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Mahlow J, Gupta S. Pathology focused review of morphologic subtypes and molecular variants of urothelial carcinoma with an emphasis on clinical/treatment relevance. Urol Oncol 2024; 42:193-202. [PMID: 38341364 DOI: 10.1016/j.urolonc.2024.01.016] [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: 09/07/2023] [Revised: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Urothelial carcinoma (UC) has significant morbidity, mortality, and remains the most financially costly carcinoma to manage and treat. This review will cover special morphologic features of UC that may be noted by the pathologist and any subsequent significance in terms of clinical management or treatment considerations as mentioned or recommended in the latest WHO 2022 classification of GU tumors. Many important potentially therapy altering morphologic findings can be consistently identified and reported on routine microscopic examination of hematoxylin and eosin (H&E) stained slides. Furthermore, there has been a rapid advancement of molecular diagnostics and tailored therapies throughout oncology, and we will briefly highlight some of these as they relate to the management of UC. We will actively attempt to limit the discussion of histologic descriptions or pathologic diagnostic criteria of these entities and focus rather on the recognition of their importance/implication for clinicians who must make clinical management decisions based upon these findings. Finally, the importance of open lines of communication with the pathologists who review clinical specimens as well as their practice and reporting methods cannot be overstated.
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Affiliation(s)
- Jonathon Mahlow
- Department of Pathology, University of Utah, Salt Lake City, UT.
| | - Sumati Gupta
- Huntsman Cancer Institute, Division of Medical Oncology, University of Utah, Salt Lake City, UT; George E. Whalen Department of Veterans Affairs Medical Center, Salt Lake City UT
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2
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Ghose A, Lapitan P, Apte V, Ghosh A, Kandala A, Basu S, Parkes J, Shinde SD, Boussios S, Sharma A, Das P, Vasdev N, Rebuzzi SE, Ürün Y, Kanesvaran R, Maniam A, Banna GL. Antibody Drug Conjugates in Urological Cancers: A Review of the Current Landscape. Curr Oncol Rep 2024:10.1007/s11912-024-01524-7. [PMID: 38652426 DOI: 10.1007/s11912-024-01524-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Our review delves into the progress across urological malignancies and discusses ongoing challenges and future directions in antibody-drug conjugate (ADC) development, emphasising their transformative potential in cancer care. RECENT FINDINGS ADCs have advanced from hematologic to solid tumours, notably in breast cancer, and are now pivotal in metastatic urological cancers as both monotherapies and in combination regimens, underscored by the FDA's approval of enfortumab vedotin and sacituzumab govitecan for metastatic urothelial cancer. Progress in metastatic prostate cancer, particularly with ADCs targeting PSMA and STEAP1, is noteworthy, although renal cell cancer presents ongoing challenges. There is a continual search for agents in the metastatic, relapsed testicular cancer landscape. ADCs have emerged as a pivotal innovation in oncology, blending targeted antibody therapy with potent cytotoxic drugs, significantly advancing treatment options for urological malignancies.
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Affiliation(s)
- Aruni Ghose
- Department of Medical Oncology, Barts Cancer Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
- Department of Medical Oncology, Medway NHS Foundation Trust, Kent, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, Mount Vernon and Watford NHS Trust, Watford, UK
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
- Immuno-Oncology Clinical Network, London, UK
- The Meet-URO Group, Italian Network for Research in Uro-Oncology, Milan, Italy
- British Oncology Network for Undergraduate Societies, London, UK
- United Kingdom and Ireland Global Cancer Network, London, UK
| | - Patricia Lapitan
- British Oncology Network for Undergraduate Societies, London, UK
- United Kingdom and Ireland Global Cancer Network, London, UK
- School of Medical Sciences, University of Manchester, Manchester, UK
- UCL Cancer Institute, University College London, London, UK
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey, UK
| | - Vedika Apte
- University College London Medical School, London, UK
- University College London Oncology Society, London, UK
| | - Adheesh Ghosh
- UCL Cancer Institute, University College London, London, UK
| | | | - Sreejana Basu
- UCL Cancer Institute, University College London, London, UK
- University College London Oncology Society, London, UK
| | - Jo Parkes
- Immuno-Oncology Clinical Network, London, UK
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
- British Oncology Pharmacy Association, London, UK
| | - Sayali D Shinde
- Cancer Academic Sciences Unit, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Kent, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
- Kent and Medway Medical School, University of Kent, Canterbury, UK
- AELIA Organisation, 9Th Km Thessaloniki - Thermi, 57001, Thessaloniki, Greece
| | - Anand Sharma
- Department of Medical Oncology, Mount Vernon Cancer Centre, Mount Vernon and Watford NHS Trust, Watford, UK
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
| | - Prantik Das
- Department of Oncology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Department of Urology, Lister Hospital, East and North Herts NHS Trust, Stevenage, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Apollo Hospitals Educational and Research Foundation (AHERF), Chennai, India
| | - Sara E Rebuzzi
- The Meet-URO Group, Italian Network for Research in Uro-Oncology, Milan, Italy
- Medical Oncology Unit, Ospedale San Paolo, Savona, Italy
- Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy
| | - Yüksel Ürün
- Department of Medical Oncology, Ankara University School of Medicine, Ankara, Turkey
- Ankara University Cancer Research Institute, Ankara, Turkey
| | - Ravindran Kanesvaran
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, SingHealth Duke-NUS Oncology Academic Clinical Programme, Singapore, Singapore
| | - Akash Maniam
- Department of Medical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
- Caribbean Cancer Research Institute, Port of Spain, Trinidad and Tobago.
| | - Giuseppe L Banna
- The Meet-URO Group, Italian Network for Research in Uro-Oncology, Milan, Italy
- Department of Medical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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3
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Ozden SB, Simsekoglu MF, Sertbudak I, Demirdag C, Gurses I. Epithelioid malignant peripheral nerve sheath tumor of the bladder and concomitant urothelial carcinoma: A case report. World J Clin Cases 2024; 12:551-559. [PMID: 38322457 PMCID: PMC10841956 DOI: 10.12998/wjcc.v12.i3.551] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Epithelioid malignant peripheral nerve sheath tumor (EMPNST) of the bladder is a rare entity with devastating features. These tumors are thought to originate from malignant transformation of pre-existing schwannomas of pelvic autonomic nerve plexuses, and unlike the conventional malignant peripheral nerve sheath tumor (MPNST), are not associated with neurofibromatosis. The tumor has distinctive morphological, immunohistochemical and molecular features. Additionally, it tends to be more aggressive and have a higher mortality. This is the first case that presents with a synchronous urothelial carcinoma of the bladder and the epithelioid variant of MPNST in the literature. It's also the second reported case of EMPNST originating from the bladder wall. CASE SUMMARY In this case report, we present the detailed clinical course of a 71-year-old patient with EMPNST of the bladder alongside a literature review. CONCLUSION During the management of EMPNST cases, offering aggressive treatment modalities to the patient, such as radical cystectomy, is appropriate for the best chance to contain the disease, regardless of the tumor stage and the extent of local disease at initial diagnosis.
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Affiliation(s)
- Sami Berk Ozden
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Urology, Istanbul 34100, Fatih, Turkey
| | - Muhammed Fatih Simsekoglu
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Urology, Istanbul 34100, Fatih, Turkey
| | - Ipek Sertbudak
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Pathology, Istanbul 34100, Fatih, Turkey
| | - Cetin Demirdag
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Urology, Istanbul 34100, Fatih, Turkey
| | - Iclal Gurses
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine Department of Pathology, Istanbul 34100, Fatih, Turkey
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Miller EJ, Galsky MD. Precision Medicine in Urothelial Carcinoma: Current Markers to Guide Treatment and Promising Future Directions. Curr Treat Options Oncol 2023; 24:1870-1888. [PMID: 38085403 DOI: 10.1007/s11864-023-01151-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 01/11/2024]
Abstract
OPINION STATEMENT The treatment landscape for urothelial cancer has changed dramatically in the last 10 years, with the approval of several new treatments. At the same time, profiling of individual tumors has become more commonplace with widespread availability of molecular testing and immunohistochemistry. For urothelial cancer, this has led to current guidelines recommending that molecular testing be obtained in the metastatic setting, and that it be considered in the setting of locally advanced disease. Between molecular testing and immunohistochemistry testing of tumors, the only current guideline-directed application of these tests is in the identification of FGFR3 or FGFR2 alterations for use of FGFR inhibitors. While additional recurrent molecular alterations linked to the pathogenesis of urothelial cancer have been identified, the ability to successfully "drug" the pathways association with such alterations remains limited. There has been extensive research into whether expression of particular proteins might inform specific treatment approaches such as the use of PD-L1 testing to guide immune checkpoint blockade. With the integration of antibody-drug conjugates into the treatment armamentarium for urothelial cancer, ongoing research is seeking to determine whether expression of the targets of these therapies, such as Nectin 4, Trop-2, or HER2, could help to guide treatment.
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Affiliation(s)
- Eric J Miller
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai/Tisch Cancer Institute, New York, NY, 10029, USA
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai/Tisch Cancer Institute, New York, NY, 10029, USA.
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Woo S, Becker AS, Das JP, Ghafoor S, Arita Y, Benfante N, Gangai N, Teo MY, Goh AC, Vargas HA. Evaluating residual tumor after neoadjuvant chemotherapy for muscle-invasive urothelial bladder cancer: diagnostic performance and outcomes using biparametric vs. multiparametric MRI. Cancer Imaging 2023; 23:110. [PMID: 37964386 PMCID: PMC10644594 DOI: 10.1186/s40644-023-00632-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) before radical cystectomy is standard of care in patients with muscle-invasive bladder cancer (MIBC). Response assessment after NAC is important but suboptimal using CT. We assessed MRI without vs. with intravenous contrast (biparametric [BP] vs. multiparametric [MP]) for identifying residual disease on cystectomy and explored its prognostic role. METHODS Consecutive MIBC patients that underwent NAC, MRI, and cystectomy between January 2000-November 2022 were identified. Two radiologists reviewed BP-MRI (T2 + DWI) and MP-MRI (T2 + DWI + DCE) for residual tumor. Diagnostic performances were compared using receiver operating characteristic curve analysis. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with disease-free survival (DFS). RESULTS 61 patients (36 men and 25 women; median age 65 years, interquartile range 59-72) were included. After NAC, no residual disease was detected on pathology in 19 (31.1%) patients. BP-MRI was more accurate than MP-MRI for detecting residual disease after NAC: area under the curve = 0.75 (95% confidence interval (CI), 0.62-0.85) vs. 0.58 (95% CI, 0.45-0.70; p = 0.043). Sensitivity were identical (65.1%; 95% CI, 49.1-79.0) but specificity was higher in BP-MRI compared with MP-MRI for determining residual disease: 77.8% (95% CI, 52.4-93.6) vs. 38.9% (95% CI, 17.3-64.3), respectively. Positive BP-MRI and residual disease on pathology were both associated with worse DFS: hazard ratio (HR) = 4.01 (95% CI, 1.70-9.46; p = 0.002) and HR = 5.13 (95% CI, 2.66-17.13; p = 0.008), respectively. Concordance between MRI and pathology results was significantly associated with DFS. Concordant positive (MRI+/pathology+) patients showed worse DFS than concordant negative (MRI-/pathology-) patients (HR = 8.75, 95% CI, 2.02-37.82; p = 0.004) and compared to the discordant group (MRI+/pathology- or MRI-/pathology+) with HR = 3.48 (95% CI, 1.39-8.71; p = 0.014). CONCLUSION BP-MRI was more accurate than MP-MRI for identifying residual disease after NAC. A negative BP-MRI was associated with better outcomes, providing complementary information to pathological assessment of cystectomy specimens.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Jeeban P Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zürich, CH-8091, Switzerland
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Min Yuen Teo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
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Lebret T, Paoletti X, Pignot G, Roumiguié M, Colombel M, Savareux L, Verhoest G, Guy L, Rigaud J, De Vergie S, Poinas G, Droupy S, Kleinclauss F, Courtade-Saïdi M, Piaton E, Radulescu C, Rioux-Leclercq N, Kandel-Aznar C, Renaudin K, Cochand-Priollet B, Allory Y, Nivet S, Rouprêt M. Artificial intelligence to improve cytology performance in urothelial carcinoma diagnosis: results from validation phase of the French, multicenter, prospective VISIOCYT1 trial. World J Urol 2023; 41:2381-2388. [PMID: 37480491 PMCID: PMC10465399 DOI: 10.1007/s00345-023-04519-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/01/2023] [Indexed: 07/24/2023] Open
Abstract
PURPOSE Cytology and cystoscopy, the current gold standard for diagnosing urothelial carcinomas, have limits: cytology has high interobserver variability with moderate or not optimal sensitivity (particularly for low-grade tumors); while cystoscopy is expensive, invasive, and operator dependent. The VISIOCYT1 study assessed the benefit of VisioCyt® for diagnosing urothelial carcinoma. METHODS VISIOCYT1 was a French prospective clinical trial conducted in 14 centers. The trial enrolled adults undergoing endoscopy for suspected bladder cancer or to explore the lower urinary tract. Participants were allocated either Group 1: with bladder cancer, i.e., with positive cystoscopy or with negative cystoscopy but positive cytology, or Group 2: without bladder cancer. Before cystoscopy and histopathology, slides were prepared for cytology and the VisioCyt® test from urine samples. The diagnostic performance of VisioCyt® was assessed using sensitivity (primary objective, 70% lower-bound threshold) and specificity (75% lower-bound threshold). Sensitivity was also assessed by tumor grade and T-staging. VisioCyt® and cytology performance were evaluated relative to the histopathological assessments. RESULTS Between October 2017 and December 2019, 391 participants (170 in Group 1 and 149 in Group 2) were enrolled. VisioCyt®'s sensitivity was 80.9% (95% CI 73.9-86.4%) and specificity was 61.8% (95% CI 53.4-69.5%). In high-grade tumors, the sensitivity was 93.7% (95% CI 86.0-97.3%) and in low-grade tumors 66.7% (95% CI 55.2-76.5%). Sensitivity by T-staging, compared to the overall sensitivity, was higher in high-grade tumors and lower in low-grade tumors. CONCLUSION VisioCyt® is a promising diagnostic tool for urothelial cancers with improved sensitivities for high-grade tumors and notably for low-grade tumors.
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Affiliation(s)
| | - Xavier Paoletti
- Institut Curie, Saint Cloud, France
- Université Versailles Saint-Quentin, Université Paris-Saclay, Saint Cloud, France
| | | | - Mathieu Roumiguié
- Urology Department, Centre Hospitalier Universitaire (CHU) Rangueil, IUCT Oncopole, Toulouse, France
| | - Marc Colombel
- Urology Department, Hôpital Edouard Herriot, Lyon, France
| | - Laurent Savareux
- Urology Auvergne Centre, Clinique de la Chataigneraie, Beaumont, France
| | | | - Laurent Guy
- Urology Department of Urology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | | | | | - Grégoire Poinas
- Urology Department, Clinique Beausoleil, Montpellier, France
| | | | | | | | - Eric Piaton
- Centre de Pathologie Est, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Camelia Radulescu
- Service d'Anatomie et Cytologie Pathologiques, Hôpital Foch, Suresnes, France
| | | | | | - Karine Renaudin
- Department of Pathology, CHU Hôtel Dieu, Nantes, France
- Centre de Recherche en Transplantation et en Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France
| | | | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France
- Institut Curie, PSL Research University, CNRS, UMR144, Equipe Labellisée Ligue Contre le Cancer, Paris, France
| | | | - Morgan Rouprêt
- Urology Department, GRC n°5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
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7
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Anbarasan T, Nissar S, Turbitt J, Walls K, McLuckie S, Clark C, Bourdon JC, Tracey J, Bray S, Shamsuddin A, Alcorn J, Jain S, Hislop R, Biyani CS, Nabi G. Urinary bladder recurrences following ureteroscopic biopsies of upper tract urothelial cancers: a multi-centre observational study with genomic assessment for clonality. Scott Med J 2023; 68:4-13. [PMID: 36576735 DOI: 10.1177/00369330221134233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS Urinary bladder recurrences (UBRs) after radical nephroureterectomy (RNUx) are a known challenge in patients with upper-tract urothelial cancers (UTUCs). We aim to assess factors associated with UBR and clonal-relatedness with resected UTUC. METHODS Patients who underwent RNUx for UTUC between 1998 and 2015 in five institutions were identified. Clonal relatedness between primary UTUC and subsequent UBR in a sub-cohort was assessed using next-generation sequencing. A Kaplan-Meier curve was used to assess differences in UBR between two groups (with or without ureteroscopic biopsy). RESULTS Of 267 patients with complete records, 73 (27.3%) had UBR during follow-up. The five-year UBR-free survival in all patients was 64.7%. The five-year UBR-free-survival was inferior in patients who underwent URS biopsy compared with patients who did not undergo ureteroscopic biopsy (49.9% vs 76.4%, p < 0.001). History of bladder tumour (HR, 95% CI; 2.94, 1.73-5.00, p < 0.001), ureteroscopic biopsy (HR, 95% CI; 2.21, 1.38-3.53, p = 0.001) and preoperative urine cytology ≥C3 (HR, 95% CI; 2.06, 1.24-3.40, p = 0.005) were independently associated with UBR. Patients with ureteroscopic biopsy (n = 3/5) showed identical mutational changes for common genes (TP53 and FGFR3) between primary UTUC and subsequent UBR. CONCLUSIONS Ureteroscopic biopsy of UTUC is a significant risk factor for UBR. Qualitative clonality assessment showed identical mutational signatures between primary UTUC and UBR.
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Affiliation(s)
| | - Sheikh Nissar
- Department of Urology, Pilgrim Hospital, United Lincolnshire NHS Trust, England, UK
| | - Julie Turbitt
- Department of Medical Genetics, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Kathryn Walls
- Tayside Centre for Genomic Analysis, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Sarah McLuckie
- Academic Urology Unit, Division of Imaging Sciences and Technology, University of Dundee, Ninewells Hospital, Dundee, UK
| | - Caroline Clark
- Department of Medical Genetics, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Joel Tracey
- Department of Medical Genetics, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Susan Bray
- Division of Cellular Medicine, University of Dundee, Ninewells Hospital, Dundee, UK.,Tayside Biorepository (TBR), Ninewells Hospital, Dundee, UK
| | - Atlaf Shamsuddin
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jason Alcorn
- Department of Urology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Sunjay Jain
- Pyrah Department of Urology, Leeds Teaching hospitals, NHS Trust, Leeds, UK
| | - Robert Hislop
- Department of Pathology, Ninewells Hospital, Dundee, UK
| | | | - Ghulam Nabi
- Academic Urology Unit, Division of Imaging Sciences and Technology, University of Dundee, Ninewells Hospital, Dundee, UK
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8
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Beijert IJ, Hentschel AE, Bründl J, Compérat EM, Plass K, Rodríguez O, Subiela Henríquez JD, Hernández V, de la Peña E, Alemany I, Turturica D, Pisano F, Soria F, Čapoun O, Bauerová L, Pešl M, Bruins HM, Runneboom W, Herdegen S, Breyer J, Brisuda A, Calatrava A, Rubio-Briones J, Seles M, Mannweiler S, Bosschieter J, Kusuma VRM, Ashabere D, Huebner N, Cotte J, Mertens LS, Claps F, Masson-Lecomte A, Liedberg F, Cohen D, Lunelli L, Cussenot O, El Sheikh S, Volanis D, Côté JF, Rouprêt M, Haitel A, Shariat SF, Mostafid AH, Nieuwenhuijzen JA, Zigeuner R, Dominguez-Escrig JL, Hacek J, Zlotta AR, Burger M, Evert M, Hulsbergen-van de Kaa CA, van der Heijden AG, Kiemeney LALM, Soukup V, Molinaro L, Gontero P, Llorente C, Algaba F, Palou J, N'Dow J, Ribal MJ, van der Kwast TH, Babjuk M, Sylvester RJ, van Rhijn BWG. Prognosis of Primary Papillary Ta Grade 3 Bladder Cancer in the Non-muscle-invasive Spectrum. Eur Urol Oncol 2023; 6:214-221. [PMID: 36670042 DOI: 10.1016/j.euo.2023.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive. OBJECTIVE To evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 5170 primary Ta-T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Time to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution. RESULTS AND LIMITATIONS Ta G3 represented 7.5% (387/5170) of Ta-T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7-4.8%) of Ta G2, 13% (95% CI 9.3-17%) of Ta G3, and 20% (95% CI 17-23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p < 0.001) and longer than for T1 G3 (p = 0.002). Patients with Ta G3 NMIBC with concomitant carcinoma in situ (CIS) had worse prognosis and a similar time to progression as for patients with T1 G3 NMIBC with CIS (p = 0.5). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS The prognosis of Ta G3 tumors in terms of progression appears to be in between that of Ta G2 and T1 G3. However, patients with Ta G3 NMIBC with concomitant CIS have worse prognosis that is comparable to that of T1 G3 with CIS. Our results support the recent EAU NMIBC guideline changes for more refined risk stratification of Ta G3 tumors because many of these patients have better prognosis than previously thought. PATIENT SUMMARY We used data from 17 centers in Europe and Canada to assess the prognosis for patients with stage Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC). Time to cancer progression for Ta G3 cancer differed from both Ta G2 and T1 G3 tumors. Our results support the recent change in the European Association of Urology guidelines for more refined risk stratification of Ta G3 NMIBC because many patients with this tumor have better prognosis than previously thought.
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Affiliation(s)
- Irene J Beijert
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anouk E Hentschel
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Karin Plass
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Oscar Rodríguez
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Virginia Hernández
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Enrique de la Peña
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Isabel Alemany
- Department of Pathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Diana Turturica
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Francesca Pisano
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Otakar Čapoun
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Lenka Bauerová
- Department of Pathology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Michael Pešl
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - H Maxim Bruins
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willemien Runneboom
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sonja Herdegen
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Antonin Brisuda
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Ana Calatrava
- Department of Pathology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Maximilian Seles
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Judith Bosschieter
- Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Venkata R M Kusuma
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - David Ashabere
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Nicolai Huebner
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Juliette Cotte
- Department of Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alexandra Masson-Lecomte
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Fredrik Liedberg
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Daniel Cohen
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Luca Lunelli
- Department of Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Olivier Cussenot
- Department of Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Soha El Sheikh
- Department of Pathology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Volanis
- Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Jean-François Côté
- Department of Pathology, Pitié Salpétrière Hospital, AP-HP, Pierre et Marie Curie Medical School, Sorbonne University, Paris, France
| | - Morgan Rouprêt
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Andrea Haitel
- Department of Pathology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - A Hugh Mostafid
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Richard Zigeuner
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Medical University of Graz, Graz, Austria
| | - Jose L Dominguez-Escrig
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Pathology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Jaromir Hacek
- Department of Pathology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Alexandre R Zlotta
- Department of Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Matthias Evert
- Department of Pathology, University of Regensburg, Regensburg, Germany
| | | | | | - Lambertus A L M Kiemeney
- Department of Health Evidence and Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Viktor Soukup
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Luca Molinaro
- Department of Pathology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Paolo Gontero
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Carlos Llorente
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Ferran Algaba
- Deaprtment of Pathology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Palou
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James N'Dow
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Maria J Ribal
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
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9
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Kang SY, Heo YJ, Kwon GY, Lee J, Park SH, Kim KM. Five-gene signature for the prediction of response to immune checkpoint inhibitors in patients with gastric and urothelial carcinomas. Pathol Res Pract 2023; 241:154233. [PMID: 36455365 DOI: 10.1016/j.prp.2022.154233] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ample evidence supports the potential of programmed death-ligand 1 (PD-L1) expression, detected by immunohistochemistry, as a predictive biomarker for immunotherapy in patients with advanced cancers. To predict the response to immune checkpoint inhibitors in patients with gastric and urothelial carcinomas, we aimed to replace PD-L1 combined positive score (CPS) with CD274 mRNA in the original four-gene signature and PD-L1 CPS model developed by us. METHOD We used quantitative real-time polymerase chain reaction (qRT-PCR) to measure the expression levels of five target genes in a cohort of 49 patients (33 with gastric cancer and 16 with urothelial carcinoma) who had received immunotherapy and whose therapeutic responses were available. The predictive performance was evaluated using R package maxstat. RESULTS Cutoff values of mRNA expression level were measured using the log-rank statistics for progression-free survival (PFS). Based on these cutoffs, immunotherapy responses were predicted and sorted into responder (n = 12, 24.5%) and non-responder (n = 37, 75.5%) groups. The median PFS values of predicted responders and non-responders were 14.8 months (95% confidence interval [CI]: 0-34.7) and 4.7 months (95% CI: 1.0-8.4, p = 0.02), respectively. Among the 12 predicted responders, 10 had microsatellite-stable tumors with a low tumor mutational burden. The actual clinical responses (complete and partial) were higher in the responder group than those in the non-responder group: 83.3% and 16.2%, respectively. CONCLUSION We modified a predictive biomarker for CD274 mRNA expression to predict the response to immunotherapy in patients with gastric or urothelial carcinomas.
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Affiliation(s)
- So Young Kang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - You Jeong Heo
- The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ghee Young Kwon
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeeyun Lee
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se Hoon Park
- Department of Medicine, Division of Hematology-Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Center of Companion Diagnostics, Samsung Medical Center, Seoul, Republic of Korea.
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10
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Beijert IJ, Hentschel AE, Bründl J, Compérat EM, Plass K, Rodríguez O, Subiela Henríquez JD, Hernández V, de la Peña E, Alemany I, Turturica D, Pisano F, Soria F, Čapoun O, Bauerová L, Pešl M, Maxim Bruins H, Runneboom W, Herdegen S, Breyer J, Brisuda A, Calatrava A, Rubio-Briones J, Seles M, Mannweiler S, Bosschieter J, Kusuma VRM, Ashabere D, Huebner N, Cotte J, Mertens LS, Masson-Lecomte A, Liedberg F, Cohen D, Lunelli L, Cussenot O, El Sheikh S, Volanis D, Côté JF, Rouprêt M, Haitel A, Shariat SF, Mostafid AH, Nieuwenhuijzen JA, Zigeuner R, Dominguez-Escrig JL, Hacek J, Zlotta AR, Burger M, Evert M, Hulsbergen-van de Kaa CA, van der Heijden AG, A L M Kiemeney L, Soukup V, Molinaro L, Gontero P, Llorente C, Algaba F, Palou J, N'Dow J, Ribal MJ, van der Kwast TH, Babjuk M, Sylvester RJ, van Rhijn BWG. T1G1 Bladder Cancer: Prognosis for this Rare Pathological Diagnosis Within the Non-muscle-invasive Bladder Cancer Spectrum. Eur Urol Focus 2022; 8:1627-1634. [PMID: 35577750 DOI: 10.1016/j.euf.2022.04.014] [Citation(s) in RCA: 4] [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: 03/04/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The pathological existence and clinical consequence of stage T1 grade 1 (T1G1) bladder cancer are the subject of debate. Even though the diagnosis of T1G1 is controversial, several reports have consistently found a prevalence of 2-6% G1 in their T1 series. However, it remains unclear if T1G1 carcinomas have added value as a separate category to predict prognosis within the non-muscle-invasive bladder cancer (NMIBC) spectrum. OBJECTIVE To evaluate the prognostic value of T1G1 carcinomas compared to TaG1 and T1G2 carcinomas within the NMIBC spectrum. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 5170 primary Ta and T1 bladder tumors from 17 hospitals in Europe and Canada were analyzed. Transurethral resection (TUR) was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Time to recurrence and progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox regression models stratified by institution. RESULTS AND LIMITATIONS T1G1 represented 1.9% (99/5170) of all carcinomas and 5.3% (99/1859) of T1 carcinomas. According to primary TUR dates, the proportion of T1G1 varied between 0.9% and 3.5% per year, with similar percentages in the early and later calendar years. We found no difference in time to recurrence between T1G1 and TaG1 (p = 0.91) or between T1G1 and T1G2 (p = 0.30). Time to progression significantly differed between TaG1 and T1G1 (p < 0.001) but not between T1G1 and T1G2 (p = 0.30). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS The relative prevalence of T1G1 diagnosis was low and remained constant over the past three decades. Time to recurrence of T1G1 NMIBC was comparable to that for other stage/grade NMIBC combinations. Time to progression of T1G1 NMIBC was comparable to that for T1G2 but not for TaG1, suggesting that treatment and surveillance of T1G1 carcinomas should be more like the approaches for T1G2 NMIBC in accordance with the intermediate and/or high risk categories of the European Association of Urology NMIBC guidelines. PATIENT SUMMARY Although rare, stage T1 grade 1 (T1G1) bladder cancer is still diagnosed in daily clinical practice. Using individual patient data from 17 centers in Europe and Canada, we found that time to progression of T1G1 cancer was comparable to that for T1G2 but not TaG1 cancer. Therefore, our results suggest that primary T1G1 bladder cancers should be managed with more aggressive treatment and more frequent follow-up than for low-risk bladder cancer.
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Affiliation(s)
- Irene J Beijert
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anouk E Hentschel
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Karin Plass
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Oscar Rodríguez
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Virginia Hernández
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Enrique de la Peña
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Isabel Alemany
- Department of Pathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Diana Turturica
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Francesca Pisano
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Otakar Čapoun
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Lenka Bauerová
- Department of Pathology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Michael Pešl
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - H Maxim Bruins
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willemien Runneboom
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sonja Herdegen
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Antonin Brisuda
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Ana Calatrava
- Department of Pathology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Maximilian Seles
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Judith Bosschieter
- Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Venkata R M Kusuma
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - David Ashabere
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Nicolai Huebner
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Juliette Cotte
- Department of Urology, Pitié Salpétrière Hospital, AP-HP, GRC no. 5, Oncotype-Uro, Sorbonne University, Paris, France
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alexandra Masson-Lecomte
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Fredrik Liedberg
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Daniel Cohen
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Luca Lunelli
- Department of Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Olivier Cussenot
- Department of Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Soha El Sheikh
- Department of Pathology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Volanis
- Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Jean-François Côté
- Department of Pathology, Pitié Salpétrière Hospital, AP-HP, Pierre et Marie Curie Medical School, Sorbonne University, Paris, France
| | - Morgan Rouprêt
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Pitié Salpétrière Hospital, AP-HP, GRC no. 5, Oncotype-Uro, Sorbonne University, Paris, France
| | - Andrea Haitel
- Department of Pathology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - A Hugh Mostafid
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Richard Zigeuner
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Medical University of Graz, Graz, Austria
| | - Jose L Dominguez-Escrig
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Jaromir Hacek
- Department of Pathology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Alexandre R Zlotta
- Department of Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Matthias Evert
- Department of Pathology, University of Regensburg, Regensburg, Germany
| | | | | | - Lambertus A L M Kiemeney
- Department of Health Evidence and Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Viktor Soukup
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Luca Molinaro
- Department of Pathology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Paolo Gontero
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Carlos Llorente
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Palou
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James N'Dow
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Maria J Ribal
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
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11
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Tariq A, McCart Reed AE, Morton A, Porten S, Vela I, Williams ED, Yaxley JW, Black PC, Roberts MJ. Urothelial Carcinoma and Prostate-specific Membrane Antigen: Cellular, Imaging, and Prognostic Implications. Eur Urol Focus 2022; 8:1256-1269. [PMID: 34429271 DOI: 10.1016/j.euf.2021.07.016] [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: 05/18/2021] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Staging, restaging, and surveillance of urothelial carcinoma (UC) is challenging due to suboptimal accuracy of standard of care imaging modalities. Prostate-specific membrane antigen (PSMA) imaging may serve to improve characterisation of UC. OBJECTIVE To appraise available literature regarding cellular, imaging, and prognostic implications of PSMA for UC. EVIDENCE ACQUISITION A systematic review was performed considering all available literature (including conference abstracts) published from 1990 to 2020 and reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines following registration in PROSPERO (CRD42020186744). All relevant texts relating to immunohistochemical analysis and PSMA-based imaging in UC were included and collated. Additionally, FOLH1 (gene encoding PSMA) expression according to The Cancer Genome Atlas (TCGA) database was analysed as well as according to consensus and TCGA molecular classification subtypes and subsequently compared with clinical outcomes. EVIDENCE SYNTHESIS PSMA expression across UC tumour tissue was heterogeneous (0-100%) but appeared to decrease with increased grade and stage. The TCGA analysis demonstrated loss of FOLH1 expression with increasing T stage (p = 0.0180) and N stage (p = 0.0269), and reduced FOLH1 expression was associated with worse disease-free survival. PSMA expression in UC neovasculature was variable but mostly increased (44-100%). Eleven reports of PSMA-based imaging for UC were identified, reporting on 18 patients. PSMA positron emission tomography (PET) imaging was positive in 17 out of 18 patients. The included literature review data were limited by mostly low-quality, retrospective studies. CONCLUSIONS Tissue PSMA, or FOLH1 expression, may inversely be associated with pathological and survival outcomes in localised UC. PSMA PET imaging may improve detection of metastatic disease and response to systemic therapy due to PSMA expression in neovasculature. Available evidence is limited; thus, larger, prospective studies are required to confirm early results and define populations that benefit most. PATIENT SUMMARY In this systematic review, we assess the potential role of prostate-specific membrane antigen in urothelial cancer. We found that its utility is in expression of blood vessels surrounding metastasis. We conclude that it may be beneficial in detecting metastasis and response to systemic therapies.
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Affiliation(s)
- Arsalan Tariq
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amy E McCart Reed
- University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia
| | - Andrew Morton
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Sima Porten
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Ian Vela
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Urology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Australian Prostate Cancer Research Centre-Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia
| | - Elizabeth D Williams
- Australian Prostate Cancer Research Centre-Queensland, Brisbane, Queensland, Australia; School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia
| | - John W Yaxley
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Queensland, Australia; Department of Urology, Redcliffe Hospital, Brisbane, Queensland, Australia.
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12
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Sorce G, Chierigo F, Flammia RS, Hoeh B, Hohenhorst L, Tian Z, Goyal JA, Graefen M, Terrone C, Gallucci M, Chun FKH, Saad F, Shariat SF, Montorsi F, Briganti A, Karakiewicz PI. Survival trends in chemotherapy exposed metastatic bladder cancer patients and chemotherapy effect across different age, sex, and race/ethnicity. Urol Oncol 2022; 40:380.e19-380.e27. [PMID: 35431135 DOI: 10.1016/j.urolonc.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/01/2022] [Accepted: 03/22/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To test for survival differences in metastatic urothelial carcinoma of the urinary bladder (mUCUB) patients, according to years of diagnosis, age, sex, and race/ethnicity over time and for the effect of chemotherapy on overall mortality (OM). MATERIALS AND METHODS Within the Surveillance, Epidemiology, and End Results (2000-2016), we identified 6860 mUCUB patients. Of those, 3,249 were exposed to chemotherapy. Kaplan-Meier plots and Cox regression models focused on OM. First, we tested the effect of years of diagnosis (historical [2000-2005] vs. intermediate [2006-2011] vs. contemporary [2012-2016]) in chemotherapy exposed mUCUB patients. Second, we tested the effect of chemotherapy in all mUCUB patients. RESULTS In chemotherapy exposed mUCUB patients according to historical vs. intermediate vs. contemporary years, median overall survival was 11 vs. 13 vs. 14 months respectively, which translated into hazard ratios (HR) of 0.86 (P = 0.005) and 0.75 (P < 0.001) in intermediate and contemporary vs. historical, respectively. Subgroup analyses in <70 years old, males and Caucasians were in agreement regarding statistically significant differences between historical vs. intermediate vs. contemporary, respectively. In multivariable Cox regression models fitted in the entire mUCUB cohort, chemotherapy exposure reduced OM (HR: 0.46; P < 0.001). Virtually the same results were recorded in age, sex, and race/ethnicity subgroups analyses. CONCLUSIONS Contemporary chemotherapy exposed mUCUB patients exhibited better survival than their historical and intermediate counterparts. Chemotherapy reduced mortality by half, across all patient types.
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Affiliation(s)
- Gabriele Sorce
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Rocco Simone Flammia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Jordan A Goyal
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza University Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Departments of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Praga, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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13
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Valderrama BP, González-Del-Alba A, Morales-Barrera R, Peláez Fernández I, Vázquez S, Caballero Díaz C, Domènech M, Fernández Calvo O, Gómez de Liaño Lista A, Arranz Arija JÁ. SEOM-SOGUG clinical guideline for localized muscle invasive and advanced bladder cancer (2021). Clin Transl Oncol 2022; 24:613-24. [PMID: 35347572 DOI: 10.1007/s12094-022-02815-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 11/05/2022]
Abstract
Most muscle-invasive bladder cancer (BC) are urothelial carcinomas (UC) of transitional origin, although histological variants of UC have been recognized. Smoking is the most important risk factor in developed countries, and the basis for prevention. UC harbors high number of genomic aberrations that make possible targeted therapies. Based on molecular features, a consensus classification identified six different MIBC subtypes. Hematuria and irritative bladder symptoms, CT scan, cystoscopy and transurethral resection are the basis for diagnosis. Radical cystectomy with pelvic lymphadenectomy is the standard approach for muscle-invasive BC, although bladder preservation is an option for selected patients who wish to avoid or cannot tolerate surgery. Perioperative cisplatin-based neoadjuvant chemotherapy is recommended for cT2-4aN0M0 tumors, or as adjuvant in patients with pT3/4 and or pN + after radical cystectomy. Follow-up is particularly important after the availability of new salvage therapies. It should be individualized and adapted to the risk of recurrence. Cisplatin–gemcitabine is considered the standard first line for metastatic tumors. Carboplatin should replace cisplatin in cisplatin-ineligible patients. According to the EMA label, pembrolizumab or atezolizumab could be an option in cisplatin-ineligible patients with high PD-L1 expression. For patients whose disease respond or did not progress after first-line platinum chemotherapy, maintenance with avelumab prolongs survival with respect to the best supportive care. Pembrolizumab also increases survival versus vinflunine or taxanes in patients with progression after chemotherapy who have not received avelumab, as well as enfortumab vedotin in those progressing to first-line chemotherapy followed by an antiPDL1/PD1. Erdafitinib may be considered in this setting in patients with FGFR alterations. An early onset of supportive and palliative care is always strongly recommended.
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14
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Stokkel LE, van Montfoort ML, van Boven HH, Mertens LS, van Rhijn BWG. Two Patients with Urachal Cancer with Multifocal Adenocarcinoma Recurrences in the Urothelium of the Prostatic and Penile Urethra. EUR UROL SUPPL 2021; 33:56-60. [PMID: 34622223 DOI: 10.1016/j.euros.2021.08.010] [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] [Accepted: 08/09/2021] [Indexed: 11/21/2022] Open
Abstract
We report two cases with recurrences of urachal adenocarcinoma (UrAC) in the urethra. Both patients had mucinous UrAC without metastasis, for which they were treated with en-bloc partial cystectomy and umbilectomy. The first patient developed recurrence of UrAC in the distal urethra after 1 yr. Distal urethrectomy revealed multiple additional recurrences in the penile and prostatic urethra. The patient underwent radical cystoprostatectomy with en-bloc urethrectomy. At 5 mo after surgery, liver metastases were found. A search in our institutional database revealed a second patient who developed a solitary recurrence of UrAC in the prostatic urethra 8 yr after partial cystectomy. Radical cystoprostatectomy was performed. The patient subsequently experienced recurring UrAC in the urethra, which were treated with multiple surgeries and radiation. Unfortunately, local tumor control could not be achieved and the patient developed distant metastases 7 yr after cystoprostatectomy. Our two cases and four comparable cases reported in the literature indicate that urothelial spread of UrAC is rare but possible. It remains to be determined if UrAC spreads along the urothelium similar to urothelial cancer or if these multifocal urethral recurrences were the first sign of local metastasis.
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15
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Colling R, Colling H, Browning L, Verrill C. Validation of grading of non-invasive urothelial carcinoma by digital pathology for routine diagnosis. BMC Cancer 2021; 21:995. [PMID: 34488682 PMCID: PMC8420048 DOI: 10.1186/s12885-021-08698-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 08/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Pathological grading of non-invasive urothelial carcinoma has a direct impact upon management. This study evaluates the reproducibility of grading these tumours on glass slides and digital pathology. Methods Forty eight non-invasive urothelial bladder carcinomas were graded by three uropathologists on glass and on a digital platform using the 1973 WHO and 2004 ISUP/WHO systems. Results Consensus grades for glass and digital grading gave Cohen’s kappa scores of 0.78 (2004) and 0.82 (1973). Of 142 decisions made on the key therapeutic borderline of low grade versus high grade urothelial carcinoma (2004) by the three pathologists, 85% were in agreement. For the 1973 grading system, agreement overall was 90%. Conclusions Agreement on grading on glass slide and digital screen assessment is similar or in some cases improved, suggesting at least non-inferiority of DP for grading of non-invasive urothelial carcinoma.
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Affiliation(s)
- Richard Colling
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK. .,Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Hayleigh Colling
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Lisa Browning
- Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,Department of Cellular Pathology, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford, OX3 9DU, UK.,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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16
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Roslly MZ, Mustapha AWMM, Zainal IA. Gastrocnemius acrometastasis from muscle-invasive urothelial bladder carcinoma: A case report. Radiol Case Rep 2021; 16:2099-2102. [PMID: 34158902 PMCID: PMC8203580 DOI: 10.1016/j.radcr.2021.04.069] [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: 02/03/2021] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 11/05/2022] Open
Abstract
Urinary bladder carcinoma is a common malignancy worldwide. The metastatic disease to distant organs including lung, liver, and bone is well established. However, metastasis to below-knee-level; also known as acrometastasis is a rare occurrence and occurs approximately 0.1% of all bone metastases. It is standard of care to obtain a contrast enhanced computed tomography scan of the chest, abdomen, and pelvis for pretreatment planning, primary staging, and post treatment disease surveillance. This makes the occurrence of acrometastasis harder to detect and may only manifest clinically in advance disease. We report a case of 55 years old gentleman treated as muscle-invasive bladder urothelial carcinoma, presented with chronic left knee pain, and imaging demonstrating tumor in the left knee region. Histopathologic study shows features of metastatic disease from urinary bladder carcinoma to the left gastrocnemius muscle. The attending physician should raise the suspicion of metastatic disease if the patient with known malignancy presented with new soft tissue lesion elsewhere in the body.
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Affiliation(s)
- Mohd Zulkimi Roslly
- Department of Radiology, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Aida Widure Mustapha Mohd Mustapha
- Department of Radiology, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Isa Azzaki Zainal
- Department of Radiology, Faculty of Medicine, Hospital Canselor Tunku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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17
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Manzano RG, Catalan-Latorre A, Brugarolas A. RB1 and TP53 co-mutations correlate strongly with genomic biomarkers of response to immunity checkpoint inhibitors in urothelial bladder cancer. BMC Cancer 2021; 21:432. [PMID: 33879103 PMCID: PMC8056512 DOI: 10.1186/s12885-021-08078-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/22/2021] [Indexed: 12/30/2022] Open
Abstract
Background Muscle invasive urothelial bladder carcinoma (MIBC) present RB1 and TP53 somatic alterations in a variable percentage of tumors throughout all molecular subtypes. MIBCs with neuroendocrine features have a high response rate to immunity checkpoint inhibitors (ICIs). Whether the presence of somatic co-alterations in these 2 genes in MIBCs is relevant to their responsiveness to ICIs is not known. Methods The potential correlation of different genomic biomarkers of response to ICIs like tumor mutational burden (TMB), single nucleotide variants (SNV) predicted neoantigens, DNA damage response (DDR) genes, DNA somatic signatures and TILs infiltrate was explored in patients with somatic co-alterations in RB1 and TP53 (RB1&TP53) as compared with patients with no alterations in any (double wild type, DWT) or with alterations in just one of the 2 genes. The Cancer Genome Atlas (TCGA) pancancer BLCA dataset of cystectomy specimens (n = 407) with mutation, copy number alterations and transcriptomic (RNA sequencing) data as well as the IMVigor 210 study (n = 348) of metastatic urothelial bladder cancers treated with atezolizumab (PD-L1 inhibitor) with clinical response data containing transcriptomic (RNA sequencing), along with a subset (n = 274) with mutation and copy number data were used for this purpose. A novel tumor microenvironment metascore (TMM) was developed based in a LASSO regularized Cox model with predictive and prognostic ability. Results Samples with co-altered RB1&TP53: a) were enriched in immunity effectors (CD8 cytotoxic lymphocytes, NK cells) and display higher scores of a T cell inflamed signature; b) have a higher TMB, higher number of SNV predicted neoantigens and higher TILs fractions; c) have a higher number of DDR mutated and deep deleted DDR genes; d) have DNA somatic signatures 2 and 13 related to APOBEC mutagenesis. Using the IMVigor 210 dataset, RB1&TP53 samples had the highest response rate to atezolizumab and a strong correlation with TMB and TMM. The consensus molecular subtype classification in the IMVigor 210 dataset showed a significant correlation with both the response to treatment (p = 0.001, Chisquare) and the presence of RB1 and TP53 genomic alterations (p < 0.001, Chisquare). Conclusions RB1&TP53 co-alterations are strongly associated with genomic biomarkers of response to ICIs in MIBCs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08078-y.
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Affiliation(s)
- Ramon Gonzalez Manzano
- Molecular Genetics and Genomics Laboratory, Unidad de Consejo Genetico, Plataforma de Oncologia, Hospital Quironsalud Torrevieja, Pda. La Loma s/n, 03184, Torrevieja (Alicante), Spain.
| | - Ana Catalan-Latorre
- Unidad de Farmacocinetica y Farmacoterapia Personalizada, Plataforma de Oncologia, Hospital Quironsalud Torrevieja, Pda. La Loma s/n, 03184, Torrevieja (Alicante), Spain
| | - Antonio Brugarolas
- Medical Oncology Department, Plataforma de Oncologia, Hospital Quironsalud Torrevieja, Pda. La Loma s/n, 03184, Torrevieja (Alicante), Spain
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18
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Cancel-Tassin G, Roupret M, Pinar U, Gaffory C, Vanie F, Ondet V, Compérat E, Cussenot O. Assessment of Xpert Bladder Cancer Monitor test performance for the detection of recurrence during non-muscle invasive bladder cancer follow-up. World J Urol 2021; 39:3329-3335. [PMID: 33770241 PMCID: PMC7994915 DOI: 10.1007/s00345-021-03629-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose To assess the performance of the Xpert Bladder Cancer (BC) Monitor during the follow-up of patients with non-muscle invasive bladder cancer (NMIBC). Methods Patients with previously diagnosed NMIBC and followed up in clinical practice settings in two French urology departments between September 2017 and July 2019 were consecutively enrolled in this prospective observational study. Patients with a positive cystoscopy or computed tomography urogram underwent subsequent transurethral resection of the bladder, and/or biopsy, and the specimens were pathologically assessed. Cytology and Xpert BC Monitor tests were performed on urine samples. Xpert BC Monitor performance was assessed versus cystoscopy for disease-negative patients or versus histology for disease-positive patients, and was compared to that of cytology. Results Overall, 500 patients with a median age of 70.0 years were included. NMIBC recurrence was diagnosed in 44 cases (8.8%). Overall sensitivity, specificity, and negative predictive values (NPVs) were 72.7% (32/44), 73.7% (330/448) and 96.5% (330/342) for the Xpert BC Monitor, and 7.7% (2/26), 97.8% (310/317) and 92.8% (310/334) for cytology, respectively. The Xpert BC Monitor detected 92.3% (12/13) of the high-grade tumours and ruled out their presence in 99.7% (330/331) of cases. Analysis of the areas under the receiver operating characteristic curves demonstrated the superior performance of the Xpert BC Monitor over that of cytology. Conclusion Xpert BC Monitor performance was superior to that of cytology in the follow-up of NMIBC. The exclusion of aggressive tumours with a very high NPV (99.7%) supports the use of this urinary test in daily practice.
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Affiliation(s)
- G Cancel-Tassin
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,CeRePP, Hôpital Tenon, 75020, Paris, France
| | - M Roupret
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - U Pinar
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France
| | - C Gaffory
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,CeRePP, Hôpital Tenon, 75020, Paris, France
| | - F Vanie
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - V Ondet
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France
| | - E Compérat
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.,CeRePP, Hôpital Tenon, 75020, Paris, France.,Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Olivier Cussenot
- Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France. .,CeRePP, Hôpital Tenon, 75020, Paris, France.
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Polanco-Pujol L, Caño-Velasco J, Moralejo-Garate M, Bataller-Monfort V, Subirá-Ríos D, Hernández Fernández C. [Penile metastasis from urothelial carcinoma: Review of literature.]. ARCH ESP UROL 2021; 74:208-214. [PMID: 33650535] [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: 06/12/2023]
Abstract
OBJECTIVE Penile metastasis is a very rare clinical entity. The primary origin is usually genitourinar y followed by the gastrointestinal. MATERIAL AND METHODS: Review of the available literature on a case of penile metastasis of urothelial bladder carcinoma. RESULTS Penile metastasis is an exceptional entity despite the rich vascularization of this organ. Less than 500 cases have been described. Most cases manifestas exophytic or nodular lesions. Its association with disseminated disease conditions its palliative management in a large part of the cases, as well as an unfavorable prognosis. In selected cases, surgical treatment can be chosen. CONCLUSIONS: Since its clinical presentation is variable, clinical suspicion is important in the presence of a skin lesion of torpid evolution taking into account the patient's oncological history.
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Affiliation(s)
- Lucia Polanco-Pujol
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | - Jorge Caño-Velasco
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
| | | | | | - David Subirá-Ríos
- Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España
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van Rhijn BWG, Hentschel AE, Bründl J, Compérat EM, Hernández V, Čapoun O, Bruins HM, Cohen D, Rouprêt M, Shariat SF, Mostafid AH, Zigeuner R, Dominguez-Escrig JL, Burger M, Soukup V, Gontero P, Palou J, van der Kwast TH, Babjuk M, Sylvester RJ. Prognostic Value of the WHO1973 and WHO2004/2016 Classification Systems for Grade in Primary Ta/T1 Non-muscle-invasive Bladder Cancer: A Multicenter European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel Study. Eur Urol Oncol 2021; 4:182-191. [PMID: 33423944 DOI: 10.1016/j.euo.2020.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 10/15/2020] [Revised: 11/23/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND In the current European Association of Urology (EAU) non-muscle-invasive bladder cancer (NMIBC) guideline, two classification systems for grade are advocated: WHO1973 and WHO2004/2016. OBJECTIVE To compare the prognostic value of these WHO systems. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 5145 primary Ta/T1 NMIBC patients from 17 centers were collected between 1990 and 2019. The median follow-up was 3.9 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Univariate and multivariable analyses of WHO1973 and WHO2004/2016 stratified by center were performed for time to recurrence, progression (primary endpoint), cystectomy, and duration of survival, taking into account age, concomitant carcinoma in situ, gender, multiplicity, tumor size, initial treatment, and tumor stage. Harrell's concordance (C-index) was used for prognostic accuracy of classification systems. RESULTS AND LIMITATIONS The median age was 68 yr; 3292 (64%) patients had Ta tumors. Neither classification system was prognostic for recurrence. For a four-tier combination of both WHO systems, progression at 5-yr follow-up was 1.4% in low-grade (LG)/G1, 3.8% in LG/G2, 7.7% in high grade (HG)/G2, and 18.8% in HG/G3 (log-rank, p < 0.001). In multivariable analyses with WHO1973 and WHO2004/2016 as independent variables, WHO1973 was a significant prognosticator of progression (p < 0.001), whereas WHO2004/2016 was not anymore (p = 0.067). C-indices for WHO1973, WHO2004, and the WHO systems combined for progression were 0.71, 0.67, and 0.73, respectively. Prognostic analyses for cystectomy and survival showed results similar to those for progression. CONCLUSIONS In this large prognostic factor study, both classification systems were prognostic for progression but not for recurrence. For progression, the prognostic value of WHO1973 was higher than that of WHO 2004/2016. The four-tier combination (LG/G1, LG/G2, HG/G2, and HG/G3) of both WHO systems proved to be superior, as it divides G2 patients into two subgroups (LG and HG) with different prognoses. Hence, the current EAU-NMIBC guideline recommendation to use both WHO classification systems remains correct. PATIENT SUMMARY At present, two classification systems are used in parallel to grade non-muscle-invasive bladder tumors. Our data on a large number of patients showed that the older classification system (WHO1973) performed better in terms of assessing progression than the more recent (WHO2004/2016) one. Nevertheless, we conclude that the current guideline recommendation for the use of both classification systems remains correct, since this has the advantage of dividing the large group of WHO1973 G2 patients into two subgroups (low and high grade) with different prognoses.
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Affiliation(s)
- Bas W G van Rhijn
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
| | - Anouk E Hentschel
- Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes Bründl
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Virginia Hernández
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Otakar Čapoun
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - H Maxim Bruins
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniel Cohen
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Royal Free London - NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Morgan Rouprêt
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - A Hugh Mostafid
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Richard Zigeuner
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Medical University of Graz, Graz, Austria
| | - Jose L Dominguez-Escrig
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Fundación Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
| | - Maximilian Burger
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Viktor Soukup
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Paolo Gontero
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Joan Palou
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
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Pradere B, D'Andrea D, Schuettfort VM, Foerster B, Quhal F, Mori K, Abufaraj M, Margulis V, Deuker M, Briganti A, Muilwijk T, Hendricksen K, Lotan Y, Karakiewic P, F Shariat S; UTUC collaboration. Pre-therapy serum albumin-to-globulin ratio in patients treated with neoadjuvant chemotherapy and radical nephroureterectomy for upper tract urothelial carcinoma. World J Urol 2021; 39:2567-77. [PMID: 33067726 DOI: 10.1007/s00345-020-03479-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/21/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The accurate selection of patients who are most likely to benefit from neoadjuvant chemotherapy is an important challenge in oncology. Serum AGR has been found to be associated with oncological outcomes in various malignancies. We assessed the association of pre-therapy serum albumin-to-globulin ratio (AGR) with pathologic response and oncological outcomes in patients treated with neoadjuvant platin-based chemotherapy followed by radical nephroureterectomy (RNU) for clinically non-metastatic UTUC. METHODS We retrospectively included all clinically non-metastatic patients from a multicentric database who had neoadjuvant platin-based chemotherapy and RNU for UTUC. After assessing the pretreatment AGR cut-off value, we found 1.42 to have the maximum Youden index value. The overall population was therefore divided into two AGR groups using this cut-off (low, < 1.42 vs high, ≥ 1.42). A logistic regression was performed to measure the association with pathologic response after NAC. Univariable and multivariable Cox regression analyses tested the association of AGR with OS and RFS. RESULTS Of 172 patients, 58 (34%) patients had an AGR < 1.42. Median follow-up was 26 (IQR 11-56) months. In logistic regression, low AGR was not associated with pathologic response. On univariable analyses, pre-therapy serum AGR was neither associated with OS HR 1.15 (95% CI 0.77-1.74; p = 0.47) nor RFS HR 1.48 (95% CI 0.98-1.22; p = 0.06). These results remained true regardless of the response to NAC. CONCLUSION Pre-therapy low serum AGR before NAC followed by RNU for clinically high-risk UTUC was not associated with pathological response or long-term oncological outcomes. Biomarkers that can complement clinical factors in UTUC are needed as clinical staging and risk stratification are still suboptimal leading to both over and under treatment despite the availability of effective therapies.
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22
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Zhang Z, Fu X, Liu J, Huang Z, Liu N, Fang F, Rao J. Developing a Machine Learning Algorithm for Identifying Abnormal Urothelial Cells: A Feasibility Study. Acta Cytol 2020; 65:335-341. [PMID: 33022673 DOI: 10.1159/000510474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/05/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Urine cytology plays an important role in diagnosing urothelial carcinoma (UC). However, urine cytology interpretation is subjective and difficult. Morphogo (ALAB, Boston, MA, USA), equipped with automatic acquisition and scanning, optical focusing, and automatic classification with convolutional neural network has been developed for bone marrow aspirate smear analysis of hematopoietic diseases. The goal of this preliminary study was to determine the feasibility of developing a machine learning algorithm on Morphogo for identifying abnormal urothelial cells in urine cytology slides. METHODS Thirty-seven achieved abnormal urine cytology slides from cases with the diagnosis of atypical urothelial cells and above (suspicions or positive for UC) were obtained from 1 hospital. A pathologist (J.R.) reviewed the slides and manually selected and annotated representative cells to feed into Morphogo with following categories: benign (urothelial cells, squamous cells, degenerated cells, and inflammatory cells), atypical cells, and suspicious cells. Initial validation of the algorithm was performed on a subset of the original 37 cases. Urine samples from additional 12 unknown cases with various histological diagnoses (6 cases of high-grade urothelial carcinoma (HGUC), 1 case of low-grade urothelial carcinoma (LGUC), 1 case of prostate adenocarcinoma, 1 case of renal cell carcinoma, and 4 cases of non-neoplastic conditions) were collected from another hospital for initial blind testing. RESULTS A total of 1,910 benign and 1,978 abnormal (atypical and suspicious) cells from 37 slides were annotated for developing and training of the algorithm. This algorithm was validated on 27 slides that resulted in identification of at least 1 abnormal cell per slide, with a total of 200 abnormal cells, and an average of 7.4 cells per slide. Of the 12 unknown cases tested, the original cytology was positive for tumor cells in 2 HGUC samples. Morphogo was abnormal (atypical or suspicious) for 6 samples from patients with UC, including one with LGUC and one with prostate adenocarcinoma. CONCLUSION Morphogo machine learning algorithm is capable of identifying abnormal urothelial cells. Further validation studies with a larger number of urine samples will be needed to determine if it can be used to assist the cytological diagnosis of UC.
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Affiliation(s)
- Zhihui Zhang
- Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences (CHCAMS), Beijing, China
| | - Xinyan Fu
- Division of Medical Technology Development, Hangzhou Zhiwei Information & Technology Ltd., Hangzhou, Hangzhou, China
| | - Jiwei Liu
- Department of Oncology, The First Hospital of Dalian Medical University (FHDMU), Dalian, China
| | - Zhen Huang
- Division of Medical Technology Development, Hangzhou Zhiwei Information & Technology Ltd., Hangzhou, Hangzhou, China
| | - Natalia Liu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Fengqi Fang
- Department of Oncology, The First Hospital of Dalian Medical University (FHDMU), Dalian, China
| | - Jianyu Rao
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California, USA,
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Kiyohara T, Tanimura H. GATA3-Positive Adnexal Adenocarcinoma: Report of a Confusing Case with a Potential Pitfall of Leading to a Misdiagnosis of Urothelial Carcinoma and a Review of Published Work. Ann Dermatol 2020; 32:417-421. [PMID: 33911777 PMCID: PMC7992588 DOI: 10.5021/ad.2020.32.5.417] [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: 08/22/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/11/2022] Open
Abstract
We describe a confusing case of GATA3-positive adnexal adenocarcinoma with a potential pitfall of leading to a misdiagnosis of urothelial carcinoma. A 62-year-old male presented with a subcutaneous nodule on the right lower abdomen around a scar from surgery for urothelial carcinoma in the right urinary tract, which had been resected 8 years previously. Histologically, atypical cells possessing ample cytoplasm and partial intracytoplasmic lumens were densely grouped in the subcutaneous expansive nodule and bilateral inguinal lymph nodes dissected. Decapitation secretion could not be seen. Neoplastic cells were positive for CK7, GATA3, and GCDFP15, and negative for CK5/6, CK20, p63, CD10, PAX8, HER-2, and uroplakin-II. Neoplastic cells in the urothelium and the metastasized lung were positive for CK7, CK5/6, and GATA3, and negative for CK20, p63, GCDFP15, and TTF-1. A variable level of GATA3 expression in malignant tumors with apocrine and eccrine differentiation should be recognized by dermatologists.
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Affiliation(s)
- Takahiro Kiyohara
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
| | - Hirotsugu Tanimura
- Department of Dermatology, Kansai Medical University Medical Center, Osaka, Japan
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24
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Guo W, Lee W, Lu Y, Li X, Chandan VS. Incidence and significance of GATA3 positivity in gallbladder adenocarcinoma. Hum Pathol 2020; 106:39-44. [PMID: 32991930 DOI: 10.1016/j.humpath.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 01/11/2023]
Abstract
GATA3 immunostaining is a sensitive marker for mammary and urothelial carcinomas. It is routinely used in surgical pathology during workup of carcinomas of unknown origin. To the best of our knowledge, this is the first focused study of GATA3 expression in gallbladder adenocarcinomas. In this study, we evaluated GATA3 expression in 38 gallbladder adenocarcinomas. Eight of 38 (21%) gallbladder adenocarcinomas were positive for GATA3. The expression of GATA3 tended to be moderate to strong when present. It was patchy (<50% positivity) in 4 cases, characterized by discrete clusters or groups of malignant cells with areas of intervening negative tumor cells, whereas it was diffuse (>50% positivity) in the other 4 cases. GATA3 expression did not show any significant correlation with clinicopathologic features such as sex, histologic grade, perineural invasion, vascular invasion, pathologic stage, or distance metastasis. The results of our study show that a subset of gallbladder adenocarcinomas (21%) can be GATA3 positive. Awareness of this phenomenon is important while working up GATA3-positive carcinomas immunohistochemically.
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Affiliation(s)
- Wenchang Guo
- Department of Pathology and Laboratory Medicine, University of California-Irvine, CA, United States
| | - Whayoung Lee
- Department of Pathology and Laboratory Medicine, University of California-Irvine, CA, United States
| | - Yunxia Lu
- Department of Population Health and Disease Prevention, Program in Public Health, University of California-Irvine, CA, United States
| | - Xiaodong Li
- Department of Pathology and Laboratory Medicine, University of California-Irvine, CA, United States
| | - Vishal S Chandan
- Department of Pathology and Laboratory Medicine, University of California-Irvine, CA, United States.
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Siraj F, Dulal J, Sharma S, Gupta P, Vasudeva P, Malik A. Benign Mimickers of Urinary Bladder Cancer: a Case Series. Indian J Surg Oncol 2020; 11:161-164. [PMID: 33364688 PMCID: PMC7732960 DOI: 10.1007/s13193-020-01152-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 06/22/2020] [Indexed: 10/23/2022] Open
Abstract
Bladder cancer is one of the leading malignancies in the world associated with significant morbidity and mortality. However, several benign lesions of the bladder can mimic urothelial carcinoma clinically and radiologically owing to overlapping signs and symptoms. Thus, rendering a correct diagnosis is imperative as it will have a significant impact on the management of patients. We present an amalgamation of five cases having a high suspicion of urothelial malignancy, which were subsequently diagnosed as benign entities with better prognosis and thus warranted a different therapeutic approach.
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Affiliation(s)
- Fouzia Siraj
- Department of Pathology, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, Room number 610, 6th floor, New Delhi, India
| | - Jeewendra Dulal
- Department of Pathology, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, Room number 610, 6th floor, New Delhi, India
| | - Shruti Sharma
- Department of Pathology, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, Room number 610, 6th floor, New Delhi, India
| | - Pooja Gupta
- Department of Pathology, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, Room number 610, 6th floor, New Delhi, India
| | - Pawan Vasudeva
- Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Akanksha Malik
- Department of Pathology, ICMR-National Institute of Pathology, Safdarjung Hospital Campus, Room number 610, 6th floor, New Delhi, India
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Pfister C, Gravis G, Fléchon A, Soulié M, Guy L, Laguerre B, Mottet N, Joly F, Allory Y, Harter V, Culine S. Randomized Phase III Trial of Dose-dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin, or Gemcitabine and Cisplatin as Perioperative Chemotherapy for Patients with Muscle-invasive Bladder Cancer. Analysis of the GETUG/AFU V05 VESPER Trial Secondary Endpoints: Chemotherapy Toxicity and Pathological Responses. Eur Urol 2020; 79:214-221. [PMID: 32868138 DOI: 10.1016/j.eururo.2020.08.024] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Perioperative chemotherapy (neoadjuvant or adjuvant) has been developed to increase overall survival for nonmetastatic muscle-invasive bladder cancer (MIBC). Retrospective studies or prospective phase II trials have been reported to use dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) or gemcitabine and cisplatin (GC). As dd-MVAC has shown higher response rates in metastatic disease, better efficacy is expected in the perioperative setting. OBJECTIVE We designed a randomized phase III trial to compare the efficacy of dd-MVAC or GC in MIBC perioperative (neoadjuvant or adjuvant) setting. DESIGN, SETTING AND PARTICIPANTS A total of 500 patients were randomized from February 2013 to March 2018 in 28 centers and received either six cycles of dd-MVAC every 2 wk or four cycles of GC every 3 wk. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint (progression-free survival at 3 yr) was not reported. We focused on secondary endpoints: chemotherapy toxicity and pathological responses. RESULTS AND LIMITATIONS In the neoadjuvant group, 218 patients received dd-MVAC and 219 received GC. Of the patients, 60% received six cycles in the dd-MVAC arm and 84% received four cycles in the GC arm; 199 (91%) and 198 (90%) patients underwent surgery, respectively. Complete pathological response (ypT0pN0) was observed in 84 (42%) and 71 (36%) patients, respectively (p=0.2). An organ-confined status (<ypT3pN0) was obtained in 154 (77%) and 124 (63%) patients, respectively (p=0.001). In the adjuvant group, 40% of patients received six cycles in the dd-MVAC arm and 60% received four cycles in the GC arm. Most of Common Terminology Criteria for Adverse Events (CTCAE) grade ≥3 toxicities concerned hematological toxicities, reported for 129 (52%) patients in the dd-MVAC group and 134 (55%) patients in the GC group. Gastrointestinal (GI) grade ≥3 disorders were more frequently observed in the dd-MVAC arm (p=0.003), as well as asthenia of grade ≥3 (p<0.001). CONCLUSIONS The toxicity of dd-MVAC was manageable with more severe asthenia and GI side effects than that of GC in perioperative chemotherapy. A higher local control rate (complete pathological response, tumor downstaging, or organ confined) was observed in the dd-MVAC arm (p=0.021). However, such data have to be confirmed on progression-free survival, with primary endpoint data expected in mid-2021. PATIENT SUMMARY The authors have designed a randomized phase III controlled study comparing the efficacy of gemcitabine and cisplatin, and dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) in patients for whom chemotherapy has been decided, before or after radical cystectomy. Higher toxicity regarding asthenia and gastrointestinal side effects along with a better bladder control rate were observed in the dd-MVAC arm. However, such data have to be confirmed on progression-free survival, with primary endpoint data expected in mid-2021.
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Affiliation(s)
- Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen, France; Clinical Investigation Center, Inserm 1404, Onco-Urology, Rouen, France.
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmette Institute, Marseille, France
| | - Aude Fléchon
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Michel Soulié
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Laurent Guy
- Department of Urology, Montpied University Hospital, Clermont-Ferrand, France
| | - Brigitte Laguerre
- Department of Medical Oncology, Marquis Cancer Center, Rennes, France
| | - Nicolas Mottet
- Department of Urology, Nord University Hospital, Saint-Etienne, France
| | - Florence Joly
- Department of Medical Oncology, Baclesse Cancer Center, Caen, France
| | - Yves Allory
- Department of Pathology, Institut Curie, Saint-Cloud, France; Department of Pathology, Foch Hospital, Suresnes, France
| | - Valentin Harter
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Stéphane Culine
- Department of Medical Oncology, Saint-Louis-APHP, Faculté de Paris, France
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Andrade DL, Moretti TBC, Neto WA, Benedetti J, Reis LO. Smoke load prognostic impact on bacillus Calmette-Guérin (BCG) treated non-muscle invasive bladder cancer. Int Urol Nephrol 2020; 52:1471-1476. [PMID: 32157620 DOI: 10.1007/s11255-020-02438-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/03/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Smoking habit is the major risk factor for bladder cancer (BC), related to about 50% of these tumors; however, the tobacco dose-effect impact on BC immune treatment is underexplored. This study evaluates the impact of smoke load on non-muscle invasive bladder cancer (NMIBC) prognosis after intravesical BCG. METHODS Smoke load, recurrence, progression and disease-specific survival were evaluated in a retrospective study including NMIBC patients treated with intravesical BCG between 2006 and 2015. Multivariate Cox regression, ROC and Kaplan-Meier curves were utilized. RESULTS 132 pT1 NMIBC patients were included: 95 (72%) males, mean age 69.6 ± 10.5 years and mean smoking pack-years 22.0 ± 20.8. Recurrence, progression and disease-specific death occurred in 69 (52.3%, mean 20.55 ± 20.44 months), 22 (16.7%, mean 31.39 ± 20.19 months) and 11 (8.3%, mean 37.23 ± 18.34 months), respectively. Smoke load significantly impacted recurrence, HR = 1.019 (95% CI 1.008-1.030, p = 0.0004), and progression, HR = 1.034 (95% CI 1.016-1.052, p = 0.0002), but not survival. For every 1-year increment in pack-years, the risk of relapse and progression increases by 1.9% and 3.4%, respectively. Over 20 pack-year showed the best predictive prognostic power. CONCLUSION The smoke load has a potential prognostic role in terms of recurrence and progression in the BCG treated NMIBC. Future studies should explore the smoking impact on the immune system, mainly beyond 20 pack-year.
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Affiliation(s)
- Danilo Leite Andrade
- Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil
| | - Tomas Bernardo Costa Moretti
- Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil
| | - Wilmar Azal Neto
- Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil
| | - Júlia Benedetti
- Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil
| | - Leonardo Oliveira Reis
- Department of Urology, UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Av. John Boyd Dunlop-Jardim Ipaussurama, Campinas, SP, CEP: 13034-685, Brazil.
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Sangoi AR, Chan E, Stohr BA, Kunju LP. Invasive plasmacytoid urothelial carcinoma: A comparative study of E-cadherin and P120 catenin. Hum Pathol 2020; 102:54-59. [PMID: 32673685 DOI: 10.1016/j.humpath.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
Invasive plasmacytoid urothelial carcinomas (PUCs) are an uncommon aggressive variant, which often shows immunohistochemical loss of E-cadherin, underlying its distinct discohesive histology. The marker P120 (well described in breast pathology as being a diagnostic tool alongside E-cadherin for lobular neoplasia) has not been evaluated in PUCs. Biopsies, transurethral resections, and cystectomies of PUCs were collected, and whole-slide immunohistochemical analysis of E-cadherin and P120 was applied. A subset of cases were also tested for CDH1 mutation. PUC cases were stratified into morphologic categories of classic, pleomorphic, or desmoplastic. For E-cadherin, 24 of 33 (73%) cases showed an abnormal staining pattern, consisting of complete absence of staining (17/24; 71%) or cytoplasmic staining (7/24; 29%). For P120, 24 of 33 (73%) cases showed an abnormal staining pattern, consisting of loss of membranous staining with cytoplasmic reactivity. Only 2 cases showed a discordant E-cadherin/P120 immunoprofile (94% concordance). Significant staining differences among the 3 morphologic categories were not found. CDH1 mutation was found in 4 of 8 (50%) of cases, with 3 of 4 (75%) cases showing matched molecular/immunoprofile reactivity. No cases with CDH1 mutation showed discordant pattern E-cadherin/P120 immunoreactivity. Our rate of aberrant E-cadherin immunoreactivity in PUCs (73%) is similar to a meta-analysis of published cases (74%). We also report an identical rate of aberrant P120 immunoreactivity in PUCs (73%). While PUC remains a histologic diagnosis, in a subset of cases showing a less appreciated pattern (such as desmoplastic) or confounding cytoplasmic E-cadherin reactivity, the utility of paired P120 staining may be a useful diagnostic tool.
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Affiliation(s)
| | - Emily Chan
- University of California San Francisco, Pathology, San Francisco, CA, USA
| | - Bradley A Stohr
- University of California San Francisco, Pathology, San Francisco, CA, USA
| | - L Priya Kunju
- University of Michigan, Pathology, Ann Arbor, MI, USA
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29
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Hussien MT, Helmy E, Elsaba TM, Elkady A, Alrefai H, Hetta HF. Assessing CD 10 Expression Level and Its Prognostic Impact in Egyptian Patients with Urothelial Carcinoma. Asian Pac J Cancer Prev 2020; 21:1573-1583. [PMID: 32592351 PMCID: PMC7568887 DOI: 10.31557/apjcp.2020.21.6.1573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Indexed: 01/11/2023] Open
Abstract
Background and aim: CD10 is expressed in urothelial carcinoma cells and cancer associated fibroblasts (CAF). In the current study, CD10 immunohistochemical staining (IHC) and CD10 mRNA expression in urothelial carcinoma of bladder (UCB) were assessed, and its relationship with tumor progression and prognosis was investigated. Patients and Methods: In this study, 106 formalin fixed paraffin-embedded (FFPE) tissue of UCB, obtained through radical cystectomy specimen, and 10 matched normal tissue samples were included.CD10 expression was evaluated by immunohistochemistry and real time PCR techniques. Results: CD10 expression in tumor cells and associated stromal fibroblasts was significantly associated with high tumor grade and advanced stage. Significant correlation was found between CD10 tumor expression and lymphovascular invasion (LVI) (P<0.001) as well as perineural invasion (PNI). CD10 expression in stromal fibroblasts was significantly associated with squamous differentiation of tumor cells, lymph node metastasis (LNM), and tumor necrosis. Positive CD10 expression in both tumor cells and associated stromal fibroblasts was associated with shorter OS . CD10 mRNA was overexpressed in tumors in comparison with the matched normal tissues. CD10 mRNA was significantly higher in invasive tumor, advanced stage tumor, and high grade tumor. There was significant correlation between CD10 mRNA tumor expression and LVI, PNI, and tumor recurrence. Conclusion: Increased expression of CD10 in the tumor and CAF was strongly correlated with tumor progression, invasion, metastasis, shorter OS, and RFS in urothelial carcinoma patients. CD10 mRNA showed significantly higher expression in tumor tissue than in matched normal tissue. CD10 mRNA was associated with depth of invasion, TNM stage, tumor grade, vascular tumor invasion, and tumor recurrence.
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Affiliation(s)
- Marwa T Hussien
- Department of Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Eatemad Helmy
- Department of Pathology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Tarek M Elsaba
- Department of Pathology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Azza Elkady
- Sohag university medical adminstartion,Sohag, Egypt
| | - Hani Alrefai
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Mansoura University Mansoura, Egypt
| | - Helal F Hetta
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH , USA
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30
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Aoun G, Hayek E, Nasseh I. Mandibular Metastasis of a Recurrent Poorly Differentiated Urothelial Bladder Carcinoma. J Clin Imaging Sci 2020; 10:27. [PMID: 32363089 PMCID: PMC7193201 DOI: 10.25259/jcis_46_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 11/17/2022] Open
Abstract
Metastatic lesions to the oral cavity are uncommon; they represent between 1 and 3% of all malignant oral neoplasms. In this article, we report a rare case of metastatic urothelial bladder carcinoma in the mandible detected on oral radiographic images and confirmed with multiple imaging modalities. A 67-year-old woman presented to our clinic suffering from pain in the right side of the mandible with a mild swelling. Panoramic radiograph revealed an ill-defined relatively radiolucent lesion in the right mandibular premolar-canine region presenting with permeative changes. Cone-beam computed tomography showed a relatively hypodense lesion with demineralization, interruption of the buccal cortices, and slight thickening and sclerosis of the buccal cortical bone. The patient was referred for further evaluation including additional advanced imaging radiographic techniques (MRI and PET scan) and clinical and histopathological examinations that lead to a final diagnosis of metastatic lesion from an underlying urothelial bladder carcinoma.
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Affiliation(s)
- Georges Aoun
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Elie Hayek
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Ibrahim Nasseh
- Department of Oral Medicine and Maxillofacial Radiology, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
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31
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Hasan O, Houlihan M, Wymer K, Hollowell CMP, Kohler TS. Cutaneous metastasis of bladder urothelial carcinoma. Urol Case Rep 2020; 28:101066. [PMID: 31788428 DOI: 10.1016/j.eucr.2019.101066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 09/10/2019] [Revised: 10/29/2019] [Accepted: 10/31/2019] [Indexed: 12/23/2022] Open
Abstract
Cutaneous metastases of genitourinary malignancies are an extremely rare phenomenon. Few cases of skin metastasis from urothelial carcinoma of the bladder have been reported. We report a case of 71-year-old female with primary bladder transitional cell carcinoma who presented with the initial presentation of cutaneous skin lesions that covered the entire lower abdominal wall.
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32
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Gallan AJ, Choy B, Paner GP. Contemporary Grading and Staging of Urothelial Neoplasms of the Urinary Bladder: New Concepts and Approaches to Challenging Scenarios. Surg Pathol Clin 2018; 11:775-795. [PMID: 30447841 DOI: 10.1016/j.path.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Grading and staging of urothelial neoplasm are the most crucial factors in risk stratification and management; both necessitate optimal accuracy and consistency. Several updates and recommendations have been provided though recent publications of the 4th edition of the World Health Organization classification, the 8th edition of the American Joint Committee on Cancer staging system, and the International Consultation on Urological Diseases-European Association of Urology updates on bladder cancer. Updates and recent studies have provided better insights into and approaches to the challenging scenarios in grading and staging of urothelial neoplasm; however, there remain aspects that need further investigation and refinement.
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Affiliation(s)
- Alexander J Gallan
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA
| | - Bonnie Choy
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA
| | - Gladell P Paner
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA; Department of Surgery, Section of Urology, University of Chicago, 5841 South Maryland Avenue, AMB S626-MC6101, Chicago, IL 60637, USA.
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33
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Cumberbatch MGK, Jubber I, Black PC, Esperto F, Figueroa JD, Kamat AM, Kiemeney L, Lotan Y, Pang K, Silverman DT, Znaor A, Catto JWF. Epidemiology of Bladder Cancer: A Systematic Review and Contemporary Update of Risk Factors in 2018. Eur Urol 2018; 74:784-795. [PMID: 30268659 DOI: 10.1016/j.eururo.2018.09.001] [Citation(s) in RCA: 443] [Impact Index Per Article: 73.8] [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: 06/26/2018] [Accepted: 09/01/2018] [Indexed: 01/05/2023]
Abstract
CONTEXT Bladder cancer (BC) is a significant health problem, and understanding the risk factors for this disease could improve prevention and early detection. OBJECTIVE To provide a systematic review and summary of novel developments in epidemiology and risk factors for BC. EVIDENCE ACQUISITION A systematic review of original articles was performed by two pairs of reviewers (M.G.C., I.J., F.E., and K.P.) using PubMed/Medline in December 2017, updated in April 2018. To address our primary objective of reporting contemporary studies, we restricted our search to include studies from the last 5yr. We subdivided our review according to specific risk factors (PICO [Population Intervention Comparator Outcome]). EVIDENCE SYNTHESIS Our search found 2191 articles, of which 279 full-text manuscripts were included. We separated our manuscripts by the specific risk factor they addressed (PICO). According to GLOBOCAN estimates, there were 430000 new BC cases and 165000 deaths worldwide in 2012. Tobacco smoking and occupational exposure to carcinogens remain the factors with the highest attributable risk. The literature was limited by heterogeneity of data. CONCLUSIONS Evidence is emerging regarding gene-environment interactions, particularly for tobacco and occupational exposures. In some populations, incidence rates are declining, which may reflect a decrease in smoking. Standardisation of reporting may help improve epidemiologic evaluation of risk. PATIENT SUMMARY Bladder cancer is common worldwide, and the main risk factors are tobacco smoking and exposure to certain chemicals in the working and general environments. There is ongoing research to identify and reduce risk factors, as well as to understand the impact of genetics on bladder cancer risk.
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Affiliation(s)
| | - Ibrahim Jubber
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | - Jonine D Figueroa
- Usher Institute of Population Health Sciences and Informatics, CRUK Edinburgh Centre, University of Edinburgh, UK
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lambertus Kiemeney
- Department for Health Evidence, Radboud University Medical Center (Radboudumc), The Netherlands; Department of Urology, Radboud University Medical Center (Radboudumc), The Netherlands
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karl Pang
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Debra T Silverman
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute (NCI), National Institutes of Health (NIH), USA
| | - Ariana Znaor
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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34
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Ahmed MAH, Ali MH, Abbas HH, Elatrash GA, Foda AAM. Expression of TOMM34 and Its Clinicopathological Correlations in Urothelial Carcinoma of the Bladder. Pathol Oncol Res 2018; 26:411-418. [PMID: 30382527 DOI: 10.1007/s12253-018-0524-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/25/2018] [Indexed: 02/06/2023]
Abstract
The substantial difference between normal cells and cancer cells in terms of their energy metabolism in mitochondria provides an interesting basis for the development of novel therapeutic agents targeting energy machinery of tumour cells. TOMM34 is one of the Tom (translocase of the outer membrane of mitochondria) family that was found to be overexpressed in colorectal, hepatocellular, lung and early invasive breast carcinomas. The expression profile of mitochondrial translocases in bladder cancer compared to normal urinary bladder tissues has not been investigated yet. Therefore, the aim of the current study is to investigate the expression pattern of TOMM34 in bladder cancer tissues and explore its correlation with the clinico-pathological parameters of those cases. Sixty patients who underwent either transurethral resection or radical cystectomy for bladder cancer were included in this study with revision of all their clinicopathological data and tumor slides. Ten histologically normal urothelial biopsies were also included. Immunohistochemical staining for TOMM34 was done and semi-quantitatively scored using the modified H-score. All relations were analysed using established statistical methodologies. TOMM34 overexpression was significantly associated with high tumour stage, muscle invasion and high grade. Significant positive association was observed between TOMM34 expression and poor outcome in terms of shorter disease-specific survival. This study suggests TOMM34 as a biomarker of progression and poor prognosis in urothelial cell carcinoma patients. Furthermore, we suggest a role played by mitochondrial machinery in urothelial cell carcinoma progression, which is a potential target for the newly-discovered vaccine therapy for urothelial cell carcinoma.
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Affiliation(s)
- Mohamed A H Ahmed
- Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.,East Sussex Health Care Trust, Eastbourne District General Hospital, Eastbourne, UK
| | - Mohamed Hassan Ali
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hashem Hafez Abbas
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Gamal Ali Elatrash
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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35
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Abstract
PURPOSE OF REVIEW Recent whole genome characterizations of primary human bladder cancers revealed that they can be grouped into "intrinsic" basal and luminal molecular subtypes. Here, we provide an overview of the subtypes and discuss their biological and clinical properties. RECENT FINDINGS Basal cancers are characterized by advanced stage and metastatic disease at presentation. They tend to be enriched with squamous and small cell/neuroendocrine features and inactivating mutations and deletions of TP53 and RB1. Basal cancers can be divided into "epithelial" and "mesenchymal" (also known as "claudin low") subsets, and a portion of the latter form a "neuroendocrine/neuronal" subset that is associated with particularly poor survival. Luminal cancers are often enriched with papillary histopathological features and activating mutations in FGFR3, and they can also be divided into additional subsets based on differential stromal cell infiltration, relative genomic instability, and high- versus low-level expression of carcinoma in situ (CIS) gene expression signatures. Importantly, the bladder cancer molecular subtypes display differential sensitivities to neoadjuvant chemotherapy and immune checkpoint blockade, and preliminary data also suggest that they respond differently to radiation with or without hypoxia modulation. Ongoing studies are investigating the relevance of the molecular subtypes to the bladder cancer histopathological variants and to upper tract urothelial cancer. The bladder cancer molecular subtypes were associated with different prognoses and responses to conventional and targeted therapies in retrospective studies. If validated in prospective studies, molecular subtyping will be integrated into bladder cancer clinical management.
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36
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Gregg RW, Vera-Badillo FE, Booth CM, Mahmud A, Brundage M, Leveridge MJ, Hanna TP. Perioperative chemotherapy for urothelial carcinoma of the upper urinary tract: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2018; 128:58-64. [PMID: 29958631 DOI: 10.1016/j.critrevonc.2018.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 01/19/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022] Open
Abstract
INTRODUCTION Upper tract urothelial carcinomas are rare malignancies with differences in anatomy and biology requiring therapeutic strategies that differ from bladder cancer. The role of perioperative systemic therapy in this disease remains uncertain with limited data to support its use. A systematic review of the literature and meta-analysis was therefore undertaken to provide more information and guide clinical practice. METHODS A literature search was performed using Embase and Medline databases with additional searches performed manually using terms associated with upper tract urothelial malignancies. Data was extracted from studies of patients that underwent nephrouretectomy for the management of upper tract urothelial carcinoma and received either neoadjuvant or adjuvant systemic therapy. Overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were summated and analyzed using Cochrane Revman software Version 5.3. RESULTS There were 13 comparative studies and no randomized studies identified for data extraction; 11 adjuvant and 2 neoadjuvant with 1170 patients receiving perioperative systemic therapy and 3472 controls that did not. Perioperative chemotherapy was associated with improved OS (HR 0.75, 95%CI 0.57-0.99), DFS (HR 0.54, 95%CI 0.32-0.92), and CSS (HR 0.69, 95%CI 0.42-1.15). CONCLUSIONS The available data suggests that perioperative systemic therapy is associated with improved survival in patients with upper tract urothelial cancer.
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Affiliation(s)
- Richard W Gregg
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada.
| | - Francisco E Vera-Badillo
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Canadian Cancer Trials Group, Queen's Cancer Research Institute, Canada
| | - Christopher M Booth
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Canada
| | - Aamer Mahmud
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada
| | - Michael Brundage
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Canada
| | - Michael J Leveridge
- Department of Oncology, Queen's University, Canada; Department of Urology, Queen's University, Canada
| | - Timothy P Hanna
- Department of Oncology, Queen's University, Canada; Cancer Centre of Southeastern Ontario, Canada; Cancer Care and Epidemiology, Queen's Cancer Research Institute, Canada
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37
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Abstract
Bladder cancer has a high incidence and involves high associated morbidity and mortality. Since its initial clinical suspicion, early diagnostic confirmation and multimodal treatment involve different medical specialties. For this reason, we consider it important to spread the current consensus for its management. Recent advances in immunology and Chemotherapy make it necessary to expose and reflect on future perspectives.
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Affiliation(s)
| | - Oscar Buisan Rueda
- Servicio de Urología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Luis Ibarz
- Servicio de Urología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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38
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Aneese AM, Manuballa V, Amin M, Cappell MS. Bladder urothelial carcinoma extending to rectal mucosa and presenting with rectal bleeding. World J Gastrointest Endosc 2017; 9:282-295. [PMID: 28690772 PMCID: PMC5483421 DOI: 10.4253/wjge.v9.i6.282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/11/2017] [Accepted: 04/24/2017] [Indexed: 02/06/2023] Open
Abstract
An 87-year-old-man with prostate-cancer-stage-T1c-Gleason-6 treated with radiotherapy in 1996, recurrent prostate cancer treated with leuprolide hormonal therapy in 2009, and bladder-urothelial-carcinoma in situ treated with Bacillus-Calmette-Guerin and adriamycin in 2010, presented in 2015 with painless, bright red blood per rectum coating stools daily for 5 mo. Rectal examination revealed bright red blood per rectum; and a hard, fixed, 2.5 cm × 2.5 cm mass at the normal prostate location. The hemoglobin was 7.6 g/dL (iron saturation = 8.4%, indicating iron-deficiency-anemia). Abdominopelvic-CT-angiography revealed focal wall thickening at the bladder neck; a mass containing an air cavity replacing the normal prostate; and adjacent rectal invasion. Colonoscopy demonstrated an ulcerated, oozing, multinodular, friable, 2.5 cm × 2.5 cm mass in anterior rectal wall, at the usual prostate location. Histologic and immunohistochemical analysis of colonoscopic biopsies of the mass revealed poorly-differentiated-carcinoma of urothelial origin. At visceral angiography, the right-superior-rectal-artery was embolized to achieve hemostasis. The patient subsequently developed multiple new metastases and expired 13 mo post-embolization. Comprehensive literature review revealed 16 previously reported cases of rectal involvement from bladder urothelial carcinoma, including 11 cases from direct extension and 5 cases from metastases. Patient age averaged 63.7 ± 9.6 years (all patients male). Rectal involvement was diagnosed on average 13.5 ± 11.8 mo after initial diagnosis of bladder urothelial carcinoma. Symptoms included constipation/gastrointestinal obstruction-6, weight loss-5, diarrhea-3, anorexia-3, pencil thin stools-3, tenesmus-2, anorectal pain-2, and other-5. Rectal examination in 9 patients revealed annular rectal constriction-6, and rectal mass-3. The current patient had the novel presentation of daily bright red blood per rectum coating the stools simulating hemorrhoidal bleeding; the novel mechanism of direct bladder urothelial carcinoma extension into rectal mucosa via the prostate; and the novel aforementioned colonoscopic findings underlying the clinical presentation.
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39
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Warzecha HN, Fend F, Steinhilber J, Abele H, Henes M, Harland N, Staebler A. Non-invasive papillary urothelial carcinoma of the vagina: molecular analysis of a rare case identifies clonal relationship to non-invasive urothelial carcinoma of the bladder. Virchows Arch 2017; 471:347-353. [PMID: 28589387 DOI: 10.1007/s00428-017-2165-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/04/2017] [Accepted: 05/30/2017] [Indexed: 11/25/2022]
Abstract
We present a rare case of non-invasive papillary urothelial carcinoma of the vagina as the initial presentation of a multicentric urothelial carcinoma also involving bladder and renal pelvis and report for the first time in the literature the molecular alterations observed in the vaginal urothelial lesion and the synchronous lesions of the urinary tract. In this case, the non-invasive papillary urothelial carcinoma in the vagina displayed the same genetic alterations in the FGFR3 and PIK3CA genes as those seen in the non-invasive papillary urothelial carcinoma of the bladder contrasting with the wild phenotype observed in the invasive urothelial carcinoma of the renal pelvis. This observation could reinforce the theory of "seeding" of carcinoma cells as a valid and most likely explanation of this multifocality. In addition, we emphasize in this report the importance of recognizing this rare lesion in the female genital tract and its differential diagnosis.
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Affiliation(s)
- Hind N Warzecha
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany.
| | - Falko Fend
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Julia Steinhilber
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Harald Abele
- Department of Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Melanie Henes
- Department of Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Niklas Harland
- Department of Urology, University Hospital Tuebingen, Tuebingen, Germany
| | - Annette Staebler
- Department of Pathology, University Hospital Tuebingen, Tuebingen, Germany
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40
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El Ochi MR, Oukabli M, Bouaiti E, Chahdi H, Boudhas A, Allaoui M, Ameur A, Abbar M, Al Bouzidi A. Expression of human epidermal growth factor receptor 2 in bladder urothelial carcinoma. BMC Clin Pathol 2017; 17:3. [PMID: 28396613 PMCID: PMC5381084 DOI: 10.1186/s12907-017-0046-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/14/2016] [Accepted: 03/29/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Urothelial bladder carcinoma (UBC) is one of the most prevalent cancers in men worldwide. Human epidermal growth factor receptor 2 (HER2) expression has been detected in a wide range of urothelial carcinoma. Despite many reports in the literature, the prognostic significance of this overexpression remains unclear. The aim of this study was to assess the expression of HER2 in urothelial bladder carcinomas and its association with clinical and pathological parameters. METHODS 103 cases of UBC were diagnosed in our department between January 2014 and December 2015. The tumor specimens obtained by transurethral resection or cystectomy were evaluated by immunohistochemistry using HER2 antibody. RESULTS HER2 protein overexpression was present in 11.7% of cases and associated with tumor grade (p = 0.003) and pathological stage (p = 0.015). In multivariate analysis, HER2 overexpression was associated only with tumor grade (P = 0.04). CONCLUSION HER2 protein overexpression is noted in patients with high grade cancer. This expression may select patients for anti HER2 targeted therapy. Future larger and prospective studies will verify the frequency of HER2 alteration and the role of HER2 in the aggressive behavior.
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Affiliation(s)
- Mohamed Reda El Ochi
- Department of Pathology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco.,Hôpital militaire Mohamed V, Hay Riad, BP10000 Rabat, Morocco
| | - Mohamed Oukabli
- Department of Pathology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco
| | - Elarbi Bouaiti
- Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco.,Laboratory of Biostatistics Clinical Research and Epidemiology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco
| | - Hafsa Chahdi
- Department of Pathology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco
| | - Adil Boudhas
- Department of Pathology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco
| | - Mohamed Allaoui
- Department of Pathology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco
| | - Ahmed Ameur
- Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco.,Department of Urology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco
| | - Mohamed Abbar
- Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco.,Department of Urology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco
| | - Abderrahmane Al Bouzidi
- Department of Pathology, Mohamed V Military Hospital, Hay Riad, Rabat, Morocco.,Faculty of Medicine and Pharmacy, Mohammed V University, Hay Riad, Rabat, Morocco
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Leng B, Guo M, Zhao J, Gong Y. Utility and pitfalls of GATA3 immunocytochemistry for diagnosis of metastatic breast carcinoma and urothelial carcinoma on cytology specimens. J Am Soc Cytopathol 2017; 6:73-79. [PMID: 31042637 DOI: 10.1016/j.jasc.2016.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Although GATA3 expression has been studied extensively on histology specimens and has demonstrated a high level of accuracy in detecting carcinomas from breast or urothelial origin, its utility on cytology samples, especially the influence of different sample (fine-needle aspiration [FNA] versus effusion fluid) and preparation (cell block versus smear) on the staining, is understudied. MATERIALS AND METHODS We retrospectively searched our institution's pathology database for cytologic cases where GATA3 immunostaining was performed during diagnostic workup and identified a total of 178 cases, consisting of 89 metastatic breast carcinomas, 22 metastatic urothelial carcinomas, and 67 malignant neoplasms of other origin. Frequency of GATA3 expression was evaluated in each group. RESULTS For metastatic breast carcinomas, 75% expressed GATA3; 74% on FNA samples and 77% on fluid samples; 71% on cell block and 89% on smear. GATA3 was positive in 44% triple-negative breast carcinomas. Of the 22 metastatic urothelial carcinomas (21 FNA samples and 1 fluid; 21 cell blocks and 1 smear), all were positive for GATA3. Of the 67 malignancies of other origin, 4 (6%) were positive for GATA3 (ie, a metastatic ovarian serous carcinoma, a metastatic squamous cell carcinoma, a recurrent poorly differentiated skin adnexal carcinoma, and a metastatic thymic carcinoma). CONCLUSIONS GATA3 is a useful biomarker for detecting carcinomas of breast or urothelial origin on cytologic specimens. It may detect breast cancers with the triple-negative phenotype. Both cell block and smear preparations can be reliably used for the staining. GATA3-positive immunostaining is occasionally seen in other tumors, which may cause diagnostic confusion.
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Affiliation(s)
- Bing Leng
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ming Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jun Zhao
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yun Gong
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Ramos JD, Casey MF, Crabb SJ, Bamias A, Harshman LC, Wong YN, Bellmunt J, De Giorgi U, Ladoire S, Powles T, Pal SK, Niegisch G, Recine F, Alva A, Agarwal N, Necchi A, Vaishampayan UN, Rosenberg JE, Galsky MD, Yu EY. Venous thromboembolism in metastatic urothelial carcinoma or variant histologies: incidence, associative factors, and effect on survival. Cancer Med 2016; 6:186-194. [PMID: 28000388 PMCID: PMC5269690 DOI: 10.1002/cam4.986] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 09/27/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022] Open
Abstract
Venous thromboembolism (VTE) is common in cancer patients. However, little is known about VTE risk in metastatic urothelial carcinoma or variant histologies (UC/VH). We sought to characterize the incidence, associative factors, including whether various chemotherapy regimens portend different risk, and impact of VTE on survival in metastatic UC/VH patients. Patients diagnosed with metastatic UC/VH from 2000 to 2013 were included in this multicenter retrospective, international study from 29 academic institutions. Cumulative and 6‐month VTE incidence rates were determined. The association of first‐line chemotherapy (divided into six groups) and other baseline characteristics on VTE were analyzed. Each chemotherapy treatment group and statistically significant baseline clinical characteristics were assessed in a multivariate, competing‐risk regression model. VTE patients were matched to non‐VTE patients to determine the impact of VTE on overall survival. In all, 1762 patients were eligible for analysis. There were 144 (8.2%) and 90 (5.1%) events cumulative and within the first 6 months, respectively. VTE rates based on chemotherapy group demonstrated no statistical difference when gemcitabine/cisplatin was used as the comparator. Non‐urotheilal histology (SHR: 2.67; 95% CI: 1.72–4.16, P < 0.001), moderate to severe renal dysfunction (SHR: 2.12; 95% CI: 1.26–3.59, P = 0.005), and cardiovascular disease (CVD) or CVD risk factors (SHR: 2.27; 95% CI: 1.49–3.45, P = 0.001) were associated with increased VTE rates. Overall survival was worse in patients with VTE (median 6.0 m vs. 10.2 m, P < 0.001). Thus, in metastatic UC/VH patients, VTE is common and has a negative impact on survival. We identified multiple associated potential risk factors, although different chemotherapy regimens did not alter risk.
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Affiliation(s)
| | - Martin F Casey
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Yu-Ning Wong
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Ugo De Giorgi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sylvain Ladoire
- Georges François Leclerc Center, Dijon, France.,Université de Bourgogne, Dijon, France
| | - Thomas Powles
- Barts and the London School of Medicine, London, England
| | | | | | - Federica Recine
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ajjai Alva
- University of Michigan, Ann Arbor, Michigan
| | | | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | | | - Evan Y Yu
- University of Washington, Seattle, Washington
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Rouprêt M, Colin P, Xylinas E, Compérat E, Dubosq F, Houédé N, Larré S, Masson-Lecomte A, Neuzillet Y, Pignot G, Puech P, Roumiguié M, Méjean A. [CCAFU french national guidelines 2016-2018 on upper tract tumors]. Prog Urol 2016; 27 Suppl 1:S55-S66. [PMID: 27846934 DOI: 10.1016/s1166-7087(16)30703-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The purpose was to propose an update of the french guidelines from the national committee CCAFU on upper tract urothelial carcinomas (UTUC). METHODS A systematic Medline search was performed between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of UTUC, to evaluate different references with levels of evidence. RESULTS The diagnosis of this rare pathology is based on CT-scan acquisition during excretion and ureteroscopy with histological biopsies. Radical nephroureterectomy (RNU) remains the gold standard for surgical treatment, nevertheless a conservative endoscopic approach can be proposed for low risk lesion: unifocal tumour, possible complete resection and low grade and absence of invasion on CT-scan. Close monitoring with endoscopic follow-up (flexible ureteroscope) in compliant patients is therefore necessary. After RNU, bladder instillation of chemotherapy is recommended to reduced risk of baldder recurrence. The place of systemic therapy (adjuvant and neoadjuvant chemotherapy) remains to define. CONCLUSION These updated guidelines will contribute to increase the level of urological care for diagnosis and treatment for UTUC. © 2016 Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France.
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - F Dubosq
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - P Puech
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France
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Wise SS, Holmes AL, Liou L, Adam RM, Wise JP. Hexavalent chromium induces chromosome instability in human urothelial cells. Toxicol Appl Pharmacol 2016; 296:54-60. [PMID: 26908176 PMCID: PMC4886549 DOI: 10.1016/j.taap.2016.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 01/25/2016] [Revised: 02/12/2016] [Accepted: 02/17/2016] [Indexed: 11/22/2022]
Abstract
Numerous metals are well-known human bladder carcinogens. Despite the significant occupational and public health concern of metals and bladder cancer, the carcinogenic mechanisms remain largely unknown. Chromium, in particular, is a metal of concern as incidences of bladder cancer have been found elevated in chromate workers, and there is an increasing concern for patients with metal hip implants. However, the impact of hexavalent chromium (Cr(VI)) on bladder cells has not been studied. We compared chromate toxicity in two bladder cell lines; primary human urothelial cells and hTERT-immortalized human urothelial cells. Cr(VI) induced a concentration- and time-dependent increase in chromosome damage in both cell lines, with the hTERT-immortalized cells exhibiting more chromosome damage than the primary cells. Chronic exposure to Cr(VI) also induced a concentration-dependent increase in aneuploid metaphases in both cell lines which was not observed after a 24h exposure. Aneuploidy induction was higher in the hTERT-immortalized cells. When we correct for uptake, Cr(VI) induces a similar amount of chromosome damage and aneuploidy suggesting that the differences in Cr(VI) sensitivity between the two cells lines were due to differences in uptake. The increase in chromosome instability after chronic chromate treatment suggests this may be a mechanism for chromate-induced bladder cancer, specifically, and may be a mechanism for metal-induced bladder cancer, in general.
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Affiliation(s)
- Sandra S Wise
- Wise Laboratory of Environmental and Genetic Toxicology, Maine Center for Toxicology and Environmental Health, Department of Applied Medical Science, University of Southern Maine, Science Building, 96 Falmouth Street, Portland, ME 04103, USA
| | - Amie L Holmes
- Wise Laboratory of Environmental and Genetic Toxicology, Maine Center for Toxicology and Environmental Health, Department of Applied Medical Science, University of Southern Maine, Science Building, 96 Falmouth Street, Portland, ME 04103, USA; Department of Radiation Oncology, Dana Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - Louis Liou
- Department of Pathology, Boston University School of Medicine, 670 Albany St., Boston, MA 02118, USA
| | - Rosalyn M Adam
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - John Pierce Wise
- Wise Laboratory of Environmental and Genetic Toxicology, Maine Center for Toxicology and Environmental Health, Department of Applied Medical Science, University of Southern Maine, Science Building, 96 Falmouth Street, Portland, ME 04103, USA.
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45
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Wang HJ, Solanki S, Traboulsi S, Kassouf W, Brimo F. Neoadjuvant chemotherapy-related histologic changes in radical cystectomy: assessment accuracy and prediction of response. Hum Pathol 2016; 53:35-40. [PMID: 27321168 DOI: 10.1016/j.humpath.2016.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/26/2016] [Accepted: 02/10/2016] [Indexed: 12/28/2022]
Abstract
We evaluated the spectrum of histologic changes associated with neoadjuvant chemotherapy (NAC) and compared them with those resulting from transurethral resection (TUR). Twenty-five patients who received NAC were divided based on both their preoperative clinical/radiographic findings (clinical stage, hydronephrosis, palpable mass) and the cystectomy (RC) findings into NAC respondents (advanced clinical stage and <pT2+pN0), possible NAC respondents (non-advanced clinical stage and <pT2+pN0), and NAC nonrespondents (≥pT2and/or ≥pN1). In addition, 14 patients who received TUR alone and had <pT2+pN0 on RC were included. Presence/absence of the following histologic features was assessed: fibrosis/myofibroblastic reaction, hyalinization in the bladder wall, inflammatory reaction, calcification, foreign-body giant cells, necrosis, sheets of foamy macrophages, and fibrosis/hyalinization/necrosis in the lymph nodes (LNs). Overall, there was a significant histologic overlap between all groups. However, patients who received NAC had a significantly higher likelihood of showing hyalinization and less giant cells and inflammatory reaction than did those who received TUR only. Moreover, the only significantly different histologic features in NAC respondents versus TUR respondents were hyalinization and LN changes, with those 2 features in 25% and 0% of the possible NAC respondents group, respectively. Lastly, there was no significant difference in the possible NAC respondent group in comparison to the TUR-only arm. It appears that TUR and NAC result in overlapping histologic changes. In cases with no/minimal residual disease on RC, it is difficult to attribute the changes to NAC effect only, except if (1) hyalinization of the bladder wall or LN changes are present, or (2) if the preoperative clinical stage was beyond what could be resected by TUR.
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Affiliation(s)
- Hui Jun Wang
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Shraddha Solanki
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Samer Traboulsi
- Department of Urology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1
| | - Fadi Brimo
- Department of Pathology, McGill University Health Center and McGill University, Montreal, Québec, Canada H4A 3J1.
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Kubiak M, Klein J, de Perrot T, Tille JC, Iselin CE. Testicular Metastasis of a Upper Urinary Tract High-grade Papillary Urothelial Carcinoma, 2 Years After Nephroureterectomy. Urol Case Rep 2016; 4:25-6. [PMID: 26793571 PMCID: PMC4719909 DOI: 10.1016/j.eucr.2015.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/25/2015] [Indexed: 11/06/2022] Open
Abstract
Urothelial carcinomas are the fourth most common tumors in men. Upper tract urinary carcinomas (UTUCs) are uncommon and represent only 5–10% of urothelial carcinomas.1 Metastatic testicular cancers are rare and primary tumor sources are the prostate, lung, and gastrointestinal tract. We report the first case of testicular metastasis 2 years after initial curative surgery for a high-grade UTUC, all other reported cases weren't proceed by curative surgery.3
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Affiliation(s)
- M Kubiak
- Department of Surgery, Division of Urology, University Hospitals of Geneva, Switzerland
| | - J Klein
- Department of Surgery, Division of Urology, University Hospitals of Geneva, Switzerland
| | - T de Perrot
- Department of Radiology, University Hospitals of Geneva, Switzerland
| | - J C Tille
- Department of Histopathology, University Hospitals of Geneva, Switzerland
| | - C E Iselin
- Department of Surgery, Division of Urology, University Hospitals of Geneva, Switzerland
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47
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Mbeutcha A, Lucca I, Margulis V, Karam JA, Wood CG, de Martino M, Mathieu R, Haitel A, Xylinas E, Kluth L, Rouprêt M, Karakiewicz PI, Briganti A, Rink M, Rieken M, Weizer AZ, Raman JD, Rioux-Leclecq N, Bolenz C, Bensalah K, Lotan Y, Seitz C, Remzi M, Shariat SF, Klatte T. Prognostic role of ERCC1 protein expression in upper tract urothelial carcinoma following radical nephroureterectomy with curative intent. World J Urol 2016; 34:1155-61. [PMID: 26658888 DOI: 10.1007/s00345-015-1737-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 11/25/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Excision repair cross-complementing 1 (ERCC1) has been associated with outcomes of urothelial carcinoma of the bladder, but was not yet studied in upper tract urothelial carcinoma (UTUC). The aim of this study was to assess the prognostic role of ERCC1 expression in a large international cohort of UTUC patients. METHODS Immunohistochemical ERCC1 expression was evaluated in 716 UTUC patients who underwent radical nephroureterectomy with curative intent. ERCC1 was considered positive when the H-score was >1.0. Associations with overall survival and cancer-specific survival were assessed using univariable and multivariable Cox models. RESULTS ERCC1 was expressed in 303 tumors (42.3 %) and linked with the presence of tumor necrosis (16.2 vs. 10.4 %, p = 0.023), but not with any other clinical or pathological variable. ERCC1 status did not predict cancer-specific survival and overall survival on both univariable (p = 0.70 and 0.32, respectively) and multivariable analyses (p = 0.48 and 0.33, respectively). CONCLUSIONS ERCC1 is expressed in a significant proportion of UTUC and is linked with tumor necrosis, but its expression appears not to be associated with prognosis following radical nephroureterectomy.
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Honeycutt J, Hammam O, Hsieh MH. Schistosoma haematobium egg-induced bladder urothelial abnormalities dependent on p53 are modulated by host sex. Exp Parasitol 2015; 158:55-60. [PMID: 26160678 DOI: 10.1016/j.exppara.2015.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/21/2015] [Accepted: 07/01/2015] [Indexed: 01/02/2023]
Abstract
INTRODUCTION AND OBJECTIVE The bladder urothelium changes dramatically during Schistosoma haematobium infection (urogenital schistosomiasis). These alterations include hyperplasia, ulceration, dysplasia, squamous metaplasia and frank carcinogenesis. Defining the pathways underpinning these urothelial responses will contribute to a deeper understanding of how S. haematobium egg expulsion, hematuria, and bladder cancer develop in humans. The tumor suppressor gene p53 is of particular interest, given its role in many cancers, including bladder cancer generally and schistosomal bladder cancer specifically. METHODS Transgenic mice featuring tamoxifen-inducible Cre recombinase activity in cells expressing the urothelial-specific gene uroplakin-3a (Upk3a-GCE mice) were crossed with either TdTomato-floxed-EGFP reporter or p53-floxed mice. Mice were administered tamoxifen or vehicle control to induce excision of floxed genes. TdTomato-EGFP reporter mice were sacrificed and their bladders harvested, sectioned, and imaged by fluorescence microscopy. p53-floxed mice underwent bladder wall injection with S. haematobium eggs or vehicle controls. Three months later, mice were sacrificed and their bladders subjected to histological analysis (H&E staining). RESULTS We first confirmed the phenotypic fidelity of Upk3a-GCE mice by crossing them with TdTomato-floxed-EGFP reporter mice and administering tamoxifen to their progeny. As expected, these progeny switched from TdTomato to EGFP expression in their bladder urothelium. Having confirmed the phenotype of Upk3a-GCE mice, we next crossed them to p53-floxed mice. The resulting progeny were given tamoxifen or vehicle control to render them urothelial p53-haploinsufficient or -intact, respectively. Then, we injected S. haematobium eggs or control vehicle into the bladder walls of these mice. Male p53-intact, egg-injected mice exhibited similar histological changes as their p53-haploinsufficient counterparts, including urothelial hyperplasia and ulceration. In contrast, female p53-intact, egg-injected mice featured no urothelial ulceration, whereas their p53-haploinsufficient counterparts often had significant ulceration. CONCLUSIONS Urothelial p53 signaling indeed seems to affect urothelial homeostasis during S. haematobium infection, albeit in a sex-specific manner. Ongoing work seeks to determine whether p53 mediates associated alterations in urothelial cell cycle status and frank carcinogenesis in the setting of urogenital schistosomiasis.
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Affiliation(s)
| | - Olfat Hammam
- Department of Pathology, Theodor Bilharz Research Institute, Giza, Egypt
| | - Michael H Hsieh
- Biomedical Research Institute, Rockville, MD, USA; Division of Urology, Children's National Health System, Washington, DC, USA; The George Washington University, Washington, DC, USA.
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Mai KT, Truong LD, Ball CG, Williams P, Flood TA, Belanger EC. Invasive urothelial carcinoma exhibiting basal cell immunohistochemical markers: A variant of urothelial carcinoma associated with aggressive features. Pathol Res Pract 2015; 211:610-8. [PMID: 26100813 DOI: 10.1016/j.prp.2015.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 04/14/2015] [Accepted: 05/22/2015] [Indexed: 01/10/2023]
Abstract
We characterize invasive urothelial carcinoma (UC) exhibiting urothelial basal cell immunohistochemical markers. Consecutive invasive UCs were immunostained with CK20 and urothelial basal cell markers, cytokeratin 5 (CK5)/CD44. Immunostaining for CK5 and CD44 was scored as follows: positive for staining of more than 25% thickness of the epithelial nest or epithelium and low for lesser immunoreactivity. Invasive urothelial carcinoma (UC) exhibiting positive CK5/CD44 staining was designated as basal-like UC (BUC). In this study, of 251 invasive UC (pT1 in 57% and pT2-4 in 43%), BUC accounted for 40% of cases (accounting for most pT2-4 UC) and often presented as non-papillary UC without previous history of UC. In addition, BUC exhibited uniform nuclei with lesser degree of atypia than non BUC and decreased or negative cytokeratin 20 reactivity. Nested and microcystic variants of UC immunohistochemically stained as BUCs. Invasive non-BUCs were often papillary with marked cytologic atypia and pleomorphism, and accounted for most pT1 UC. The rates of perivesical invasion, lymph node and distant metastases were higher for BUC than non-BUC. All nine cases with absent/minimal residual in situ UC in 102 radical cystectomy specimens were from invasive non-BUC. BUC is distinguished from non-BUC due to this aggressive behavior, distinct immunohistochemical profile, and predominant non-papillary architecture. Our findings are consistent with recent studies identifying a subtype of muscle-invasive UC with molecular expression of basal cell and luminal cell molecular profiles. Our study further supports categorizing invasive UCs into these subtypes with different biological behaviors, possibly contributing to better therapeutic strategies.
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Affiliation(s)
- Kien T Mai
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada.
| | - Luan D Truong
- Department of Pathology and Genomic Medicine, The Methodist Hospital Physician Organization, Weill Cornell Medical College of Cornell University, United States
| | - Christopher G Ball
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| | - Phillip Williams
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| | - Trevor A Flood
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| | - Eric C Belanger
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
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Molina-Cerrillo J, Martínez-Sáez O, Alonso-Gordoa T, Tirado-Zambrano P, Delgado-Vargas B, Earl J, Grande E. Primary Sarcomatoid Tumor of the Bladder: A Different Entity but the Same Approach? Clin Genitourin Cancer 2015; 13:493-8. [PMID: 26027772 DOI: 10.1016/j.clgc.2015.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/21/2015] [Accepted: 05/04/2015] [Indexed: 12/16/2022]
Abstract
Bladder cancer remains a frequent cancer worldwide, and most tumors are diagnosed at localized stages. Urothelial carcinoma (UC) accounts for 90% of bladder cancer cases. Sarcomatoid carcinoma (SaC) of the bladder is a rare variant (0.5% of total bladder cancers) characterized by 2 components based on histology; the epithelial and mesenchymal phenotypes, which can be easily differentiated by immunohistochemistry. SaC has similar epidemiologic features to UC but different behavior, aggressiveness, and prognosis. In this review, we summarize the main differences between UC bladder cancers and SaC subtypes. The therapeutic strategies used in SaC today do not differ much from those used for the urothelial variant. However, there is still no standard treatment--the result of a lack of clinical trials for the sarcomatoid variant. Further multicenter comparative studies are needed to devise a better treatment strategy for patients with this rare histologic tumor subtype.
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Affiliation(s)
| | - Olga Martínez-Sáez
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | | | | | | | - Julie Earl
- Molecular Biology Laboratory, Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Enrique Grande
- Medical Oncology Department, Ramón y Cajal University Hospital, Madrid, Spain.
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