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Compérat E, Amin MB, Berney DM, Cree I, Menon S, Moch H, Netto GJ, Rao V, Raspollini MR, Rubin MA, Srigley JR, Tan PH, Tickoo SK, Turajlic S, Tsuzuki T. What's new in WHO fifth edition - urinary tract. Histopathology 2022; 81:439-446. [PMID: 35942645 DOI: 10.1111/his.14764] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
The fifth edition of the WHO Blue Book on urological tumours, specifically in the bladder chapter, represents a refinement and update in the classification of bladder tumours building on the aggregate major changes made in previous editions. Progress in the molecular underpinnings of urothelial tumours, particularly with promising stratifiers for more precision-based treatment approaches, have been made. Special attention has been paid to burning questions in bladder pathology, such as grading, heterogeneous lesions, inverted tumours and substaging. The concept of neuroendocrine tumours will be explained precisely.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, General Hospital, Medical University Vienna, Vienna, Austria
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Knoxville, TN, USA
- Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Dan M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Ian Cree
- International Agency for Research on Cancer (IARC), World Health Organisation, Lyon, France
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - George J Netto
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishal Rao
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mark A Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - John R Srigley
- Trillium Health Partners and University of Toronto, Mississauga, ON, Canada
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Satish Kumar Tickoo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London and Renal and Skin Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, School of Medicine, Aichi Medical University, Nagoya, Japan
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Ranasinghe R, Mathai ML, Zulli A. Cisplatin for cancer therapy and overcoming chemoresistance. Heliyon 2022; 8:e10608. [PMID: 36158077 PMCID: PMC9489975 DOI: 10.1016/j.heliyon.2022.e10608] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Cisplatin spearheads the anticancer chemotherapeutics in present-day use although acute toxicity is its primary impediment factor. Among a plethora of experimental medications, a drug as effective or surpassing the benefits of cisplatin has not been discovered yet. Although Oxaliplatin is considered more superior to cisplatin, the former has been better for colorectal cancer while cisplatin is widely used for treating gynaecological cancers. Carcinoma imposes a heavy toll on mortality rates worldwide despite the novel treatment strategies and detection methods that have been introduced; nanomedicine combined with precision medicine, immunotherapy, volume-regulated anion channels, and fluorodeoxyglucose-positron emission tomography. Millions of deaths occur annually from metastatic cancers which escape early detection and the concomitant diseases caused by highly toxic chemotherapy that causes organ damage. It continues due to insufficient knowledge of the debilitative mechanisms induced by cancer biology. To overcome chemoresistance and to attenuate the adverse effects of cisplatin therapy, both in vitro and in vivo models of cisplatin-treated cancers and a few multi-centred, multi-phasic, randomized clinical trials in pursuant with recent novel strategies have been tested. They include plant-based phytochemical compounds, de novo drug delivery systems, biochemical/immune pathways, 2D and 3D cell culture models using small molecule inhibitors and genetic/epigenetic mechanisms, that have contributed to further the understanding of cisplatin's role in modulating the tumour microenvironment. Cisplatin was beneficial in cancer therapy for modulating the putative cellular mechanisms; apoptosis, autophagy, cell cycle arrest and gene therapy of micro RNAs. Specific importance of drug influx, efflux, systemic circulatory toxicity, half-maximal inhibition, and the augmentation of host immunometabolism have been identified. This review offers a discourse on the recent anti-neoplastic treatment strategies to enhance cisplatin efficacy and to overcome chemoresistance, given its superiority among other tolerable chemotherapies.
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Affiliation(s)
- Ranmali Ranasinghe
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
| | - Michael L Mathai
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
| | - Anthony Zulli
- Institute for Health and Sport, College of Health and Medicine, Victoria University, Melbourne, Australia
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Park JS, Yuk HD, Jeong CW, Kwak C, Kim HH, Ku JH. Comparison of functional and oncological outcomes between uterus-sparing radical cystectomy and standard radical cystectomy in females: A retrospective study. Investig Clin Urol 2022; 63:612-622. [PMID: 36347550 PMCID: PMC9643730 DOI: 10.4111/icu.20220220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/15/2022] [Accepted: 08/29/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose This study aimed to compare the functional and oncological outcomes of females who underwent uterus-sparing radical cystectomy (USRC) and standard radical cystectomy (SRC). Materials and Methods Between February 2009 and December 2020, 90 female patients who underwent radical cystectomy with urinary diversion were included in this study, comprising the USRC and SRC groups. Functional outcomes were assessed in 63 patients who only underwent radical cystectomy with neobladder formation. Questionnaire scores, clean intermittent catheterization (CIC) rate, and urinary continence rate were analyzed. Oncological outcomes were assessed in 86 patients, regardless of the urinary diversion type. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared. Results CIC rate was significantly lower in the USRC group than in the SRC group (14.7% vs. 48.0%; p=0.005). The continence rate was significantly higher in the USRC group than in the SRC group (85.3% vs. 40.0%; p=0.001). There were no significant differences in OS (p=0.890), CSS (p=0.700), or RFS (p=0.270) between the two groups. In multivariate analysis, uterine preservation did not significantly increase the hazard ratio (HR) of OS (HR, 0.62; 95% CI, 0.18–2.11; p=0.450), CSS (HR, 0.99; 95% CI, 0.22–4.40; p=0.990), or RFS (HR, 0.46; 95% CI, 0.19–1.11; p=0.840). Conclusions USRC resulted in higher continence rates and lower CIC rates than SRC without negatively affecting oncological outcomes. Hence, with thorough deliberation, USRC should be considered for females undergoing radical cystectomy.
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Affiliation(s)
- Jae Suk Park
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeong Dong Yuk
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Bladder preservation versus radical cystectomy in transitional cell carcinoma and squamous cell carcinoma muscle invasive bladder cancer. Curr Urol 2021; 15:11-15. [PMID: 34084116 PMCID: PMC8137092 DOI: 10.1097/cu9.0000000000000009] [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: 02/09/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background Randomizing patients to bladder preservation or radical cystectomy (RC) for the treatment of bladder cancer has not been practical, due to patient and physician preferences. Therefore, continually comparing the 2 treatment modalities is needed, in order to make the proper choice for each patient. Patients and methods The records of T1-4N0M0 bladder cancer patients, who presented to the South Egypt Cancer Institute between 2007 and 2017 and were treated by either bladder preservation or RC were reviewed. Results Out of the 166 included patients, 81 (48.8%) patients were treated by bladder preservation and 85 (51.2%) patients had RC. For the patients treated by bladder preservation and the patients treated by RC, the 5-year overall survival (OS) was 56% and 60% (p = 0.67), the 5-year local recurrence-free survival was 69% and 73% (p = 0.69), and the 5-year disease-free survival was 45% and 53% (p = 0.16), respectively. After propensity matching analysis, the mean 5-year OS was 58% for the bladder preservation patients and 61% for the RC patients (p = 0.51). It is notable that among the bladder preservation group, 8 patients (10%) had squamous cell carcinoma (SCC) pathology and refused RC. Their OS was 56% compared to 53% for the SCC patients treated by RC (p = 0.6). Conclusion Bladder preservation is a safe alternative to cystectomy in transitional cell carcinoma stages T1-4aN0M0, and its use in SCC bladder cancer should be further studied, as it could be feasible to spare them from initial cystectomy.
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Garcia-Valdecasas Gayo S, Ruiz-Alvarez MJ, Gonzalez-Gay D, Ramos-Corral R, Marquez-Lietor E, Del Amo N, Plata MDC, Guillén-Santos R, Arribas I, Cava-Valenciano F. CYFRA 21-1 in patients with suspected cancer: evaluation of an optimal cutoff to assess the diagnostic efficacy and prognostic value. ADVANCES IN LABORATORY MEDICINE 2020; 1:20200005. [PMID: 37360615 PMCID: PMC10197668 DOI: 10.1515/almed-2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/25/2020] [Indexed: 06/28/2023]
Abstract
Objectives Chosen cutoff for cytokeratin 19 fragment antigen (CYFRA 21-1) as a tumor biomarker considerably influences its diagnostic and prognostic usefulness. The aim of the present study is to determine an optimal cutoff value for diagnostic validity of CYFRA 21-1 by Lumipulse ® technology in patients with suspected cancer and also to determine if CYFRA 21-1 levels provide prognostic value. Methods A consecutive 284 patients suggestive of malignant disease from six hospitals of Madrid were enrolled in a retrospective design. Optimal CYFRA 21-1 cutoff value was obtained by receiver operating characteristic curve and Youden test. The diagnostic validity was evaluated according to sensitivity, specificity, predictive values and likelihood ratios. The prognostic value of CYFRA 21-1 was checked using multiple logistic regression. Thirty-two diagnostic cancers were confirmed. Results The most optimal cutoff was 3.15 ng/mL. This cutoff showed a better specificity 93.63% (95% confidence interval [CI], 89.66-96.16), positive predictive value 60.98% (95% CI, 44.54-75.38) and positive likelihood ratio 12.65 (95% CI, 7.64-20.95) than the cutoff recommended by Fujirebio® (1.8 ng/mL) (specificity: 73.71% [95% CI, 67.72-78.95], positive predictive value: 29.79% [95% CI, 21.02-40.23] and positive likelihood ratio 3.43 [95% CI, 2.71-4.35]), improving the current diagnostic accuracy. In multivariate analysis, elevated levels of CYFRA 21-1 (>3.15 ng/mL) was confirmed as an unfavorable prognostic factor. Conclusions The best cutoff for CYFRA 21-1 obtained was 3.15 ng/mL in patients with suspected cancer. This new cutoff decreases the false positive rate and improves the diagnostic efficacy of CYFRA 21-1 as a tumor marker as well as its association with death events.
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Affiliation(s)
- Sonsoles Garcia-Valdecasas Gayo
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Maria Jesus Ruiz-Alvarez
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Daniel Gonzalez-Gay
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Raquel Ramos-Corral
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Eva Marquez-Lietor
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Nazaret Del Amo
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Maria del Carmen Plata
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Raquel Guillén-Santos
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Ignacio Arribas
- Department of Clinical Chemistry, Ramón y Cajal University Hospital, San Sebastian de los Reyes, Madrid, Spain
| | - Fernando Cava-Valenciano
- Central Laboratory BR Salud, Department of Clinical Chemistry, Infanta Sofia University Hospital, San Sebastian de los Reyes, Madrid, Spain
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Abstract
BACKGROUND In the last few years, significant progress has been achieved in the therapeutic options for advanced urothelial bladder cancer. OBJECTIVES The aim of this work was to give an overview of the status and future perspective of the therapeutic options in this setting. Its focus is on the discussion of tissue-based therapy-predictive markers, which are evaluated through (molecular) pathology and thereby strengthening the role of pathology itself. MATERIALS AND METHODS Current (clinical study) data, the literature, and our own expertise were considered and summarized in the areas of therapy prediction of platinum-based chemotherapy, immunotherapy, and other therapeutic approaches. RESULTS AND CONCLUSIONS Molecular subtypes exhibit a predictive value both in platinum-based chemotherapy as well as in immunotherapy. However, further work is required to elucidate the predictive role of molecular subtypes in both settings. Changes in the DNA damage repair enzyme (DDR) genes, ERCC2, and ERBB2 as well as differences in the expression of EMMPRIN, survivin, and HMGA2 show promising results as further markers of chemotherapy efficacy. In the prediction of immunotherapy success, this mainly relates to the evaluation of the tumor mutation burden (TMB), tumor neoantigen burden (TNB), APOBEC signatures (MSig1; 3A/3B), and CD8-positive T‑effector cell signature. When using the fibroblast growth factor receptor (FGFR) inhibitor erdafitinib, which has not yet been approved in Germany, the evaluation of specific FGFR mutations and/or gene fusions by a companion diagnostic test is mandatory in the USA.
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Affiliation(s)
- H Reis
- Institut für Pathologie, Westdeutsches Tumorzentrum, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland.
| | - T Szarvas
- Klinik für Urologie, Semmelweis Universität, Budapest, Ungarn.,Klinik für Urologie, Westdeutsches Tumorzentrum, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
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Reis H, Szarvas T, Grünwald V. [Predictive biomarkers in oncologic uropathology]. DER PATHOLOGE 2019; 40:264-275. [PMID: 31073639 DOI: 10.1007/s00292-019-0606-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Tumors of the genitourinary system are common. In recent years, our understanding of their molecular background and therefore the number of potential predictive biomarkers has massively increased. OBJECTIVES The aim of the current work is to give an overview of recent (molecular) developments and predictive biomarkers in urologic oncology and to give a perspective of what might become relevant in the future of the field. MATERIAL AND METHODS We considered the recent literature and study data and combined it with our own expertise in tumors of the urinary system, kidneys, and prostate. RESULTS AND CONCLUSIONS The molecular subtypes of muscle-invasive urothelial bladder cancer (MIBC) hold a predictive and prognostic significance and correlate with clinicopathological features. Immune therapy with checkpoint inhibitors (CPI) has a major role in urothelial carcinoma (UC), but also in renal cell carcinoma and a subgroup of prostate cancers. The first-line use in UC is restricted to PD-L1-"positive" cases (≥IC2/3, CPS ≥ 10). Further predictive markers are currently under evaluation, while the predictive significance of tumor mutational burden (TMB) is under debate. In addition to a subgroup of renal cell carcinomas, a subgroup of prostate carcinomas with alterations in the DNA repair system might benefit from a customized therapy approach (PARP inhibitors, platin-containing chemotherapy). The multitude of potentially therapy-relevant molecular alterations and related predictive biomarkers calls for the implementation of sophisticated molecular analyses in daily routine. This will lead to an even more rapid dynamic in the field of genitourinary pathology.
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Affiliation(s)
- H Reis
- Institut für Pathologie, Westdeutsches Tumorzentrum Essen, Universitätsmedizin Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - T Szarvas
- Klinik für Urologie, Westdeutsches Tumorzentrum Essen, Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland.,Klinik für Urologie, Semmelweis-Universität, Budapest, Ungarn
| | - V Grünwald
- Interdisziplinäre Uroonkologie des Westdeutschen Tumorzentrums Essen, Klinik für Urologie, Innere Medizin (Tumorforschung), Universitätsmedizin Essen, Universität Duisburg-Essen, Essen, Deutschland
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Klaile Y, Schlack K, Boegemann M, Steinestel J, Schrader AJ, Krabbe LM. Variant histology in bladder cancer: how it should change the management in non-muscle invasive and muscle invasive disease? Transl Androl Urol 2016; 5:692-701. [PMID: 27785426 PMCID: PMC5071184 DOI: 10.21037/tau.2016.06.13] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Bladder cancer (BC) is a frequent type of carcinoma with an estimated incidence of approximately 100,000 men and women each year in the European Union (EU) with an associated mortality of 30,000 of these patients. In more than 70% the disease is diagnosed in a non-muscle invasive stage with the chance of minimally invasive, local treatment only, which might be required repetitively due to high rate of recurrence. In contrast, muscle invasive or metastatic stages need multimodal treatment strategies including surgical treatment and chemotherapy (CTX) in neoadjuvant (NAC), adjuvant, or palliative settings. Therapy recommendations and guidelines mainly refer to the most common histological type of BC, pure urothelial carcinoma (UC). However, BC can be classified as urothelial and non-UC. Non-urothelial BC and variants of UC account for up to 25% of all BCs. Further discrimination can be made into epithelial and non-epithelial non-UC. Most of the non-UCs are of epithelial origin (approximately 90%) including squamous-cell carcinoma, adenocarcinoma and small-cell carcinoma. Non-epithelial tumors are rare and include variants as sarcoma, carcinosarcoma, paraganglioma, melanoma and lymphoma. Even though it is unclear whether the prognosis of non-urothelial cancer truly differs from that of UC, there is evidence that additional variant histology might prognosticate an impaired prognosis. Accordingly, aggressive behavior and often advanced stages at primary presentation are frequently observed in non-UC arguing for radical and sometimes different treatment strategies as compared to pure UC. This review aims to summarize the available data for the most common histological variants of non-urothelial BC.
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Affiliation(s)
- Yvonne Klaile
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Katrin Schlack
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Martin Boegemann
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Julie Steinestel
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Andres Jan Schrader
- Department of Urology, University of Muenster Medical Center, Muenster, Germany
| | - Laura-Maria Krabbe
- Department of Urology, University of Muenster Medical Center, Muenster, Germany; ; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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