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Zaghloul MS, Zaghloul TM, Bishr MK, Baumann BC. Urinary schistosomiasis and the associated bladder cancer: update. J Egypt Natl Canc Inst 2020; 32:44. [DOI: 10.1186/s43046-020-00055-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Urinary schistosomiasis and its severe complications, mainly bladder cancer, are scarce in non-endemic areas. The deficiency in knowledge and clinical experience of schistosomiasis may lead to inadequate management. Highlighting these topics may be of value, especially with the increased immigration from endemic low-/middle-income countries (LMIC) to non-endemic high-income countries (HIC). Schistosomiasis is a parasitic infection endemic in many low- and middle-income countries. It can affect various systems but is best known for its effect on the urinary system.
Main Body
PubMed, Scopus, Google Scholar, and the Cochrane Library databases were searched for urinary schistosomiasis and its related bladder cancer published from 1980 till 2020.
Schistosoma haematobium (SH) infecting the urinary bladder was considered by the IARC as group 1 definitive biological carcinogenic agent. Several carcinogenic pathways have been postulated but the exact mechanism(s) are not defined yet. A more thorough understanding of the parasite life cycle was explored to help eradicate the infection especially for the immigrants from endemic areas. This may prevent or slow down the process of carcinogenesis that leads to Schistosoma-associated bladder cancer (SA-BC), which is usually, but not conclusively, squamous cell carcinoma. Treatment of SA-BC generally follows the same guidelines as urothelial Schistosoma-non-associated bladder cancer (SNA-BC) management; however, prospective trials to confirm and refine the treatment approach for SA-BC have been relatively limited.
Conclusion
The available data showed that despite some etiologic and carcinogenic differences, the oncologic outcomes are generally comparable for SA-BC and NSA-BC when adjusting for stage, risk status, and comorbidities.
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Wang F, Ma X, Mao G, Zhang X, Kong Z. STAT3 enhances radiation-induced tumor migration, invasion and stem-like properties of bladder cancer. Mol Med Rep 2020; 23:87. [PMID: 33236137 PMCID: PMC7716396 DOI: 10.3892/mmr.2020.11728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
Bladder cancer (BCa) is the most common cancer of the human urinary system, and is associated with poor patient prognosis and a high recurrence rate. Cancer stem cells (CSCs) are the primary cause of tumor recurrence and metastasis, possessing self-renewal properties and resistance to radiation therapy. Our previous studies indicated that phosphorylated signal transduction and transcription activator 3 (STAT3) may be a potential biomarker to predict radiation tolerance and tumor recurrence in patients with BCa, following conventional radiotherapy. The aim of the present study was to investigate the underlying mechanism of STAT3 in the radio-resistance of BCa cells. It was found that fractionated irradiation promoted the activation of two STAT3-associated CSCs signaling pathways in BCa cells, namely suppressor of variegation 3–9 homolog 1/GATA binding protein 3/STAT3 and Janus kinase 2/STAT3. Surviving cells exhibited elevated migratory and invasive abilities, enhanced CSC-like characteristics and radio-resistance. Furthermore, knockdown of STAT3 expression or inhibition of STAT3 activation markedly decreased the self-renewal ability and tumorigenicity of radiation-resistant BCa cells. Kaplan-Meier analysis revealed that decreased STAT3 mRNA levels were associated with increased overall survival times in patients with BCa. Taken together, these data indicated that STAT3 may be an effective therapeutic target for inhibiting the progression, metastasis and recurrence of BCa in patients receiving radiotherapy.
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Affiliation(s)
- Fang Wang
- Department of Radiobiology, Institute of Radiation Medicine, Fudan University, Shanghai 200032, P.R. China
| | - Xiangli Ma
- Department of Radiobiology, Institute of Radiation Medicine, Fudan University, Shanghai 200032, P.R. China
| | - Guangmin Mao
- Department of Radiobiology, Institute of Radiation Medicine, Fudan University, Shanghai 200032, P.R. China
| | - Xiangyan Zhang
- Department of Radiobiology, Institute of Radiation Medicine, Fudan University, Shanghai 200032, P.R. China
| | - Zhaolu Kong
- Department of Radiobiology, Institute of Radiation Medicine, Fudan University, Shanghai 200032, P.R. China
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Nason GJ, Ajib K, Tan GH, Kulkarni GS. Radical cystectomy-what is the optimal surgical approach? Transl Androl Urol 2020; 9:2308-2312. [PMID: 33209702 PMCID: PMC7658163 DOI: 10.21037/tau-20-880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Gregory J Nason
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Guan-Hee Tan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Ding H, Fan N, Ning Z, Ma D. Trimodal Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Meta-Analysis. Front Oncol 2020; 10:564779. [PMID: 33154943 PMCID: PMC7591759 DOI: 10.3389/fonc.2020.564779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To compare the difference between trimodal therapy (TMT) and radical cystectomy (RC) in treating muscle-invasive bladder cancer, we performed a meta-analysis for data from the following database. Methods: We searched PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wanfang databases, and Google Scholar up to December 2019. The main outcome measures assessed were overall survival (OS), cancer-specific survival (CSS), mortality, and Charlson comorbidity score (CCS). Two authors independently evaluated the study quality and extracted data. All data were analyzed using Review Manager (version 5.3). Results: After database retrieval, article selection, data extraction, and quality assessment, nine articles comprising 5,721 cases from the TMT group and 48,262 cases from the RC group were included in this study. The data showed that there was no statistical difference between TMT and RC at <10 years OS [pooled hazard ratio (HR) = 1.26, 95% confidence interval (CI): 0.92–1.73, Z = 1.46, P = 0.14], while OS of the RC group was higher than that of the TMT group at more than 10 years (pooled HR = 1.34, 95% CI: 1.18–1.54, Z = 4.33, P < 0.0001). As for CSS, compared with the TMT group, the patients in the RC group had longer CSS (pooled HR = 1.50, 95% CI: 1.29–1.76, Z = 5.15, P < 0.00001). Compared with RC, TMT is linked to an obvious increase in all-cause mortality and bladder-specific cancer mortality (pooled HR = 1.30, 95% CI: 1.16–1.46, Z = 4.55, P < 0.00001; pooled HR = 1.32, 95% CI: 1.15–1.51, Z = 3.92, P < 0.0001). The bladder cancer patients belonging to CCS “0” score preferred RC [pooled relative risk (OR) = 0.94, 95% CI: 0.89–0.98, Z = 2.79, P = 0.005], while CCS “2” score's patients were prone to TMT (pooled OR = 1.40, 95% CI: 1.29–1.53, Z = 7.73, P < 0.00001). Conclusions: Overall, this meta-analysis suggests that the efficacy of TMT is non-inferior to that of RC at <10-year OS, and RC is superior to TMT at more than 10-year OS. Therefore, TMT may be a reasonable treatment option in well-selected patients who are unsuitable for surgery or are not willing to experience surgery. In the future, more high-quality, large-sample randomized controlled trials (RCTs) are needed to verify the results.
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Affiliation(s)
- Hui Ding
- Key Laboratory of Diseases of Urological System Gansu Province, Department of Urology, Gansu Nephro-Urological Clinical Center, Lanzhou University Second Hospital, Lanzhou, China.,Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ning Fan
- Key Laboratory of Diseases of Urological System Gansu Province, Department of Urology, Gansu Nephro-Urological Clinical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhongyun Ning
- Key Laboratory of Diseases of Urological System Gansu Province, Department of Urology, Gansu Nephro-Urological Clinical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Deyuan Ma
- The Second Clinical College of Lanzhou University, Lanzhou, China
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Nakagawa T. Lymph node dissection for bladder cancer: Current standards and the latest evidence. Int J Urol 2020; 28:7-15. [PMID: 33145855 DOI: 10.1111/iju.14398] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/13/2020] [Indexed: 12/23/2022]
Abstract
Lymph node dissection is an indispensable component of radical cystectomy for bladder cancer. Information obtained with lymph node dissection is highly predictive of patient survival, affecting decision-making for adjuvant therapy (diagnostic role). Also, lymph node dissection provides survival benefits in certain patients by removing metastasized nodes (therapeutic role). However, an optimal extent of lymph node dissection has not been established yet. Data from surgical mapping studies showed that approximately 10% of the primary lymphatic landing sites were common iliac nodes, suggesting that lymph node dissection below the common iliac bifurcation is suboptimal. Several retrospective studies have shown a possible survival advantage with more extended lymph node dissection. However, the results of the first prospective randomized controlled trial failed to prove the survival advantage of extended lymph node dissection up to the level of the inferior mesenteric artery, compared with lymph node dissection below the bifurcation of the common iliac artery. Currently, lymph node dissection templates recommended by major guidelines are not consistent with each other. Furthermore, the evidence is limited in the settings of neoadjuvant chemotherapy, robot-assisted surgery and high-risk non-muscle-invasive disease. Physicians need to decide the extent of lymph node dissection for each patient, taking into account the potential survival benefit and possible harms of extended lymph node dissection. Another randomized controlled trial is currently underway and will provide further evidence shortly.
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Affiliation(s)
- Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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56
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Voskuilen CS, Seiler R, Rink M, Poyet C, Noon AP, Roghmann F, Necchi A, Aziz A, Lavollé A, Young MJ, Marks P, Saba K, van Rhijn BW, Fransen van de Putte EE, Ablat J, Black PC, Sosnowski R, Dobruch J, Kumar P, Jallad S, Catto JW, Xylinas E, Hendricksen K. Urothelial Carcinoma in Bladder Diverticula: A Multicenter Analysis of Characteristics and Clinical Outcomes. Eur Urol Focus 2020; 6:1226-1232. [DOI: 10.1016/j.euf.2018.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 02/07/2023]
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57
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Cardoso M, Choudhury A, Christie D, Eade T, Foroudi F, Hayden A, Holt T, Kneebone A, Sasso G, Shakespeare TP, Sidhom M. FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC. J Med Imaging Radiat Oncol 2020; 64:882-893. [DOI: 10.1111/1754-9485.13120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/17/2020] [Accepted: 09/29/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Michael Cardoso
- Cancer Therapy Centre Liverpool Hospital New South Wales Australia
- Centre for Medical Radiation Physics University of Wollongong Wollongong New South Wales Australia
- South Western Sydney Clinical School University of New South Wales New South Wales Australia
| | - Ananya Choudhury
- Division of Cancer Sciences University of Manchester Manchester UK
- The Christie NHS Foundation Trust Manchester UK
| | - David Christie
- Genesis Cancer Care Queensland Australia
- Department of Health Sciences and Medicine Bond University Gold Coast Queensland Australia
| | - Thomas Eade
- Northern Sydney Cancer CentreRoyal North Shore Hospital New South Wales Australia
- Northern Medical School University of Sydney Sydney New South Wales Australia
| | - Farshad Foroudi
- Department of Radiation Oncology Newton‐John Cancer Wellness and Research CentreAustin Health Heidelberg Victoria Australia
- Latrobe University Melbourne Victoria Australia
| | - Amy Hayden
- Sydney West Radiation Oncology Westmead Hospital Sydney New South Wales Australia
| | - Tanya Holt
- Princess Alexandra Hospital‐ROPART Brisbane Queensland Australia
- University of Queensland Queensland Australia
| | - Andrew Kneebone
- Northern Sydney Cancer CentreRoyal North Shore Hospital New South Wales Australia
- Northern Medical School University of Sydney Sydney New South Wales Australia
- Central Coast Cancer Centre Gosford Hospital Gosford New South Wales Australia
- Genesis Cancer Care New South Wales Australia
| | - Giuseppe Sasso
- Radiation Oncology Department Auckland District Health Board Auckland New Zealand
- Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand
| | - Thomas P. Shakespeare
- Department of Radiation Oncology Mid North Coast Cancer Institute Coffs Harbour New South Wales Australia
- University of New South Wales Rural Clinical School Coffs Harbour Australia
| | - Mark Sidhom
- Cancer Therapy Centre Liverpool Hospital New South Wales Australia
- South Western Sydney Clinical School University of New South Wales New South Wales Australia
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58
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Dinh TKT, Mitin T, Bagshaw HP, Hoffman KE, Hwang C, Jeffrey Karnes R, Kishan AU, Liauw SL, Lloyd S, Potters L, Showalter TN, Taira AV, Vapiwala N, Zaorsky NG, D'Amico AV, Nguyen PL, Davis BJ. Executive Summary of the American Radium Society Appropriate Use Criteria for Radiation Treatment of Node-Negative Muscle Invasive Bladder Cancer. Int J Radiat Oncol Biol Phys 2020; 109:953-963. [PMID: 33127490 DOI: 10.1016/j.ijrobp.2020.10.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE Definitive radiation therapy (RT), with or without concurrent chemotherapy, is an alternative to radical cystectomy for patients with localized, muscle-invasive bladder cancer (MIBC) who are either not surgical candidates or prefer organ preservation. We aim to synthesize an evidence-based guideline regarding the appropriate use of RT. METHODS AND MATERIALS We performed a Preferred Reporting Items for Systematic Reviews and Meta-analyses literature review using the PubMed and Embase databases. Based on the literature review, critical management topics were identified and reformulated into consensus questions. An expert panel was assembled to address key areas of both consensus and controversy using the modified Delphi framework. RESULTS A total of 761 articles were screened, of which 61 were published between 1975 and 2019 and included for full review. There were 7 well-designed studies, 20 good quality studies, 28 quality studies with design limitations, and 6 references not suited as primary evidence. Adjuvant radiation therapy after cystectomy was not included owing to lack of high-quality data or clinical use. An expert panel consisting of 14 radiation oncologists, 1 medical oncologist, and 1 urologist was assembled. We identified 4 clinical variants of MIBC: surgically fit patients who wish to pursue organ preservation, patients surgically unfit for cystectomy, patients medically unfit for cisplatin-based chemotherapy, and borderline cystectomy candidates based on age with unilateral hydronephrosis and normal renal function. We identified key areas of controversy, including use of definitive radiation therapy for patients with negative prognostic factors, appropriate radiation therapy dose, fractionation, fields and technique when used, and chemotherapy sequencing and choice of agent. CONCLUSIONS There is limited level-one evidence to guide appropriate treatment of MIBC. Studies vary significantly with regards to patient selection, chemotherapy use, and radiation therapy technique. A consensus guideline on the appropriateness of RT for MIBC may aid practicing oncologists in bridging the gap between data and clinical practice.
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Affiliation(s)
- Tru-Khang T Dinh
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Timur Mitin
- Department of Radiation Medicine, Oregon Health Sciences University, Portland, Oregon.
| | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University Clinics, Palo Alto, California
| | - Karen E Hoffman
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Clara Hwang
- Department of Hematology/Oncology, Henry Ford Health System, Detroit, Michigan
| | | | - Amar U Kishan
- Department of Radiation Oncology, University of California at Los Angeles Medical Center, Los Angeles, California
| | - Stanley L Liauw
- Department of Radiation Oncology, University of Chicago, Chicago, Illinois
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Louis Potters
- Department of Radiation Oncology, Northwell Health, New Hyde Park, New York
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Al V Taira
- Sutter Health Radiation Oncology, San Mateo, California
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State University Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer, Institute, Boston, Massachusetts
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana Farber Cancer, Institute, Boston, Massachusetts
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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59
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van der Horst G, van de Merbel AF, Ruigrok E, van der Mark MH, Ploeg E, Appelman L, Tvingsholm S, Jäätelä M, van Uhm J, Kruithof-de Julio M, Thalmann GN, Pelger RCM, Bangma CH, Boormans JL, van der Pluijm G, Zwarthoff EC. Cationic amphiphilic drugs as potential anticancer therapy for bladder cancer. Mol Oncol 2020; 14:3121-3134. [PMID: 32896947 PMCID: PMC7718956 DOI: 10.1002/1878-0261.12793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022] Open
Abstract
More effective therapy for patients with either muscle‐invasive or high‐risk non‐muscle‐invasive urothelial carcinoma of the bladder (UCB) is an unmet clinical need. For this, drug repositioning of clinically approved drugs represents an interesting approach. By repurposing existing drugs, alternative anticancer therapies can be introduced in the clinic relatively fast, because the safety and dosing of these clinically approved pharmacological agents are generally well known. Cationic amphiphilic drugs (CADs) dose‐dependently decreased the viability of a panel of human UCB lines in vitro. CADs induced lysosomal puncta formation, a hallmark of lysosomal leakage. Intravesical instillation of the CAD penfluridol in an orthotopic mouse xenograft model of human UCB resulted in significantly reduced intravesical tumor growth and metastatic progression. Furthermore, treatment of patient‐derived ex vivo cultured human UCB tissue caused significant partial or complete antitumor responses in 97% of the explanted tumor tissues. In conclusion, penfluridol represents a promising treatment option for bladder cancer patients and warrants further clinical evaluation.
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Affiliation(s)
| | | | - Eline Ruigrok
- Department of Urology, Leiden University Medical Center, The Netherlands
| | | | - Emily Ploeg
- Department of Urology, Leiden University Medical Center, The Netherlands
| | - Laura Appelman
- Department of Urology, Leiden University Medical Center, The Netherlands
| | - Siri Tvingsholm
- Cell Death and Metabolism, Center for Autophagy, Recycling and Disease, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marja Jäätelä
- Cell Death and Metabolism, Center for Autophagy, Recycling and Disease, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Janneke van Uhm
- Department of Urology, Leiden University Medical Center, The Netherlands
| | - Marianna Kruithof-de Julio
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - George N Thalmann
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Rob C M Pelger
- Department of Urology, Leiden University Medical Center, The Netherlands
| | - Chris H Bangma
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Ellen C Zwarthoff
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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60
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Ferran-Carpintero A, Domínguez-García A, Muñoz-Rodríguez J, Barquero-López M, Prera-Vilaseca Á, Bonfill-Abella T, Gallardo-Díaz E, Hannaoui-Hadi N, García-Rojo D, Prats-López J. Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer. Actas Urol Esp 2020; 44:489-496. [PMID: 32600878 DOI: 10.1016/j.acuro.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer. MATERIAL AND METHODS Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male<130mg/dL, female<120mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates. RESULTS Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA>2: 54.6 vs. 27.5%; P=.003), ectasia rate previous to RC (41.6 vs. 19.5%; P=.002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P<.001), blood transfusion rate (25.8 vs. 11.5%; P=.015) and pathological stage (pT>2: 49.4 vs. 33.3%; P=.03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P=.001), cancer-specific survival (89 vs. 61 months; P=.004) and recurrence-free survival (85 vs. 57 months; P=.002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT>2 and N≥1 were independently associated with overall mortality. CONCLUSION Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients.
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61
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Hodgson A, van Rhijn BWG, Kim SS, Ding C, Saleeb R, Vesprini D, Liu SK, Yousef GM, van der Kwast TH, Xu B, Downes MR. Reassessment of p53 immunohistochemistry thresholds in invasive high grade bladder cancer shows a better correlation with TP53 and FGFR3 mutations. Pathol Res Pract 2020; 216:153186. [PMID: 32861170 DOI: 10.1016/j.prp.2020.153186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/16/2020] [Accepted: 08/17/2020] [Indexed: 01/13/2023]
Abstract
FGFR3 mutations are frequently mutually exclusive of TP53 mutations in invasive high grade urothelial carcinoma (HGUC) and p53 immunohistochemistry is often used as a surrogate for TP53 mutations. A 10 % staining cut off has been used in HGUC for designation as p53 positive or negative however, a novel contemporary method we have previously proposed (0% or >50 % - abnormal vs. 1-49 % - wild type) has shown significant correlation with oncologic outcome as well. We aimed to compare how a ≥10 % vs. 0 % and ≥ 50 % cut off p53 assessment method correlates with TP53 and FGFR3 mutation status. Tissue microarrays created from three retrospective cohorts (two cystectomy cohorts (cohort A, n = 206 and cohort B, n = 91; one T1 transurethral resection cohort (cohort C, n = 47)) were stained with p53 and scored by two blinded reviewers using both p53 scoring schemes. 50 cases from cohort A were assessed for TP53 and FGFR3 mutation status using next generation sequencing and FGFR3 mutation status was separately assessed in cohorts B and C using SNaPshot methodology. 202 (58.7 %) and 142 (41.3 %) cases showed abnormal and wild type p53 staining, respectively. Using the 10 % cut off, 254 cases were positive (73.8 %) and 90 cases were negative (26.2 %). 27 (14.4 %) and 15 (30 %) assessed cases demonstrated FGFR3 and TP53 mutations, respectively; 19/27 FGFR3 mutated showed a wild type pattern of p53 expression while 15/15 TP53 mutated tumours showed an abnormal pattern of p53 expression. There was a significant correlation between the contemporary p53 scoring scheme and TP53 and FGFR3 mutations (p < 0.0001 and p = 0.002, respectively). Improved sensitivity, specificity, positive predictive value, and negative predictive value for TP53 mutation was also seen compared to the 10 % cut off; specifically, the sensitivity and negative predictive value were 100 %. These findings might be of clinical relevance in the era of precision medicine.
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Affiliation(s)
- Anjelica Hodgson
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Sung Sun Kim
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Anatomic Pathology, St Michael's Hospital, Toronto, ON, Canada; Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Colleen Ding
- Li Ka Shing Knowledge Institute, Anatomic Pathology, St Michael's Hospital, Toronto, ON, Canada
| | - Rola Saleeb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Anatomic Pathology, St Michael's Hospital, Toronto, ON, Canada
| | - Danny Vesprini
- Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - Stanley K Liu
- Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre and University of Toronto, 2075 Bayview Avenue, Toronto ON M4N 3M5, Canada
| | - George M Yousef
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, Anatomic Pathology, St Michael's Hospital, Toronto, ON, Canada; Department of Pediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Theodorus H van der Kwast
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle R Downes
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
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62
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Cunneen C, Kelly M, Nason G, Ryan E, Creavin B, Winter D. The Role of Exenterative Surgery in Advanced Urological Neoplasms. Curr Urol 2020; 14:57-65. [PMID: 32774229 DOI: 10.1159/000499258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/11/2019] [Indexed: 01/22/2023] Open
Abstract
Pelvic exenterative surgery is both complex and challenging, especially in the setting of locally recurrent disease. In recent decades, improved surgical techniques have facilitated more extensive resection of both locally advanced and recurrent pelvic malignancies, but its role in urological cancer surgery is highly selective. However, it remains an important part of the armamentarium for the management of bladder and prostate cancer cases where there is local invasion into adjacent organs or localized recurrence. Better diagnostics, reconstructive options and centralized care have reduced associated morbidity considerably, and it is still used rarely in palliative settings. Despite this, there is sparse prospective evidence reporting on long-term oncological or quality of life outcomes.
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Affiliation(s)
- Colla Cunneen
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Michael Kelly
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Gregory Nason
- Department of Urology, Mater University Hospital, Dublin, Ireland
| | - Eanna Ryan
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Ben Creavin
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
| | - Des Winter
- Centre for Colorectal Disease, Department of Colorectal Surgery, St. Vincent's University Hospital, Dublin
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Olkhov-Mitsel E, Hodgson A, Liu SK, Vesprini D, Bayani J, Bartlett J, Xu B, Downes MR. Immune gene expression profiles in high-grade urothelial carcinoma of the bladder: a NanoString study. J Clin Pathol 2020; 74:53-57. [PMID: 32471889 DOI: 10.1136/jclinpath-2020-206631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/31/2022]
Abstract
AIMS The advent of immune checkpoint inhibitor therapy has proven beneficial in a subset of high-grade urothelial carcinomas (HGUC) of the bladder. Although treatment selection is currently largely determined by programmed death-ligand 1 (PD-L1) status, multiple factors in the immune system may modulate the host immune response to HGUC and immunotherapy. In this pilot study, we used a transcriptomic approach to identify the immune milieu associated with PD-L1 expression to enhance our understanding of the HGUC immune evasion network. METHODS The immune transcriptome of 40 HGUC cystectomy cases was profiled using the NanoString nCounter Human V.1.1 PanCancer Panel. All cases were assessed for associated PD-L1 status (SP263) using whole tissue sections. PD-L1 status was determined as high or low using 25% tumour and/or immune cell staining. RESULTS The most significantly differentially expressed gene was PD-L1 messenger RNA (CD274), which strongly correlated with protein expression (r=0.720, p<0.001). The sensitivity, specificity, positive and negative predictive values of CD274 for PD-L1 expression were 85%, 96%, 92% and 93%, respectively. The PD-L1 associated gene signature also included complement components C1QA and CD46 and NOD2 (innate immune system), proinflammatory cytokines CXCL14, CXCL16, CCL3, CCL3L1 and OSM along with the immune response mediator SMAD3, among others. Pathway analysis determined enrichment of these genes in interleukin-10 production, lymphocyte chemotaxis and aberrant IFNγ, NF-κB and ERK signalling networks. CONCLUSIONS We report key genes and pathways in the immune transcriptome and their association with PD-L1 status, which may be involved in immune evasion of HGUC and warrants further investigation.
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Affiliation(s)
- Ekaterina Olkhov-Mitsel
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anjelica Hodgson
- Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Stanley K Liu
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Vesprini
- Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jane Bayani
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - John Bartlett
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Bin Xu
- Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michelle R Downes
- Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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64
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Zhegalik AG, Polyakov SL, Rolevich AI, Volkov AN, Minich AA, Vasilevich VJ, Mokhort AA, Krasny SA, Sukonko OG. Long-term results of a single-center prospective randomized trial assessing efficacy of a shortened course of adjuvant chemotherapy after radical cystectomy in patients with locally advanced bladder cancer. Cent European J Urol 2020; 73:26-32. [PMID: 32395319 PMCID: PMC7203780 DOI: 10.5173/ceju.2020.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 02/23/2020] [Accepted: 02/23/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction This study assesses the efficacy and tolerability of two cycles of adjuvant chemotherapy (AC) with gemcitabine and cisplatin after radical cystectomy in patients with a high risk of progression of muscle-invasive urothelial bladder cancer as compared to chemotherapy at relapse, in a prospective randomized study. Material and methods From 2008 to 2013, all patients after radical cystectomy at our institution for primary or recurrent urothelial bladder cancer with stage pT3-4 and/or pN+ on histopathology and without contraindications to combination cisplatin-based chemotherapy, were randomized either to two cycles of gemcitabine and cisplatin chemotherapy or to follow-up and chemotherapy at the time of relapse. The study endpoints were overall, cancer-specific, and disease-free survival. Results The study included 100 patients, of whom 53 received AC and the other 47 were assigned to the control arm. Out of 53 allocated to AC arm, 16 patients did not start chemotherapy or received only one cycle of AC. The median follow-up for patients in the AC and control arms was 88 and 86 months, respectively. In the AC arm the hazard ratio for death from any cause, death from bladder cancer, and disease relapse were 0.70 (95% CI 0.45-1.11; p = 0.13), 0.84 (95% CI 0.50-1.41; p = 0.51), and 0.77 (95% CI 0.46-1.28; p = 0.31), respectively. Conclusions Two cycles of AC with gemcitabine and cisplatin in patients with high-risk urothelial bladder cancer after radical cystectomy does not improve overall, cancer-specific, and disease-free survival. Only 53% of patients randomized to AC received the entire planned treatment.
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Affiliation(s)
- Alexander G Zhegalik
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Sergey L Polyakov
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Alexander I Rolevich
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Alexander N Volkov
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Alexander A Minich
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | | | - Andrey A Mokhort
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Sergey A Krasny
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
| | - Oleg G Sukonko
- Department of Urology, N.N. Alexandrov National Research Cancer Center, Minsk, Belarus
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Nason GJ, Ajib K, Tan GH, Kulkarni GS. Bladder-sparing treatment options in localized muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2020; 20:179-188. [PMID: 32129122 DOI: 10.1080/14737140.2020.1736565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction: Bladder cancer is the 9th most common cancer in the world and the 4th and 8th most common cancer diagnosed in men in the United States and United Kingdom respectively. The standard of care for the treatment of MIBC is radical cystectomy. Bladder preserving treatment approaches are emerging for select patients and should be considered strongly in patients who decline a radical cystectomy.Areas covered: In this review we look at the European and American recommended guidelines, the current standard of care, bladder-preserving options in MIBC, trimodal therapy and discuss future developments in the identification of molecular biomarkers that can predict therapeutic outcomes.Expert opinion: We strongly advocate bladder preservation for the right patient with strict criteria for enrolling patients in bladder preservation. The development of a specialized bladder cancer clinic could facilitate the selection of patients to be offered trimodal therapy. We believe that the future of bladder cancer will involve individualized care plans based upon clinical, radiological, endoscopic and molecular assessments.
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Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Guan H Tan
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Heck MM, Koll FJ, Retz M, Autenrieth M, Magg K, Lunger L, Gschwend JE, Nawroth R. Molecular lymph node staging for bladder cancer patients undergoing radical cystectomy with pelvic lymph node dissection. Urol Oncol 2020; 38:639.e11-639.e19. [PMID: 32146127 DOI: 10.1016/j.urolonc.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Presence of lymph node (LN) metastasis in bladder cancer (BCa) is a main risk factor for tumor recurrence after radical cystectomy (RC). Molecular analysis facilitates detection of small-volume LN metastases with higher sensitivity than standard histopathology. The aim of the present study was to establish molecular LN analysis in BCa patients undergoing RC with lymph node dissection (LND) and to determine its ability to predict tumor recurrence. PATIENTS AND METHODS Five transcripts with overexpression in BCa (FXYD3, KRT17, KRT20, SPINK1, UPKII) were evaluated for molecular LN analysis. We included 76 BCa patients from the prospective, randomized surgical phase-III trial (LEA AUO AB 25/02, NCT01215071) investigating extended vs. limited LND at RC. The primary endpoint was recurrence-free survival (RFS). As control, 136 LNs from 45 patients without BCa were analyzed to determine a threshold for pathologic gene expression. RESULTS About 1,319 LNs were investigated with molecular and histopathologic examination. Histopathology detected 39 LN metastases in 17 (22%) patients. Of the tested genes FXYD3 performed best and classified all pN+-patients correctly as node-positive (pN+/molN+). In addition, FXYD3 reclassified 43 histopathologic negative LNs and 7 (9%) pN0-patients as molecular node-positive (pN0/molN+). Molecular and histopathologic LN status (pN0/molN0 vs. pN0/molN+ vs. pN+/molN+) was significantly associated with locally advanced disease (P = 0.006) and poor RFS (P < 0.001). Median RFS was not reached in LN-negative patients (pN0/molN0), 45 months (95%CI 8-83) in exclusively molecular positive patients (pN0/molN+) and 9 months (95%CI 5-13) in patients with histopathologic and molecular positive LNs (pN+/molN+). CONCLUSIONS Molecular LN analysis with FXYD3 identified additional LN metastases in histopathologic negative LNs and identified patients with elevated risk of tumor recurrence after RC. Thus, molecular LN analysis improves LN staging and might serve as a tool to guide adjuvant treatment.
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Affiliation(s)
- Matthias M Heck
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany.
| | - Florestan J Koll
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
| | - Margitta Retz
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
| | - Michael Autenrieth
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
| | - Kathrin Magg
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
| | - Lukas Lunger
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
| | - Jürgen E Gschwend
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
| | - Roman Nawroth
- Technical University of Munich, School of Medicine, Rechts der Isar Medical Center, Department of Urology, Munich, Germany
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Regnier P, DE Luca V, Brunelle S, Sfumato P, Walz J, Rybikowski S, Maubon T, Branger N, Fakhfakh S, Durand M, Gravis G, Pignot G. Impact of sarcopenia status of muscle-invasive bladder cancer patients on kidney function after neoadjuvant chemotherapy. Minerva Urol Nephrol 2020; 73:215-224. [PMID: 32083413 DOI: 10.23736/s2724-6051.20.03616-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sarcopenia is suspected to influence the complication rates in patients undergoing radical cystectomy (RC). The aim of our study was to assess variations in sarcopenia in patients scheduled for neoadjuvant cisplatin-based chemotherapy (NAC) and RC for muscle invasive bladder cancer (MIBC) and to explore the impact of sarcopenia on complications linked to NAC or surgery. METHODS Between 2012 and 2017, 82 consecutive patients who underwent NAC and RC for cT2-T4 N0 MIBC were retrospectively selected. Using CT scan before and after NAC, Lumbar Skeletal Muscle Index (SMI) was assessed by two observers. We defined severe sarcopenia as SMI <50 cm2/m2 for men and SMI <35 cm2/m2 for women. We evaluated pre- and post-NAC cisplatin-based chemotherapy renal function and post-operative complication rates after cystectomy using the Clavien-Dindo classification. We explored risk factors of complications by logistic regression models. RESULTS According to the SMI, 47 patients (57.3%) were classified as sarcopenic and 35 patients (42.7%) non-sarcopenic. Patients' characteristics between sarcopenic and non-sarcopenic patients were not significantly different except for BMI (P<0.001). Among patients non-sarcopenic before NAC, nine (25.7%) became sarcopenic after NAC. In multivariate analysis, sarcopenia was an independent significant predictor of renal impairment after NAC (P=0.02). Moreover, sarcopenia and ASA score were independent significant predictors of postoperative early complications (P=0.01 and P=0.03, respectively). CONCLUSIONS We observed significant changes in sarcopenic status during NAC. Sarcopenia, estimated by the lumbar SMI measurement, was an independent predictor associated with the risk of renal impairment during NAC and early postoperative complications after RC.
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Affiliation(s)
- Pierre Regnier
- Department of Urology, Nice University Hospital, University of Nice Sophia Antipolis, Nice, France
| | - Valeria DE Luca
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | - Serge Brunelle
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | - Patrick Sfumato
- Department of Biostatistics, Paoli-Calmettes Institute, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | | | - Thomas Maubon
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Nicolas Branger
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Sami Fakhfakh
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France
| | - Matthieu Durand
- Department of Urology, Nice University Hospital, University of Nice Sophia Antipolis, Nice, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Paoli-Calmettes Institute, Marseille, France -
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Tan MP, Harris V, Warren-Oseni K, McDonald F, McNair H, Taylor H, Hansen V, Sharabiani M, Thomas K, Jones K, Dearnaley D, Hafeez S, Huddart RA. The Intensity-Modulated Pelvic Node and Bladder Radiotherapy (IMPART) Trial: A Phase II Single-Centre Prospective Study. Clin Oncol (R Coll Radiol) 2020; 32:93-100. [PMID: 31400946 PMCID: PMC6966321 DOI: 10.1016/j.clon.2019.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/20/2022]
Abstract
AIMS Node-positive bladder cancer (NPBC) carries a poor prognosis and has traditionally been treated palliatively. However, surgical series suggest that a subset of NPBC patients can achieve long-term control after cystectomy and lymph node dissection. There is little published data regarding the use of radiotherapy to treat NPBC patients. This is in part due to concerns regarding the toxicity of whole-pelvis radiotherapy using conventional techniques. We hypothesised that, using intensity-modulated radiotherapy (IMRT), the pelvic nodes and bladder could be treated within a radical treatment volume with acceptable toxicity profiles. MATERIALS AND METHODS The Intensity-modulated Pelvic Node and Bladder Radiotherapy (IMPART) trial was a phase II single-centre prospective study designed to assess the feasibility of delivering IMRT to treat the bladder and pelvic nodes in patients with node-positive or high-risk node-negative bladder cancer (NNBC). The primary end point was meeting predetermined dose constraints. Secondary end points included acute and late toxicity, pelvic relapse-free survival and overall survival. RESULTS In total, 38 patients were recruited and treated between June 2009 and November 2012; 22/38 (58%) had NPBC; 31/38 (81.6%) received neoadjuvant chemotherapy; 18/38 (47%) received concurrent chemotherapy; 37/38 (97%) patients had radiotherapy planned as per protocol. Grade 3 gastrointestinal and genitourinary acute toxicity rates were 5.4 and 20.6%, respectively. At 1 year, the grade 3 late toxicity rate was 5%; 1-, 2- and 5-year pelvic relapse-free survival rates were 55, 37 and 26%, respectively. The median overall survival was 1.9 years (95% confidence interval 1.1-3.8) with 1-, 2- and 5-year overall survival rates of 68, 50 and 34%, respectively. CONCLUSION Delivering IMRT to the bladder and pelvic nodes in NPBC and high-risk NNBC is feasible, with low toxicity and low pelvic nodal recurrence rates. Long-term control seems to be achievable in a subset of patients. However, relapse patterns suggest that strategies targeting both local recurrence and the development of distant metastases are required to improve patient outcomes.
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Affiliation(s)
- M P Tan
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - V Harris
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - K Warren-Oseni
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - F McDonald
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - H McNair
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - H Taylor
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - V Hansen
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - M Sharabiani
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; The School of Public Health, Imperial College London, London, UK
| | - K Thomas
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; ICBARC, London, UK
| | - K Jones
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - D Dearnaley
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S Hafeez
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - R A Huddart
- Academic Radiotherapy Unit, Institute of Cancer Research, Sutton, Surrey, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
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Wang C, Yang S, Jin L, Dai G, Yao Q, Xiang H, Zhang Y, Liu X, Xue B. Biological and Clinical Significance of GATA3 Detected from TCGA Database and FFPE Sample in Bladder Cancer Patients. Onco Targets Ther 2020; 13:945-958. [PMID: 32099398 PMCID: PMC6999784 DOI: 10.2147/ott.s237099] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of the present study was to investigate the biological and clinical significance of GATA binding protein 3 (GATA3) in bladder cancer patients. Patients and Methods For the detection of the correlation between GATA3 expression and bladder cancer, we downloaded the mRNA expression data from the Cancer Genome Atlas (TCGA) database and conducted immunohistochemistry staining on formalin-fixed paraffin-embedded (FFPE) sample tissues. Then, bladder cancer cell lines were utilized to investigate the potential functions of GATA3 by cell apoptosis, proliferation and cycle assays. Results The mRNA data from TCGA database and bladder cancer cell lines suggested that GATA3 mRNA expression was significantly higher compared with normal tissues and cells. Conversely, the Western blot assay revealed that the expression of GATA3 was significantly lower in bladder cancer than normal urothelial cell line. Additionally, we found that over-expression of GATA3 was significantly associated with tumor subtype (P = 0.001 in TCGA; P = 0.004 in FFPE tissues), earlier clinical stage (P < 0.001 in TCGA; P < 0.001 in FFPE) and lower grade tumor (P = 0.057 in TCGA; P = 0.002 in FFPE). Kaplan-Meier analysis and multivariate Cox regression analysis indicated that age (P < 0.001 in both cohort), clinical stage (P = 0.028 in TCGA; P = 0.011 in FFPE), recurrence (P < 0.001) and low GATA3 in TCGA cohort (P = 0.035) but high GATA3 in FFPE cohort (P = 0.033) were independent risk factors for overall survival in patients. The assay to detect potential functions of GATA3 indicated that this biomarker could arrest the cell cycle of G2/M and S phase in T24 cells, and inhibit bladder cancer cells proliferation. Conclusion Collectively, our findings identified that GATA3 served as an important prognosis biomarker for bladder cancer patients. However, the mechanism of GATA3 in bladder cancer deserves further studies.
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Affiliation(s)
- Chenglu Wang
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Shuang Yang
- Department of Pathology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Lu Jin
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Guangcheng Dai
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Qiu Yao
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Han Xiang
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Yongsheng Zhang
- Department of Pathology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Xiaolong Liu
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
| | - Boxin Xue
- Department of Urology, Second Affiliated Hospital of Soochow University, Suzhou 215004, People's Republic of China
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Elsayed AS, Aldhaam NA, Nitsche L, Siam A, Jing Z, Hussein AA, Shigemura K, Fujisawa M, Guru KA. Robot‐assisted radical cystectomy: Review of surgical technique, and perioperative, oncological and functional outcomes. Int J Urol 2020; 27:194-205. [DOI: 10.1111/iju.14178] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/04/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Ahmed S Elsayed
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Naif A Aldhaam
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Lindsay Nitsche
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Alat Siam
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Zhe Jing
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | - Ahmed A Hussein
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
| | | | - Masato Fujisawa
- Department of Urology Kobe University Hospital Kobe Hyogo Japan
| | - Khurshid A Guru
- Roswell Park Comprehensive Cancer Center Buffalo New York USA
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Ballas L, Wei O, Daneshmand S, Schuckman A, Djaladat H, Aron M, D'Souza A, Quinn D, Dorff TB. Chemoradiation for Management of Locally Recurrent or Residual Bladder Cancer: A Case Series and Review of the Literature. Clin Genitourin Cancer 2020; 18:e473-e477. [PMID: 32044240 DOI: 10.1016/j.clgc.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Leslie Ballas
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA.
| | - Oren Wei
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anne Schuckman
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Hooman Djaladat
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Monish Aron
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anishka D'Souza
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - David Quinn
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Tanya B Dorff
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
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Albisinni S, Veccia A, Aoun F, Diamand R, Esperto F, Porpiglia F, Roumeguère T, De Nunzio C. A systematic review and meta-analysis comparing the outcomes of open and robotic assisted radical cystectomy. MINERVA UROL NEFROL 2019; 71:553-568. [DOI: 10.23736/s0393-2249.19.03546-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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73
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Hayashi Y, Fujita K. A new era in the detection of urothelial carcinoma by sequencing cell-free DNA. Transl Androl Urol 2019; 8:S497-S501. [PMID: 32042630 PMCID: PMC6989842 DOI: 10.21037/tau.2019.08.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- Yujiro Hayashi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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Kalampokis N, Grivas N, Ölschläger M, Hassan FN, Gakis G. Radical Cystectomy in Female Patients - Improving Outcomes. Curr Urol Rep 2019; 20:83. [PMID: 31781877 DOI: 10.1007/s11934-019-0951-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW To review the methods of improving surgical, oncological, and functional outcomes in women with bladder cancer treated with radical cystectomy. RECENT FINDINGS Οrthotopic urinary diversion (ONB) is a safe option for well-selected women as it combines high rates of daytime and nighttime continence with exceptional oncologic outcomes. It is considered safe even for patients with limited lymph node disease and trigone involvement, as long as a preoperative biopsy of the bladder neck or an intraoperative frozen section analysis of distal urethral margin rules out malignant disease. Nerve-sparing techniques have shown promising results. For well-selected patients with early invasive disease, sparing of internal genitalia has proven to be oncologically safe. Yet, generally accepted and evidence-based oncological and functional follow-up schemes for women after radical cystectomy are still lacking. Properly designed prospective studies are needed with adequate number of participants in order to safely conclude about a broader use of pelvic organ-sparing cystectomy.
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Affiliation(s)
| | - Nikolaos Grivas
- Department of Urology, G. Hatzikosta General Hospital, Ioannina, Greece
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius Maximillians University, Oberdürrbacher Strasse 6, 97080, Würzburg, Germany.
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75
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Cao R, Yuan L, Ma B, Wang G, Qiu W, Tian Y. An EMT-related gene signature for the prognosis of human bladder cancer. J Cell Mol Med 2019; 24:605-617. [PMID: 31657881 PMCID: PMC6933372 DOI: 10.1111/jcmm.14767] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/06/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022] Open
Abstract
The transition from non-muscle-invasive bladder cancer (NMIBC) to muscle-invasive bladder cancer (MIBC) is detrimental to bladder cancer (BLCA) patients. Here, we aimed to study the underlying mechanism of the subtype transition. Gene set variation analysis (GSVA) revealed the epithelial-mesenchymal transition (EMT) signalling pathway with the most positive correlation in this transition. Then, we built a LASSO Cox regression model of an EMT-related gene signature in BLCA. The patients with high risk scores had significantly worse overall survival (OS) and disease-free survival (DFS) than those with low risk scores. The EMT-related gene signature also performed favourably in the accuracy of prognosis and in the subtype survival analysis. Univariate and multivariate Cox regression analyses demonstrated that the EMT-related gene signature, pathological N stage and age were independent prognostic factors for predicting survival in BLCA patients. Furthermore, the predictive nomogram model was able to effectively predict the outcome of BLCA patients by appropriately stratifying the risk score. In conclusion, we developed a novel EMT-related gene signature that has tumour-promoting effects, acts as a negative independent prognostic factor and might facilitate personalized counselling and treatment in BLCA.
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Affiliation(s)
- Rui Cao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lushun Yuan
- Division of Nephrology, Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Bo Ma
- Department of Stomatology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Gang Wang
- Department of Biological Repositories, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Qiu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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76
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Shi F, Deng Z, Zhou Z, Jiang C, Zhao R, Sun F, Cui D, Bei X, Yang B, Sun Q, Wang X, Wu Q, Xia S, Han B. QKI-6 inhibits bladder cancer malignant behaviours through down-regulating E2F3 and NF-κB signalling. J Cell Mol Med 2019; 23:6578-6594. [PMID: 31449345 PMCID: PMC6787450 DOI: 10.1111/jcmm.14481] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/13/2019] [Accepted: 05/15/2019] [Indexed: 02/06/2023] Open
Abstract
Quaking homolog (QKI) is a member of the RNA-binding signal transduction and activator of proteins family. Previous studies showed that QKI possesses the tumour suppressor activity in human cancers by interacting with the 3'-untraslated region (3'-UTR) of various gene transcripts via the STAR domain. This study first assessed the association of QKI-6 expression with clinicopathological and survival data from bladder cancer patients and then investigated the underlying molecular mechanisms. Bladder cancer tissues (n = 223) were subjected to immunohistochemistry, and tumour cell lines and nude mice were used for different in vitro and in vivo assays following QKI-6 overexpression or knockdown. QKI-6 down-regulation was associated with advanced tumour TNM stages and poor patient overall survival. QKI-6 overexpression inhibited bladder cancer cell growth and invasion capacity, but induced tumour cell apoptosis and cell cycle arrest. Furthermore, ectopic expression of QKI-6 reduced tumour xenograft growth and expression of proliferation markers, Ki67 and PCNA. However, knockdown of QKI-6 expression had opposite effects in vitro and in vivo. QKI-6 inhibited expression of E2 transcription factor 3 (E2F3) by directly binding to the E2F3 3'-UTR, whereas E2F3 induced QKI-6 transcription by binding to the QKI-6 promoter in negative feedback mechanism. QKI-6 expression also suppressed activity and expression of nuclear factor-κB (NF-κB) signalling proteins in vitro, implying a novel multilevel regulatory network downstream of QKI-6. In conclusion, QKI-6 down-regulation contributes to bladder cancer development and progression.
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Affiliation(s)
- Fei Shi
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
| | - Zheng Deng
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
| | - Zheng Zhou
- Department of UrologyShanghai General Hospital Affiliated to Nanjing Medical UniversityShanghaiChina
| | - Chen‐Yi Jiang
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
| | - Rui‐Zhe Zhao
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
| | - Feng Sun
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
- Institute of UrologyShanghai Jiao Tong UniversityShanghaiChina
| | - Di Cui
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
- Institute of UrologyShanghai Jiao Tong UniversityShanghaiChina
| | - Xiao‐Yu Bei
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
- Institute of UrologyShanghai Jiao Tong UniversityShanghaiChina
| | - Bo‐Yu Yang
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
| | - Qian Sun
- Department of UrologyShanghai General Hospital Affiliated to Nanjing Medical UniversityShanghaiChina
| | - Xing‐Jie Wang
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
- Institute of UrologyShanghai Jiao Tong UniversityShanghaiChina
| | - Qi Wu
- Department of UrologyShanghai General Hospital Affiliated to Nanjing Medical UniversityShanghaiChina
| | - Shu‐Jie Xia
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
- Institute of UrologyShanghai Jiao Tong UniversityShanghaiChina
| | - Bang‐Min Han
- Department of Urology, School of MedicineShanghai General Hospital, Shanghai Jiao Tong UniversityShanghaiChina
- Institute of UrologyShanghai Jiao Tong UniversityShanghaiChina
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Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup. J Urol 2019; 203:522-529. [PMID: 31549935 DOI: 10.1097/ju.0000000000000565] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE The RAZOR (Randomized Open versus Robotic Cystectomy) trial revealed noninferior 2-year progression-free survival for robotic radical cystectomy. This update was performed with extended followup for 3 years to determine potential differences between the approaches. We also report 3-year overall survival and sought to identify factors predicting recurrence, and progression-free and overall survival. MATERIALS AND METHODS We analyzed the per protocol population of 302 patients from the RAZOR study. Cumulative recurrence was estimated using nonbladder cancer death as the competing risk event and the Gray test was applied to assess significance in differences. Progression-free survival and overall survival were estimated by the Kaplan-Meier method and compared with the log rank test. Predictors of outcomes were determined by Cox proportional hazard analysis. RESULTS Estimated progression-free survival at 36 months was 68.4% (95% CI 60.1-75.3) and 65.4% (95% CI 56.8-72.7) in the robotic and open groups, respectively (p=0.600). At 36 months overall survival was 73.9% (95% CI 65.5-80.5) and 68.5% (95% CI 59.8-75.7) in the robotic and open groups, respectively (p=0.334). There was no significant difference in the cumulative incidence rates of recurrence (p=0.802). Patient age greater than 70 years, poor performance status and major complications were significant predictors of 36-month progression-free survival. Stage and positive margins were significant predictors of recurrence, and progression-free and overall survival. Surgical approach was not a significant predictor of any outcome. CONCLUSIONS This analysis showed no difference in recurrence, 3-year progression-free survival or 3-year overall survival for robotic vs open radical cystectomy. It provides important prospective data on the oncologic efficacy of robotic radical cystectomy and high level data for patient counseling.
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Schubert T, Renninger M, Schmid MA, Hassan FN, Sokolakis I, Fahmy O, Hatzichristodoulou G, Stenzl A, Gakis G. Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer. Urol Oncol 2019; 38:4.e7-4.e15. [PMID: 31537484 DOI: 10.1016/j.urolonc.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/10/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). MATERIAL AND METHODS A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10-55). RESULTS Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence. CONCLUSIONS In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer.
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Affiliation(s)
- Tina Schubert
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Renninger
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Manuel Alexander Schmid
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Ioannis Sokolakis
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Omar Fahmy
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany; Department of Urology, University Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany.
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79
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Bao Y, Liu X, Liu Y, Wang S, Wu B. Ras-association domain family 1 (RASSF1A) gene regulates progression, migration and invasion of bladder cancer. Surg Oncol 2019; 30:63-71. [DOI: 10.1016/j.suronc.2019.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/11/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022]
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80
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Martin C, West JM, Palermo S, Patel DP, Presson AP, Comploj E, Pycha A, Hancock JB, Dechet CB, Trenti E. Elderly patients undergoing cystectomy, comparing preoperative American Society of Anesthesiology and Eastern Cooperative Oncology Group scores and operative approaches. Urologia 2019; 86:183-188. [DOI: 10.1177/0391560319864846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate preoperative scoring systems and operative management and their relation to complications in patients older than 75 years undergoing cystectomy at two academic institutions. Methods: In total, 212 patients aged 75–95 years with muscle invasive bladder cancer underwent cystectomy at the University of Utah and Central Hospital of Bolzano, Italy. The rates of Grade 3 Clavien-Dindo complications and above in radical cystectomy patients (n = 199) were compared using Eastern Cooperative Oncology Group Scores and American Society of Anesthesiologists Physical Status Classification. The rates of Grade 3 Clavien-Dindo complications and above were also compared by urinary diversion type. Logistic regression was used to control for source institution. Results: In total, 199 cases were included in the primary analysis. Neither of the preoperative scoring systems were predictive for identification of radical cystectomy patients with ⩾Grade 3 Clavien-Dindo complications. In secondary analysis (n = 212, including partial cystectomy), none of the urinary diversion types associated with radical cystectomy had a significantly different rate of complications. However, partial cystectomy (n = 13) had a significantly lower rate of complications. Conclusion: Complication rates among elderly patients undergoing cystectomy for muscle invasive bladder cancer were very high. For patients who are approved for surgery after the history and physical exam, none of our objective metrics adequately predicted operative risk. A unique diversion procedure described by the Bolzano group, uretero-ureterocutaneostomy, had equivalent complication rates to the more common diversion procedures. It also appears based on outcomes in this cohort that partial cystectomy is a particularly favorable option within the elderly population in terms of perioperative morbidity.
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Affiliation(s)
- Christopher Martin
- Huntsman Cancer Institute and Division of Urology, The University of Utah, Salt Lake City, UT, USA
| | - Jeremy M West
- Huntsman Cancer Institute and Division of Urology, The University of Utah, Salt Lake City, UT, USA
- Department of Urology, University of Iowa Hospitals & Clinics, University of Iowa, Iowa City, IA, USA
| | | | - Darshan P Patel
- Huntsman Cancer Institute and Division of Urology, The University of Utah, Salt Lake City, UT, USA
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, The University of Utah, Salt Lake City, UT, USA
| | - Evi Comploj
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
- Sigmund Freud University Medical School, Vienna, Austria
| | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
- Department of Research, College of Health Care Professions Claudiana, Bolzano, Italya
| | - Joel B Hancock
- Huntsman Cancer Institute and Division of Urology, The University of Utah, Salt Lake City, UT, USA
| | - Christopher B Dechet
- Huntsman Cancer Institute and Division of Urology, The University of Utah, Salt Lake City, UT, USA
| | - Emanuela Trenti
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
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81
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Merten R, Ott O, Haderlein M, Bertz S, Hartmann A, Wullich B, Keck B, Kühn R, Rödel CM, Weiss C, Gall C, Uter W, Fietkau R. Long-Term Experience of Chemoradiotherapy Combined with Deep Regional Hyperthermia for Organ Preservation in High-Risk Bladder Cancer (Ta, Tis, T1, T2). Oncologist 2019; 24:e1341-e1350. [PMID: 31292267 PMCID: PMC6975936 DOI: 10.1634/theoncologist.2018-0280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 02/11/2019] [Indexed: 01/19/2023] Open
Abstract
This article reports on the different treatments for bladder cancer and related effects on frequency of bladder preservation, disease‐free survival, and overall survival, with a focus on the efficacy and safety of chemoradiotherapy combined with regional deep hyperthermia of high‐risk bladder cancer after transurethral resection of bladder tumor. Background. The aim of this study was to evaluate the efficacy and safety of chemoradiotherapy (RCT) combined with regional deep hyperthermia (RHT) of high‐risk bladder cancer after transurethral resection of bladder tumor (TUR‐BT). Materials and methods. Between 1982 and 2016, 369 patients with pTa, pTis, pT1, and pT2 cN0–1 cM0 bladder cancer were treated with a multimodal treatment after TUR‐BT. All patients received radiotherapy (RT) of the bladder and regional lymph nodes. RCT was administered to 215 patients, RCT + RHT was administered to 79 patients, and RT was used in 75 patients. Treatment response was evaluated 4–6 weeks after treatment with TUR‐BT. Results. Complete response (CR) overall was 83% (290/351), and in treatment groups was RT 68% (45/66), RCT 86% (178/208), and RCT + RHT 87% (67/77). CR was significantly improved by concurrent RCT compared with RT (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.05–5.12; p = .037), less influenced by hyperthermia (OR, 2.56; 95% CI, 0.88–8.00; p = .092). Overall survival (OS) after RCT was superior to RT (hazard ratio [HR], 0.7; 95% CI, 0.50–0.99; p = .045). Five‐year OS from unadjusted Kaplan‐Meier estimates was RCT 64% versus RT 45%. Additional RHT increased 5‐year OS to 87% (HR, 0.32; 95% CI, 0.18–0.58; p = .0001). RCT + RHT compared with RCT showed a significantly better bladder‐preservation rate (HR, 0.13; 95% CI, 0.03–0.56; p = .006). Median follow‐up was 71 months. The median number of RHT sessions was five. Conclusion. The multimodal treatment consisted of a maximal TUR‐BT followed by RT; concomitant platinum‐based chemotherapy combined with RHT in patients with high‐grade bladder cancer improves local control, bladder‐preservation rate, and OS. It offers a promising alternative to surgical therapies like radical cystectomy. Implications for Practice. Radical cystectomy with appropriate lymph node dissection has long represented the standard of care for muscle‐invasive bladder cancer in medically fit patients, despite many centers reporting excellent long‐term results for bladder preserving strategies. This retrospective analysis compares different therapeutic modalities in bladder‐preservation therapy. The results of this study show that multimodal treatment consisting of maximal transurethral resection of bladder tumor followed by radiotherapy, concomitant platinum‐based chemotherapy combined with regional deep hyperthermia in patients with Ta, Tis, T1–2 bladder carcinomas improves local control, bladder‐preservation rate, and survival. More importantly, these findings offer a promising alternative to surgical therapies like radical cystectomy. The authors hope that, in the future, closer collaboration between urologists and radiotherapists will further improve treatments and therapies for the benefit of patients.
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Affiliation(s)
- Ricarda Merten
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Bastian Keck
- Department of Urology and Pediatric Urology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Reinhard Kühn
- Department of Urology, Martha Maria Medical Center, Nuremberg, Germany
| | - Claus Michael Rödel
- Department of Radiotherapy and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Christian Weiss
- Department of Radiation Oncology, Klinikum Darmstadt GmbH, Darmstadt, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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82
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Hupe MC, Gakis G, Seiler R. [Molecular tumor board-urothelial cancer]. Urologe A 2019; 58:760-767. [PMID: 31172245 DOI: 10.1007/s00120-019-0967-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Molecular tumor boards (MTB) are becoming more common. There are several molecular alterations in urothelial cancer a molecular tumor board can potentially rely on. OBJECTIVES The aim is to specify molecular alterations and their correlations with different clinical endpoints and to highlight potential questions addressed to a MTB for urothelial cancer. MATERIALS AND METHODS Descriptive review of the literature based on PubMed. RESULTS The landscape of molecular alterations in urothelial cancer is heterogeneous. Thus, recent biomarker research has been focusing on biomarker panels and classifiers instead of single biomarkers. Recently, molecular subtypes of urothelial cancer have been identified and correlated with different clinical endpoints. Furthermore, circulating tumor cells and tumor DNA are under investigation as potential biomarkers. In addition to treatment response and prognosis, molecular markers are also needed to improve clinical staging prior to radical cystectomy or for proper patient selection for neoadjuvant chemotherapy. Erdafitinib is the first targeted therapy (fibroblast growth factor receptor [FGFR] alteration) in urothelial cancer that was recently approved (in the USA). CONCLUSIONS Due to the lack of external validation, none of the identified biomarkers is currently established in clinical routine. In addition, there is no single driver mutation in urothelial cancer that facilitates the development of biomarkers and targeted therapies.
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Affiliation(s)
- M C Hupe
- Klinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - G Gakis
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - R Seiler
- Departement für Urologie, Inselspital Bern, 3010, Bern, Schweiz
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83
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Chen L, Xiong W, Guo W, Su S, Qi L, Zhu B, Mo M, Jiang H, Li Y. Significance of CLASP2 expression in prognosis for muscle-invasive bladder cancer patients: A propensity score-based analysis. Urol Oncol 2019; 37:800-807. [PMID: 31130343 DOI: 10.1016/j.urolonc.2019.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/27/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cytoplasmic linker-associated protein 2 (CLASP2) belongs to a family of microtubule plus-end tracking proteins that localize to the distal ends of microtubules and is involved in various microtubule-dependent processes. We previously showed that CLASP2 is involved in the epithelial-to-mesenchymal transition of bladder urothelial cancer. This research aimed to explore the significance of CLASP2 expression as a prognostic marker for muscle-invasive bladder urothelial cancer (MIBC) patients after radical cystectomy-pelvic lymph node dissection (RC-PLND). METHODS CLASP2 expression was analyzed in 76 benign bladder tissues and 160 MIBC tissues by tissue immunohistochemistry. Survival analysis and multiple regression analysis following propensity score matching were performed to investigate the correlation between high CLASP2 expression and MIBC patients' survival. RESULTS CLASP2 expression was increased in MIBC patients, especially those with high-stage tumors or lymph node metastasis. In the follow-up of MIBC patients after propensity score matching, whether MIBC patients received adjuvant chemotherapy after RC-PLND, high CLASP2 expression was significantly associated with a poor prognosis. MIBC patients with low CLASP2 expression who received adjuvant chemotherapy tended to have an improved survival prognosis. CONCLUSION CLASP2 expression is correlated with malignant progression of MIBC. High CLASP2 expression predicted a poor prognosis for MIBC patients after RC-PLND.
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Affiliation(s)
- Lingxiao Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wei Xiong
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Wei Guo
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Shitong Su
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Lin Qi
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Bisong Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Miao Mo
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Huichuan Jiang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
| | - Yuan Li
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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84
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Fan L, Wang Y, Wang W, Wei X. Carcinogenic role of K-Ras-ERK1/2 signaling in bladder cancer via inhibition of H1.2 phosphorylation at T146. J Cell Physiol 2019; 234:21135-21144. [PMID: 31032946 DOI: 10.1002/jcp.28716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 12/17/2022]
Abstract
It has been reported that Ras-ERK signaling regulated tumor suppressive genes via epigenetic mechanisms. Herein, we set out to investigate the correlation between K-Ras-ERK1/2 signaling and H1.2 phosphorylation, to provide a better understanding of K-Ras-ERK signaling in cancer. A plasmid for expression of mutated K-Ras was transfected into human bladder carcinoma HT1197 cells. Western blot was carried out for testing the expression changes of ERK1/2 and H1.2. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, soft-agar colony formation assay, and transwell assay were used to test the effects of H1.2 phosphorylation at T146 (H1.2 T146ph ) on HT1197 cells growth and migration. Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and chromatin immunoprecipitation (ChIP) were performed to test whether H1.2 T146ph regulated K-Ras-ERK1/2 downstream genes. Furthermore, how K-Ras-ERK1/2 regulated H1.2 T146ph expression was studied. We found that the ERK1/2 was activated when K-Ras was mutated, and H1.2 T146ph expression was significantly downregulated by K-Ras mutation. H1.2 T146E for mimicking H1.2 T146ph significantly attenuated K-Ras mutation induced increases in HT1197 cells viability, colony formation, and relative migration. Besides, H1.2 T146ph regulated the transcription of K-Ras-ERK1/2 downstream genes, including NT5E, GDF15, CARD16, CYR61, IGFBP3, and WNT16B. Furthermore, K-Ras-ERK1/2 signaling inhibited H1.2 phosphorylation at T146 through degradation of DNA-PK, and the degraded DNA-PK by K-Ras-ERK1/2 possibly via modulation of MDM2. In conclusion, the activation of K-Ras-ERK1/2 signaling will repress the phosphorylation of H1.2 at T146, and thereby, promoted the growth and migration of bladder cancer cells. K-Ras-ERK1/2 signaling repressed H1.2 phosphorylation possibly by MDM2-mediated degradation of DNA-PK.
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Affiliation(s)
- Li Fan
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yao Wang
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Weihua Wang
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xin Wei
- Department of Urology, China-Japan Union Hospital of Jilin University, Changchun, China
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85
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Mossanen M, Krasnow RE, Zlatev DV, Tan WS, Preston MA, Trinh QD, Kibel AS, Sonpavde G, Schrag D, Chung BI, Chang SL. Examining the relationship between complications and perioperative mortality following radical cystectomy: a population-based analysis. BJU Int 2019; 124:40-46. [DOI: 10.1111/bju.14636] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Matthew Mossanen
- Division of Urology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
- Center for Surgery and Public Health; Brigham and Women's Hospital; Boston MA USA
| | - Ross E. Krasnow
- Department of Urology; Georgetown University; Washington DC USA
| | - Dimitar V. Zlatev
- Division of Urology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
| | - Wei Shen Tan
- Division of Surgery and Interventional Sciences; Department of Urology; University College London; London UK
- Department of Urology; Imperial College Healthcare; London UK
| | - Mark A. Preston
- Division of Urology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
| | - Quoc-Dien Trinh
- Division of Urology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
- Center for Surgery and Public Health; Brigham and Women's Hospital; Boston MA USA
| | - Adam S. Kibel
- Division of Urology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
| | - Guru Sonpavde
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
| | - Deborah Schrag
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
| | - Benjamin I. Chung
- Department of Urology; Stanford University Medical Center; Stanford CA USA
| | - Steven L. Chang
- Division of Urology; Harvard Medical School; Brigham and Women's Hospital; Boston MA USA
- Lank Center for Genitourinary Oncology; Dana-Farber Cancer Institute; Boston MA USA
- Department of Urology; Stanford University Medical Center; Stanford CA USA
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Wei X, Siemens DR, Mackillop WJ, Booth CM. Use of radiotherapy for bladder cancer: A population-based study of evolving referral and practice patterns. Can Urol Assoc J 2019; 13:92-101. [PMID: 30273116 PMCID: PMC6456345 DOI: 10.5489/cuaj.5447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Definitive treatment for muscle-invasive bladder cancer includes either cystectomy or radiotherapy (RT). We describe use of RT and radiation oncology (RO) referral patterns in the contemporary era. METHODS The Ontario Cancer Registry and linked records of treatment were used to identify all patients who received cystectomy or RT for bladder cancer from 1994-2013. Physician billing records were linked to identify RO consultation before radical treatment. Multilevel logistic regression models were used to examine patient factors and physician-level variation in referral to RO and use of RT. RESULTS A total of 7461 patients underwent cystectomy or RT for bladder cancer from 1994-2013; 5574 (75%) had cystectomy and 1887 (25%) had RT. Use of RT decreased from 43% (126/289) in 1994 to 23% (112/478) in 2008 and remained stable from 2009-2013 (23%, 507/2202). RO referral rate among all cases decreased from 46% (134/289) in 1994 to 30% (143/478) in 2008; however, the rates began to rise in the contemporary era from 31% (137/442) in 2009 to 37% (165/448) in 2013 (p=0.03). Patient factors associated with use of RT include older age, greater comorbidity, and geographic location. Surgeon-level factors associated with greater preoperative referral to RO include higher surgeon case volume and practicing in a teaching hospital. CONCLUSIONS One-quarter of patients treated with curative intent therapy for bladder cancer receive RT. While referral rates to RO are increasing, future data will identify the extent to which this has altered practice. Collaborative efforts promoting multidisciplinary care and RO consultation before radical treatment are warranted.
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Affiliation(s)
- Xuejiao Wei
- Department of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
| | - D Robert Siemens
- Department of Urology, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - William J Mackillop
- Department of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON Canada
| | - Christopher M Booth
- Department of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON Canada
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Daga M, Pizzimenti S, Dianzani C, Cucci MA, Cavalli R, Grattarola M, Ferrara B, Scariot V, Trotta F, Barrera G. Ailanthone inhibits cell growth and migration of cisplatin resistant bladder cancer cells through down-regulation of Nrf2, YAP, and c-Myc expression. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2019; 56:156-164. [PMID: 30668336 DOI: 10.1016/j.phymed.2018.10.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Ailanthone (Aila) is a natural active compound isolated from the Ailanthus altissima, which has been shown to possess an "in vitro" growth-inhibitory effect against several cancer cell lines. Advanced bladder cancer is a common disease characterized by a frequent onset of resistance to cisplatin-based therapy. The cisplatin (CDDP) resistance is accompanied by an increase in Nrf2 protein expression which contributes to conferring resistance. Recently, we demonstrated a cross-talk between Nrf2 and YAP. YAP has also been demonstrated to play an important role in chemoresistance of bladder cancer. PURPOSE We analyzed the antitumor effect of Aila in sensitive and CDDP-resistant bladder cancer cells and the molecular mechanisms involved in Aila activity. STUDY DESIGN Sensitive and CDDP-resistant 253J B-V and 253J bladder cancer cells, intrinsically CDDP-resistant T24 bladder cancer cells and HK-2 human renal cortex cells were used. Cells were treated with diverse concentrations of Aila and proliferation, cell cycle, apoptosis and gene expressions were determined. METHODS Aila toxicity and proliferation were determined by MTT and colony forming methods, respectively. Cell cycle was determined by cytofluorimetric analysis through PI staining method. Apoptosis was detected using Annexin V and PI double staining followed by quantitative flow cytometry. Expressions of Nrf2, Yap, c-Myc, and house-keeping genes were determined by western blot with specific antibodies. Cell migration was detected by wound healing and Boyden chamber analysis. RESULTS Aila inhibited the growth of sensitive and CDDP-resistant bladder cancer cells with the same effectiveness. On the contrary, the growth of HK-2 cells was only slightly reduced by Aila. Cell cycle analysis revealed an accumulation of Aila-treated bladder cancer cells in the G0/G1 phase. Interestingly, Aila strongly reduced Nrf2 expression in these cell lines. Moreover, Aila significantly reduced YAP, and c-Myc protein expression. The random and the oriented migration of bladder cancer cells were strongly inhibited by Aila treatment, in particular in CDDP-resistant cells. CONCLUSION Aila inhibited proliferation and invasiveness of bladder cancer cells. Its high effectiveness in CDDP resistant cells could be related to the inhibition of Nrf2, YAP, and c-Myc expressions. Aila could represent a new tool to treating CDDP-resistant bladder cancers.
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Affiliation(s)
- Martina Daga
- Department of Clinical and Biological Science, University of Turin, Corso Raffaello 30, 10125 Torino, Italy
| | - Stefania Pizzimenti
- Department of Clinical and Biological Science, University of Turin, Corso Raffaello 30, 10125 Torino, Italy.
| | - Chiara Dianzani
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Marie Angele Cucci
- Department of Clinical and Biological Science, University of Turin, Corso Raffaello 30, 10125 Torino, Italy
| | - Roberta Cavalli
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Margherita Grattarola
- Department of Clinical and Biological Science, University of Turin, Corso Raffaello 30, 10125 Torino, Italy
| | - Benedetta Ferrara
- Department of Drug Science and Technology, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Valentina Scariot
- Department of Agricultural, Forest and Food Sciences, University of Turin, Largo Paolo Braccini 2, 10095 Grugliasco (TO), Italy
| | - Francesco Trotta
- Department of Chemistry, University of Turin, Via Pietro Giuria 7, 10125 Turin, Italy
| | - Giuseppina Barrera
- Department of Clinical and Biological Science, University of Turin, Corso Raffaello 30, 10125 Torino, Italy
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88
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Current controversies on the role of lymphadenectomy for bladder cancer. Urol Oncol 2019; 37:193-200. [DOI: 10.1016/j.urolonc.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 11/22/2022]
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89
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Urinary Bladder Tumors Clinical and Statistical Retrospective Study. CURRENT HEALTH SCIENCES JOURNAL 2019; 44:64-70. [PMID: 30622758 PMCID: PMC6295191 DOI: 10.12865/chsj.44.01.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 11/29/2022]
Abstract
Nowadays, urinary bladder cancer represents a major health problem, due to very high medical and social costs. This disease affects mainly the elderly. We performed a study on 1073 patients admitted to the Urology Clinic within the Emergency Clinical Hospital of Craiova, between 2013-2015 with bladder cancer. Of the 1073 cases, 741(69.06%) were diagnosed in men, and 332 (30.94%) were found in women, the men/ women ratio being of 2.23/1. The highest incidence of bladder tumors was recorded in individuals aged between 60 and 79 years old. In this age group, there were admitted 734 patients with bladder cancer, representing 68.44%. Regarding the tumor recurrence, out of 1073 bladder tumors, a number of 608 (56.66%) patients were diagnosed with primary tumors, while a number of 465 (43.34%) patients presented recurrent tumors. Of the symptoms presented by the patients, the most frequent were haematuria (present in about 87% of the patients), pollakiuria (present in 64% of the patients), dysuria (present in 55% of the patients) and urinary infections (present in about 23% of the patients).
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90
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Jønck S, Helgstrand JT, Røder MA, Klemann N, Grønkaer Toft B, Brasso K. The prognostic impact of incidental prostate cancer following radical cystoprostatectomy: a nationwide analysis. Scand J Urol 2019; 52:358-363. [PMID: 30624125 DOI: 10.1080/21681805.2018.1534885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND To determine the prevalence and prognostic impact of incidental prostate cancer in patients undergoing radical cystoprostatectomy. METHODS A nationwide population-based study of incidental prostate cancer diagnosed following radical cystoprostatectomy. Information on vital status, Gleason score, positive and negative tumor margins, pT-category and subsequent prostate cancer therapies were obtained from the Danish Prostate Cancer Registry and by manual chart review. RESULTS A total of 1,450 men who underwent radical cystoprostatectomy in Denmark from 1995-2011 were identified. Forty-six men were excluded from analysis, thus 1,404 patients were eligible. The median follow-up was 7.8 years. A total of 466 (33.2%) had incidental prostate cancer diagnosed. No statistical differences in 10- and 15-year cumulative overall mortality were observed when comparing men with, or without, incidental prostate cancer. In men diagnosed with incidental prostate cancer, neither Gleason score, positive surgical margins or locally advanced prostate cancer (pT3-4) was associated with mortality. Only 0.9% received post-operative prostate cancer-related treatment. CONCLUSION In this population-based cohort of patients with incidental prostate cancer diagnosed at radical cystoprostatectomy, we found no impact of incidental prostate cancer on overall mortality, regardless of Gleason score, surgical margin status and pathological T-category. Patients diagnosed with incidental prostate cancer following radical cystoprostatectomy are unlikely to benefit from additional follow-up.
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Affiliation(s)
- Simon Jønck
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - John Thomas Helgstrand
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Martin Andreas Røder
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Nina Klemann
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Birgitte Grønkaer Toft
- b Department of Pathology , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Klaus Brasso
- a Copenhagen Prostate Cancer Center , Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
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91
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Ott OJ. Multimodality Treatment for Bladder Conservation. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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92
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Local Treatment, Radical Cystectomy, and Urinary Diversion. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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93
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Moudouni SM, Latabi AF, Aarab M, Lakmichi MA, Dahami Z, Sarf I. [Oncological results of a series of 93 laparoscopic radical cystectomies: 5 years of follow-up]. Prog Urol 2018; 29:86-94. [PMID: 30584022 DOI: 10.1016/j.purol.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report oncological results at 5 years after laparoscopic radical cystectomy (LRC) with lymph node dissection for bladder cancer (BC). PATIENTS AND METHODS This is a retrospective single-center study of all patients who underwent LRC for BC by the same surgeon from February 2007 to March 2016. Demographic, perioperative and oncologic data were collected. We reported overall survival rate (OS), cancer specific (CSS) and recurrence-free survival (SSR), as primary indicators of oncologycal outcomes. These survival rates were estimated according to the Kaplan-Meier method. Log-rank tests were used to explore overall survival according tumor stage, lymph node involvement and surgical margins status. RESULTS In all, 93 patients (82 men and 11 women) underwent LRC. Mean age was 59 years. Minor complications (Clavien I-II) occurred in 24.7%. Major complications (Clavien IIIa-V) were observed in 8.6%. No patients received neoadjuvant chemotherapy. Median lymph node (LN) yield was 15 and 26.5% patients had positive LN. The positive surgical margins (SMs) rate was 5.3%. Median follow-up for the entire patients was 50 months (19-84 months). Forty-three patients (46.2%) were followed for at least 71 months. Five year RFS, CSS and OS were 67%, 85% and 79%, respectively. Non organ confined desease, positive LN and positive SMs were associated with poorer OS (P<0.039, P<0.016 and P<0.001). CONCLUSION LRC was associated with acceptable long-term oncologic outcomes, similar to those currently reported after open cystectomy for BC. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- S M Moudouni
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - A F Latabi
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc.
| | - M Aarab
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - M A Lakmichi
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - Z Dahami
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - I Sarf
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
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Hwang C. Genitourinary Pathology Reporting Parameters Most Relevant to the Medical Oncologist. Surg Pathol Clin 2018; 11:877-891. [PMID: 30447846 DOI: 10.1016/j.path.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Pathologic variables play an important role in prognostication in urologic malignancies. Histologic subtype, histologic grade, and anatomic extent of disease (pathologic tumor and nodal staging) influence treatment decisions in both the adjuvant and metastatic settings. This article discusses treatment paradigms for the most common urologic malignancies, followed by the evidence base to support the relationship between pathologic assessment and decision making by the medical oncologist.
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Affiliation(s)
- Clara Hwang
- Department of Internal Medicine, Division of Hematology and Oncology, Henry Ford Cancer Institute, Henry Ford Health System, 2799 West Grand Boulevard, CFP5, Detroit, MI 48202, USA.
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95
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Sjödahl G, Eriksson P, Lövgren K, Marzouka NAD, Bernardo C, Nordentoft I, Dyrskjøt L, Liedberg F, Höglund M. Discordant molecular subtype classification in the basal-squamous subtype of bladder tumors and matched lymph-node metastases. Mod Pathol 2018; 31:1869-1881. [PMID: 29967424 DOI: 10.1038/s41379-018-0096-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 02/02/2023]
Abstract
Molecular subtypes of muscle-invasive bladder tumors have emerged as a promising research tool with potential to stratify patients for neoadjuvant treatment. Prior to radical cystectomy, the utility of molecular classification and biomarkers depend on concordance between tissue from transurethrally resected specimens and disseminated disease. We assess the concordance of molecular subtypes and a large number of potential biomarkers in 67 pairs of muscle-invasive bladder tumors and synchronous lymph-node metastases. Tissue cores were stained for 29 immunohistochemistry markers and immunohistochemistry-based molecular subtype classification was performed. Molecular subtype was determined by mRNA profiling for 57 bladder tumors and 28 matched lymph-node metastases. Full section immunohistochemistry was performed to assess intra-tumor subtype heterogeneity in discordant cases, and exome sequencing was performed for 20 sample pairs. Discordant subtype classification between the bladder tumor and lymph-node metastasis was generally rare (12/67, 18%), but most (7/12, 58%) involved the Basal/Squamous-like subtype. Discordant Basal/Squamous-like tumors showed either Urothelial-like or Genomically Unstable, luminal-like phenotype in the lymph-node metastasis. Full section immunohistochemistry revealed intra-tumor subtype heterogeneity for six discordant cases including four involving the Basal/Squamous-like subtype. Subtype concordance for non- Basal/Squamous-like tumors was 91%. RNA-based classification agreed with immunohistochemistry classification but quantitative assessment is necessary to avoid false detection of subtype shifts. Most high confidence cancer mutations were shared between samples (n = 93, 78%), and bladder tumor private mutations (n = 20, 17%) were more frequent than those private to the lymph-node metastasis (n = 7, 6%). We conclude that bladder tumors and lymph-node metastases have overall similar molecular subtype, biomarker expression, and cancer mutations. The main exception was tumors of the Basal/Squamous-like subtype where most cases showed discordant classification, some with evidence of intra-tumor heterogeneity. The data are of relevance for neoadjuvant treatment stratification and raises questions on the dynamics of molecular subtypes during bladder cancer progression.
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Affiliation(s)
- Gottfrid Sjödahl
- Division of Urological Research, Department of Translational Medicine, Lund University, Lund, Sweden. .,Department of Urology, Skåne University Hospital, Malmö, Sweden.
| | - Pontus Eriksson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kristina Lövgren
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Nour-Al-Dain Marzouka
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Carina Bernardo
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Iver Nordentoft
- Department of Molecular Medicine (MOMA), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Lars Dyrskjøt
- Department of Molecular Medicine (MOMA), Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Fredrik Liedberg
- Division of Urological Research, Department of Translational Medicine, Lund University, Lund, Sweden.,Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Mattias Höglund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Martini T, Heinkele J, Mayr R, Weis CA, Wezel F, Wahby S, Eckstein M, Schnöller T, Breyer J, Wirtz R, Ritter M, Bolenz C, Erben P. Predictive value of lymphangiogenesis and proliferation markers on mRNA level in urothelial carcinoma of the bladder after radical cystectomy. Urol Oncol 2018; 36:530.e19-530.e27. [PMID: 30446441 DOI: 10.1016/j.urolonc.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the mRNA expression of lymphangiogenesis and proliferation markers and to examine its association with histopathological characteristics and clinical outcome in patients with urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). PATIENTS AND METHODS Gene expression analysis of the vascular endothelial growth -C and -D (VEGF-C/-D), its receptor VEGF receptor-3 (VEGFR-3), MKI67, and RACGAP1 was performed in 108 patients after radical cystectomy and their correlation with clinical-pathological parameters was investigated. Uni- and multivariate regression analyses were used to identify predictors for cancer-specific survival (CSS), recurrence-free survival (RFS) and overall survival (OS) after RC. RESULTS The expression of RACGAP1 and VEGFR-3 showed an association with a higher pT stage (P = 0.049; P = 0.009). MKI67 showed an association with a high-grade urothelial carcinoma of the bladder (P = 0.021). VEGFR-3 expression was significantly associated with the presence of lymphovascular invasion (LVI) (P = 0.016) and lymph node metastases (pN+) (P = 0.028). With the univariate analysis, overexpression of VEGFR-3 (P = 0.029) and the clinical-pathological parameters pT stage (P < 0.0001), pN+ (P = 0.0004), LVI (P < 0.0001) and female gender (P = 0.021) were significantly associated with a reduced CSS. Multivariate analysis identified a higher pT stage (P = 0.017) and LVI (P = 0.008) as independent predictors for reduced CSS. Independent predictors for reduced OS were a higher pT stage (P = 0.0007) and LVI (P = 0.0021), while overexpression of VEGF-D was associated with better OS (P < 0.0001). CONCLUSIONS The mRNA expression of the investigated markers showed associations with common histopathological parameters. Increased expression of VEGF-D is independently associated with better overall survival.
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Affiliation(s)
| | - Jakob Heinkele
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Roman Mayr
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Germany
| | - Cleo-Aron Weis
- Institute of Pathology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Felix Wezel
- Department of Urology, University of Ulm, Ulm, Germany
| | - Sarah Wahby
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Markus Eckstein
- Institute of Pathology, University of Erlangen-Nüremberg, Erlangen, Germany
| | | | - Johannes Breyer
- Department of Urology, University of Regensburg, Caritas St. Josef Medical Center, Germany
| | - Ralph Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany; Institute of Pathology, The St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Manuel Ritter
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Philipp Erben
- Department of Urology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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97
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Mossanen M, Caldwell J, Sonpavde G, Lehmann LS. Treating Patients With Bladder Cancer: Is There an Ethical Obligation to Include Smoking Cessation Counseling? J Clin Oncol 2018; 36:3189-3191. [DOI: 10.1200/jco.18.00577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthew Mossanen
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Joshua Caldwell
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Guru Sonpavde
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa Soleymani Lehmann
- Matthew Mossanen, Brigham and Women’s Hospital, Harvard Medical School, Center for Surgery and Public Health, Brigham and Women’s Hospital; and Dana-Farber Cancer Institute, Boston, MA; Joshua Caldwell, Harvard Medical School, Boston, MA; Guru Sonpavde, Dana-Farber Cancer Institute, Boston, MA; and Lisa Soleymani Lehmann, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, and Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
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98
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Azuma H, Inamoto T, Takahara K, Ibuki N, Nomi H, Komura K, Uehara H, Minami K, Yamamoto K, Narumi Y. Tetramodal therapy using balloon-occluded arterial infusion of anticancer agents, the Azuma regimen, for lymph node-involved bladder cancer. Int J Oncol 2018; 54:167-176. [PMID: 30387836 DOI: 10.3892/ijo.2018.4619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/10/2018] [Indexed: 11/06/2022] Open
Abstract
Overall, >900 patients have been treated at Osaka Medical College (Takatsuki, Osaka, Japan) using the novel approach of balloon-occluded arterial infusion (BOAI) to deliver an extremely high concentration of the anticancer agents cisplatin (CDDP)/gemcitabine to the pelvis (referred to as the OMC-regimen), together with pelvic irradiation. In a previous study, overall survival (OS) rate was significantly higher in this treatment group compared with that in a control group receiving total cystectomy (79.6 vs. 49.6%, respectively, at 10 years). It was speculated that intensive treatment of the pelvic area may aid in preventing metastasis, and thus the present study focused on the effect of this therapy in patients with lymph node metastasis (LN+). A total of 102 patients with advanced LN+ bladder cancer received tetramodal therapy (termed the Azuma regimen), comprising radical transurethral resection of the bladder tumor, systemic chemotherapy, BOAI and pelvic irradiation. Patients who failed to achieve a complete response (CR) underwent secondary BOAI with an increased amount of CDDP and/or gemcitabine with/without hemodialysis. A CR was achieved in 57.8% (59/102) of patients in total, and in 78.8% (41/52) of patients with N1 and Tis-3 disease. Among the complete responders, 81.4% (48/59) of patients retained their bladders with no evidence of recurrence or metastasis within a mean follow-up period of 121 weeks. Stages N2-3 and T4 were determined as significant risk factors for treatment failure in addition to survival. Notably, the 10-year overall survival rates in N1, Tis-3, and N1 and Tis-3 were 67.6% (vs. 33.6% in N2-3; P=0.0003), 61.5% (vs. 37.9% in T4; P=0.0485) and 75.1% (vs. 35.5% in N2-3 or T4; P=0.0002), respectively. No patients suffered from grade IV toxicities. In conclusion, the Azuma regimen may be a feasible option for patients with LN+ disease. The use of intensive treatment in the pelvic area may serve an important role in outcome improvement, and the prevention of metastasis may be its mechanism.
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Affiliation(s)
- Haruhito Azuma
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Teruo Inamoto
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University, School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Naokazu Ibuki
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Hayahito Nomi
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Kazumasa Komura
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Hirofumi Uehara
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Koichiro Minami
- Department of Urology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, Takatsuki, Osaka 569-0801, Japan
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99
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Shim JS, Seo HK, Ku JH, Jeong BC, Hong B, Kang SH. Oncologic, Perioperative Outcomes of Female Radical Cystectomy: Results from a Multicenter Study in Korea. Cancer Res Treat 2018; 51:1064-1072. [PMID: 30376708 PMCID: PMC6639238 DOI: 10.4143/crt.2018.515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The lower incidence of bladder cancer among women has led to a lack of information on female radical cystectomy (RC). This study aimed to analyze the characteristics related with female RC in a cohort from multiple academic institutions. MATERIALS AND METHODS This was a retrospective review of 384 female patients who underwent RC for bladder cancer. Epidemiologic, perioperative variables including urologic referral periodwith consequent pathologic stage distributions were assessed. The changes in surgical techniques over time were illustrated. Also, we evaluated recurrence-free survival (RFS) at 2 and 5 years and overall survival (OS) at 5 years with stage-specific analyses using the Kaplan-Meier method. RESULTS The mean follow-up time was 35 months (interquartile rage [IQR], 9 to 55). The average time to urologic referral with initial symptoms was 5.5 (IQR, 1 to 6) months and over 20% of patients visited clinics after 6 months. In subsequent stage distributions according to referral period, T2 or higher stage distributions were abruptly increased after 1 year. Overall 2-year/5-year RFS rates were 0.72/0.57 and 5-year OS was 0.61. Notable surgical descriptions were as follows: 91% of patients underwent open RC; 80% of patients underwent an ileal conduit; and 83% of patients received anterior exenteration. However, the proportions of robotic surgery, orthotopic neobladder and organ sparing cystectomy have increased recen-tly. CONCLUSION We identified the general characteristics and changes in pattern of female RC. Our results also suggest that women are susceptible to delays in referral to an urologist and are at greater risk for worse prognosis.
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Affiliation(s)
- Ji Sung Shim
- Department of Urology, Korea University School of Medicine, Seoul, Korea
| | - Ho Kyung Seo
- Department of Urology, National Cancer Center, Goyang, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University School of Medicine, Seoul, Korea
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100
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Mathes J, Rausch S, Todenhöfer T, Stenzl A. Trimodal therapy for muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2018; 18:1219-1229. [DOI: 10.1080/14737140.2018.1535314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Joachim Mathes
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University of Tübingen, Tübingen, Germany
| | | | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
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