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Steinberg GD, Shore ND, Redorta JP, Galsky MD, Bedke J, Ku JH, Kretkowski M, Hu H, Penkov K, Vermette JJ, Tarazi JC, Randall AE, Pierce KJ, Saltzstein D, Powles TB. CREST: phase III study of sasanlimab and Bacillus Calmette-Guérin for patients with Bacillus Calmette-Guérin-naïve high-risk non-muscle-invasive bladder cancer. Future Oncol 2024; 20:891-901. [PMID: 38189180 DOI: 10.2217/fon-2023-0271] [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] [Indexed: 01/09/2024] Open
Abstract
Bacillus Calmette-Guérin (BCG) is the standard of care for patients with high-risk non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of bladder tumor (TURBT). BCG in combination with programmed cell death-1 (PD-1) inhibitors may yield greater anti-tumor activity compared with either agent alone. CREST is a phase III study evaluating the efficacy and safety of the subcutaneous PD-1 inhibitor sasanlimab in combination with BCG for patients with BCG-naive high-risk NMIBC. Eligible participants are randomized to receive sasanlimab plus BCG (induction ± maintenance) or BCG alone for up to 25 cycles within 12 weeks of TURBT. The primary outcome is event-free survival. Secondary outcomes include additional efficacy end points and safety. The target sample size is around 1000 participants.
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Affiliation(s)
- Gary D Steinberg
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | - Neal D Shore
- Carolina Urologic Research Center, Grand Strand Urology, 823 82nd Parkway, Myrtle Beach, SC 29572, USA
| | - Joan Palou Redorta
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, C. de Cartagena 340-350, 08025 Barcelona, Spain
| | - Matthew D Galsky
- The Tisch Cancer Institute, Mount Sinai, 1190 One Gustave L. Levy Place, New York, NY 10029, USA
| | - Jens Bedke
- Department of Urology, Eberhard Karls University Tübingen, Geschwister-Scholl-Platz, 72074 Tübingen, Germany
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Michal Kretkowski
- Clinical Research Center, Spolka z Ograniczona, Feliksa Nowowiejskiego 5, 61-731 Poznań, Poland
| | - Hailong Hu
- Institute of Urology, Second Hospital of Tianjin Medical University, 23 Pingjiang Road, Hexi District, Tianjin 300211, China
| | - Konstantin Penkov
- Private Medical Institution Euromedservice, Suvorovskiy Prospekt, 60, St Petersburg, Russia
| | | | - Jamal C Tarazi
- Pfizer Oncology, Pfizer, 10646 Science Center Drive, San Diego, CA 92121, USA
| | - Alison E Randall
- Pfizer Oncology, Pfizer, 235 East 42nd Street, New York, NY 10017, USA
| | - Kristen J Pierce
- Pfizer Oncology, Pfizer, 280 Shennecossett Road, Groton, CT 06340, USA
| | - Daniel Saltzstein
- Division of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA
| | - Thomas B Powles
- Barts Experimental Cancer Medicine Centre, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 5PZ, UK
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Kastner L, Rieger C, Pfister D, Schmautz M, Storz E, Heidenreich A. HIVEC as an alternative option in non-muscle-invasive bladder cancer: Experiences from a high-volume center. Urol Oncol 2024:S1078-1439(24)00340-5. [PMID: 38653592 DOI: 10.1016/j.urolonc.2024.01.300] [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: 11/27/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND High risk non-muscle invasive bladder cancer (NMIBC) is usually treated with intravesical BCG-therapy. In case of BCG failure radical cystectomy (RC) is the treatment of choice. Nevertheless, many patients are unfit for or unwilling to undergo RC. Hyperthermic intravesical chemotherapy (HIVEC) is a promising bladder sparing therapy in such cases. It was the purpose of the study to evaluate the efficacy of HIVEC in patients with BCG failure as well as in BCG naïve patients in case of BCG shortage or given contra-indications for BCG. METHODS We analyzed the first 60 patients who received hyperthermic intravesical chemotherapy (HIVEC) at our department. The therapy regimen consisted of an induction course of 6 weekly sessions, followed by a maintenance course with 6 monthly sessions. Fluorescence cystoscopy with urine cytology and bladder mapping was performed after completion of induction and maintenance therapy at 3 and 12 months. About 68.6 % had received a recurrence after or during BCG treatment, 55% of the subjects were BCG-unresponsive NMIBC according to EAU guidelines. RESULTS The median follow up was 12 months with 12 cycles of HIVEC therapy being administered on average, representing completion of induction and maintenance therapy with 6 cycles each. The 1- and 2-year recurrence-free-survival (RFS) was 67% and 40% respectively. Only one out of 60 patients developed progression to muscle invasion with progression-free-survival (PFS) of 98% at 2 years. No statistical differences were found in RFS for patients failure to BCG compared to patients that were BCG-naïve (BCG unresponsive vs. BCG-naïve) and patients that carried carcinoma in situ (CIS) compared to patients without CIS (CIS vs. no CIS). CONCLUSION Chemohyperthermia using HIVEC results in high recurrence-free survival and a 2-year progression-free survival rate of 98% with a bladder preservation rate of almost 80%. Comparing our data, HIVEC shows better oncological results together with better tolerability and safety making HIVEC a good alternative for patients who refuse radical cystectomy or who are ineligible for radical cystectomy.
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Affiliation(s)
- Lucas Kastner
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Constantin Rieger
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany.
| | - David Pfister
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Max Schmautz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Enno Storz
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Urologic Oncology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany
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Parrao D, Lizana N, Saavedra C, Larrañaga M, Lindsay CB, San Francisco IF, Bravo JC. Active Surveillance in Non-Muscle Invasive Bladder Cancer, the Potential Role of Biomarkers: A Systematic Review. Curr Oncol 2024; 31:2201-2220. [PMID: 38668066 PMCID: PMC11048875 DOI: 10.3390/curroncol31040163] [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: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.
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Affiliation(s)
- Diego Parrao
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Nemecio Lizana
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Catalina Saavedra
- School of Medicine, University of O’Higgins, Rancagua 282000, Chile; (D.P.); (N.L.); (C.S.)
| | - Matías Larrañaga
- Department of Urology, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
| | - Carolina B. Lindsay
- Research Department, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
| | - Ignacio F. San Francisco
- Division of Urologic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA;
| | - Juan Cristóbal Bravo
- Department of Urology, Libertador Bernardo O’Higgins Regional Hospital, Rancagua 282000, Chile;
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Sanguedolce F, Falagario UG, Zanelli M, Palicelli A, Zizzo M, Busetto GM, Cormio A, Carrieri G, Cormio L. Integrating the PD-L1 Prognostic Biomarker in Non-Muscle Invasive Bladder Cancer in Clinical Practice-A Comprehensive Review on State-of-the-Art Advances and Critical Issues. J Clin Med 2024; 13:2182. [PMID: 38673455 PMCID: PMC11050441 DOI: 10.3390/jcm13082182] [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: 02/22/2024] [Revised: 03/17/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
Bladder cancer (BC) is one of the most prevalent cancers worldwide. Non-muscle invasive bladder cancer (NMIBC), comprising the majority of initial BC presentations, requires accurate risk stratification for optimal management. This review explores the evolving role of programmed cell death ligand 1 (PD-L1) as a prognostic biomarker in NMIBC, with a particular focus on its implications in the context of Bacillus Calmette-Guérin (BCG) immunotherapy. The literature suggests a potential association between elevated PD-L1 status and adverse outcomes, resistance to BCG treatment, and disease progression. However, conflicting findings and methodological issues highlight the heterogeneity of PD-L1 assessment in NMIBC, probably due to the complex biological mechanisms that regulate the interaction between PD-L1 and the tumor microenvironment. The identification of PD-L1 as a prognostic biomarker provides ground for tailored therapeutic interventions, including immune checkpoint inhibitors (ICIs). Nevertheless, challenges such as intratumoral heterogeneity and technical issues underscore the need for standardized protocols and larger, homogeneous trials. This review contributes to the ongoing debate on the personalized management of NMIBC patients, focusing on the advances and perspectives of incorporating PD-L1 as a biomarker in this setting.
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Affiliation(s)
| | - Ugo Giovanni Falagario
- Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, 71122 Foggia, Italy; (U.G.F.); (G.M.B.); (G.C.); (L.C.)
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (M.Z.); (A.P.)
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy;
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, 71122 Foggia, Italy; (U.G.F.); (G.M.B.); (G.C.); (L.C.)
| | - Angelo Cormio
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti Di Ancona, Università Politecnica Delle Marche, Via Conca 71, 60126 Ancona, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, 71122 Foggia, Italy; (U.G.F.); (G.M.B.); (G.C.); (L.C.)
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, Policlinico Foggia, University of Foggia, 71122 Foggia, Italy; (U.G.F.); (G.M.B.); (G.C.); (L.C.)
- Department of Urology, Bonomo Teaching Hospital, 76123 Andria, Italy
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Jaromin M, Konecki T, Kutwin P. Revolutionizing Treatment: Breakthrough Approaches for BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2024; 16:1366. [PMID: 38611044 PMCID: PMC11010925 DOI: 10.3390/cancers16071366] [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: 03/01/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Bladder cancer is the 10th most popular cancer in the world, and non-muscle-invasive bladder cancer (NMIBC) is diagnosed in ~80% of all cases. Treatments for NMIBC include transurethral resection of the bladder tumor (TURBT) and intravesical instillations of Bacillus Calmette-Guérin (BCG). Treatment of BCG-unresponsive tumors is scarce and usually leads to Radical Cystectomy. In this paper, we review recent advancements in conservative treatment of BCG-unresponsive tumors. The main focus of the paper is FDA-approved medications: Pembrolizumab and Nadofaragene Firadenovec (Adstiladrin). Other, less researched therapeutic possibilities are also included, namely: N-803 immunotherapy, TAR-200 and TAR-210 intravesical delivery systems and combined Cabazitaxel, Gemcitabine and Cisplatin chemotherapy. Conservative treatment and delaying radical cystectomy would greatly benefit patients' quality of life; it is undoubtedly the future of BCG-unresponsive NMIBC.
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Affiliation(s)
| | | | - Piotr Kutwin
- 1st Department of Urology, Medical University of Lodz, 93-513 Lodz, Poland; (M.J.); (T.K.)
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Rahman KMM, Kumbham S, Bist G, Woo S, Foster BA, You Y. Comparison of red and green light for treating non-muscle invasive bladder cancer in rats using singlet oxygen-cleavable prodrugs with PPIX-PDT. Photochem Photobiol 2024. [PMID: 38533776 DOI: 10.1111/php.13933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/28/2024]
Abstract
It has been 30 years since Photofrin-PDT was approved for the treatment of bladder cancer in Canada. However, Photofrin-PDT failed to gain popularity due to bladder complications. The PDT with red light and IV-administered Photofrin could permanently damage the bladder muscle. We have been developing a new combination strategy of PpIX-PDT with singlet oxygen-cleavable prodrugs for NMIBC with minimal side effects, avoiding damage to the bladder muscle layer. PpIX can be excited by either green (532 nm) or red (635 nm) light. Red light could be more efficacious in vivo due to its deeper tissue penetration than green light. Since HAL preferentially produces PpIX in tumors, we hypothesized that illuminating PpIX with red light might spare the muscle layer. PpIX-PDT was used to compare green and red laser efficacy in vitro and in vivo. The IC50 of in vitro PpIX-PDT was 18 mW/cm2 with the red laser and 22 mW/cm2 with the green laser. The in vivo efficacy of the red laser with 50, 75, and 100 mW total dose was similar to the same dose of green laser in reducing tumor volume. Combining PpIX-PDT with prodrugs methyl-linked mitomycin C (Mt-L-MMC) and rhodamine-linked SN-38 (Rh-L-SN-38) significantly improved efficacy (tumor volume comparison). PpIX-PDT or PpIX-PDT + prodrug combination did not cause muscle damage in histological analysis. Overall, a combination of PpIX-PDT and prodrug with 635 nm laser is promising for non-muscle invasive bladder cancer treatment.
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Affiliation(s)
- Kazi Md Mahabubur Rahman
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Soniya Kumbham
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Ganesh Bist
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Sukyung Woo
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Barbara A Foster
- Department of Pharmacology & Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Youngjae You
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Rahman KMM, Bist G, Kumbham S, Foster BA, Woo S, You Y. Mitochondrial targeting improves the selectivity of singlet-oxygen cleavable prodrugs in NMIBC treatment. Photochem Photobiol 2024. [PMID: 38433310 DOI: 10.1111/php.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/24/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Mitochondria play an essential role in cancer treatment by providing apoptotic signals. Hexyl aminolevulinate, an FDA-approved diagnosis for non-muscle invasive bladder cancer, induces the production of protoporphyrin IX (PpIX) preferentially by mitochondria in cancer cells. Photosensitizer PpIX upon illumination can release active chemotherapy drugs from singlet oxygen-activatable prodrugs. Prodrugs placed close enough to PpIX formed in mitochondria can improve the antitumor efficiency of PpIX-PDT. The preferred uptake of prodrugs by cancer cells and tumors can further enhance the selective damage of cancer cells over non-cancer cells and surrounding normal tissues. Mitochondriotropic prodrugs of anticancer drugs, such as paclitaxel and SN-38, were synthesized using rhodamine, a mitochondrial-targeting moiety. In vitro, the mitochondrial targeting helped achieve preferential cellular uptake in cancer cells. In RT112 cells (human bladder cancer cells), intracellular prodrug concentrations were 2-3 times higher than the intracellular prodrug concentrations in BdEC cells (human bladder epithelial cells), after 2 h incubation. In an orthotopic rat bladder tumor model, mitochondria-targeted prodrugs achieved as much as 34 times higher prodrug diffusion in the tumor area compared to the nontumor bladder area. Overall, mitochondria targeting made prodrugs more effective in targeting cancer cells and tumors over non-tumor areas, thereby reducing nonspecific toxicity.
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Affiliation(s)
- Kazi Md Mahabubur Rahman
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Ganesh Bist
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Soniya Kumbham
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Barbara A Foster
- Department of Pharmacology & Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Sukyung Woo
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Youngjae You
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
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Li D, Wu R, Wang J, Ye J, Yu Q, Feng D, Han P. A Prognostic Index Derived From LASSO-Selected Preoperative Inflammation and Nutritional Markers for Non-Muscle-Invasive Bladder Cancer. Clin Genitourin Cancer 2024:102061. [PMID: 38519296 DOI: 10.1016/j.clgc.2024.02.012] [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: 12/10/2023] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND There is an urgent need to identify a robust predictor for BCG response in patients with non-muscle-invasive bladder cancer (NMIBC). We aimed to employ the Lasso regression model for the selection and construction of an index (BCGI) utilizing inflammation and nutrition indicators to predict the response to BCG therapy. METHODS After acquiring the ethics approval, we searched the electric medical records in our institution and performed data screening. Then, we developed the BCGI using a Lasso regression model and subsequently evaluated its performance in both the train and internal test datasets through Kaplan-Meier survival curves and Cox regression analysis. Then, we also evaluated the prognostic value of BCGI alongside the EAU2021 model. RESULTS The training dataset and internal test dataset contained 295 and 196 patients, respectively. Referring to the Lasso results, BCGI consisted of hemoglobin, albumin, and platelet count, which could significantly predict the recurrence of NMIBC patients who accepted BCG in train (P = .012) and test (P = .004) datasets. The BCGI also exhibited statistically prognostic value in no smoking history, World Health Organization high grade, and T1 subgroups, both in train and test datasets. In multivariable analysis, BCGI exhibited independent prognostic value in train (P = .012) and test (P = .012) datasets. Finally, we constructed a nomogram that consisted of smoking history, T stage, World Health Organization grade, tumor size, and BCGI. Then, BCGI demonstrated significant independent prognostic value in NMIBC patients treated with BCG, a result not observed with the EAU2021 score or classification. CONCLUSION Based on the results, we reasonably suggest that BCGI may be a useful predictor for NMIBC patients who accepted BCG. Furthermore, we have demonstrated the efficacy of constructing a prognostic index using clinical factors and a Lasso regression model, a versatile approach applicable to various medical conditions.
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Affiliation(s)
- Dengxiong Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ruicheng Wu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Junjiang Ye
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qingxin Yu
- Ningbo Diagnostic Pathology Center, Ningbo City, Zhejiang Province, China
| | - Dechao Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
| | - Ping Han
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.
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Haas M, Engelmann SU, Mayr R, Gossler C, Pickl C, Kälble S, Yang Y, Otto W, Hartmann V, Burger M, Hartmann A, Breyer J, Eckstein M. A novel grading approach predicts worse outcomes in stage pT1 non-muscle-invasive bladder cancer. BJU Int 2024. [PMID: 38409965 DOI: 10.1111/bju.16298] [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] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To develop a prognostically relevant scoring system for stage pT1 non-muscle-invasive bladder cancer (NMIBC) incorporating tumour budding, growth pattern and invasion pattern because the World Health Organisation grading system shows limited prognostic value in such patients. PATIENTS AND METHODS The tissue specimens and clinical data of 113 patients with stage pT1 NMIBC who underwent transurethral resection of bladder tumour were retrospectively investigated. Tumour budding, and growth and invasion patterns were evaluated and categorised into two grade groups (GGs). GGs and other clinical and histopathological variables were investigated regarding recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) using univariable and multivariable Cox regression analyses. RESULTS The integration of two tumour budding groups, two growth patterns, and two invasion patterns yielded an unfavourable GG (n = 28; 24.7%) that had a high impact on oncological outcomes. The unfavourable GG was identified as an independent RFS and OS predictor (P = 0.004 and P = 0.046, respectively) and linked to worse PFS (P = 0.001) and CSS (P = 0.001), irrespective of the European Association of Urology risk group. The unfavourable GG was associated with higher rates of BCG-unresponsive tumours (P = 0.006). Study limitations include the retrospective, single-centre design, diverse therapies and small cohort. CONCLUSIONS We present a morphology-based grading system for stage pT1 NMIBC that correlates with disease aggressiveness and oncological patient outcomes. It therefore identifies a highest risk group of stage pT1 NMIBC patients, who should be followed up more intensively or receive immediate radical cystectomy. The grading incorporates objective variables assessable on haematoxylin and eosin slides and immunohistochemistry, enabling an easy-to-use low-cost approach that is applicable in daily routine. Further studies are needed to validate and confirm these results.
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Affiliation(s)
- Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Simon U Engelmann
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Roman Mayr
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christopher Gossler
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christoph Pickl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Sebastian Kälble
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Yushan Yang
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Valerie Hartmann
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Xu Y, Sun G, Yang T, Li H, Hu P, Luo W, Zhang T, Liu H, Chen G, Ye Z, Wu Y, Yu J, Chen W, Zhao K, Liu C, Zhang H. Validation of hyperthermia as an enhancer of chemotherapeutic efficacy: insights from a bladder cancer organoid model. Int J Hyperthermia 2024; 41:2316085. [PMID: 38346911 DOI: 10.1080/02656736.2024.2316085] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVE This study aimed to evaluate the combined efficacy of hyperthermia and chemotherapy using a bladder cancer organoid model and to explore hyperthermia-related molecular pathways. METHOD Tumor organoids were generated by embedding RT4 bladder cancer cells into Matrigel. The resulting organoids were treated with pirarubicin or gemcitabine at 37 °C or 42 °C. Proliferation was determined by Ki67 immunofluorescence staining, and apoptosis was assessed using a TdT-mediated dUTP nick end labeling (TUNEL) assay. RNA sequencing was used to identify the differentially expressed genes. RESULTS Bladder cancer organoids were successfully established and exhibited robust proliferative abilities. Treatment with gemcitabine or pirarubicin under hyperthermic conditions caused pronounced structural damage to the organoids and increased cell death compared to that in the normothermically treated group. Furthermore, Ki67 labeling and TUNEL assays showed that the hyperthermia chemotherapy group showed a significantly reduced proliferation rate and high level of apoptosis. Finally, RNA sequencing revealed the IFN-γ signaling pathway to be associated with hyperthermia. CONCLUSION Overall, hyperthermia combined with chemotherapy exerted better therapeutic effects than those of normothermic chemotherapy in grade 1-2 non-muscle-invasive bladder cancer, potentially through activation of the IFN-γ-JAK-STAT pathway.
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Affiliation(s)
- Ying Xu
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Guoliang Sun
- Department of Urology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Tiantian Yang
- College of Pharmacy, Hubei University of Science and Technology, Hubei, China
| | - Huaibiao Li
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Poyi Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Wanru Luo
- College of Pharmacy, Hubei University of Science and Technology, Hubei, China
| | | | - Haoran Liu
- Bio-X, Stanford University School of Medicine, Stanford, CA, USA
| | - Guoyi Chen
- Department of Urology, Jianyang First Hospital, Fujian, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Yuqing Wu
- Suzhou OptoMedic Technologies Inc, Jiangsu, China
| | - Jie Yu
- School of Life Science and Technology, Wuhan Polytechnic University, Hubei, China
| | - Wanyi Chen
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Kai Zhao
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Chunyan Liu
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
| | - Huiping Zhang
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China
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Ma G, Jia H, Zhang G, Liang Y, Dong X, Fu G, Wang X, Niu H. Presence, Subtypes, and Prognostic Significance of Tertiary Lymphoid Structures in Urothelial Carcinoma of the Bladder. Oncologist 2024; 29:e248-e258. [PMID: 37874923 PMCID: PMC10836299 DOI: 10.1093/oncolo/oyad283] [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: 07/16/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE To evaluate the presence and subtypes of tertiary lymphatic structures (TLSs) in urothelial carcinoma of the bladder (UCB) and to analyze their associated clinicopathological characteristics and prognostic significance. METHODS The study enrolled 580 patients with surgically treated UCB, including 313 non-muscle invasive bladder cancer (NMIBC) and 267 muscle-invasive bladder cancer (MIBC). The presence and subtypes of TLSs were identified by immunohistochemistry (CD20, CD3, Bcl-6, and CD21). TLSs were classified into non-GC (nGC) TLS and GC TLS subtypes based on germinal center (GC) formation. Disease-free survival (DFS) was used as an endpoint outcome to evaluate the prognostic significance of TLS and its subtypes in UCB. RESULTS TLSs were more common in MIBC than in NMIBC (67.8% vs 48.2%, P < .001), and the tumor-infiltrating lymphocyte (TIL) mean density was significantly higher in MIBC than in NMIBC (24.0% vs 17.5%, P < .001). Moreover, a positive correlation was found between TLS presence and GC structure formation and TIL infiltration in UCB. Endpoint events occurred in 191 patients. Compared to patients with endpoint events, patients without disease progression exhibited higher TIL density and more TLSs (P < .05). Kaplan-Meier curves showed that TLS was associated with better DFS in NMIBC (P = .041) and MIBC (P = .049). However, the Cox multivariate analysis did not demonstrate the prognostic significance of TLS. CONCLUSIONS TLS is heterogeneous in UCB, and that TLS and GC structures are related to TIL density and prognostic events. However, TLS as a prognostic indicator remains unclear, warranting further investigation.
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Affiliation(s)
- Guofeng Ma
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Huiqing Jia
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Guofang Zhang
- Department of Gynecology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Ye Liang
- Key Laboratory, Department of Urology and Andrology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xianning Dong
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Guangming Fu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Xinsheng Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
| | - Haitao Niu
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China
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12
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Singh R, Sharma G, Priyadarshi S, Fauzdar G. Prognostic significance of preoperative pyuria & neutrophil to lymphocyte ratio in patients with non-muscle-invasive bladder cancer: A prospective cohort study. Urologia 2024; 91:69-75. [PMID: 37909427 DOI: 10.1177/03915603231203780] [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] [Indexed: 11/03/2023]
Abstract
BACKGROUND The most prevalent cancer of the urinary system and the fourth most frequent cancer in men is bladder cancer. Up to 45% of non-muscle-invasive bladder cancers (NMIBC), may develop into muscle-invasive disease within 5 years after initial diagnosis, depending on the risk profile. The neutrophil to lymphocyte ratio (NLR), which is an emerging marker of host inflammation and can be easily calculated from routine complete blood counts (CBCs) with differentials, has shown to be an independent prognostic factor for a variety of solid malignancies, including urinary tract cancer. Pyuria is a well-documented prognostic factor in urinary tract carcinomas, according to several research. The relationship between preoperative pyuria and recurrence in patients with NMIBC is unclear, even though some studies found that pyuria was a strong predictor of poor prognosis in patients with NMIBC. Our study's objective was to compare the prognostic effect of pre-treatment pyuria and NLR on the likelihood of progression and recurrence in individuals with primary NMIBC. MATERIALS AND METHODOLOGY Data obtained from 100 bladder cancer patients who underwent transurethral resection of bladder tumor (TURBT) from June 2021 to January 2023 were evaluated prospectively. INCLUSION CRITERIA Age more than 18 years, having tumor size less than 3 × 3 cm, single tumor, no H/O TURBT. EXCLUSION CRITERIA Age less than 18 years, size more than 3 × 3 cm, multiple tumors, H/O TURBT. RESULTS We demonstrated in the current study that, compared to NLR, preoperative pyuria was more substantially linked with intravesical recurrence, higher T stage and disease progression following TURBT for NMIBC.
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Affiliation(s)
- Rahul Singh
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | - Govind Sharma
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Gaurav Fauzdar
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
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13
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Bourlotos G, Baigent W, Hong M, Plagakis S, Grundy L. BCG induced lower urinary tract symptoms during treatment for NMIBC-Mechanisms and management strategies. Front Neurosci 2024; 17:1327053. [PMID: 38260019 PMCID: PMC10800852 DOI: 10.3389/fnins.2023.1327053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) accounts for ~70-75% of total bladder cancer tumors and requires effective early intervention to avert progression. The cornerstone of high-risk NMIBC treatment involves trans-urethral resection of the tumor followed by intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. However, BCG therapy is commonly accompanied by significant lower urinary tract symptoms (LUTS) including urinary urgency, urinary frequency, dysuria, and pelvic pain which can undermine treatment adherence and clinical outcomes. Despite this burden, the mechanisms underlying the development of BCG-induced LUTS have yet to be characterized. This review provides a unique perspective on the mechanisms thought to be responsible for the development of BCG-induced LUTS by focussing on the sensory nerves responsible for bladder sensory transduction. This review focuses on how the physiological response to BCG, including inflammation, urothelial permeability, and direct interactions between BCG and sensory nerves could drive bladder afferent sensitization leading to the development of LUTS. Additionally, this review provides an up-to-date summary of the latest clinical data exploring interventions to relieve BCG-induced LUTS, including therapeutic targeting of bladder contractions, inflammation, increased bladder permeability, and direct inhibition of bladder sensory signaling. Addressing the clinical burden of BCG-induced LUTS holds significant potential to enhance patient quality of life, treatment compliance, and overall outcomes in NMIBC management. However, the lack of knowledge on the pathophysiological mechanisms that drive BCG-induced LUTS has limited the development of novel and efficacious therapeutic options. Further research is urgently required to unravel the mechanisms that drive BCG-induced LUTS.
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Affiliation(s)
- Georgia Bourlotos
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - William Baigent
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Matthew Hong
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sophie Plagakis
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke Grundy
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
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Ku JH, Lee LS, Lin TP, Kikuchi E, Kitamura H, Ng CF, Ng JYS, Poon DMC, Kanesvaran R, Seo HK, Spiteri C, Tan EM, Tran B, Tsai YS, Nishiyama H. Risk stratification and management of non-muscle-invasive bladder cancer: A physician survey in six Asia-Pacific territories. Int J Urol 2024; 31:64-71. [PMID: 37800879 DOI: 10.1111/iju.15309] [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: 03/31/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Multiple clinical practice guidelines, conflicting evidence, and physician perceptions result in variations in risk stratification among patients with non-muscle-invasive bladder cancer (NMIBC). This study aims to describe the extent of this variation and its impact on management approaches in the Asia-Pacific region. METHODS We conducted a cross-sectional survey involving 32 urologists and seven medical oncologists with ≥8 years of experience managing early-stage bladder cancer patients across Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. The physicians completed an anonymous questionnaire that assessed their risk stratification and respective management approaches, based on 19 NMIBC characteristics. For each NMIBC characteristic, they were required to select one risk group, and their most preferred management approach. RESULTS Our results demonstrated a higher consensus on risk classification versus management approaches. More than 50% of the respondents agreed on the risk classification of all NMIBC characteristics, but 42% or fewer chose the same treatment option as their preferred choice for all but two characteristics-existence of variant histology (55%) and persistent high-grade T1 disease on repeat resection (52%). Across territories, there was the greatest variation in preferred treatment options (i.e., no treatment, intravesical chemotherapy, or Bacillus Calmette-Guérin [BCG] treatment) for intermediate-risk patients and the highest consensus on the treatment of very high-risk patients, namely radical cystectomy. CONCLUSIONS Our study revealed considerable variation in risk stratification and management of NMIBC in the region. It is critical to develop practical algorithms to facilitate the recognition of NMIBC and standardize the treatment of NMIBC patients.
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Affiliation(s)
- Ja Hyeon Ku
- Seoul National University, Seoul, South Korea
| | | | - Tzu-Ping Lin
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - Eiji Kikuchi
- St Marianna University School of Medicine, Kawasaki, Japan
| | | | - Chi-Fai Ng
- The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | | | | | | | | | - Ee Min Tan
- IQVIA Asia-Pacific, Singapore, Singapore
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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15
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Scheipner L, Zurl H, Altziebler JV, Pichler GP, Schöpfer-Schwab S, Jasarevic S, Gaisl M, Pohl KC, Pemberger K, Andlar S, Hutterer GC, Bele U, Leitsmann C, Leitsmann M, Augustin H, Zigeuner R, Ahyai S, Mischinger J. Charlson-Deyo Comorbidity Index as a Novel Predictor for Recurrence in Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2023; 15:5770. [PMID: 38136315 PMCID: PMC10742244 DOI: 10.3390/cancers15245770] [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: 11/04/2023] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To test the association between the Charlson-Deyo Comorbidity Index (CCI) and the recurrence of non-muscle-invasive bladder cancer (NMIBC). METHODS NMIBC (Ta, T1, TIS) patients who underwent transurethral resection of bladder tumor (TURB) between 2010 and 2018 were identified within a retrospective data repository of a large university hospital. Kaplan-Meier estimates and uni- and multivariable Cox regression models tested for differences in risk of recurrence according to low vs. high comorbidity burden (CCI ≤ 4 vs. >4) and continuously coded CCI. RESULTS A total of 1072 NMIBC patients were identified. The median follow-up time of the study population was 55 months (IQR 29.6-79.0). Of all 1072 NMIBC patients, 423 (39%) harbored a low comorbidity burden vs. 649 (61%) with a high comorbidity burden. Overall, the rate of recurrence was 10% at the 12-month follow-up vs. 22% at the 72-month follow-up. In low vs. high comorbidity burden groups, rates of recurrence were 6 vs. 12% at 12 months and 18 vs. 25% at 72 months of follow-up (p = 0.02). After multivariable adjustment, a high comorbidity burden (CCI > 4) independently predicted a higher risk of recurrence (HR 1.42, 95% confidence interval (CI) 1.06-1.92, p = 0.018). After multivariable adjustment, the hazard of recurrence increased by 5% per each one-unit increase on the CCI scale (HR 1.05, 95% CI 1.00-1.10, p = 0.04). CONCLUSIONS Comorbidities in NMIBC patients are common. Our data suggest that patients with higher CCI have an increased risk of BC recurrence. As a consequence, patients with a high comorbidity burden should be particularly encouraged to adhere to NMIBC guidelines and conform to follow-up protocols.
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Affiliation(s)
- Lukas Scheipner
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Hanna Zurl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Julia V. Altziebler
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Georg P. Pichler
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Stephanie Schöpfer-Schwab
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Samra Jasarevic
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Michael Gaisl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Klara C. Pohl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Karl Pemberger
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Stefan Andlar
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Georg C. Hutterer
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Uros Bele
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Conrad Leitsmann
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Marianne Leitsmann
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
- Institute for Applied Quality Improvement and Research in Health Care, 37073 Goettingen, Germany
| | - Herbert Augustin
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Johannes Mischinger
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
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16
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Teoh JYC, D'Andrea D, Gallioli A, Yanagisawa T, MacLennan S, Nicoletti R, Fai NC, Maffei D, Hurle R, Lusuardi L, Malavaud B, Miki J, Kramer M, Mostafid H, Enikeev D, Babjuk M, Breda A, Shariat S, Gontero P, Herrmann T. En bloc resection of bladder tumour: the rebirth of past through reminiscence. World J Urol 2023; 41:2599-2606. [PMID: 37584691 PMCID: PMC10581917 DOI: 10.1007/s00345-023-04547-0] [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: 05/18/2023] [Accepted: 07/20/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To learn about the history and development of en bloc resection of bladder tumour (ERBT), and to discuss its future directions in managing bladder cancer. METHODS In this narrative review, we summarised the history and early development of ERBT, previous attempts in overcoming the tumour size limitation, consolidative effort in standardising the ERBT procedure, emerging evidence in ERBT, evolving concepts in treating large bladder tumours, and the future directions of ERBT. RESULTS Since the first report on ERBT in 1980, there has been tremendous advancement in terms of its technique, energy modalities and tumour retrieval methods. In 2020, the international consensus statement on ERBT has been developed and it serves as a standard reference for urologists to practise ERBT. Recently, high-quality evidence on ERBT has been emerging. Of note, the EB-StaR study showed that ERBT led to a reduction in 1-year recurrence rate from 38.1 to 28.5%. An individual patient data meta-analysis is currently underway, and it will be instrumental in defining the true value of ERBT in treating non-muscle-invasive bladder cancer. For large bladder tumours, modified approaches of ERBT should be accepted, as the quality of resection is more important than a mere removal of tumour in one piece. The global ERBT registry has been launched to study the value of ERBT in a real-world setting. CONCLUSION ERBT is a promising surgical technique in treating bladder cancer and it has gained increasing interest globally. It is about time for us to embrace this technique in our clinical practice.
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Affiliation(s)
- Jeremy Yuen-Chun Teoh
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Urothelial Cancer Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU, Amsterdam, Netherlands.
| | - David D'Andrea
- Urothelial Cancer Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU, Amsterdam, Netherlands
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrea Gallioli
- Urothelial Cancer Working Group, European Association of Urology-Young Academic Urologists (EAU-YAU, Amsterdam, Netherlands
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Rossella Nicoletti
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Ng Chi Fai
- Department of Surgery, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Davide Maffei
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Lukas Lusuardi
- Department of Urology and Andrology, Salzburg University Hospital, Paracelsus Medical University, 5020, Salzburg, Austria
| | - Bernard Malavaud
- Institut Universitaire du Cancer Toulouse-Oncopôle, Toulouse, France
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mario Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Hugh Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Marek Babjuk
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Shahrokh Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Paolo Gontero
- Department of Urology, Città Della Salute e Della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Thomas Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
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17
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Enikeev D, Morozov A, Shpikina A, Fajkovic H, Baniel J, Herrmann TRW. A 10-year renaissance of en bloc resection of bladder tumors (ERBT): Are we approaching the peak or is it back to the trough? World J Urol 2023; 41:2607-2615. [PMID: 37244879 DOI: 10.1007/s00345-023-04439-3] [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: 01/30/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The number of studies suggesting that en bloc resection of bladder tumor (ERBT) is superior to transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) management is growing. The aim of this review is to discuss the features of these procedures and to determine the prospects of en bloc in NMIBC management. MATERIALS AND METHODS We conducted a literature search using two databases (Medline and Scopus) and included any research which reported ERBT outcomes. RESULTS The lasers with minimal tissue penetration depth are becoming the main tool for ERBT. Unfortunately, most of the systematic reviews continue to be characterized by high heterogeneity. However, recent studies indicate that ERBT may have the edge when it comes to the detrusor muscle rate and the quality of the histological specimen. ERBT may favor in terms of in-field relapse, but its rate in the studies varies greatly. As for out-field relapse-free survival, the data are still lacking. The strongest evidence supports that ERBT is superior to TURBT in complications rate (bladder perforation). ERBT is feasible irrespective to tumor size and location. CONCLUSIONS ERBT has gained in momentum with the increasingly widespread use of this kind of laser surgery. The introduction of novel sources (TFL and Thulium:YAG pulsed laser) will definitely affect how the field develops and will result in further improvements in safety and precision. The latest trials make us more certain in our belief that ERBT will be beneficial in terms of histological specimen quality, relapse rate and complications rate.
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Affiliation(s)
- Dmitry Enikeev
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
| | - Andrey Morozov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Anastasia Shpikina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Jack Baniel
- Division of Urology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Thomas R W Herrmann
- Department of Urology, Spital Thurgau AG (STGAG), Frauenfeld, Switzerland
- Department of Urology, Stellenbosch University, Western Cape, South Africa
- Hannover Medical School, MHH Carl Neuberg Str. 1, 30625, Hannover, Germany
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18
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Chu C, Pietzak E. Immune mechanisms and molecular therapeutic strategies to enhance immunotherapy in non-muscle invasive bladder cancer: Invited review for special issue "Seminar: Treatment Advances and Molecular Biology Insights in Urothelial Carcinoma". Urol Oncol 2023; 41:398-409. [PMID: 35811207 PMCID: PMC10167944 DOI: 10.1016/j.urolonc.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/12/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
Intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) has been the standard of care for patients with high-risk non non-muscle invasive bladder cancer (NMIBC) for over four decades. Despite its success as a cancer immunotherapy, disease recurrence and progression remain common. Current efforts are focused on developing effective and well-tolerated alternatives to BCG and salvage bladder preservation therapies after BCG has failed. The focus of this review is to synthesize our current understanding of the molecular biology and tumor immune microenvironment of NMIBC to provide rationale for existing and emerging therapeutic targets. We highlight recent and ongoing clinical trials and define the current treatment landscape, challenges, and future directions of salvage treatment. Combination regimens that are rationally designed will be needed to make meaningful therapeutic advancements. Investigations into the molecular underpinnings of NMIBC are leading to the emergence of predictive molecular biomarkers that provide greater insight into the clinical heterogeneity of NMIBC and enable us to identify drivers of treatment resistance and new therapeutic targets.
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Affiliation(s)
- Carissa Chu
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eugene Pietzak
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Urology, Weill Cornell Medical College, New York, NY.
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19
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Heishima K, Sugito N, Abe C, Hirata A, Sakai H, Akao Y. Targeting microRNA-145-mediated progressive phenotypes of early bladder cancer in a molecularly defined in vivo model. Mol Ther Nucleic Acids 2023; 33:960-982. [PMID: 37727442 PMCID: PMC10505924 DOI: 10.1016/j.omtn.2023.06.009] [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] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 06/09/2023] [Indexed: 09/21/2023]
Abstract
A progressive subclass of early-stage non-muscle-invasive bladder cancer (NMIBC) frequently recurs and progress into invasive carcinoma, thus decreasing the overall survival rate of NMIBC. However, therapeutic development for progressive NMIBC has been challenging due to the lack of molecularly validated in vivo models and agents targeting its genetic vulnerability. We herein molecularly characterized an interventional model of progressive NMIBC and revealed the principal functions and therapeutic potential of microRNA-145 (miR-145) in early bladder tumorigenesis. N-butyl-N-(4-hydroxybutyl)nitrosamine-induced premalignant lesions (BiPLs) in rats exhibited downregulated expression of miR-145 as well as highly similar mutation/expression profiles to those of the human progressive NMIBC subclass with the worst prognosis. The expression patterns of miR-145 inversely correlated with those of BC-related oncogenes in BiPLs. We also demonstrated that miR-145 dominantly regulated interferon pathways and c-Myc expression, which play a crucial role in the pathogenesis of progressive NMIBC. Furthermore, we demonstrated that miR-145 replacement with a novel miR-145-based intravesical agent (miR-145S1) significantly inhibited the progression of BiPLs in vivo. These results provide insights into the essential role of miR-145 as the earliest-acting oncogenic driver of bladder tumorigenesis as well as a validated interventional model and novel miR-145-based nucleic acid therapeutic agent for progressive NMIBC.
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Affiliation(s)
- Kazuki Heishima
- The United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Gifu, Japan
- Institute for Advanced Study (GUiAS), Gifu University, Gifu, Gifu, Japan
- Center for One Medicine Innovative Translational Research (COMIT), Gifu University, Gifu, Gifu, Japan
| | - Nobuhiko Sugito
- The United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Gifu, Japan
| | - Chikara Abe
- Department of Physiology, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Akihiro Hirata
- Center for One Medicine Innovative Translational Research (COMIT), Gifu University, Gifu, Gifu, Japan
- Laboratory of Veterinary Pathology, Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Gifu, Japan
| | - Hiroki Sakai
- Center for One Medicine Innovative Translational Research (COMIT), Gifu University, Gifu, Gifu, Japan
- Laboratory of Veterinary Pathology, Joint Department of Veterinary Medicine, Faculty of Applied Biological Sciences, Gifu University, Gifu, Gifu, Japan
| | - Yukihiro Akao
- The United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Gifu, Japan
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20
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Hmaidy O, Roumi Jamal B, Mayo M, Haidar M, Horan M, Alsayed-Ahmad ZA. Non-muscle invasive urothelial bladder cancer in a 17-year-old male: A rare case report. Int J Surg Case Rep 2023; 110:108728. [PMID: 37683512 PMCID: PMC10509874 DOI: 10.1016/j.ijscr.2023.108728] [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: 07/22/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Urothelial carcinoma of the bladder predominantly affects adults with rare cases in young patients. This manuscript presents a rare case of urothelial carcinoma highlighting clinical characteristics, diagnosis, treatment, and prognosis in this age group. Our aim is to raise awareness among healthcare professionals for improved outcomes in children and adolescents with bladder urothelial carcinoma. CASE PRESENTATION A 17-year-old male presented with hematuria and urinary symptoms. No history of smoking, alcohol, surgeries, family conditions, or medications. The patient had environmental chemical exposure near an oil refinery. An initial ultrasound and Cystoscopy showed a sizable bladder tumor. A complete TURBT was done, followed by cauterization and catheter placement. The tumor was diagnosed as low-grade urothelial carcinoma (pT1). Follow-up cystoscopies after 3 and 9 months showed no recurrence. CLINICAL DISCUSSION Urothelial bladder carcinoma (UBC) is linked to occupational exposure and smoking. Limited research exists on UBC in young patients, but genetic factors and environmental exposure may play a role. In young individuals, UBC typically presents as low-grade, non-muscle invasive tumors (NMIBC). Transurethral resection may be sufficient for low-grade tumors, and postoperative follow-up with ultrasound is important. Larger tumors have a higher risk of recurrence and progression. CONCLUSION The present case emphasizes the need to consider urothelial bladder carcinoma as a potential cause of hematuria in young patients and conduct a thorough evaluation of all risk factors. Future research is needed to establish evidence-based guidelines for managing this condition in pediatric and adolescent patients.
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Affiliation(s)
- Osama Hmaidy
- Department of Urologic Surgery, Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Mohammed Mayo
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Mariam Haidar
- Department of Pathology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Mohammad Horan
- Department of urology, NMC ROYAL HOSPITAL SHARJAH, NMC healthcare, Sharjah, United Arab Emirates.
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21
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Schwarzova L, Varchulova Novakova Z, Danisovic L, Ziaran S. Molecular classification of urothelial bladder carcinoma. Mol Biol Rep 2023; 50:7867-7877. [PMID: 37525073 PMCID: PMC10460735 DOI: 10.1007/s11033-023-08689-7] [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: 05/02/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023]
Abstract
Urothelial bladder carcinoma (UC) ranks among the top ten most commonly diagnosed cancers worldwide on an annual basis. The standardized classification system for urothelial bladder tumors is the Tumor, Node, Metastasis classification, which reflects differences between non-muscle-invasive bladder carcinoma (NMIBC) and muscle-invasive bladder carcinoma (MIBC) and it depends on the extent to which tumor has infiltrated the bladder wall and other tissues and organs. NMIBC and MIBC exhibit great intrinsic heterogeneity regarding different prognoses, survival, progression, and treatment outcomes. In recent years, studies based on mRNA expression profiling revealed the existence of biologically relevant molecular subtypes of UC, which show variant molecular features that can provide more precise stratification of UC patients. Here, we present a complex classification of UC based on mRNA expression studies and molecular subtypes of NMIBC and MIBC in detail with regard to different mRNA expression profiles, mutational signatures, and infiltration by non-tumor cells. The possible impact of molecular subtyping on treatment decisions and patients' outcomes is outlined, too.
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Affiliation(s)
- Lucia Schwarzova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Zuzana Varchulova Novakova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
| | - Stanislav Ziaran
- Department of Urology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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22
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Arai T, Sazuka T, Oka R, Tsukamoto R, Sato H, Goto Y, Imamura Y, Sakamoto S, Ichikawa T. Investigation on the Usefulness of Photodynamic Diagnosis-assisted Targeted Bladder Biopsy: Japanese Real-world Study. Anticancer Res 2023; 43:3615-3621. [PMID: 37500129 DOI: 10.21873/anticanres.16541] [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: 05/18/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND/AIM Photodynamic diagnosis (PDD)-assisted transurethral resection of a bladder tumor (PDD-TURBT) in a patient receiving 5-aminolevulinic acid improved the detection of micro- and flat lesions of the bladder. This study used real-world data in Japan to examine the diagnostic accuracy of PDD-assisted targeted biopsies and white-light (WL) random biopsies and reevaluated the necessity of random biopsies. PATIENTS AND METHODS A total of 133 patients diagnosed with bladder cancer who underwent TURBT from April 2020 to March 2022 were included in the study. Biopsy specimens obtained from 407 flat lesions or normal-like lesions, excluding biopsies from elevated lesions and TUR specimens, were used to analyze diagnostic accuracy in PDD and WL findings. RESULTS The respective sensitivities, specificities, and negative predictive values of PDD vs. WL findings were 81.4% vs. 54.0% (p=0.0039), 70.4% vs. 81.4% (p=0.0012), and 96.4% vs. 90.6% (p=0.0144), indicating that PDD was useful for a diagnosis of exclusion. Combining the PDD and WL findings improved the detection of malignant flat lesions. Ten (PDD-positive and WL-negative) specimens from 9 patients were diagnosed as malignant. The results of PDD-assisted targeted biopsy provided an accurate assessment of the risk classification for recurrence and progression of non-muscle invasive bladder cancer (NMIBC) as defined by the Japanese Urological Association (JUA) guidelines. CONCLUSION For NMIBC treatment, a more accurate diagnosis is important for postoperative treatment decisions. PDD-assisted targeted biopsy may be necessary and sufficient for diagnosis of flat lesions in patients with bladder cancer for treatment decision making based on JUA risk classification.
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Affiliation(s)
- Takayuki Arai
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryuji Oka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ryo Tsukamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroaki Sato
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Goto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yusuke Imamura
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
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23
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Tang Z, Peng J, Wu S, Zhao F, Wu M. Combined use of a 980‑nm diode laser and preoperative intravesical instillation of pirarubicin for the prevention of short‑term recurrence of non‑muscle invasive bladder cancer: A pilot study. Oncol Lett 2023; 26:322. [PMID: 37415632 PMCID: PMC10320430 DOI: 10.3892/ol.2023.13908] [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: 02/18/2023] [Accepted: 05/31/2023] [Indexed: 07/08/2023] Open
Abstract
At present, transurethral resection of bladder tumors (TURBT) is the main surgical method for treating non-muscle invasive bladder cancer (NMIBC), but its postoperative recurrence needs to be prevented. The aim of the present study was to investigate the efficacy of a 980-nm diode laser combined with preoperative intravesical instillation of pirarubicin (THP) for the prevention of NMIBC recurrence. The data of 120 patients with NMIBC who underwent transurethral resection between May 2021 and July 2022 were retrospectively collected, and these patients were followed up. The patients were divided into four groups based on the surgical method used and preoperative intravesical instillation of THP as follows: i) 980-nm diode laser with THP (LaT); ii) 980-nm diode laser alone (La); iii) TURBT with THP (TUT); and iv) TURBT alone (TU). Clinicopathological variables, postoperative complications and short-term outcomes among the aforementioned groups were analyzed. The blood loss volume and the incidence of perforation and delayed bleeding were significantly lower in the LaT and La groups compared with those in the TUT and TU groups. The days of bladder irrigation, catheter extubation and postoperative hospitalization were significantly shorter in the LaT and La groups compared with the TUT and TU groups. The detection rate of suspicious lesions was significantly higher in the THP irrigation groups (LaT and TUT) compared with that in the saline irrigation groups (La and TU). Tumor diameter and number, 980-nm laser and THP irrigation were shown to be independent risk factors in the Cox regression analysis. In addition, the recurrence-free survival (RFS) rate of the LaT group was significantly higher than that of the other three groups. In conclusion, a 980-nm diode laser can effectively reduce intraoperative blood loss and the incidence of perforation, and accelerate postoperative recovery. Preoperative intravesical instillation of THP is conducive to identifying suspicious lesions. The combination of a 980-nm laser with preoperative THP intravesical instillation can significantly prolong RFS time.
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Affiliation(s)
- Zhen Tang
- Department of Urology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region 545005, P.R. China
| | - Jiao Peng
- Department of Medical Imaging, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region 545005, P.R. China
| | - Shangxin Wu
- Department of Urology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region 545005, P.R. China
| | - Fenfen Zhao
- Department of Urology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region 545005, P.R. China
| | - Mingui Wu
- Department of Urology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi Zhuang Autonomous Region 545005, P.R. China
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24
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Rahman KMM, Foster BA, You Y. Preclinical evaluation of singlet oxygen-cleavable prodrugs in combination with protoporphyrin IX-photodynamic therapy in an orthotopic rat model of non-muscle-invasive bladder cancer †. Photochem Photobiol 2023. [PMID: 37469327 DOI: 10.1111/php.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/21/2023]
Abstract
Photodynamic therapy (PDT) initially employed red light, which caused some patients to experience permanent bladder contractions. PDT using the FDA-approved drug hexaminolevulinate (HAL), which produces protoporphyrin IX (PpIX) in the tumor, showed some promise but has low efficacy in treating non-muscle-invasive bladder cancer (NMIBC). We developed singlet oxygen-activatable prodrugs of two anticancer drugs, paclitaxel and mitomycin C, to enhance the antitumor effect of PpIX-PDT without producing systemic side effects, by promoting only local release of the active chemotherapeutic agent. Orthotopic NMIBC model was used to compare the efficacy of prodrugs only, PpIX-PDT, and prodrugs + PpIX-PDT. 532 nm laser with a total power of 50 mW for 20 min (60 J, single treatment) was used with HAL and prodrugs. Histology and microscopic methods with image analysis were used to evaluate the tumor staging, antitumor efficacy, and local toxicity. Prodrug + PpIX-PDT produced superior antitumor efficacy than PpIX-PDT alone with statistical significance. Both PpIX-PDT alone and combination therapy resulted in mild damage to the bladder epithelium in the normal bladder area with no apparent damage to the muscle layer. Overall, SO-cleavable prodrugs improved the antitumor efficacy of PpIX-PDT without causing severe and permanent damage to the bladder muscle layer.
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Affiliation(s)
- Kazi Md Mahabubur Rahman
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
| | - Barbara A Foster
- Department of Pharmacology & Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Youngjae You
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, New York, USA
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25
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Kawada T, Yanagisawa T, Bekku K, Laukhtina E, Deimling MV, Majdoub M, Chlosta M, Pradere B, Babjuk M, Gontero P, Moschini M, Araki M, Shariat SF. Low-dose or -number of BCG in non-muscle invasive bladder cancer: updated systematic review and meta-analysis. Immunotherapy 2023. [PMID: 37409426 DOI: 10.2217/imt-2022-0309] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
Aim: We aimed to review the evidence of reducing the dose or number of BCG instillations in non-muscle invasive bladder cancer (NMIBC) patients. Material & methods: A literature search was done according to Preferred Reporting Items for Meta-Analyses statement. Results: Overall, 15 and 13 studies were eligible for qualitative and quantitative synthesis, respectively. In patients with NMIBC, lowering either the dose or number of BCG instillations increases the risk of recurrence, but not the risk of progression. Lowering the dose of BCG decreases the risk of adverse events compared with standard-dose BCG. Conclusion: Standard-dose and -number of BCG is preferred for NMIBC patients based on oncologic efficacy; however, low-dose BCG could be considered in selected patients who suffer from significant adverse events.
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Affiliation(s)
- Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama, 700-8530, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, 105-8471, Japan
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama, 700-8530, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Institute for Urology & Reproductive Health, Sechenov University, Moscow, 119435, Russia
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany
| | - Mohammed Majdoub
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, Hillel Yaffe Medical Center, Hadera, 3820302, Israel
| | - Marcin Chlosta
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, Jagiellonian University Medical College, Cracow, 31-008, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, 31130, France
| | - Marko Babjuk
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Department of Urology, Second Faculty of Medicine of Charles University, University Hospital Motol, Prague, 150 06, Czech Republic
| | - Paolo Gontero
- Urology Unit, Department of Surgical Sciences, University of Turin, Turin, 10124, Italy
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital & Vita-Salute San Raffaele University, Milan, 20132, Italy
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama, 700-8530, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090, Vienna, Austria
- Institute for Urology & Reproductive Health, Sechenov University, Moscow, 119435, Russia
- Division of Urology, Department of Special Surgery, The University of Jordan, Amman, 11942, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, 150 06, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, NY 1300, USA
- Karl Landsteiner Institute of Urology & Andrology, Vienna, 1090, Austria
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26
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Sun JX, Xia QD, Zhong XY, Liu Z, Wang SG. The bladder microbiome of NMIBC and MIBC patients revealed by 2bRAD-M. Front Cell Infect Microbiol 2023; 13:1182322. [PMID: 37351184 PMCID: PMC10282653 DOI: 10.3389/fcimb.2023.1182322] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/15/2023] [Indexed: 06/24/2023] Open
Abstract
Background Bladder cancer (BCa) is the most common malignancy of the urinary tract which can be divided into non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), and their microbial differences are not fully understood. This study was conducted by performing 2bRAD sequencing for Microbiome (2bRAD-M) on NMIBC and MIBC tissue samples to investigate the microbiota differences between NMIBC and MIBC individuals. Methods A total of 22 patients with BCa, including 7 NMIBC and 15 MIBC, were recruited. Tumor tissues were surgically removed as samples and DNA was extracted. Type IIB restriction endonucleases were used to enzymatically cleave the microbial genome for each microbe's tag and map it to species-specific 2bRAD markers to enable qualitative and quantitative studies of microbes between MIBC and NMIBC tissues. Results A total of 527 species were detected. The microbial diversity of NMIBC tissues was significantly higher than that of MIBC tissues. Microbial composition of the two tumor tissues was similar, where Ralstonia_sp000620465 was the most dominant species. 4 species (Acinetobacter_guillouiae, Anoxybacillus_A_rupiensis, Brevibacillus_agri and Staphylococcus_lugdunensis) were enriched in NMIBC, while Ralstonia_mannitolilytica, Ralstonia_pickettii, and Ralstonia_sp000620465 were overrepresented in MIBC. 252 discriminatory character taxa were also revealed by linear discriminant analysis effect sizea (LEfSe). Species importance point plots identified Ralstonia_sp000620465, Cutibacterium_acnes and Ralstonia_pickettii as the three most important species between the two groups. Meanwhile, functional annotation analysis showed 3011 different COGs and 344 related signaling pathways between MIBC and NMIBC microbiome. Conclusion This first 2bRAD-M microbiome study on MIBC and NMIBC tissues revealed significant differences in the microbial environment between the two groups, which implies a potential association between tumor microbial dysbiosis and BCa, and provides a possible target and basis for subsequent studies on the mechanisms of BCa development and progression.
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Affiliation(s)
| | | | | | - Zheng Liu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shao-Gang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Karaburun MC, Özkaya MF, Ergüder Bİ, Süer E. Investigation of Atypical Cell Parameter in the Surveillance of Patients with NMIBC; Initial Outcomes of a Single Center Prospective Study. J Med Syst 2023; 47:41. [PMID: 36976368 DOI: 10.1007/s10916-023-01929-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To investigate how well the Sysmex automated urine-analyzer's atypical-cell parameter can predict oncological outcomes when compared to cytology and pathology data in the follow-up of NMIBC patients. MATERIAL AND METHODS We prospectively collected clinical data from 273 patients who underwent cystoscopic examination due to benign and malign reasons in our center between June 2020 and March 2021. Patients were divided into 2 groups. (Group-1: Patients with no previous diagnosis of bladder cancer(BC), Group-2: Patients with previously diagnosed NMIBC). The a typical-cell parameter was determined by studying the urine sample given by the patient for urinalysis. The atypical-cell parameter's sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were assessed. RESULTS A total of 76(41.1%) patients underwent diagnostic procedures (Group-1) and remaining 109(58.9%) patients were NMIBC patients (Group-2) who subjected to control cystoscopy on follow-up. BC was detected in 70 patients, 28 of whom were newly diagnosed (Group-1). Remaining 42 patients had recurrence during their follow-up (Group-2). Atypical cell values of 70 patients with BC were determined to be statistically significantly higher than those without malignancy. In Group-2, median atypical-cell values for those with no malignancy, those with low-grade BC reccurrence, and those with high-grade BC recurrence were 0.00(IQR:0.00-0.80), 0.25(IQR:0.10℃1.10) and 1.20(IQR:0.70-2.15), respectively (p<0.001). For a cut-off of 0.1 atypical cells/µL, sensitivity and specificity were measured as 83.33% and 53.73%, respectivel (AUC:0.727;p-value<0.001). CONCLUSION Atypical-cell parameter of the Sysmex-UF-5000 automated urine-analyzer is a newly introduced research parameter. The results of this study are promising. Based on our results, we presume that the atypical-cell parameter may be used in surveillance of the NMIBC patients. Multi-center studies with larger patient populations are required to prove its efficacy.
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Affiliation(s)
| | - Mehmet Fatih Özkaya
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey.
| | - Berrin İmge Ergüder
- Department of Biochemistry, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Semeniuk-Wojtaś A, Poddębniak-Strama K, Modzelewska M, Baryła M, Dziąg-Dudek E, Syryło T, Górnicka B, Jakieła A, Stec R. Tumour microenvironment as a predictive factor for immunotherapy in non-muscle-invasive bladder cancer. Cancer Immunol Immunother 2023:10.1007/s00262-023-03376-9. [PMID: 36928373 DOI: 10.1007/s00262-023-03376-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
Bladder cancer (BC) can be divided into two subgroups depending on invasion of the muscular layer: non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Its aggressiveness is associated, inter alia, with genetic aberrations like losses of 1p, 6q, 9p, 9q and 13q; gain of 5p; or alterations in the p53 and p16 pathways. Moreover, there are reported metabolic disturbances connected with poor diagnosis-for example, enhanced aerobic glycolysis, gluconeogenesis or haem catabolism.Currently, the primary way of treatment method is transurethral resection of the bladder tumour (TURBT) with adjuvant Bacillus Calmette-Guérin (BCG) therapy for NMIBC or radical cystectomy for MIBC combined with chemotherapy or immunotherapy. However, intravesical BCG immunotherapy and immune checkpoint inhibitors are not efficient in every case, so appropriate biomarkers are needed in order to select the proper treatment options. It seems that the success of immunotherapy depends mainly on the tumour microenvironment (TME), which reflects the molecular disturbances in the tumour. TME consists of specific conditions like hypoxia or local acidosis and different populations of immune cells including tumour-infiltrating lymphocytes, natural killer cells, neutrophils and B lymphocytes, which are responsible for shaping the response against tumour neoantigens and crucial pathways like the PD-L1/PD-1 axis.In this review, we summarise holistically the impact of the immune system, genetic alterations and metabolic changes that are key factors in immunotherapy success. These findings should enable better understanding of the TME complexity in case of NMIBC and causes of failures of current therapies.
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Affiliation(s)
| | | | | | | | | | - Tomasz Syryło
- Department of General, Active and Oncological Urology, Military Institute of Medicine, Warsaw, Poland
| | - Barbara Górnicka
- Pathomorphology Department, Medical University of Warsaw, Warsaw, Poland
| | - Anna Jakieła
- Oncology Department, 4 Military Clinical Hospital with a Polyclinic, Wroclaw, Poland
| | - Rafał Stec
- Oncology Department, Medical University of Warsaw, Warsaw, Poland
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Gupta P, Sarangi SS, Singh M, Pandey H, Choudhary GR, Madduri VKS, Bhirud DP, Sandhu AS, Jena R. To determine correlation between VIRADS scoring and pathological staging in bladder cancer: A prospective study and review of literature. Urologia 2023:3915603231151738. [PMID: 36847430 DOI: 10.1177/03915603231151738] [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] [Indexed: 03/01/2023]
Abstract
The development of standardized reporting systems is of paramount importance in medical-imaging. Based on the "RADS" methodology, PIRADS and BI-RADS have been successfully used. The management of bladder cancer (BC) depends on the stage at the time of identification. Accurate assessment of the muscle-invasive stage can alter therapies that are radically different. MRI can accurately diagnose this in a standardized manner (Vesical Imaging-Reporting and Data System: VIRADS) and spare additional procedures. The aim of the study is to determine diagnostic accuracy of VIRADS scoring in evaluation of muscle invasiveness in patients with BC. This study was conducted in a single center over a period of 2 years from April 2020. A total of 76 patients with bladder SOL/diagnosed BC were included. Final VIRADS scoring was calculated and compared with histopathological report.76 patients were evaluated which included 64 males and 12 females. Most of the cases came under the VIRADS-II category (23, 30.26%) followed by VIRADS-V (17, 22.36%). VIRADS-I was reported in 14 cases (18.42%). A total of 8 cases (10.52 %) were reported as VIRADS III and 14 cases (18.42%) as VIRADS IV. VIRADS-III was taken as cut off and found to have a sensitivity of 94.44%, a specificity of 87.50%, a positive predictive value of 87.17% and a negative predictive value of 94.59%. Though number of cases are still less to accurately predict test characteristics of VIRADS, our results are consistent with previously done retrospective studies and VIRADS has got good correlation with pathological staging.
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Affiliation(s)
- Prateek Gupta
- Department of Urology, Aadhar Health Institute, Hisar, Haryana, India
| | - Shakti Swarup Sarangi
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Mahendra Singh
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- Department of Urooncology, MPMMC-TMH, Varanasi, Uttar Pradesh, India
| | - Gautam Ram Choudhary
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Deepak Prakash Bhirud
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arjun Singh Sandhu
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Jena
- Department of Urology All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Anastay V, Baboudjian M, Masson-Lecomte A, Lebacle C, Chamouni A, Irani J, Tillou X, Waeckel T, Monges A, Duperron C, Gravis G, Walz J, Lechevallier E, Pignot G. Is CIS a Contraindication to Hyperthermic Intravesical Chemotherapy (HIVEC) after BCG-Failure? Cancers (Basel) 2023; 15. [PMID: 36900247 DOI: 10.3390/cancers15051455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
CIS of the bladder is associated with a high risk of progression. In the case of BCG failure, radical cystectomy should be performed. For patients who refuse or are ineligible, bladder-sparing alternatives are evaluated. This study aims to investigate the efficacy of Hyperthermic IntraVesical Chemotherapy (HIVEC) depending on the presence or absence of CIS. This retrospective, multicenter study was conducted between 2016 and 2021. Patients with non-muscle-invasive bladder cancer (NMIBC) with BCG failure received 6-8 adjuvant instillations of HIVEC. The co-primary endpoints were recurrence-free survival (RFS) and progression-free survival (PFS). A total of 116 consecutive patients met our inclusion criteria of whom 36 had concomitant CIS. The 2-year RFS rate was 19.9% and 43.7% in patients with and without CIS, respectively (p = 0.52). Fifteen patients (12.9%) experienced progression to muscle-invasive bladder cancer with no significant difference between patients with and without CIS (2-year PFS rate = 71.8% vs. 88.8%, p = 0.32). In multivariate analysis, CIS was not a significant prognostic factor in terms of recurrence or progression. In conclusion, CIS may not be considered a contraindication to HIVEC, as there is no significant association between CIS and the risk of progression or recurrence after treatment.
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Lin PT, Hung WK, Chang YH, Hsieh ML, Liu CY, Huang LK, Chu YC, Kan HC, Lin PH, Yu KJ, Chuang CK, Wu CT, Pang ST, Shao IH. Replacement Instead of Discontinuation of Bacillus Calmette-Guérin Instillation in Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2023; 15. [PMID: 36831686 DOI: 10.3390/cancers15041345] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/01/2023] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND To evaluate the efficacy of intravesical chemotherapy replacement in patients with intermediate- and high-risk non-muscle-invasive bladder cancer (NMIBC), who underwent bacillus Calmette-Guérin (BCG) instillation but discontinued due to global shortages or toxicity of BCG. METHODS This retrospective study included patients with intermediate- and high-risk NMIBC who received BCG intravesical instillation. Those who discontinued the treatment were divided into the pure BCG group and chemotherapy replacement group. Comparisons between these groups were performed. The primary endpoint was bladder recurrence-free survival (RFS). RESULTS A total of 480 patients were included. Baseline characteristics were similar between groups, but the total instillation times were higher in the chemotherapy replacement group than in the pure BCG group (n = 14.9 vs. 10.5). The chemotherapy replacement group had a better three-year RFS (p = 0.022). On multivariate analysis, the pure BCG group had significantly increased all-time and 3-year recurrences (hazard ratio 2.015 and 2.148) compared to the chemotherapy replacement group. CONCLUSIONS Chemotherapy replacement has a better three-year RFS than no instillation in patients with intermediate- and high-risk NMIBC who received BCG instillation but facing treatment stoppage.
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Ye K, Xiao M, Li Z, He K, Wang J, Zhu L, Xiong W, Zhong Z, Tang Y. Preoperative systemic inflammation response index is an independent prognostic marker for BCG immunotherapy in patients with non-muscle-invasive bladder cancer. Cancer Med 2023; 12:4206-4217. [PMID: 36214475 PMCID: PMC9972176 DOI: 10.1002/cam4.5284] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/26/2022] [Accepted: 09/12/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND The Systemic Inflammatory Response Index (SIRI) is a novel prognostic biomarker based on peripheral blood counts of neutrophils, monocytes, and lymphocytes. Recent evidence suggests that it is associated with poor prognosis in various cancers. However, the predictive value of the SIRI in non-muscle-invasive bladder cancer (NMIBC) patients treated with intravesical Bacillus Calmette-Guerin (BCG) immunotherapy remains elusive. Therefore, this study aimed to evaluate the potential of SIRI as a prognostic factor in these patients. METHODS A total of 540 patients with NMIBC who underwent BCG immunotherapy following transurethral resection of bladder tumor (TURBT) were enrolled in this study. Using receiver operating characteristic (ROC) curves and the Youden index, patients were divided into high and low SIRI groups based on the cutoff values. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of BCG non-response. Thereafter, propensity score matching (PSM) was used to eliminate bias due to confounding factors between the low and high SIRI groups. Finally, the Kaplan-Meier method was used to compare recurrence-free survival (RFS) and progression-free survival (PFS) between the two groups. RESULTS Multivariable logistic regression analysis revealed that high SIRI (p = 0.001), high MLR (p = 0.015), and high tumor pathological T stage (p = 0.015) were significantly correlated with non-response to BCG therapy. In addition, both RFS and PFS were shorter in the high SIRI group than in the other group before and after PSM (both p < 0.05). Collectively, our results indicate that the combination of tumor pathological T staging and the SIRI can enhance the predictive power of BCG response. CONCLUSION Pretreatment peripheral blood SIRI can be employed to predict the response to BCG immunotherapy and the prognosis of NMIBC patients. Taken together, the combination of T stage and SIRI demonstrated robust performance in predicting the response to BCG immunotherapy in NMIBC patients.
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Affiliation(s)
- Kun Ye
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Ming Xiao
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Zitaiyu Li
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Kancheng He
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Jinhua Wang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Liang Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wei Xiong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxin Tang
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
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Ding L, Deng X, Wang K, Xia W, Zhang Y, Zhang Y, Shao X, Wang J. Preoperative Systemic Inflammatory Markers as a Significant Prognostic Factor After TURBT in Patients with Non-Muscle-Invasive Bladder Cancer. J Inflamm Res 2023; 16:283-296. [PMID: 36713048 PMCID: PMC9875575 DOI: 10.2147/jir.s393511] [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: 10/20/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) have been widely proposed to have predictive value for the patient prognosis of many malignancies, including bladder cancer. However, the predictive value of their combination in non-muscle-invasive bladder cancer (NMIBC) is unclear. Methods Cases of NMIBC patients who underwent transurethral resection of the bladder tumor were recruited from two tertiary public medical centers. A systemic inflammatory marker (SIM) score was calculated based on comprehensive consideration of NLR, PLR, and LMR. Recurrence-free survival (RFS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. The Log rank test was used to compare differences between the groups. Cox regression was used to screen risk factors affecting RFS and PFS. Nomogram models were established and validated, and patients were stratified based on the model scores. Results The study dataset was grouped according to a 7:3 randomization, with the training cohort consisting of 292 cases and the validation cohort consisting of 124 cases. Cox regression analysis showed that SIM score is an independent predictor of RFS and PFS in NMIBC patients. The novel models were established based on the SIM score and other statistically significant clinicopathological features. The area under the curve (AUC) for predicting 1-, 2-, and 3-year RFS was 0.667, 0.689, and 0.713, respectively. The AUC for predicting 1-, 2-, and 3-year PFS was 0.807, 0.775, and 0.862, respectively. Based on the risk stratification, patients at high risk of recurrence and progression could be accurately identified. The established models were applied to the patient evaluation of the validation cohort, which proved the great performance of the novel models. Conclusion The novel models based on the SIM score and clinicopathological characteristics can accurately predict the survival prognosis of NMIBC patients, and the models can be used by clinicians for individualized patient assessment and to assist in clinical decision-making.
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Affiliation(s)
- Li Ding
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xiaobin Deng
- Department of Urology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530000, People’s Republic of China
| | - Kun Wang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Wentao Xia
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Yang Zhang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Yan Zhang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xianfeng Shao
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Junqi Wang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China,Correspondence: Junqi Wang, Email
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Wu K, Jiang D, Zhang L, Jiang S, Lin T, Luo Y, Fan J, Yang T, Chen H, Zhang P, Wang X, Wei Q, Guo J, Huang Y, He D. Efficacy and safety of a novel 450 nm blue diode laser versus plasmakinetic electrocautery for the transurethral resection of non-muscle invasive bladder cancer: The protocol and result of a multicenter randomized controlled trial. Front Oncol 2023; 12:1065735. [PMID: 36733358 PMCID: PMC9887014 DOI: 10.3389/fonc.2022.1065735] [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: 10/10/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives To be the first to apply a novel 450 nm blue diode laser in transurethral resection of bladder tumor (TURBt) to treat patients with non-muscle invasive bladder cancer (NMIBC) and evaluate its efficacy and safety during the preoperative period compared to the conventional plasmakinetic electrocautery. Materials and Methods Randomized controlled trial (RCT) in five medical centers was designed as a non-inferiority study and conducted from October 2018 to December 2019. Patients with NMIBC were randomized to the blue laser or plasmakinetic electrocautery group for TURBt. As the first study to evaluate this novel blue laser device, the primary outcome was the effective resection rate of bladder tumors, including effective dissection and hemostasis. The secondary outcomes were the perioperative records, including surgical time, postoperative indwelling catheter time, hospital stay length, blood loss, reoperation rate, wound healing and adverse events. Results A total of 174 patients were randomized to either the blue laser group (85 patients) or plasmakinetic electrocautery group (89 patients). There was no statistical significance in the clinical features of bladder tumors, including tumor site, number and maximum lesion size. Both the blue laser and plasmakinetic electrocautery could effectively dissect all visible bladder tumors. The surgical time for patients in the blue laser group was longer (p=0.001), but their blood loss was less than that of patients in the control group (p=0.003). There were no differences in the postoperative indwelling catheter time, hospital stay length, reoperation rate or other adverse events. However, the patients undergoing TURBt with the blue laser showed a faster wound healing at 3 months after operation. Conclusion The novel blue laser could be effectively and safely used for TURBt in patients with NMIBC, and this method was not inferior to plasmakinetic electrocautery during the perioperative period. However, TURBt with the blue laser may provide the benefit to reduce preoperative blood loss and accelerate postoperative wound healing. Moreover, longer follow-up to confirm recurrence-free survival benefit was required.
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Affiliation(s)
- Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Dali Jiang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lianhua Zhang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuai Jiang
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianhai Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Luo
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Tao Yang
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haige Chen
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Peng Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianming Guo
- Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yiran Huang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China,*Correspondence: Yiran Huang, ; Dalin He,
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Yiran Huang, ; Dalin He,
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Zhao Y, Sun W, Ji Z, Liu X, Qiao Y. Serum metabolites as early detection markers of non-muscle invasive bladder cancer in Chinese patients. Front Oncol 2023; 13:1061083. [PMID: 36937410 PMCID: PMC10020364 DOI: 10.3389/fonc.2023.1061083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/04/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Biomarkers of different stages and grades of bladder cancer (BC) are important in clinical work. The objective of our study was to investigate new biomarkers of early-stage BC with liquid chromatography-high resolution mass spectrometry (LC-HRMS) using serum samples. Methods A total of 215 cases were included in our study, including 109 healthy adults as the control group and 106 non-muscle invasive bladder cancer (NMIBC) patients as the NMIBC group. Serum samples were collected from BC patients in the early stage, called NMIBC, and healthy people before surgery. We used LC-HRMS to distinguish the NMIBC group from the control group and the low-grade NMIBC group from the control group. Results An apparent difference between the NMIBC group and the control group was visualized by unsupervised principal component analysis (PCA). Metabolite panels for 16-hydroxy-10-oxohexadecanoic acid, PGF2a ethanolamide, sulfoglycolithocholate, and threoninyl-alanine were used to distinguish the two groups. The area under the curve (AUC) of the panels was 0.985, and the sensitivity and specificity were 98.63% and 98.59%, respectively. To distinguish the low-grade NMIBC group from the control group, serum metabolic profiling differences between the low-grade NMIBC group and control group samples were also analyzed. Metabolite panels of L-octanoylcarnitine, PGF2a ethanolamide, and threoninyl-alanine showed good discrimination performance. The AUC of the panels was 0.999, and the sensitivity and specificity were 97.8% and 100%, respectively. Conclusion Metabolomics analysis of serum samples can distinguish the NMIBC group from the control group, particularly the early-stage low-grade NMIBC group.
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Affiliation(s)
- Yi Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Science, Beijing, China
| | - Wei Sun
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Wei Sun, ; Zhigang Ji,
| | - Zhigang Ji
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Science, Beijing, China
- *Correspondence: Wei Sun, ; Zhigang Ji,
| | - Xiaoyan Liu
- School of Basic Medicine, Institute of Basic Medical Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Qiao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Science, Beijing, China
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36
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Li K, Raveendran A, Xie G, Zhang Y, Wu H, Huang Z, Jia Z, Yang J. Prediction for recurrent non-muscle invasive bladder cancer. Cancer Biomark 2023; 38:275-285. [PMID: 37661872 DOI: 10.3233/cbm-220373] [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] [Indexed: 09/05/2023]
Abstract
Non-muscle invasive bladder cancer (NMIBC) has a high recurrence rate, which places a significant burden on both patients and the healthcare system. Hence, it holds significant importance to predict the recurrence risk following treatment for individuals diagnosed with non-muscle invasive bladder cancer (NMIBC). As new generation technologies continue to emerge, an increasing number of recurrence risk prediction tools are being developed and discovered. This article provides an overview of the primary recurrence risk prediction tools currently available, including the liquid biopsy, tissue biopsy, and risk prediction tables. Each of these tools is described in detail and illustrated with relevant examples. Furthermore, we conduct an analysis of the advantages and disadvantages of these tools. This article aims to enhance the reader's understanding of the current progress in recurrence prediction tools and encourage their practical utilization in the fields of precision medicine and public health.
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Affiliation(s)
- Keqiang Li
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Aravind Raveendran
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Guoqing Xie
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Yu Zhang
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Haofan Wu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhenlin Huang
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhankui Jia
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jinjian Yang
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
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Del Giudice F, D'Andrea D, Pradere B, Berndl F, Pallauf M, Flammia RS, Philipp D, Moschini M, Mari A, Albisinni S, Krajewski W, Laukhtina E, Gallioli A, Mertens LS, Marcq G, Cimadamore A, Afferi L, Gontero P, Shariat SF, Chung BI, Soria F. Surgical checklist adherence across urology expertise levels impacts TURBT quality indicators. BJU Int 2022; 131:712-719. [PMID: 36251366 DOI: 10.1111/bju.15920] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumor (TURBT) accuracy and oncologic outcomes in non-muscle invasive bladder cancer (NMIBC). MATERIALS AND METHODS we relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardized peri-procedural 9-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS). RESULTS A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 patients (29.6%) and by residents in 89 patients (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (OR: 1.75, 95%CI 1.03-2.99, p=0.04). Conversely, no differences in DM presence were observed between young vs expert consultants (OR: 1.09, 95%CI 0.71-1.70, p=0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts counterparts (56% and 56% vs 44%, p=0.009). When focusing on patients receiving a 2nd look TURBT, the persistent disease was associated with resident status (OR: 4.24, 95%CI 1.14-17.70, p=0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS. CONCLUSION Surgeon's experience in case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at Re-TURBT, although no 5-yr RFS differences were noted.
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Affiliation(s)
- Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy.,Department of Urology, Stanford University School of Medicine, Stanford, USA, CA
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Florian Berndl
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Maximilian Pallauf
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Rocco Simone Flammia
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Dominik Philipp
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Simone Albisinni
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrea Gallioli
- Fundacio Puigvert, 16444, Urology, Barcelona, Catalunya, Spain
| | - Laura S Mertens
- Department of urology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, CHU Lille, F-59000, Lille, France.,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Alessia Cimadamore
- Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Paolo Gontero
- Urology Division, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, New York, USA.,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Benjamin I Chung
- Department of Urology, Stanford University School of Medicine, Stanford, USA, CA
| | - Francesco Soria
- Urology Division, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
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Shalata AT, Shehata M, Van Bogaert E, Ali KM, Alksas A, Mahmoud A, El-Gendy EM, Mohamed MA, Giridharan GA, Contractor S, El-Baz A. Predicting Recurrence of Non-Muscle-Invasive Bladder Cancer: Current Techniques and Future Trends. Cancers (Basel) 2022; 14:5019. [PMID: 36291803 DOI: 10.3390/cancers14205019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/17/2022] Open
Abstract
Bladder cancer (BC) is the 10th most common cancer globally and has a high mortality rate if not detected early and treated promptly. Non-muscle-invasive BC (NMIBC) is a subclassification of BC associated with high rates of recurrence and progression. Current tools for predicting recurrence and progression on NMIBC use scoring systems based on clinical and histopathological markers. These exclude other potentially useful biomarkers which could provide a more accurate personalized risk assessment. Future trends are likely to use artificial intelligence (AI) to enhance the prediction of recurrence in patients with NMIBC and decrease the use of standard clinical protocols such as cystoscopy and cytology. Here, we provide a comprehensive survey of the most recent studies from the last decade (N = 70 studies), focused on the prediction of patient outcomes in NMIBC, particularly recurrence, using biomarkers such as radiomics, histopathology, clinical, and genomics. The value of individual and combined biomarkers is discussed in detail with the goal of identifying future trends that will lead to the personalized management of NMIBC.
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Sun B, Mullapudi SS, Zhang Y, Neoh KG. Glycosylated phospholipid-coated upconversion nanoparticles for bioimaging of non-muscle invasive bladder cancers. Mikrochim Acta 2022; 189:349. [PMID: 36006510 DOI: 10.1007/s00604-022-05411-5] [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: 05/01/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
Detection of non-muscle invasive bladder cancer (NMIBC) is crucial to facilitate complete tumor resection, thus improving the survival rate as well as reducing the recurrence frequency and treatment expense. Fluorescence imaging cystoscopy is an effective method for the detection of NMIBC. However, its application is limited as the commonly applied fluorescent agents such as dyes and photosensitizers usually lack specific tumor accumulation and are vulnerable to photobleaching. Furthermore, the broad emission band of conventional fluorescent agents limits their imaging and detection efficacy. To overcome these limitations, upconversion nanoparticles (UCNPs) have been selected as the fluorescent agent, due to their resistance to photobleaching, less background auto-fluorescence, and narrow emission bands. In order to achieve active tumor targeting, the UCNPs are coated with a glycosylated phospholipid layer. The glycosylated phospholipid-coated UCNPs exhibited high selective accumulation in cancer cells over normal cells and enhanced the upconversion luminescence (UCL) (at 540 nm and 660 nm) from bladder cancer cells under 980 nm laser irradiation. Glycosylated phospholipid coating that promotes uptake of UCNPs by cancer cells, and UCL emitted from UCNPs under NIR (980 nm) laser irradiation for cancer cell imaging.
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Affiliation(s)
- Bowen Sun
- Department of Chemical and Biomolecular Engineering, College of Design and Engineering, National University of Singapore, Singapore, 117585, Singapore.,Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Sneha Sree Mullapudi
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, 117583, Singapore
| | - Yong Zhang
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, 117583, Singapore.
| | - Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering, College of Design and Engineering, National University of Singapore, Singapore, 117585, Singapore.
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40
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Oswald D, Pallauf P, Deininger S, Herrmann TRW, Netsch C, Becker B, Fiedler M, Haecker A, Homberg R, Klein JT, Lehrich K, Miernik A, Olbert P, Schöb DS, Sievert KD, Gross AJ, Westphal J, Lusuardi L. [Safety and efficacy of en bloc vs. conventional transurethral resection of bladder tumors: a meta-analysis and systematic review]. Urologie 2022; 61:644-652. [PMID: 35286433 DOI: 10.1007/s00120-022-01765-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] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. OBJECTIVE To analyze current data on ERBT in efficacy and safety compared to cTURBT. DATA SOURCES PubMed. STUDY SELECTION Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. DATA SYNTHESIS The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. CONCLUSION ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.
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Affiliation(s)
- D Oswald
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich.
| | - P Pallauf
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | - S Deininger
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
| | | | - C Netsch
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - B Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - M Fiedler
- Klinik für Urologie, SLK-Kliniken Heilbronn GmbH, Heilbronn, Deutschland
| | - A Haecker
- Klinik für Urologie und Kinderurologie, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - R Homberg
- Klinik für Urologie, Kinderurologie und Uro-Gynäkologie, St. Barbara-Klinik Hamm-Heessen, Hamm, Deutschland
| | - J T Klein
- Urologische Klinik am Lerchenberg, Heilbronn, Deutschland
| | - K Lehrich
- Klinik für Urologie, Vivantes Auguste-Viktoria-Klinikum, Berlin, Deutschland
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - P Olbert
- BRIXSANA private clinic, Brixen, Italien
| | - D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - K D Sievert
- UKOWL, Campus Klinikum Lippe, Detmold, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Deutschland
| | - J Westphal
- Klinik für Urologie, Kinderurologie und Urogynäkologie, Krankenhaus Maria Hilf der Alexianer GmbH, Krefeld, Deutschland
| | - L Lusuardi
- Universitätsklink für Urologie und Andrologie, Paracelsus Medizinische Universität Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Österreich
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Hirata Y, Higuchi M, Osawa T, Hinotsu S, Harabayashi T, Mochizuki T, Enami N, Nounaka O, Shinno Y, Kikuchi H, Matsumoto R, Abe T, Murai S, Shinohara N. Late recurrence in patients with non-muscle-invasive bladder cancer after 5-year cancer-free periods. Int J Urol 2022; 29:1140-1146. [PMID: 35598096 DOI: 10.1111/iju.14936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES There is no consensus about the follow-up schedule after 5-year cancer-free periods. In this study, we aimed to elucidate the risk factors for the recurrence in patients with non-muscle-invasive bladder cancer who remained cancer free for more than 5 years. METHODS Data from six Japanese institutions were retrospectively reviewed. Among the patients with non-muscle-invasive bladder cancer who were treated with transurethral resection of bladder tumor between 1990 and 2013, those who had no recurrence for more than 5 years were included in this study. The Kaplan-Meier method and Cox hazards model were used to estimate recurrence-free survival and to determine the pathologic and clinical factors affecting late recurrence. RESULTS In total, 434 patients were enrolled in this study. Of these patients, 55 patients (12.7%) experienced late recurrence. The median follow-up time was 8.9 years (interquartile range 6.9-11.3 years). Prior history of bladder cancer before the most recent transurethral resection was a significant predictor for late recurrence (hazard ratio 1.99 [95% confidence interval 1.13-3.47], P = 0.019), although other clinical factors including tumor grade, pathologic stage, tumor multiplicity, and current risk classification systems were not associated with late recurrence. CONCLUSIONS Late recurrence after a long tumor-free period is not rare and it was not predicted by current risk classification systems. Only prior history of bladder cancer was a significant predictor for late recurrence in this study.
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Affiliation(s)
- Yurie Hirata
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics, Sapporo Medical University, Sapporo, Japan
| | | | - Tango Mochizuki
- Department of Urology, Asahikawa City Hospital, Asahikawa, Japan
| | - Nobuyasu Enami
- Department of Urology, Nikko Memorial Hospital, Muroran, Japan
| | - Osamu Nounaka
- Department of Urology, Chitose City Hospital, Chitose, Japan
| | | | - Hiroshi Kikuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Garczyk S, Degener S, Bischoff F, Schnitzler T, Salz A, Golz R, Buchner A, Schulz GB, Schneider U, Gaisa NT, Knüchel R. Heterogenous NECTIN4 expression in urothelial high-risk non-muscle-invasive bladder cancer. Virchows Arch 2022. [PMID: 35484425 DOI: 10.1007/s00428-022-03328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/12/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022]
Abstract
High-grade non-muscle-invasive bladder cancer (HG NMIBC) patients are at high risk (HR) of progression to muscle-invasion. Bladder-preserving therapies for this patient subgroup are limited, and additional treatments are desirable. Recently, enfortumab vedotin, targeting cancer-associated NECTIN4, has been approved for the treatment of advanced urothelial carcinoma. However, data on the expression of NECTIN4 and its therapeutic potential for HR NMIBC are scarce. Here, NECTIN4 was immunohistochemically analyzed in urothelial HG NMIBC by studying cohorts of carcinoma in situ (CIS)/T1HG (N = 182 samples), HG papillary tumors from mixed-grade lesions (mixed TaHG) (N = 87) and papillary HG tumors without a history of low-grade disease (pure TaHG/T1HG) (N = 98) from overall 225 patients. Moreover, inter-lesional NECTIN4 heterogeneity in multifocal HG NMIBC tumors was determined. A high prevalence of NECTIN4 positivity was noted across HG NMIBC subgroups (91%, N = 367 samples), with 77% of samples showing moderate/strong expression. Heterogenous NECTIN4 levels were observed between HG NMIBC subgroups: non-invasive areas of CIS/T1HG and pure TaHG/T1HG samples showed NECTIN4 positivity in 96% and 99%, with 88% and 83% moderate/strong expressing specimens, respectively, whereas significantly lower NECTIN4 levels were detected in mixed TaHG lesions (72% positivity, 48% of samples with moderate/strong NECTIN4 expression). Moreover, higher NECTIN4 heterogeneity was observed in patients with multifocal mixed TaHG tumors (22% of patients) compared to patients with multifocal CIS/T1HG and pure TaHG/T1HG tumors (9% and 5%). Taken together, NECTIN4-directed antibody–drug conjugates might be promising for the treatment of HR NMIBC patients, especially for those exhibiting CIS/T1HG and pure TaHG/T1HG tumors without a history of low-grade disease.
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Symeonidis EN, Baniotis P, Langas G, Stefanidis P, Tsiakaras S, Stratis M, Savvides E, Bouchalakis A, Petras S, Memmos D, Anastasiadis A, Mykoniatis I, Vakalopoulos I, Toutziaris C, Dimitriadis G, Sountoulides P. En bloc resection, is this the future of non-muscle invasive bladder cancer management? Presentation of our technique and brief review of the literature. Urologia 2022; 90:75-79. [PMID: 35467455 DOI: 10.1177/03915603221093739] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The quality of the initial transurethral resection of bladder tumors (TURBT) plays a key role in accurate local staging thus affecting treatment decision-making and disease prognosis. TURBT is still the gold standard for non-muscle invasive bladder cancer (NMIBC). However, en bloc resection of bladder tumors (ERBT) gradually expanded as a promising alternative to TURBT, aiming to overcome certain inherent limitations of conventional resection. We hereby describe a step-by-step bipolar ERBT technique and briefly review the current trends surrounding the role of various en bloc techniques in the field. CASE PRESENTATION We present the case of a 65-year old patient undergoing bipolar ERBT for a single, approximately 2 cm, papillary bladder mass. An experienced urologist completed the procedure within 17 min and without any intra- or postoperative complications. No conversion to TURBT was needed, and an adequate specimen for histological assessment was obtained. The patient made an uneventful recovery, and no recurrence was noted at 12-months. CONCLUSION Our initial experience demonstrates that ERBT via bipolar current is relatively quick, safe, and reliable. Prospective comparative clinical trials will examine its efficacy, and long-term oncological superiority in managing NMIBC.
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Affiliation(s)
- Evangelos N Symeonidis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Baniotis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Langas
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Stefanidis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavros Tsiakaras
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michail Stratis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eliophotos Savvides
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Bouchalakis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Petras
- Department of Pathology, "G. Gennimatas" General Hospital, Thessaloniki, Greece
| | - Dimitrios Memmos
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Anastasiadis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Vakalopoulos
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Chrysovalantis Toutziaris
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Sountoulides
- First Department of Urology, School of Medicine, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Fasulo V, Paciotti M, Lazzeri M, Contieri R, Casale P, Saita A, Lughezzani G, Diana P, Frego N, Avolio PP, Colombo P, Elefante GM, Guazzoni G, Buffi NM, Bates M, Hurle R. Xpert Bladder Cancer Monitor May Avoid Cystoscopies in Patients Under "Active Surveillance" for Recurrent Bladder Cancer (BIAS Project): Longitudinal Cohort Study. Front Oncol 2022; 12:832835. [PMID: 35155263 PMCID: PMC8830778 DOI: 10.3389/fonc.2022.832835] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/03/2022] [Indexed: 12/11/2022] Open
Abstract
Objectives To test the hypothesis that patients under active surveillance (AS) for Non-muscle Invasive Bladder Cancer (NMIBC) who were negative on longitudinal re-testing by the Xpert® Bladder Cancer Monitor (Xpert BC Monitor) assay may avoid unnecessary cystoscopies and urine cytology (UC). Subjects/Patients (or Materials) and Methods This is a prospective cohort study of patients enrolled in the AS protocol for recurrent NMIBC (Bladder Cancer Italian Active Surveillance, BIAS project), whose urine samples were analyzed by Xpert BC Monitor upon entry in the study (T0). Patients who had a negative Xpert test and did not fail AS, underwent additional Xpert tests after 4 (T1), 8 (T2), and 12 (T3) months. The clinical utility of Xpert was assessed by determining the number of cystoscopies and UC that could be avoided within 1 year. Results Overall, 139 patients were tested with Xpert at T0. Median follow-up was 23 (IQR 17–27) months. Sixty-eight (48.9%) patients failed AS, 65 (46.7%) are currently on AS, and 6 (4.3%) were lost at follow-up. At T0 57 (41.0%) patients had a negative test and 36 (63.2%) are still in AS. In patients with 2 consecutives negative Xpert tests, we could have avoided 73.9% of unnecessary cystoscopies, missing 26.4% failure, up to avoid all cystoscopies with 4 negative tests missing only 12% of failure. All the patients with negative Xpert had negative UC. Failure-free-survival at median follow-up (23 month) stratified for having 0, 1, or ≥2 negative tests was 67.0, 55.1. and 84.1, respectively. Conclusion Our findings suggest that Xpert BC Monitor assay, when it is longitudinally repeated, could significantly reduce the number of unnecessary cystoscopies and UC during their follow-up.
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Affiliation(s)
- Vittorio Fasulo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Paolo Casale
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Pietro Diana
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Nicola Frego
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Pier Paolo Avolio
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Grazia Maria Elefante
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
| | - Michael Bates
- Medical and Scientific Affairs and Strategy, Oncology, Cepheid, Sunnyvale, CA, United States
| | - Rodolfo Hurle
- Department of Urology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, Milan, Italy
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45
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Balasubramanian A, Gunjur A, Weickhardt A, Papa N, Bolton D, Lawrentschuk N, Perera M. Adjuvant therapies for non-muscle-invasive bladder cancer: advances during BCG shortage. World J Urol 2022. [PMID: 35083522 DOI: 10.1007/s00345-021-03908-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Non-muscle-invasive bladder cancer (NMIBC) represents a significant global therapeutic challenge, particularly in the era of Bacillus Calmette-Guérin (BCG) shortage. High-risk NMIBC can progress to muscle invasive or metastatic disease in 25% of patients. Optimal treatment selection, according to risk stratification, is imperative. International guidelines slightly differ in their categorisation of low, intermediate and high-risk NMIBC. Nonetheless, a single post-operative instillation of chemotherapy with Mitomycin C (MMC) or Gemcitabine improves relapse-free survival (RFS) in low-risk NMIBC. Induction and maintenance intravesical BCG remains the historical gold standard for patients with intermediate or high-risk NMIBC. However, clinicians may be forced to consider alternatives given the current BCG shortage. Both intravesical MMC and Gemcitabine have been associated with similar efficacy to BCG, albeit in smaller studies. MMC may also be manipulated using a variety of methods to potentiate its effects. BCG treatment delivery may also be modified without affecting efficacy through dose reduction and abbreviation or omission of maintenance therapy. Preliminary data also highlight that directly proceeding to radical cystectomy may not adversely affect long-term quality of life measures. Access to new systemic and intravesical therapies must be prioritised for patients with BCG recurrent or unresponsive disease. When used in conjunction with molecularly defined biomarkers, these agents herald the potential for improved survival outcomes and alleviation of the current BCG shortage.
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46
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Bani-Hani M, Abdel Majid A, Al-Zubi MT, Al Demour S, Al Zoubi MS, Abuhamad M, Santarisi A, Taysir Eldos B, Alsmadi J, Elayan B. Continuous Saline Bladder Irrigation in Reducing Recurrence and Progression When Compared to Immediate Mitomycin- C Instillation Post- Resection of Bladder Tumor: A Short Communication. Asian Pac J Cancer Prev 2022; 23:171-175. [PMID: 35092385 PMCID: PMC9258664 DOI: 10.31557/apjcp.2022.23.1.171] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Intravesical chemotherapy instillation by mitomycin - C (MMC) immediately after transurethral resection of bladder tumor (TURBT), although effective in reducing the incidence of non- muscle invasive bladder cancer (NMIBC) recurrence, can result in non desirable effects like bladder irritation and hematuria . Continuous bladder irrigation with saline post resection has been studied as an alternative. In our study we compare the rates of NMIBC recurrence and progression in patients who were treated with either MMC or CSBI immediately after tumor resection. Methods: We retrospectively reviewed the medical records of patients with NMIBC at our institution in Jordan university hospital in the period between 2015-2019. Postoperative instillation of MMC or CSBI for four hours was recorded. Follow up of the patients for recurrence or progression in the first 2 years after diagnosis was recorded and compared for both groups. Results: One hundred nineteen patients met inclusion criteria. Fifty four patients received MMC and 65 patients received CSBI immediately post TURBT. Kaplan–Meieranalysis for recurrence- free survival and progression- free survival didn’t show a significant difference between both groups with P- value 0.88 and 0.14 respectively. Conclusion: Postoperative CSBI for four hours following tumor resection is equivalent to immediate postoperative MMC instillation for NMIBC in terms of recurrence or progression rates with fewer side effects . However further research is needed in this field .
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Affiliation(s)
- Morad Bani-Hani
- Department of Special Surgery, Division of Urology, School of Medicine, University of Hashemite University, Zarka, Jordan
| | | | - Mohammad Talal Al-Zubi
- Department of Surgery, Division of Urology, School of Medicine, Yarmouk University, Irbid, Jordan
| | - Saddam Al Demour
- Department of Special Surgery, Division of Urology, School of Medicine, University of Jordan, Amman
| | - Mazhar Salim Al Zoubi
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | | | | | - Batool Taysir Eldos
- Department of Clinical Sciences, School of Medicine, Yarmouk university, Irbid, Jordan
| | - Jad Alsmadi
- Department of Special Surgery, Division of Urology, School of Medicine, University of Hashemite University, Zarka, Jordan
| | - Basel Elayan
- Faculty of Medicine, Yarmouk University, Irbid, Jordan
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47
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Rahman KMM, Thapa P, Hurst R, Woo S, You Y. Singlet Oxygen Activatable Prodrugs of Paclitaxel, SN-38, MMC, and CA4: Non-mitochondria Targeted Prodrugs. Photochem Photobiol 2021; 98:389-399. [PMID: 34970997 DOI: 10.1111/php.13589] [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: 11/23/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 10/19/2022]
Abstract
We established a light-activatable prodrug strategy that produces the combination effect of photodynamic therapy (PDT) and site-specific chemotherapy. Prodrugs are activated by singlet oxygen (SO), generated from PS and visible or near IR light, in either intra- or inter-molecular manner. The goal of this study is to evaluate cytotoxic effects of non-mitochondria targeted prodrugs of a number of anticancer drugs with different mechanisms of action. They were tested in both 2D and 3D in vitro conditions via inter-molecular activation of prodrugs by SO generated in mitochondria by protoporphyrin IX-PDT (PpIX-PDT). Prodrugs of anticancer drugs (paclitaxel, SN-38, combrestatin A4, and mitomycin C) were synthesized using facile and high yielding reactions. Non-mitochondria targeted prodrugs showed limited dark toxicity while all of them showed greatly enhanced phototoxicity compared to PpIX-PDT in the 2D culture model. Prodrugs generated up to about 95% cell killing at 2.5 μM when administered with hexyl-aminolevulinate (HAL) to produce Protoporphyrin IX in cancer cells in both 2D monolayer and 3D spheroids model. The data demonstrate that mitochondria-targeting of prodrugs is not fully essential for our inter-molecular activation prodrug strategy. The prodrug strategy also worked for anticancer drugs with diverse MOAs.
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Affiliation(s)
- Kazi Md Mahabubur Rahman
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, 14214, USA
| | - Pritam Thapa
- Drug Discovery Program, Midwest Veterans' Biomedical Research Foundation, KCVA Medical Center, Kansas City, MO, 64128, USA
| | - Robert Hurst
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - Sukyung Woo
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, 14214, USA
| | - Youngjae You
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, 14214, USA
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48
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Fu J, Fu F, Wang Y. 1470 nm/980 nm dual-wavelength laser is safe and efficient for the en-bloc resection of non-muscle invasive bladder cancer: A propensity score-matched analysis. J Int Med Res 2021; 49:3000605211065388. [PMID: 34939431 PMCID: PMC8721717 DOI: 10.1177/03000605211065388] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of a 1470 nm/980 nm dual-wavelength laser system used for the en-bloc resection of non-muscle invasive bladder cancer (NMIBC) compared with transurethral resection of bladder tumour (TURBT). METHODS This retrospective study analysed the demographic and clinical data from patients diagnosed with NMIBC that were treated by either dual laser or TURBT. Intraoperative characteristics, postoperative characteristics and outcomes between the two groups were compared. RESULTS This study analysed 64 patients, 32 in each group. No severe complications were identified in either group. After propensity score-matching, there were no significant differences between the two groups in terms of the demographics, clinical and tumour characteristics. There was no significant difference between the two groups in terms of specimen quality. In the laser group, intraoperative blood loss was significantly lower and significantly fewer patients required continuous bladder irrigation after surgery, compared with the TURBT group. No significant differences were observed in the catheterization time, gross haematuria time and hospitalization time. Operation time in the laser group was significantly longer compared with the TURBT group. No significant difference was found in the recurrence and progression rates between the two groups. CONCLUSIONS The 1470 nm/980 nm dual-wavelength laser provides a safe and effective surgical treatment option for patients with NMIBC.
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Affiliation(s)
- Jianhan Fu
- Department of Urology, The Second Xiangya Hospital, 70566Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Fajun Fu
- Department of Urology, Changsha Central Hospital, Changsha, Hunan Province, China
| | - Yinhuai Wang
- Department of Urology, The Second Xiangya Hospital, 70566Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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49
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Hurst CD, Cheng G, Platt FM, Castro MA, Marzouka NADS, Eriksson P, Black EV, Alder O, Lawson AR, Lindskrog SV, Burns JE, Jain S, Roulson JA, Brown JC, Koster J, Robertson AG, Martincorena I, Dyrskjøt L, Höglund M, Knowles MA. Stage-stratified molecular profiling of non-muscle-invasive bladder cancer enhances biological, clinical, and therapeutic insight. Cell Rep Med 2021; 2:100472. [PMID: 35028613 PMCID: PMC8714941 DOI: 10.1016/j.xcrm.2021.100472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/09/2021] [Revised: 08/09/2021] [Accepted: 11/18/2021] [Indexed: 12/26/2022]
Abstract
Understanding the molecular determinants that underpin the clinical heterogeneity of non-muscle-invasive bladder cancer (NMIBC) is essential for prognostication and therapy development. Stage T1 disease in particular presents a high risk of progression and requires improved understanding. We present a detailed multi-omics study containing gene expression, copy number, and mutational profiles that show relationships to immune infiltration, disease recurrence, and progression to muscle invasion. We compare expression and genomic subtypes derived from all NMIBCs with those derived from the individual disease stages Ta and T1. We show that sufficient molecular heterogeneity exists within the separate stages to allow subclassification and that this is more clinically meaningful for stage T1 disease than that derived from all NMIBCs. This provides improved biological understanding and identifies subtypes of T1 tumors that may benefit from chemo- or immunotherapy.
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Affiliation(s)
- Carolyn D. Hurst
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Guo Cheng
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Fiona M. Platt
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Mauro A.A. Castro
- Bioinformatics and Systems Biology Laboratory, Federal University of Paraná, Curitiba, Brazil
| | | | - Pontus Eriksson
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma V.I. Black
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Olivia Alder
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Andrew R.J. Lawson
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
| | - Sia V. Lindskrog
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Julie E. Burns
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Sunjay Jain
- Pyrah Department of Urology, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Jo-An Roulson
- Department of Histopathology, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Joanne C. Brown
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Jan Koster
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - A. Gordon Robertson
- Canada’s Michael Smith Genome Sciences Center, BC Cancer, Vancouver, BC V5Z 4S6, Canada
| | - Inigo Martincorena
- Cancer, Ageing and Somatic Mutation Programme, Wellcome Sanger Institute, Hinxton CB10 1SA, UK
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mattias Höglund
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Margaret A. Knowles
- Division of Molecular Medicine, Leeds Institute of Medical Research at St James’s, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK
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50
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Dreyer T, Ernst A, Jensen JB. Optimal intervals for follow-up cystoscopy in non-muscle invasive bladder cancer: a systematic review regarding oncological safety. Scand J Urol 2021; 56:39-46. [PMID: 34913840 DOI: 10.1080/21681805.2021.2014562] [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] [Indexed: 10/19/2022]
Abstract
CONTEXT Improving efficiency of follow-up for non-muscle invasive bladder tumours (NMIBC) without risking disease progression through delays of recurrence diagnosis, is a highly relevant field of research. OBJECTIVE The aim of our systematic review was to investigate whether the available evidence support alternative follow-up cytoscopic schedules with respect to oncological safety, compared to those currently given in clinical guidelines for NMIBC. Evidence acquisition we included prospective studies investigating cystoscopy based follow-up schedules including, but not restricted to, comparison of two or more different follow-up schedules with respect to oncological safety measured by recurrence free survival, progression free survival, and overall survival. We allowed for supplementation of modalities such as urinary biomarkers. We screened 680 studies identified by a systematic literature search and, based on our inclusion and exclusion criteria, we included three studies for the narrative synthesis of evidence. CONCLUSION In our systematic search of the literature, we found only low level evidence to support current or alternative cystoscopic follow-up schedules. Clinical trials directly aimed at investigating novel follow-up schedules for NMIBC are needed before substantial changes to existing clinical guidelines can be made.
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Affiliation(s)
- Thomas Dreyer
- Department of Urology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andreas Ernst
- Department of Urology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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