in 576 peer-reviewed articles. A further 12 articles from additional sources were included. A total of 473 articles were eliminated due to lack of relevance to the topic of concern. A further 93 articles evaluating NMIBC and articles evaluating Radiotherapy were excluded and a total of 22 studies were studied. Results In total, 22 studies were identified. The vast majority of studies were prospective descriptive studies (n=9), while there were 7 cross-sectional surveys and 6 randomised controlled trials. Most studies evaluated the impact of intravesical treatment on QoL. NMIBC survivors had significantly lower QoL compared to the general population, Surveillance strategies involving repeated intravesical therapies and cystoscopies have a negative impact on QoL with impaired physical function and mental health. Conclusions This article emphasizes the importance of assessing the QoL in patients with NMIBC undergoing long term surveillance, as they represent the majority of bladder cancer patients. Development and validation of specific instruments to measure QoL in patients with NMIBC are desperately needed to assess, better understand, and manage the burden of disease and healthcare in this group of patients.
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Affiliation(s)
- Arvind Nayak
- RCS Robotic Fellow Urology, Lister Hospital, Stevenage, Coreys Mill Lane, Stevenage, UK
| | - Joanne Cresswell
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Paramananthan Mariappan
- Department of Urology, University of Edinburgh, Edinburgh, UK.,Department of Urology, Western General Hospital, Crewe Road South, Edinburgh, UK
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Abstract
The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.
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Affiliation(s)
- Lawrence H C Kim
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Manish I Patel
- Department of Urology, Westmead Hospital, Sydney, Australia.,Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia
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Abstract
Non-muscle invasive bladder cancer (NMIBC) is characterized by its high rate of disease recurrence and relevant disease progression rates. Up to today clinical models are insufficiently predicting outcomes for reliable patient counseling and treatment decision-making. This particularly is a serious problem in patients with high-risk NMIBC who are at high risk for failure of local treatment and thus candidates for early radical cystectomy or even systemic (neoadjuvant) chemotherapy. Next to its clinical variability, bladder cancer is genetically a highly heterogeneous disease. There is an essential need of biomarkers for improving clinical staging, real-time monitoring of disease with or without active treatment, as well as improved outcome prognostication. Liquid biopsies of circulating biomarkers in the blood and urine are promising non-invasive diagnostics that hold the potential facilitating these needs. In this review we report the latest data and evidence on cell-free circulating tumor desoxyribonucleic acid (ctDNA) and circulating tumor cells (CTC) in NMIBC. We summarize their current status in clinical diagnostics, discuss limitations and address future needs.
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Affiliation(s)
- Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heidi Schwarzenbach
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Riethdorf
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Differences in the epidemiology, diagnosis and outcomes according to gender in patients diagnosed with non-muscle invasive bladder cancer (NMIBC) has been widely reported. In this article we present gender-specific differences in NMIBC in terms of epidemiology, risk factors, first clinical presentation, management and clinical outcomes based on systematically review evidence of existing literature. A literature search of English-language publications that included an analysis of the association of gender differences in patients with NMIBC was performed using PubMed. Sixty-four studies were selected for analysis with consensus of all authors. The incidence and mortality for urothelial bladder cancer (UBC) are higher in men, whereas cancer specific mortality to incidence ratio is significantly lower for men than for women. This phenomenon could be partially explained by differences in exposure to bladder cancer carcinogens. However female gender is associated with higher stage at presentation. Thirteen studies with a total of 11,069 patients diagnosed with NMIBC were included for analysis according to outcomes. In studies that found statistically significant differences in outcomes between sexes, female gender was reported as risk factor for disease recurrence, progression or cancer specific mortality. None of included studies found worse outcomes in men when compared to women with NMIBC. Results of our review suggest that female gender in patients diagnosed with NMIBC is associated—though inconsistently—with higher stage at presentation and poorer outcomes. Numerous factors may influence gender gap in incidence rate, clinical management and reported outcomes. Consensus on comparable data collection in routine practice and prospective trials including clinical outcomes are required to identify gender-specific differences in patients diagnosed with NMIBC.
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Affiliation(s)
- Konrad Bilski
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, Warsaw, Poland
| | - Łukasz Zapała
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, Warsaw, Poland
| | - Michał A Skrzypczyk
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, Warsaw, Poland
| | - Maciej Oszczudłowski
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Professor W. Orlowski, Warsaw, Poland
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12
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Zamboni S, Baumeister P, Mattei A, Mordasini L, Antonelli A, Simeone C, Moschini M. Single postoperative instillation for non-muscle invasive bladder cancer: are there still any indication? Transl Androl Urol 2019; 8:76-84. [PMID: 30976571 PMCID: PMC6414349 DOI: 10.21037/tau.2018.08.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/22/2022] Open
Abstract
Intravesical chemotherapeutical agents after transurethral resection have shown to be effective in reducing the risk of recurrence and progression during the follow up. Specifically, an early single chemotherapeutical instillation (SI) might play an important role but the efficacy of this treatment has been questioned. For these reasons, we sought to review and summarize the current evidence with a non-systematic Medline/PubMed literature search. Level 1a evidence strongly supports the utility of SI in reducing recurrence in low-intermediate risk non-muscle invasive bladder cancer (NMIBC) patients, with about 35% of relative reduction rates in patients with single, <3 cm and low-intermediate stage and grade tumors. The efficacy of this procedure is particularly evident when epirubicin or mitomycin C is administered. However, no randomized controlled trials compared the effect of the different types of drugs for SI. Only few trials have analyzed the effect of timing in SI, therefore, the optimal delivery timeframe is not yet completely clear with some series suggesting that a delivery within the first 2 hours after surgery might have an impact on recurrence rates and others that show no differences with those treated within 24 hours. None of the patients included in the randomized controlled trials analyzed in this review suffered from systemic toxicity. On the other hand, other side effects were recorded, including: chemical cystitis and skin reaction. Although it is a safe procedure, rare severe complications have been reported in the literature, mostly due to extravasation of drugs in patients who underwent extended resection or bladder perforation. To avoid potential deadly complications, SI should not be administered in these patients.
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Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland.,Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Philipp Baumeister
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
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13
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Abstract
Non-muscle invasive bladder cancer (NMIBC) is a challenging disease, with a high risk of recurrence and even progression to muscle invasive disease. The present standard treatment is suboptimal, and consists of a complete transurethral resection of the visible bladder tumour(s), followed by prophylactic intravesical instillations mitomycin-C (MMC) or bacillus Calmette-Guérin (BCG). In search for higher efficacy, several adjuvant device-assisted intravesical therapies are developed. Chemohyperthermia may be based on microwave-/radiofrequency-induced (RF) hyperthermia systems, for which most evidence exists, or on hyperthermic intravesical chemotherapy, which is applied by conductive or loco-regional heating systems. RF-induced CHT has shown superiority over MMC alone, and in one prospective study superiority over BCG in per-protocol analysis, which has led to the ‘weak’ recommendation in the EAU guidelines to consider RF-based CHT as a bladder preservation strategy in patients with BCG-refractory tumours, who are not candidates for radical cystectomy due to comorbidities. Prospective studies on hyperthermic intravesical chemotherapy for patients with intermediate-risk NMIBC are awaited next year. The combination of electromotive drug administration (EMDA) with MMC has shown superiority over MMC as well, and seems promising when combined with BCG in sequential treatment. Photodynamic therapy should still be considered experimental, in which a study with the intravenous photosensitizer Radachlorin® has shown promising results.
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Affiliation(s)
- Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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14
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Abstract
Bladder cancer (BC) is a common disease in both sexes and majority of cases present as non-muscle invasive BC (NMIBC). The percentage of NMIBC progressing to muscle invasive BC (MIBC) varies between 25% and 75% and currently there are no reliable molecular markers that may predict the outcome of high-risk (HR) NMIBC. Transurethral resection of the bladder tumour (TURBT) with intravesical bacillus Calmette-Guérin (BCG) or immediate radical cystectomy (RC) are the current gold standard treatment options. The European Association of Urology (EAU) guidelines recommend immediate or delayed RC for HR- and a subgroup of “highest-risk” NMIBC. These cases include pT1, carcinoma in-situ (CIS), multifocal disease, histological variants such as micropapillary and sarcomatoid, and patients who have contraindications to, or have failed with BCG. The comparative risks between maintenance BCG (mBCG) and immediate RC are unclear. However, RC may give patients the best oncological outcome.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Aidan P Noon
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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15
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Marcq G, Hénon F, Ouzaid I, Fantoni JC, Hermieu JF, Xylinas E. Active surveillance for non-muscle invasive bladder cancer. Transl Androl Urol 2019; 8:54-60. [PMID: 30976569 PMCID: PMC6414342 DOI: 10.21037/tau.2018.10.20] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 10/22/2018] [Indexed: 12/24/2022] Open
Abstract
Most of low grade (LG) bladder tumors will experience disease recurrence and very few of them (<2%) will experience disease progression. Therefore active surveillance (AS) for LG non-muscle invasive bladder cancer (NMIBC) has emerged. The goal of our study was to provide a literature review of AS for LG NMIBC including inclusion criteria, modalities and oncological outcomes. We conducted a systematic review (registered in PROSPERO: CRD42018102935) using MEDLINE and EMBASE between June 2018 and August 2018 with the following terms: LG, NMIBC, AS, urothelial neoplasm. Overall, 6 studies that reached our scope of review were included cumulating 403 patients with 2 prospective trials. Inclusion criteria were: recurrent LG (G1 and G2) Ta or T1 NMIBC, with a negative cytology, a low volume (<10 mm) and low number (<5) of tumors. Cystoscopy every 3 months during the first 2 years and every 6 months afterwards were required. AS dropout criteria were presence of tumor-related symptoms, a positive cytology, a modification of tumor morphology or size and patient's request. Pooled data showed an overall 65% reclassification rate where 15% of patients were reclassified based on grade and 10% on stage with a median follow-up of 32 months (IQR, 24-42 months). Only one study reported on progression to MIBC in 4 patients out of 186 (2%). Most of patients enrolled in an AS protocol for recurrent LG NMIBC will undergo a TURBT eventually. Many patients may be eligible to this therapeutic approach but current knowledge does not support its use in daily practice outside of a clinical trial.
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Affiliation(s)
| | | | - Idir Ouzaid
- Department of Urology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | | | - Jean-François Hermieu
- Department of Urology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris Descartes University, Paris, France
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16
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Abstract
Bladder cancer (BC) is a common disease in both sexes and majority of cases present as non-muscle invasive BC (NMIBC). The percentage of NMIBC progressing to muscle invasive BC (MIBC) varies between 25% and 75% and currently there are no reliable biomarkers that may predict the outcome of high-risk (HR) NMIBC. Whilst The Cancer Genome Atlas (TCGA) project has identified genetic alteration in MIBC using next-generation sequencing (NGS), genetic data in HR-NMIBC outcome prediction using this new technology are limited. We reviewed data on NGS performed on DNA and RNA extracted from tissue, plasma and urinary samples obtained from patients with NMIBC. Analysis on different specimens revealed genetic alterations and microRNA alterations in common oncogenic pathways such as gene expression (TERT) and cell proliferation (PTEN, cyclin D). Validation of a 12-gene (CDC25B, KPNA2, BIRC5, COL18A1, MSN, UBE2C, COL4A1, FABP4, MBNL2, SKAP2, COL4A3BP, NEK1) progression score has shown significant association with progression. ARID1A mutations are associated with an increased risk of recurrence after Bacillus Calmette-Guerin (BCG) together with a high DNA damage repair (DDR) gene alterations in HR-NMIBC. Patients with progressive disease seem to have significantly higher levels of both plasma and urinary tumour DNA compared with patients with recurrence. Although experimental data appear promising, well-designed systematic studies are urgently needed to translate applicability to clinical practice.
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Affiliation(s)
- Karl H Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK.,Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Aidan P Noon
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
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17
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Yan J, Shen P, Zheng J, Liu M. Clinical correlation between serum YKL-40 protein level and recurrence of non-muscle invasive bladder cancer. Ann Transl Med 2016; 3:354. [PMID: 26807409 DOI: 10.3978/j.issn.2305-5839.2015.11.22] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To explore the clinical correlation between serum YKL-40 protein level and recurrence of non-muscle invasive bladder cancer (NMIBC). METHODS Totally 76 NMIBC patients (including 34 patients with confirmed recurrence and 42 patients without recurrence during the 2-year post-operative follow-up) and 31 healthy volunteers were recruited in this study. Blood samples were collected early in the morning, and serum YKL-40 protein levels of all these patients were analysed by using enzyme-linked immunosorbent assay (ELISA). RESULTS Serum YKL-40 protein levels were significantly higher in NMIBC patients than in healthy controls (P<0.001). Meanwhile, serum YKL-40 protein levels were found to be significantly higher in patients with recurrent NMIBC than those without tumor recurrence (P=0.001). CONCLUSIONS Serum YKL-40 protein can be a reliable molecular marker for the clinical diagnosis of NMIBC recurrence. In particular, it can inform the post-operative management.
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Affiliation(s)
- Jiasheng Yan
- Department of Urology, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
| | - Peijun Shen
- Department of Urology, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
| | - Junhua Zheng
- Department of Urology, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
| | - Min Liu
- Department of Urology, Shanghai 10th People's Hospital, Tongji University, Shanghai 200072, China
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