Increased urinary B2-microglobulin is associated with poor prognosis of upper tract urothelial carcinoma

BACKGROUND

Kidney tubular damage markers are biomarkers of acute or chronic kidney injury. Hypothetically, upper tract urothelial cancer (UTUC), which induces obstructive uropathy or direct invasion of the renal parenchyma, may also induce increased excretion of urinary tubular damage proteins. Therefore, this study aimed to investigate the use of tubular damage biomarker as prognostic markers for UTUC.

METHODS

The records of 417 surgically resected patients with UTUC were obtained from the Seoul National University Prospectively Enrolled Registry for urothelial cancer-upper tract urothelial cancer (SUPER-UC-UTUC) between January 2016 and December 2020. Patients with non-urothelial cancer or without urinary tubular injury marker measurement were excluded, and finally, 296 patients were finally included. B2-microglobulin (B2-MG) was an injury marker, and a value higher than 0.3 was considered abnormally elevated, according to previous studies.

RESULTS

The mean age was 70.9 years, and the male sex was predominant (n = 211, 71.3%). The incidences of renal pelvis and ureter cancer were similar (50.7% vs. 49.3%). Most patients had high-grade diseases (n = 254, 88.8%). The high urine B2-MG group was older, had decreased renal function, and had a higher pathologic T stage than did the low group. Multivariate Cox regression analysis of disease-free survival (DFS), open surgical method (Hazard ratio (HR) 1.52, p = 0.027), large tumor size (HR 1.06, p = 0.017), tumor multifocality (HR 1.90, p = 0.038), lymphovascular invasion (HR 2.19, p < 0.001), and high urine B2-MG (HR 1.57, p = 0.021) were significantly associated with shortened metastasis-free survival (MFS). Kaplan-Meier curve analysis revealed short DFS (median survival 15.5 months vs. unattained, log-rank p = 0.001) and MFS (unattained median survival in both groups, log-rank p = 0.003) for the high urine B2-MG group compared to the low urine B2-MG group.

CONCLUSION

Patients with UTUC presenting with increased pre-operative urine B2-MG levels were associated with disease recurrence and metastasis. This biomarker may aid in performing pre-operative risk stratification and in assessing the individual prognosis of patients with UTUC.

Acidic urine is associated with poor prognosis in patients with bladder cancer undergoing radical cystectomy

PURPOSE

To assess the prognostic value of acidic urine (low urine pH) in patients with bladder cancer undergoing radical cystectomy.

MATERIALS AND METHODS

We reviewed patients enrolled in the Seoul National University Prospectively Enrolled Registry for Urothelial Cancer-Cystectomy (SUPER-UC-Cx) who underwent radical cystectomy for bladder cancer between March 2016 and December 2020 at the Seoul National University Hospital. During this period, 368 patients were registered in our database. To eliminate confounding factors, we excluded patients diagnosed with non-urothelial cancer and end-stage renal disease.

RESULTS

A total of 351 patients with a mean age of 69.8 ± 10.5 years and median follow-up of 16.0 months were eligible for the analysis. The mean preoperative urine pH was 6.0. The patients were divided into low (pH ≤ 5.5) and high (pH≥6.0) urine pH groups for comparison. All clinicopathological features, including the tumor size, grade, and stage were comparable between the low and high urine pH groups. A Cox regression analysis was performed to assess the independent effect of acidic urine on patient survival. A multivariate analysis showed that high T stage (T3-4) (hazard ratio (HR) 5.18, P<0.001), decreased renal function (estimated glomerular filtration rate <60 mL/min/1.73 m2) (HR 2.29, P=0.003), and low urine pH (≤5.5) (HR 1.69, P=0.05) were associated with shortened recurrence-free survival (RFS). Regarding the overall survival (OS), high T stage (T3-4) (HR 7.15, P<0.001) and low urine pH (≤5.5) (HR 2.66, P=0.029) were significantly associated with shortened survival. A Kaplan-Meier analysis demonstrated that the acidic urine group showed shorter RFS (P=0.04) and OS (P=0.028) than the other groups.

CONCLUSIONS

Acidic urine was independently associated with reduced RFS and OS in patients with bladder cancer undergoing radical cystectomy. Acidic urine contributing to an acidic tumor environment may promote aggressive behavior in bladder cancer.

Progression to T1 High Grade (T1HG) from a Lower Stage/Grade is Associated with Poorer Survival Outcomes than Initial Diagnosis with T1HG Bladder Cancer

BACKGROUND

Several studies have documented a poor prognosis in those patients who were initially diagnosed with non-muscle-invasive bladder cancer (NMBIC) and progressed to muscle-invasive bladder cancer (MIBC) compared with those who initially presented with MIBC. However, studies regarding this issue have not yet been performed in patients with T1 high-grade (T1HG) tumor. We aimed to compare survival outcomes between patients diagnosed as T1HG after initial transurethral resection of the bladder tumor (TUR-BT) and patients who presented with lower stage and/or grade but progressed to T1HG at the time of tumor recurrence.

METHODS

The study comprised 499 patients who had a diagnosis of T1HG after initial TUR-BT (initial T1HG group) and 62 patients who progressed to T1HG after TUR-BT at the time of tumor recurrence (progressed T1HG group). Progression was defined as recurrence to a higher grade and/or stage than the previous result, while MIBC progression was defined as progression to stage T2 or higher and/or N+, and/or M1.

RESULTS

The median overall survival (OS) and cancer-specific survival (CSS) durations were 38.0 and 29.0 months, respectively. Kaplan-Meier curve analysis showed significantly decreased 5-year OS (74.4 vs. 57.4%), CSS (86.4 vs. 72.8%), and MIBC progression-free survival (82.6 vs. 62.2%) in the progressed T1HG group. Multivariate analysis revealed that progressed T1HG was a significant predictor of OS, CSS, and MIBC progression (all, p < 0.05).

CONCLUSIONS

The progressed T1HG group showed poorer survival outcomes compared with the initial T1HG group. Consequently, in patients who progress to T1HG, intensive surveillance and treatment strategies should be considered.

Significance of nocturnal hesitancy in treatment of men with lower urinary tract symptoms

OBJECTIVES

To determine the significance of nocturnal hesitancy in the treatment of men with lower urinary tract symptoms.

METHODS

A total of 123 patients with nocturia were prospectively studied. The nocturnal hesitancy scores ranged from 0 to 5 and were scored according to the International Prostate Symptom Score. The patients were stratified on the basis of their nocturnal hesitancy scores as group 1 (0 to 1, n = 57), group 2 (2 to 3, n = 45), and group 3 (4 to 5, n = 21). All patients received treatment with an alpha-blocker once daily for 4 weeks.

RESULTS

Group 3 scored significantly higher on the International Prostate Symptom Score at baseline and after treatment than did group 1. The actual number of nightly voids was greatest in group 3 and was lowest in group 1 (P = 0.011 at baseline and P = 0.046 after treatment, respectively). The baseline nocturia indexes were greatest in group 3 and were lowest in group 2 (P = 0.027). A significant but weak correlation was also noted between the nocturia hesitancy score and the differences in scores between the posttreatment and baseline voiding symptoms (r = -0.234, P = 0.021) and total International Prostate Symptom Score (r = -0.270, P = 0.011), respectively. In our multivariate analyses, the straining score was a significant determinant of nocturnal hesitancy.

CONCLUSIONS

The results of our study revealed that more emphasis should be placed on nocturnal hesitancy in the terminology of lower urinary tract symptoms. Additional research regarding the pathophysiologic mechanisms underlying nocturnal hesitancy, as well as its effects on those with it, is clearly warranted.

Concurrent Multilocular Cystic Renal Cell Carcinoma and Leiomyoma in the Same Kidney: Previously Unreported Association

We present an unusual case of concurrent occurrence of a multilocular cystic renal cell carcinoma and a leiomyoma in the same kidney of a patient with no evident clinical symptoms. A 38-year-old man was found incidentally to have a cystic right renal mass on computed tomography. Laparoscopic radical nephrectomy was performed under a preoperative diagnosis of cystic renal cell carcinoma. Histology revealed a multilocular cystic renal cell carcinoma and a leiomyoma. This is the first report of this kind of presentation.

A dietary commensal microbe enhances antitumor immunity by activating tumor macrophages to sequester iron

Innate immune cells generate a multifaceted antitumor immune response, including the conservation of essential nutrients such as iron. These cells can be modulated by commensal bacteria; however, identifying and understanding how this occurs is a challenge. Here we show that the food commensal Lactiplantibacillus plantarum IMB19 augments antitumor immunity in syngeneic and xenograft mouse tumor models. Its capsular heteropolysaccharide is the major effector molecule, functioning as a ligand for TLR2. In a two-pronged manner, it skews tumor-associated macrophages to a classically active phenotype, leading to generation of a sustained CD8+ T cell response, and triggers macrophage 'nutritional immunity' to deploy the high-affinity iron transporter lipocalin-2 for capturing and sequestering iron in the tumor microenvironment. This process induces a cycle of tumor cell death, epitope expansion and subsequent tumor clearance. Together these data indicate that food commensals might be identified and developed into 'oncobiotics' for a multi-layered approach to cancer therapy.

Psychometric validation study of the Korean version of the Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index

PURPOSES

To evaluate the reliability and validity of a Korean version of the Functional Assessment of Cancer Therapy (FACT)-Vanderbilt Cystectomy Index (VCI) in Korean patients who underwent radical cystectomy (RC) and urinary diversion (UD).

MATERIALS AND METHODS

We prospectively recruited 108 RC and UD patients who did not have evidence of recurrence from 1994 December to 2015 March. All participants were instructed to complete the Korean FACT-VCI and Short-Form 36-Item Health Survey (SF-36; 1st measurement) and to repeat the Korean FACT-VCI survey one month later (2nd measurement). Statistical analysis included intraclass correlation, Cronbach's α, time and UD type fixed mixed linear model, principal components analysis, and criterion-related validity with SF-36.

RESULTS

Korean FACT-VCI was internally consistent (α = 0.802) and had adequate test-retest reliability (interclass correlation = 0.803 and 0.822). The three components model of principal component analysis (cumulative explanatory power, 49.2%) confirmed the internal structural validity of the additional concerns (AC) component of the Korean FACT-VCI, and each component represented the "voiding problem", "bowel problem", and "social/functional problem with equivalent explanatory power (19.5%, 15.4%, and 14.4%). Korean FACT-VCI domain scores were generally well correlated with SF-36 domain scores (Pearson correlation coefficients range: 0.286-0.688; all p <0.01). Mixed linear models revealed that the major effect of measurement times was not significant on FACT-VCI (p = 0.589).

CONCLUSIONS

This prospective study confirms the reliability and validation of the Korean FACT-VCI. We expect that this validated tool can be widely utilized in the health-related quality of life studies of Korean patients.

High-dose terazosin therapy (5mg) in Korean patients with lower urinary tract symptoms with or without concomitant hypertension: a prospective, open-label study

PURPOSE

We determined the efficacy and safety of a relatively high dose of terazosin (5mg) in Korean patients with lower urinary tract symptoms (LUTS), with or without concomitant hypertension.

MATERIALS AND METHODS

From July to December 2006, 200 men who consecutively presented with LUTS were prospectively studied. Eight weeks after treatment, blood pressure (BP), uroflowmetry, and International Prostate Symptom Score (I-PSS) were assessed. For analysis purposes, patients were stratified according to concomitant hypertension. Of the 200 patients, 173 completed the scheduled eight-week treatment period.

RESULTS

At baseline, no differences were evident in the two groups in terms of I-PSS, Qmax, PVR and BP. After eight weeks of treatment-although I-PSS and uroflowmetry parameters were not significantly different in the two groups-systolic and diastolic BP in the non-hypertensive control group were higher than in the hypertensive group (p= 0.001 and p=0.0100, respectively). Changes in I-PSS, uroflowmetry parameters, and BPs measured at week eight post- treatment commencement did not significantly differ between the two groups. Moreover, the addition of 5mg of terazosin to antihypertensives did not cause a significant reduction in either systolic or diastolic BP in either group.

CONCLUSION

Adding terazosin to existing antihypertensive regimens did not seem to increase the incidence of adverse events. Our findings suggest that 5mg terazosin is effective and that it has an acceptable safety profile as an add-on therapy for patients with LUTS and concomitant hypertension.

A retrospective multicenter comparison of conditional cancer-specific survival between laparoscopic and open radical nephroureterectomy in locally advanced upper tract urothelial carcinoma

BACKGROUND

Upper urinary tract urothelial carcinomas are relatively rare and have a cancer-specific survival rate of 20%-30%. The current gold standard treatment for nonmetastatic high-grade urinary tract urothelial carcinoma is radical nephroureterectomy with bladder cuff resection.

OBJECTIVE

This study aimed to compare conditional cancer-specific survival between open radical nephroureterectomy and laparoscopic radical nephroureterectomy in patients with nonmetastatic stage pT3-4 or TxN(+) locally advanced urinary tract urothelial carcinoma from five tertiary centers.

METHODS

The medical records of 723 patients were retrospectively reviewed. The patients had locally advanced and nodal staged tumors and had undergone open radical nephroureterectomy (n = 388) or laparoscopic radical nephroureterectomy (n = 260) at five tertiary Korean institutions from January 2000 and December 2012. To control for heterogenic baseline differences between the two modalities, propensity score matching and subgroup analysis were conducted. Conditional survival analysis was also conducted to determine survival outcome and to overcome differences in follow-up duration between the groups.

RESULTS

During the median 50.8-month follow up, 255 deaths occurred. In univariate analysis, significant factors affecting cancer-specific survival (e.g., age, history of bladder cancer, American Society of Anesthesiologists score, pathological N stage, and presence of lymphovascular invasion and carcinoma in situ) differed in each subsequent year. The cancer-specific survival between patients treated with open radical nephroureterectomy and laparoscopic radical nephroureterectomy was not different between patients with and without a history of bladder cancer. After adjusting baseline differences between the two groups by using propensity score matching, both groups still had no significant differences in cancer-specific survival.

CONCLUSION

The two surgical modalities showed no significant differences in the 5-year cancer-specific survival in patients with locally advanced urinary tract urothelial carcinoma.

Prognostic Impact of Preoperative Renal Insufficiency on Metastasis-Free Survival after Radical Cystectomy

Several studies founded that preoperative renal insufficiency is associated with a higher risk of upper tract urothelial carcinoma recurrence and mortality than normal renal function patients. However, previous studies were all retrospective; no study focused on urothelial carcinoma in the bladder and metastasis-free survival (MFS). Herein, we examined the prognostic impact of preoperative renal insufficiency on the oncologic outcomes of patients with urothelial carcinoma in the bladder after radical cystectomy. We used data from 262 patients prospectively collected from a radical cystectomy cohort between March 2016 and February 2021. The patients were divided into those with a preoperative glomerular filtration rate (GFR) of <60 mL/min/1.73 m2 (renal insufficiency; n=66) and those with a GFR ≥60 mL/min/1.73 m2 (control; n=196). We investigated MFS, cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves and Cox proportional hazard regression were used to estimate the prognostic impact of renal insufficiency. The mean MFS was significantly shorter in the renal insufficiency group than in the control group (36.58±3.09 months vs. 47.37±1.87 months); however, OS and CSS were not significantly different. T stage ≥3 (hazard ratio [HR]: 2.79), lymph node positivity (HR: 2.261), and renal insufficiency (HR: 2.04) were significant independent predictors of MFS. Preoperative renal insufficiency was an independent prognostic factor for worse MFS. Well-designed randomized clinical trials and translational studies are needed to clarify the mechanism of relationship between preoperative renal insufficiency and MFS.

Risk of connective-tissue disease in men with testicular or penile prostheses: a preliminary study

AIM

To help clarifying the possibility of connective-tissue diseases in men with penile or testicular prostheses.

METHODS

Eight patients underwent inflatable penile prostheses and 15, testicular prostheses consented to the study. Their medical records were reviewed and a follow-up interview and physical and serological examinations were performed.

RESULTS

In patients with penile prostheses, there was no abnormal antinuclear antibody (ANA) or IgM elevation. The serum levels of the rheumatoid factor (RF), C4, IgA and IgG were abnormal in one patient, and the levels of erythrocyte sedimentation rate (ESR) and C3, abnormal in two. Four had elevated IgE. In patients with testicular prostheses, there was no abnormal RF, ANA or IgM. The serum levels of ESR and IgA were abnormal in two, and three had abnormal C4, ten abnormal C3, and eleven decreased IgG. All had increased IgE. Men with penile prostheses had higher serum levels of IgG and IgM than those with testicular prostheses (P=0.001, P=0.016, respectively). The rates of abnormal values of IgE and IgG were higher in men with testicular prostheses than in men with penile prostheses (P=0.008, P=0.009, respectively). Physical examination was normal in all patients and nobody had documented symptoms pertinent to connective-tissue diseases.

CONCLUSION

Our findings suggest that the risk of connective-tissue diseases is not higher in patients wearing prostheses as the ANA is negative and there is no apparent manifestation suggestive of connective-tissue diseases.

Tubular damage marker as a predictive factor for pathologically upstaged renal cell carcinoma

PURPOSE

To investigate if increased tubular damage biomarker can predict pathologically upstaged renal cell carcinoma (RCC), which may possess sub-radiologic invasive behavior, leading to surrounding tubular damage.

MATERIALS AND METHODS

We examined 1563 patients with surgically resected RCC between March 2016 and June 2021 from the prospective database SUPER-RCC-Nx. Exclusion criteria were cancer not originating from the kidneys, benign renal tumor, and end-stage renal disease.

RESULTS

Of 1297 patients, 131 had a clinically high T stage (T3-4), whereas 1166 had a low one. Patients with a clinically low T stage were subgrouped into identical-stage (n = 1041) and upstaged (n = 125) groups, who were confirmed as a pathologically high T stage. The upstaged group had older age (p = 0.003), larger tumor size (5.72 ± 3.24 vs. 3.12 ± 2.08, p < 0.001), higher Fuhrman grade (grades 3-4) (57.3% vs. 47.1%, p = 0.032), and higher urine N-acetyl-beta-D-glucosaminidase/creatinine (NAG/Cr) (5.13 ± 4.78 vs. 4.05 ± 2.84, p = 0.026). Tumor size (> 4 cm; odds ratio = 10.2, p < 0.001) and urine NAG/Cr (odds ratio = 1.16, p = 0.003) were independently associated with pathological upstaging in patients with normal renal function, while age and tumor size were significant risk factors in those with decreased renal function. The receiver operating characteristic curve analysis showed that the model using tumor size and urine NAG/Cr strongly predicted pathological upstaging (area under the curve, 0.84).

CONCLUSION

Urine NAG/Cr may be a useful biomarker predicting pathologically upstaged RCC. Clinicians should be prudent in making management decisions when a large RCC is accompanied by an increased urine NAG/Cr.

The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial

BACKGROUND

This study investigated the effects of intraoperative goal-directed hemodynamic therapy (GDHT) on postoperative outcomes in patients undergoing open radical cystectomy.

METHODS

This prospective, single-center, randomized controlled trial included 82 patients scheduled for open radical cystectomy between September 2018 and November 2021. The GDHT group (n = 39) received the stroke volume index- and cardiac index-based hemodynamic management using advanced hemodynamic monitoring, while the control group (n = 36) received the standard care under the discretion of attending anesthesiologists during surgery. The primary outcome was the incidence of a composite of in-hospital postoperative complications during hospital stays.

RESULTS

A total of 75 patients were included in the final analysis. There was no significant difference in the incidence of in-hospital postoperative complications (28/39 [71.8%] vs. 30/36 [83.3%], risk difference [95% CI], -0.12 [-0.30 to 0.07], P = 0.359) between the groups. The amounts of intraoperative fluid administered were similar between the groups (2700 [2175-3250] vs. 2900 [1950-3700] ml, median difference [95% CI] -200 [-875 to 825], P = 0.714). The secondary outcomes, including the incidence of seven major postoperative complications, duration of hospital stay, duration of intensive care unit stay, and grade of complications, were comparable between the two groups. Trends in postoperative estimated glomerular filtration rate, serum creatinine, and C-reactive protein did not differ significantly between the two groups.

CONCLUSIONS

Intraoperative GDHT did not reduce the incidence of postoperative in-hospital complications during the hospital stay in patients who underwent open radical cystectomy.

TRIAL REGISTRATION

This study was registered at http://www.

CLINICALTRIALS

gov (Registration number: NCT03505112; date of registration: 23/04/2018).

Histological diagnosis of prostate cancer in Korean men aged 70-79 years

BACKGROUND

The objective of this study was to evaluate the value of the prostate-specific antigen (PSA) in the diagnosis of prostate cancer in elderly Korean men, aged 70-79 years.

METHODS

Patients with an abnormal digital rectal examination (DRE) and/or a serum PSA level greater than 2.0 ng/ml underwent a biopsy. A total of 344 men (median age 73 years) constituted the study cohort.

RESULTS

Of 344 men, 163 (47.4%) were diagnosed with prostate cancer upon initial biopsy. The positive predictive value (PPV) for cancer was 48.4% for a PSA cutoff of 4 ng/ml, 65.3% for a cutoff of 10 ng/ml, and 87.0% for a cutoff of 20 ng/ml. When combined with an abnormal DRE, the predictive values for these PSA cutoffs increased to 79.3, 87.3 and 100%, respectively. When 10 ng/ml was chosen as a PSA cutoff level, about 50% of patients were found to have a Gleason score of 7 or higher. When 4 ng/ml was chosen as a PSA cutoff level, more than 50% of patients with an abnormal DRE were found to have a Gleason score of 7 or higher.

CONCLUSIONS

In elderly men, more than 50% of patients are found to have cancers with a Gleason score of 7 or higher when their PSA level is greater than 10 ng/ml. This threshold may be lowered to 4 ng/ml in the presence of an abnormal DRE. Our findings provide a rationale for recommending a prostate biopsy in elderly patients with an abnormal DRE and/or an elevated serum PSA level. However, at present, it is not clear whether elderly men have better outcomes when they undergo cancer screening.

Differences in peritumoral pseudocapsule characteristics according to clinicopathological factors in clinical T1a renal tumors

OBJECTIVES

To evaluate the status of peritumoral pseudocapsules in renal tumors and the effects of clinicopathological factors on their formation.

METHODS

From January 2011 to December 2012, 258 patients with solitary clinical stage T1a renal tumors who underwent partial nephrectomy were analyzed. Status of pseudocapsule was re-evaluated by a pathologist.

RESULTS

The mean long diameter (± SD) of the tumor and the width of the safety margin were 2.17 (± 0.94) cm and 3.2 (± 2.4) mm, respectively. A complete pseudocapsule was identified in 152 (58.9%) tumors, an incomplete pseudocapsule was identified in 69 (26.7%) tumors, and no pseudocapsule was identified in 37 (14.3%) tumors. Out of 152 tumors with complete pseudocapsules, 45 (29.6%) were confirmed to directly invade the renal parenchyma. In a multivariable analysis, age (odds ratio [OR], 1.045; 95% confidence interval [CI], 1.021-1.070, P < 0.001) and histologic subtype (chromophobe type: OR, 19.455; 95% CI, 4.233-89.471, P < 0.001; oncocytoma: OR, 11.307; 95% CI, 1.357-94.198, P = 0.025) were significant factors for an incomplete or absent pseudocapsule.

CONCLUSIONS

Peritumoral pseudocapsules are absent or incomplete in a significant portion of renal tumors. Old age as well as chromophobe and oncocytoma histologic subtypes were significant risk factors for an incomplete or absent peritumoral pseudocapsule.

Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial

BACKGROUND

The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC.

METHODS

This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4 weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1-2 mg/kg) and fentanyl (50-100 μg/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses.

RESULTS

15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant.

CONCLUSIONS

A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach.

TRIAL REGISTRATION NUMBER

NCT03597087.

Does reduced E-cadherin expression correlate with poor prognosis in patients with upper tract urothelial cell carcinoma?: A systematic review and meta-analysis

BACKGROUND

E-cadherin has emerged as a prognostic factor of urothelial cell carcinoma. In the present work we investigate the relationship between expression of E-cadherin and clinical outcomes, following radical nephroureterectomy for upper tract urothelial cell carcinoma.

METHODS

We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify eligible studies published until July 2017.

RESULT

Six studies were included in the meta-analysis, with a total of 1014 patients. The pooled hazard ratio (HR) for recurrence-free survivor was 0.69 (95% confidence interval [CI], 0.44-1.09, I = 63%, P = .04). Also, reduced E-cadherin was not significantly associated with poor cancer-specific survivor (pooled HR, 1.40; 95% CI, 0.66-1.43, I = 54%, P = .11). The pooled HR for overall survivor was not statistically significant (pooled HR, 0.68; 95% CI, 0.32-1.46, I = 80%, P = .007). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis.

CONCLUSIONS

Reduced E-cadherin expression did not appear to be significantly associated with disease prognosis after nephroureterectomy in the meta-analysis. However, further high quality, prospective studies are warranted to better address this issue.