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Cigliola A, Basnet A, Jacob JM, Mercinelli C, Tateo V, Patanè DA, Bratslavsky G, Cheng L, Grivas P, Kamat AM, Spiess PE, Pavlick DC, Lin DI, Ross JS, Necchi A. Urachal and Nonurachal Adenocarcinomas of the Urinary Bladder: A Comprehensive Genomic Profiling Study. JCO Precis Oncol 2024; 8:e2400200. [PMID: 39151108 DOI: 10.1200/po.24.00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/08/2024] [Accepted: 06/26/2024] [Indexed: 08/18/2024] Open
Abstract
PURPOSE Although both urachal (U) and nonurachal (NU) bladder adenocarcinomas (adenoCas) share several histologic similarities, they differ in location and sometimes in therapeutic options. We analyzed the differences in genomic alterations (GAs) between these tumor entities, with the aim of identifying potential therapeutic targets for clinical trials. MATERIALS AND METHODS Overall, 133 U and 328 NU adenoCas were analyzed. Hybrid capture-based comprehensive genomic profiling (CGP) was performed to evaluate all classes of GA. Germline status of GA was predicted using a validated somatic-germline computational method. CGP was performed using the FoundationOne and FoundationOne CDx assays (Foundation Medicine, Inc). RESULTS The most frequent GA in both U and NU cohorts included TP53 (86.5% v 81.1%) and KRAS (34.6% v 27.7%). GAs characteristic of colorectal adenoCa, such as SMAD4 (P = .069) and GNAS (P = .071), were more common in U versus NU. Conversely, TERT (P < .01) and RB1 (P = .071) were more prevalent in NU adenoCa. Notably, both U and NU adenoCas exhibited possibly targetable GA in PIK3CA (7.5% v 7.9%) and ERBB2 (6.8% v 7.6%). Biomarkers associated with potential benefit from anti-PD-1/L1 were infrequent. Median tumor mutational burden was 2.6 and 3.5 mutations per megabase for U and NU, respectively, and PD-L1 expression >1% was rare. Genomic ancestry and genomic signature distribution were similar in both tumor types. GAs were most commonly of somatic nature. Limitations include lack of clinical data, tumor heterogeneity, and retrospective nature. CONCLUSION U and NU adenoCAs revealed differences in GA, with PIK3CA and ERBB2 being identified as putative therapeutic targets. Biomarkers of response to anti-PD-(L)1 were uncommon. Results highlight the potential of CGP to personalize treatment options of bladder adenoCa and inform clinical trial designs.
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Affiliation(s)
- Antonio Cigliola
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Valentina Tateo
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Department of Surgery (Urology), Brown University, Providence, RI
- Legorreta Cancer Center, Brown University, Providence, RI
- Lifespan Health Care System, Brown University, Providence, RI
| | - Petros Grivas
- Division of Hematology/Oncology, Department of Medicine, University of Washington; Fred Hutchinson Cancer Center, Seattle, WA
| | - Ashish M Kamat
- Department of Urology Under Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Philippe E Spiess
- Department of GU Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | | | - Jeffrey S Ross
- SUNY Upstate Medical University, Syracuse, NY
- Foundation Medicine, Inc, Cambridge, MA
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Jha P, Pengal R, Shah M, Kulkarni PM, Mishra R, Menon N, Vikkath N, Menon S, Ramachandran V, Prakash G, Noronha V, Prabhash K, Kumar P. Identification of Rare EIF3E::RSPO2 Fusion in Recurrent and Aggressive Urachal Adenocarcinoma. Genes Chromosomes Cancer 2024; 63:e23250. [PMID: 38884183 DOI: 10.1002/gcc.23250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024] Open
Abstract
INTRODUCTION Urachal cancer (UC) is a rare genitourinary malignancy arising from the urachus, an embryonic remnant of the placental allantois. Its diagnosis remains ambiguous with late-stage cancer detection and represents a highly aggressive disease. Due to its rarity, there is no clear consensus on molecular signatures and appropriate clinical management of UC. CASE REPORT We report a 45-year-old man with recurrent urachal adenocarcinoma (UA) treated with cystectomies, chemotherapy, and radiotherapy. The patient initially presented with hematuria and abdominal pain. Imaging revealed a nodular mass arising from the superior wall of the urinary bladder and extending to the urachus. Biopsy results suggested moderately differentiated UA with muscle layer involvement. The tumor recurred after 20 months, following which, another partial cystectomy was performed. Repeat progression was noted indicating highly aggressive disease. Targeted next-generation sequencing revealed the presence of EIF3E::RSPO2 fusion, along with BRAF and TP53 mutations, and EGFR gene amplification. This is the first case reporting the presence of this fusion in UA. Palliative medication and radiotherapy were administered to manage the disease. CONCLUSION Current treatment modality of surgery may be effective in the early stages of recurrent UA; however, a standard chemotherapy and radiotherapy regimen is yet to be determined for advanced stages. The detection of the rare EIF3E::RSPO2 fusion warrants further studies on the significance of this variant as a possible therapeutic target for improved clinical management.
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Affiliation(s)
- Prerana Jha
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
- Karkinos Foundation, Mumbai, Maharashtra, India
| | - Ruma Pengal
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
- Karkinos Foundation, Mumbai, Maharashtra, India
| | - Minit Shah
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Pooja Mahesh Kulkarni
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
| | - Rohit Mishra
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Narendranath Vikkath
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Venkataramanan Ramachandran
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
- Karkinos Foundation, Mumbai, Maharashtra, India
- Department of Surgery, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gagan Prakash
- Department of Surgery, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prashant Kumar
- Advance Centre for Cancer Diagnostics and Research, Karkinos Healthcare Pvt Ltd, Navi Mumbai, Maharashtra, India
- Karkinos Foundation, Mumbai, Maharashtra, India
- Centre of Excellence for Cancer, Gangwal School of Medical Sciences and Technology, Indian Institute of Technology Kanpur, Kanpur, Uttar Pradesh, India
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3
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Reis H, Paner GP. Glandular Lesions of the Urinary Bladder: Diagnostic and Molecular Updates. Adv Anat Pathol 2024; 31:88-95. [PMID: 38323607 DOI: 10.1097/pap.0000000000000432] [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: 02/08/2024]
Abstract
Glandular lesions in the urinary tract or their associated pathologies can pose a diagnostic challenge. There is a variety of benign alterations and tumor types that need to be taken into account in differential diagnostic considerations. In recent times, efforts for better defining these alterations or lesions both on the histopathological and molecular levels have been undertaken. This article will provide an update on current diagnostic and molecular considerations of these lesions.
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Affiliation(s)
- Henning Reis
- University Hospital Frankfurt, Dr. Senckenberg Institute of Pathlogy (SIP), Goethe University Frankfurt, Frankfurt, Germany
| | - Gladell P Paner
- Departments of Pathology and Surgery (Urology), University of Chicago, Chicago, IL
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4
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Yang G, Shahatiaili A, Bai S, Wang L, Jin D, Cao M, Su P, Liu Q, Tao K, Long Q, Shi Y, Xiao J, Tian F, Zhang L, Chen H, Su X. Mutational signature and prognosis in adenocarcinoma of the bladder. J Pathol 2024; 262:334-346. [PMID: 38180342 DOI: 10.1002/path.6239] [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: 08/02/2023] [Revised: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024]
Abstract
Adenocarcinoma of the bladder is a rare urinary bladder carcinoma with limited therapy options due to lack of molecular characterization. Here, we aimed to reveal the mutational and transcriptomic landscapes of adenocarcinoma of the bladder and assess any relationship with prognosis. Between February 2015 and June 2021, a total of 23 patients with adenocarcinoma of the bladder were enrolled. These included 16 patients with primary bladder adenocarcinomas and seven patients with urachal adenocarcinoma. Whole exome sequencing (16 patients), whole genome sequencing (16 patients), bulk RNA sequencing (RNA-seq) (19 patients), and single-cell RNA-seq (5 patients) were conducted for the specimens. Correlation analysis, survival analysis, and t-tests were also performed. Prevalent T>A substitutions were observed among somatic mutations, and major trinucleotide contexts included 5'-CTC-3' and 5'-CTG-3'. This pattern was mainly contributed by COSMIC signature 22 related to chemical carcinogen exposure (probably aristolochic acid), which has not been reported in bladder adenocarcinoma. Moreover, genes with copy number changes were also enriched in the KEGG term 'chemical carcinogenesis'. Transcriptomic analysis suggested high immune cell infiltration and luminal-like features in the majority of samples. Interestingly, a small fraction of samples with an APOBEC-derived mutational signature exhibited a higher risk of disease progression compared with samples with only a chemical carcinogen-related signature, confirming the molecular and prognostic heterogeneity of bladder adenocarcinoma. This study presents mutational and transcriptomic landscapes of bladder adenocarcinoma, and indicates that a chemical carcinogen-related mutational signature may be related to a better prognosis compared with an APOBEC signature in adenocarcinoma of the bladder. © 2024 The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Guoliang Yang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Akezhouli Shahatiaili
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shihao Bai
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Liyang Wang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Di Jin
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Ming Cao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Peipei Su
- Innovative Program of Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qiang Liu
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Kun Tao
- Department of Pathology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qi Long
- Joint School of Life Sciences, Guangzhou Medical University & Guangzhou Institutes of Biomedicine and Health-Chinese Academy of Sciences, Guangzhou, PR China
| | - Yi Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders, Shanghai Jiao Tong University, Shanghai, PR China
| | - Jing Xiao
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, PR China
| | - Futong Tian
- Department of Design, Politecnico di Milano, Milan, Italy
| | - Lianhua Zhang
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Haige Chen
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Xianbin Su
- Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, PR China
- eHealth Program of Shanghai Anti-doping Laboratory, Shanghai University of Sport, Shanghai, PR China
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Mathavan A, Mathavan A, Murillo-Alvarez R, Gera K, Krekora U, Winer AJ, Mathavan M, Altshuler E, Ramnaraign BH. Clinical Presentation and Targeted Interventions in Urachal Adenocarcinoma: A Single-Institution Case Series and Review of Emerging Therapies. Clin Genitourin Cancer 2024; 22:67-75. [PMID: 37770301 DOI: 10.1016/j.clgc.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Akshay Mathavan
- Department of Internal Medicine, University of Florida, Gainesville, FL
| | - Akash Mathavan
- Department of Internal Medicine, University of Florida, Gainesville, FL
| | - Rodrigo Murillo-Alvarez
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Kriti Gera
- Department of Internal Medicine, University of Florida, Gainesville, FL
| | - Urszula Krekora
- University of Central Florida College of Medicine, University of Central Florida, Orlando, FL
| | - Aaron J Winer
- Department of Internal Medicine, University of Florida, Gainesville, FL
| | - Mohit Mathavan
- Department of Family Medicine, Ocala Hospital, Ocala, FL
| | - Ellery Altshuler
- Department of Internal Medicine, University of Florida, Gainesville, FL
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Ke C, Liu X, Wan J, Hu Z, Yang C. UroVysion ™ fluorescence in situ hybridization (FISH) possibly has a high positive rate in carcinoma of non-urothelial lineages. Front Mol Biosci 2023; 10:1250442. [PMID: 37867556 PMCID: PMC10586327 DOI: 10.3389/fmolb.2023.1250442] [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: 06/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Background: Positive UroVysion™ fluorescence in situ hybridization (FISH) is generally considered as urothelial carcinoma (UC). We clarify if UroVysion™ FISH can be positive in carcinoma of non-urothelial lineages (CNUL), and verify the consistency of urine FISH and histological FISH in CNUL. Methods: All CNUL subjects detected by urine FISH assay due to haematuria from Tongji Hospital were screened. Meanwhile, 2 glandular cystitis and 2 urothelial carcinoma were served as negative or positive control. Paraffin-embedded tissue sections of all subjects were sent to the pathology department for histological FISH detection. Results: A total of 27 patients were included in this study, including 9 with adenocarcinomas, 11 with squamous cell carcinomas, and 7 with other tumour types. The overall positive rate in urine FISH was 64.00% (16/25) in patients with CNUL, 77.78% (7/9) in those with adenocarcinoma and 54.55% (6/11) in those with squamous carcinoma. There was a significant difference in the GLP p16 gene deletion rate between UC and CNUL (100% vs. 8.00%, p = 0.017). Histological FISH results showed that the histological results of 19 patients were consistent with their urine FISH results, and only one patient with stage Ⅲa urachal carcinoma had inconsistent histological FISH results (positive) and urine FISH (negative) results. Conclusion: We demonstrated for the first time the application value of FISH in CNUL on urine samples. Positive urine FISH tests indicate not only UC, but also CNUL. UroVysion™ FISH possibly has a high positive rate in CNUL. CNUL and UC have different genetic changes shown by FISH.
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Affiliation(s)
- Chunjin Ke
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Xuguang Liu
- Department of Pathology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Jie Wan
- Department of Pathology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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7
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Patel J, Villegas A. Urachal Adenocarcinoma: A Rare Primary Cancer Managed With FOLFOX Chemotherapy. Cureus 2023; 15:e43849. [PMID: 37736429 PMCID: PMC10510567 DOI: 10.7759/cureus.43849] [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] [Accepted: 08/20/2023] [Indexed: 09/23/2023] Open
Abstract
Urachal adenocarcinoma (UA) represents a rare subset of bladder tumors involving a urachal remnant. Incidental gross hematuria is often the only presenting symptom, with patients often presenting late in their course, thereby imparting an overall poor prognosis. Although there are prior case reports, there is little literature reported and no standardized treatment guidelines. We report a case of a middle-aged male who presented with incidental gross hematuria after a fall. Workup indicated the presence of a calcified bladder dome mass and pathology reported a primary urachal adenocarcinoma with pelvic nodal involvement. Patient underwent surgical resection and subsequent adjuvant, systemic chemotherapy regimen with leucovorin, fluorouracil, and oxaliplatin (FOLFOX). We hope to bring greater awareness to this rare cause of bladder malignancy.
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Affiliation(s)
- Jay Patel
- Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, USA
| | - Augusto Villegas
- Hematology and Oncology, Florida Cancer Specialists, Fleming Island, USA
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8
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Benjamin DJ, Kalebasty AR. Treatment approaches for urachal cancer: Use of immunotherapy and targeted therapies. Rare Tumors 2023; 15:20363613231189984. [PMID: 37465663 PMCID: PMC10350764 DOI: 10.1177/20363613231189984] [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: 02/28/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
Urachal cancer is a rare genitourinary malignancy that arises from the embryologic remnant of the urachus. The malignancy is considered to be aggressive, with no clear consensus on appropriate management for advanced disease. Although traditionally considered to be related to bladder cancer given its embryologic origin, several next generation sequencing studies have revealed the genomic profile of this genitourinary malignancy most closely resembles colorectal cancer. Moreover, these studies have identified potentially actionable mutations including EGFR, KRAS and MET. In addition, recent data suggests that immunotherapy may benefit some patients with advanced urachal cancer. Nonetheless, continued research is warranted to better understand how to treat this rare genitourinary cancer.
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9
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Zheng Y, Peng H, Hu X, Ou Y, Wang D, Wang H, Ren S. Progress and prospects of targeted therapy and immunotherapy for urachal carcinoma. Front Pharmacol 2023; 14:1199395. [PMID: 37324454 PMCID: PMC10267743 DOI: 10.3389/fphar.2023.1199395] [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: 04/03/2023] [Accepted: 05/17/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: Urachal carcinoma (UrC) is a rare and aggressive disease. Systematic chemotherapy shows limited efficacy in patients with advanced disease, while targeted therapy and immunotherapy may provide a reasonable alternative for specific populations. The molecular pattern of colorectal cancer (CRC) have recently been identified; this understanding has significantly influenced the clinical management of CRC in terms of molecular-targeted therapy. Although some genetic alterations have been associated with UrC, there is still no systematic overview of the molecular profile of this rare malignancy. Methods: In this review, we comprehensively discuss the molecular profile of UrC and further identify potential targets for the personalized treatment of UrC as well as immune checkpoint inhibitors that represent underlying biomarkers. A systematic literature search was carried out by searching the PubMed, EMBASE, and Web of Science databases to identify all literature related to targeted therapy and immunotherapy in urachal carcinoma from inception to February 2023. Results: A total of 28 articles were eligible, and most studies included were case report sand retrospective case series. Furthermore, 420 cases of UrC were identified to analyze the association between mutations and UrC. The most commonly mutated gene in UrC was TP53 with the prevalence of 70%, followed by KRAS mutations in 28.3%, MYC mutations in 20.3%, SMAD4 mutations in 18.2% and GNAS mutations in 18%, amongst other genes. Discussion: The molecular patterns of UrC and CRC are similar yet distinct. Notably, targeted therapy, especially EGFR-targeting therapy, might provide curative efficacy for patients with UrC by applying specific molecular markers. Additional potential biomarkers for the immunotherapy of UrC are mismatch repair (MMR) status and PD-L1 expression profile. In addition, combined regimens featuring targeted agents and immune checkpoint blockers might increase antitumor activity and exert better efficacy in UrC patients with specific mutational burden.
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Affiliation(s)
- Yang Zheng
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Heling Peng
- Medical Administration Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Xu Hu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Ou
- Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Dong Wang
- Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
| | - Han Wang
- Department of Gastroenterology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Shangqing Ren
- Robotic Minimally Invasive Surgery, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
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Mohanty SK, Lobo A, Mishra SK, Cheng L. Precision Medicine in Bladder Cancer: Present Challenges and Future Directions. J Pers Med 2023; 13:jpm13050756. [PMID: 37240925 DOI: 10.3390/jpm13050756] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Bladder cancer (BC) is characterized by significant histopathologic and molecular heterogeneity. The discovery of molecular pathways and knowledge of cellular mechanisms have grown exponentially and may allow for better disease classification, prognostication, and development of novel and more efficacious noninvasive detection and surveillance strategies, as well as selection of therapeutic targets, which can be used in BC, particularly in a neoadjuvant or adjuvant setting. This article outlines recent advances in the molecular pathology of BC with a better understanding and deeper focus on the development and deployment of promising biomarkers and therapeutic avenues that may soon make a transition into the domain of precision medicine and clinical management for patients with BC.
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Affiliation(s)
- Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute and CORE Diagnostics, Gurgaon 122016, India
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine, Kapoor Center for Pathology and Urology, Raipur 490042, India
| | - Sourav K Mishra
- Department of Medical Oncology, All India Institute of Medical Sciences, Bhubaneswar 750017, India
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School, Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, 593 Eddy Street, APC 12-105, Providence, RI 02903, USA
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11
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Urachal carcinoma: The journey so far and the road ahead. Pathol Res Pract 2023; 243:154379. [PMID: 36821941 DOI: 10.1016/j.prp.2023.154379] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
Urachal carcinoma, a rare cancer arising from urachus, accounts for about 1% of bladder cancer. The diagnosis at stage I shows about 63% 5-year survival whereas only 8% of the patients at stage IV shows a 5-year survival. Above 90% of urachal carcinomas are adenocarcinomas and most of the urachal carcinoma cases are invasive, showing a high resemblance to adenocarcinoma of various origins, making it hard for a conclusive diagnosis. Even though inconclusive, immunohistochemistry can play a significant role in identifying urachal carcinoma. Most cases show the biomarkers CK20 and CDX2, whereas CK7 and β-catenin are expressed at a lesser frequency. Due to the few cases available, there is a lack of evidence regarding specific markers differentiating urachal carcinoma from colorectal or primary bladder adenocarcinomas. In addition to immunohistochemistry, genomic characterization is emerging to play a role in the classification and treatment of the disease. Urachal carcinoma has been reported to have a molecular level similarity with colorectal malignancies regarding certain gene expressions. The TP53 mutations inactivating the tumor suppressor can probably be explored as a possible target in treating urachal carcinoma. Additionally, certain targets identified in gastric and breast cancer along with anti-HER2 treatment strategies can be explored. Immuno-oncology utilizes immune checkpoint inhibitors for the treatment of MSI-H tumors whereas a combination of tyrosine kinase inhibitors along with immune checkpoint inhibitors are being studied to treat MSI stable tumors. The article is an in-depth overview of urachal carcinoma addressing the current landscape with an emphasis on the future scenario.
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Ke C, Hu Z, Yang C. Preoperative accuracy of diagnostic evaluation of urachal carcinoma. Cancer Med 2023; 12:9106-9115. [PMID: 36734315 PMCID: PMC10166928 DOI: 10.1002/cam4.5648] [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: 11/01/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We analyzed the clinical data of patients with urachal carcinoma (UrC) in order to strengthen urologists' understanding of UrC and improve preoperative diagnosis. METHODS The clinical data of 37 patients with UrC admitted to our hospital from October 2005 to April 2022 were retrospectively analyzed, and 40 patients with urothelial carcinoma (UCa) of bladder were enrolled as the control group. We compared and analyzed the imaging, cystoscopy and immunohistochemistry, serum tumor markers, fluorescence in situ hybridization (FISH) of UrC and bladder UCa for early diagnosis and evaluation of diagnostic accuracy. RESULTS A total of 37 patients with UrC were enrolled in this study, including 30 males and seven females, with a median age of 52.00 (44.50-63.50) years. Imaging and cystoscopy suggest that UrC grows primarily outside the bladder cavity and is found in the middle line of the dome or anterior wall of the bladder. There was a significant difference in tumor location between the UrC group and the UCa group (10.13 mm vs. -7.06 mm, p < 0.001). Immunohistochemistry revealed that CK20 and CDX-2 were both diffusely and strongly positive. β-catenin was strongly positive in cytoplasm and membrane, but negative in nuclear staining. Carcinoembryonic antigen (CEA) and carbohydrate antigen 72-4 (CA724) expression levels were significantly higher in the UrC group than in the UCa group (p < 0.05). In the diagnosis of UrC, the area under the curve (AUC) of CEA combined with CA724 was the greatest. FISH's sensitivity in diagnosing UrC (5/7, 71.43%) was not significantly different from that of UCa (71.43% vs. 77.50%, p = 0.659). Imaging examination has the highest sensitivity and specificity among the accuracy evaluation of different diagnostic methods. CONCLUSIONS Imaging and cystoscopy are the powerful diagnostic methods for UrC. Serum tumor markers may assist in diagnosis, prognosis, and monitoring. Positive urine FISH can easily misdiagnose UrC as UCa.
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Affiliation(s)
- Chunjin Ke
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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13
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Varadi M, Nagy N, Reis H, Hadaschik B, Niedworok C, Modos O, Szendroi A, Ablat J, Black PC, Keresztes D, Csizmarik A, Olah C, Gaisa NT, Kiss A, Timar J, Toth E, Csernak E, Gerstner A, Mittal V, Karkampouna S, Kruithof de Julio M, Gyorffy B, Bedics G, Rink M, Fisch M, Nyirady P, Szarvas T. Clinical sequencing identifies potential actionable alterations in a high rate of urachal and primary bladder adenocarcinomas. Cancer Med 2023; 12:9041-9054. [PMID: 36670542 PMCID: PMC10134276 DOI: 10.1002/cam4.5639] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Administration of targeted therapies provides a promising treatment strategy for urachal adenocarcinoma (UrC) or primary bladder adenocarcinoma (PBAC); however, the selection of appropriate drugs remains difficult. Here, we aimed to establish a routine compatible methodological pipeline for the identification of the most important therapeutic targets and potentially effective drugs for UrC and PBAC. METHODS Next-generation sequencing, using a 161 cancer driver gene panel, was performed on 41 UrC and 13 PBAC samples. Clinically relevant alterations were filtered, and therapeutic interpretation was performed by in silico evaluation of drug-gene interactions. RESULTS After data processing, 45/54 samples passed the quality control. Sequencing analysis revealed 191 pathogenic mutations in 68 genes. The most frequent gain-of-function mutations in UrC were found in KRAS (33%), and MYC (15%), while in PBAC KRAS (25%), MYC (25%), FLT3 (17%) and TERT (17%) were recurrently affected. The most frequently affected pathways were the cell cycle regulation, and the DNA damage control pathway. Actionable mutations with at least one available approved drug were identified in 31/33 (94%) UrC and 8/12 (67%) PBAC patients. CONCLUSIONS In this study, we developed a data-processing pipeline for the detection and therapeutic interpretation of genetic alterations in two rare cancers. Our analyses revealed actionable mutations in a high rate of cases, suggesting that this approach is a potentially feasible strategy for both UrC and PBAC treatments.
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Affiliation(s)
- Melinda Varadi
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Nikolett Nagy
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Henning Reis
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany.,Institute of Pathology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Christian Niedworok
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Orsolya Modos
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Attila Szendroi
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Jason Ablat
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - David Keresztes
- Department of Urology, Semmelweis University, Budapest, Hungary.,Department of Molecular Biology, Institute of Biochemistry and Molecular Biology, Semmelweis University, Budapest, Hungary
| | - Anita Csizmarik
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Csilla Olah
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Nadine T Gaisa
- Institute of Pathology, RWTH Aachen University, Aachen, Germany
| | - Andras Kiss
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Jozsef Timar
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
| | - Erika Toth
- National Institute of Oncology, Budapest, Hungary
| | | | | | - Vinay Mittal
- Thermo Fisher Scientific, Ann Arbor, Michigan, USA
| | - Sofia Karkampouna
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland
| | - Marianna Kruithof de Julio
- Department for BioMedical Research, Urology Research Laboratory, University of Bern, Bern, Switzerland.,Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Balazs Gyorffy
- Research Centre for Natural Sciences, Cancer Biomarker Research Group, Institute of Enzymology, Budapest, Hungary.,2nd Department of Pediatrics and Department of Bioinformatics, Semmelweis University, Budapest, Hungary
| | - Gabor Bedics
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Nyirady
- Department of Urology, Semmelweis University, Budapest, Hungary
| | - Tibor Szarvas
- Department of Urology, Semmelweis University, Budapest, Hungary.,Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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14
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Guerin M, Miran C, Colomba E, Cabart M, Herrmann T, Pericart S, Maillet D, Neuzillet Y, Deleuze A, Coquan E, Laramas M, Thibault C, Abbar B, Mesnard B, Borchiellini D, Dumont C, Boughalem E, Deville JL, Cancel M, Saldana C, Khalil A, Baciarello G, Flechon A, Walz J, Gravis G. Urachal carcinoma: a large retrospective multicentric study from the French Genito-Urinary Tumor Group. Front Oncol 2023; 13:1110003. [PMID: 36741023 PMCID: PMC9892758 DOI: 10.3389/fonc.2023.1110003] [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: 11/28/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
Introduction Urachal cancer (UrC) is a rare, non-urothelial malignancy. Its natural history and management are poorly understood. Although localized to the bladder dome, the most common histological subtype of UrC is adenocarcinoma. UrC develops from an embryonic remnant, and is frequently diagnosed in advanced stage with poor prognosis. The treatment is not standardized, and based only on case reports and small series. This large retrospective multicentric study was conducted by the French Genito-Urinary Tumor Group to gain a better understanding of UrC. Material and Methods data has been collected retrospectively on 97 patients treated at 22 French Cancer Centers between 1996 and 2020. Results The median follow-up was 59 months (range 44-96). The median age at diagnosis was 53 years (range 20-86), 45% were females and 23% had tobacco exposure. For patients with localized disease (Mayo I-II, n=46) and with lymph-node invasion (Mayo III, n=13) median progression-free-survival (mPFS) was 31 months (95% CI: 20-67) and 7 months (95% CI: 6-not reached (NR)), and median overall survival (mOS) was 73 months (95% CI: 57-NR) and 22 months (95% CI: 21-NR) respectively. For 45 patients with Mayo I-III had secondary metastatic progression, and 20 patients were metastatic at diagnosis. Metastatic localization was peritoneal for 54% of patients. Most patients with localized tumor were treated with partial cystectomy, with mPFS of 20 months (95% CI: 14-49), and only 12 patients received adjuvant therapy. Metastatic patients (Mayo IV) had a mOS of 23 months (95% CI: 19-33) and 69% received a platin-fluorouracil combination treatment. Conclusion UrC is a rare tumor of the bladder where patients are younger with a higher number of females, and a lower tobacco exposure than in standard urothelial carcinoma. For localized tumor, partial cystectomy is recommended. The mOS and mPFS were low, notably for patients with lymph node invasion. For metastatic patients the prognosis is poor and standard therapy is not well-defined. Further clinical and biological knowledge are needed.
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Affiliation(s)
- M. Guerin
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France,*Correspondence: M. Guerin,
| | - C. Miran
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - E. Colomba
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - M. Cabart
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | - T. Herrmann
- Department of Medical Oncology, Centre Jean-Perrin, Clermont-Ferrand, France
| | - S. Pericart
- Department of Anatomo-pathology, Institut Universitaire du Cancer, Centre Hospital-Universitaire de Toulouse, Toulouse, France
| | - D. Maillet
- Department of Medical Oncology, Centre hospitalo-Universitaire Hospices civils, Lyon, France
| | - Y. Neuzillet
- Department of Urology, Hopital Foch, Paris, France
| | - A. Deleuze
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - E. Coquan
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M. Laramas
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Grenoble, France
| | - C. Thibault
- Department of Medical Oncology, Hopital Europeen Georges Pompidou, Paris, France
| | - B. Abbar
- Department of Medical Oncology, Hopital Pitié-Salpetriere, Paris, France
| | - B. Mesnard
- Department of Urology, Centre Hospitalo-Universitaire, Nantes, France
| | - D. Borchiellini
- Department of Medical Oncology, Centre Lacassagne, Nice, France
| | - C. Dumont
- Department of Medical Oncology, Hopital Saint-Louis, Paris, France
| | - E. Boughalem
- Department of Medical Oncology, Centre Paul Papin, Angers, France
| | - JL. Deville
- Department of Medical Oncology, Centre Hospitalo-Universitaire Timone, Marseille, France
| | - M. Cancel
- Department of Medical Oncology, Centre Hospitalo-Universitaire Bretonneau, Tours, France
| | - C. Saldana
- Department of Medical Oncology, Hopital Henri Mondor, Paris, France
| | - A. Khalil
- Department of Medical Oncology, Hopital tenon, Paris, France
| | - G. Baciarello
- Department of Cancer Medicine, Institut Gustave-Roussy, University of Paris Saclay, Villejuif, France
| | - A. Flechon
- Department of Medical Oncology, Centre Leon-Berard, Lyon, France
| | - J. Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - G. Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
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15
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Ke C, Xu L, Wang M, Wang Y, Zhou Q, Chen J, Wang Z, Wang S, Hu Z, Yang C. Treatment options and prognostic risk factors for urachal carcinoma: A multicetnter retrospective study. Urol Oncol 2023; 41:50.e1-50.e9. [PMID: 36283930 DOI: 10.1016/j.urolonc.2022.09.017] [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: 06/23/2022] [Revised: 09/06/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Urachal carcinoma (UC) is a rare genitourinary cancer with an insidious onset, high risk of recurrence, and a poor prognosis. Surgical resection alone has difficulty in controlling the tumor. We aim to explore treatment options and prognostic risk factors for UC based on a multicenter cohort and long-term follow-up database. MATERIALS AND METHODS The clinical data, treatment and follow-up results of 163 patients with UC in 6 medical centers were analyzed retrospectively. Kaplan-Meier analysis and a Cox proportional hazards model were used to assess the treatment options and prognostic risk factors for UC. RESULTS Kaplan-Meier analysis showed no difference in the 5-year recurrence-free survival rate (P =0.282) or overall survival rate (P =0.673) between extended partial cystectomy (EPC) and radical cystectomy (RC) for patients at stage III and below. Whether bilateral pelvic lymph nodes were dissected was also not significantly correlated with the patient's recurrence (P =0.921) or prognosis (P =0.741). Postoperative adjuvant chemotherapy significantly reduced the recurrence rate of patients with stage Ⅲb or below (P =0.005). Combined treatment of postoperative recurrence patients prolonged the survival time of patients compared with single chemotherapy or conservative treatment (34.022±5.031 vs. 12.837±2.349 or 6.192±0.875 months, P <0.001). Kaplan-Meier and univariate Cox regression analyses showed that age >55 years, Sheldon stage, carbohydrate antigen 19-9 (CA19-9) >9.935 U/mL, carbohydrate antigen 72-4 (CA724) >6.02 U/mL, and postoperative adjuvant chemotherapy were closely related to the overall survival and recurrence-free survival of patients (P <0.05). Multivariate Cox proportional hazard regression confirmed that the Sheldon stage and CA724 >6.02 U/mL were independent recurrence risk factors. CONCLUSIONS EPC or RC provides similar oncologic results for UC, but bilateral pelvic lymph node dissection is not necessary in early-stage patients. Postoperative adjuvant chemotherapy can significantly reduce the recurrence rate, and combination therapy may provide better survival outcomes. CA724 can predict tumor recurrence or metastasis at an early stage.
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Affiliation(s)
- Chunjin Ke
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Lu Xu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Maoyu Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yinzhao Wang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Zhou
- Department of Urology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Science, Jinan, China
| | - Jinchao Chen
- Department of Urology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, China
| | - Zhihua Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
| | - Chunguang Yang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China.
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16
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Gandhi J, Chen JF, Al-Ahmadie H. Urothelial Carcinoma: Divergent Differentiation and Morphologic Subtypes. Surg Pathol Clin 2022; 15:641-659. [PMID: 36344181 PMCID: PMC9756812 DOI: 10.1016/j.path.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Urothelial carcinoma (UC) is known to encompass a wide spectrum of morphologic features and molecular alterations. Approximately 15% to 25% of invasive UC exhibits histomorphologic features in the form of "divergent differentiation" along other epithelial lineages, or different "subtypes" of urothelial or sarcomatoid differentiation. It is recommended that the percentage of divergent differentiation and or subtype(s) be reported whenever possible. Recent advances in molecular biology have led to a better understanding of the molecular underpinning of these morphologic variations. In this review, we highlight histologic characteristics of the divergent differentiation and subtypes recognized by the latest version of WHO classification, with updates on their molecular and clinical features.
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Affiliation(s)
- Jatin Gandhi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Jie-Fu Chen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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17
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UroVysionTM Fluorescence In Situ Hybridization in Urological Cancers: A Narrative Review and Future Perspectives. Cancers (Basel) 2022; 14:cancers14215423. [DOI: 10.3390/cancers14215423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
UroVysionTM is a fluorescence in situ hybridization assay that was developed for the detection of bladder cancer (UC accounted for 90%) in urine specimens. It consists of fluorescently labeled DNA probes to the pericentromeric regions of chromosomes 3, 7, 17 and to the 9p21 band location of the P16 tumor suppressor gene, which was approved by the Food and Drug Administration (FDA) in 2001 and 2005, respectively, for urine detection in patients with suspected bladder cancer and postoperative recurrence monitoring. Furthermore, recent studies also demonstrated that U-FISH was useful for assessing superficial bladder cancer patients’ response to Bacillus Calmette–Guérin therapy and in detecting upper tract urothelial carcinoma. Therefore, positive U-FISH was well known to urologists as a molecular cytogenetic technique for the detection of UC. However, with the continuous enrichment of clinical studies at home and abroad, U-FISH has shown a broader application space in the detection of various urinary primary tumors and even metastatic tumors. This review focuses on summarizing the research status of U-FISH in UC, non-urothelial carcinoma and metastatic tumor, so as to strengthen urologists’ more comprehensive understanding of the application value of U-FISH and better complete the accurate diagnosis and treatment of urological cancers.
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18
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Jardim DLF, Millis SZ, Ross JS, Lippman S, Ali SM, Kurzrock R. Comprehensive Landscape of Cyclin Pathway Gene Alterations and Co-occurrence with FGF/FGFR Aberrations Across Urinary Tract Tumors. Oncologist 2022; 28:e82-e91. [PMID: 36082904 PMCID: PMC9907036 DOI: 10.1093/oncolo/oyac180] [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: 05/09/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cyclin pathway gene alterations are frequent in urothelial tumors and may co-exist with other important aberrations, leading to therapeutic opportunities. We characterized the landscape of cyclin gene alterations in urothelial and non-urothelial urinary tract (UT) malignancies. PATIENTS AND METHODS Overall, 6842 urothelial and 897 non-urothelial UT cancers were analyzed (hybrid-capture-based comprehensive genomic profile (Foundation Medicine)). Alteration frequency in cyclin-sensitizing and -resistance genes, and co-occurrence with fibroblast growth factor receptor (FGFR) gene abnormalities were evaluated. RESULTS Cyclin-activating gene alterations were detected in 47.3% of urothelial and 37.9% of non-urothelial UT cancers. Frequency varied by histology and tumor site. CDKN2A and CDKN2B loss were the most frequent alterations in urothelial tumors (present in 38.5% and 30.4% of patients, respectively). Both genes were less frequently altered in adenocarcinomas (15.2% and 8.9%), but commonly altered in squamous cell carcinomas (74.4% and 39%). Tumors of neuroendocrine origin were relatively silent in activating cyclin alterations, but frequently displayed Rb1 alterations (86% and 83.7% of neuroendocrines and small cell carcinomas). Urachal tumors (n = 79) presented a distinct landscape of cyclin alterations relative to other UT cancers, with less frequent alterations overall. FGF/FGFR genes were altered in 34.9% of urothelial (22.1% in FGFR3), and 19.4% of non-urothelial urinary tract tumors (6.8% FGFR3). Cyclin-activating alterations frequently co-occurred with FGF/FGFR alterations but were in general mutually exclusively with cyclin resistance alterations (RB1/CCNE1). CONCLUSIONS Cyclin pathway activating alterations are common in urinary tract tumors, but frequency varies with histology and tumors sites. Co-occurrence of cyclin and FGFR pathway alterations may inform therapeutic opportunities.
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Affiliation(s)
- Denis L F Jardim
- Corresponding author: Denis L.F. Jardim, MD, PhD, Department of Clinical Oncology, Hospital Sirio Libanes, Adma Jafet Street, 91. Bela Vista, 01308-050, São Paulo, Brazil. Tel: +55 (11) 2344 3080;
| | | | - Jeffrey S Ross
- Foundation Medicine, Cambridge, MA, USA,Departments of Pathology and Urology, Upstate Medical University, Syracuse, NY, USA
| | - Scott Lippman
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, University of California, San Diego, CA, USA
| | | | - Razelle Kurzrock
- WIN Consortium for Personalized Cancer Therapy, Paris, France,Medical College of Wisconsin, Milwaukee, WI, USA,University of Nebraska (adjunct)
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19
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Demographic profiles and survival outcomes of patients with urachal adenocarcinoma: a rare tumor of the urachal remnant. Clin Genitourin Cancer 2022. [DOI: 10.1016/j.clgc.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Zaleski MP, Chen H, Roy-Chowdhuri S, Patel KP, Luthra R, Routbort MJ, Kamat AM, Gao J, Siefker-Radtke A, Czerniak B, Guo CC. Distinct Gene Mutations Are Associated With Clinicopathologic Features in Urachal Carcinoma. Am J Clin Pathol 2022; 158:263-269. [PMID: 35467000 PMCID: PMC9350833 DOI: 10.1093/ajcp/aqac039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 03/04/2022] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate the gene mutational profile of urachal carcinoma in correlation with its clinicopathologic features. METHODS We analyzed genetic mutations in 30 cases of urachal carcinoma by next-generation sequencing (NGS) test. Histologic slides and clinical data were reviewed. RESULTS The patients included 21 men and 9 women, with a mean age of 53 years (range, 24-75 years). The urachal carcinomas included mucinous (11), enteric (10), signet ring cell (8), and high-grade neuroendocrine (1) subtypes. Targeted NGS analysis demonstrated genetic mutations in all the urachal tumors (mean, 2; range, 1-4). TP53 was the most mutated gene (25), followed by KRAS (9) and GNAS (8) genes. TP53 mutations were more common in the signet ring cell subtype (7/8), and GNAS mutations were present only in the mucinous (5/11) and signet ring cell subtypes (3/8) but not in the enteric subtype (0/10). KRAS mutations were significantly associated with cancer stage IV (P = .02) and younger patient age (P = .046). Furthermore, the presence of KRAS mutations in urachal carcinoma portended a poorer overall survival (P = .006). CONCLUSIONS Urachal carcinoma demonstrates frequent gene mutations that are associated with distinct clinicopathologic features. Gene mutation may underlie the development and progression of this aggressive disease.
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Affiliation(s)
- Michael P Zaleski
- Department Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hui Chen
- Department Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- Department Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Keyur P Patel
- Department Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajyalakshmi Luthra
- Department Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark J Routbort
- Department Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jianjun Gao
- Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arlene Siefker-Radtke
- Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bogdan Czerniak
- Department Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Charles C Guo
- Department Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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21
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Wessolly M, Mairinger FD, Herold T, Hadaschik B, Szarvas T, Reis H. Proteasomal Processing Immune Escape Mechanisms in Platinum-Treated Advanced Bladder Cancer. Genes (Basel) 2022; 13:genes13030422. [PMID: 35327977 PMCID: PMC8948673 DOI: 10.3390/genes13030422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023] Open
Abstract
In recent years, the number and type of treatment options in advanced bladder cancer (BC) have been rapidly evolving. To select an effective therapy and spare unnecessary side effects, predictive biomarkers are urgently needed. As the host’s anti-cancer immune response is by far the most effective system to impede malignant tumor growth, immune system-based biomarkers are promising. We have recently described altered proteasomal epitope processing as an effective immune escape mechanism to impair cytotoxic T-cell activity. By altering the neoantigens’ characteristics through different proteasomal peptide cleavage induced by non-synonymous somatic mutations, the ability for T-cell activation was decreased (“processing escapes”). In the present study, we analyzed primary chemo-naïve tissue samples of 26 adjuvant platinum-treated urothelial BC patients using a targeted next-generation sequencing panel followed by the epitope determination of affected genes, a machine-learning based prediction of epitope processing and proteasomal cleavage and of HLA-affinity as well as immune activation. Immune infiltration (immunohistochemistries for CD8, granzyme B, CD45/LCA) was digitally quantified by a pathologist and clinico-pathological and survival data were collected. We detected 145 epitopes with characteristics of a processing escape associated with a higher number of CD8-positive but lower number of granzyme B-positive cells and no association with PD-L1-expression. In addition, a high prevalence of processing escapes was associated with unfavorable overall survival. Our data indicate the presence of processing escapes in advanced BC, potentially creating a tumor-promoting pro-inflammatory environment with lowered anti-cancerous activity and independence from PD-L1-expression. The data also need to be prospectively validated in BC treated with immune therapy.
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Affiliation(s)
- Michael Wessolly
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.W.); (F.D.M.); (T.H.)
| | - Fabian D. Mairinger
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.W.); (F.D.M.); (T.H.)
| | - Thomas Herold
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.W.); (F.D.M.); (T.H.)
| | - Boris Hadaschik
- Department of Urology, University Medicine Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.H.); (T.S.)
| | - Tibor Szarvas
- Department of Urology, University Medicine Essen, University of Duisburg-Essen, 45147 Essen, Germany; (B.H.); (T.S.)
- Department of Urology, Semmelweis University Budapest, 1085 Budapest, Hungary
| | - Henning Reis
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, 45147 Essen, Germany; (M.W.); (F.D.M.); (T.H.)
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-69-6301-4514
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22
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Zhang X, Wang S, Nie RC, Qu C, Chen J, Yang Y, Cai M. Immune Microenvironment Characteristics of Urachal Carcinoma and Its Implications for Prognosis and Immunotherapy. Cancers (Basel) 2022; 14:cancers14030615. [PMID: 35158883 PMCID: PMC8833550 DOI: 10.3390/cancers14030615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 02/01/2023] Open
Abstract
Urachal carcinoma (UrC) is an exceedingly rare tumor and lacks effective treatment. Herein, we characterized an immune microenvironment characteristic of UrC in detail and identified its implications for prognosis and immunotherapy. In total, 37 resections of UrC were stained for CD20, CD3, CD4, CD8, FOXP3, CD68, HLA-DR, CD163, PD1, and PD-L1, as well as mismatch repair protein including MSH2, MSH6, MLH1, and PMS2 by immunohistochemistry. Intratumoral and peritumoral immune cell densities or the proportion of PD1 and PD-L1 expression alongside MSH2, MSH6, MLH1, and PMS2 status were manually evaluated using the whole slide. UrC patients with the number of tertiary lymphoid structures (TLS) per slide tended to be higher in tumors with dMMR (p = 0.1919), and tumors with higher number of TLS tended to have longer OS (p = 0.0940) and DFS (p = 0.0700). High densities of CD3+ T, CD8+ T, and CD68+ cells were significantly associated with worse OS and DFS (both p<0.05). Increased intratumoral (p = 0.0111) and peritumoral (p = 0.0485) CD8+ T cell densities were significantly associated with PD-L1 expression or increasing proportion of PD-L1 expression on immune cells. Similarly, increased intratumoral (p = 0.0008) and peritumoral (p = 0.063) CD8+ T cell densities were significantly associated with increasing proportion of PD1 expression on immune cells. Tumors with PD-L1 positive expression on immune cells had a significantly increased proportion of PD1 expression (p = 0.0121). High peritumoral CD8+ T cell density (>73.7/mm2) was significantly associated with worse OS (p = 0.0120) and DFS (p = 0.00095). The number of TLS seems to be considered not only as histopathological characteristics in predicting MMR status of UrC, but also as a prognostic or therapeutic biomarker, and we also provide some important suggestions for targeting PD-1/PD-L1 checkpoint in UrC.
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Affiliation(s)
- Xinke Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
| | - Suijing Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
| | - Run-Cong Nie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
| | - Chunhua Qu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
| | - Jierong Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
| | - Yuanzhong Yang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
- Correspondence: (Y.Y.); (M.C.); Tel.: +86-20-8734-2274 (M.C.)
| | - Muyan Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (X.Z.); (S.W.); (R.-C.N.); (C.Q.); (J.C.)
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Guangzhou 510080, China
- Correspondence: (Y.Y.); (M.C.); Tel.: +86-20-8734-2274 (M.C.)
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23
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Chen M, Xue C, Huang RQ, Ni MQ, Li L, Li HF, Yang W, Hu AQ, Zheng ZS, An X, Shi Y. Treatment Outcome of Different Chemotherapy in Patients With Relapsed or Metastatic Malignant Urachal Tumor. Front Oncol 2021; 11:739134. [PMID: 34604084 PMCID: PMC8479186 DOI: 10.3389/fonc.2021.739134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background Malignant urachal tumor is a rare subtype of genitourinary cancer. Our aim was to explore the optimal chemotherapy regimens for relapsed or metastatic urachal carcinoma. Materials and Methods We retrospectively enrolled 24 adult patients with relapsed or metastatic urachal carcinoma from January 2014 to September 2020 at Sun Yat-sen University Cancer Center. We summarized the chemotherapy regimens and classified them as fluorouracil based, platinum based, and paclitaxel based. Nine patients received XELOX (capecitabine and oxaliplatin) regimens, seven patients received TX (paclitaxel and capecitabine) regimens, and eight of them received chemotherapy including GP (gemcitabine and cisplatin), TP (paclitaxel and cisplatin), TN (paclitaxel and nedaplatin), and tislelizumab. Results The disease control rate was 75%. Among all patients, one patient treated with XELOX achieved partial remission (PR), while 17 patients showed stable disease. The median progression-free survival (PFS) and overall survival (OS) in all treated patients was 7.43 and 29.7 months, respectively. The patients receiving first-line platinum-based chemotherapy presented better PFS than those without platinum (median PFS 8.23 vs. 3.80 months, p = 0.032), but not significant for OS between two groups. There is no significant difference in PFS and OS for fluorouracil-based and paclitaxel-based groups as first-line regimen. Next-generation gene sequencing revealed TP53 mutation and low tumor mutational burden in five out of seven cases. Conclusion The platinum-based chemotherapy regimen is effective for relapsed or metastatic urachal carcinoma.
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Affiliation(s)
- Meiting Chen
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Cong Xue
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ri-Qing Huang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Meng-Qian Ni
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lu Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hai-Feng Li
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Yang
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - An-Qi Hu
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhou-San Zheng
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xin An
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yanxia Shi
- Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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24
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Yu X, Ma C, Wang M, Ying Y, Zhang Z, Ai X, Wang L, Zeng S, Xu C. Construction and Validation of Novel Prediction Tools Based on Large Population-Based Database to Predict the Prognosis of Urachal Cancer After Surgery. Front Oncol 2021; 11:718691. [PMID: 34595114 PMCID: PMC8476958 DOI: 10.3389/fonc.2021.718691] [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: 06/01/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022] Open
Abstract
Background Urachal cancer is a rare neoplasm in the urological system. To our knowledge, no published study has explored to establish a model for predicting the prognosis of urachal cancer. The present study aims to develop and validate nomograms for predicting the prognosis of urachal cancer based on clinicopathological parameters. Methods Based on the data from the Surveillance, Epidemiology, and End Results database, 445 patients diagnosed with urachal cancer between 1975 and 2018 were identified as training and internal validation cohort; 84 patients diagnosed as urachal cancer from 2001 to 2020 in two medical centers were collected as external validation cohort. Nomograms were developed using a multivariate Cox proportional hazards regression analysis in the training cohort, and their performance was evaluated in terms of its discriminative ability, calibration, and clinical usefulness by statistical analysis. Results Three nomograms based on tumor–node–metastasis (TNM), Sheldon and Mayo staging system were developed for predicting cancer-specific survival (CSS) of urachal cancer; these nomograms all showed similar calibration and discrimination ability. Further internal (c-index 0.78) and external (c-index 0.81) validation suggested that Sheldon model had superior discrimination and calibration ability in predicting CSS than the other two models. Moreover, we found that the Sheldon model was able to successfully classify patients into different risk of mortality both in internal and external validation cohorts. Decision curve analysis proved that the nomogram was clinically useful and applicable. Conclusions The nomogram model with Sheldon staging system was recommended for predicting the prognosis of urachal cancer. The proposed nomograms have promising clinical applicability to help clinicians on individualized patient counseling, decision-making, and clinical trial designing.
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Affiliation(s)
- Xiaowen Yu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China.,Department of Geriatrics, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chong Ma
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Maoyu Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yidie Ying
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhensheng Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xing Ai
- Senior Department of Urology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Linhui Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shuxiong Zeng
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
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25
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Shao G, Xu C, Liu J, Li X, Li L, Li X, Zhang X, Fan Y, Zhou L. Clinical, Pathological, and Prognostic Analysis of Urachal Carcinoma. Urol Int 2021; 106:199-208. [PMID: 34515250 DOI: 10.1159/000518028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to improve understanding the clinical, pathologic, and prognostic features of urachal carcinoma (UrC), a retrospectively descriptive study was done in 2 clinical centers. METHODS After excluding the 2 missed patients, the clinical and pathological data of 59 patients with UrC, who were diagnosed or treated at 2 clinical centers between 1986 and 2019, was retrospectively analyzed. SPSS 22.0 (IBM) and GraphPad Prism 8.0.1 were used for statistics and data visualization. Survival data were analyzed by the Kaplan-Meier method and Log-rank tests. Cox proportional hazards regression were performed for find risk factors on predicting the prognosis. RESULTS Of all 59 patients, 47 were male and 12 were female. The median age at diagnosis was 51.6 years (range: 22-84 years). Gross hematuria was the most common symptom (79.66%). The majority of urachal neoplasms were adenocarcinomas (94.92%). Forty-two patients (72.41%) underwent extended partial cystectomy with en bloc resection of the entire urachus. The mean follow-up was 52 months (3-277 months). Median overall survival was 52.8 months (4-93 months). The 3-year cancer-specific survival (CSS) rate and 5-year CSS rate were 69.1% and 61.2%. There was no significant difference among localized T stage, tumor histologic grade and surgical procedures in determining prognosis by survival analyze. While patients with high-risk TNM stage (local abdominal metastasis, lymph node metastasis, or distant metastasis) (p = 0.003) and positive surgical margin (p < 0.001) had significantly worse prognosis. CONCLUSIONS The results indicate that high-risk TNM stage and positive surgical margin are risk predictors of prognosis. Localized T stage, histologic grade, and surgical procedure cause no significant effect on patient prognosis. The extended partial cystectomy is the recommended surgical approach for patients with UrC. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.
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Affiliation(s)
- Guangjun Shao
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China,
| | - Chunru Xu
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Jikai Liu
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Luchao Li
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaofeng Li
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaoqing Zhang
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
| | - Yidong Fan
- Department of Urology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Beijing, China.,Institute of Urology, Peking University, Beijing, China.,National Urological Cancer Center, Beijing, China
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26
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Voutsadakis IA. Successful treatment of locally advanced urachal adenocarcinoma with peri-operative gemcitabine - cisplatin combination therapy: a case report and perspective on targeted therapies. Cent European J Urol 2020; 73:476-481. [PMID: 33552573 PMCID: PMC7848837 DOI: 10.5173/ceju.2020.0176] [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: 06/15/2020] [Revised: 10/23/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] Open
Abstract
Urachal adenocarcinoma is a rare cancer and is treated based on the experience from case series and expert opinion as no randomized studies have been performed. This report adds to the current literature the experience of a patient with locally advanced urachal adenocarcinoma who was treated with combination of neoadjuvant gemcitabine/ cisplatin chemotherapy, surgery and adjuvant chemotherapy and has obtained a long recurrence free survival currently for more than 5 years. Although 5-FU-based chemotherapy is favored by many experts in the treatment of metastatic urachal adenocarcinoma, gemcitabine-based regimens have produced partial responses in metastatic disease and have been used in peri-operative treatment with a manageable adverse effect profile. A brief discussion of molecular lesions in urachal carcinomas and of the emerging role of targeted therapies is included in the current report.
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Affiliation(s)
- Ioannis A Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, Sault Ste. Marie, Ontario, Canada, and Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, Ontario, Canada
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27
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Nagy N, Reis H, Hadaschik B, Niedworok C, Módos O, Szendrői A, Bíró K, Hager T, Herold T, Ablat J, Black PC, Okon K, Tolkach Y, Csizmarik A, Oláh C, Keresztes D, Bremmer F, Gaisa NT, Kriegsmann J, Kovalszky I, Kiss A, Tímár J, Szász MA, Rink M, Fisch M, Nyirády P, Szarvas T. Prevalence of APC and PTEN Alterations in Urachal Cancer. Pathol Oncol Res 2020; 26:2773-2781. [PMID: 32754865 PMCID: PMC7471184 DOI: 10.1007/s12253-020-00872-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
Urachal carcinoma (UrC) is a rare tumor with remarkable histological and molecular similarities to colorectal cancer (CRC). Adenomatous polyposis coli (APC) is the most frequently affected gene in CRC, but the prevalence and significance of its alterations in UrC is poorly understood. In addition, loss of phosphatase and tensin homologue (PTEN) was shown to be associated with therapy resistance in CRC. Our primary aim was to assess specific genetic alterations including APC and PTEN in a large series of UrC samples in order to identify clinically significant genomic alterations. We analyzed a total of 40 UrC cases. Targeted 5-gene (APC, PTEN, DICER1, PRKAR1A, TSHR, WRN) panel sequencing was performed on the Illumina MiSeq platform (n = 34). In addition, ß-catenin (n = 38) and PTEN (n = 30) expressions were assessed by immunohistochemistry. APC and PTEN genes were affected in 15% (5/34) and 6% (2/34) of cases. Two of five APC alterations (p.Y1075*, p.K1199*) were truncating pathogenic mutations. One of the two PTEN variants was a pathogenic frameshift insertion (p.C211fs). In 29% (11/38) of samples, at least some weak nuclear ß-catenin immunostaining was detected and PTEN loss was observed in 20% (6/30) of samples. The low prevalence of APC mutations in UrC represents a characteristic difference to CRC. Based on APC and ß-catenin results, the Wnt pathway seems to be rarely affected in UrC. Considering the formerly described involvement of PTEN protein loss in anti-EGFR therapy-resistance its immunohistochemical testing may have therapeutic relevance.
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Affiliation(s)
- Nikolett Nagy
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | - Henning Reis
- Institute of Pathology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147, Essen, Germany
| | - Boris Hadaschik
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147, Essen, Germany
| | - Christian Niedworok
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147, Essen, Germany
| | - Orsolya Módos
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | - Attila Szendrői
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | | | - Thomas Hager
- Institute of Pathology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147, Essen, Germany
| | - Thomas Herold
- Institute of Pathology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147, Essen, Germany
| | - Jason Ablat
- Vancouver Prostate Centre, University of British Columbia, Vancouver, V6H 3Z6, Canada
| | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, V6H 3Z6, Canada
| | - Krzysztof Okon
- Department of Pathomorphology, Jagiellonian University, 30252, Cracow, Poland
| | - Yuri Tolkach
- Institute of Pathology, University of Bonn, 53113, Bonn, Germany
| | - Anita Csizmarik
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | - Csilla Oláh
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | - David Keresztes
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | - Felix Bremmer
- Institute of Pathology, University of Göttingen, 37073, Göttingen, Germany
| | - Nadine T Gaisa
- Institute of Pathology, RWTH Aachen University, 52074, Aachen, Germany
| | - Joerg Kriegsmann
- Cytology and Molecular Diagnostics Trier, Center for Histology, 54296, Trier, Germany
| | - Ilona Kovalszky
- 1st Institute of Pathology and Expreimental Cancer Research, Semmelweis University, Budapest, 1085, Hungary
| | - András Kiss
- 2nd Department of Pathology, Semmelweis University, Budapest, 1091, Hungary
| | - József Tímár
- 2nd Department of Pathology, Semmelweis University, Budapest, 1091, Hungary
| | - Marcell A Szász
- Cancer Center, Semmelweis University, Budapest, 1083, Hungary
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Péter Nyirády
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary
| | - Tibor Szarvas
- Department of Urology, Semmelweis University, Budapest, 1082, Hungary.
- Department of Urology, West German Cancer Center, University of Duisburg-Essen, University Hospital Essen, 45147, Essen, Germany.
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28
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Maurer A, Ortiz-Bruechle N, Guricova K, Rose M, Morsch R, Garczyk S, Stöhr R, Bertz S, Golz R, Reis H, Bremmer F, Zimpfer A, Siegert S, Kristiansen G, Schwamborn K, Gassler N, Knuechel R, Gaisa NT. Comparative genomic profiling of glandular bladder tumours. Virchows Arch 2020; 477:445-454. [PMID: 32198650 PMCID: PMC7443184 DOI: 10.1007/s00428-020-02787-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
Primary glandular bladder tumours (bladder adenocarcinoma [BAC], urachal adenocarcinoma [UAC], urothelial carcinoma with glandular differentiation [UCg]) are rare malignancies with histological resemblance to colorectal adenocarcinoma (CORAD) in the majority of this subgroup. Definite case numbers are very low, molecular data are limited and the pathogenesis remains poorly understood. Therefore, this study was designed to complement current knowledge by in depth analysis of BAC (n = 12), UAC (n = 13), UCg (n = 11) and non-invasive glandular lesions (n = 19). In BAC, in addition to known alterations in TP53, Wnt, MAP kinase and MTOR pathway, mutations in SMAD4, ARID1A and BRAF were identified. Compared to published data on muscle invasive bladder cancer (BLCA) and CORAD, UCg exhibited frequent "urothelial" like alterations while BAC and UAC were characterised by a more "colorectal" like mutational pattern. Immunohistochemically, there was no evidence of DNA mismatch repair deficiency or PD-L1 tumour cell positivity in any sample. Depending on the used antibody 0-45% of BAC, 0-30% of UCg and 0% UAC cases exhibited PD-L1 expressing tumour associated immune cells. A single BAC (9%, 1/11) showed evidence of ARID1A protein loss, and two cases of UCg (20%, 2/10) showed loss of SMARCA1 and PBRM1, respectively. Taken together, our data suggest at least in part involvement of similar pathways driving tumourigenesis of adenocarcinomas like BAC, UAC and CORAD independent of their tissue origin. Alterations of TERT and FBXW7 in single cases of intestinal metaplasia further point towards a possible precancerous character in line with previous reports.
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Affiliation(s)
- Angela Maurer
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadina Ortiz-Bruechle
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Karolina Guricova
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Michael Rose
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ronja Morsch
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
- Department of Urology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Stefan Garczyk
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Robert Stöhr
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen, Erlangen, Germany
| | - Reinhard Golz
- Institute of Pathology, HELIOS Clinic Wuppertal, Wuppertal, Germany
| | - Henning Reis
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Felix Bremmer
- Institute of Pathology, University Medical Center, University of Göttingen, Göttingen, Germany
| | - Annette Zimpfer
- Institute of Pathology, University Medical Center Rostock, Rostock, Germany
| | | | | | | | - Nikolaus Gassler
- Institute of Legal Medicine, Section Pathology, University Hospital Jena, Jena, Germany
| | - Ruth Knuechel
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Nadine T Gaisa
- Institute of Pathology, University Hospital RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
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Mollica V, Maggio I, Lopez-Beltran A, Montironi R, Cimadamore A, Cheng L, Rizzo A, Giunchi F, Schiavina R, Fiorentino M, Brunocilla E, Massari F. Combination therapy in advanced urothelial cancer: the role of PARP, HER-2 and mTOR inhibitors. Expert Rev Anticancer Ther 2020; 20:755-763. [PMID: 32757789 DOI: 10.1080/14737140.2020.1807334] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Despite significant advances in the treatment of metastatic urothelial carcinoma, including the advent of immune checkpoint inhibitors, this disease is still challenging to treat and associated poor outcomes remain. Genomic characterization of advanced-stage urothelial carcinoma is widening the field of potential treatments due to the identification of novel biologic drivers. AREAS COVERED In this review, we explore the role of PARP, HER-2, and mTOR inhibitors in the therapeutic scenario of advanced urothelial carcinoma, as these pathways are frequently altered in urothelial carcinoma. We report ongoing clinical trials involving these agents, either in monotherapy or in combination with other compounds, highlighting the dynamic scenario of metastatic urothelial carcinoma treatment. EXPERT OPINION Several challenges need to be faced in the development of new potential therapeutic strategies, such as inter/intratumoral heterogeneity and the lack of validated biomarkers.
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Affiliation(s)
- Veronica Mollica
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni , Bologna, Italy
| | - Ilaria Maggio
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni , Bologna, Italy
| | - Antonio Lopez-Beltran
- Unit of Anatomical Pathology, Faculty of Medicine, Cordoba University , Cordoba, Spain
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals , Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine , Indianapolis, IN, USA
| | - Alessandro Rizzo
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni , Bologna, Italy
| | - Francesca Giunchi
- Pathology Service, Addarii Institute of Oncology, S-Orsola-Malpighi Hospital , Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital , Bologna, Italy
| | | | - Eugenio Brunocilla
- Department of Urology, University of Bologna, S-Orsola-Malpighi Hospital , Bologna, Italy
| | - Francesco Massari
- Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni , Bologna, Italy
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30
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Hager T, Kraywinkel K, Szarvas T, Hadaschik B, Schmid KW, Reis H. Urachal Cancer in Germany and the USA: An RKI/SEER Population-Based Comparison Study. Urol Int 2020; 104:803-809. [PMID: 32784300 DOI: 10.1159/000509481] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Urachal cancer (UrC) is a rare but aggressive cancer. Due to its low incidence, structured epidemiological data have only rarely been reported. To date, no valid data on UrC are available for the German population. METHODS Data on incidence and relative 5-year survival of urachal lesions (ICD-10: C67.7) were collected from all population-based cancer registries in Germany, provided by the Robert Koch-Institut (RKI). Data were anonymized and included age, sex, and general histology (ICD-O-3). For comparison, a similar inquiry of the "Surveillance, Epidemiology, and End Results program" (SEER-18) database for the USA was conducted. RESULTS From 2011 to 2015, a total of 154 and 152 cases of UrC were reported for Germany (RKI) and the USA (SEER-18 area), respectively. Age-standardized incidence was 0.32/1,000,000 age-standardized cases/year in both cohorts, and elderly persons were more often affected. The major histological type was adenocarcinoma (64.9 and 81.6%). Relative 5-year survival was 54.8% (CI: 45.0-64.6) in Germany (RKI) and 64.4% (54.1-72.1) in the USA (SEER-18 cohort). Discusssion/Conclusion: The collected data demonstrate low incidence rates and similar epidemiological and clinicopathological characteristics of UrC for both registries. This is the first report of structured epidemiological data for UrC for the German population.
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Affiliation(s)
- Thomas Hager
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Tibor Szarvas
- Department of Urology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany.,Clinic of Urology, Semmelweis University, Budapest, Hungary
| | - Boris Hadaschik
- Department of Urology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Kurt Werner Schmid
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany
| | - Henning Reis
- Institute of Pathology, University Medicine Essen, University of Duisburg-Essen, Essen, Germany,
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31
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Grilo I, Rodrigues C, Soares A, Grande E. Facing treatment of non-urothelial bladder cancers in the immunotherapy era. Crit Rev Oncol Hematol 2020; 153:103034. [PMID: 32622321 DOI: 10.1016/j.critrevonc.2020.103034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022] Open
Abstract
Non-urothelial Bladder Cancer (BC) and variants of urothelial carcinoma account for up to 25 % of all BCs. Given their heterogeneity, these entities are not well represented in clinical trials and treatment remains challenging. Checkpoint inhibitor therapy has shown a role in the treatment of urothelial BC. By contrast, robust evidence regarding its use in other histological types is lacking. We aimed to provide a comprehensive update of non-urothelial and variant urothelial BC, exploring the evidence for immune checkpoint inhibitor therapy. A detailed analysis of the literature was conducted regarding epidemiology, aetiology, diagnosis, prognosis, treatment and outcomes of these patients in the immunotherapy era. A growing body of evidence suggests that immune checkpoint inhibition might have a role to play in non-urothelial BC, similarly to what happened with urothelial carcinomas.
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Affiliation(s)
- I Grilo
- Medical Oncology Department, Centro Hospitalar de Trás-os-Montes e Alto Douro, EPE, Vila Real, Portugal
| | - C Rodrigues
- Medical Oncology Department, Centro Hospitalar de Entre o Douro e Vouga, EPE, Sta Maria da Feira, Portugal
| | - A Soares
- Medical Oncology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - E Grande
- Medical Oncology Department, MD Anderson Cancer Center Madrid, Madrid, Spain.
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32
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Mäkelä R, Arjonen A, Härmä V, Rintanen N, Paasonen L, Paprotka T, Rönsch K, Kuopio T, Kononen J, Rantala JK. Ex vivo modelling of drug efficacy in a rare metastatic urachal carcinoma. BMC Cancer 2020; 20:590. [PMID: 32576176 PMCID: PMC7313172 DOI: 10.1186/s12885-020-07092-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Ex vivo drug screening refers to the out-of-body assessment of drug efficacy in patient derived vital tumor cells. The purpose of these methods is to enable functional testing of patient specific efficacy of anti-cancer therapeutics and personalized treatment strategies. Such approaches could prove powerful especially in context of rare cancers for which demonstration of novel therapies is difficult due to the low numbers of patients. Here, we report comparison of different ex vivo drug screening methods in a metastatic urachal adenocarcinoma, a rare and aggressive non-urothelial bladder malignancy that arises from the remnant embryologic urachus in adults. METHODS To compare the feasibility and results obtained with alternative ex vivo drug screening techniques, we used three different approaches; enzymatic cell viability assay of 2D cell cultures and image-based cytometry of 2D and 3D cell cultures in parallel. Vital tumor cells isolated from a biopsy obtained in context of a surgical debulking procedure were used for screening of 1160 drugs with the aim to evaluate patterns of efficacy in the urachal cancer cells. RESULTS Dose response data from the enzymatic cell viability assay and the image-based assay of 2D cell cultures showed the best consistency. With 3D cell culture conditions, the proliferation rate of the tumor cells was slower and potency of several drugs was reduced even following growth rate normalization of the responses. MEK, mTOR, and MET inhibitors were identified as the most cytotoxic targeted drugs. Secondary validation analyses confirmed the efficacy of these drugs also with the new human urachal adenocarcinoma cell line (MISB18) established from the patient's tumor. CONCLUSIONS All the tested ex vivo drug screening methods captured the patient's tumor cells' sensitivity to drugs that could be associated with the oncogenic KRASG12V mutation found in the patient's tumor cells. Specific drug classes however resulted in differential dose response profiles dependent on the used cell culture method indicating that the choice of assay could bias results from ex vivo drug screening assays for selected drug classes.
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Affiliation(s)
- Rami Mäkelä
- Misvik Biology Ltd, Karjakatu 35 B, FI-20520, Turku, Finland
| | - Antti Arjonen
- Misvik Biology Ltd, Karjakatu 35 B, FI-20520, Turku, Finland.,Brinter Ltd, Turku, Finland
| | - Ville Härmä
- Misvik Biology Ltd, Karjakatu 35 B, FI-20520, Turku, Finland.,University of Sheffield, Sheffield, UK
| | - Nina Rintanen
- Central Finland Health Care District, Jyväskylä, Finland
| | | | - Tobias Paprotka
- Eurofins Genomics Europe Sequencing GmbH, Constance, Germany
| | - Kerstin Rönsch
- Eurofins Genomics Europe Sequencing GmbH, Constance, Germany
| | - Teijo Kuopio
- Central Finland Health Care District, Jyväskylä, Finland
| | - Juha Kononen
- Central Finland Health Care District, Jyväskylä, Finland.,Docrates Hospital, Helsinki, Finland
| | - Juha K Rantala
- Misvik Biology Ltd, Karjakatu 35 B, FI-20520, Turku, Finland. .,University of Sheffield, Sheffield, UK.
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Alderson M, Grivas P, Milowsky MI, Wobker SE. Histologic Variants of Urothelial Carcinoma: Morphology, Molecular Features and Clinical Implications. Bladder Cancer 2020. [DOI: 10.3233/blc-190257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bladder cancer is a heterogeneous disease including conventional urothelial carcinoma (UC) and its histologic variants, and non-urothelial carcinoma, including squamous and glandular neoplasms. Urothelial carcinoma accounts for the majority of bladder cancer cases, but morphologic variants are common and include nested, microcystic, micropapillary, lymphoepithelioma-like, plasmacytoid, sarcomatoid, giant cell, undifferentiated, clear cell and lipoid. Certain variants of UC tend to be associated with a poor prognosis and have diagnostic and potential treatment implications that make the identification of variant histology crucial to clinical decision making. While there is still uncertainty regarding the prognostic implications of many of these variants, identifying and reporting variant histology is important to develop our understanding of their biology. Unique molecular features accompany many of these morphologic variants and to better understand these tumors, we review the molecular and clinical implications of histologic variants of bladder cancer. Major efforts are underway to include variant histology and divergent differentiation of UC in clinical trials to develop evidence based approaches to treatment. The purpose of this article is to review the current literature on variant histology of urothelial cancer and to highlight molecular findings and the clinical relevance of these tumors.
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Affiliation(s)
- Meera Alderson
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Petros Grivas
- University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Matthew I. Milowsky
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Sara E. Wobker
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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34
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Meeks JJ, Al-Ahmadie H, Faltas BM, Taylor JA, Flaig TW, DeGraff DJ, Christensen E, Woolbright BL, McConkey DJ, Dyrskjøt L. Genomic heterogeneity in bladder cancer: challenges and possible solutions to improve outcomes. Nat Rev Urol 2020; 17:259-270. [PMID: 32235944 PMCID: PMC7968350 DOI: 10.1038/s41585-020-0304-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
Histological and molecular analyses of urothelial carcinoma often reveal intratumoural and intertumoural heterogeneity at the genomic, transcriptional and cellular levels. Despite the clonal initiation of the tumour, progression and metastasis often arise from subclones that can develop naturally or during therapy, resulting in molecular alterations with a heterogeneous distribution. Variant histologies in tumour tissues that have developed distinct morphological characteristics divergent from urothelial carcinoma are extreme examples of tumour heterogeneity. Ultimately, heterogeneity contributes to drug resistance and relapse after therapy, resulting in poor survival outcomes. Mutation profile differences between patients with muscle-invasive and metastatic urothelial cancer (interpatient heterogeneity) probably contribute to variability in response to chemotherapy and immunotherapy as first-line treatments. Heterogeneity can occur on multiple levels and averaging or normalizing these alterations is crucial for clinical trial and drug design to enable appropriate therapeutic targeting. Identification of the extent of heterogeneity might shape the choice of monotherapy or additional combination treatments to target different drivers and genetic events. Identification of the lethal tumour cell clones is required to improve survival of patients with urothelial carcinoma.
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Affiliation(s)
- Joshua J Meeks
- Departments of Urology and Biochemistry, Molecular Genetics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Bishoy M Faltas
- Department of Medicine and Department of Cell and Developmental biology, Weill-Cornell Medicine, New York, NY, USA
| | - John A Taylor
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - David J DeGraff
- Departments of Pathology, Biochemistry & Molecular Biology and Surgery, Division of Urology, Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Emil Christensen
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | | | - David J McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus N, Denmark
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Abstract
PURPOSE OF REVIEW Molecular characterization of cancer allows us to understand oncogenesis and clinical prognosis as well as facilitates development of biomarkers and treatment. Our aim was to review the current literature on genomic characterization of bladder cancer, and how far we are in implementing genomics into clinical practice. RECENT FINDINGS Bladder cancers are molecularly diverse tumors with a high mutational rate. On molecular level, bladder cancer can be categorized into at least six subtypes called luminal-papillary, luminal-unstable, luminal non-specified, basal-squamous, neuroendocrine-like, and stroma-rich. These subtypes have characteristic genomic and transcriptomic profiles and appear to have different prognoses. Several molecular subtypes have been identified in bladder cancer. Prospective trials are underway to validate the applicability of genomic subtypes for clinical decision making. Further integrative analyses of genomic alterations, gene expression, epigenetics, and proteomics need to be performed before genomic subtyping can be attained in clinical practice.
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Affiliation(s)
- Tuomas Jalanko
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.,Department of Urology, Helsinki University, Helsinki, Finland
| | - Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
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36
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Ingenwerth M, Goetz M, Schmid KW, Theurer S. The mismatch repair system is not affected in medullary thyroid carcinoma independent of stromal desmoplasia or ret proto-oncogene mutation. Ann Diagn Pathol 2019; 44:151445. [PMID: 31862521 DOI: 10.1016/j.anndiagpath.2019.151445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/07/2019] [Accepted: 12/02/2019] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Medullary thyroid carcinoma (MTC) is an aggressive neuroendocrine neoplasia of the thyroid with 10 year overall survival of 50% and limited therapeutic options. High tumor mutational burden because of microsatellite instability (MSI) seems to be a predictor of response to immune checkpoint inhibitor therapy in different tumors. Therefor in 2017 the U.S. Food and Drug Administration (FDA) permitted the therapy of solid tumors with proven Microsatellite instability (MSI) with PD1 antibody Pembrolizumab independently of their origin. As little is known about MSI in MTC and new therapeutic strategies would be eligible we tried to find out, if therapy with PD1-inhibitors could be promising. MATERIAL AND METHODS We performed MSI-analyses of 38 cases of MTC. Included were MTCs with and without stromal desmoplasia and with/without lymph node metastases. We also checked the immunhistochemical expression of PD-L-1 and performed next generation sequencing for genetic alterations. RESULTS All cases revealed stable conditions of the microsatellites and showed immunohistochemically positive staining of the four mismatch repair proteins. PD-L-1- Immunostaining was negative in all cases. DISCUSSION Our data show there is no MSI in MTCs, irrespectively of their status of desmoplasia, metastases and/or ret-mutation. Therefore a positive effect of PD1 inhibitors, because of MSI-associated high tumor mutational burden, seems to be unlikely.
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Affiliation(s)
- Marc Ingenwerth
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Moritz Goetz
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Kurt W Schmid
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany
| | - Sarah Theurer
- Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen, Germany.
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37
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[Urachal Cancer: an update of current molecular findings]. DER PATHOLOGE 2019; 40:239-243. [PMID: 31705235 DOI: 10.1007/s00292-019-00689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urachal cancer is a rare type of cancer, often following a clinically aggressive course. Due to its rarity, knowledge about its molecular background is still limited. In addition, no sufficiently reliable diagnostic markers are available. OBJECTIVES The aim of the present study is to give an overview of our recent molecular projects on urachal cancer and to connect it with current literature in the field. MATERIALS AND METHODS Three projects are introduced. The first project identified and validated diagnostic biomarkers in urachal adenocarcinomas compared to colorectal adenocarcinomas and primary adenocarcinomas of the bladder using various proteomic methods. In the second project, the most relevant differential diagnostic markers between urachal adenocarcinomas and colorectal adenocarcinomas compared to normal tissue (urachal remnants) were determined by analyzing a miRNA panel. Sequence analyses were performed in the third project. The focus was on molecular differences to colorectal adenocarcinomas and urothelial carcinomas. RESULTS AND CONCLUSIONS We detected potential biomarker candidates for the immunohistochemical differential-diagnosis and generated a miRNA-based diagnostic scoring system with a potentially high differential-diagnostic significance. The sequence analyses data confirm the molecular autonomy of the urachal adenocarcinomas compared to other entities.
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38
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Jones D, Guan JJ, Calagua C, Hansel DE, Epstein JI, Ye H. Primary adenocarcinoma of the bladder lacks mismatch repair deficiency and demonstrates PD-L1 expression in tumor-infiltrating immune cells, with implications in both diagnosis and therapeutics. Hum Pathol 2019; 94:58-63. [PMID: 31666198 DOI: 10.1016/j.humpath.2019.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/21/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022]
Abstract
Primary adenocarcinoma of the bladder is a rare and highly aggressive disease with no standard therapy. Effectiveness of immune checkpoint blockade in bladder adenocarcinoma is unknown due to lack of clinical trials. Due to the disease rarity, the rate of PD-L1 expression and DNA mismatch repair deficiency is largely unknown. In this study, we examined PD-L1 expression in 56 cases of bladder adenocarcinoma and mismatch repair protein expression in 42 cases of bladder adenocarcinoma using immunohistochemistry. Mismatch repair protein expression was uniformly intact in all cases of bladder adenocarcinoma, in comparison with 19% of advanced colorectal adenocarcinoma being mismatch repair deficient. This finding indicates that mismatch repair proteins may be combined with β-catenin and GATA-3 to create an immunostaining panel which, in addition to clinical studies, can aid in distinguishing bladder adenocarcinoma from secondary involvement by colorectal carcinoma. 4% of cases were found to overexpress PD-L1 in tumor cells while approximately a third of cases were found to display PD-L1 expression in tumor-infiltrating immune cells. These results indicate hypermutators are likely rare in bladder adenocarcinoma, yet 20-30% of the patients may be eligible for immune checkpoint blockade therapy.
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Affiliation(s)
- Derek Jones
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA 02215
| | - Jia Jun Guan
- Department of Pathology, University of California Los Angeles, Los Angeles, CA 90095
| | - Carla Calagua
- Hematology-Oncology Division, Beth Israel Deaconess Medical Center, Boston, MA 02215
| | - Donna E Hansel
- Department of Pathology, Oregon Health & Science University, Portland, OR 97239
| | - Jonathan I Epstein
- Department of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287
| | - Huihui Ye
- Department of Pathology, University of California Los Angeles, Los Angeles, CA 90095.
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39
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Cornejo KM, Cosar EF, Paner GP, Yang P, Tomaszewicz K, Meng X, Mehta V, Sirintrapun SJ, Barkan GA, Hutchinson L. Mutational Profile Using Next-Generation Sequencing May Aid in the Diagnosis and Treatment of Urachal Adenocarcinoma. Int J Surg Pathol 2019; 28:51-59. [PMID: 31496327 DOI: 10.1177/1066896919872535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives. The rare urachal adenocarcinoma (UAC) of the bladder has striking morphologic and immunohistochemical overlap with colorectal adenocarcinoma (CAC) and bladder adenocarcinoma (BAC). To date, the mutational status in UAC and BAC has not been well investigated. Methods. We retrospectively evaluated 34 UACs (mucinous, n = 9; intestinal, n = 3; signet ring cell, n = 1; not otherwise specified, n = 21) and 4 BACs (n = 4). Next-generation sequencing analysis of 50 cancer "hotspot" gene mutations using the Ampliseq Cancer Hotspot Panel v2 was performed. Two UAC cases did not have adequate DNA quality with poor sequencing coverage and were excluded from the study. Results. RAS mutations were identified in 16 of 32 (50%) UACs (15 KRAS; 1 NRAS) and none of the BACs (0%). TP53 mutations were found in both UACs (18/32; 56%) and BACs (4/4; 100%). GNAS (n = 4), SMAD4 (n = 3), and BRAF (n = 1) mutations were only found in UACs. In contrast, APC (n = 2) mutations were only found in BACs. The mucinous subtype of UAC contained a SMAD4 mutation in 33% of cases (3/9), which was not identified in any other subtype (0/23; 0%) (P = .0169). The only BRAF mutation was identified in the single signet ring cell subtype of UAC. There were no other differences in the mutation profile when comparing histologic subtypes of UAC. Conclusions. In summary, UAC and BAC have overlapping but distinct mutation profiles and these differences may aid in separating these 2 entities. Next-generation sequencing to identify therapeutic targets or resistance markers may aid treatment decisions.
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Affiliation(s)
- Kristine M Cornejo
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Ediz F Cosar
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | | | - Ping Yang
- Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Keith Tomaszewicz
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Xiuling Meng
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
| | - Vikas Mehta
- Mount Sinai Hospital Medical Center, Chicago, IL, USA
| | | | | | - Lloyd Hutchinson
- University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA, USA
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40
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Sahu KK, Pandey D, Mishra AK, O'Shea J, Chen Y, McGregor B. Mystery of neck lump: an uncommon presentation of urachal cancer. BMJ Case Rep 2019; 12:e230215. [PMID: 31451464 PMCID: PMC6720782 DOI: 10.1136/bcr-2019-230215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 01/04/2023] Open
Abstract
We present the case of a 55-year-old male patient who presented with palpable cervical lymphadenopathy. Excisional biopsy showed metastatic adenocarcinoma of unknown origin. Imaging showed a bladder mass following which he underwent transurethral resection of bladder tumour. Histopathological evaluation of mass confirmed a poorly differentiated adenocarcinoma with signet-ring cell features. Immunohistochemistry was suggestive of metastatic urachal cancer. He agreed for enrollment in a clinical trial, however soon after 1st cycle, he developed immune pneumonitis requiring high dose steroids. On follow-up, MRI brain was done for evaluation of headache which showed metastatic intracranial disease. He completed radiotherapy following which he was started on FOLFOX chemo regimen (folinic acid, 5-fluorouracil and oxaliplatin).
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Deepali Pandey
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Ajay Kumar Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - James O'Shea
- Division of Hematology and Medical Oncology, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Yayan Chen
- Department of Pathology, Saint Vincent Hospital, Worcester, Massachusetts, USA
| | - Bradley McGregor
- Department of Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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41
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Abstract
Urachal cancer is a rare but aggressive disease. In addition to the non-glandular tumors, non-cystic urachal adenocarcinomas are nowadays distinguished from the primary cystic variant. (Immunohistochemical) markers are only of minor differential diagnostic value and, therefore, the diagnosis is primarily established in a multidisciplinary approach. The non-cystic variant accounts for the majority of cases (83%), is more common in men (63%), shows a median age at diagnosis of 51 years and has a 5-year survival rate of about 50%. In organ-confined disease, usually a partial cystectomy of the tumor in the bladder dome, including the median umbilical ligament and umbilicus, is performed. In advanced stages, systemic therapy is needed while 5‑fuorouracil (5-FU) containing regimes have been shown to be more effective. Due to the rarity of the tumor, targeted therapy approaches based on a biological rationale are becoming increasingly relevant. As molecular data are still sparse, we compiled and analyzed the largest urachal cancer cohort to date. In 31% of the cases, MAPK-/PI3K signaling pathway alterations were detected (especially in K-/NRAS) with implications for anti-EGFR therapy approaches. Further potentially therapeutic alterations were detected in FGFR1, MET, PDGFRA, and erbB2/HER2. Additionally, PD-L1 tumor cell expression (clone: 22C3) was demonstrated in 16% of cases, therefore making anti-PD-1/PD-L1 immuno-oncological approaches worth considering despite the absence of mismatch repair deficiency (MMR-d) and/or high microsatellite instability (MSI-h). Finally, urachal adenocarcinomas seem to be a distinct entity on the molecular level with closer resemblance to colorectal adenocarcinomas than to urothelial carcinomas.
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Affiliation(s)
- H Reis
- Institute of Pathology, University Medicine Essen, West German Cancer Center Essen, University Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - T Szarvas
- Clinic of Urology, University Medicine Essen, West German Cancer Center Essen, University Duisburg-Essen, Essen, Germany
- Clinic of Urology, Semmelweis University, Budapest, Hungary
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42
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Lin CY, Saleem A, Stehr H, Zehnder JL, Pinsky BA, Kunder CA. Molecular profiling of clear cell adenocarcinoma of the urinary tract. Virchows Arch 2019; 475:727-734. [PMID: 31372739 DOI: 10.1007/s00428-019-02634-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/20/2019] [Accepted: 07/24/2019] [Indexed: 12/21/2022]
Abstract
Clear cell adenocarcinoma (CCA) of the urinary tract is a rare type of malignancy whose molecular profiles remain undefined. Here we reported an integrated clinicopathologic and molecular profiling analysis of four cases of clear cell adenocarcinoma arising in the urethra or the bladder. Utilizing a clinically validated 130-gene exon-sequencing assay, we identified recurrent pathogenic PIK3CA (p. E545K) and KRAS (p.G12D) variants in three of four (75%) of the cases. In addition, an APC variant (P.S2310X), a TP53 variant (p.R273C), and a MYC amplification event were identified. The only CCA case without either PIK3CA or KRAS variants has a distinct pathogenesis through BK virus, demonstrated by positive BK virus PCR and SV40 immunohistochemistry. The novel finding of recurrent variants in the PI3K/AKT/mTOR pathway provides not only insights into oncogenesis but also potential clinical therapeutic targets for patients with clear cell adenocarcinoma of the urinary tract.
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Affiliation(s)
- Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine, Campus box 8118, 660 South Euclid Ave., St. Louis, MO, 63110, USA. .,Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA.
| | - Atif Saleem
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Henning Stehr
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - James L Zehnder
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA.,Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Christian A Kunder
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, 94305, USA
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43
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Reis H, Szarvas T. [Urachal cancer - current concepts of a rare cancer (German version)]. DER PATHOLOGE 2018; 39:291-300. [PMID: 30470871 DOI: 10.1007/s00292-018-0498-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Urachal cancer is a rare but aggressive disease. In addition to the non-glandular tumors, non-cystic urachal adenocarcinomas are nowadays distinguished from the primary cystic variant. (Immunohistochemical) markers are only of minor differential diagnostic value and, therefore, the diagnosis is primarily established in a multidisciplinary approach. The non-cystic variant accounts for the majority of cases (83%), is more common in men (63%), shows a median age at diagnosis of 51 years and has a 5-year survival rate of about 50%. In organ-confined disease, usually a partial cystectomy of the tumor in the bladder dome, including the median umbilical ligament and umbilicus, is performed. In advanced stages, systemic therapy is needed while 5‑fuorouracil (5-FU) containing regimes have been shown to be more effective. Due to the rarity of the tumor, targeted therapy approaches based on a biological rationale are becoming increasingly relevant. As molecular data are still sparse, we compiled and analyzed the largest urachal cancer cohort to date. In 31% of the cases, MAPK-/PI3K signaling pathway alterations were detected (especially in K-/NRAS) with implications for anti-EGFR therapy approaches. Further potentially therapeutic alterations were detected in FGFR1, MET, PDGFRA, and erbB2/HER2. Additionally, PD-L1 tumor cell expression (clone: 22C3) was demonstrated in 16% of cases, therefore making anti-PD-1/PD-L1 immuno-oncological approaches worth considering despite the absence of mismatch repair deficiency (MMR-d) and/or high microsatellite instability (MSI-h). Finally, urachal adenocarcinomas seem to be a distinct entity on the molecular level with closer resemblance to colorectal adenocarcinomas than to urothelial carcinomas.
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Affiliation(s)
- H Reis
- Institut für Pathologie, Universitätsmedizin Essen, Westdeutsches Tumorzentrum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - T Szarvas
- Klinik für Urologie, Universitätsmedizin Essen, Westdeutsches Tumorzentrum Essen, Universität Duisburg-Essen, Essen, Deutschland.,Klinik für Urologie, Semmelweis Universität, Budapest, Ungarn
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