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Pramod SV, Safriadi F, Hernowo BS, Dwiyana RF, Trianasari N, Egawa S. Cytoplasmic Androgen Receptor, CD24 Expression and Smoking Intensity to Urothelial Carcinoma of the Bladder Invasiveness: A Cross-Sectional Study. Res Rep Urol 2023; 15:485-494. [PMID: 37933300 PMCID: PMC10625756 DOI: 10.2147/rru.s433705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose To the best of our knowledge, Androgen receptor (AR) and cluster of differentiation 24 (CD24) expression in bladder urothelial carcinoma (UC) has not yet been reported in our population. The aim of this study was to evaluate the expression of both markers in UCB using immunohistochemistry. Materials and Methods Data from 60 patients with UCB were obtained between 2009 and 2018. The samples were divided into four groups based on their smoking history. Group 1 included non-smokers, group 2 smoked <20 cigarettes/day for 30 years, group 3 smoked for 31-40 years, and group 4 smoked for > 40 years. Each group then divided into Non muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC) subgroups. The smear was stained with hematoxylin and eosin (HE) - immunohistochemistry of CD24 and RA, followed by histoscore assessment. Results The male to female smoking rates was 1.8. Based on gender, in the NMIBC group there were 85.7% men and 14.3% were women while in MIBC 74.4% men and 25.6% women. The mean age of the NMIBC and MIBC groups was 56.3 years and 54.5 years, respectively. There was no significant relationship between smoking status in group 2 (OR 0.31, CI 95% CI, p=0,39), group 3 (OR 013, CI 95% CI, p=0,05), and group 4 (OR 0.23, CI 95% CI, p=0215) to the UCB invasiveness. A significant relationship was observed between cytoplasmic AR expression and UCB invasiveness (OR 0.14[0,04; 0.47], CI 95%, p=0.001). There was no significant relationship between RA in the nucleus and UCB invasion (OR 1.09[0,18; 6.48] CI 95%, p=1000). No significant relationship was observed between CD24 expression and UCB invasiveness (OR 0.81[0,27-2,45] CI 95%, p=0712). Conclusion Cytoplasmic AR expression is associated with UCB invasiveness. Smoking history and CD24 expression were not associated with UCB invasion.
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Affiliation(s)
- Sawkar Vijay Pramod
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin Academic Medical Center, Bandung, Indonesia
| | - Ferry Safriadi
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin Academic Medical Center, Bandung, Indonesia
| | - Bethy S Hernowo
- Department of Pathology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin Academic Medical Center, Bandung, Indonesia
| | | | - Nurvita Trianasari
- Economics and Business School, Telkom University, Bandung, West Java, Indonesia
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Nishi-Shimbashi, Minato-ku, Tokyo, Japan
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Selvaraj N, Dholakia K, Ragavan N. A Single Tertiary Center Experience in a South Asian Population: Does Tobacco Use Influence Bladder Cancer? Cureus 2021; 13:e18734. [PMID: 34796048 PMCID: PMC8589334 DOI: 10.7759/cureus.18734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Tobacco use, especially cigarette smoking, is a well-documented risk factor for cancer; however, its specific effect on bladder cancer has not been clearly defined. This study aimed to determine the association between tobacco use and bladder cancer in a South Asian population. Materials and methods We conducted a retrospective review of the medical records of 64 patients diagnosed with bladder tumors from February 2018 to March 2020. Patients included in the study were surveyed via a questionnaire regarding tobacco use. All patients received transurethral resection of the bladder tumor, and we analyzed histopathological and clinical outcomes. Results Our study population’s median age was 57 years, and the study included twice as many male patients as female patients. Most patients (n=45; 70%) reported not using tobacco products, and 19 patients (30%) reported tobacco use. Thirty-five of 45 nontobacco users (78%) had high-grade cancer, and 10 (22%) had low-grade cancer. Among the tobacco users, 10 (52%) had high-grade cancer, and nine (48%) had low-grade cancer. Conclusions According to our findings, a substantial cohort of bladder cancer patients is not tobacco users, and high-grade bladder cancer was more common to people who are not tobacco users. Other environmental factors play a key role in developing bladder cancer in our South Asian study population. Prevention efforts should focus on reducing bladder cancer risk factors.
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Zuniga KB, Graff RE, Feiger DB, Meng MV, Porten SP, Kenfield SA. Lifestyle and Non-muscle Invasive Bladder Cancer Recurrence, Progression, and Mortality: Available Research and Future Directions. Bladder Cancer 2020; 6:9-23. [PMID: 34095407 PMCID: PMC8174672 DOI: 10.3233/blc-190249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND: A broad, comprehensive review of studies exploring associations between lifestyle factors and non-muscle invasive bladder cancer (NMIBC) outcomes is warranted to consolidate recommendations and identify gaps in research. OBJECTIVE: To summarize the literature on associations between lifestyle factors and clinical outcomes among patients with NMIBC. METHODS: PubMed was systematically queried for articles published through March 2019 regarding lifestyle factors and recurrence, progression, cancer-specific mortality, and all-cause mortality among patients with NMIBC. RESULTS: Notwithstanding many ambiguities, there is good-quality evidence suggesting a benefit of smoking avoidance/cessation, healthy body mass index (BMI), and type II diabetes mellitus prevention and treatment. Lactobacillus casei probiotic supplementation may reduce recurrence. There have been individual studies suggesting a benefit for uncooked broccoli and supplemental vitamin E as well as avoidance of supplemental vitamin B9, areca nut chewing, and a “Western diet” pattern high in fried foods and red meat. Additional studies do not suggest associations between NMIBC outcomes and use of fibrin clot inhibitors; insulin and other oral hypoglycemics; statins; supplemental selenium, vitamin A, vitamin C, and vitamin B6; fluid intake and intake of specific beverages (e.g., alcohol, coffee, green tea, cola); various dietary patterns (e.g., Tex-Mex, high fruit and vegetable, low-fat); and occupational and chemical exposures. CONCLUSIONS: Despite a myriad of publications on lifestyle factors and NMIBC, a need remains for research on unexplored associations (e.g., physical activity) and further studies that can elucidate causal effects. This would inform future implementation strategies for healthy lifestyle change in NMIBC patients.
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Affiliation(s)
- Kyle B Zuniga
- Department of Urology, University of California, San Francisco, CA, USA.,Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.,College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Rebecca E Graff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - David B Feiger
- Department of Urology, University of California, San Francisco, CA, USA.,School of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Maxwell V Meng
- Department of Urology, University of California, San Francisco, CA, USA
| | - Sima P Porten
- Department of Urology, University of California, San Francisco, CA, USA
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, CA, USA
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Tae BS, Jeong CW, Kwak C, Kim HH, Ku JH. Does reduced E-cadherin expression correlate with poor prognosis in patients with upper tract urothelial cell carcinoma?: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17377. [PMID: 31577742 PMCID: PMC6783224 DOI: 10.1097/md.0000000000017377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND E-cadherin has emerged as a prognostic factor of urothelial cell carcinoma. In the present work we investigate the relationship between expression of E-cadherin and clinical outcomes, following radical nephroureterectomy for upper tract urothelial cell carcinoma. METHODS We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify eligible studies published until July 2017. RESULT Six studies were included in the meta-analysis, with a total of 1014 patients. The pooled hazard ratio (HR) for recurrence-free survivor was 0.69 (95% confidence interval [CI], 0.44-1.09, I = 63%, P = .04). Also, reduced E-cadherin was not significantly associated with poor cancer-specific survivor (pooled HR, 1.40; 95% CI, 0.66-1.43, I = 54%, P = .11). The pooled HR for overall survivor was not statistically significant (pooled HR, 0.68; 95% CI, 0.32-1.46, I = 80%, P = .007). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis. CONCLUSIONS Reduced E-cadherin expression did not appear to be significantly associated with disease prognosis after nephroureterectomy in the meta-analysis. However, further high quality, prospective studies are warranted to better address this issue.
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Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital,
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Blackwell J, Saxena S, Alexakis C, Bottle A, Cecil E, Majeed A, Pollok RC. The impact of smoking and smoking cessation on disease outcomes in ulcerative colitis: a nationwide population-based study. Aliment Pharmacol Ther 2019; 50:556-567. [PMID: 31389044 DOI: 10.1111/apt.15390] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/29/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Smokers are less likely to develop ulcerative colitis (UC) but the impact of smoking and subsequent cessation on clinical outcomes in UC is unclear. AIM To evaluate the effect of smoking status and smoking cessation on disease outcomes. METHODS Using a nationally representative clinical research database, we identified incident cases of UC during 2005-2016. Patients were grouped as never-smokers, ex-smokers and smokers based on smoking status recorded in the 2 years preceding UC diagnosis. We defined subgroups of persistent smokers and smokers who quit within 2 years after diagnosis. We compared the rates of overall corticosteroid use, corticosteroid-requiring flares, corticosteroid dependency, thiopurine use, hospitalisation and colectomy between these groups. RESULTS We identified 6754 patients with a new diagnosis of UC over the study period with data on smoking status, of whom 878 were smokers at diagnosis. Smokers had a similar risk of corticosteroid-requiring flares (OR 1.16, 95% CI 0.92-1.25), thiopurine use (HR 0.84, 95% CI 0.62-1.14), corticosteroid dependency (HR 0.85, 95% CI 0.60-1.11), hospitalisation (HR 0.92, 95% CI 0.72-1.18) and colectomy (HR 0.78, 95% CI 0.50-1.21) in comparison with never-smokers. Rates of flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy were not significantly different between persistent smokers and those who quit smoking after a diagnosis of UC. CONCLUSIONS Smokers and never-smokers with UC have similar outcomes with respect to flares, thiopurine use, corticosteroid dependency, hospitalisation and colectomy. Smoking cessation was not associated with worse disease course. The risks associated with smoking outweigh any benefits. UC patients should be counselled against smoking.
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Affiliation(s)
- Jonathan Blackwell
- Department of Gastroenterology, St George's Healthcare NHS Trust and St George's University, London, UK
| | - Sonia Saxena
- School of Public Health, Imperial College London, London, UK
| | - Christopher Alexakis
- Department of Gastroenterology, St George's Healthcare NHS Trust and St George's University, London, UK
| | - Alex Bottle
- School of Public Health, Imperial College London, London, UK
| | - Elizabeth Cecil
- School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- School of Public Health, Imperial College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Healthcare NHS Trust and St George's University, London, UK
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van Osch FHM, Jochems SHJ, Reulen RC, Pirrie SJ, Nekeman D, Wesselius A, James ND, Wallace DMA, Cheng KK, van Schooten FJ, Bryan RT, Zeegers MP. The association between smoking cessation before and after diagnosis and non-muscle-invasive bladder cancer recurrence: a prospective cohort study. Cancer Causes Control 2018; 29:675-683. [PMID: 29846846 PMCID: PMC5999150 DOI: 10.1007/s10552-018-1046-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Smoking is a major risk factor for bladder cancer, but the relationship between smoking cessation after initial treatment and bladder cancer recurrence has been investigated less frequently and not prospectively yet. METHODS 722 non-muscle-invasive bladder cancer (NMIBC) patients (pTa, pT1, and CIS) from the prospective Bladder Cancer Prognosis Programme (BCPP) cohort, selected in the UK between 2005 and 2011, provided complete data on smoking behavior before and up to 5 years after diagnosis. The impact of smoking behavior on NMIBC recurrence was explored by multivariable Cox regression models investigating time-to-first NMIBC recurrence. RESULTS Over a median follow-up period of 4.21 years, 403 pathologically confirmed NMIBC recurrences occurred in 210 patients. Only 25 current smokers at diagnosis quit smoking (14%) during follow-up and smoking cessation after diagnosis did not decrease risk of recurrence compared to continuing smokers (p = 0.352). CONCLUSIONS Although quitting smoking after diagnosis might reduce the risk of recurrence based on retrospective evidence, this is not confirmed in this prospective study because the number of NMIBC patients quitting smoking before their first recurrence was too low. Nevertheless, this indicates an important role for urologists and other health care professionals in promoting smoking cessation in NMIBC.
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Affiliation(s)
- Frits H M van Osch
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Sylvia H J Jochems
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Raoul C Reulen
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Sarah J Pirrie
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Duncan Nekeman
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Anke Wesselius
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - D Michael A Wallace
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK
| | - K K Cheng
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Frederik J van Schooten
- Department of Pharmacology and Toxicology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Richard T Bryan
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Maurice P Zeegers
- Unit of Nutritional and Cancer Epidemiology, Chairgroup of Complex Genetics and Epidemiology, School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- Chairgroup of Complex Genetics and Epidemiology, Care and Public Health Research Institute (CAPRHI), Maastricht University, Maastricht, The Netherlands
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D'Andrea D, Hassler MR, Abufaraj M, Soria F, Ertl IE, Ilijazi D, Mari A, Foerster B, Egger G, Shariat SF. Progressive tissue biomarker profiling in non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2018; 18:695-703. [PMID: 29737231 DOI: 10.1080/14737140.2018.1474104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The recurrence rate of non-muscle-invasive bladder cancer (NMIBC) is up to 60% within the first year of therapy. Accurate risk stratification is necessary for patient counselling, follow-up scheduling and individualized therapeutic decision making. Current prognostic models rely on clinicopathologic features, but their discrimination remains limited when in external cohorts. Despite intense efforts regarding the value of biomarkers in prognosticating outcomes in NMIBC, clinical utility remains suboptimal. It is clear that a single biomarker is not enough for the prediction of disease recurrence. Therefore, panels of non-redundant biomarkers have been created and integrated in clinical prognostic model further research relying on high throughput technologies is required. Areas covered: We performed a systematic research of the English-language literature on tissue biomarkers for prediction of NMIBC outcomes up to December 2017. Expert commentary: Despite the essential milestones achieved in our knowledge and understanding of the molecular biology underlying NMIBC, no biomarker has been implemented together with clinical feature in clinical practice. Integration of such biomarkers into predictive and prognostic model could, however, improve our accuracy, thereby paving the way for personalized medicine in the management of NMIBC.
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Affiliation(s)
- David D'Andrea
- a Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Melanie R Hassler
- a Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Mohammad Abufaraj
- a Department of Urology , Medical University of Vienna , Vienna , Austria.,b Division of Urology, Department of Special Surgery , Jordan University Hospital, The University of Jordan , Amman , Jordan
| | - Francesco Soria
- a Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Iris E Ertl
- a Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Dafina Ilijazi
- a Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Andrea Mari
- c Department of Urology , University of Florence, Careggi Hospital , Florence , Italy
| | - Beat Foerster
- a Department of Urology , Medical University of Vienna , Vienna , Austria
| | - Gerda Egger
- d Department of Pathology , Medical University of Vienna , Vienna , Austria
| | - Shahrokh F Shariat
- a Department of Urology , Medical University of Vienna , Vienna , Austria.,e Institute of Andrology and Urology , Karl Landsteiner University , Krems an der Donau , Austria.,f Department of Urology , University of Texas Southwestern Medical Centre , Dallas , TX , USA.,g Department of Urology , Weill Cornell Medical College , New York , NY , USA
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8
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Barbosa ALA, Vermeulen SHHM, Aben KK, Grotenhuis AJ, Vrieling A, Kiemeney LA. Smoking intensity and bladder cancer aggressiveness at diagnosis. PLoS One 2018; 13:e0194039. [PMID: 29570711 PMCID: PMC5865728 DOI: 10.1371/journal.pone.0194039] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/25/2018] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To explore the relation between cigarette smoking intensity and bladder cancer aggressiveness at first diagnosis. METHODS Patients diagnosed with urinary bladder cancer (BC) between 1995-2011 under the age of 75 years were retrospectively identified from the Netherlands Cancer Registry and invited for a study on genetic and lifestyle risk factors for BC. Information on patients' self-reported smoking history was retrieved by means of a postal questionnaire. Tumors were stratified regarding the risk of progression defined by tumor stage and grade. Multinomial logistic regression was used to analyze the relation between smoking intensity and aggressiveness of the tumor. RESULTS The UBC study population comprised 323 (17.4%) never smokers, 870 (46.8%) former cigarette smokers, and 630 (33.9%) current cigarette smokers. A higher smoking amount was a risk factor of getting high-risk non-muscle invasive bladder cancer (NMIBC) compared with low-risk NMIBC in ever and former cigarette smokers (OR: 1.02 per cigarette smoked, 95% CI: 1.00-1.03 and OR: 1.03, 95% CI: 1.01-1.05, respectively). A statistically significant dose-response increase in the risk of a more aggressive cancer type (high-risk NMIBC and MIBC) was observed with increasing smoking duration among former smokers (p for trend 0.035 and 0.008, respectively). No significant association of the evaluated smoking intensity variables was observed in current smokers. A longer time of smoking cessation correlated with a lower odds of a more aggressive cancer. CONCLUSION We observed a weak increase in the risk of a more aggressive tumor type with increasing smoking intensity in former smokers, but this association was absent in current smokers. This conflicting result may suggest that there is no strong relation between smoking intensity and bladder cancer aggressiveness. Analyses of prospective studies with longitudinal smoking assessment may provide a more definitive answer to the research question.
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Affiliation(s)
- André L. A. Barbosa
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Federal University of Bahia, Salvador, Brazil
| | - Sita H. H. M. Vermeulen
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Katja K. Aben
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Anne J. Grotenhuis
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Lambertus A. Kiemeney
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
- Department of Urology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
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Risk Factors and Molecular Features Associated with Bladder Cancer Development. MOLECULAR PATHOLOGY LIBRARY 2018. [DOI: 10.1007/978-3-319-64769-2_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10
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Abstract
Clinical outcomes for patients with bladder cancer have largely remained unchanged over the last three decades despite improvements in surgical techniques, perioperative therapies, and postoperative management. Current management still heavily relies on pathologic staging that does not always reflect an individual patient's risk. The genesis and progression of bladder cancer is now increasingly recognized as being a result of alterations in several pathways that affect the cell cycle, apoptosis, cellular signaling, gene regulation, immune modulation, angiogenesis, and tumor cell invasion. Multiplexed assessment of biomarkers associated with alterations in these pathways offers novel insights into tumor behavior while identifying panels that are capable of reproducibly predicting patient outcomes. Future management of bladder cancer will likely incorporate such prognostic molecular models for risk stratification and treatment personalization.
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Affiliation(s)
- Anirban P Mitra
- Institute of Urology, Keck School of Medicine of the University of Southern California, 1441 Eastlake Avenue, Suite 7416, MC 9178, Los Angeles, CA, 90033, USA.
| | - Siamak Daneshmand
- Institute of Urology, Keck School of Medicine of the University of Southern California, 1441 Eastlake Avenue, Suite 7416, MC 9178, Los Angeles, CA, 90033, USA
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Yuruk E, Tuken M, Colakerol A, Serefoglu EC. The awareness of patients with non - muscle invasive bladder cancer regarding the importance of smoking cessation and their access to smoking cessation programs. Int Braz J Urol 2017; 43:607-614. [PMID: 28537702 PMCID: PMC5557435 DOI: 10.1590/s1677-5538.ibju.2016.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/19/2017] [Indexed: 02/04/2023] Open
Abstract
Objectives Smoking is the most important risk factor for bladder cancer and smoking cessation is associated with reduced risk of tumor recurrence and progression. The aim of this study is to assess the awareness of non-muscle invasive bladder cancer (NMIBC) patients regarding the importance of smoking cessation, determine their access to smoking cessation programs and the effects of smoking cessation on recurrence rates of NMIBC. Materials and Methods NMIBC patients who were followed with cystoscopy were included in the study. Their demographic properties were recorded, along with their smoking habits, awareness regarding the effects of smoking on bladder cancer and previous attempts for smoking cessation. Moreover, the patients were asked whether they applied for a smoking cessation program. Recurrence of bladder cancer during the follow-up period was also noted. Results A total of 187 patients were included in the study. The mean age was 64.68±12.05 (range: 15-90) and the male to female ratio was 167/20. At the time of diagnosis, 114 patients (61.0%) were active smokers, 35 patients (18.7%) were ex-smokers and 38 patients (20.3%) had never smoked before. After the diagnosis, 83.3% of the actively smoking patients were advised to quit smoking and 57.9% of them quit smoking. At the time of the study, 46.52% of the NMIBC patients were aware of the link between smoking and bladder cancer, whereas only 4.1% of the smoking patients were referred to smoking cessation programs. After a mean follow-up of 32.28±11.42 months, 84 patients (44.91%) had recurrence; however, current smoking status or awareness of the causative role of smoking on NMIBC did not affect the recurrence. Conclusion In our study group, the majority of the NMIBC patients were not aware of the association between smoking and bladder cancer. Although most of the physicians advised patients to quit smoking, a significant amount of the patients were still active smokers during follow-up. Only a small proportion of patients were referred to smoking cessation programs. Urologists should take a more active role in the battle against smoking and refer those patients to smoking cessation programs. Larger study populations with longer follow-up periods are needed to better demonstrate the beneficial effects of smoking cessation on recurrence rates.
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Affiliation(s)
- Emrah Yuruk
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Murat Tuken
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Aykut Colakerol
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Ege Can Serefoglu
- Department of Urology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Reduced E-cadherin expression is correlated with poor prognosis in patients with bladder cancer: a systematic review and meta-analysis. Oncotarget 2017; 8:62489-62499. [PMID: 28977963 PMCID: PMC5617523 DOI: 10.18632/oncotarget.19934] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/25/2017] [Indexed: 12/27/2022] Open
Abstract
The prognostic significance of E-cadherin expression in bladder cancer (BC) has been elevated for years, but published results remain controversial and inconsistent. We thus performed a systematic review and meta-analysis to determine the association between E-cadherin expression and BC prognosis. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science databases to identify eligible studies published until March 2017. On the basis of our inclusion and exclusion criteria, a total of 2,089 patients from 19 studies were eligible for final analysis. Our results showed that reduced E-cadherin expression in BC was associated with poor overall survival (hazard ratio [HR] = 2.73, 95% CI: 1.74–4.27, p < 0.001), poor progression-free survival (HR = 6.39, 95% CI: 3.48–11.73, p < 0.001), and poor recurrence-free survival (HR = 2.48, 95% CI: 1.68–3.64, p < 0.001). Moreover, reduced E-cadherin expression was significantly correlated with pathological T stage (T2-4 vs. Ta-1: risk ratio [RR] = 2.14, 95% CI: 1.70–2.71), metastasis (yes vs. no: RR = 1.68, 95% CI: 1.17–2.40), grade (3 vs. 1/2: RR = 1.58, 95% CI: 1.29–1.93), and carcinoma in situ (yes vs. no: RR = 1.68, 95% CI: 1.09–2.58). This meta-analysis suggested that reduced E-cadherin expression was associated with poor prognosis and advanced clinicopathological characteristics and can serve as a useful biomarker for the clinical management of BC.
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Glaser AP, Fantini D, Shilatifard A, Schaeffer EM, Meeks JJ. The evolving genomic landscape of urothelial carcinoma. Nat Rev Urol 2017; 14:215-229. [PMID: 28169993 DOI: 10.1038/nrurol.2017.11] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Survival of patients with urothelial carcinoma (including bladder cancer and upper tract urothelial carcinoma) is limited by our current approaches to staging, surgery, and chemotherapy. Large-scale, next-generation sequencing collaborations, such as The Cancer Genome Atlas, have already identified drivers and vulnerabilities of urothelial carcinoma. This disease has a high degree of mutational heterogeneity and a high frequency of somatic mutations compared with other solid tumours, potentially resulting in an increased neoantigen burden. Mutational heterogeneity is mediated by multiple factors including the apolipoprotein B mRNA editing enzyme catalytic polypeptide family of enzymes, smoking exposure, viral integrations, and intragene and intergene fusion proteins. The mutational landscape of urothelial carcinoma, including specific mutations in pathways and driver genes, such as FGFR3, ERBB2, PIK3CA, TP53, and STAG2, affects tumour aggressiveness and response to therapy. The next generation of therapies for urothelial carcinoma will be based on patient-specific targetable mutations found in individual tumours. This personalized-medicine approach to urothelial carcinoma has already resulted in unique clinical trial design and has the potential to improve patient outcomes and survival.
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Affiliation(s)
- Alexander P Glaser
- Northwestern University, Department of Urology, 303 E. Chicago Avenue, Tarry 16-703, Chicago, Illinois 60611, USA
| | - Damiano Fantini
- Northwestern University, Department of Urology, 303 E. Chicago Avenue, Tarry 16-703, Chicago, Illinois 60611, USA
| | - Ali Shilatifard
- Northwestern University, Department of Urology, 303 E. Chicago Avenue, Tarry 16-703, Chicago, Illinois 60611, USA
| | - Edward M Schaeffer
- Northwestern University, Department of Urology, 303 E. Chicago Avenue, Tarry 16-703, Chicago, Illinois 60611, USA
| | - Joshua J Meeks
- Northwestern University, Department of Urology, 303 E. Chicago Avenue, Tarry 16-703, Chicago, Illinois 60611, USA
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Zhao M, He XL, Teng XD. Understanding the molecular pathogenesis and prognostics of bladder cancer: an overview. Chin J Cancer Res 2016; 28:92-8. [PMID: 27041931 DOI: 10.3978/j.issn.1000-9604.2016.02.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The knowledge of cellular mechanisms in malignances of the bladder has grown exponentially. Molecular technologies have led to the discovery of the molecular pathways distinguishing low-and high-grade urothelial neoplasms. This trend portends the future in which the classification and diagnosis of the bladder tumors through morphologic analysis will be supported by molecular information correlating with prognosis and targeted therapy. This article outlines tumor molecular pathology of bladder cancer with an emphasis on several promising candidate biomarkers that may soon make their transition to the realm of clinical management of bladder cancer.
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Affiliation(s)
- Ming Zhao
- 1 Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China ; 2 Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiang-Lei He
- 1 Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China ; 2 Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao-Dong Teng
- 1 Department of Pathology, Zhejiang Provincial People's Hospital, Hangzhou 310014, China ; 2 Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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15
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Mitra AP. Molecular substratification of bladder cancer: moving towards individualized patient management. Ther Adv Urol 2016; 8:215-33. [PMID: 27247631 DOI: 10.1177/1756287216638981] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite advances in surgical techniques, perioperative therapies and postoperative management, outcomes for patients with bladder cancer have largely remained unchanged. Current management of bladder cancer still relies on pathologic staging that does not always reflect the risk for an individual patient. Studies assessing molecular alterations in individual tumors are offering insights into the myriad of cellular pathways that are deregulated in bladder tumorigenesis and progression. Alterations in pathways involved in cell-cycle regulation, apoptosis, cell signaling, angiogenesis and tumor-cell invasion have been shown to influence disease behavior. High-throughput assays are now allowing multiplexed assessment of biomarker alterations, thereby enabling characterization of novel molecular subtypes of bladder cancer. Such approaches have also been used for discovery and validation of robust prognostic molecular signatures. The future of bladder cancer management will rely on the use of validated multimarker panels for risk stratification, optimal surgical management, and theranostic strategies to identify and target specific alterations in individual tumors.
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Affiliation(s)
- Anirban P Mitra
- Institute of Urology, University of Southern California, 1441 Eastlake Avenue, Suite 7416, MC 9178, Los Angeles, CA 90033, USA
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16
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Sapre N, Macintyre G, Clarkson M, Naeem H, Cmero M, Kowalczyk A, Anderson PD, Costello AJ, Corcoran NM, Hovens CM. A urinary microRNA signature can predict the presence of bladder urothelial carcinoma in patients undergoing surveillance. Br J Cancer 2016; 114:454-62. [PMID: 26812572 PMCID: PMC4815774 DOI: 10.1038/bjc.2015.472] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/28/2015] [Accepted: 12/03/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The objective of this study was to determine whether microRNA (miRNA) profiling of urine could identify the presence of urothelial carcinoma of the bladder (UCB) and to compare its performance characteristics to that of cystoscopy. METHODS In the discovery cohort we screened 81 patients, which included 21 benign controls, 30 non-recurrers and 30 patients with active cancer (recurrers), using a panel of 12 miRNAs. Data analysis was performed using a machine learning approach of a Support Vector Machine classifier with a Student's t-test feature selection procedure. This was trained using a three-fold cross validation approach and performance was measured using the area under the receiver operator characteristic curve (AUC). The miRNA signature was validated in an independent cohort of a further 50 patients. RESULTS The best predictor to distinguish patients with UCB from non-recurrers was achieved using a combination of six miRNAs (AUC=0.85). This validated in an independent cohort (AUC=0.74) and detected UCB with a high sensitivity (88%) and sufficient specificity (48%) with all significant cancers identified. The performance of the classifier was best in detecting clinically significant disease such as presence of T1 Stage disease (AUC=0.92) and high-volume disease (AUC=0.81). Cystoscopy rates in the validation cohort would have been reduced by 30%. CONCLUSIONS Urinary profiling using this panel of miRNAs shows promise for detection of tumour recurrence in the surveillance of UCB. Such a panel may be useful in reducing the morbidity and costs associated with cystoscopic surveillance, and now merits prospective evaluation.
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Affiliation(s)
- Nikhil Sapre
- Department of Surgery, Division of Urology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Geoff Macintyre
- NICTA Victoria Research Laboratory, Department of Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia.,Department of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Neural Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Clarkson
- Department of Surgery, Division of Urology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Haroon Naeem
- NICTA Victoria Research Laboratory, Department of Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia.,Department of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Neural Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Marek Cmero
- NICTA Victoria Research Laboratory, Department of Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam Kowalczyk
- NICTA Victoria Research Laboratory, Department of Electronic Engineering, University of Melbourne, Melbourne, Victoria, Australia.,Department of Computing and Information Systems, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Neural Engineering, University of Melbourne, Melbourne, Victoria, Australia
| | - Paul D Anderson
- Department of Surgery, Division of Urology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Anthony J Costello
- Department of Surgery, Division of Urology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Niall M Corcoran
- Department of Surgery, Division of Urology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - Christopher M Hovens
- Department of Surgery, Division of Urology, Royal Melbourne Hospital, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
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17
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Kukreja JB, Messing EM. Editorial Comment. Urology 2015; 86:972-3. [PMID: 26414727 DOI: 10.1016/j.urology.2015.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Janet Baack Kukreja
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Edward M Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY
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18
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Mitra AP, Lerner SP. Potential Role for Targeted Therapy in Muscle-Invasive Bladder Cancer. Urol Clin North Am 2015; 42:201-15, viii. [DOI: 10.1016/j.ucl.2015.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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19
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Kavalieris L, O'Sullivan PJ, Suttie JM, Pownall BK, Gilling PJ, Chemasle C, Darling DG. A segregation index combining phenotypic (clinical characteristics) and genotypic (gene expression) biomarkers from a urine sample to triage out patients presenting with hematuria who have a low probability of urothelial carcinoma. BMC Urol 2015; 15:23. [PMID: 25888331 PMCID: PMC4391477 DOI: 10.1186/s12894-015-0018-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/16/2015] [Indexed: 12/02/2022] Open
Abstract
Background Hematuria can be symptomatic of urothelial carcinoma (UC) and ruling out patients with benign causes during primary evaluation is challenging. Patients with hematuria undergoing urological work-ups place significant clinical and financial burdens on healthcare systems. Current clinical evaluation involves processes that individually lack the sensitivity for accurate determination of UC. Algorithms and nomograms combining genotypic and phenotypic variables have largely focused on cancer detection and failed to improve performance. This study aimed to develop and validate a model incorporating both genotypic and phenotypic variables with high sensitivity and a high negative predictive value (NPV) combined to triage out patients with hematuria who have a low probability of having UC and may not require urological work-up. Methods Expression of IGFBP5, HOXA13, MDK, CDK1 and CXCR2 genes in a voided urine sample (genotypic) and age, gender, frequency of macrohematuria and smoking history (phenotypic) data were collected from 587 patients with macrohematuria. Logistic regression was used to develop predictive models for UC. A combined genotypic-phenotypic model (G + P INDEX) was compared with genotypic (G INDEX) and phenotypic (P INDEX) models. Area under receiver operating characteristic curves (AUC) defined the performance of each INDEX: high sensitivity, NPV >0.97 and a high test-negative rate was considered optimal for triaging out patients. The robustness of the G + P INDEX was tested in 40 microhematuria patients without UC. Results The G + P INDEX offered a bias-corrected AUC of 0.86 compared with 0.61 and 0.83, for the P and G INDEXs respectively. When the test-negative rate was 0.4, the G + P INDEX (sensitivity = 0.95; NPV = 0.98) offered improved performance compared with the G INDEX (sensitivity = 0.86; NPV = 0.96). 80% of patients with microhematuria who did not have UC were correctly triaged out using the G + P INDEX, therefore not requiring a full urological work-up. Conclusion The adoption of G + P INDEX enables a significant change in clinical utility. G + P INDEX can be used to segregate hematuria patients with a low probability of UC with a high degree of confidence in the primary evaluation. Triaging out low-probability patients early significantly reduces the need for expensive and invasive work-ups, thereby lowering diagnosis-related adverse events and costs.
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Affiliation(s)
| | | | | | | | | | - Christophe Chemasle
- Department of Urology, Palmerston North Hospital, Palmerston North, New Zealand.
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Abstract
Molecular biomarkers are used routinely in the clinical management of several tumours such as prostate, colon, ovarian and pancreatic cancer but management decisions in bladder cancer remain dependent on clinical and pathological criteria, which are limited in their ability to predict outcomes. Molecular markers are urgently needed in detection, surveillance and prognostication of bladder cancer as well as to predict treatment response to intravesical and systemic therapies. Advances in cancer genomics and platforms for biomarker profiling have led to a plethora of biomarkers, which must now be rigorously validated in the clinical setting. Pre-clinical and clinical studies exploring the role of emerging targeted therapies to risk stratify and reduce cancer progression are also needed.
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21
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Miyata Y, Mitsunari K, Akihiro A, Watanabe SI, Mochizuki Y, Sakai H. Smoking-induced changes in cancer-related factors in patients with upper tract urothelial cancer. Mol Clin Oncol 2014; 3:287-294. [PMID: 25798255 DOI: 10.3892/mco.2014.471] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/14/2014] [Indexed: 11/06/2022] Open
Abstract
Cigarette smoking is a major risk factor for urothelial cancer (UC) development. However, the associations between smoking and changes in the pathological characteristics and molecular expression of cancer-related molecules in upper tract (UT) UC have not been fully elucidated. We investigated the associations between smoking status and cancer-related factors, including cancer cell proliferation, apoptosis, angiogenesis, lymphangiogenesis and expression of vascular endothelial growth factor-A and -C, matrix metalloproteinase (MMP)-2 and -9, cyclooxygenase (COX)-2 and urokinase-type plasminogen activator, in patients with UTUC. A total of 134 patients who underwent nephroureterectomy were retrospectively investigated. Proliferation index (PI), microvessel density and lymphatic vessel density (LVD) were measured using anti-Ki-67, anti-CD105 and anti-D2-40 antibodies in formalin-fixed specimens. The apoptotic index was evaluated using the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method. Other cancer-related molecules were investigated by immunohistochemistry in similar specimens. The patients were divided into three groups; non-smoker (n=54, 40.3%), former smoker (n=46, 34.3%) and current smoker (n=34, 25.4%). The PI and the apoptotic index were not found to be correlated with smoking status; however, the mean/standard deviation level of LVD in current smokers (40.9/12.9) was significantly higher (P=0.034) compared to that in patients who had never smoked (34.4/10.6). In addition, smoking status was positively correlated with the presence of intratumoral lymphatic vessels (iLV) (P=0.010) and the expression of COX-2 and MMP-9 (P=0.032). The multivariate analysis demonstrated that current smoking was independently associated with all the abovementioned smoking-related factors. However, former smoking was correlated with LVD and the presence of iLV. In the survival analysis, LVD, the presence of iLV and the expression of COX-2 and MMP-9 were identified as predictive factors for metastasis following surgery. In conclusion, lymphangiogenesis and the expression levels of COX-2 and MMP-9 were found to be associated with the smoking status of UTUC patients. Our results may provide important insights into the pathological changes precipitated by smoking in these patients.
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Affiliation(s)
- Yasuyoshi Miyata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Kensuke Mitsunari
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Asai Akihiro
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Shin-Ichi Watanabe
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Yasushi Mochizuki
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8501, Japan
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Heme oxygenase-1 expression is associated with tumor aggressiveness and outcomes in patients with bladder cancer: a correlation with smoking intensity. Transl Res 2014; 164:468-76. [PMID: 25063314 DOI: 10.1016/j.trsl.2014.06.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/28/2014] [Accepted: 06/26/2014] [Indexed: 12/21/2022]
Abstract
Heme oxygenase (HO)-1 is upregulated in malignancies and, in turn, regulates other cancer-related factors. Although HO-1 expression has been associated with cigarette smoking under various pathologic conditions, little is known about their association in patients with bladder cancer. HO-1 expression was assessed in 215 formalin-fixed bladder cancer specimens by immunohistochemistry. Microvessel density, lymph vessel density (LVD), proliferation index (PI), and expression of the vascular endothelial growth factor (VEGF)-A, -C, and -D, cyclooxygenase (COX)-2, matrix metalloproteinase (MMP)-2, and MMP-9 were investigated by similar methods. Multivariate analyses were performed to evaluate the pathologic role and predictive value of HO-1 expression. Our results demonstrated that HO-1 expression was positively associated with T stage, lymph node metastasis, and grade. HO-1 expression was also positively correlated with PI, LVD, and expression levels of VEGF-D, COX-2, MMP-2, and MMP-9 (P < 0.001). In addition, multivariate analyses showed that HO-1 expression positively correlated with smoking intensity. Positive HO-1 expression was a significant predictor of subsequent metastasis (P = 0.008) and poor cause-specific survival (P < 0.001). Similarly, multivariate analyses showed that HO-1 expression was a predictor of cause-specific survival (hazard ratio = 3.13, P = 0.013). In conclusion, pathologic changes of HO-1-related factors were dependent on smoking intensity. Smoking upregulated HO-1 expression, and HO-1 was associated with malignant behavior of bladder cancer. Cancer cell proliferation, lymphangiogenesis, and expression levels of VEGF-D, COX-2, and MMP-2 played important roles in these HO-1-related effects. The clinical correlations of HO-1 were regulated by a complex mechanism that depended on smoking intensity.
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Mitra AP, Lam LL, Ghadessi M, Erho N, Vergara IA, Alshalalfa M, Buerki C, Haddad Z, Sierocinski T, Triche TJ, Skinner EC, Davicioni E, Daneshmand S, Black PC. Discovery and validation of novel expression signature for postcystectomy recurrence in high-risk bladder cancer. J Natl Cancer Inst 2014; 106:dju290. [PMID: 25344601 PMCID: PMC4241889 DOI: 10.1093/jnci/dju290] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Nearly half of muscle-invasive bladder cancer patients succumb to their disease following cystectomy. Selecting candidates for adjuvant therapy is currently based on clinical parameters with limited predictive power. This study aimed to develop and validate genomic-based signatures that can better identify patients at risk for recurrence than clinical models alone. Methods Transcriptome-wide expression profiles were generated using 1.4 million feature-arrays on archival tumors from 225 patients who underwent radical cystectomy and had muscle-invasive and/or node-positive bladder cancer. Genomic (GC) and clinical (CC) classifiers for predicting recurrence were developed on a discovery set (n = 133). Performances of GC, CC, an independent clinical nomogram (IBCNC), and genomic-clinicopathologic classifiers (G-CC, G-IBCNC) were assessed in the discovery and independent validation (n = 66) sets. GC was further validated on four external datasets (n = 341). Discrimination and prognostic abilities of classifiers were compared using area under receiver-operating characteristic curves (AUCs). All statistical tests were two-sided. Results A 15-feature GC was developed on the discovery set with area under curve (AUC) of 0.77 in the validation set. This was higher than individual clinical variables, IBCNC (AUC = 0.73), and comparable to CC (AUC = 0.78). Performance was improved upon combining GC with clinical nomograms (G-IBCNC, AUC = 0.82; G-CC, AUC = 0.86). G-CC high-risk patients had elevated recurrence probabilities (P < .001), with GC being the best predictor by multivariable analysis (P = .005). Genomic-clinicopathologic classifiers outperformed clinical nomograms by decision curve and reclassification analyses. GC performed the best in validation compared with seven prior signatures. GC markers remained prognostic across four independent datasets. Conclusions The validated genomic-based classifiers outperform clinical models for predicting postcystectomy bladder cancer recurrence. This may be used to better identify patients who need more aggressive management.
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Affiliation(s)
- Anirban P Mitra
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB).
| | - Lucia L Lam
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Mercedeh Ghadessi
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Nicholas Erho
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Ismael A Vergara
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Mohammed Alshalalfa
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Christine Buerki
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Zaid Haddad
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Thomas Sierocinski
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Timothy J Triche
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Eila C Skinner
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Elai Davicioni
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Siamak Daneshmand
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
| | - Peter C Black
- Department of Pathology and Center for Personalized Medicine (APM, TJT) and Institute of Urology and Norris Comprehensive Cancer Center (SD), University of Southern California, Los Angeles, CA; GenomeDx Biosciences, Inc., Vancouver, BC (LLL, MG, NE, IAV, MA, CB, ZH, TS, TJT, ED); Department of Urology and the Stanford Cancer Institute, Stanford University, Stanford, CA (ECS); Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada (PCB)
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Pinto-Leite R, Arantes-Rodrigues R, Ferreira R, Palmeira C, Oliveira PA, Santos L. Treatment of muscle invasive urinary bladders tumors: A potential role of the mTOR inhibitors. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.biomag.2014.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Xylinas E, Kluth LA, Lotan Y, Daneshmand S, Rieken M, Karakiewicz PI, Shariat SF. Blood- and tissue-based biomarkers for prediction of outcomes in urothelial carcinoma of the bladder. Urol Oncol 2014; 32:230-42. [DOI: 10.1016/j.urolonc.2013.06.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/15/2013] [Accepted: 06/18/2013] [Indexed: 01/29/2023]
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Sledge DG, Patrick DJ, Fitzgerald SD, Xie Y, Kiupel M. Differences in Expression of Uroplakin III, Cytokeratin 7, and Cyclooxygenase-2 in Canine Proliferative Urothelial Lesions of the Urinary Bladder. Vet Pathol 2014; 52:74-82. [DOI: 10.1177/0300985814522819] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The expression of immunohistochemical markers that have been used in diagnosis and/or prognostication of urothelial tumors in humans (uroplakin III [UPIII], cytokeratin 7 [CK7], cyclooxygenase-2 [COX-2], and activated caspase 3) was evaluated in a series of 99 canine proliferative urothelial lesions of the urinary bladder and compared to the lesion classification and grade as defined by the World Health Organization / International Society of Urologic Pathology consensus system. There were significant associations between tumor classification and overall UPIII pattern ( P = 1.49 × 10–18), loss of UPIII ( P = 1.27 × 10–4), overall CK7 pattern ( P = 4.34 × 10–18), and COX-2 pattern ( P = 8.12 × 10–25). In addition, there were significant associations between depth of neoplastic cell infiltration into the urinary bladder wall and overall UPIII pattern ( P = 1.54 × 10–14), loss of UPIII ( P = 2.07 × 10–4), overall CK7 pattern ( P = 1.17 × 10–13), loss of CK7 expression ( P = .0485), and COX-2 pattern ( P = 8.23 × 10–21). There were no significant associations between tumor classification or infiltration and caspase 3 expression pattern.
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Affiliation(s)
- D. G. Sledge
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | | | - S. D. Fitzgerald
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Y. Xie
- Pharmanet/i3, Haslett, MI, USA
| | - M. Kiupel
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
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Mitra AP, Skinner EC, Schuckman AK, Quinn DI, Dorff TB, Daneshmand S. Effect of gender on outcomes following radical cystectomy for urothelial carcinoma of the bladder: A critical analysis of 1,994 patients. Urol Oncol 2014; 32:52.e1-9. [DOI: 10.1016/j.urolonc.2013.08.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 08/14/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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Randén M, Helde-Frankling M, Runesdotter S, Gunvén P. Unfavorable cancers of unknown primaries: presentation and prognostic factors. A population-based 8-year experience. Med Oncol 2013; 30:706. [DOI: 10.1007/s12032-013-0706-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/20/2013] [Indexed: 01/02/2023]
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