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Chakra MA, Azoulai D, Moussa M, Ismail K, Peyromaure M, Delongchamps NB, Saighi D, Bailly H, Duquesne I. The prognostic role of pre-cystectomy thrombocytosis in invasive bladder cancer. Int Urol Nephrol 2022; 54:3153-3161. [PMID: 36008697 DOI: 10.1007/s11255-022-03346-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE We aim to evaluate the impact of preoperative thrombocytosis on oncological outcomes in patients with bladder cancer (BC) who undergo radical cystectomy (RC). METHODS Retrospective data collection of 1092 patients managed by RC for BC from 2 tertiary-care centers was performed. Elevated platelet count (PLT) was defined as > 450 × 109/L. Univariable and multivariable logistic regression analyses were used to investigate the impact of thrombocytosis on oncological outcomes. These outcomes were also compared using Kaplan-Meier survival analysis. RESULTS The median follow-up was 50 months (32-64 months). Thrombocytosis was detected in 18.6% of the patients. The 3-year cancer-specific survival (CSS) for patients with normal PLT count was 92% which was higher than those with elevated PLT count (55%, P < 0.001). Similar results were found for the 6-year CSS with 82% for the no thrombocytosis group and 27% for the thrombocytosis group. Thrombocytosis was still significantly associated with poor prognosis for overall survival and recurrence-free survival (P < 0.001). In the multivariate analysis, CSS was significantly lower in patients with thrombocytosis (HR = 1.71, 95% CI = 1.22-2.39, P = 0.002). Patients with elevated PLT counts were also significantly more likely to receive adjuvant chemotherapy, to have a T stage > pT2b (P = 0.024), to have a positive lymph node, to have variant histology and positive resection margins, and to have concomitant carcinoma in situ (CIS) on final pathology (all P < 0.001). CONCLUSIONS Preoperative thrombocytosis was valuable for predicting the oncological outcomes of patients undergoing RC for BC.
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Affiliation(s)
- Mohamad Abou Chakra
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France.
- Department of Urology, Lebanese University, Beirut, Lebanon.
| | - David Azoulai
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France
| | - Mohamad Moussa
- Surgery and Urology Department, Lebanese University, Beirut, Lebanon
| | - Khadija Ismail
- Epidemiology and Statistic Department, Lebanese University, Beirut, Lebanon
| | - Michael Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France
| | - Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France
| | - Djillali Saighi
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France
| | - Hugo Bailly
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75013, Paris, France
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Gakis G, Schmid MA, Hassan F, Stenzl A, Renninger M. The predictive and prognostic value of pre-cystectomy serum gamma-glutamyltransferase levels in patients with invasive bladder cancer. Clin Genitourin Cancer 2022; 20:e310-e316. [DOI: 10.1016/j.clgc.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 11/03/2022]
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Maisch P, Lunger L, Düwel C, Schmid SC, Horn T, Gschwend JE, Sauter A, Heck MM. Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer. Urol Oncol 2021; 39:368.e11-368.e17. [PMID: 33431328 DOI: 10.1016/j.urolonc.2020.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radical cystectomy (Cx) is the standard of care for muscle-invasive bladder cancer (BCa). In locally advanced pT4 BCa the oncologic outcome is inexplicit but Cx may be necessary for palliation. OBJECTIVES The aim of this retrospective study was to evaluate the outcomes of Cx performed in patients with locally advanced pT4 BCa and to identify patient subgroups with improved outcome. METHODS Between 2008 and 2017, we identified 76 of 905 patients who underwent Cx for pT4 BCa at a single tertiary referral center. The physical patients' status was estimated according to the American Society of Anesthesiologists (ASA) classification. For the classification of postoperative complication rates, the Clavien-Dindo grading was used. Time-to-event variables with log-rank statistics were calculated with the use of the Kaplan-Meier method. RESULTS Median age was 74 years (range 42-90). Preoperatively, the physical status was estimated poor in 40 (52%) patients (ASA-score of ≥3). Overall, 19 (25%) patients had pT4b BCa, 41 (54%) patients were lymph node positive (c/pN+) and 14 (18%) patients had distant metastases (c/pM+). Within 30 and 90 days after surgery, 21% and 30% of the patients, respectively, developed severe complications (Clavien-Dindo grade ≥3). Overall, 30- and 90-day mortality rates were 9% and 11%, respectively. Moreover, 86% and 75% of patients who died within 30 and 90 days after surgery, respectively, had an ASA-score ≥3. At a median postoperative follow-up of 8 months (range 0-85), 53 (70%) patients have died. During the follow-up period, 46% of the patients died due to progressive disease, 16% died of a noncancer-specific cause, and for 8% of the patients, the reason remains unknown. Median overall survival (OS) and cancer-specific survival were 13.0 and 16.0 months, respectively. In subgroup analyses ASA-score ≥3 and hemoglobin <11.7 g/dl was significantly associated with poor OS. No statistically significant differences were detected between subgroups. CONCLUSION Cx performed in patients with locally advanced pT4 BCa is associated with an increased mortality rate within 90 days postoperatively. Our study revealed that the ASA-score is a relevant and easily available tool to rate the patient´s condition and estimate postoperative outcome.
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Affiliation(s)
- Phillipp Maisch
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany.
| | - Lukas Lunger
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Sebastian C Schmid
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Thomas Horn
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Andreas Sauter
- Department of Radiology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Matthias M Heck
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
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Ran Z, Chen W, Shang J, Li X. The prognostic implication of pre-treatment hemoglobin levels in esophageal cancer patients: A systematic review and meta-analysis. Meta Gene 2020. [DOI: 10.1016/j.mgene.2020.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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5
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Ferran-Carpintero A, Domínguez-García A, Muñoz-Rodríguez J, Barquero-López M, Prera-Vilaseca Á, Bonfill-Abella T, Gallardo-Díaz E, Hannaoui-Hadi N, García-Rojo D, Prats-López J. Impact of anemia on the survival of patients undergoing radical cystectomy for bladder cancer. Actas Urol Esp 2020; 44:489-496. [PMID: 32600878 DOI: 10.1016/j.acuro.2020.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/05/2020] [Accepted: 04/15/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the prevalence of preoperative anemia and its effect on oncological outcomes in patients undergoing radical cystectomy (RC) due to bladder cancer. MATERIAL AND METHODS Retrospective single-center study with 176 RCs between May 2008 and July 2018. Anemia was defined according to the WHO classification (male<130mg/dL, female<120mg/dL). Kaplan-Meier test was used to estimate recurrence-free, cancer-specific and overall survival rates. Multivariate logistic regression was used to identify factors associated with overall mortality rates. RESULTS Overall, 89 (50.6%) patients had preoperative anemia, and 44 of them (49.4%) received neoadjuvant chemotherapy. Anemic patients resulted in higher rates of ASA (ASA>2: 54.6 vs. 27.5%; P=.003), ectasia rate previous to RC (41.6 vs. 19.5%; P=.002), treatment with neoadjuvant chemotherapy (49.4 vs. 19.5%; P<.001), blood transfusion rate (25.8 vs. 11.5%; P=.015) and pathological stage (pT>2: 49.4 vs. 33.3%; P=.03) compared to non-anemic patients. Median follow-up was 27.2 months (IQR 11.12-72.28). Median overall survival (105 vs. 34 months, log-rank; P=.001), cancer-specific survival (89 vs. 61 months; P=.004) and recurrence-free survival (85 vs. 57 months; P=.002) were significantly lower in anemic patients compared to the non-anemic group. In multivariable Cox analysis, preoperative anemia, pT>2 and N≥1 were independently associated with overall mortality. CONCLUSION Preoperative anemia was common in patients undergoing RC for bladder cancer, and it is related with a worse cancer prognosis. Anemia is a preoperative modifiable factor; we believe that the implementation of Patient Blood Management programs during prehabilitation may have a relevant role in improving the oncological outcomes in these patients.
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Boström PJ, Jensen JB, Jerlström T, Arum CJ, Gudjonsson S, Ettala O, Syvänen KT. Clinical markers of morbidity, mortality and survival in bladder cancer patients treated with radical cystectomy. A systematic review. Scand J Urol 2020; 54:267-276. [PMID: 32516016 DOI: 10.1080/21681805.2020.1773527] [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] [Indexed: 02/08/2023]
Abstract
Context: Radical cystectomy and pelvic lymph node dissection (RC and PLND) are an essential part of the treatment paradigm in high risk bladder cancer. However, these patients have high rates of morbidity and mortality related both to the treatment and to the disease.Objective: To provide overview of current literature about clinical markers that can be used to predict and improve BC-patient outcomes at the time of RC and PLND and to study if they are properly validated.Evidence acquisition: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria between January 1990 and October 2018 to identify English written original and review articles relevant to this topic. Prospective and retrospective studies were included.Evidence synthesis: There are several risk factors identified from non-randomised trials that can be improved before surgery to reduce perioperative mortality and morbidity. These include poor nutritional status, anaemia, renal function and smoking. Preoperative nomograms have also been developed to help decision-making and to inform patients about the risks of surgery. They can be used to estimate risk of postoperative mortality after RC and PLND with accuracy varying from 70 to 86%. These nomograms are largely based on retrospective data. Likewise, nomograms developed to calculate estimates about patient's overall and cancer specific survival have the same limitations.Conclusion: Clinical markers to predict morbidity, mortality and survival in patients with bladder cancer treated with RC and PLND may help to improve patient outcomes and treatment decision-making, but available data come from small retrospective trials and have not been properly validated. Prospective, multi-centre studies are needed to implement and disseminate predictive clinical markers and nomograms such that they can be utilised in treatment decision-making in daily practice.
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Affiliation(s)
- Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | | | - Tomas Jerlström
- School of Medical Sciences, Faculty of Medicine and Health, University of Örebro, Örebro, Sweden
| | - Carl-Jørgen Arum
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Otto Ettala
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, Turku University Hospital, Turku, Finland
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Gakis G, Hassan FN, Schmid MA, Ölschläger M, Hackenberg S, Stenzl A, Renninger M. Prognostic significance of previous tonsillectomy after radical cystectomy for bladder cancer. Scand J Urol 2020; 54:297-303. [PMID: 32500778 DOI: 10.1080/21681805.2020.1773530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: To examine whether previous tonsillectomy (TE) impacts on survival after radical cystectomy (RC) for bladder cancer (BC).Patients and Methods: A total of 320 patients were staged cM0 and underwent RC for BC between 2002 and 2013. We retrospectively investigated whether patients had undergone TE prior to RC. Chi-square/Fisher-Exact test was carried out to compare clinicopathological features between the TE- and non-TE-group. Kaplan-Meier analysis with log-rank test was used to estimate recurrence-free survival (RFS) and multivariable Cox-regression analysis of risk factors of recurrence. The median follow-up was 31 months (interquartile range: 9-54).Results: A history of TE was present in 18 of the 320 patients (5.6%). All TEs were performed for benign conditions. TE prior to RC was associated with a history of appendectomy (p = 0.045), lower age at RC (p = 0.029), tumor unifocality (p < 0.001), advanced histopathological tumor stage (p = 0.015), non-pure urothelial carcinoma (p = 0.025), lymphovascular invasion (p = 0.035) and receipt of palliative chemotherapy (p = 0.004). The 3-year RFS was 39.2% for patients with previous TE and 62.4% for those without (p = 0.008). In multivariable analysis, adjusted for all significant parameters of univariable analysis, lymph-node tumor involvement (p = 0.017), positive surgical margins (p = 0.047), tumor grade (p = 0.032), advanced tumor stage (≥pT3a; p = 0.049) and a history of TE (p = 0.021) remained independent prognosticators of recurrence.Conclusion: In this series, previous TE was an independent predictor of recurrence after RC for BC. Further studies are needed to assess whether TE induces immunological alterations that might exert adverse effects on cancer progression of patients with invasive BC.
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Affiliation(s)
- Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany.,Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany.,Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Manuel Alexander Schmid
- Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Ölschläger
- Department of Urology and Pediatric Urology, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Stephan Hackenberg
- Department of ENT, University Hospital of Würzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Renninger
- Department of Urology, University Hospital of Würzburg, Eberhard-Karls University, Tuebingen, Germany
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Mori K, Miura N, Mostafaei H, Quhal F, Motlagh RS, Lysenko I, Kimura S, Egawa S, Karakiewicz PI, Shariat SF. Prognostic value of preoperative hematologic biomarkers in urothelial carcinoma of the bladder treated with radical cystectomy: a systematic review and meta-analysis. Int J Clin Oncol 2020; 25:1459-1474. [PMID: 32451768 PMCID: PMC7392936 DOI: 10.1007/s10147-020-01690-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
This systematic review and meta-analysis aimed to assess the prognostic value of preoperative hematologic biomarkers in patients with urothelial carcinoma of the bladder treated with radical cystectomy. PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in September 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in patients with urothelial carcinoma of the bladder with and without pretreatment laboratoryabnormalities. Formal meta-analyses were performed for this outcome. The systematic review identified 36 studies with 23,632 patients, of these, 32 studies with 22,224 patients were eligible for the meta-analysis. Several preoperative hematologic biomarkers were significantly associated with cancer-specific survival as follows: neutrophil − lymphocyte ratio (pooled hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.11–1.29), hemoglobin (pooled HR: 0.87, 95% CI 0.82–0.94), C-reactive protein (pooled HR: 1.44, 95% CI 1.26–1.66), De Ritis ratio (pooled HR: 2.18, 95% CI 1.37–3.48), white blood cell count (pooled HR: 1.05, 95% CI 1.02–1.07), and albumin-globulin ratio (pooled HR: 0.26, 95% CI 0.14–0.48). Several pretreatment laboratory abnormalities in patients with urothelial carcinoma of the bladder were associated with cancer-specific mortality. Therefore, it might be useful to incorporate such hematologic biomarkers into prognostic tools for urothelial carcinoma of the bladder. However, given the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.
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Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Noriyoshi Miura
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ivan Lysenko
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
- Department of Urology, Weill Cornell Medical College, New York, NY, USA.
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Urology, University of Jordan, Amman, Jordan.
- European Association of Urology Research Foundation, Arnhem, The Netherlands.
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Tamalunas A, Buchner A, Kretschmer A, Jokisch F, Schulz G, Eismann L, Stief C, Grimm T. Impact of Routine Laboratory Parameters in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: A Long-Term Follow-Up. Urol Int 2020; 104:551-558. [DOI: 10.1159/000506263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
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10
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Schubert T, Renninger M, Schmid MA, Hassan FN, Sokolakis I, Fahmy O, Hatzichristodoulou G, Stenzl A, Gakis G. Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer. Urol Oncol 2019; 38:4.e7-4.e15. [PMID: 31537484 DOI: 10.1016/j.urolonc.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/10/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). MATERIAL AND METHODS A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10-55). RESULTS Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence. CONCLUSIONS In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer.
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Affiliation(s)
- Tina Schubert
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Markus Renninger
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Manuel Alexander Schmid
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Fahmy Nabil Hassan
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Ioannis Sokolakis
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Omar Fahmy
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany; Department of Urology, University Putra Malaysia (UPM), Serdang, Selangor, Malaysia
| | - Georgios Hatzichristodoulou
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Julius-Maximilians University, Wuerzburg, Germany; Department of Urology, University Hospital of Tuebingen, Eberhard-Karls University, Tuebingen, Germany.
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Calvete J, Larrinaga G, Errarte P, Martín AM, Dotor A, Esquinas C, Nunes-Xavier CE, Pulido R, López JI, Angulo JC. The coexpression of fibroblast activation protein (FAP) and basal-type markers (CK 5/6 and CD44) predicts prognosis in high-grade invasive urothelial carcinoma of the bladder. Hum Pathol 2019; 91:61-68. [PMID: 31279874 DOI: 10.1016/j.humpath.2019.07.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/04/2019] [Accepted: 07/01/2019] [Indexed: 12/17/2022]
Abstract
High-grade urothelial carcinoma (UC) of the bladder is a heterogeneous disease with dismal prognosis. Bladder tumors with basal phenotype are intrinsically aggressive, and morphological parameters that define disease staging remain main prognosticators. We intend to evaluate the role of cancer-associated fibroblasts (CAFs) in the prognosis of bladder cancer and its association with basal and luminal phenotypes. Clinical and pathological parameters, including the immunohistochemical expression of fibroblast activation protein (FAP) and markers of basal (CK5/6, CD44) and luminal (CK20, GATA3) phenotypes, have been investigated in a series of 121 patients with UC of the bladder treated by radical cystectomy with lymph node dissection, and their implication in long-term cancer-specific survival has been evaluated. A cytoplasmic immunostaining of FAP in CAFs implies worse disease-specific survival (hazard ratio [HR] = 1.68; P = .048). FAP expression is associated with tumor staging (P < .0001), with best discrimination at T2a/T2b level, and with negative expression of markers of luminal phenotype, such as CK20 (P < .0001) and GATA3 (P = .005). In the multivariate analysis, simultaneous expression of FAP, CK5/6, and CD44 is a strong prognosticator of disease-specific survival (HR = 2.3; P = .001), together with nodal invasion (HR = 3.47; P < .0001) and bladder infiltration up to deep muscle or beyond (HR = 2.47; P = .02). There is no association between positive FAP expression in primary tumor and nodal disease (P = .22). FAP expression in CAFs favors tumor invasion in high-grade invasive UC of the bladder with basal phenotype. This new immunohistochemical marker could be added to the routine immunohistochemical protocol to predict clinical behavior in these patients.
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Affiliation(s)
- Julio Calvete
- Service of Medical Oncology, University Hospital Puerta del Mar, Cádiz 11009, Spain
| | - Gorka Larrinaga
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV-EHU), Leioa 48940, Spain; Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, Barakaldo 48903, Spain
| | - Peio Errarte
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV-EHU), Leioa 48940, Spain; Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, Barakaldo 48903, Spain
| | - Ana M Martín
- Service of Pathology, University Hospital of Getafe, Getafe 28905, Madrid, Spain
| | - Ana Dotor
- Service of Pathology, University Hospital of Getafe, Getafe 28905, Madrid, Spain
| | - Cristina Esquinas
- Service of Urology, University Hospital of Getafe, Getafe 28905, Madrid, Spain
| | - Caroline E Nunes-Xavier
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, Barakaldo 48903, Spain; Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital Radiumhospitalet, Oslo 0372, Norway
| | - Rafael Pulido
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, Barakaldo 48903, Spain; Ikerbasque, The Basque Foundation for Science, Bilbao 48013, Spain
| | - José I López
- Biomarkers in Cancer Unit, Biocruces-Bizkaia Institute, Barakaldo 48903, Spain; Service of Pathology, Cruces University Hospital, Barakaldo 48903, Spain; Department of Medical-Surgical Specialties, Faculty of Medicine and Nursing, University of the Basque Country (UPV-EHU), Leioa 48940, Spain.
| | - Javier C Angulo
- Service of Urology, University Hospital of Getafe, Getafe 28905, Madrid, Spain; Clinical Department, Faculty of Biomedical Sciences, European University of Madrid, Laureate Universities, Madrid 28670, Spain
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12
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Hernández-Fernández C, Herranz-Amo F, Moralejo-Gárate M, Subirá-Ríos D, Caño-Velasco J, Barbas-Bernardos G. Infiltrating bladder cancer: prognostic factors, follow-up and treatment of relapses. Actas Urol Esp 2017; 41:352-358. [PMID: 27561847 DOI: 10.1016/j.acuro.2016.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Bladder cancer is the cause of more than 150,000 deaths per year. The overall rate of survival is approximately 45%, with a 10-year recurrence-free rate of 50-59%, with no changes in the last decade. OBJECTIVE Due to a lack of agreement on the follow-up of cystectomy or on a uniform treatment when faced with the various types of recurrence, we have analysed the most recent literature in an attempt to unify the criteria for the diagnosis and treatment of bladder cancer. ACQUISITION OF EVIDENCE Review of Spanish and English publications in the medical literature in the last 10 years, highlighting the most significant series in terms of the number of patients, follow-up time, as well as the existing meta-analyses. SYNTHESIS OF THE EVIDENCE Recurrence after cystectomy can occur in the urinary apparatus (upper urinary tract or distal urethra) and local (cystectomy bed) and/or distant metastases. Despite strict control, more than 60% of the relapses are discovered based on symptoms and not by the routine follow-up test. Locoregional and distant relapses are more common the more advanced the stage at the time of cystectomy, going from 11-21% in pT2N0 to 52-72% when there is lymphocytic N+ involvement. Recurrence in the urethra and/or upper urinary track has other prognostic factors such as multiplicity, the presence of Cis and involvement of prostatic stroma. There are various treatments for tumour relapses. Increasingly, the patient's comorbidity is considered when deciding on the therapeutic strategy. Treatments are typically multimodal and include surgery, radiotherapy and chemotherapy. CONCLUSION The follow-up of patients who undergo cystectomy should be individualised, taking into account the prognostic factors of recurrence and the patient's comorbidity, assuming that in some cases, multimodal treatment is indicated.
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Luo F, Wang YS, Su YH, Zhang ZH, Sun HH, Li J. Prognostic implications of preoperative anemia in urothelial carcinoma: A meta-analysis. PLoS One 2017; 12:e0171701. [PMID: 28182725 PMCID: PMC5300162 DOI: 10.1371/journal.pone.0171701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/08/2017] [Indexed: 01/11/2023] Open
Abstract
The prognostic significance of preoperative anemia (PA) has been identified in various malignancies. However, its predictive role in urothelial carcinoma (UC) remains controversial. The aim of this study was to investigate the prognostic value of PA in UC patients. We performed a meta-analysis of the association between PA and survival outcome in UC patients. Electronic databases were searched up to June 30, 2016. Study characteristics and prognostic data were extracted from each included study. Cancer-specific survival (CSS), recurrence-free survival (RFS), and overall survival (OS) were pooled using hazard ratio (HR) with corresponding 95% confidence intervals (CI). Herein, 12 studies comprising 3815 patients were included in the meta-analysis. There were 1593 (41.76%) patients in the PA group and 2222 (58.24%) in the control group. The overall pooled HRs of PA for CSS, RFS, and OS were significant at 2.21, (95% CI: 1.83-2.65, Pheterogeneity = 0.49, I2 = 0%), 1.87 (95% CI: 1.59-2.20, Pheterogeneity = 0.22, I2 = 28%), and 2.04(95% CI: 1.76-2.37, Pheterogeneity = 0.36, I2 = 9%) respectively. Stratified analyses indicated that PA was a predictor of poor prognosis based on ethnicity, sample size, tumor T stage, G grade, lymphovascular invasion (LVI), concomitant carcinoma in situ (CIS), and follow-up values. Our findings show that PA has negative prognostic effects on the survival outcome (CSS, RFS, and OS) in UC patients and can serve as a useful and cost-effective marker to aid prognosis prediction.
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Affiliation(s)
- Fei Luo
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Ya-Shen Wang
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Yan-Hui Su
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Zhi-Hua Zhang
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Hong-Hong Sun
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
| | - Jian Li
- Department of Urology, Tianjin Union Medical Center, Tianjin, China
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14
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Luo F, Wang YS, Su YH, Zhang ZH, Sun HH, Li J. Prognostic impact of preoperative anemia on non-muscle-invasive bladder carcinoma treated with GreenLight laser vaporization. Lasers Med Sci 2016; 32:397-403. [DOI: 10.1007/s10103-016-2133-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
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15
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Xia L, Guzzo TJ. Preoperative Anemia and Low Hemoglobin Level Are Associated With Worse Clinical Outcomes in Patients With Bladder Cancer Undergoing Radical Cystectomy: A Meta-Analysis. Clin Genitourin Cancer 2016; 15:263-272.e4. [PMID: 27665259 DOI: 10.1016/j.clgc.2016.08.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/14/2016] [Accepted: 08/19/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE The aim of this study was to determine the effect of preoperative anemia status and hemoglobin level on clinical outcomes in patients with bladder cancer undergoing radical cystectomy. MATERIALS AND METHODS A systematic review of literature with meta-analyses of predefined outcomes based on a search of PubMed and EMBASE was performed. Hazard ratios (HRs) measuring the association between preoperative anemia/hemoglobin and all-cause mortality, cancer-specific mortality, and disease recurrence were calculated with random effects model. Study heterogeneities were quantified by I2 tests. Publication bias was assessed with funnel plots. RESULTS A total of 17 studies evaluating the impact of preoperative anemia status (categorical, 11 studies) and hemoglobin level (continuous, 7 studies) on clinical outcomes were included. The cutoff value of anemia varied among studies (10.5-13.5 g/dL for male, 10.5-13.4 g/dL for female). Meta-analyses showed that compared with non-anemia, anemia was associated with increased all-cause mortality (HR, 1.75; 95% confidence interval [CI], 1.48-2.05; P < .00001; I2 = 30%), cancer-specific mortality (HR, 1.80; 95% CI, 1.45-2.25; P < .00001; I2 = 26%), and disease recurrence (HR, 1.37; 95% CI, 1.16-1.62; P = .0002; I2 = 9%). Meta-analyses showed that higher level of hemoglobin was associated with decreased all-cause mortality (HR, 0.90; 95% CI, 0.87-0.92; P < .00001; I2 = 13%), cancer-specific mortality (HR, 0.90; 95% CI, 0.85-0.95; P = .0003; I2 = 61%), and disease recurrence (HR, 0.95; 95% CI, 0.91-0.99; P = .01; I2 = 53%). No obvious publication bias was observed. CONCLUSIONS Preoperative anemia and low hemoglobin level are associated with earlier recurrence and shorter survival of patients with bladder cancer undergoing radical cystectomy. However, well-designed prospective studies with large sample size and limited confounding factors are needed to confirm and update our findings.
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Affiliation(s)
- Leilei Xia
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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