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Grabe-Heyne K, Henne C, Mariappan P, Geiges G, Pöhlmann J, Pollock RF. Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs. Front Oncol 2023; 13:1170124. [PMID: 37333804 PMCID: PMC10272547 DOI: 10.3389/fonc.2023.1170124] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Bladder cancer ranks among the most common cancers globally. At diagnosis, 75% of patients have non-muscle-invasive bladder cancer (NMIBC). Patients with low-risk NMIBC have a good prognosis, but recurrence and progression rates remain high in intermediate- and high-risk NMIBC, despite the decades-long availability of effective treatments for NMIBC such as intravesical Bacillus Calmette-Guérin (BCG). The present review provides an overview of NMIBC, including its burden and treatment options, and then reviews aspects that counteract the successful treatment of NMIBC, referred to as unmet treatment needs. The scale and reasons for each unmet need are described based on a comprehensive review of the literature, including insufficient adherence to treatment guidelines by physicians because of insufficient knowledge, training, or access to certain therapy options. Low rates of lifestyle changes and treatment completion by patients, due to BCG shortages or toxicities and adverse events as well as their impact on social activities, represent additional areas of potential improvement. Highly heterogeneous evidence for the effectiveness and safety of some treatments limits the comparability of results across studies. As a result, efforts are underway to standardize treatment schedules for BCG, but intravesical chemotherapy schedules remain unstandardized. In addition, risk-scoring models often perform unsatisfactorily due to significant differences between derivation and real-world cohorts. Reporting in clinical trials suffers from a lack of consistent outcomes reporting in bladder cancer clinical trials, paired with an under-representation of racial and ethnic minorities in many trials.
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Affiliation(s)
| | | | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, United Kingdom
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152
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Mandrik O, Hahn AI, Catto JWF, Zauber AG, Cumberbatch M, Chilcott J. Critical Appraisal of Decision Models Used for the Economic Evaluation of Bladder Cancer Screening and Diagnosis: A Systematic Review. PHARMACOECONOMICS 2023; 41:633-650. [PMID: 36890355 PMCID: PMC10548889 DOI: 10.1007/s40273-023-01256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Bladder cancer is common among current and former smokers. High bladder cancer mortality may be decreased through early diagnosis and screening. The aim of this study was to appraise decision models used for the economic evaluation of bladder cancer screening and diagnosis, and to summarise the main outcomes of these models. METHODS MEDLINE via PubMed, Embase, EconLit and Web of Science databases was systematically searched from January 2006 to May 2022 for modelling studies that assessed the cost effectiveness of bladder cancer screening and diagnostic interventions. Articles were appraised according to Patient, Intervention, Comparator and Outcome (PICO) characteristics, modelling methods, model structures and data sources. The quality of the studies was also appraised using the Philips checklist by two independent reviewers. RESULTS Searches identified 3082 potentially relevant studies, which resulted in 18 articles that met our inclusion criteria. Four of these articles were on bladder cancer screening, and the remaining 14 were diagnostic or surveillance interventions. Two of the four screening models were individual-level simulations. All screening models (n = 4, with three on a high-risk population and one on a general population) concluded that screening is either cost saving or cost effective with cost-effectiveness ratios lower than $53,000/life-years saved. Disease prevalence was a strong determinant of cost effectiveness. Diagnostic models (n = 14) assessed multiple interventions; white light cystoscopy was the most common intervention and was considered cost effective in all studies (n = 4). Screening models relied largely on published evidence generalised from other countries and did not report the validation of their predictions to external data. Almost all diagnostic models (n = 13 out of 14) had a time horizon of 5 years or less and most of the models (n = 11) did not incorporate health-related utilities. In both screening and diagnostic models, epidemiological inputs were based on expert elicitation, assumptions or international evidence of uncertain generalisability. In modelling disease, seven models did not use a standard classification system to define cancer states, others used risk-based, numerical or a Tumour, Node, Metastasis classification. Despite including certain components of disease onset or progression, no models included a complete and coherent model of the natural history of bladder cancer (i.e. simulating the progression of asymptomatic primary bladder cancer from cancer onset, i.e. in the absence of treatment). CONCLUSIONS The variation in natural history model structures and the lack of data for model parameterisation suggest that research in bladder cancer early detection and screening is at an early stage of development. Appropriate characterisation and analysis of uncertainty in bladder cancer models should be considered a priority.
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Affiliation(s)
- Olena Mandrik
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Anne I Hahn
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James W F Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2RX, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - Ann G Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marcus Cumberbatch
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2RX, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - James Chilcott
- Health Economics and Decision Science, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
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153
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Catto JW, Mandrik O, Quayle LA, Hussain SA, McGrath J, Cresswell J, Birtle AJ, Jones RJ, Mariappan P, Makaroff LE, Knight A, Mostafid H, Chilcott J, Sasieni P, Cumberbatch M. Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real-world findings from NHS England between 2013 and 2019. BJU Int 2023; 131:734-744. [PMID: 36680312 PMCID: PMC10952282 DOI: 10.1111/bju.15970] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We report NHS England data for patients with bladder cancer (BC), upper tract urothelial cancer (UTUC: renal pelvic and ureteric), and urethral cancers from 2013 to 2019. MATERIALS AND METHODS Hospital episode statistics, waiting times, and cancer registrations were extracted from NHS Digital. RESULTS Registrations included 128 823 individuals with BC, 16 018 with UTUC, and 2533 with urethral cancer. In 2019, 150 816 persons were living with a diagnosis of BC, of whom 113 067 (75.0%) were men, 85 117 (56.5%) were aged >75 years, and 95 553 (91.7%) were Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100 000 population). Most patients 52 097 (mean [range] 41.3% [40.7-42.0%]) were referred outside the 2-week-wait pathway and 15 340 (mean [range] 12.2% [11.7-12.6%]) presented as emergencies. Surgery, radiotherapy, chemotherapy, or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27% and 29% (n = 6616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location, and tumour histology. Overall survival rates did not improve over time (relative change: 0.97, 95% confidence interval 0.97-0.97) at 2 years in contrast to other cancers. CONCLUSION The diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use of radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete.
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Affiliation(s)
- James W.F. Catto
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
- Department of UrologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Olena Mandrik
- Health Economics and Decision Science, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Lewis A. Quayle
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
| | - Syed A. Hussain
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
- Department of Medical OncologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - John McGrath
- Department of UrologyRoyal Devon University Hospitals Foundation Trust, University of ExeterExeterUK
| | | | - Alison J. Birtle
- Rosemere Cancer CentreLancashire Teaching HospitalsPrestonUK
- University of ManchesterManchesterUK
- University of Central LancashireLancasterUK
| | - Rob J. Jones
- School of Cancer Sciences, Beatson West of Scotland Cancer CentreUniversity of GlasgowGlasgowUK
| | | | - Lydia E. Makaroff
- Fight Bladder CancerOxfordshireUK
- World Bladder Cancer Patient CoalitionBrusselsBelgium
| | - Allen Knight
- Patient and TrusteeAction Bladder Cancer UKGuildfordUK
| | - Hugh Mostafid
- Department of UrologyThe Royal Surrey County HospitalGuildfordUK
| | - Jim Chilcott
- Health Economics and Decision Science, School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Peter Sasieni
- School of Cancer and Pharmaceutical SciencesKing's College LondonLondonUK
| | - Marcus Cumberbatch
- Department of Oncology and MetabolismUniversity of SheffieldSheffieldUK
- Department of UrologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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154
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Kodera A, Mohammed M, Lim P, Abdalla O, Elhadi M. The Management of Bacillus Calmette-Guérin (BCG) Failure in High-Risk Non-muscle Invasive Bladder Cancer: A Review Article. Cureus 2023; 15:e40962. [PMID: 37503461 PMCID: PMC10369196 DOI: 10.7759/cureus.40962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) is a common urological malignancy, and bacillus Calmette-Guérin (BCG) therapy is the gold standard treatment in intermediate and high-risk groups. However, BCG failure occurs in a significant proportion of patients, emphasizing the need for effective alternative treatment modalities to address this burden. These treatments include immunotherapy, enhanced drug delivery, targeted therapy, device-assisted chemotherapy, vaccine therapy, and gene therapy, which show varying degrees of safety and efficacy. The objective of this review is to summarize the current evidence and ongoing research on these emerging therapies, offering insight into their potential for improving patient outcomes and quality of life. Although radical cystectomy remains the standard of care for high-risk NMIBC patients unresponsive to BCG, novel treatment modalities hold promise for the future management of this challenging patient population.
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Affiliation(s)
- Ahmed Kodera
- Urology, Worcestershire Acute Hopsitals NHS Trust, Worcester, GBR
| | - Mahmoud Mohammed
- Urology, Worcestershire Acute Hospitals NHS Trust, Worcester, GBR
- Surgical Oncology, South Egypt Cancer Institute, Assiut, EGY
| | - Paul Lim
- Urology, Worcestershire Acute Hospitals NHS Trust, Worcestershire, GBR
| | - Omer Abdalla
- Urology, Wirral University Hospital, Liverpool, GBR
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155
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Inman BA, Hahn NM, Stratton K, Kopp R, Sankin A, Skinner E, Pohar K, Gartrell BA, Pham S, Rishipathak D, Mariathasan S, Davarpanah N, Carter C, Steinberg GD. A Phase 1b/2 Study of Atezolizumab with or Without Bacille Calmette-Guérin in Patients with High-risk Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2023; 6:313-320. [PMID: 36803840 DOI: 10.1016/j.euo.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/02/2022] [Accepted: 01/20/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Bacille Calmette-Guérin (BCG) is the standard therapy after transurethral resection of bladder tumour for high-risk non-muscle-invasive bladder cancer (NMIBC). However, post-BCG recurrence/progression occurs frequently, and noncystectomy options are limited. OBJECTIVE To evaluate the safety and clinical activity of atezolizumab ± BCG in high-risk BCG-unresponsive NMIBC. DESIGN, SETTING, AND PARTICIPANTS This phase 1b/2 GU-123 study (NCT02792192) treated patients with BCG-unresponsive NMIBC who had carcinoma in situ with atezolizumab ± BCG. INTERVENTION Patients in cohorts 1A and 1B received atezolizumab 1200 mg IV q3w for ≤96 wk. Those in cohort 1B also received standard BCG induction (six weekly doses) and maintenance courses (three doses weekly starting at month 3) with optional maintenance at 6, 12, 18, 24, and 30 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Coprimary endpoints were safety and 6-mo complete response (CR) rate. Secondary endpoints included 3-mo CR rate and duration of CR; 95% confidence intervals were calculated using the Clopper-Pearson method. RESULTS AND LIMITATIONS At data cut-off (September 29, 2020), 24 patients were enrolled (cohort 1A, n = 12; cohort 1B, n = 12), and the recommended BCG dose was 50 mg in cohort 1B. Four patients (33%) had adverse events (AEs) leading to BCG dose modification/interruption. Three patients (25%) in cohort 1A reported atezolizumab-related grade 3 AEs; cohort 1B had no atezolizumab- or BCG-related grade ≥3 AEs. No grade 4/5 AEs were reported. The 6-mo CR rate was 33% in cohort 1A (median duration of CR, 6.8 mo) and 42% in cohort 1B (median duration of CR, not reached [≥12 mo]). These results are limited by the small sample size of GU-123. CONCLUSIONS In this first report of the atezolizumab-BCG combination in NMIBC, atezolizumab ± BCG was well tolerated, with no new safety signals or treatment-related deaths. Preliminary results suggested clinically meaningful activity; the combination favoured a longer duration of response. PATIENT SUMMARY We studied atezolizumab with and without bacille Calmette-Guérin (BCG) to determine whether this combination was safe and had clinical activity in patients with high-risk noninvasive bladder cancer (high-grade bladder tumours that affect the outermost lining of the bladder wall) that has previously been treated with BCG and is still present or occurred again. Our results suggest that atezolizumab with or without BCG was generally safe and could be used to treat patients unresponsive to BCG.
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Affiliation(s)
- Brant A Inman
- Duke Cancer Institute, Duke University, Durham, NC, USA.
| | - Noah M Hahn
- Department of Oncology, Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Urology, Johns Hopkins Greenberg Bladder Cancer Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ryan Kopp
- Department of Urology, Oregon Health & Science University, Portland, OR, USA; VA Portland Healthcare System, Portland, OR, USA
| | - Alex Sankin
- Department of Urology, Montefiore Medical Center, Bronx, NY, USA
| | - Eila Skinner
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
| | | | - Song Pham
- Genentech Inc, South San Francisco, CA, USA
| | | | | | | | | | - Gary D Steinberg
- Goldstein Bladder Cancer Program, NYU Langone Health, New York, NY, USA; Department of Urology, New York University School of Medicine, New York, NY, USA
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156
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Wang Z, Kwan ML, Haque R, Goniewicz M, Pratt R, Lee VS, Roh JM, Ergas IJ, Cannavale KL, Loo RK, Aaronson DS, Quesenberry CP, Zhang Y, Ambrosone CB, Kushi LH, Tang L. Associations of dietary isothiocyanate exposure from cruciferous vegetable consumption with recurrence and progression of non-muscle-invasive bladder cancer: findings from the Be-Well Study. Am J Clin Nutr 2023; 117:1110-1120. [PMID: 37044209 PMCID: PMC10447500 DOI: 10.1016/j.ajcnut.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND High recurrence and progression rates are major clinical challenges for non-muscle-invasive bladder cancer (NMIBC). Dietary isothiocyanates (ITCs), phytochemicals primarily from cruciferous vegetables (CV), show strong anticancer activities in preclinical BC models, yet their effect on NMIBC prognosis remains unknown. OBJECTIVES This study aimed to investigate the associations of dietary ITC exposure at diagnosis with NMIBC recurrence and progression. METHODS The study analyzed 1143 participants from the Be-Well study, a prospective cohort of newly diagnosed NMIBC cases in 2015-2019 with no prior history of BC. Dietary ITC exposure was indicated by self-reported CV intake, estimated ITC intake, urinary metabolites, and plasma ITC-albumin adducts. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence and progression, and unconditional logistic regression models were used to calculate odds ratios (ORs) and 95% CIs for delayed and multiple recurrence. RESULTS Over a mean follow-up of 25 mo, 347 (30%) developed recurrence and 77 (6.7%) had disease progression. Despite no significant associations with the overall risk of recurrence, urinary ITC metabolites (OR: 1.96; 95% CI: 1.01, 4.43) and dietary ITC intake (OR: 2.13; 95% CI: 1.03, 4.50) were associated with late recurrence after 12-mo postdiagnosis compared with before 12-mo postdiagnosis. Raw CV intake was associated with reduced odds of having ≥2 recurrences compared with having one (OR: 0.34; 95% CI: 0.16, 0.68). Higher plasma concentrations of ITC-albumin adducts were associated with a reduced risk of progression, including progression to muscle-invasive disease (for benzyl ITC, HR: 0.40; 95% CI: 0.17, 0.93; for phenethyl ITC, HR: 0.40; 95% CI: 0.19, 0.86). CONCLUSIONS Our findings indicate the possible beneficial role of dietary ITCs in NMIBC prognosis. Given the compelling preclinical evidence, increasing dietary ITC exposure with CV intake could be a promising strategy to attenuate recurrence and progression risks in patients with NMIBC.
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Affiliation(s)
- Zinian Wang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Reina Haque
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, United States
| | - Maciej Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Rachel Pratt
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Isaac J Ergas
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Kimberly L Cannavale
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Ronald K Loo
- Department of Urology, Kaiser Permanente Downey Medical Center, Downey, CA, United States
| | - David S Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA, United States
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Yuesheng Zhang
- Department of Pharmacology and Toxicology, and Massey Cancer Center, Virginia Commonwealth University, School of Medicine, Richmond, VA, United States
| | - Christine B Ambrosone
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States.
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157
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Lonati C, Soria F, Pradere B, D'Andrea D, Laukhtina E, Mertens LS, Albisinni S, Krajewski W, Afferi L, Del Giudice F, Gallioli A, Moschini M. Comment on: "Accuracy of the European Association of Urology (EAU) NMIBC 2021 scoring model in predicting progression in a large cohort of HG T1 NMIBC patients treated with BCG". Minerva Urol Nephrol 2023; 75:407-409. [PMID: 37221831 DOI: 10.23736/s2724-6051.23.05337-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Chiara Lonati
- Unit of Urology, Department of Medical and Surgical Specialities, Radiological Science and Public Health, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy -
| | - Francesco Soria
- School of Medicine, Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, France
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Simone Albisinni
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University, Rome, Italy
| | - Wojciech Krajewski
- Unit of Urology and Oncological Urology, Department of Public Health, Wrocław Medical University, Wrocław, Poland
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urologic Sciences, Umberto I Polyclinic Hospital, Sapienza University, Rome, Italy
| | - Andrea Gallioli
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Marco Moschini
- Unit of Urology, Division of Experimental Oncology, IRCCS Urological Research Institute, San Raffaele Hospital, Milan, Italy
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158
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Ślusarczyk A, Zapała P, Zapała Ł, Radziszewski P. The impact of smoking on recurrence and progression of non-muscle invasive bladder cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2023; 149:2673-2691. [PMID: 36404390 PMCID: PMC10129946 DOI: 10.1007/s00432-022-04464-6] [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: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Although smoking is a well-recognized causative factor of urothelial bladder cancer and accounts for 50% of cases, less is known about the prognostic significance of smoking on non-muscle invasive bladder cancer (NMIBC) prognosis. This systematic review and meta-analysis aimed to evaluate the effect of smoking on the risk of NMIBC recurrence and progression. MATERIALS AND METHODS We systematically searched Medline, Web of Science and Scopus databases for original articles published before October 2021 regarding the effect of smoking on NMIBC recurrence and progression. Information about smoking status and the number of events or odds ratio or hazard ratio for event-free survival must have been reported to include the study in the analysis. Quality In Prognosis Studies tool was utilized for the risk of bias assessment. RESULTS We selected 64 eligible studies, including 28 617 patients with NMIBC with available data on smoking status. In a meta-analysis of 28 studies with 7885 patients, we found that smokers (current/former) were at higher risk for recurrence (OR = 1.68; 95% CI 1.34-2.09; P < 0.0001) compared to never smokers. Subgroup analysis of 2967 patients revealed that current smokers were at a 1.24 higher risk of recurrence (OR = 1.24; 95% CI 1.02-1.50; P = 0.03) compared to former smokers. A meta-analysis of the hazard ratio revealed that smokers are at higher risk of recurrence (HR = 1.31; 95%CI 1.15-1.48; P < 0.0001) and progression (HR = 1.18; 95%CI 1.08-1.29; P < 0.001) compared to never smokers. Detrimental prognostic effect of smoking on progression, but not for recurrence risk was also noted in the subgroup analysis of high-risk patients (HR = 1.30; 95%CI 1.09-1.55; P = 0.004) and BCG-treated ones (HR = 1.15; 95%CI 1.06-1.25; P < 0.001). CONCLUSION In conclusion, patients with non-muscle invasive bladder cancer and a history of smoking have a worse prognosis regarding recurrence-free and progression-free survival compared to non-smokers.
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Affiliation(s)
- Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
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159
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Ren L, Yang X, Liu J, Wang W, Liu Z, Lin Q, Huang B, Pan J, Mao X. An innovative model based on N7-methylguanosine-related lncRNAs for forecasting prognosis and tumor immune landscape in bladder cancer. Cancer Cell Int 2023; 23:85. [PMID: 37158958 PMCID: PMC10165842 DOI: 10.1186/s12935-023-02933-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND As a novel type of the prevalent post-transcriptional modifications, N7-methylguanosine (m7G) modification is essential in the tumorigenesis, progression, and invasion of many cancers, including bladder cancer (BCa). However, the integrated roles of m7G-related lncRNAs in BCa remain undiscovered. This study aims to develop a prognostic model based on the m7G-related lncRNAs and explore its predictive value of the prognosis and anti-cancer treatment sensitivity. METHODS We obtained RNA-seq data and corresponding clinicopathological information from the TCGA database and collected m7G-related genes from previous studies and GSEA. Based on LASSO and Cox regression analysis, we developed a m7G prognostic model. The Kaplan-Meier (K-M) survival analysis and ROC curves were performed to evaluate the predictive power of the model. Gene set enrichment analysis (GSEA) was conducted to explore the molecular mechanisms behind apparent discrepancies between the low- and high-risk groups. We also investigated immune cell infiltration, TIDE score, TMB, the sensitivity of common chemotherapy drugs, and the response to immunotherapy between the two risk groups. Finally, we validated the expression levels of these ten m7G-related lncRNAs in BCa cell lines by qRT-PCR. RESULTS We developed a m7G prognostic model (risk score) composed of 10 m7G-related lncRNAs that are significantly associated with the OS of BCa patients. The K-M survival curves revealed that the high-risk group patients had significantly worse OS than those in the low-risk group. The Cox regression analysis confirmed that the risk score was a significant independent prognostic factor for BCa patients. We found that the high-risk group had higher the immune scores and immune cell infiltration. Furthermore, the results of the sensitivity of common anti-BCa drugs showed that the high-risk group was more sensitive to neoadjuvant cisplatin-based chemotherapy and anti-PD1 immunotherapy. Finally, qRT-PCR revealed that AC006058.1, AC073133.2, LINC00677, and LINC01338 were significantly downregulated in BCa cell lines, while the expression levels of AC124312.2 and AL158209.1 were significantly upregulated in BCa cell lines compared with normal cell lines. CONCLUSION The m7G prognostic model can be applied to accurately predict the prognosis and provide robust directions for clinicians to develop better individual-based and precise treatment strategies for BCa patients.
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Affiliation(s)
- Lei Ren
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Xu Yang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jinwen Liu
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Weifeng Wang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Zixiong Liu
- Department of Urology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Shenzhen, China
| | - Qingyuan Lin
- Department of Urology, The Seventh Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, Shenzhen, China
| | - Bin Huang
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
| | - Jincheng Pan
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
| | - Xiaopeng Mao
- Department of Urology, The First Affiliated Hospital of Sun Yat-Sen University, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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Caglayan A, Horsanali MO. Can Peripheral Blood Systemic Immune Response Parameters Predict Oncological Outcomes in Patients with Non-Muscle-Invasive Bladder Cancer? Niger J Clin Pract 2023; 26:591-598. [PMID: 37357475 DOI: 10.4103/njcp.njcp_399_22] [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: 06/27/2023]
Abstract
Background Many studies have investigated most cancer types - associations with systemic inflammatory response (SIR) parameters. Aim: This study investigated predictive values of SIR parameters in oncological outcomes and survival - to primary non-muscle-invasive bladder cancer (NMIBC) patients. Materials and Methods We analyzed 74 primary NMIBC patients. Clinical features, laboratory results, and tumor characteristics were recorded. In addition, the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), serum C-reactive protein, albumin-to-globulin ratio (AGR), and modified Glasgow prognostic scores (mGPS) were calculated. Results The - mean age of the patients was - 67.41 ± 11.31 years, and the follow-up duration was 38.77 ± 19.53 months. We - found no significant NLR, CRP, and AGR - correlations with tumor characteristics and oncological outcomes. There were significant - correlations between MLR and pathological-T-stage and the PLR, pathological-T-stage, and tumor count. Carcinoma in situ was associated with a high mGPS. Multivariate analysis revealed no significant - correlations between systemic inflammatory response parameters and oncological outcomes. Patients with a high mGPS had poor cancer-specific survival. Increased NLR was associated with reduced overall survival. Conclusions This study revealed no significant correlation between SIR parameters and oncological outcomes. Therefore, we need more reliable indicators than SIR parameters in NMIBC patients in clinical practice.
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Affiliation(s)
- A Caglayan
- Department of Urology, Çigli Training and Research Hospital, Izmir Bakirçay University, Izmir, Turkey
| | - M O Horsanali
- Deparment of Urology, Faculty of Medicine, Izmir Bakırçay University, Izmir, Turkey
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Soorojebally Y, Neuzillet Y, Lebret T, Allory Y, Descotes F, Ferlicot S, Kassab-Chahmi D, Lamy PJ, Oudard S, Rébillard X, Roy C, Roumiguié M, Rouprêt M, Audenet F. Photodynamic cystoscopy for bladder cancer diagnosis and for NMIBC follow-up: An overview of systematic reviews and meta-analyses. Prog Urol 2023; 33:307-318. [PMID: 37088584 DOI: 10.1016/j.purol.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Currently, bladder cancer detection is based on cytology and cystoscopy. White light cystoscopy (WLC) is an invasive procedure and may under-detect flat lesions. Blue light cystoscopy (BLC) and narrow band imaging (NBI) cystoscopy are new modalities that could improve the detection of non-muscle invasive bladder cancer (NMIBC) and its recurrence or progression to muscle invasive bladder cancer. We present a systematic review on BLC and NBI cystoscopy for bladder cancer diagnosis and NMIBC follow-up. MATERIAL AND METHODS All available systematic reviews and meta-analyses on cystoscopy published in PubMed® between May 2010 and March 2021 were identified and reviewed. The main endpoints were clinical performance for bladder cancer diagnosis and for recurrence or progression detection during NMIBC follow-up, and additional value compared with cytology and/or WLC. RESULTS Most of the meta-analyses and systematic reviews published suggest a better sensitivity of BLC and NBI cystoscopy compared to WLC, particularly for the detection of flat lesions (CIS). NBI- and BLC-guided TURBT could decrease the recurrence rates. However, their clinical utility to reduce progression rate and increase survival is still unclear. CONCLUSIONS BLC and NBI cystoscopy are efficient techniques for bladder cancer diagnosis and NMIBC follow-up. However, their clinical benefit remains to be confirmed.
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Affiliation(s)
- Y Soorojebally
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Y Neuzillet
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - T Lebret
- Department of urology, Foch Hospital, Paris Saclay University, Suresnes, France
| | - Y Allory
- Department of pathology, Institut Curie, Saint-Cloud, France
| | - F Descotes
- Biochemistry, biology and pathology centre South, Hospices civils de Lyon (HCL), Université Claude-Bernard Lyon I, Pierre-Bénite, France
| | - S Ferlicot
- Service d'anatomie pathologique, Hôpital de Bicêtre, AP-HP, Le Kremlin Bicêtre, France
| | | | - P-J Lamy
- Biopathologie et génétique des cancers, Institut médical d'analyse génomique, Imagenome, Inovie, Montpellier, France
| | - S Oudard
- Department of medical oncology, Hôpital européen Georges-Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France
| | - X Rébillard
- Urology Department, Beausoleil Private Hospital, Montpellier, France
| | - C Roy
- Department of radiology B, Strasbourg University Hospital - New Civil Hospital, Strasbourg, France
| | - M Roumiguié
- Department of urology, andrology and renal transplantation, CHU Rangueil, Paul-Sabatier University, Toulouse cedex, France
| | - M Rouprêt
- Sorbonne University, GRC 5 predictive Onco-Uro, Urology, Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - F Audenet
- Department of urology, Hôpital européen Georges-Pompidou, AP-HP.Centre, Université Paris Cité, Paris, France.
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162
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Hsieh TY, Sung WW, Chang YC, Yu CY, Lu LY, Dong C, Lee TH, Chen SL. Melatonin induces cell cycle arrest and suppresses tumor invasion in urinary bladder urothelial carcinoma. Aging (Albany NY) 2023; 15:3107-3119. [PMID: 37086261 DOI: 10.18632/aging.204673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
Urinary bladder urothelial carcinoma (UBUC) encompasses about 90% of all bladder cancer cases, and the mainstream treatment is the transurethral resection of the bladder tumor followed by intravesical instillation. High rates of mortality, recurrence, and progression in bladder cancer have stimulated the search for alternative adjuvant therapies. The aim of this study was to investigate the potential of melatonin as adjuvant therapy in bladder cancer. Cell viability and clonogenic ability were assessed by an MTT assay and colony formation. Cell cycle and apoptosis analysis were performed by flow cytometry and Hoechst 33342 staining, while cell metastasis capacity was measured by wound healing and transwell assays. Potential mechanisms were investigated by an oncology array and verified via western blotting. The melatonin treatment significantly reduced T24 and UMUC3 bladder cancer cell proliferation and clonogenic ability. G1 arrest and sub-G1 accumulation in the T24 and UMUC3 cells led to cell proliferation suppression and cell death, and Hoechst 33342 staining further verified the apoptosis induction directly by melatonin. Moreover, melatonin weakened cell motility and invasiveness. Based on the oncology array results, we demonstrated that melatonin exerts its anti-cancer effect by down-regulating the HIF-1α and NF-κB pathways and downstream pathways, including Bcl-2, leading to cell cycle arrest and apoptosis induction in the UBUC cells. Overall, these findings support the potential of melatonin as adjuvant therapy in bladder cancer.
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Affiliation(s)
- Tzuo-Yi Hsieh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Wei Sung
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Chuan Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chia-Ying Yu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Li-Yu Lu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chen Dong
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Tsung-Hsien Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Obstetrics and Gynecology, Chung Shan Medical University, Taichung, Taiwan
- Division of Infertility Clinic, Lee Women’s Hospital, Taichung, Taiwan
| | - Sung-Lang Chen
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
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163
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Relouw S, Dugbartey GJ, Sener A. Non-Invasive Imaging Modalities in Intravesical Murine Models of Bladder Cancer. Cancers (Basel) 2023; 15:cancers15082381. [PMID: 37190309 DOI: 10.3390/cancers15082381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Bladder cancer (BCa) is the sixth most prevalent cancer in men and seventeenth most prevalent cancer in women worldwide. Current treatment paradigms have limited therapeutic impact, suggesting an urgent need for the investigation of novel therapies. To best emulate the progression of human BCa, a pre-clinical intravesical murine model is required in conjunction with existing non-invasive imaging modalities to detect and evaluate cancer progression. Non-invasive imaging modalities reduce the number of required experimental models while allowing for longitudinal studies of novel therapies to investigate long-term efficacy. In this review, we discuss the individual and multi-modal use of non-invasive imaging modalities; bioluminescence imaging (BLI), micro-ultrasound imaging (MUI), magnetic resonance imaging (MRI), and positron emission tomography (PET) in BCa evaluation. We also provide an update on the potential and the future directions of imaging modalities in relation to intravesical murine models of BCa.
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Affiliation(s)
- Sydney Relouw
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, Western University, London, ON N6A 5A5, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - George J Dugbartey
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, Western University, London, ON N6A 5A5, Canada
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Legon, Accra P.O. Box LG 1181, Ghana
- Department of Surgery, Division of Urology, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, ON N6A 5A5, Canada
| | - Alp Sener
- Matthew Mailing Center for Translational Transplant Studies, London Health Sciences Centre, Western University, London, ON N6A 5A5, Canada
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Department of Surgery, Division of Urology, London Health Sciences Centre, London, ON N6A 5A5, Canada
- Multi-Organ Transplant Program, London Health Sciences Center, London, ON N6A 5A5, Canada
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164
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Awad M, Harraz AM, Farg H, Gabr HS, Sharaf DE, Abou-El-Ghar M, El-Hefnawy AS, Osman Y. Microscopic hematuria and pelvic ultrasonography could rule out flexible cystoscopy during surveillance for T1-low grade non-muscle invasive bladder cancer. Arab J Urol 2023; 21:150-155. [PMID: 37521447 PMCID: PMC10373612 DOI: 10.1080/2090598x.2023.2202930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/09/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose Cystoscopy (rigid/flexible [FC]) is the standard surveillance tool for non-muscle invasive bladder cancer (NMIBC). Nevertheless, it has its drawbacks. The objective of this study is to evaluate the performance of microscopic hematuria (MH), abdominal ultrasonography (US), and urine cytology (UC) as potential substitutes for FC in patients with T1-low-grade (T1-LG) NMIBC. Methods Over a 12-month period, patients attending our tertiary referral center for T1-LG NMIBC follow-up underwent urine analysis for MH and UC, and then US and FC were performed as outpatient surveillance procedures. Those with positive findings underwent inpatient rigid cystoscopy under anesthesia and biopsy. The negative predictive values (NPV) and sensitivity of different combinations of MH, UC, US, and FC were compared with the standard histopathology. Results In 218 evaluated patients, FC had the highest NPV (97.9%). However, this figure showed no statistically significant difference if compared with the combination of negative MH and US (93.8%) (difference = 0.04, p = 0.1) or the combination of MH, US, and UC (94.9%) (difference = 0.03, p = 0.2). The reported sensitivity results were similarly comparable between FC (94.2%) and the aforementioned combinations (90.4% and 92.3%; differences: 0.038 and 0.019; p = 0.4 and 0.7, respectively). Conclusions During the surveillance of NMIBC for patients diagnosed with T1-LG disease, the combination of MH/US has comparable sensitivity and NPV with FC. This non-invasive combination could be considered the first station that might preclude the need for FC in a considerable percentage of this group of patients.
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Affiliation(s)
- Mohamed Awad
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Ahmed M. Harraz
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Hashim Farg
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Hady S. Gabr
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | - Doaa E. Sharaf
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
| | | | | | - Yasser Osman
- Urology and nephrology center, Mansoura University, Mansoura, Egypt
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165
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Teixeira-Marques A, Lourenço C, Oliveira MC, Henrique R, Jerónimo C. Extracellular Vesicles as Potential Bladder Cancer Biomarkers: Take It or Leave It? Int J Mol Sci 2023; 24:ijms24076757. [PMID: 37047731 PMCID: PMC10094914 DOI: 10.3390/ijms24076757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
Bladder cancer (BC) is the 10th most frequently diagnosed cancer worldwide. Although urine cytology and cystoscopy are current standards for BC diagnosis, both have limited sensitivity to detect low-grade and small tumors. Moreover, effective prognostic biomarkers are lacking. Extracellular vesicles (EVs) are lipidic particles that contain nucleic acids, proteins, and metabolites, which are released by cells into the extracellular space, being crucial effectors in intercellular communication. These particles have emerged as potential tools carrying biomarkers for either diagnosis or prognosis in liquid biopsies namely urine, plasma, and serum. Herein, we review the potential of liquid biopsies EVs’ cargo as BC diagnosis and prognosis biomarkers. Additionally, we address the emerging advantages and downsides of using EVs within this framework.
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Affiliation(s)
- Ana Teixeira-Marques
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC Raquel Seruca), 4200-072 Porto, Portugal
| | - Catarina Lourenço
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC Raquel Seruca), 4200-072 Porto, Portugal
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135 Porto, Portugal
- INEB—Instituto Nacional de Engenharia Biomédica, Universidade do Porto, 4200-135 Porto, Portugal
- Doctoral Programme in Biomedical Sciences, School Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
| | - Miguel Carlos Oliveira
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC Raquel Seruca), 4200-072 Porto, Portugal
| | - Rui Henrique
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC Raquel Seruca), 4200-072 Porto, Portugal
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOPorto), 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC Raquel Seruca), 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, School of Medicine & Biomedical Sciences, University of Porto (ICBAS-UP), 4050-313 Porto, Portugal
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Pradere B, Basile G, Seisen T. Re: Maria S. Lindgren, Eric Hansen, Nessn Azawi, Anna M. Nielsen, Lars Dyrskjøt, Jørgen B. Jensen. DaBlaCa-13 Study: Oncological Outcome of Short-term, Intensive Chemoresection with Mitomycin in Nonmuscle Invasive Bladder Cancer: Primary Outcome of a Randomized Controlled Trial. J Clin Oncol. In press. https://doi.org/10.1200/JCO.22.00470. Eur Urol 2023; 83:e105-e106. [PMID: 36717285 DOI: 10.1016/j.eururo.2022.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 01/29/2023]
Affiliation(s)
- Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint Fonsegrives, France; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Basile
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Thomas Seisen
- Department of Urology, Pitié-Salpêtrière Hospital, APHP, Sorbonne University, GRC 5, Predictive Onco-Urology, Paris, France.
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167
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Lindgren MS, Jensen JB. Reply to Benjamin Pradere, Giuseppe Basile, and Thomas Seisen's Letter to the Editor re: Maria S. Lindgren, Eric Hansen, Nessn Azawi, Anna M. Nielsen, Lars Dyrskjøt, Jørgen B. Jensen. DaBlaCa-13 Study: Oncological Outcome of Short-term, Intensive Chemoresection with Mitomycin in Nonmuscle Invasive Bladder Cancer: Primary Outcome of a Randomized Controlled Trial. J Clin Oncol 2023;41:2,206-11. Eur Urol 2023; 83:e107-e108. [PMID: 36710202 DOI: 10.1016/j.eururo.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Affiliation(s)
- Maria S Lindgren
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
| | - Jørgen B Jensen
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark; Department of Urology, Regional Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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168
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Hof JP, Vermeulen SH, van der Heijden AG, Verhaegh GW, Dyrskjøt L, Catto JWF, Mengual L, Bryan RT, Fleshner NE, Kiemeney LALM, Galesloot TE. An Association Study of Germline Variants in Bladder Cancer-Related Genes with the Prognosis of Non-Muscle Invasive Bladder Cancer. Bladder Cancer 2023; 9:59-71. [PMID: 38994482 PMCID: PMC11181778 DOI: 10.3233/blc-220076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/22/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Various germline genetic variants are associated with the prognosis of non-muscle invasive bladder cancer (NMIBC). Germline variants in genes frequently somatically mutated in bladder cancer have not been studied thoroughly in relation to risk of recurrence or progression in NMIBC. OBJECTIVE To identify germline DNA variants in bladder carcinogenesis-related genes associated with recurrence or progression in NMIBC. METHODS We analysed associations between single-nucleotide polymorphisms (SNPs) and NMIBC recurrence and progression using data from the Nijmegen Bladder Cancer Study (NBCS, 1,443 patients). We included 5,053 SNPs within 46 genes known to have mutation, overexpression or amplification in bladder cancer. We included all recurrences in the statistical analysis and performed both single variant analysis and gene-based analysis. SNPs and genes that showed significant or suggestive association (false discovery rate P value < 20%) were followed-up in independent cohorts for replication analysis, through eQTL analysis and tests for association of tumour expression levels with NMIBC recurrence and progression. RESULTS Single variant analysis showed no statistically significant associations with recurrence or progression. In gene-based analysis, the aggregate effect of the 25 SNPs in the Cyclin D1 gene (CCND1) was statistically significantly associated with NMIBC recurrence (Punadj = 0.001, PFDR = 0.046), but not with progression (Punadj = 0.17, PFDR = 0.54). Validation analysis in independent cohorts did not confirm the association of CCND1 with NMIBC recurrence. CONCLUSIONS We could not identify reproducible associations between common germline variants in bladder carcinogenesis-related genes and NMIBC recurrence or progression.
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Affiliation(s)
- Jasper P Hof
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sita H Vermeulen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gerald W Verhaegh
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Lourdes Mengual
- Department and Laboratory of Urology, Universitat de Barcelona, Barcelona, Spain
| | - Richard T Bryan
- Institute of Cancer & Genomic Sciences, Bladder Cancer Research Centre, University of Birmingham, Birmingham, UK
| | - Neil E Fleshner
- Department of Urology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tessel E Galesloot
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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Creswell ML, Sholklapper TN, Markel MJ, Mason JB, Pianka MA, Dall CP, Ulu C, Stamatakis L. Economic Outcomes of Hexaminolevulinate Blue-Light Cystoscopy in Non-Muscle Invasive Bladder Cancer: A 5-Year, Medicare-Based Model. Bladder Cancer 2023; 9:87-96. [PMID: 38994485 PMCID: PMC11181828 DOI: 10.3233/blc-220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/28/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Bladder cancer is the most expensive cancer to treat on a per-patient basis. Blue light cystoscopy with hexaminolevulinate (BLC) has demonstrated improved diagnostic accuracy compared with white light cystoscopy (WLC) in non-muscle invasive bladder cancer (NMIBC). With higher upfront costs, questions remain about long-term BLC cost outcomes. OBJECTIVE This study seeks to investigate the 5-year cost comparison of BLC and WLC from the Medicare payer perspective. METHODS A representative 5-year NMIBC management model was constructed and Medicare reimbursement values were overlaid. The primary outcome was mean year-over-year cumulative cost discounted to present value at a 3% annual percentage rate. The secondary outcome was the rate of clinical events. RESULTS Patients in the BLC cohort experienced fewer recurrences. On a cumulative present value cost basis, BLC was more expensive per patient in years 1, 2, and 3 than WLC, however, in years 4 and 5, BLC was economically favorable. Year 5 BLC mean cumulative cost savings was $1,172 per patient. Overall, 31.6% of all patients in the BLC group generated cumulative cost savings compared to WLC at year 1 compared with 50.9% at the end of year 5. CONCLUSIONS Despite a higher initial annual cost, a slight cumulative economic advantage of BLC is realized after surveillance year 3. Additionally, a greater proportion of patients who received BLC achieved cost savings at the end of year 5. As novel technology emerges, economic models can help health care systems predict associated costs and quality improvements.
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Affiliation(s)
- Michael L Creswell
- Georgetown University School of Medicine, Washington, DC, USA
- Georgetown University McDonough School of Business, Washington, DC, USA
| | | | | | - James B Mason
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mark A Pianka
- Georgetown University School of Medicine, Washington, DC, USA
| | - Christopher P Dall
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Canan Ulu
- Georgetown University McDonough School of Business, Washington, DC, USA
| | - Lambros Stamatakis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
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170
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Castaneda PR, Theodorescu D, Rosser CJ, Ahdoot M. Identifying novel biomarkers associated with bladder cancer treatment outcomes. Front Oncol 2023; 13:1114203. [PMID: 37064102 PMCID: PMC10090444 DOI: 10.3389/fonc.2023.1114203] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/08/2023] [Indexed: 03/31/2023] Open
Abstract
Bladder cancer is a complex disease with variable prognosis. Recent investigations into the molecular landscape of bladder cancer have revealed frequent genetic alterations and molecular subtypes with therapeutic implications. Consequently, a shift toward personalized treatment of bladder cancer is underway. To this end, several biomarkers have been developed and tested in their ability to predict response to treatment in patients with bladder cancer and potentially help direct therapy. We performed a search of recently published PubMed articles using terms "biomarker," "bladder cancer," and the respective treatment discussed (i.e., "neoadjuvant" or "BCG"). In this review, we summarize the latest studies on novel biomarkers in bladder cancer with a focus on those intended to improve risk stratification and treatment selection.
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Affiliation(s)
- Peris R. Castaneda
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Dan Theodorescu
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
| | - Charles J. Rosser
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, United States
| | - Michael Ahdoot
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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171
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Yang T, Chi Z, Liu G, Hong X, Cao S, Cheng K, Zhang Y. Screening ANLN and ASPM as bladder urothelial carcinoma-related biomarkers based on weighted gene co-expression network analysis. Front Genet 2023; 14:1107625. [PMID: 37051591 PMCID: PMC10083327 DOI: 10.3389/fgene.2023.1107625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Introduction: Bladder cancer (BLCA) is one of the most common malignancies in the urinary system with a poor prognosis and high treatment costs. Identifying potential prognostic biomarkers is significant for exploring new therapeutic and predictive targets of BLCA.Methods: In this study, we screened differentially expressed genes using the GSE37815 dataset. We then performed a weighted gene co‐expression network analysis (WGCNA) to identify the genes correlated with the histologic grade and T stage of BLCA using the GSE32548 dataset. Subsequently, Kaplan Meier survival analysis and Cox regression were used to further identify prognosis‐related hub genes using the datasets GSE13507 and TCGA‐BLCA. Moreover, we detected the expression of the hub genes in 35 paired samples, including BLCA and paracancerous tissue, from the Shantou Central Hospital by qRT‐polymerase chain reaction.Results: This study showed that Anillin (ANLN) and Abnormal spindle-like microcephaly-associated gene (ASPM) were prognostic biomarkers for BLCA. High expression of ANLN and ASPM was associated with poor overall survival.The qRT‐PCR results revealed that ANLN and ASPM genes were upregulated in BLCA, and there was a correlation between the expression of ANLN and ASPM in cancer tissues and paracancerous tissue. Additionally, the increasing multiples in the ANLN gene was obvious in high-grade BLCA.Discussion: In summary, this preliminary exploration indicated a correlation between ANLN and ASPM expression. These two genes, serving as the risk factors for BLCA progression, might be promising targets to improve the occurrence and progression of BLCA.
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172
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Daza J, Grauer R, Chen S, Lavallèe E, Razdan S, Dey L, Steineck G, Renström-Koskela L, Li Q, Hussein AA, Mehrazin R, Waingankar N, Guru K, Wiklund P, Sfakianos JP. Development of a predictive model for recurrence-free survival in pTa low-grade bladder cancer. Urol Oncol 2023; 41:256.e9-256.e15. [PMID: 36941190 DOI: 10.1016/j.urolonc.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/04/2023] [Accepted: 01/27/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Data on Ta low-grade (LG) non-muscle invasive bladder cancer (NMIBC) have shown that follow-up cystoscopies are normal in 82% and 67% of patients with single and multiple tumors, respectively. OBJECTIVE To develop a predictive model associated with recurrence-free survival (RFS) at 6, 12, 18 and 24 months in TaLG cases that consider the patients' risk aversion. MATERIALS AND METHODS Data from a prospectively maintained database of 202 newly diagnosed TaLG NMIBC patients treated at Scandinavian institutions were used for the analysis. To identify risk groups associated with recurrence, we performed a classification tree analysis. Association between risk groups and RFS was evaluated by Kaplan Meier analysis. A Cox proportional hazard model selected significant risk factors associated with RFS using the variables defining the risk groups. The reported C index for the Cox model was 0.7. The model was internally validated and calibrated using 1000 bootstrapped samples. A nomogram to estimate RFS at 6, 12, 18, and 24 months was generated. The performance of our model was compared to EUA/AUA stratification using a decision curve analysis (DCA). RESULTS The tree classification found that tumor number, tumor size and age were the most relevant variables associated with recurrence. The patients with the worst RFS were those with multifocal or single, ≥ 4cm tumors. All the relevant variables identified by the classification tree were significantly associated with RFS in the Cox proportional hazard model. DCA analysis showed that our model outperformed EUA/AUA stratification and the treat all/none approaches. CONCLUSION We developed a predictive model to identify TaLG patients that benefit from less frequent follow-up cystoscopy schedule based on the estimated RFS and personal recurrence risk aversion.
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Affiliation(s)
- Jorge Daza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sophie Chen
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Etienne Lavallèe
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirin Razdan
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Linda Dey
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Qiang Li
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Ahmed A Hussein
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Khurshid Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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173
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Semeniuk-Wojtaś A, Poddębniak-Strama K, Modzelewska M, Baryła M, Dziąg-Dudek E, Syryło T, Górnicka B, Jakieła A, Stec R. Tumour microenvironment as a predictive factor for immunotherapy in non-muscle-invasive bladder cancer. Cancer Immunol Immunother 2023:10.1007/s00262-023-03376-9. [PMID: 36928373 DOI: 10.1007/s00262-023-03376-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
Bladder cancer (BC) can be divided into two subgroups depending on invasion of the muscular layer: non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC). Its aggressiveness is associated, inter alia, with genetic aberrations like losses of 1p, 6q, 9p, 9q and 13q; gain of 5p; or alterations in the p53 and p16 pathways. Moreover, there are reported metabolic disturbances connected with poor diagnosis-for example, enhanced aerobic glycolysis, gluconeogenesis or haem catabolism.Currently, the primary way of treatment method is transurethral resection of the bladder tumour (TURBT) with adjuvant Bacillus Calmette-Guérin (BCG) therapy for NMIBC or radical cystectomy for MIBC combined with chemotherapy or immunotherapy. However, intravesical BCG immunotherapy and immune checkpoint inhibitors are not efficient in every case, so appropriate biomarkers are needed in order to select the proper treatment options. It seems that the success of immunotherapy depends mainly on the tumour microenvironment (TME), which reflects the molecular disturbances in the tumour. TME consists of specific conditions like hypoxia or local acidosis and different populations of immune cells including tumour-infiltrating lymphocytes, natural killer cells, neutrophils and B lymphocytes, which are responsible for shaping the response against tumour neoantigens and crucial pathways like the PD-L1/PD-1 axis.In this review, we summarise holistically the impact of the immune system, genetic alterations and metabolic changes that are key factors in immunotherapy success. These findings should enable better understanding of the TME complexity in case of NMIBC and causes of failures of current therapies.
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Affiliation(s)
| | | | | | | | | | - Tomasz Syryło
- Department of General, Active and Oncological Urology, Military Institute of Medicine, Warsaw, Poland
| | - Barbara Górnicka
- Pathomorphology Department, Medical University of Warsaw, Warsaw, Poland
| | - Anna Jakieła
- Oncology Department, 4 Military Clinical Hospital with a Polyclinic, Wroclaw, Poland
| | - Rafał Stec
- Oncology Department, Medical University of Warsaw, Warsaw, Poland
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174
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Cimier A, Thach S, Lacroix B, Mariat C. [Evaluation of the efficacy and safety of HIVEC intravesical thermochemotherapy with intermediate-risk and high-risk non-muscle-invasive bladder cancer]. Prog Urol 2023; 33:254-264. [PMID: 36906430 DOI: 10.1016/j.purol.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/25/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Non-muscle-infiltrating cancers (NMIBC) represent 75% of bladder tumors. The objective of our study is to report a single-center experience of the efficacy and tolerability of HIVEC on intermediate- and high-risk NMIBC in adjuvant therapy. MATERIAL AND METHOD Between December 2016 and October 2020, patients with intermediate-risk or high-risk NMIBC were included. They were all treated with HIVEC as an adjuvant therapy to bladder resection. Efficacy was assessed by endoscopic follow-up and tolerance by a standardized questionnaire. RESULTS A total of 50 patients were included. The median age was 70years (34-88). The median follow-up time was 31 months (4-48). Forty-nine patients had cystoscopy as part of the follow-up. Nine recurred. One patient progressed to Cis. The 24-month recurrence-free survival was 86.6%. There were no severe adverse events (grade 3 or 4). The ratio of delivered instillations to planned instillations was 93%. CONCLUSION HIVEC with the COMBAT system is well tolerated in adjuvant treatment. However, it is not better than standard treatments, especially for intermediate-risk NMIBC. While waiting for recommendations, it cannot be proposed as an alternative to standard treatment. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- A Cimier
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France.
| | - S Thach
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - B Lacroix
- Service d'urologie, clinique Mutualiste, 3, rue Le Verrier, 42000 Saint-Étienne, France
| | - C Mariat
- Service d'urologie, CHU de Saint-Étienne, hôpital Nord, 42055 Saint-Étienne, France
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175
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Tsukamoto R, Sazuka T, Hattori Y, Sato H, Arai T, Goto Y, Imamura Y, Sakamoto S, Ichikawa T. Relationship between Preoperative Pyuria and Bacille Calmette-Guerin Treatment in Intravesical Recurrence after Transurethral Resection of High-Risk, Non-Muscle Invasive, Bladder Carcinoma: A Retrospective Study of Human Data. Cancers (Basel) 2023; 15:cancers15061638. [PMID: 36980524 PMCID: PMC10046501 DOI: 10.3390/cancers15061638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Some researchers have found that preoperative pyuria is a risk factor for recurrence after transurethral resection of high-risk non-muscle invasive bladder cancer. However, to our knowledge, none have clarified the risks associated with pyuria according to bacille Calmette-Guerin (BCG) treatment status. We retrospectively selected patients with high-risk non-muscle invasive bladder cancer according to Japanese Urological Association guidelines. Pyuria was defined as ≥10 white blood cells per high-powered field. We analyzed recurrence-free rates (RFS) in 424 patients who had and had not undergone BCG treatment. The median duration of follow-up was 45.2 months. According to multivariate analysis, postoperative intravesical BCG induction and preoperative pyuria were independent risk factors for intravesical recurrence in the whole study cohort. We found no significant risk factors for recurrence in the BCG-treated group (n = 179). In the non-BCG-treated group (n = 245), patients with pyuria were much more frequently female and more often had T1 disease than patients without pyuria. According to univariate and multivariate analysis, preoperative pyuria is an independent risk factor for intravesical recurrence. There was no significant difference in the severity of pyuria between the BCG and non-BCG-treated groups. Aggressive BCG treatment may need to be considered in patients with high-risk NMIBC and pyuria.
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Affiliation(s)
| | - Tomokazu Sazuka
- Correspondence: ; Tel.: +81-43-226-2134; Fax: +81-43-226-2136
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176
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Sharma V, Chamie K, Schoenberg M, Lee VS, Fero K, Lec P, Munneke JR, Aaronson DS, Kushi LH, Quesenberry CP, Tang L, Kwan ML. Natural History of Multiple Recurrences in Intermediate-Risk Non-Muscle Invasive Bladder Cancer: Lessons From a Prospective Cohort. Urology 2023; 173:134-141. [PMID: 36574911 DOI: 10.1016/j.urology.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To describe the risk of multiple recurrences in intermediate-risk non-muscle invasive bladder cancer (IR-NMIBC) and their impact on progression. Prognostic studies of IR-NMIBC have focused on initial recurrences, yet little is known about subsequent recurrences and their impact on progression. MATERIALS AND METHODS IR-NMIBC patients from the Be-Well Study, a prospective cohort study of NMIBC patients diagnosed from 2015 to 2019 at Kaiser Permanente Northern California, were identified. The frequency of first, second, and third intravesical recurrences of urothelial carcinoma were characterized using conditional Kaplan-Meier analyses and random-effects shared-frailty models. The association of multiple recurrences with progression was examined. RESULTS In 291 patients with IR-NMIBC (median follow-up 38 months), the 5-year risk of initial recurrence was 54.4%. After initial recurrence (n = 137), 60.1% of patients had a second recurrence by 2 years. After second recurrence (n = 70), 51.5% of patients had a third recurrence by 3 years. In multivariable analysis, female sex (Hazard Ratio 1.51, P< .01), increasing tumor size (HR 1.14, P< .01) and number of prior recurrences (HR 1.24, P< .01) were associated with multiple recurrences; whereas maintenance BCG (HR 0.66, P = .03) was associated with reduced recurrences. The 5-year risk of progression varied significantly (P< .01) by number of recurrences: 9.5%, 21.9%, and 37.9% for patients with 1, 2, and 3+ recurrences, respectively. CONCLUSIONS Multiple recurrences are common in IR-NMIBC and are associated with progression. Female sex, larger tumors, number of prior recurrences, and lack of maintenance BCG were associated with multiple recurrences. Multiple recurrences may prove useful as a clinical trial endpoint for IR-NMIBC.
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Affiliation(s)
- Vidit Sharma
- Department of Urology, University of California Los Angeles, Los Angeles, CA; Department of Urology, Mayo Clinic, Rochester, MN
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Mark Schoenberg
- Department of Urology, The Albert Einstein College of Medicine, Bronx, NY
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Katherine Fero
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Patrick Lec
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Julie R Munneke
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - David S Aaronson
- Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Li Tang
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.
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177
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Yang Z, Bi Y, Xu W, Guo R, Hao M, Liang Y, Shen Z, Yin L, Yu C, Wang S, Wang J, Li J, Zhang J, Cheng R, Zhai Q, Wang H. Glabridin inhibits urothelial bladder carcinoma cell growth in vitro and in vivo by inducing cell apoptosis and cell cycle arrest. Chem Biol Drug Des 2023; 101:581-592. [PMID: 36098706 DOI: 10.1111/cbdd.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/20/2022] [Accepted: 09/11/2022] [Indexed: 11/28/2022]
Abstract
Glabridin (GLA) has a variety of biological activities and therapeutic effects in cancers. Whereas the effect of GLA on urothelial bladder carcinoma (UBC) cells and its underlying mechanisms remain unknown. The study revealed the effect of GLA on UBC and the potential mechanism of inducing cell apoptosis in vivo and in vitro. After treated with different concentrations of GLA, the cell activity decreased in a time- and dose-dependent manner. The IC50 values of BIU-87 and EJ cells at 48 h were 6.02 μg/ml (18.6 μm) and 4.36 μg/ml (13.4 μm), respectively. Additionally, GLA-induced apoptosis and cycle arrest of BIU-87 and EJ cells in G2 phase. Furthermore, wound healing experiments showed that GLA significantly reduced the migration activities of BIU-87 and EJ cells. Mechanically, GLA obviously increased the expression of BIM, BAK1, and CYCS in both mRNA and protein levels, which led to the activation of the endogenous apoptotic pathway. Finally, GLA remarkably inhibited the growth of UBC tumors in vivo. In summary, GLA inhibited UBC cells growth in vitro and in vivo by inducing cell apoptosis and cell cycle arrest, highlighting that GLA could be utilized as a component to design a novel anti-UBC drug.
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Affiliation(s)
- Zhao Yang
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China.,College of Life Science and Technology, Key Laboratory of Protection and Utilization of Biological Resources in Tarim Basin of Xinjiang Production and Construction Corps, Tarim University, Alar, Xinjiang, China
| | - Ying Bi
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Wenkai Xu
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China.,Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rui Guo
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Mingxuan Hao
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Youfeng Liang
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Zongyi Shen
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Liqi Yin
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Changyuan Yu
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Shihui Wang
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Jiansong Wang
- College of Life Science and Technology, Innovation Center of Molecular Diagnostics, Beijing University of Chemical Technology, Beijing, China
| | - Jinmei Li
- Department of Pathology, Key Laboratory of Molecular Pathology and Early Diagnosis of Tumor in Hebei Province, First Central Hospital of Baoding City, Baoding, Hebei, China
| | - Jinku Zhang
- Department of Pathology, Key Laboratory of Molecular Pathology and Early Diagnosis of Tumor in Hebei Province, First Central Hospital of Baoding City, Baoding, Hebei, China
| | - Runfen Cheng
- Department of Pathology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Qiongli Zhai
- Department of Pathology, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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178
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Brun A, Koutlidis N, Thibault T, Escoffier A, Bardet F, Cormier L. [The impact of restaging transurethral resection on recurrence and progression free survival in patients with T1 high grade bladder cancer]. Prog Urol 2023; 33:125-134. [PMID: 36604247 DOI: 10.1016/j.purol.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Restaging transurethral resection (re-TUR) of high grade T1 bladder cancer (HGT1-BC) is recommended but the impact in terms of recurrence-free survival (RFS) and progression-free survival (PFS) is discussed. The objective of this study was to evaluate our practice of re-TUR for these tumors and its impact on overall survival (OS), RFS and PFS. MATERIALS AND METHODS A retrospective observational study was conducted between 2010 and 2020. The inclusion criteria was the presence of newly diagnosed HGT1-BC. Patients with incomplete resection, suspicion of infiltrating tumor, upper tract urothelial cancer, or metastatic disease were ineligible. Two groups were defined : Group 1 with re-TUR and Group 2 without re-TUR. RFS and PFS were evaluated. RESULTS A total of 78 patients were included, including 50 (64,1%) in group 1. There were no significant differences between the two groups. The mean time to re-TUR was 8 weeks and 60% residual tumor was found. Initial under-staging was found in 12% of cases. RFS and PFS were significantly better in Group 1 (P=0.0019; P=0,02). No significant were found between the groups in OS and specific survival (SS). CONCLUSION Performing a re-TUR for high grade T1 bladder tumors allows detection of residual tumor and decreases the risk of under-evaluation. It is associated with a significant improvement in RFS and PFS with no impact on OS and SS. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- A Brun
- Service d'urologie et andrologie, centre hospitalier universitaire François-Mitterrand, Dijon, France; Service d'urologie, centre hospitalier William Morey, Chalon sur Saône, France.
| | - N Koutlidis
- Service d'urologie, centre hospitalier William Morey, Chalon sur Saône, France
| | - T Thibault
- Service de médecine interne, centre hospitalier universitaire Francois-Mitterrand, Dijon, France
| | - A Escoffier
- Service d'urologie et andrologie, centre hospitalier universitaire François-Mitterrand, Dijon, France
| | - F Bardet
- Service d'urologie et andrologie, centre hospitalier universitaire François-Mitterrand, Dijon, France
| | - L Cormier
- Service d'urologie et andrologie, centre hospitalier universitaire François-Mitterrand, Dijon, France
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179
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Horňák J, Brisuda A, Babjuk M. Transurethral resection of bladder cancer with or without fluorescence. Curr Opin Urol 2023; 33:152-156. [PMID: 36630205 DOI: 10.1097/mou.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Transurethral resection of bladder cancer (TURBT) is in its standard form an inherently imperfect technique. Fluorescence-guided photodynamic diagnosis (PDD) represents one way to improve the outcome by enhancing tumour detection. Fluorescence has been used in connection with bladder cancer since the 1970s, with a number of studies being published since then. However, the method is still not recommended as a standard part of TURBT mainly because of the limited level of evidence of concerned studies, questionable cost-effectiveness and even contradictory results. The review lists the latest articles covering this topic. RECENT FINDINGS Several recently published meta-analyses reviewed a series of randomized controlled trials (RCTs) concerning PDD assisted TURBT. Results were generally supporting the positive effect on reduction of recurrence rate. However, the mentioned meta-analyses are overlapping in terms of reviewed RCT that provide only a low level of evidence according to a recent Cochrane review. Supposed limitations of PDD (timing of the procedure, low specificity) and possible solutions are also covered. SUMMARY Most of the published data confirmed reduced early recurrence rate after PDD assisted TURBT comparing to standard TURBT. Its impact on late recurrence rate, progression rate or cost-effectiveness has not been sufficiently demonstrated.
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Affiliation(s)
- Jakub Horňák
- Department of Urology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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180
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Nishikawa R, Miyake M, Morizane S, Shimizu R, Teraoka S, Honda M, Iida K, Nishimura N, Sazuka T, Kimura T, Ito A, Shiga K, Taoka R, Kojima T, Kobayashi T, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Takenaka A. C-reactive protein as a prognostic predictor for non-muscle invasive bladder cancer after intravesical bacillus Calmette-Guérin therapy: A Japan Urological Oncology Group study analysis. Int J Urol 2023; 30:299-307. [PMID: 36448522 DOI: 10.1111/iju.15106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To investigate the involvement of pretreatment C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in the prognosis of patients who underwent intravesical bacillus Calmette-Guérin (BCG) therapy for non-muscle invasive bladder cancer (NMIBC). METHODS The clinicopathological data of 1709 patients with NMIBC who underwent initial intravesical BCG therapy after transurethral resection of bladder tumor were retrospectively analyzed to evaluate the outcome of intravesical BCG therapy in a multicenter study conducted by the Japan Urological Oncology Group. The prognoses of these patients were analyzed to determine whether the biomarkers (CRP and NLR) could predict the efficacy of intravesical BCG therapy. Patients were divided into two groups according to the pretreatment CRP and NLR, with cutoff values defined as CRP ≥ 0.5 mg/dl and NLR ≥ 2.5, based on several previous reports. RESULTS In the univariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence, cancer-specific survival, and bladder cancer (BC) progression, while NLR ≥ 2.5 was not significantly associated with patient prognosis. In the multivariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence and BC progression. The concordance index was used to examine the accuracy in predicting recurrence and progression events. While CRP was slightly, though not statistically significant, inferior to the European Association of Urology risk classification, the combination of them showed improved predictive accuracy. CONCLUSION This study suggests that CRP can be a prognostic factor after intravesical BCG therapy and may provide useful data for determining treatment and follow-up strategies for patients with NMIBC.
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Affiliation(s)
- Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Kota Iida
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Tomokazu Sazuka
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Chiba City, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Minato-ku, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduates School of Medicine, Miyagi, Sendai, Japan
| | - Kenichiro Shiga
- Department of Urology, Harasanshin Hospital, Fukuoka City, Fukuoka, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center, Nagoya City, Aichi, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
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181
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Patient Preferences for Treatment of Bacillus Calmette-Guérin-unresponsive Non-muscle-invasive Bladder Cancer: A Cross-country Choice Experiment. EUR UROL SUPPL 2023; 49:92-99. [PMID: 36874596 PMCID: PMC9974996 DOI: 10.1016/j.euros.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background Patients with non-muscle-invasive bladder cancer (NMIBC) that is unresponsive to bacillus Calmette-Guérin (BCG) immunotherapy face a difficult choice. Immediate radical cystectomy (RC) is effective but might represent overtreatment. Continuing bladder preservation with medical therapy is an alternative, but it risks progression to muscle-invasive bladder cancer (MIBC) and a reduction in survival. Objective To understand the trade-offs patients are willing to make in selecting treatments for BCG-unresponsive NMIBC. Design setting and participants Adults with NMIBC from the UK, France, Germany, and Canada who reported current receipt of BCG, disease unresponsive to BCG, or receipt of RC in the previous 12 mo after failure of BCG were recruited to participate in an online choice experiment. Patients were asked to make repeated choices between two hypothetical medical treatments and the option to undergo immediate RC. The medical treatments required trade-offs between the time to RC, the mode and frequency of administration, the risk of experiencing serious side effects, and the risk of disease progression. Outcome measurements and statistical analysis Error component logit models were used to calculate relative attribute importance (RAI) scores as the maximum percentage contribution to a preference and acceptable benefit-risk trade-offs. Results and limitations Most of the 107 participants (average age 63 yr) never selected RC (89%) as their preferred option in the choice experiment. Preferences were most affected by time to RC (RAI 55%), followed by risk of progressing to MIBC (RAI 25%), medication administration (RAI 12%), and the risk of serious side effects (RAI 8%). To increase the time to RC from 1 yr to 6 yr, patients accepted a 43.8% increase in the risk of progression and a 66.1% increase in the risk of serious side effects. Conclusions Patients with BCG-treated NMIBC valued bladder-sparing treatments and were willing to make substantial benefit-risk trade-offs to delay RC. Patient summary Adults with bladder cancer not invading the bladder muscle completed an online experiment in which they chose between hypothetical medications and bladder removal. The results show that patients would be willing to accept different risks associated with medications to delay bladder removal. Patients considered disease progression the most important risk of medicinal treatment.
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182
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Combining targeted chemotherapy of hydroxyethyl starch prodrug and photothermal therapy of MoS2 for treatment of bladder cancer. Colloid Polym Sci 2023. [DOI: 10.1007/s00396-023-05065-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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183
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Is CIS a Contraindication to Hyperthermic Intravesical Chemotherapy (HIVEC) after BCG-Failure? Cancers (Basel) 2023; 15:cancers15051455. [PMID: 36900247 PMCID: PMC10001134 DOI: 10.3390/cancers15051455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
CIS of the bladder is associated with a high risk of progression. In the case of BCG failure, radical cystectomy should be performed. For patients who refuse or are ineligible, bladder-sparing alternatives are evaluated. This study aims to investigate the efficacy of Hyperthermic IntraVesical Chemotherapy (HIVEC) depending on the presence or absence of CIS. This retrospective, multicenter study was conducted between 2016 and 2021. Patients with non-muscle-invasive bladder cancer (NMIBC) with BCG failure received 6-8 adjuvant instillations of HIVEC. The co-primary endpoints were recurrence-free survival (RFS) and progression-free survival (PFS). A total of 116 consecutive patients met our inclusion criteria of whom 36 had concomitant CIS. The 2-year RFS rate was 19.9% and 43.7% in patients with and without CIS, respectively (p = 0.52). Fifteen patients (12.9%) experienced progression to muscle-invasive bladder cancer with no significant difference between patients with and without CIS (2-year PFS rate = 71.8% vs. 88.8%, p = 0.32). In multivariate analysis, CIS was not a significant prognostic factor in terms of recurrence or progression. In conclusion, CIS may not be considered a contraindication to HIVEC, as there is no significant association between CIS and the risk of progression or recurrence after treatment.
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184
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van Ginkel N, van Gennep EJ, Oosterbaan L, Greidanus J, Boellaard TN, Wondergem M, Vis AN, de Reijke TM, van Rhijn BWG, Mertens LS. Added Clinical Value of 18F-FDG-PET/CT to Stage Patients With High-Risk Non-Muscle Invasive Bladder Cancer Before Radical Cystectomy. Clin Genitourin Cancer 2023; 21:342-348. [PMID: 36918302 DOI: 10.1016/j.clgc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION AND OBJECTIVES 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (FDG-PET/CT) is increasingly used in the preoperative staging of patients with muscle-invasive bladder cancer. The clinical added value of FDG-PET/CT in high-risk non-muscle invasive bladder cancer (NMIBC) is unknown. In this study, the value of FDG-PET/CT in addition to contrast enhanced (CE)-CT was evaluated in high-risk NMIBC before radical cystectomy (RC). MATERIALS AND METHODS This is a retrospective analysis of consecutive patients with high risk and very-high risk urothelial NMIBC scheduled for RC in a tertiary referral center between 2011 and 2020. Patients underwent staging with CE-CT (chest and abdomen/pelvis) and FDG-PET/CT. We assessed the clinical disease stage before and after FDG-PET/CT and the treatment recommendation based on the stage before and after FDG-PET/CT. The accuracy of CT and FDG-PET/CT for identifying metastatic disease was defined by the receiver-operating curve using a reference-standard including histopathology/cytology (if available), imaging and follow-up. RESULTS A total of 92 patients were identified (median age: 71 years). In 14/92 (15%) patients, FDG-PET/CT detected metastasis (12 suspicious lymph nodes and 4 distant metastases). The disease stage changed in 11/92 (12%) patients based on additional FDG-PET/CT findings. FDG-PET/CT led to a different treatment in 9/92 (10%) patients. According to the reference standard, 25/92 (27%) patients had metastases. The sensitivity, specificity and accuracy of FDG-PET/CT was 36%, 93% and 77% respectively, versus 12%, 97% and 74% of CE-CT only. The area under the ROC curve was 0.643 for FDG-PET/CT and 0.545 for CT, P = .036. CONCLUSION The addition of FDG-PET/CT to CE-CT imaging changed the treatment in 10% of patients and proved to be a valuable diagnostic tool in a selected subgroup of NMIBC patients scheduled for RC.
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Affiliation(s)
- Noor van Ginkel
- Department of Urology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands; Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Erik J van Gennep
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands; Department of Urology, Leiden UMC, Leiden, The Netherlands
| | - Liselot Oosterbaan
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands
| | - Joyce Greidanus
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Theo M de Reijke
- Department of Urology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Amsterdam, The Netherlands.
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185
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Seok J, Kwak HJ, Kwak Y, Lee M, Park KS, Kim A, Cho SG. Anti-oncogenic effects of dutasteride, a dual 5-alpha reductase inhibitor and a drug for benign prostate hyperplasia, in bladder cancer. J Transl Med 2023; 21:129. [PMID: 36800968 PMCID: PMC9938606 DOI: 10.1186/s12967-023-03972-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND The incidence of bladder cancer (BCa) is approximately four times higher in men than in women. To develop effective BCa treatments, there is an urgent need to understand the differences in the BCa control mechanisms based on gender. Our recent clinical study showed that androgen suppression therapy using 5α-reductase inhibitors and androgen deprivation therapy affects BCa progression, but the underlying mechanisms are still unknown. METHODS mRNA expression levels of the androgen receptor (AR) and SLC39A9 (membrane AR) in T24 and J82 BCa cells were evaluated by reverse transcription-PCR (RT-PCR). The effect of dutasteride, a 5α-reductase inhibitor, in BCa progression was determined in cells transfected with control and AR-overexpressing plasmids. In addition, cell viability and migration assays, RT-PCR, and western blot analysis were performed to analyze the effect of dutasteride on BCa in the presence of testosterone. Finally, steroidal 5α-reductase 1 (SRD5A1), one of the dutasteride target genes, was silenced in T24 and J82 BCa cells using control and shRNA-containing plasmids, and the oncogenic role of SRD5A1 was evaluated. RESULTS Dutasteride treatment led to significant inhibition of the testosterone-induced increase dependent on AR and SLC39A9 in cell viability and migration of T24 and J82 BCa cells and induced alterations in the expression level of cancer progression proteins, such as metalloproteases, p21, BCL-2, NF-KB, and WNT in AR-negative BCa. Furthermore, the bioinformatic analysis showed that mRNA expression levels of SRD5A1 were significantly higher in BCa tissues than in normal paired tissues. A positive correlation between SRD5A1 expression and poor patient survival was observed in patients with BCa. Also, Dutasteride treatment reduced cell proliferation and migration via blocking the SRD5A1 in BCa. CONCLUSIONS Dutasteride inhibited testosterone-induced BCa progression dependent on SLC39A9 in AR-negative BCa and repressed oncogenic signaling pathways, including those of metalloproteases, p21, BCL-2, NF-KB, and WNT. Our results also suggest that SRD5A1 plays a pro-oncogenic role in BCa. This work provides potential therapeutic targets for the treatment of BCa.
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Affiliation(s)
- Jaekwon Seok
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea
| | - Hee Jeong Kwak
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea
| | - Yeonjoo Kwak
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea
| | - Moonjung Lee
- grid.258676.80000 0004 0532 8339Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029 Republic of Korea ,grid.258676.80000 0004 0532 8339Department of Advanced Translational Medicine, Konkuk University, Seoul, 05029 Republic of Korea
| | - Kyoung Sik Park
- grid.411120.70000 0004 0371 843XDepartment of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030 Republic of Korea
| | - Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea.
| | - Ssang-Goo Cho
- Department of Stem Cell and Regenerative Biotechnology, Molecular & Cellular Reprogramming Center (MCRC), and Incurable Disease Animal Model & Stem Cell Institute (IDASI), Konkuk University, Seoul, 05029, Republic of Korea.
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Drachneris J, Rasmusson A, Morkunas M, Fabijonavicius M, Cekauskas A, Jankevicius F, Laurinavicius A. CD8+ Cell Density Gradient across the Tumor Epithelium-Stromal Interface of Non-Muscle Invasive Papillary Urothelial Carcinoma Predicts Recurrence-Free Survival after BCG Immunotherapy. Cancers (Basel) 2023; 15:1205. [PMID: 36831546 PMCID: PMC9954554 DOI: 10.3390/cancers15041205] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Bacille Calmette-Guerin (BCG) immunotherapy is the first-line treatment in patients with high-risk non-muscle invasive papillary urothelial carcinoma (NMIPUC), the most common type of bladder cancer. The therapy outcomes are variable and may depend on the immune response within the tumor microenvironment. In our study, we explored the prognostic value of CD8+ cell density gradient indicators across the tumor epithelium-stroma interface of NMIPUC. METHODS Clinical and pathologic data were retrospectively collected from 157 NMIPUC patients treated with BCG immunotherapy after transurethral resection. Whole-slide digital image analysis of CD8 immunohistochemistry slides was used for tissue segmentation, CD8+ cell quantification, and the assessment of CD8+ cell densities within the epithelium-stroma interface. Subsequently, the gradient indicators (center of mass and immunodrop) were computed to represent the density gradient across the interface. RESULTS By univariable analysis of the clinicopathologic factors, including the history of previous NMIPUC, poor tumor differentiation, and pT1 stage, were associated with shorter RFS (p < 0.05). In CD8+ analyses, only the gradient indicators but not the absolute CD8+ densities were predictive for RFS (p < 0.05). The best-performing cross-validated model included previous episodes of NMIPUC (HR = 4.4492, p = 0.0063), poor differentiation (HR = 2.3672, p = 0.0457), and immunodrop (HR = 5.5072, p = 0.0455). CONCLUSIONS We found that gradient indicators of CD8+ cell densities across the tumor epithelium-stroma interface, along with routine clinical and pathology data, improve the prediction of RFS in NMIPUC.
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Affiliation(s)
- Julius Drachneris
- Faculty of Medicine, Institute of Biomedical Sciences, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, 01513 Vilnius, Lithuania
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Allan Rasmusson
- Faculty of Medicine, Institute of Biomedical Sciences, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, 01513 Vilnius, Lithuania
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
| | - Mindaugas Morkunas
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
- Institute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, 01513 Vilnius, Lithuania
| | - Mantas Fabijonavicius
- Center of Urology, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | - Albertas Cekauskas
- Institute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, 01513 Vilnius, Lithuania
- Center of Urology, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | - Feliksas Jankevicius
- Institute of Clinical Medicine, Faculty of Medicine, Clinic of Gastroenterology, Nephrourology and Surgery, Vilnius University, 01513 Vilnius, Lithuania
- Center of Urology, Vilnius University Hospital Santaros Klinikos, 08410 Vilnius, Lithuania
| | - Arvydas Laurinavicius
- Faculty of Medicine, Institute of Biomedical Sciences, Department of Pathology, Forensic Medicine and Pharmacology, Vilnius University, 01513 Vilnius, Lithuania
- National Center of Pathology, Affiliate of Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
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187
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Impact of an optimized surveillance protocol based on the European Association of Urology substratification on surveillance costs in patients with primary high-risk non-muscle-invasive bladder cancer. PLoS One 2023; 18:e0275921. [PMID: 36763567 PMCID: PMC9916549 DOI: 10.1371/journal.pone.0275921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/26/2022] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES The optimal frequency and duration of surveillance in patients with high-risk non-muscle-invasive bladder cancer (NMIBC) remain unclear. The aim of the present study is to develop an optimal surveillance protocol based on the European Association of Urology (EAU) substratification in order to improve surveillance costs after transurethral resection of bladder tumor (TURBT) in patients with primary high-risk NMIBC. MATERIALS AND METHODS We retrospectively evaluated 428 patients with primary high-risk NMIBC who underwent TURBT from November 1993 to April 2019. Patients were substratified into the highest-risk and high-risk without highest-risk groups based on the EAU guidelines. An optimized surveillance protocol that enhances cost-effectiveness was then developed using real incidences of recurrence after TURBT. A recurrence detection rate ([number of patients with recurrence / number of patients with surveillance] × 100) of ≥ 1% during a certain period indicated that routine surveillance was necessary in this period. The 10-year total surveillance cost was compared between the EAU guidelines-based protocol and the optimized surveillance protocol developed herein. RESULTS Among the 428 patients with primary high-risk NMIBC, 97 (23%) were substratified into the highest-risk group. Patients in the highest-risk group had a significantly shorter recurrence-free survival than those in the high-risk without highest-risk group. The optimized surveillance protocol promoted a 40% reduction ($394,990) in the 10-year total surveillance cost compared to the EAU guidelines-based surveillance protocol. CONCLUSION The optimized surveillance protocol based on the EAU substratification could potentially reduce over investigation during follow-up and improve surveillance costs after TURBT in patients with primary high-risk NMIBC.
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188
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Al-Maghrabi JA, Khabaz MN. Clinical significance of galectin-3 expression in urinary bladder carcinoma. J Int Med Res 2023; 51:3000605231153323. [PMID: 36748414 PMCID: PMC9909066 DOI: 10.1177/03000605231153323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To uncover the clinical significance of galectin-3 in the evolution of urinary bladder cancer by defining galectin-3 expression and examining the relationship between its expression in a group of urothelial carcinomas versus normal tissues along with clinicopathological factors. METHODS This retrospective study included histopathological reports and archival blocks and slides of all patients with urinary bladder cancer treated at King Abdulaziz University Hospital (Jeddah, Saudi Arabia). An anti-galectin-3 monoclonal antibody was used for immunohistochemical staining of tissue microarray slides comprising 128 cases of urothelium carcinoma and 24 specimens of normal bladder mucosa. RESULTS Galectin-3 was downregulated during transformation, with positive expression found in 50 (39%) urinary bladder neoplasms, of which 33 (66%) showed weak immunostaining. All positively-stained malignant tumor and normal bladder mucosa samples showed cytoplasmic staining; a few samples also showed nuclear staining. No correlation was noted between galectin-3 and histotype, grade, stage, muscularis propria invasion, lymph node invasion, vascular invasion, or metastasis. A Cox proportional hazards model and Kaplan-Meier survival curves did not show differences in survival on the basis of galectin-3 expression. CONCLUSION Galectin-3 is down-regulated in bladder cancer but is not a helpful marker for the diagnosis or prognosis of urinary bladder cancer.
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Affiliation(s)
- Jaudah Ahmed Al-Maghrabi
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Mohamad Nidal Khabaz
- Department of Pathology, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Mohamad Nidal Khabaz, Department of Pathology, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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189
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Pérez-Aizpurua X, Monzó-Gardiner JI, Maqueda-Arellano J, Buendía-González E, Cuello-Sánchez L, Tufet I Jaumot JJ, Alonso-Román J, Gómez-Jordana Mañas B, Ruiz de Castroviejo Blanco J, Osorio Ospina F, Cabello Benavente R, González-Enguita C. BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours. Actas Urol Esp 2023; 47:250-258. [PMID: 36754206 DOI: 10.1016/j.acuroe.2023.01.005] [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: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION During 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression-free survival rates and tumoral relapse specific characteristics. METHODS Retrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain. Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan-Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. RESULTS Median follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145-448) during 2019 and 382 days (215-567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04-3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. CONCLUSION BCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.
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Affiliation(s)
- X Pérez-Aizpurua
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain.
| | - J I Monzó-Gardiner
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - J Maqueda-Arellano
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - E Buendía-González
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - L Cuello-Sánchez
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - J J Tufet I Jaumot
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - J Alonso-Román
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | | | | | - F Osorio Ospina
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - R Cabello Benavente
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
| | - C González-Enguita
- Department of Urology, Fundación Jíménez Diaz University Hospital, Madrid, Spain
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PRR11 is a prognostic biomarker and correlates with immune infiltrates in bladder urothelial carcinoma. Sci Rep 2023; 13:2051. [PMID: 36739300 PMCID: PMC9899238 DOI: 10.1038/s41598-023-29316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/02/2023] [Indexed: 02/05/2023] Open
Abstract
Abnormal proline-rich protein 11 (PRR11) expression is associated with various tumors. However, there are few reports concerning PRR11 with prognostic risk, immune infiltration, or immunotherapy of bladder urothelial carcinoma (BLCA). This study is based on online databases, such as Oncomine, GEPIA, HPA, LinkedOmics, TIMER, ESTIMATE and TISIDB, and BLCA data downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus, we employed an array of bioinformatics methods to explore the potential oncogenic roles of PRR11, including analyzing the relationship between PRR11 and prognosis, tumor mutational burden (TMB), microsatellite instability, and immune cell infiltration in BLCA. The results depict that PRR11 is highly expressed in BLCA, and BLCA patients with higher PRR11 expression have worse outcomes. In addition, there was a significant correlation between PRR11 expression and TMB and tumor immune infiltration. These findings suggest that PRR11 can be used as a potential marker for BLCA patient assessment and risk stratification to improve clinical prognosis, and its potential regulatory mechanism in the BLCA tumor microenvironment and targeted therapy is worthy of further investigation.
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Al Hussein Al Awamlh B, Chang SS. Novel Therapies for High-Risk Non-Muscle Invasive Bladder Cancer. Curr Oncol Rep 2023; 25:83-91. [PMID: 36571706 PMCID: PMC9791638 DOI: 10.1007/s11912-022-01350-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW The treatment options for high-risk non-muscle invasive bladder cancer (NMIBC), particularly following BCG, remain limited. We highlight recent, promising therapies for high-risk NMIBC. RECENT FINDINGS Several therapies utilizing different mechanisms of action have demonstrated favorable results in the BCG-naïve and BCG-unresponsive settings. These treatments include intravenous and intravesical immunotherapy, viral- and bacterial-based intravesical therapies, combination intravesical chemotherapy regimens, and novel intravesical chemotherapy administration. Overall, the efficacy and tolerability of emerging treatments for NMIBC appear promising and provide potential alternatives to radical cystectomy. As the landscape of managing BCG-unresponsive disease evolves, clinical trials will explore future options and determine effective alternatives.
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Affiliation(s)
- Bashir Al Hussein Al Awamlh
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center Drive, Nashville, TN 37232 USA
| | - Sam S. Chang
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center Drive, Nashville, TN 37232 USA
- Vanderbilt Ingram Cancer Center, Nashville, TN USA
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192
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Taylor J, Lotan Y. Is Office-based Management of Intermediate-risk Low-grade Non-muscle-invasive Bladder Cancer Ready For Prime Time? Eur Urol 2023; 83:131-132. [PMID: 36153249 DOI: 10.1016/j.eururo.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Jacob Taylor
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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193
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Hekman MCH, Wijn SRW, Lotan Y, Govers TM, Witjes JA. Bladder EpiCheck urine test in the follow-up of NMIBC: a cost analysis. World J Urol 2023; 41:471-476. [PMID: 36534153 DOI: 10.1007/s00345-022-04252-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE In the Netherlands yearly more than 5000 patients are diagnosed with non-muscle invasive bladder cancer (NMIBC). With a specificity of 88.0% and a negative predictive value (NPV) for high grade NMIBC of 99.3%, the Bladder EpiCheck (BE) urine test may be used in NMIBC to reduce the burden of follow-up cystoscopies. METHODS In this study a cost analysis of the BE follow-up strategy in the Dutch healthcare system was performed. In half of the follow-up appointments, BE was used as a rule-in for cystoscopy. In addition, the possible delay in recurrence detection was estimated. A cost calculation tool was developed using Microsoft Excel. RESULTS The BE strategy results in an estimated cost reduction of 8%, 4% and 9% in low, intermediate and high risk patients, respectively. In the Netherlands this may result in a cost reduction of approximately 1.6 million euro per year. The estimated delay in the detection of recurrent disease would be 3.9, 1.7 and 1.3 months in low, intermediate and high risk NMIBC patients respectively. CONCLUSION To conclude, the BE can be used to reduce the costs of NMIBC follow-up, with a small delay in diagnosis of recurrent disease.
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Affiliation(s)
| | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tim Martin Govers
- Department of Operating Rooms, Radboudumc, Nijmegen, The Netherlands
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194
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Kiełbik A, Sowa PW, Pakhomov AG, Gudvangen E, Mangalanathan U, Kulbacka J, Pakhomova ON. Urine protects urothelial cells against killing with nanosecond pulsed electric fields. Bioelectrochemistry 2023; 149:108289. [DOI: 10.1016/j.bioelechem.2022.108289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
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195
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Angulo JC, Álvarez-Ossorio JL, Domínguez-Escrig JL, Moyano JL, Sousa A, Fernández JM, Gómez-Veiga F, Unda M, Carballido J, Carrero V, Fernandez-Aparicio T, García de Jalón Á, Solsona E, Inman B, Palou J. Hyperthermic Mitomycin C in Intermediate-risk Non-muscle-invasive Bladder Cancer: Results of the HIVEC-1 Trial. Eur Urol Oncol 2023; 6:58-66. [PMID: 36435738 DOI: 10.1016/j.euo.2022.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/29/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Optimising therapeutic strategies of intermediate-risk non-muscle-invasive bladder cancer (IR-NMIBC) is needed. OBJECTIVE To compare recurrence-free survival (RFS) with adjuvant intravesical mitomycin C (MMC) at normothermia or hyperthermia using the COMBAT bladder recirculation system at 43 °C for 30 and 60 min. DESIGN, SETTING, AND PARTICIPANTS A prospective open-label, phase 3 randomised controlled trial (HIVEC-1) accrued across 13 centres between 2014 and 2020 in Spain. After complete transurethral resection of the bladder and immediate postoperative MMC instillation, patients with IR-NMIBC were randomised (1:1:1) to four weekly followed by three monthly 40-mg MMC instillations at normothermia (control; n = 106), 43 °C for 30 min (n = 107), or 43 °C for 60 min (n = 106) were investigated. Therapeutic compliance was defined as four or more instillations. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was RFS at 24 mo in the intention-to-treat (ITT) and per-protocol (PP) populations. The secondary outcomes included progression-free survival at 24 mo, safety outcome measures, and changes in health-related quality of life. Log-rank, Fisher, χ2, and analysis of variance tests were used. RESULTS AND LIMITATIONS The ITT 24-mo RFS was 77% for control, 82% for 43 °C-30 min, and 80% for 43 °C-60 min (p = 0.6). The PP 24-mo RFS was 77% for control, 83% for 43 °C-30 min, and 80% for 43 °C-60 min (p = 0.59). Six patients progressed to muscle-invasive disease in the ITT population (four in the control, 43 °C-30 min, and 43 °C-60 min groups each) and four in the PP population (all controls). Serious adverse events occurred in 26 patients (8.1%), and we were unable to demonstrate a difference between groups (p = 0.5). Adverse events, mainly dysuria and spasms, occurred in 124 patients (33% in control, 35% in 43 °C-30 min, and 48% in 43 °C-60 min; p = 0.05). The total International Prostate Symptom Score worsened by 1.2 ± 7.3 points, similarly across groups (p = 0.29). The Functional Assessment of Cancer Therapy-Bladder domains and indexes showed no significant change. CONCLUSIONS Four-month adjuvant hyperthermic MMC using the COMBAT system for 30 and 60 min in IR-NMIBC is well tolerated, but we did not find it to be superior to normothermic MMC at 24 mo. PATIENT SUMMARY We were unable to demonstrate the effectiveness of hyperthermia using the COMBAT system in intermediate-risk non-muscle-invasive bladder cancer. Further evaluation of long-term recurrence and progression, and maintenance regimens appears mandatory.
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Affiliation(s)
- Javier C Angulo
- Clinical Department, Faculty of Medical Sciences, Universidad Europea de Madrid, Madrid, Spain; Department of Urology, Hospital Universitario de Getafe, Getafe, Madrid, Spain.
| | | | | | - José L Moyano
- Department of Urology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | - Alejandro Sousa
- Department of Urology, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, Spain
| | - Jesús M Fernández
- Department of Urology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Francisco Gómez-Veiga
- Department of Urology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Miguel Unda
- Department of Urology, Hospital Universitario Basurto, Bilbao, Vizcaya, Spain
| | - Joaquín Carballido
- Department of Urology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Victor Carrero
- Department of Urology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Ángel García de Jalón
- Department of Urology, Hospital General Universitario Miguel Servet, Zaragoza, Spain
| | - Eduardo Solsona
- Department of Urology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Brant Inman
- Duke Cancer Center Genitourinary Clinic, Durham, NC, USA
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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196
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Evaluation of the Small Heat Shock Protein Family Members HSPB2 and HSPB3 in Bladder Cancer Prognosis and Progression. Int J Mol Sci 2023; 24:ijms24032609. [PMID: 36768927 PMCID: PMC9917356 DOI: 10.3390/ijms24032609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 01/31/2023] Open
Abstract
Bladder cancer (BlCa) represents the sixth most commonly diagnosed type of male malignancy. Due to the clinical heterogeneity of BlCa, novel markers would optimize treatment efficacy and improve prognosis. The small heat shock proteins (sHSP) family is one of the major groups of molecular chaperones responsible for the maintenance of proteome functionality and stability. However, the role of sHSPs in BlCa remains largely unknown. The present study aimed to examine the association between HSPB2 and HSPB3 expression and BlCa progression in patients, and to investigate their role in BlCa cells. For this purpose, a series of experiments including reverse transcription-quantitative PCR, Western blotting, MTT assay and flow cytometry were performed. Initial analyses revealed increased vs. human transitional carcinoma cells, expression levels of the HSPB2 and HSPB3 genes and proteins in high grade BlCa cell lines. Therefore, we then evaluated the clinical significance of the HSPB2 and HSPB3 genes expression levels in bladder tumor samples and matched adjusted normal bladder specimens. Total RNA from 100 bladder tumor samples and 49 paired non-cancerous bladder specimens were isolated, and an accurate SYBR-Green based real-time quantitative polymerase chain reaction (qPCR) protocol was developed to quantify HSPB2 and HSPB3 mRNA levels in the two cohorts of specimens. A significant downregulation of the HSPB2 and HSPB3 genes expression was observed in bladder tumors as compared to matched normal urothelium; yet, increased HSPB2 and HSPB3 levels were noted in muscle-invasive (T2-T4) vs. superficial tumors (TaT1), as well as in high-grade vs. low-grade tumors. Survival analyses highlighted the significantly higher risk for post-treatment disease relapse in TaT1 patients poorly expressing HSPB2 and HSPB3 genes; this effect tended to be inverted in advanced disease stages (muscle-invasive tumors) indicating the biphasic impact of HSPB2, HSPB3 genes in BlCa progression. The pro-survival role of HSPB2 and HSPB3 in advanced tumor cells was also evident by our finding that HSPB2, HSPB3 genes expression silencing in high grade BlCa cells enhanced doxorubicin toxicity. These findings indicate that the HSPB2, HSPB3 chaperone genes have a likely pro-survival role in advanced BlCa; thus, they can be targeted as novel molecular markers to optimize treatment efficacy in BlCa and to limit unnecessary interventions.
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197
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Ding L, Deng X, Wang K, Xia W, Zhang Y, Zhang Y, Shao X, Wang J. Preoperative Systemic Inflammatory Markers as a Significant Prognostic Factor After TURBT in Patients with Non-Muscle-Invasive Bladder Cancer. J Inflamm Res 2023; 16:283-296. [PMID: 36713048 PMCID: PMC9875575 DOI: 10.2147/jir.s393511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) have been widely proposed to have predictive value for the patient prognosis of many malignancies, including bladder cancer. However, the predictive value of their combination in non-muscle-invasive bladder cancer (NMIBC) is unclear. Methods Cases of NMIBC patients who underwent transurethral resection of the bladder tumor were recruited from two tertiary public medical centers. A systemic inflammatory marker (SIM) score was calculated based on comprehensive consideration of NLR, PLR, and LMR. Recurrence-free survival (RFS) and progression-free survival (PFS) were estimated by Kaplan-Meier analysis. The Log rank test was used to compare differences between the groups. Cox regression was used to screen risk factors affecting RFS and PFS. Nomogram models were established and validated, and patients were stratified based on the model scores. Results The study dataset was grouped according to a 7:3 randomization, with the training cohort consisting of 292 cases and the validation cohort consisting of 124 cases. Cox regression analysis showed that SIM score is an independent predictor of RFS and PFS in NMIBC patients. The novel models were established based on the SIM score and other statistically significant clinicopathological features. The area under the curve (AUC) for predicting 1-, 2-, and 3-year RFS was 0.667, 0.689, and 0.713, respectively. The AUC for predicting 1-, 2-, and 3-year PFS was 0.807, 0.775, and 0.862, respectively. Based on the risk stratification, patients at high risk of recurrence and progression could be accurately identified. The established models were applied to the patient evaluation of the validation cohort, which proved the great performance of the novel models. Conclusion The novel models based on the SIM score and clinicopathological characteristics can accurately predict the survival prognosis of NMIBC patients, and the models can be used by clinicians for individualized patient assessment and to assist in clinical decision-making.
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Affiliation(s)
- Li Ding
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xiaobin Deng
- Department of Urology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530000, People’s Republic of China
| | - Kun Wang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Wentao Xia
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Yang Zhang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Yan Zhang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Xianfeng Shao
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China
| | - Junqi Wang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China,Correspondence: Junqi Wang, Email
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198
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Beijert IJ, Hentschel AE, Bründl J, Compérat EM, Plass K, Rodríguez O, Subiela Henríquez JD, Hernández V, de la Peña E, Alemany I, Turturica D, Pisano F, Soria F, Čapoun O, Bauerová L, Pešl M, Bruins HM, Runneboom W, Herdegen S, Breyer J, Brisuda A, Calatrava A, Rubio-Briones J, Seles M, Mannweiler S, Bosschieter J, Kusuma VRM, Ashabere D, Huebner N, Cotte J, Mertens LS, Claps F, Masson-Lecomte A, Liedberg F, Cohen D, Lunelli L, Cussenot O, El Sheikh S, Volanis D, Côté JF, Rouprêt M, Haitel A, Shariat SF, Mostafid AH, Nieuwenhuijzen JA, Zigeuner R, Dominguez-Escrig JL, Hacek J, Zlotta AR, Burger M, Evert M, Hulsbergen-van de Kaa CA, van der Heijden AG, Kiemeney LALM, Soukup V, Molinaro L, Gontero P, Llorente C, Algaba F, Palou J, N'Dow J, Ribal MJ, van der Kwast TH, Babjuk M, Sylvester RJ, van Rhijn BWG. Prognosis of Primary Papillary Ta Grade 3 Bladder Cancer in the Non-muscle-invasive Spectrum. Eur Urol Oncol 2023; 6:214-221. [PMID: 36670042 DOI: 10.1016/j.euo.2023.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/05/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive. OBJECTIVE To evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas. DESIGN, SETTING, AND PARTICIPANTS Individual patient data for 5170 primary Ta-T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Time to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution. RESULTS AND LIMITATIONS Ta G3 represented 7.5% (387/5170) of Ta-T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7-4.8%) of Ta G2, 13% (95% CI 9.3-17%) of Ta G3, and 20% (95% CI 17-23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p < 0.001) and longer than for T1 G3 (p = 0.002). Patients with Ta G3 NMIBC with concomitant carcinoma in situ (CIS) had worse prognosis and a similar time to progression as for patients with T1 G3 NMIBC with CIS (p = 0.5). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS The prognosis of Ta G3 tumors in terms of progression appears to be in between that of Ta G2 and T1 G3. However, patients with Ta G3 NMIBC with concomitant CIS have worse prognosis that is comparable to that of T1 G3 with CIS. Our results support the recent EAU NMIBC guideline changes for more refined risk stratification of Ta G3 tumors because many of these patients have better prognosis than previously thought. PATIENT SUMMARY We used data from 17 centers in Europe and Canada to assess the prognosis for patients with stage Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC). Time to cancer progression for Ta G3 cancer differed from both Ta G2 and T1 G3 tumors. Our results support the recent change in the European Association of Urology guidelines for more refined risk stratification of Ta G3 NMIBC because many patients with this tumor have better prognosis than previously thought.
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Affiliation(s)
- Irene J Beijert
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anouk E Hentschel
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Karin Plass
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Oscar Rodríguez
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Virginia Hernández
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Enrique de la Peña
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Isabel Alemany
- Department of Pathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Diana Turturica
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Francesca Pisano
- Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Otakar Čapoun
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Lenka Bauerová
- Department of Pathology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Michael Pešl
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - H Maxim Bruins
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willemien Runneboom
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sonja Herdegen
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Antonin Brisuda
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Ana Calatrava
- Department of Pathology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Maximilian Seles
- Department of Urology, Medical University of Graz, Graz, Austria
| | | | - Judith Bosschieter
- Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Venkata R M Kusuma
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - David Ashabere
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Nicolai Huebner
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Juliette Cotte
- Department of Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Alexandra Masson-Lecomte
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Fredrik Liedberg
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Daniel Cohen
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Luca Lunelli
- Department of Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Olivier Cussenot
- Department of Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Soha El Sheikh
- Department of Pathology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Volanis
- Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Jean-François Côté
- Department of Pathology, Pitié Salpétrière Hospital, AP-HP, Pierre et Marie Curie Medical School, Sorbonne University, Paris, France
| | - Morgan Rouprêt
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Andrea Haitel
- Department of Pathology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - A Hugh Mostafid
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Richard Zigeuner
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Medical University of Graz, Graz, Austria
| | - Jose L Dominguez-Escrig
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Pathology, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Jaromir Hacek
- Department of Pathology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Alexandre R Zlotta
- Department of Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Matthias Evert
- Department of Pathology, University of Regensburg, Regensburg, Germany
| | | | | | - Lambertus A L M Kiemeney
- Department of Health Evidence and Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Viktor Soukup
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Luca Molinaro
- Department of Pathology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Paolo Gontero
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Carlos Llorente
- Department of Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Ferran Algaba
- Deaprtment of Pathology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Palou
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James N'Dow
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Maria J Ribal
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia; Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
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199
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Bandzevičiūtė R, Platkevičius G, Čeponkus J, Želvys A, Čekauskas A, Šablinskas V. Differentiation of Urothelial Carcinoma and Normal Bladder Tissues by Means of Fiber-Based ATR IR Spectroscopy. Cancers (Basel) 2023; 15:cancers15020499. [PMID: 36672447 PMCID: PMC9857111 DOI: 10.3390/cancers15020499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/06/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Surgical treatment is widely applied curative approach for bladder cancer. White light cystoscopy (WLC) is currently used for intraoperative diagnostics of malignant lesions but has relatively high false-negative rate. Here we represent an application of label free fiber-based attenuated total reflection infrared spectroscopy (ATR IR) for freshly resected human bladder tissue examination for 54 patients. Defined molecular spectral markers allow to identify normal and urothelial carcinoma tissues. While methods of statistical analysis (Hierarchical cluster analysis (HCA) and Principal component analysis (PCA)) used for spectral data treatment allow to discriminate tissue types with 91% sensitivity and 96-98% specificity. In the present study the described method was applied for tissue examination under ex vivo conditions. However, after method validation the equipment could be translated from laboratory studies to in situ or even in vivo studies in operating room.
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Affiliation(s)
- Rimantė Bandzevičiūtė
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, Saulėtekio av. 3, LT-10257 Vilnius, Lithuania
- Correspondence: (R.B.); (G.P.)
| | - Gediminas Platkevičius
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/27, LT-03101 Vilnius, Lithuania
- Correspondence: (R.B.); (G.P.)
| | - Justinas Čeponkus
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, Saulėtekio av. 3, LT-10257 Vilnius, Lithuania
| | - Arūnas Želvys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/27, LT-03101 Vilnius, Lithuania
| | - Albertas Čekauskas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Čiurlionio g. 21/27, LT-03101 Vilnius, Lithuania
| | - Valdas Šablinskas
- Institute of Chemical Physics, Faculty of Physics, Vilnius University, Saulėtekio av. 3, LT-10257 Vilnius, Lithuania
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200
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Woodcock VK, Chen J, Purshouse K, Butcher C, Collins L, Haddon C, Verrall G, Elhussein L, Roberts C, Tarlton A, Rei M, Napolitani G, Salio M, Middleton MR, Cerundolo V, Crew J, Protheroe AS. PemBla: A Phase 1 study of intravesical pembrolizumab in recurrent non‐muscle‐invasive bladder cancer. BJUI COMPASS 2023; 4:322-330. [PMID: 37025470 PMCID: PMC10071078 DOI: 10.1002/bco2.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives This study aimed to investigate the anti-PD-1 inhibitor pembrolizumab as a potential agent for use in non-muscle-invasive bladder cancer (NMIBC) by conducting a Phase 1 safety run-in study to assess the safety and tolerability of intravesical pembrolizumab after transurethral resection of the bladder tumour (TURBT). Patients and methods Eligible patients had recurrent NMIBC for which adjuvant treatment post TURBT was a reasonable treatment option, Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-1 and adequate end-organ function. Pembrolizumab was administered by intravesical instillation once weekly for a total of six doses. Intra-patient dose escalation was performed in three paired patient cohorts with doses starting at 50 mg and increasing through 100 mg to a maximum of 200 mg. Adverse events (AEs) were assessed using Common Terminology Criteria for Adverse Events (CTCAE) v4.03 with dose limiting toxicity (DLT) defined as a clinically significant, drug-related, Grade 4 haematological or Grade 3 or higher non-haematological toxicity occurring within 7 days of administration of the first treatment at a given dose for that patient. Results Six patients were treated with no DLTs seen during dose escalation. Drug-related AEs were of low grade and included dysuria and fatigue. All patients completed six doses of treatment as planned. Pharmacokinetic and pharmacodynamic assays did not detect any pembrolizumab in the serum following repeated intravesical administration, and no changes in peripheral immune cell populations were observed. Conclusions Administration of intravesical pembrolizumab was well tolerated and did not raise any safety concerns in patients with NMIBC following TURBT. There was no evidence of systemic absorption or systemic immune effects following intravesical administration. Further studies are required to assess whether intravesical administration has anti-tumour activity.
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Affiliation(s)
- Victoria K. Woodcock
- Department of Oncology Churchill Hospital, University of Oxford Oxford UK
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Ji‐Li Chen
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Karin Purshouse
- Department of Oncology Churchill Hospital, University of Oxford Oxford UK
| | - Chrissie Butcher
- Oncology Clinical Trials Office, Department of Oncology University of Oxford Oxford UK
| | - Linda Collins
- Oncology Clinical Trials Office, Department of Oncology University of Oxford Oxford UK
| | - Caroline Haddon
- Department of Oncology Churchill Hospital, University of Oxford Oxford UK
| | | | - Leena Elhussein
- Centre for Statistics in Medicine University of Oxford Oxford UK
| | - Corran Roberts
- Centre for Statistics in Medicine University of Oxford Oxford UK
| | - Andrea Tarlton
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Margarida Rei
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Giorgio Napolitani
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Mariolina Salio
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Mark R. Middleton
- Department of Oncology Churchill Hospital, University of Oxford Oxford UK
- National Institute for Health Research Oxford Biomedical Research Centre Oxford UK
| | - Vincenzo Cerundolo
- MRC Human Immunology Unit MRC Weatherall Institute of Molecular Medicine Oxford UK
| | - Jeremy Crew
- Department of Urology Churchill Hospital Oxford UK
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