Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends

Urinary exosomal lnc-TAF12-2:1 promotes bladder cancer progression through the miR-7847-3p/ASB12 regulatory axis

Exosomes encompass a great deal of valuable biological information and play a critical role in tumor development. However, the mechanism of exosomal lncRNAs remains poorly elucidated in bladder cancer (BCa). In this study, we identified exosomal lnc-TAF12-2:1 as a novel biomarker in BCa diagnosis and aimed to investigate the underlying biological function. Dual luciferase reporter assay, RNA immunoprecipitation (RIP), RNA pulldown assays, and xenograft mouse model were used to verify the competitive endogenous RNA mechanism of lnc-TAF12-2:1. We found exosomal lnc-TAF12-2:1 up-regulated in urinary exosomes, tumor tissues of patients, and BCa cells. Down-regulation of lnc-TAF12-2:1 impaired BCa cell proliferation and migration, and promoted cell cycle arrest at the G0/G1 phase and cell apoptosis. The opposite effects were also observed when lnc-TAF12-2:1 was overexpressed. lnc-TAF12-2:1 was transferred by intercellular exosomes to modulate malignant biological behavior. Mechanistically, lnc-TAF12-2:1 packaged in the exosomes relieved the miRNA-mediated silence effect on ASB12 via serving as a sponger of miR-7847-3p to accelerate progression in BCa. ASB12 was also first proved as an oncogene to promote cell proliferation and migration and depress cell cycle arrest and cell apoptosis in our data. In conclusion, exosomal lnc-TAF12-2:1, located in the cytoplasm of BCa, might act as a competitive endogenous RNA to competitively bind to miR-7847-3p, and then be involved in miR-7847-3p/ASB12 regulatory axis to promote tumorigenesis, which provided a deeper insight into the molecular mechanism of BCa.

Glycan-based therapeutic approaches for bladder cancer: Overcoming clinical barriers

Bladder cancer (BLCA) remains a significant global health concern, being characterized by high incidence, recurrence, and mortality rates. Disease heterogeneity and rapid progression pose major challenges for effective management and identification of actionable biomarkers. Conventional therapies often fail to successfully achieve disease control, urging the development of novel, personalized approaches. In recent years, anti-tumour immunotherapy approaches in both pre-clinical and clinical settings have boomed. However, the efficacy of these strategies has been limited by the low mutational burden in some tumours, which hinders neoantigen presentation and the identification of BLCA-specific signatures. Cancer-associated aberrant glycosylation presents a unique opportunity for identifying BLCA-specific glycosignatures and developing innovative targeted therapeutics. This review provides a comprehensive overview of the clinical challenges in BLCA management and emerging novel therapies. Furthermore, it highlights the potential of glycosylation alterations as a unique opportunity for developing glycan-based therapies, potentially revolutionizing BLCA treatment strategies.

Apigenin inhibits recurrent bladder cancer progression by targeting VEGF-β

Bladder cancer is a major global health concern with high incidence and mortality rates. Both muscle-invasive bladder cancer (MIBC) and recurrent non-muscle-invasive bladder cancer (NMIBC) present significant challenges in treatment. Apigenin, a naturally occurring flavonoid, has shown promise in inhibiting the growth of bladder cancer cells, however, its therapeutic mechanism remains unclear. Single-cell RNA sequencing (scRNA-seq) data analysis and drug target screening were performed. Differentially expressed genes (DEGs) and potential therapeutic targets of apigenin were identified. Molecular docking was utilized to evaluate the binding affinity between apigenin and VEGF-β. In vitro assays were conducted to evaluate the association of VEGF-β and apigenin. Drug target screening identified 51 common targets between apigenin and bladder cancer, with VEGF-β emerging as a dominant gene. Molecular docking confirmed a high binding affinity between apigenin and VEGF-β. VEGF-β was significantly upregulated in fibroblasts from recurrent bladder cancer, correlating with increased tumor malignancy. Enhanced cell communication in VEGF-β-positive fibroblasts contributed to tumor progression. In vitro experiments demonstrated that VEGF-β promotes tumor cell proliferation, migration, and invasion. Apigenin significantly inhibits bladder cancer progression by targeting VEGF-β. The upregulation of VEGF-β in fibroblasts from recurrent bladder cancer highlights its potential as a diagnostic marker and therapeutic target. This study underscores the promise of apigenin as a chemopreventive and therapeutic agent for recurrent bladder cancer.

Bladder Cancer Growth is Inhibited by Upregulating CircFUT8 through the METTL14/FMR1 Signaling Pathway

Bladder cancer (BCa) is one of the most common malignancies worldwide. This study investigates the role of the N6-methyladenosine (m6A)/circRNA regulatory axis in BCa tumor growth and elucidates its underlying molecular mechanisms. A total of 15 paired BCa and adjacent non-tumor tissues were collected. CircFUT8 expression was found to be significantly downregulated in BCa tissues and exhibited a positive correlation with methyltransferase-like 14 (METTL14) levels. It could also undergo m6A methylation, its expression was significantly upregulated following METTL14 overexpression in both T24 and UM-UC-3 cells, and silencing circFUT8 counteracted the suppressive effects of METTL14 overexpression on BCa cell growth and migration. RNA immunoprecipitation (RIP) assays confirmed that circFUT8 interacted with fragile X mental retardation 1 (FMR1), and FMR1 overexpression enhanced circFUT8 expression, while FMR1 knockdown diminished the effects of circFUT8 overexpression. In mice, FMR1 overexpression led to elevated circFUT8 levels, reduced Ki67 expression and smaller tumor volumes, and these effects could be reversed following METTL14 knockdown. Collectively, these findings highlight the METTL14/FMR1 signaling axis could enhance circFUT8 expression to inhibit BCa cells growth and migration. CircFUT8 thus represents a promising target for therapeutic intervention and provides novel mechanistic insights into the epigenetic regulation of BCa progression.

Aminopeptidase N-Triggered Electron Rearrangement of Fluorescein for Covalent Fluorescent Labeling and Image-Guided Orthotopic Bladder Cancer Resection

Bladder cancer is the most common type of malignant tumor in the urinary system, which occurs in the bladder mucosa. Due to the lack of precise diagnostic tools, bladder cancer has a high recurrence rate. Fluorescence cystoscopy is recognized as a promising tool for improving the detection rate of bladder cancer, but its clinical application is hindered due to the scarcity of fluorescent agents. To address this issue, an aminopeptidase N (APN)-activated fluorescent agent with specific recognition and labeling abilities for bladder cancer has been developed. The fluorescent agent, namely, Flu-FAPN, exhibited high sensitivity and specificity toward APN under physiological conditions. The fluorescent intensity increased more than 37-fold after reacting with APN, and the detection limit is 0.10 ng/mL for APN. In addition, the hydrolysis of alanine catalyzed by APN could initiate the intramolecular electron rearrangement process, which subsequently contributed to the formation of protein-fluorescein adduct and thereby achieved covalent labeling of bladder cancer cells. Cell experiments conducted in cancer and normal cells demonstrate that Flu-FAPN has low cytotoxicity and high specificity for bladder cancer cells with an obvious fluorescence signal, which could be retained over 80% even in fixed cells. Finally, Flu-FAPN was successfully applied for the fluorescence-image-guided resection of tumor tissues in mice with orthotopic bladder cancer. We hope this covalent labeling-based agent can provide a promising tool for surgery navigation and accelerate the clinical application of fluorescence cystoscopy, thereby improving the cure rate of bladder cancer.

Intravesical Tumor-Selective Mucoadhesive Hydrogel for Effective Chemotherapy In Murine Model

Introduction

The therapeutic efficacy of intravesical agents for bladder cancer (BCa) is frequently constrained by their clearance via urine flushing and periodic bladder emptying, as well as the absence of tumor-targeting capabilities. Consequently, an effective drug delivery system must possess both tumor-targeting and adhesion properties to overcome these limitations.

Methods

In this study, we investigated a tumor-selective hydrogel as a potential vehicle for BCa treatment. For the first time in the field of intravesical therapy, we introduced the concept of pre-targeting, sequentially instilling modified polyarginine and membrane nanoparticles into the bladder to achieve selective gelation on the tumor surface. We comprehensively evaluated tumor selectivity, endocytosis pathways, organelle localization, and osmotic capacity, and demonstrated in vivo and in vitro degradation following drug delivery.

Results

The pre-targeted hydrogel exhibited superior tumor selectivity. The drug-loaded membrane nanoparticles released during hydrogel degradation were internalized by tumor cells at levels exceeding those in normal cells by more than eightfold. Our findings indicated that this internalization process was energy-dependent and mediated by caveolin. Post-internalization, the drug-loaded membrane nanoparticles localized to the endoplasmic reticulum and Golgi apparatus, with minimal colocalization with lysosomes. Moreover, the hydrogel demonstrated profound penetration into tumor tissue. In terms of antitumor efficacy, the hydrogel loaded with gemcitabine exhibited significantly enhanced therapeutic effects compared to free gemcitabine.

Conclusion

Our dual-functional hydrogel system exhibits robust anti-tumor activity against BCa, presenting a promising alternative for intravesical therapy. This innovative approach addresses key limitations of current treatments by combining tumor targeting with sustained drug adhesion, offering a novel strategy for the management of BCa.

De Novo Transcriptome Assembly and Annotation Elucidate the Response to Extreme Temperature Stress in the Intermediate Host Bulinus globosus of Schistosoma haematobium

Schistosomiasis remains a major global public health challenge. Bulinus serves as an intermediate host for Schistosoma, including S. haematobium, S. intercalatum, and S. guineensis. Emerging evidence suggests that temperature fluctuations associated with global climate change are key factors influencing the survival and distribution of Bulinus. The ecological shifts in intermediate host snails may significantly influence schistosomiasis transmission dynamics, thereby exacerbating threats to human health. However, the physiological effects of temperature stress on the survival of B. globosus at the molecular level, including gene expression and underlying mechanisms, remain unclear. Our experimental study found that extreme temperature stress significantly reduced the survival rates of Bulinus globosus (B. globosus). De novo transcriptome sequencing revealed key genes associated with lipid metabolism, carbohydrate metabolism, homeostasis regulation, and the antioxidant system. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis identified significant enrichment of differentially expressed genes (DEGs) in heat shock protein pathways, propanoate metabolism, and N-acylethanolamine metabolism pathways. Overall, this work provides the first transcriptomic characterization of the thermal stress response in B. globosus, extending genomic resources for annotation and stress-related gene discovery. These findings establish a solid foundation for developing control strategies to mitigate climate-driven risks of schistosomiasis transmission.

N6-methyladenosine-modified RNF220 induces cisplatin resistance and immune escape via regulating PDE10A K48-linked ubiquitination in bladder cancer

Bladder cancer (BCa) remains one of the most prevalent malignancies worldwide, with cisplatin-based combination chemotherapy as the cornerstone of adjuvant treatment. However, cisplatin resistance frequently arises in advanced BCa, limiting therapeutic efficacy. Comparative proteomic analysis of cisplatin-sensitive and -resistant BCa cells identified phosphodiesterase 10A (PDE10A) as significantly downregulated at the protein level in resistant cells, despite unchanged mRNA levels, indicating post-transcriptional regulation. Functional assays demonstrated that PDE10A enhanced cisplatin sensitivity by promoting apoptosis. Mechanistically, the E3 ubiquitin ligase RNF220 directly interacted with PDE10A, facilitating its ubiquitination and degradation under cisplatin-resistant conditions. RNF220 overexpression markedly reinforced cisplatin resistance in vitro and in vivo. Furthermore, N6-methyladenosine (m6A) modification mediated by METTL3 stabilized RNF220 mRNA in an IGF2BP2-dependent manner. Additionally, RNF220 promoted PD-L1 expression by destabilizing PDE10A, thereby facilitating immune evasion in BCa. These findings establish RNF220 as a pivotal ubiquitinase that drives both cisplatin resistance and immune escape through PDE10A destabilization, highlighting its potential as a therapeutic target to enhance chemotherapy and immunotherapy efficacy in advanced BCa.

Machine Learning and Mendelian Randomization Reveal a Tumor Immune Cell Profile for Predicting Bladder Cancer Risk and Immunotherapy Outcomes

This study's objective was to develop predictive models for bladder cancer (BLCA) using tumor infiltrated immune cell (TIIC)-related genes. Multiple RNA expression data and scRNA-seq were downloaded from the TCGA and GEO databases. A tissue specificity index was calculated and a computational framework developed to identify TIIC signature scores based on three algorithms. Univariate Cox analysis was performed, and the TIIC-related model was generated by 20 machine learning algorithms. A significant correlation between TIIC signature score and survival status, tumor stage, and TNM staging system was found. Patients in the high-score BLCA group had more favorable survival outcomes and enhanced response to PD-L1 immunotherapy as compared to those in the low-score group. This TIIC model showed better performance in prognosing BLCA. Diverse frequencies of mutations were observed in human chromosomes across groups categorized by TIIC score. No statistically significant correlation was observed between noncancerous bladder conditions and BLCA when examining the single nucleotide polymorphisms (SNPs) associated with the genes in the prognostic model. However, a statistically significant association was found at the SNP sites of rs3763840. There was no significant association between bladder stones and BLCA, but there was a significant association on the SNP sites of rs3763840. A novel TIIC signature score was constructed for the prognosis and immunotherapy for BLCA, which offers direction for predicting overall survival of patients with BLCA.

A meta-analytic appraisal of robotic-assisted cystectomy outcomes in the elderly octogenarian population

OBJECTIVE

This analysis aims to compare the outcomes of robotic cystectomy in patients with bladder cancer who are under 80 years of age versus those who are 80 years or older.

MATERIALS AND METHODS

A thorough search was conducted across key databases, including Google Scholar, Cochrane Library, PubMed, EMBASE, and Web of Science, with the most recent search conducted in July 2024. Data analysis was performed using Stata 18, applying a random-effects meta-analysis model. Weighted mean differences were calculated for continuous data, and odds ratios for categorical variables, accompanied by 95% confidence intervals.

RESULTS

Four studies were included in the meta-analysis. The baseline data revealed significant differences in age, sex distribution, BMI, ASA scores (≥ 3), and cT2 staging between the two age groups. Patients aged 80 and above had significantly longer surgical durations and a greater number of lymph nodes removed compared to those under 80. Marked heterogeneity was observed in the younger cohort, which showed higher rates of urinary diversion to the neobladder and pelvic lymph node dissection. Blood loss, hospitalization duration, total complications, minor complications, and major complications did not differ notably between the age groups.

CONCLUSION

This study suggests that robot-assisted radical cystectomy (RARC) is a viable and safe procedure for carefully selected elderly patients when performed in high-volume specialized centers. However, the small sample size, intermediate follow-up period, and potential for selection bias warrant caution in interpreting long-term outcomes. Future multi-center studies with longer follow-ups are needed to confirm these findings and establish standardized criteria for patient selection.

Novel Gene expression-based Risk Stratification tool predicts recurrence in Non-muscle invasive Bladder cancer

BACKGROUND

Bladder cancer represents a heterogeneous disease with distinct clinical challenges. Non-muscle invasive bladder cancer (NMIBC) typically presents as indolent and slow-growing, yet a critical clinical challenge remains: identifying which patients will progress to muscle-invasive disease requiring radical interventions. Early detection of progression propensity is essential, as once muscle invasion occurs, the risk of distant metastasis increases substantially, and treatment shifts from conservative TURBT (Transurethral Resection of Bladder Tumor) to aggressive surgical interventions with significant morbidity. Current risk stratification methods fail to adequately predict this transition in approximately 30% of cases, highlighting the urgent need for more accurate prognostic tools.

OBJECTIVE

This retrospective study aimed to develop and validate a transcriptomics-based mRNA score for predicting early NMIBC recurrence, comparing its performance against traditional risk stratification methods.

METHODS

We analyzed mRNA expression profiles from primary retrospective NMIBC tumor specimens (n = 25) collected between [2018-2022]. Traditional risk stratification tools, including EORTC scoring, were applied alongside our novel mRNA-based risk score to evaluate predictive accuracy for recurrence.

RESULTS

The transcriptomics-based mRNA score demonstrated a median prediction accuracy of 90% across 10,000 resampling iterations for predicting early NMIBC recurrence, significantly outperforming traditional EORTC risk scores. Our comprehensive gene set identified 435 differentially expressed genes associated with recurrence. Kaplan-Meier analysis showed significantly different recurrence-free survival between high and low mRNA risk score groups (Bonferroni corrected p-value < 0.0001).

CONCLUSIONS

This retrospective analysis confirms that mRNA expression-based risk stratification provides superior predictive accuracy compared to conventional clinicopathologic risk tools. Implementation of this gene signature could potentially reduce over-investigation and improve surveillance cost-effectiveness after TURBT in patients with primary high-risk NMIBC. These findings may transform the clinical management paradigm by enabling more personalized follow-up protocols based on molecular risk assessment.

Lactylation as a metabolic epigenetic modification: Mechanistic insights and regulatory pathways from cells to organs and diseases

In recent years, lactylation, a novel post-translational modification, has demonstrated a unique role in bridging cellular metabolism and epigenetic regulation. This modification exerts a dual-edged effect in both cancer and non-cancer diseases by dynamically integrating the supply of metabolic substrates and the activity of modifying enzymes: on one hand, it promotes tissue homeostasis and repair through the activation of repair genes; on the other, it exacerbates pathological progression by driving malignant phenotypes. In the field of oncology, lactylation regulates key processes such as metabolic reprogramming, immune evasion, and therapeutic resistance, thereby shaping the heterogeneity of the tumor microenvironment. In non-cancerous diseases, including neurodegeneration and cardiovascular disorders, its aberrant activation can lead to mitochondrial dysfunction, fibrosis, and chronic inflammation. Existing studies have revealed a dynamic regulatory network formed by the cooperation of modifying and demodifying enzymes, and have identified mechanisms such as subcellular localization and RNA metabolism intervention that influence disease progression. Nevertheless, several challenges remain in the field. This article comprehensively summarizes the disease-specific regulatory mechanisms of lactylation, with the aim of providing a theoretical foundation for its targeted therapeutic application.

Microbiota-shaped neutrophil senescence regulates sexual dimorphism in bladder cancer

Sex disparities have been epidemiologically demonstrated in non-reproductive cancers, yet how the sex-specific intrinsic microbiome orchestrates the immune system to affect these disparities is unclear. Here we identify a subpopulation of RETNLG+LCN2+ senescence-like neutrophils (RLSNs) that preferentially accumulate in the male tumor microenvironment and exert a strong immunosuppressive effect to limit antitumor immunity, resulting in poor prognosis for patients with bladder cancer. This difference in enrichment of RLSNs between sexes can be attributed to intestinal bacterium Alistipes shahii, which preferentially populates in females rather than males. A. shahii-associated metabolite lurasidone directly targets iron sequestrator LCN2 in RLSNs. By freeing Fe2+, lurasidone induces ferroptosis, thereby eliminating RLSNs and promoting antitumor immunity in females. In males lacking A. shahii and lurasidone, RLSNs have a survival advantage. Together, these findings demonstrate that a microbiota-lurasidone-LCN2 circuit regulates sexual disparity in bladder cancer and indicates the therapeutic potential of lurasidone for male cancer patients.

TAR-200: Investigational intravesical drug delivery system for bladder cancer

Bladder cancer is second among the most common urothelial malignancy and one of the most expensive in terms of treatment. Localized bladder cancer is classified into non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). First line approach for treatment of NMIBC is transurethral resection of bladder tumor (TURBT) followed by intravesical instillation of immuno/chemotherapeutic agents to prevent or delay recurrence or progression. Historically intravesical Bacillus Calmette Geurin (BCG) instillation has been a mainstay of therapy for NMIBC post-TURBT. Commonly followed drug delivery is intravesical instillation that maximizes exposure of the drug to the lesion and minimizes systemic side effects. Gemcitabine used in bladder cancer due to its pharmacological properties making it appropriate for intravesical instillation. Limitations of intravesical instillation is low bladder permeability leading to decreased drug concentration in bladder tissues and frequent urination causing drug wash out or dilution reducing the effect of treatment. Effective intravesical therapy depends on the penetration of the drug into the tumor. TAR200 is a novel drug delivery system that facilitates sustained release of continuous low dose gemcitabine over an indwelling period providing a uniform concentration of drug after each voiding cycle and exposure of drug to the bladder tumor. There are completed and ongoing clinical trials to evaluate the efficacy of TAR200 alone or in combination with other chemotherapeutic agents in NMIBC and MIBC. FDA has granted breakthrough therapy designation (BTD) for TAR-200 in December 2023. This review highlights the potential of TAR-200 and clinical trials that improve bladder cancer treatment outcome.

Mechanical modulation of docetaxel-treated bladder cancer cells by various changes in cytoskeletal structures

Cytoskeleton targeting agents are a group of chemotherapeutics used in the therapy of many types of cancer, such as breast, prostate, lung, bladder cancer, and others. At the same time, the assessment of the rheological properties of cancer cells is a relevant marker of their metastatic potential and therapeutic efficacy. For these reasons, understanding the interaction between the actin microfilament (MFs) network, microtubules (MTs), and so-called intermediate filaments (IFs) is crucial for the use of the rheological properties of cells as biomechanical markers. The current work compares the rheological properties of bladder cancer cells T24 and 5637, which differ in cytoskeletal composition, treated with a low dose of docetaxel (DTX) - a microtubule targeting agent (MTA). AFM revealed that 5637 cells stiffen over time when exposed to DTX, whereas changes in rheological properties of T24 cells are less pronounced, and both softening and stiffening of cells are observed. From immunostaining and Western blot analysis, we found that in addition to changes in the content and organization of MTs, reorganization of MFs and vimentin IFs also occurs. We show that both cell and nucleus morphology changes after DTX treatment. DTX treatment decreases and increases the migratory potential of 5637 and T24 cells, respectively. The current work shows that vimentin IFs modulate the nanomechanics of bladder cancer cells.

Contemporary Trends and Predictors Associated with Adverse Pathological Upstaging Among Non-Metastatic Localized Clinical T2 Muscle-Invasive Bladder Cancers Undergoing Radical Cystectomy: Outcomes from a Single Tertiary Centre in the United Kingdom

Introduction: Radical cystectomy (RC) is the gold standard for urothelial cT2-4a, N0, M0 muscle-invasive bladder cancer (MIBC). However, bladder-sparing strategies (BSS) such as Trimodality Therapy (TMT) have emerged as alternative treatments for a select group of localized muscle-confined (cT2) urothelial bladder cancers. Accordingly, reliable preoperative staging and a reliable risk factor assessment linked to pathological upstaging play a key role in adequate counselling and patient selection for BSS. Patients and Methods: cT2 MIBC patients undergoing RC at our institution from 2014 to 2024 were reviewed. Preoperative staging modalities, demographics, and tumour and patient characteristics were assessed. Multivariable logistic regression was applied to explore the relative effect of confounders on any pathological upstaging from robot-assisted or open RC specimens. Subgroup analysis according to the local upstaging (>pT2) or nodal dissemination (pN+) was also performed. Results: N = 275 RCs were included (73.5% males, 26.5% females). Upstaging was documented in n = 141 (51%) cases. Of these, n = 125 (45.5%) were upstaged locally (>pT2) and n = 35 (23%) yielded pN+ disease. Preoperative parameters like gender, the number of TURBTs, previous BCG exposure, and concomitant CIS did not significantly influence the risk of any kind of upstaging (p > 0.05). At multivariable analysis, neoadjuvant chemotherapy (NAC) and multi-disciplinary team (MDT) discussion were found protective (odds ratio [OR]: 0.4, 95%CI 0.2-0.7, p = 0.001 and OR: 0.51, 95%CI 0.2-0.9, p = 0.01). Preoperative FDG-PET assessment yielded higher risk for later pN upstaging (OR: 1.8, 95%CI 1-3, p = 0.05). HG/G3 features at TURBT along with mixed/pure histology variants in RC specimens were the most relevant independent predictors for both any and pT upstaging (OR: 4.3, 95%CI 1-34, p = 0.04 and OR: 2.3, 95%CI 1.1-4.6, p = 0.02 for any upstaging and OR: 5.6, 95%CI 1.3-36, p = 0.02 and OR: 2.5, 95%CI 1.3-5, p = 0.01 for pT upstaging, respectively). Conclusions: In this study, over half of the patients undergoing RC for cT2 were upstaged at the final pathology. Therefore, adequate counselling and examining the non-conventional criteria for prognosis is mandatory in the contemporary era of bladder-preservation strategies.

Burden of Urological Cancers in the Labour Force from 1990 to 2021 and Projections to 2050

BACKGROUND

Urological cancers represent an increasing public health concern in the labour force, mainly including prostate cancer (PCA), kidney cancer (KCA), testicular cancer (TCA), and bladder cancer (BLCA). Limited data exist on their occurrence, deaths, and disability-adjusted life years (DALYs). The objective of this study was to analyse three-decade trends in these cancers globally and forecast future patterns.

METHODS

The study used Global Burden of Disease 2021 data from 1990 to 2021 to evaluate urological cancer stats, including prevalence, incidence, mortality, and DALYs. For people aged 15-64 years, it was then manually age-standardized once. Herein, we employed a range of analytical techniques, including decomposition analysis, a Bayesian Age-Period-Cohort model, a Concentration index and slope index, and frontier analysis, to examine the trends in 204 countries and regions. Furthermore, the relationship between the Socio-Demographic Index (SDI) and the burden of disease is addressed.

RESULTS

Over the past 30 years, PCA, TCA, and KCA rates have risen among the global labour force population. North America, North Asia, and Europe have high incidence and mortality rates. TCA mortality and BLCA and TCA prevalence are expected to continue rising globally until 2050. Urological cancer impacts vary by region and development with more burden in areas with a higher SDI.

CONCLUSIONS

Urological cancers represent a substantial disease burden on labour force populations, emphasizing the imperative for targeted interventions and healthcare resources for affected populations. It is therefore crucial to have a comprehensive understanding of the global and regional epidemiological trends, as well as the findings of health economics studies.

Trends in tobacco smoking and bladder and lung-bronchial cancer rates among non-hispanic white Americans (2000-2016)

BACKGROUND

Cancer incidence may be linked to cumulative exposure to environmental factors, including diet, lifestyle behaviors, licit drug use (such as tobacco), and endogenous processes. Tobacco smoking (TS) is strongly associated with bladder cancer (BC) and lung-bronchial cancer (LBC). This study aimed to analyze TS, BC, and LBC rates; their correlation with sex and age; and the risk of subsequent primary cancers among BC and LBC patients in non-Hispanic white Americans (NHWAs) from 13 U.S. states.

METHODS

The percentage of smokers in 13 U.S. states from 2000 to 2016 was obtained from the Centers for Disease Control and Prevention (CDC) database. LBC and BC cases in NHWAs from 2000 to 2016 were analyzed as single primary cancers or as the first of two or more neoplasms using the United States Surveillance, Epidemiology, and End Results (SEER) database.

RESULTS

The percentage of NHWA smokers decreased in all 13 U.S. states evaluated in this study from 2000 to 2016. Over 17 years, the incidence rates of BC were 36.37 and 11.66 cases per 100,000 among men and women, respectively, while those of LBC were 68.21 and 61.53 cases per 100,000, respectively. The highest incidence rates of BC and LBC occurred in individuals over 64 years of age: BC in New York (208.9 per 100,000 men) and Massachusetts (54.33 per 100,000 women), and LBC in Kentucky (503.1 per 100,000 men; 298.5 per 100,000 women). The incidence rates of BC and LBC were correlated in most states, especially in Massachusetts, California, New Jersey, and New York. Among the 657,117 patients with LBC, 4.3% had a second type of cancer, while among the 240,461 patients with BC, 14.3% had a second type.

CONCLUSION

Despite a significant decrease in the number of smokers in the United States between 2000 and 2016, the incidence of BC in men and LBC in women has not followed a similar decline. The odds ratio of a patient diagnosed with primary BC developing a second neoplasm is 3.3 times greater than that of a patient diagnosed with primary LBC.

Diagnostic and Prognostic Potential of SH3YL1 and NOX4 in Muscle-Invasive Bladder Cancer

Bladder cancer, especially muscle-invasive bladder cancer (MIBC), poses significant treatment challenges due to its aggressive nature and poor prognosis, often necessitating cisplatin-based chemotherapy. While cisplatin effectively reduces tumor burden, its nephrotoxic effects, specifically cisplatin-induced acute kidney injury (AKI), limit its clinical use. This study investigates SH3YL1 as a potential biomarker for bladder cancer progression and AKI. Plasma and urine SH3YL1 levels were measured in bladder cancer patients undergoing cisplatin treatment, showing elevated baseline levels compared to controls, suggesting a link with bladder cancer pathology rather than cisplatin-induced AKI. Functional network and Gene Ontology (GO) enrichment analyses identified SH3YL1's interactions with NADPH oxidase pathways, particularly NOX family genes, and highlighted its roles in cell adhesion, migration, and cytoskeletal organization-processes critical for tumor invasiveness. Notably, SH3YL1 and NOX4 expression were significantly higher in MIBC than in non-muscle-invasive bladder cancer (NMIBC), with a strong correlation between SH3YL1 and NOX4 (r = 0.62) in MIBC, suggesting a subtype-specific interaction. Kaplan-Meier survival analysis using The Cancer Genome Atlas bladder cancer (TCGA-BLCA) data further demonstrated that low SH3YL1 expression is significantly associated with poor overall and disease-specific survival in MIBC patients, reinforcing its role as a prognostic biomarker. In conclusion, SH3YL1 is a promising biomarker for identifying the invasive characteristics of MIBC and predicting patient outcomes. These findings underscore the importance of SH3YL1-NOX4 pathways in MIBC and suggest the need for further research into targeted biomarkers for bladder cancer progression and cisplatin-induced AKI to improve patient outcomes in high-risk cases.

The genetic associations of lipidome on bladder cancer: a Mendelian randomization study

PURPOSE

Multiple epidemiological studies have demonstrated a correlation between the lipidome and bladder cancer (BC). Nonetheless, the current literature lacks consensus on the causal link between the lipidome and BC. We utilise a two-sample Mendelian randomisation approach to meticulously evaluate the causal link between the two variables.

METHODS

A two-sample Mendelian randomisation (MR) analysis was performed utilising publically accessible genome-wide association research data. The principal technique utilised for the inquiry was the inverse variance-weighted (IVW) meta-analysis. Furthermore, Bayesian weighted Mendelian randomisation (BWMR) was employed to corroborate the findings. Supplementary validation was conducted utilising Cochran's Q test and methodologies including MR-Egger.

RESULTS

The two-sample MR analysis, in conjunction with BWMR analysis, revealed a correlation between the genetic prediction of the lipidome and the risk of BC. Sterol ester (SE) 27:1/16:0 (OR: 1.148, 95% CI: 1.020-1.293, p = 0.022), Sterol ester 27:1/20:3 (OR: 1.132, 95% CI: 1.006-1.274, p = 0.040), Phosphatidylcholine (PC) 18:0_20:3 (OR: 1.257, 95% CI: 1.101-1.436, p = 0.001), Sphingomyelin (SM) d38:1 (OR: 1.120, 95% CI: 1.016-1.235, p = 0.023), Sphingomyelin d40:2 (OR: 1.156, 95% CI: 1.033-1.295, p = 0.012), Triacylglycerol (TAG) 46:1 (OR: 1.178, 95% CI: 1.013-1.369, p = 0.034), Triacylglycerol 49:2 (OR: 1.219, 95% CI: 1.031-1.442, p = 0.021), Triacylglycerol 50:5 (OR: 1.173, 95% CI: 1.038-1.326, p = 0.011), and Triacylglycerol 52:6 (OR: 1.161, 95% CI: 1.007-1.339, p = 0.040) exhibited a positive correlation with an elevated risk of BC.

CONCLUSION

Genetic projections suggest a reciprocal causal link between the lipidome and BC, offering theoretical support and a basis for future clinical research.

The role of CDK8 gene polymorphisms in bladder cancer susceptibility and prognosis: a study in the Chinese Han population

BACKGROUND

Cyclin-dependent kinase 8 (CDK8) has been implicated in various tumors, with its role differing across tumor types. However, the association between CDK8 polymorphisms and bladder cancer (BC) remains unclear. This study investigated the association between CDK8 polymorphisms and BC susceptibility and prognosis.

METHODS

This case-control study included 271 patients with BC and 381 healthy controls. Two-tag single-nucleotide polymorphisms in the CDK8 gene (rs17083838 and rs7992670) were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Statistical analyses were performed using SNPstats and SPSS software to assess genetic associations.

RESULTS

The AG/AA genotypes of rs17083838 were associated with a significantly reduced risk of BC under the dominant model (P < 0.001, odds ratio [95% confidence interval] = 0.50 [0.33-0.76]). Stratified analysis revealed that the AG genotype of rs17083838 increased the risk of postoperative recurrence in patients with stage IV BC (P = 0.007). For rs7992670, females with the AG/AA genotype exhibited a 2.07-fold higher risk of BC than males, whereas smokers with the same genotype showed a 2.13-fold higher risk than non-smokers. The GG genotype of rs7992670 was associated with better overall survival in patients with stage III BC (P = 0.023). Among patients with recurrent muscle-invasive BC, those with the GG/AA genotype showed significantly improved survival compared with those carrying the AG genotype (P = 0.023).

CONCLUSIONS

CDK8 polymorphisms influence BC susceptibility and prognosis, with rs17083838 showing a protective effect and rs7992670 being associated with increased risk and survival outcomes in specific subgroups.

IMPACT

This study highlights the potential of CDK8 polymorphisms as biomarkers for BC susceptibility and prognosis, emphasizing the need for further research.

Asparagine drives immune evasion in bladder cancer via RIG-I stability and type I IFN signaling

Tumor cells often employ many ways to restrain type I IFN signaling to evade immune surveillance. However, whether cellular amino acid metabolism regulates this process remains unclear, and its effects on antitumor immunity are relatively unexplored. Here, we found that asparagine inhibited IFN-I signaling and promoted immune escape in bladder cancer. Depletion of asparagine synthetase (ASNS) strongly limited in vivo tumor growth in a CD8+ T cell-dependent manner and boosted immunotherapy efficacy. Moreover, clinically approved L-asparaginase (ASNase),synergized with anti-PD-1 therapy in suppressing tumor growth. Mechanistically, asparagine can directly bind to RIG-I and facilitate CBL-mediated RIG-I degradation, thereby suppressing IFN signaling and antitumor immune responses. Clinically, tumors with higher ASNS expression show decreased responsiveness to immune checkpoint inhibitor therapy. Together, our findings uncover asparagine as a natural metabolite to modulate RIG-I-mediated IFN-I signaling, providing the basis for developing the combinatorial use of ASNase and anti-PD-1 for bladder cancer.

The Association between Tea Consumption and Bladder Cancer Risk Based on the Bladder Cancer Epidemiology and Nutritional Determinants (BLEND) International Consortium

OBJECTIVES

Evidence regarding the association between tea consumption and bladder cancer (BC) risk is inconsistent. This study aimed to increase our knowledge of the association by using international data from the Bladder Cancer Epidemiology and Nutritional Determinants Consortium.

METHODS

Individual data on 2,347 cases and 6,871 controls from 15 case-control studies with information on black, green, herbal, or general tea was pooled. The association was estimated using multilevel multivariable logistic regression analysis adjusted for multiple (non-)dietary factors.

RESULTS

Association between tea consumption and BC risk was observed (odds ratio, OR = 0.72, 95% confidence interval, 95% CI = 0.65-0.80) compared to non-tea drinkers. Stratified analyses based on gender and smoking status yielded similar results. Stratified analysis showed no significant association between black or green tea consumption and BC risk across models, while herbal tea consumption was linked to a reduced BC risk (OR = 0.59, 95% CI = 0.36-0.96). As daily tea consumption increased within a suitable range (<5.67 cups/day), BC risk decreased.

CONCLUSIONS

Camellia sinensis tea showed no association with BC risk, while herbal tea was inversely linked to BC incidence. Despite some significant findings in the selected strata, further studies are required to clarify the underlying mechanisms.

Cytokeratin 17 activates AKT signaling to induce epithelial-mesenchymal transition and promote bladder cancer progression

OBJECTIVE

Bladder cancer is a common malignant tumor of the urinary tract as well as one of the most common cancers worldwide. Therefore, the study of key molecular targets involved in bladder carcinogenesis and progression is crucial for the prognosis of bladder cancer. Our study aims to investigate the mechanism by which cytokeratin 17 induces epithelial-mesenchymal transition and promotes bladder cancer progression.

METHODS

In this study, 78 bladder cancer tissue specimens were collected, the expression level of cytokeratin 17 (CK17) in bladder cancer and paracancerous tissues was detected by immunohistochemistry, and the relationship between the CK17 expression level and the prognosis of the patients was analyzed via follow-up visits. Western Blot was performed to detect the expression level of CK17 in common bladder cancer cell lines, and the CK17-silenced and overexpressed cell lines were constructed from the selected T24 cell line with high expression of CK17 and 5637 cell line with low expression of CK17. The effects of CK17 on the proliferation, migration and invasion abilities of bladder cancer cells were evaluated by flow cytometry, Cell Counting Kit-8 (CCK-8) assay, Trans-well assay, and scratch assay. The effect of CK17 on epithelial-mesenchymal transition (EMT) markers was further detected by Western Blot and immunofluorescence, and the phosphorylation levels of AKT Ser473 and Thr308 were detected by Western Blot.

RESULTS

In the clinical samples, CK17 expression was significantly up-regulated in cancer tissues compared with paracancerous tissues, and high levels of CK17 indicated shortened progression free survival and predicted a poorer clinical prognosis. By analyzing the relationship between CK17 and clinicopathological features, we found that the CK17 expression level was correlated with bladder cancer grade and TNM stage. Overexpression of CK17 promoted the proliferation, migration and invasion abilities of bladder cancer cells 5637, and silencing of CK17 inhibited the proliferation, migration and invasion abilities of bladder cancer cells T24. Further, we found that overexpression of CK17 in 5637 cells activated the AKT signaling pathway by increasing the phosphorylation level of AKT (Ser473), so as to up-regulate the expressions of the EMT mesenchymal markers vimentin, N-cadherin, and the transcription factors Slug and twist, while the opposite results were obtained by silencing CK17 in T24 cells.

CONCLUSION

We found that high expression of CK17 promoted the proliferation, migration and invasion of bladder cancer cells and induced EMT through AKT-Ser473 phosphorylation. These findings suggest that CK17 is significantly associated with malignant progression and poor prognosis of bladder cancer patients, and it may become a new biological target for bladder cancer treatment.

Development and validation of interpretable machine learning models to predict distant metastasis and prognosis of muscle-invasive bladder cancer patients

Muscle-Invasive Bladder Cancer (MIBC) is a more aggressive disease than non-muscle-invasive bladder cancer (NMIBC), with greater chances of metastasis. We sought to develop machine learning (ML) models to predict metastasis and prognosis in MIBC patients. Clinical data of MIBC cases from 2000 to 2020 were sourced from the Surveillance, Epidemiology, and End Results (SEER) database. Clinical variables used to predict DM were identified through univariate and multivariate logistic regression, and Recursive Feature Elimination (RFE). Thirteen ML models predicting DM were evaluated based on AUC, PRAUC, accuracy, sensitivity, specificity, precision, cross-entropy, Brier score, balanced accuracy, and F-beta score. SHapley Additive exPlanations (SHAP) framework helped interpret the best model. Additionally, we utilized ML algorithm combinations to predict prognosis in MIBC patients with metastasis. A total of 43,951 T2-T4 MIBC patients aged over 18 years old from the SEER database were enrolled consecutively. Nine clinical variables were selected to predict DM. The CatBoost model was identified as the optimal predictor, with AUC values of 0.956 [0.933, 0.969] for the training set, 0.882 [0.857, 0.919] for the internal test set, and 0.839 [0.723, 0.936] for the external test set. The model achieved an accuracy of 0.875 [0.854, 0.896], sensitivity of 0.869 [0.851, 0.889], specificity of 0.883 [0.823, 0.912], and precision of 0.917 [0.885, 0.944]. SHAP analysis revealed that tumor size was the most influential factor in predicting distant metastasis. For prognosis, the "RSF + Enet[alpha = 0.8]" model emerged as the top performer, with C-index values of 0.683 in training, 0.688 in the internal test, and 0.666 in the external test sets. Our ML models provide high accuracy and dependability, delivering refined, individualized predictions for metastasis risk and prognosis in MIBC patients.

Deciphering the mysteries of MEG3 LncRNA and its implications in genitourinary cancers

Maternally expressed gene 3 (MEG3), a long non-coding RNA, plays a pivotal role in various biological processes, including tumorigenesis. Aberrant expression of MEG3 has been implicated in several cancers, including genitourinary malignancies. This comprehensive review explores the multifaceted functions of MEG3 in the context of genitourinary cancers through unravelling the molecular mechanisms underlying the influence of MEG3 on cellular proliferation, apoptosis, invasion, and metastasis. Additionally, we discuss the potential clinical implications of MEG3 as a biomarker and therapeutic target in genitourinary cancers. By unraveling the intricate role of MEG3 in these biological processes, this review aims to contribute to the development of novel strategies for the diagnosis and treatment of genitourinary malignancies.

[Gender-specific differences in urological tumours]

Gender differences in medicine are playing an increasingly important role in diagnostic testing as well as therapy choices. Risk factors and mortality vary depending on gender. Diseases often manifest differently depending on gender. In diagnostic testing, gender-specific aspects need to be taken into consideration. For instance, bladder cancer diagnosis is often delayed in women compared to men as haematuria is frequently attributed to benign conditions like urinary tract infections. In therapy, decisive gender disparities should also be considered. To state an example, immune-checkpoint inhibitors have shown better response in men than in women when treating renal cell carcinoma. Furthermore, outcomes after treatment for urological tumours differ depending on gender.

Digital volumetric assessment of CIS and tumor mass compliments conventional histopathological assessment in muscle-invasive urothelial bladder cancer

Carcinoma in situ (CIS) of the bladder is a known parameter regarding the prognosis and recurrence tendency of urothelial carcinomas. Nevertheless, there is little evidence whether the amount of CIS or other precursor lesions, as well as the quantified tumor mass of muscle-invasive urothelial carcinoma, has an influence on the survival or recurrence rate of affected patients. From 80 patients with muscle invasive urothelial bladder cancer and radical cystectomy, 23 samples each were obtained as part of a whole organ mapping in a single institution study, in which the precursor lesions and tumor area were digitally measured and further correlated to pathological standard parameters, patient survival, molecular luminal and basal subtypes, and immune infiltration. Significant correlations were found between tumor mass and surface lining CIS amount for pT-stage, lymphovascular invasion, and perineural infiltration. Furthermore, an increased tumor mass as well as an increased amount of CIS combined with an increased tumor mass showed a significantly reduced survival rate in multivariable analysis (HR = 2.75; P = 0.019 vs. HR = 3.54; P = 0.002) as well as a significantly increased recurrence. No correlations could be found with molecular subtypes and immune infiltration. The exact measurement of the tumor mass with and without the CIS surface area, whether manually or, more specifically, digitally, could be incorporated into routine diagnostics and implemented as an independent predictor for patient post-surgical outcomes. It can therefore serve as an additional predictor for risk stratification and, if necessary, intensified follow-up care or therapy.

Molecular mechanisms of antiproliferative and pro-apoptotic effects of essential oil active constituents in MCF7 and T24 cancer cell lines: in vitro insights and in silico modelling of proapoptotic gene product-compound interactions

This study aims to investigate the in vitro antiproliferative and pro-apoptotic/apoptotic potential of active constituents of essential oils on two cancer cell lines; namely, breast adenocarcinoma (MCF-7) and urinary bladder cancer (T24). Essential oils active constituents (EO-ACs) entail a spectrum of phytochemicals with widely demonstrated anticancer potential. We assessed the effects of eight essential oils active constituents on T24 and MCF-7 cell lines in both dose- (16-1024 µg/mL) and time-dependent manners. Among these, five EO-ACs (citral, carvacrol, eugenol, geraniol, and thymol) exhibited IC50 values, ranging from 24 µg/mL to 34 µg/mL, as determined by the MTT assay over 72 h. It was observed that the mitochondrial membrane potential decreased while ROS generation increased substantially in treated cells compared to the control. The underlying apoptotic pathway with regard to pro-apoptotic/apoptotic genes was explored through qRT-PCR and western blotting, which showed significant (p < 0.05) upregulation of Bax, Bak, caspase 7, caspase 9, and downregulation of Bcl-2, pERK, and pAkt. The in-silico study showed strong interaction of thymol and carvacrol with Caspase 9, with complex binding energies of -6.1 Kcal/mol and - 6.3 Kcal/mol, respectively. In conclusion, EO-ACs, particularly thymol and carvacrol, effectively reduced cell viability, and triggered caspase-dependent apoptosis in both MCF-7 and T-24 cell lines. These findings categorically underscore EO-ACs as promising active compounds for anticancer therapy, warranting further in-depth exploration through in vivo studies.

Nonintravesical Interventions for Preventing Intravesical Recurrence in Patients With Nonmuscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis

Despite currently used intravesical therapies in non-muscle-invasive bladder cancer (NMIBC), the rate of intravesical recurrence remains very high. We aimed to evaluate the effectiveness of adding nonintravesical interventions to standard intravesical therapies to prevent intravesical recurrence. In April 2024, 3 databases were queried for prospective studies evaluating nonintravesical interventions in addition to standard intravesical therapies for NMIBC (CRD42024490988). The primary outcome was intravesical recurrence-free survival (iRFS). Standard pairwise meta-analyses were performed using hazard ratios (HR) and 95% confidence intervals (95% CI) with a random-effects model. We identified 18 eligible studies (14 RCTs and 4 prospective trials) comprising 4,593 NMIBC patients, which investigated pharmacological interventions (eg, selenium, vitamins, Lactobacillus casei, celecoxib, metformin, mistletoe lectin) and lifestyle modifications (diet). The addition of Lactobacillus casei significantly improved iRFS (HR: 0.50; 95% CI: 0.34-0.73; P < .001). A high western diet pattern significantly worsened iRFS (HR:1.48, 95%CI:1.06-2.06, P = .03). The other nonintravesical interventions were not associated with iRFS. Our comprehensive review of the published literature highlights the need for further research into the efficacy of nonvesical interventions for NMIBC. While Lactobacillus was shown to improve iRFS in 2 RCTs, additional high-quality randomized studies are required to evaluate the effectiveness of other interventions.

Development and validation of a nomogram for predicting prostatic urethral involvement in bladder cancer

To identify risk factors for prostatic urethral involvement (PUI) in bladder cancer and develop an accurate nomogram prediction model. We retrospectively analyzed 295 male patients with bladder urothelial carcinoma undergoing transurethral prostatic biopsy. Risk factors of PUI in bladder cancer were assessed through univariate and multivariate logistic regression analyses. A nomogram model for predicting clinical outcomes was constructed based on the independent risk factors of PUI. The performance of the model was internally validated by 'leave-one-out' cross-validation (LOOCV) and calibration curve. The decision curve analysis (DCA) was applied to evaluate the clinical utility. Further evaluation of PUI and associated risk factors within the context of non-muscle-invasive bladder cancer (NMIBC) were assessed using the same methods. Multivariate analysis revealed that the tumor multiplicity (OR = 2.44, 95% CI 1.17-5.26, P = 0.019), trigonal/neck tumor location (OR = 7.42, 95% CI 4.00-14.24, P < 0.001), high-grade tumor (OR = 5.17, 95% CI 1.52-21.95, P = 0.014), and recurrent carcinoma (OR = 4.39, 95% CI 2.32-8.63, P < 0.001) were identified as independent risk factors for PUI in bladder cancer (all P < 0.05). A final prediction nomogram was established based on these four independent risk factors. After internally validated by LOOCV, the nomogram showed strong discrimination (area under the curve, AUC = 0.8, 95%CI 0.749-0.851) and excellent calibration. DCA further confirmed the model's clinical utility across a wide range of risk thresholds. Subgroup analysis in NMIBC yielded consistent results (AUC = 0.819, 95%CI 0.764-0.874). This nomogram provides a robust tool to stratify PUI risk in bladder cancer, guiding selective prostatic biopsies and personalized management. Integration into clinical workflows may reduce understaging and optimize outcomes. Further external validation is warranted.

Sex as modifier of survival in patients with advanced urothelial cancer treated with pembrolizumab

Gender- and sex-based disparities in response to immune-checkpoint inhibitors (ICI) has been reported in a variety of tumor types. Women have different anatomy with recurrent urinary tract infections, a different sex hormonal profile, and intrinsic differences in local and systemic immune systems and urobiome composition. Existing literature data in a pan-cancer context reveal contradictory results, and real-world evidence in urothelial carcinoma (UC) is lacking. This was a real-world, multicenter, international, observational study to determine the sex effects on the clinical outcomes in metastatic urothelial carcinoma (mUC) patients progressing or recurring after platinum-based therapy and treated with pembrolizumab as a part of routine clinical care. A total of 1039 patients, treated from January 1st, 2016 to December 31st, 2023 in 68 cancer centers were included. Our data showed that women with metastatic urothelial carcinoma treated with pembrolizumab had shorter OS than men, with a 13% advantage in the 5-year OS rate for male patients. A deeper understanding of these results may inform sex-stratification in future prospective clinical trials and help develop strategies to reduce the magnitude of the sex disparities observed in urothelial cancer outcomes.

The Role of Morcellation in En Bloc Resection of Large Bladder Tumors

Background/Objectives: Conventional transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC) is usually performed in a piecemeal manner, leading to difficulties in accurate pathological assessment. En bloc resection of bladder tumor (ERBT) has been developed to address these limitations, offering improved specimen quality. So far, ERBT has been restricted to small bladder tumors due to difficulties in en bloc extraction of large ones (>3 cm). Recently, the morcellation technique has been proposed to facilitate the removal of large bladder tumors during ERBT. This narrative review aims to evaluate the feasibility of ERBT with subsequent morcellation for large bladder tumors, focusing on its role in tumor extraction and its impact on pathological assessment. Methods: A comprehensive literature search was conducted across multiple databases to identify studies evaluating the use of morcellation in ERBT for large bladder tumors. Inclusion criteria comprised studies reporting recurrence rates, detrusor muscle (DM) presence in pathological specimens, and perioperative complications. Additionally, we offered uropathologists a questionnaire to gather their perspectives on the use of morcellation following ERBT, focusing on its impact on pathological assessment, margin evaluation, and staging accuracy. Results: While there is limited evidence on the use of morcellation in ERBT for tumors larger than 3 cm and its impact on oncologic outcomes, morcellation has shown potential in facilitating the retrieval of large tumor specimens, ensuring clear resection margins and accurate staging. However, the learning curve for morcellation techniques and the need for specialized equipment may limit widespread adoption. Conclusions: Morcellation in ERBT for large bladder tumors represents a promising advancement in the management of these challenging cases, offering adequate pathological assessment and oncologic outcomes. Pathologists' reviews of morcellated specimens will likely further validate the technique. Continued research and technological innovations are necessary to optimize its implementation in clinical practice.

Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021

To evaluate the changing trend and cross-country inequality of bladder cancer (BC) burden over the past 30 years and further predict the trend until 2036. Based on the Global Burden of Disease (GBD) 2021 study, the global incidence, mortality, and disability-adjusted life years (DALYs) of bladder cancer from 1990 to 2021 were obtained. We described the distribution of BC at global, regional and national levels and overall/local trends. The age-period-cohort analysis, decomposition analysis and inequality analysis related to socio-demographic index (SDI) were conducted. Additionally, we predicted the future trend of BC burden using Bayesian age-period-cohort model. In the GBD 2021, the global incidence number of BC was 540,310, doubling compared to that in 1990. However, the age-standardized rate (ASR) drops from 6.90 to 6.35. The changes in bladder cancer mortality and DALYs are similar. The ratio of ASRs of burden between males and females is approximately 4:1. Interestingly, in regions with middle SDI, low-middle SDI, and low SDI, the ASR of incidence has shown an upward trend to varying degrees in recent 10 years. Central Europe has the highest ASR of DALYs. China bore the heaviest burden of bladder cancer and experienced the greatest increase in the burden of bladder cancer. Globally, population growth, aging, and epidemiological changes accounted for 89.83%, 83.91%, and - 73.74% of the changes in DALYs respectively. The absolute inequality related to the SDI increases significantly. The slope index of inequality for DALYs increases from 79.84 to 115.60, and the concentration index slightly decreases to 0.26 in 2021. The prediction showed that the ASRs of the three indicators of bladder cancer would continue to decline from 2022 to 2036. Despite a downward trend in ASRs from 1990 to 2021, the global bladder cancer burden has generally increased with regional and country variations. The burden growth pattern driven by population growth and aging may potentially increase the burden number in the future. Burden is concentrated in high-SDI countries and there are signs indicating a shift towards lower-SDI countries. These findings highlighted challenges in BC prevention and management.

Improved epirubicin delivery selectivity to bladder cancer achieved by functionalized hydroxyethyl starch-based prodrug

Bladder instillation of chemo-therapeutic agents is common for bladder cancer (BC) treatment, however, due to the poor tissue selectivity of chemotherapeutic agents, this method suffers from bladder irritation or even chemical cystitis. Here, we designed a hydroxyethyl starch-based prodrug for epirubicin (EPI) using a pH-sensitive hydrazone linker and folate as the active targeting moiety (FA-HES-hyd-EPI) to achieve delivery selectivity. Prodrug micelles decorated with FA (FA-m), with diameter of 203.6 ± 7.1 nm and EPI loading of 5.80 ± 0.129 %, were prepared by self-assemble method. FA-m was found with improved cellular uptake and stronger cytotoxicity over EPI. An orthotopic BC model was established with FA receptor over-expression, and FA-m showed significantly higher accumulation at tissue and cell levels compared with the FA-free counterpart. Besides, the systemic exposure of FA-m was significantly lower than EPI (AUC0-t: 28.11 ± 7.23 ng/mL/h versus 11.60 ± 4.27 ng/mL/h). More importantly, FA-m showed stronger in vivo tumor growth inhibition with average tumor weight of 0.26 ± 0.21 mg (EPI group: 1.695 ± 0.62 mg), and better safety according to body weight and HE staining data. Overall, the combination of active targeting and pH responsive prodrug strategies was a feasible way to achieve selective EPI delivery to BC via instillation that improved both therapeutic effect and safety.

Urease-powered micro/nanomotors: Current progress and challenges

Enzyme-powered micro/nanomotors (MNMs) (EMNMs) use natural enzymes to facilitate the decomposition of fuels, including hydrogen peroxide (H2O2), glucose, triglycerides, and urea to provide power. EMNMs can achieve self-propulsion through the in situ utilization of biofuels without additional fuels, exhibiting excellent biocompatibility and significant potential for application in the biomedical field. Compared with H2O2, which may cause oxidative damage to the body, urea exhibits superior biosafety characteristics. Presently, urease-powered MNMs (UMNMs) have made notable progress in their applications in the biomedical field and have garnered considerable attention from researchers. In this review, we present the latest advancements in the biomedical field of UMNMs, primarily focusing on: 1) diverse materials used for constructing the fundamental framework of motors; 2) control of motor movement through the regulation of enzymatic reaction rates; and 3) research directions for the clinical application of motors, including in vivo imaging, biomarker detection, cancer treatment, optical therapy, overcoming biological barriers, antibacterial interventions, antithrombotic strategies, and gastric disease management. Despite showing immense potential in biomedical applications, there are still several challenges impeding its practical implementation, such as maintaining activity in the in vivo environment while accurately targeting specific sites to achieve the desired clinical therapeutic effects.

Role of circRNAs in regulating cell death in cancer: a comprehensive review

Despite multiple diagnostic and therapeutic advances, including surgery, radiation therapy, and chemotherapy, cancer preserved its spot as a global health concern. Prompt cancer diagnosis, treatment, and prognosis depend on the discovery of new biomarkers and therapeutic strategies. Circular RNAs (circRNAs) are considered as a stable, conserved, abundant, and varied group of RNA molecules that perform multiple roles such as gene regulation. There is evidence that circRNAs interact with RNA-binding proteins, especially capturing miRNAs. An extensive amount of research has presented the substantial contribution of circRNAs in various types of cancer. To fully understand the linkage between circRNAs and cancer growth as a consequence of various cell death processes, including autophagy, ferroptosis, and apoptosis, more research is necessary. The expression of circRNAs could be controlled to limit the occurrence and growth of cancer, providing a more encouraging method of cancer treatment. Consequently, it is critical to understand how circRNAs affect various forms of cancer cell death and evaluate whether circRNAs could be used as targets to induce tumor death and increase the efficacy of chemotherapy. The current study aims to review and comprehend the effects that circular RNAs exert on cell apoptosis, autophagy, and ferroptosis in cancer to investigate potential cancer treatment targets.

Urease-Driven Janus Nanomotors for Dynamic Enrichment and Multiplexed Detection of Bladder Cancer MicroRNAs in Urine

Bladder cancer diagnosis typically involves approaches such as cystoscopy, biopsy, urine cytology, and medical imaging. However, these invasive procedures carry a risk of complications, and direct in vitro detection on clinical samples often results in low sensitivity. Therefore, this study proposed urease-driven magnetic nanomotors for the simultaneous detection of bladder cancer biomarkers miRNA-21 and miRNA-182 in urine samples, aiming for noninvasive diagnosis. The nanomotor was constructed from gold nanorods, mesoporous organo-silica, Fe3O4, and hairpin DNA (hDNA), functioning as a recognition probe for the target miRNAs. In the urea solution, urease catalyzed urea into ammonia and carbon dioxide, propelling the nanomotor for about 60 min, which enhanced the capacity of the probes to capture the target miRNAs. Subsequently, magnetic enrichment enabled highly sensitive dual-miRNA analysis, allowing quantification of miRNA-21 and miRNA-182 with detection limits of 29 and 362 fM, respectively. The nanoprobes also effectively detected miRNAs in spiked urine samples. This simultaneous detection of multiple miRNAs increased the reliability of cancer diagnosis, presenting a novel noninvasive strategy for bladder cancer detection through precise in vitro analysis of actual urine samples.

Intravesical BCG: A Double-Edged Sword? The Untold Story of Infection Risks

Background and Objectives: Intravesical Bacillus Calmette-Guérin (BCG) therapy remains a cornerstone in the treatment of non-muscle-invasive bladder carcinoma due to its efficacy in reducing recurrence and progression rates. However, its use is associated with various complications-including urinary tract infections (UTIs)-which necessitates further exploration. This study aims to analyze UTIs occurring during intravesical BCG treatment, emphasizing the microbial spectrum, resistance patterns, and risk factors from an infectious diseases and clinical microbiology perspective. Materials and Methods: A retrospective analysis was conducted on 240 patients diagnosed with non-muscle-invasive bladder carcinoma who received intravesical BCG therapy between 2010 and 2021. Data were collected from hospital records, including demographic characteristics, comorbidities, number of intravesical BCG cycles, and microbiological findings. UTIs were classified based on susceptibility patterns, and statistical analyses were performed to determine associations between clinical variables and UTI risk. Results: UTIs developed in 39.1% (n = 94) of patients, with 25.8% (n = 62) caused by susceptible pathogens and 13.3% (n = 32) by resistant pathogens. The most common causative agent was Escherichia coli (80.7% in susceptible UTIs, 43.8% in resistant UTIs), followed by Pseudomonas aeruginosa and Klebsiella pneumoniae. The presence of diabetes mellitus and chronic kidney disease significantly increased the risk of developing a UTI (p < 0.05). A higher number of intravesical BCG cycles correlated with increased UTI occurrence (p < 0.001). Serum C-reactive protein (CRP) levels were significantly elevated in patients with resistant UTIs, while procalcitonin levels were not a reliable predictor of UTI occurrence. Conclusions: Intravesical BCG therapy is associated with a significant incidence of UTIs, particularly among patients with predisposing comorbidities. The increasing prevalence of antibiotic-resistant infections underscores the need for careful monitoring and targeted antimicrobial stewardship strategies. CRP may serve as a useful adjunctive marker for UTI diagnosis in this setting. Future studies should focus on optimizing infection control measures and refining diagnostic criteria to differentiate between BCG-related inflammation and infectious complications.

Histone lactylation regulates PRKN-Mediated mitophagy to promote M2 Macrophage polarization in bladder cancer

BACKGROUND

Bladder cancer (BCa), particularly muscle-invasive bladder cancer (MIBC), is associated with poor prognosis, partly because of immune evasion driven by M2 tumor-associated macrophages (TAMs). Understanding the regulatory mechanisms of M2 macrophage polarization via PRKN-mediated mitophagy and histone lactylation (H3K18la) is crucial for improving treatment strategies.

METHODS

A single-cell atlas from 46 human BCa samples was constructed to identify macrophage subpopulations. Bioinformatics analysis and experimental validation, including ChIP-seq and lactylation modulation assays, were used to investigate the role of PRKN in M2 macrophage polarization and its regulation by H3K18la.

RESULTS

Single-cell analysis revealed distinct macrophage subpopulations, including M1 and M2 types. PRKN was identified as a critical regulator of mitophagy in M2 macrophages, supporting their immunosuppressive function. Bulk RNA-seq and gene intersection analysis revealed a set of mitophagy-related macrophage polarization genes (Mito_Macro_RGs) enriched in mitophagy and immune pathways. Pseudotime analysis revealed that PRKN was upregulated during the M1-to-M2 transition. siRNA-mediated PRKN knockdown impaired M2 polarization, reducing the expression of CD206 and ARG1. ChIP-seq and histone lactylation modulation confirmed that H3K18la enhanced PRKN expression, promoting mitophagy and M2 polarization and thereby facilitating immune suppression and tumor progression.

CONCLUSIONS

Histone lactylation regulated PRKN-mediated mitophagy, promoting M2 macrophage polarization and contributing to immune evasion in BCa.

Perioperative Intensive Smoking Cessation Intervention Among Smokers Who Underwent Transurethral Resection of Bladder Tumor (TURBT) in Two Different Settings: A Randomized Controlled Trial

Background/Objective: Smoking is an individual risk factor for bladder cancer. Many patients are still smoking at the time of their diagnosis, yet few trials have examined smoking cessation interventions (SCIs) in relation to transurethral resection of the bladder tumor (TURBT). This study therefore aimed to compare the efficacy of a hospital-based 6-week intensive SCI with standard treatment among this patient group. Methods: A parallel-arm randomized controlled trial was conducted from December 2021 to March 2024 at two university hospital urology departments in Denmark. A total of 38 daily smokers undergoing TURBT were allocated to the hospital-based intensive SCI, including weekly meetings, patient education, motivational support, and complimentary nicotine replacement therapy or the standard treatment with very brief advice and referral to the same intensive SCI at a municipality clinic. The primary outcome was smoking cessation at the end of the intervention, assessed through participant interviews. The secondary outcomes included continuous abstinence at three and six months, quality of life, and frailty. Analyses were performed as intention-to-treat. Results: After six weeks, 37% in the hospital-based group and 6% in the standard group achieved smoking cessation (p = 0.042). At three and six months the quit rates were, 37% and 26% in the hospital-based group, compared to 0% and 0% in the standard group, respectively. No significant differences in quality of life or frailty were found. Conclusions: This trial found that hospital-based intensive SCI increased cessation rates compared to standard treatment. It would be valuable to evaluate the impact on postoperative complications, cancer prognosis, and long-term cessation in a sizeable new study.

Liquid Biopsy Based Bladder Cancer Diagnostic by Machine Learning

Background/Objectives: The timely diagnostics of bladder cancer is still a challenge in clinical settings. The reliability of conventional testing methods does not reach desirable accuracy and sensitivity, and it has an invasive nature. The present study examines the application of machine learning to improve bladder cancer diagnostics by integrating miRNA expression levels, demographic routine laboratory test results, and clinical data. We proposed that merging these datasets would enhance diagnostic accuracy. Methods: This study combined molecular biology methods for liquid biopsy, routine clinical data, and application of machine learning approach for the acquired data analysis. We evaluated urinary exosome miRNA expression data in combination with patient test results, as well as clinical and demographic data using three machine learning models: Random Forest, SVM, and XGBoost classifiers. Results: Based solely on miRNA data, the SVM model achieved an ROC curve area of 0.75. Patient analysis' clinical and demographic data obtained ROC curve area of 0.80. Combining both data types enhanced performance, resulting in an F1 score of 0.79 and an ROC of 0.85. The feature importance analysis identified key predictors, including erythrocytes in urine, age, and several miRNAs. Conclusions: Our findings indicate the potential of a multi-modal approach to improve the accuracy of bladder cancer diagnosis in a non-invasive manner.

Emerging drivers of female bladder cancer: a pathway to precision prevention and treatment

Purpose

Bladder cancer is a public health concern, with smoking and occupational exposure being major risk factors. However, specific risks in women, particularly hormonal, lifestyle, and environmental factors, are underexplored. This study aimed to assess these risk factors in women, focusing on smoking, occupational exposure, recurrent urinary tract infections (UTIs), body mass index (BMI), menopausal status, and family history of cancer.

Materials and methods

This retrospective cohort study included 850 women diagnosed with bladder cancer (2018-2023) and age-matched controls. Data on smoking, occupational exposure, UTIs, BMI, menopausal status, and family history were collected from medical records: multivariate logistic regression and propensity score matching identified independent risk factors. Subgroup analysis explored interactions between menopausal status and other factors.

Results

Smoking (OR = 2.15, p = 0.002), occupational exposure (OR = 1.89, p = 0.007), and recurrent UTIs (OR = 1.72, p = 0.013) were significant risk factors, particularly in post-menopausal women. Menopausal status amplified the effects of smoking and UTIs but was not an independent predictor. BMI and family history showed no significant associations.

Conclusion

Smoking, occupational exposure, and recurrent UTIs are key risk factors for bladder cancer in women, especially post-menopausal women, highlighting the need for targeted prevention strategies.

Epigenetic modifications in bladder cancer: crosstalk between DNA methylation and miRNAs

Bladder cancer (BC) is a malignant tumor characterized by a high incidence of urinary system diseases. The complex pathogenesis of BC has long been a focal point in medical research. With the robust development of epigenetics, the crucial role of epigenetic modifications in the occurrence and progression of BC has been elucidated. These modifications not only affect gene expression but also impact critical biological behaviors of tumor cells, including proliferation, differentiation, apoptosis, invasion, and metastasis. Notably, DNA methylation, an important epigenetic regulatory mechanism, often manifests as global hypomethylation or hypermethylation of specific gene promoter regions in BC. Alterations in this methylation pattern can lead to increased genomic instability, which profoundly influences the expression of proto-oncogenes and tumor suppressor genes. MiRNAs, as noncoding small RNAs, participate in various biological processes of BC by regulating target genes. Consequently, this work aims to explore the interaction mechanisms between DNA methylation and miRNAs in the occurrence and development of BC. Research has demonstrated that DNA methylation not only directly influences the expression of miRNA genes but also indirectly affects the maturation and functionality of miRNAs by modulating the methylation status of miRNA promoter regions. Simultaneously, miRNAs can regulate DNA methylation levels by targeting key enzymes such as DNA methyltransferases (DNMTs), thereby establishing a complex feedback regulatory network. A deeper understanding of the crosstalk mechanisms between DNA methylation and miRNAs in BC will contribute to elucidating the complexity and dynamics of epigenetic modifications in this disease, and may provide new molecular targets and strategies for the early diagnosis, treatment, and prognostic evaluation of BC.

Ionizing radiation and photodynamic therapy lead to multimodal tumor cell death, synergistic cytotoxicity and immune cell invasion in human bladder cancer organoids

BACKGROUND

Photodynamic therapy (PDT) and radiotherapy using ionizing radiation (IR) are promising options for organ-preserving treatment of bladder cancer (BCa). A combination therapy (IR+PDT) could be beneficial for BCa treatment.

PURPOSE

For PDT, we used the near-infrared photosensitizer tetrahydroporphyrin-tetratosylate (THPTS) showing high therapeutic efficacy. Treatment responses were analyzed in BCa organoids.

METHODS

Organoids consisting of BCa cells lines, bladder fibroblasts and muscle cells were treated with IR (9 Gy) and/or PDT using THPTS (25, 50 μM; 20 J/cm2). Cytotoxicity was determined by microscopy, cell-based assays and histology. The cell death mode was analyzed by applying specific inhibitors followed by immunofluorescence or qPCR analyses of cell death markers. A matrix-based co-culture model was used to study T cell migration into the environment of treated organoids.

RESULTS

PDT and/or IR resulted in concentration-dependent reduction of metabolic activity, organoid diameter and integrity. Higher cytotoxicity of IR+PDT vs. monotherapies was observed after 72 h. Non-malignant organoids showed no cytotoxic effects. While apoptosis, necroptosis and ferroptosis were clearly involved in cell death of T-24 cells, cytotoxicity in RT-112 cells was probably provoked by apoptosis, ferroptosis and pyroptosis. IR+PDT resulted in significant migration of Jurkat cells into ECM-embedded organoids within 3 days after treatment.

CONCLUSION

Treatment with IR+PDT showed tumor-selective cytotoxicity with additive or synergistic effects in BCa organoids. Thereby, IR+PDT led to multimodal cell death depending on the cellular context. Migration of T cells into the organoid environment illustrates the immunogenic potential of IR+PDT. Therefore, it might be a promising approach for organ-preserving BCa treatment.

Single-cell RNA sequencing analysis reveals the dynamic changes in the tumor microenvironment during NMIBC recurrence

BACKGROUND

Due to the clinical characteristic of frequent recurrence in urothelial bladder cancer (UBC), patients face significant health impacts and economic burdens. Therefore, understanding the molecular mechanisms involved in UBC recurrence is crucial for reducing its recurrence rate. The aim of our study is to help urologists and clinical researchers gain a deeper understanding of the changes in the tumor microenvironment (TME) during UBC recurrence.

METHODS

We collected 10 samples from primary and recurrent non-muscle-invasive bladder cancer (NMIBC) and performed single-cell RNA sequencing. By distinguishing and annotating cell subpopulations, we identified tissue preferences of some novel cell subgroups. Next, pseudotime trajectory analysis, cell-cell communication analysis, and function enrichment analysis were applied to evaluate the dynamic changes in the TME and biological functions. Finally, we validated the distribution of some of these cell subgroups using multiplex immunofluorescence experiments.

RESULTS

We identified a tumor-associated fibroblast (CAF) subtype with high COL18A1 expression that is highly expressed in recurrent NMIBC, suggesting that the stromal component of the tumor may play a crucial role in the recurrence process. Additionally, pseudotime trajectory analysis revealed a macrophage subtype with high IL-6 expression at the terminal stage of macrophage differentiation, exhibiting significant immunosuppressive features. This indicated the presence of immune exhaustion during NMIBC recurrence. Lastly, we found an upregulation of estrogen in recurrent urothelial cancer cells, which may partially explain the gender disparity observed in UBC.

CONCLUSION

This study identified several cell subpopulations influencing NMIBC recurrence, which were heavily infiltrated in the TME of recurrent NMIBC. Additionally, the enrichment of estrogen in urothelial cancer cells from various sources suggested a role of sex hormones in NMIBC recurrence.

Transcriptomic Profiles for Elucidating Response of Bladder Intracavitary Hyperthermic Perfusion Chemotherapy in High-Risk Nonmuscular Invasive Bladder Cancer

BACKGROUND

Bladder intracavitary hyperthermic perfusion chemotherapy (HIPEC) is a promising treatment for non-muscular invasive bladder cancer (NMIBC). However, the molecular mechanisms underlying the response to HIPEC remain poorly understood. This study aimed to elucidate the transcriptomic profiles associated with the response to HIPEC in NMIBC patients.

METHODS

RNA sequencing was performed on bladder tumor samples from NMIBC patients who underwent HIPEC treatment. Differentially expressed genes (DEGs) between responders and non-responders to HIPEC were identified. Gene ontology and pathway analysis were conducted to explore the biological functions and pathways enriched in the DEGs. Additionally, the expression of specific immune-related genes was evaluated for their association with HIPEC response. The diagnostic efficiency of selected genes in predicting relapse before and after HIPEC treatment was assessed in a validation cohort.

RESULTS

We assessed the expression status of differentially expressed genes (DEGs) between responders and non-responders to HIPEC. Gene ontology and pathway analysis revealed that DEGs were enriched in immune-related pathways, including cytokine-cytokine receptor interaction, chemokine signaling pathway, and antigen processing and presentation. Furthermore, the expression of several immune-related genes, including ZMAP4, UPP2, and GALR1, was significantly associated with the response to HIPEC. Therefore, the immune system's reaction plays a crucial role in the response to HIPEC in patients with NMIBC. At last, a considerable diagnostic efficiency that tissue TMEFF2, KRT222, and GTSF1 in predicting relapse in NMIBC patients after HIPEC treatment, and ZMAP4, UPP2, and GALR1 in predicting relapse in NMIBC patients before HIPEC treatment in the validation cohort.

CONCLUSION

Transcriptomic profiling revealed that immune-related pathways and genes play a crucial role in the response to HIPEC in NMIBC patients. These findings suggest that transcriptomic profiling could provide a valuable tool for predicting treatment outcomes and identifying therapeutic targets for NMIBC.

VI steps to achieve VI-RADS assessment

Bladder cancer is categorized into nonmuscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC), distinguished by the presence of detrusor muscle invasion. Urothelial cell carcinoma is the most common subtype of bladder cancer. Transurethral resection of bladder tumor (TURBT) is the standard approach for staging and managing NMIBC, while radical cystectomy remains the cornerstone treatment for MIBC. Multiparametric magnetic resonance imaging (mpMRI), comprising morphological imaging sequences (high-resolution T2-weighted images) and functional imaging sequences (dynamic contrast-enhanced images and diffusion-weighted images), serves as an ideal modality. It provides high-contrast resolution for visualizing bladder wall layers, thereby enabling proper and timely staging of bladder cancer. MRI can guide sampling resection and identify patients understaged after primary TURBT, facilitating appropriate surgical restaging. In 2018, the Vesical Imaging Reporting and Data System (VI-RADS), implementing a 5-point scale, was developed to standardize MRI protocols and reporting criteria-including tumor location, size, morphology, and invasiveness. The aim of this article is to navigate through all the steps to achieve VI-RADS assessment and to discuss practical pearls and pitfalls in the use of mpMRI. This approach can aid in pre-TURBT prediction of muscle invasion, representing an important asset in bladder cancer staging.

Deciphering the secret codes in N7-methylguanosine modification: Context-dependent function of methyltransferase-like 1 in human diseases

N7-methylguanosine (m7G) is one of the most prevalent post-transcriptional modifications of RNA and plays a critical role in RNA translation and stability. As a pivotal m7G regulator, methyltransferase-like 1 (METTL1) is responsible for methyl group transfer during the progression of m7G modification and contributes to the structure and functional regulation of RNA. Accumulating evidence in recent years has revealed that METTL1 plays key roles in various diseases depending on its m7G RNA methyltransferase activity. Elevated levels of METTL1 are typically associated with disease development and adverse consequences. In contrast, METTL1 may act as a disease suppressor in several disorders. While the roles of m7G modifications in disease have been extensively reviewed, the critical functions of METTL1 in various types of disease and the potential targeting of METTL1 for disease treatment have not yet been highlighted. This review describes the various biological functions of METTL1, summarises recent advances in understanding its pathogenic and disease-suppressive functions and discusses the underlying molecular mechanisms. Given that METTL1 can promote or inhibit disease processes, the possibility of applying METTL1 inhibitors and agonists is further discussed, with the goal of providing novel insights for future disease diagnosis and potential intervention targets. KEY POINTS: METTL1-mediated m7G modification is crucial for various biological processes, including RNA stability, maturation and translation. METTL1 has emerged as a critical epigenetic modulator in human illnesses, with its dysregulated expression correlating with multiple diseases progression and presenting opportunities for both diagnostic biomarker development and molecular-targeted therapy. Enormous knowledge gaps persist regarding context-dependent regulatory networks of METTL1 and dynamic m7G modification patterns, necessitating mechanistic interrogation to bridge basic research with clinical translation in precision medicine.

Recent Advances in Immunotherapy for Bladder Cancer Treatment

Bladder cancer is one of the most common malignancies worldwide. Standard neoadjuvant or metastatic therapy used to be cisplatin-based chemotherapy, but many patients are ineligible due to age, renal impairment, or frailty. Checkpoint inhibitors (e.g., atezolizumab and pembrolizumab) enhance survival in cisplatin-ineligible patients. Originally approved as second-line therapy for patients after platinum-based chemotherapy, nivolumab was approved by the FDA for adjuvant therapy of high-risk muscle-invasive urothelial cancer following the Checkmate 274 trial. It is indicated for patients with resected disease or cisplatin ineligibility. Recent developments focused on the contribution of nivolumab to outcomes have been complemented by ongoing investigations on atezolizumab as a monotherapy or in combinations for muscle-invasive bladder cancer, providing further hope for improved control. This narrative review aims to clarify the current applications of immunotherapy in treating bladder cancer and to explore the future outlook based on ongoing clinical trials.