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Contieri R, Claps F, Hurle R, Buffi NM, Lughezzani G, Lazzeri M, Aveta A, Pandolfo S, Porpiglia F, Fiori C, Barone B, Crocetto F, Ditonno P, Lucarelli G, Lasorsa F, Busetto GM, Falagario U, Giudice FD, Maggi M, Cantiello F, Borghesi M, Terrone C, Bove P, Antonelli A, Veccia A, Mari A, Luzzago S, Todea-Moga C, Minervini A, Musi G, Fallara G, Mistretta FA, Bianchi R, Tozzi M, Soria F, Gontero P, Marchioni M, Janello LMI, Terracciano D, Russo GI, Schips L, Perdonà S, Tataru OS, Vartolomei MD, Autorino R, Catellani M, Sighinolfi C, Montanari E, Stasi SMD, Rocco B, de Cobelli O, Ferro M. Impact of smoking exposure on disease progression in high risk and very high-risk nonmuscle invasive bladder cancer patients undergoing BCG therapy. Urol Oncol 2024:S1078-1439(24)00748-8. [PMID: 39672689 DOI: 10.1016/j.urolonc.2024.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 11/04/2024] [Accepted: 11/11/2024] [Indexed: 12/15/2024]
Abstract
INTRODUCTION The nonmuscle invasive bladder cancer treated with BCG instillations in patients who smoke could potentially lead to poorer oncological results in the light of the new EAU risk groups classification for NMIBC that did not include BCG treated patients or smoking status. PATIENT AND METHODS Outcomes from 1313 patients with nonmuscle invasive bladder cancer treated with TURBT, re-TURBT and BCG instillations at 13 academic hospital centers, since 2002, has been included in this retrospective study. The study variables, including cumulative smoking exposure have been analyzed. A multivariable Cox proportional hazard model was used to assess associations between smoking variables and disease progression and repeated in the EAU high risk and very high-risk group. The statistical significance threshold was set at 0.05, and the statistical analysis was performed using Stata/SE version 17 (StataCorp, College Station, TX, USA). RESULTS Cox regression analysis revealed in 1313 patients diagnosed with T1G3 NMIBC that patients with a history of heavy and long-term smoking faced a more than twofold increased risk of disease progression compared to nonsmoker patients (HR 2.35; 95% CI: 1.7-3.2; P < 0.01) and a significantly poorer PFS for patients with a history of heavy long-term smoke exposure (P < 0.01). Patients with heavy long-term smoking exposure according to the EAU21 high-risk group had a PFS comparable to very high-risk patients and high-risk patients with heavy long-term smoking exposure showed a higher risk of progression when compared to the high-risk group (HR 1.4; 95% CI: 1.3-1.6; P < 0.01). CONCLUSIONS This study adds valuable information on the relationship between smoking and the progression of NMIBC and BCG therapy. The findings emphasize the need for healthcare providers to consider a patient's smoking history when managing NMIBC and express the need for individualized smoking cessation counseling and individualized treatment approach.
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Affiliation(s)
- Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Francesco Claps
- Urology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56127 Pisa, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Savio Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Francesco Porpiglia
- Department of Urology, University of Turin, AOU San Luigi Gonzaga Hospital, 10043 Orbassano, Turin, Italy
| | - Cristian Fiori
- Department of Urology, University of Turin, AOU San Luigi Gonzaga Hospital, 10043 Orbassano, Turin, Italy
| | - Biagio Barone
- Division of Urology, Department of Surgical Sciences, AORN Sant'Anna e San Sebastiano, 81100 Caserta, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy
| | - Pasquale Ditonno
- Unit of Urology, Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giuseppe Lucarelli
- Unit of Urology, Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Francesco Lasorsa
- Unit of Urology, Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy
| | - Ugo Falagario
- Department of Urology and Organ Transplantation, University of Foggia, 71122 Foggia, Italy; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy
| | | | - Marco Borghesi
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, 16126 Genoa, Italy
| | - Carlo Terrone
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, 16126 Genoa, Italy
| | - Pierluigi Bove
- Unit of Urology, Department of Surgery, Tor Vergata University, Rome, Italy; Department of Urology, San Carlo di Nancy Hospital - GVM Care and Research, Rome, Italy, 00165 Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Stefano Luzzago
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Ciprian Todea-Moga
- Department of Urology, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Gennaro Musi
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Giuseppe Fallara
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Francesco Alessandro Mistretta
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Roberto Bianchi
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Marco Tozzi
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy
| | - Letizia M I Janello
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giorgio I Russo
- Department of Surgery, Urology Section, University of Catania, 95124 Catania, Italy
| | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, Chieti, Italy
| | | | - Octavian S Tataru
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania
| | | | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Michele Catellani
- Department of Urology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy. Department of Oncology and Hematology-Oncology, University of Milan, Milan, Italy
| | - Chiara Sighinolfi
- U.O.C. Clinica Urologica, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Universitá Cattolica del Sacro Cuore, Milam, Italy
| | - Emanuele Montanari
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Savino M Di Stasi
- Department of Experimental Medicine and Surgery, Tor Vegata University, 00133 Rome, Italy
| | - Bernardo Rocco
- U.O.C. Clinica Urologica, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Universitá Cattolica del Sacro Cuore, Milam, Italy.
| | - Ottavio de Cobelli
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy
| | - Matteo Ferro
- Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, Milan 20142, Italy.
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Çetin T, Bolat D, Akgül M, Yazıcı S, Aslan G, Akan S, Baltacı S, Müezzinoğlu T, Bayazıt Y. Effect of Bacillus Calmette-Guérin Instillation Timing on Oncological Survivals after Transurethral Resection of Bladder Tumor. Urology 2024:S0090-4295(24)01133-6. [PMID: 39672342 DOI: 10.1016/j.urology.2024.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Revised: 11/19/2024] [Accepted: 12/02/2024] [Indexed: 12/15/2024]
Abstract
OBJECTIVE To investigate whether the timing of bacillus Calmette-Guerin instillation (TTBCG), which plays a key role in treating non-muscle invasive bladder cancer (NMIBC), after transurethral resection of bladder tumor (TURBT) affects oncologic outcomes. METHODS Patient data obtained from the Urologic Cancer Database- Bladder (UroCaD-B) of Turkish Uro-oncology Association (TUOA) were evaluated. Data from 292 patients from 12 centers with primary T1HG treated with TURBT and maintenance BCG between 2003 and 2023 were retrospectively analyzed. The population was subdivided according to TTBCG, while recurrence-free survival (RFS) and progression-free survival (PFS) were estimated by log-rank tests and univariable and multivariable regression analyses. RESULTS A total of 292 patients were followed, and 86% (n=251) of those included in the study were male. The median duration of TTBCG was 38.5 days (19-73). The median follow-up period was 38.4 months (21.5- 72.1 months). During follow-up, recurrence was detected in 55 (18.5%) patients and progression was detected in 22 (7.5%) patients. In univariate Cox regression analysis, long TTBCG (>27.5 days) was found to have a statistically significant effect on the risk of short RFS and PFS (p= 0.05). BCG-related side effects were not associated with TTBCG (p=0.313). Kaplan-Meier analysis showed that there was a significant difference in RFS and PFS between the TTBCG groups (p = 0.04, p= 0.011 respectively). CONCLUSIONS In this retrospective non-randomized study, we showed the negative effects of BCG delay on progression and recurrence in T1HG patients. Therefore, we think that BCG should be instilled within 4 weeks after surgery.
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Affiliation(s)
- Taha Çetin
- Izmir University of Economics Medical Point Hospital Urology Dept.
| | - Deniz Bolat
- Health Science University Izmir City Research and Training Hospital Urology Dept
| | - Murat Akgül
- Health Science University Umraniye Research and Training Hospital Urology Dept
| | - Sertaç Yazıcı
- Hacettepe University Faculty of Medicine Urology Dept
| | - Güven Aslan
- Dokuz Eylul University Faculty of Medicine Urology Dept
| | - Serkan Akan
- Health Science University Fatih Sultan Mehmet Research and Training Hospital Urology Dept
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Woldu SL, Lotan Y. Refinement of Risk Stratification Is Important for Guiding Treatment and Surveillance Recommendations. Eur Urol 2024; 86:550-551. [PMID: 39317632 DOI: 10.1016/j.eururo.2024.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 09/26/2024]
Affiliation(s)
- Solomon L Woldu
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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4
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Subiela JD, Krajewski W, González-Padilla DA, Laszkiewicz J, Taborda J, Aumatell J, Sanchez Encinas M, Basile G, Moschini M, Caño-Velasco J, Lopez Perez E, Del Olmo Durán P, Gallioli A, Tukiendorf A, D'Andrea D, Yuen-Chun Teoh J, Serna Céspedes A, Pichler R, Afferi L, Del Giudice F, Gomez Rivas J, Albisinni S, Soria F, Ploussard G, Mertens LS, Rajwa P, Laukhtina E, Pradere B, Tully K, Guerrero-Ramos F, Rodríguez-Faba Ó, Alvarez-Maestro M, Dominguez-Escrig JL, Szydełko T, Gomez Dos Santos V, Jiménez Cidre MÁ, Burgos Revilla FJ. Unlocking the Potential of Adequate Bacillus Calmette-Guérin Immunotherapy in Very-high-risk Non-muscle-invasive Bladder Carcinoma: A Multicenter Analysis of Oncological Outcomes and Risk Dynamics. Eur Urol Oncol 2024; 7:1367-1375. [PMID: 38355375 DOI: 10.1016/j.euo.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 01/29/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND The European Association of Urology (EAU) recommends discussing upfront radical cystectomy for all patients with very high risk (VHR) non-muscle-invasive bladder carcinoma (NMIBC), but the role of bacillus Calmette-Guérin (BCG) treatment remains controversial. OBJECTIVE To analyze oncological outcomes in VHR NMIBC patients (EAU risk groups) treated with adequate BCG. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional retrospective study involving patients with VHR NMIBC who received adequate BCG therapy from 2007 to 2020 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A survival analysis estimated recurrence-free survival (RFS), progression-free survival (PFS), and the cumulative incidence of cancer-specific mortality (CSM) after accounting for other causes of mortality as competing risk events and of the overall mortality (OM). Conditional survival probabilities for 0-4 yr without events were computed. Cox regression assessed the predictors of oncological outcomes. RESULTS AND LIMITATION A total of 640 patients, with a median 47 (32-67) mo follow-up for event-free individuals, were analyzed. High-grade RFS and PFS at 5 yr were 53% (49-57%) and 78% (74-82%), respectively. The cumulative incidence of CSM and OM at 5 yr was 13% (10-16%) and 16% (13-19%), respectively. Conditional RFS, PFS, overall survival, and cancer-specific survival at 4 yr were 91%, 96%, 87%, and 94%, respectively. Cox regression identified tumor grade (hazard ratio [HR]: 1.54; 1.1-2) and size (HR: 1.3; 1.1-1.7) as RFS predictors. Tumor multiplicity predicted RFS (HR: 1.6; 1.3-2), PFS (HR: 2; 1.2-3.3), and CSM (HR: 2; 1.2-3.2), while age predicted OM (HR: 1.48; 1.1-2). CONCLUSIONS Patients with VHR NMIBC who receive adequate BCG therapy have a more favorable prognosis than predicted by EAU risk groups, especially among those with a sustained response, in whom continuing maintenance therapy emerges as a viable alternative to radical cystectomy. PATIENT SUMMARY Our research shows that a sustained response to bacillus Calmette-Guérin in patients can lead to favorable outcomes, serving as a viable alternative to cystectomy for select cases.
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Affiliation(s)
- José Daniel Subiela
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain.
| | - Wojciech Krajewski
- Department of Minimally Invasive Robotic Urology, Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | | | - Jan Laszkiewicz
- Department of Minimally Invasive Robotic Urology, Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Javier Taborda
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Júlia Aumatell
- Servicio de Urología, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos Móstoles, Madrid, Spain
| | - Miguel Sanchez Encinas
- Servicio de Urología, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos Móstoles, Madrid, Spain
| | - Giuseppe Basile
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Experimental Oncology, Department of Urology, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jorge Caño-Velasco
- Department of Urology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - Enrique Lopez Perez
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Pedro Del Olmo Durán
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Andrea Gallioli
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrzej Tukiendorf
- Institute of Health Sciences, Opole University, Opole, Poland; University Clinical Hospital in Opole, Opole, Poland
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region
| | - Alejandra Serna Céspedes
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Renate Pichler
- Medical University of Innsbruck, Department of Urology, Comprehensive Cancer Center Innsbruck (CCCI), Innsbruck, Austria
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clínico San Carlos, Madrid, Spain
| | - Simone Albisinni
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences Molinette Hospital University of Torino School of Medicine, Torino, Italy
| | | | - Laura S Mertens
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Karl Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Félix Guerrero-Ramos
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain; ROC Clinic, Madrid, Spain; Department of Urology, Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Óscar Rodríguez-Faba
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Tomasz Szydełko
- Department of Minimally Invasive Robotic Urology, Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Victoria Gomez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Miguel Ángel Jiménez Cidre
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
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Abou Chaaya C, Ourfali S, Marchand C, Merienne C, Ruffion A, Brouzes H, Abid N, Pirot F, Colombel M. Comparing efficacy and safety of in-house gemcitabine to mitomycin for bladder instillation in intermediate-risk NMIBC. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102699. [PMID: 39038654 DOI: 10.1016/j.fjurol.2024.102699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 07/07/2024] [Accepted: 07/17/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Intermediate-risk (IR) Non-Muscle Invasive Bladder Cancer (NMIBC) is associated with a high rate of tumor recurrence. To improve patient outcomes, it is recommended to use adjuvant intravesical therapy, by mitomycin C (MMC) or Bacillus Calmette Guerin (BCG). Gemcitabine (GMC) is a known molecule used in urothelial cancer. We aimed to study the efficacy and safety profile of a gemcitabine solution, compared to mitomycin C, in the treatment of IR NMIBC. MATERIAL In this retrospective study, patients with IR NMIBC treated between 2016 and 2020 were selected from two participating centers using either gemcitabine (center A) as the intravesical chemotherapy regimen or mitomycin C (center B). The primary endpoint was recurrence rate and secondary end points were treatment interruption and its causes. RESULTS In our cohort of 102 IR NMIBC patients, 49 patients received GMC and 53 MMC with a median follow-up of 30 months. Overall recurrence rate was 42.1% with 22.4% in the GMC group and 60.3% in the MMC group (P<0.01). This difference was also found in the multifactorial analysis. Course interruption was observed in 14.7% of all patients, primarily attributed to adverse events (46.6%), without difference between groups. CONCLUSION Adjuvant intravesical gemcitabine in patients with IR NMIBC seems to be an interesting option associated with a lower tumor recurrence rate and a favorable tolerance profile when compared to MMC. Larger scale prospective randomized trials are needed to validate our findings. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Carla Abou Chaaya
- Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France; Service d'urologie, hospices civils de Lyon, hôpital Lyon Sud, Lyon, France; Université Claude-Bernard-Lyon 1, Lyon, France.
| | - Said Ourfali
- Service d'urologie, hospices civils de Lyon, hôpital Lyon Sud, Lyon, France
| | - Chloe Marchand
- Plateforme FRIPHARM®, service de pharmacie, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France
| | - Camille Merienne
- Plateforme FRIPHARM®, service de pharmacie, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France
| | - Alain Ruffion
- Service d'urologie, hospices civils de Lyon, hôpital Lyon Sud, Lyon, France; Université Claude-Bernard-Lyon 1, Lyon, France
| | - Hugo Brouzes
- Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France; Service d'urologie, hospices civils de Lyon, hôpital Lyon Sud, Lyon, France; Université Claude-Bernard-Lyon 1, Lyon, France
| | - Nadia Abid
- Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France
| | - Fabrice Pirot
- Plateforme FRIPHARM®, service de pharmacie, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France; Université Claude-Bernard-Lyon 1, Lyon, France
| | - Marc Colombel
- Service d'urologie et chirurgie de la transplantation, hospices civils de Lyon, hôpital Édouard-Herriot, Lyon, France; Université Claude-Bernard-Lyon 1, Lyon, France
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6
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Scilipoti P, Ślusarczyk A, de Angelis M, Soria F, Pradere B, Krajewski W, D'Andrea D, Mari A, Giudice FD, Pichler R, Subiela JD, Afferi L, Albisinni S, Mertens L, Laukhtina E, Mori K, Radziszewski P, Shariat SF, Necchi A, Xylinas E, Gontero P, Rouprêt M, Montorsi F, Briganti A, Moschini M. The Role of Mitomycin C in Intermediate-risk Non-muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2024; 7:1293-1302. [PMID: 38902138 DOI: 10.1016/j.euo.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Intravesical mitomycin C (MMC) instillations are recommended to prevent recurrence of intermediate-risk non-muscle-invasive bladder cancer (IR-NMIBC); however, the optimal regimen and dose are uncertain. Our aim was to assess the effectiveness of adjuvant MMC and compare different MMC regimens in preventing recurrence. METHODS We performed a comprehensive search in PubMed, Scopus, and Web of Science in November 2023 for studies investigating recurrence-free survival (RFS) among patients with IR-NMIBC who received adjuvant MMC. Prospective trials with different MMC regimens or other intravesical drugs as comparators were considered eligible. KEY FINDINGS AND LIMITATIONS Overall, 14 studies were eligible for systematic review and 11 for meta-analysis of RFS. Estimates of 1-yr, 2-yr, and 5-yr RFS rates were 84% (95% confidence interval [CI] 79-89%), 75% (95% CI 68-82%), and 51% (95% CI 40-63%) for patients treated with MMC induction plus maintenance, and 88% (95% CI 83-94%), 78% (95% CI 67-89%), and 66% (95% CI 57-75%) for patients treated with bacillus Calmette-Guérin (BCG) maintenance, respectively. Estimates of 2-yr RFS rates for MMC maintenance regimens were 76% (95% CI 69-84%) for 40 mg MMC (2 studies) and 66% (95% CI 60-72%) for 30 mg MMC (4 studies). Among the studies included, BCG maintenance provided comparable 2-yr RFS to 40 mg MMC with maintenance (78% vs 76%). RFS did not differ by MMC maintenance duration (>1 yr vs 1 yr vs <1 yr). CONCLUSIONS AND CLINICAL IMPLICATIONS MMC induction and maintenance regimens seem to provide short-term RFS rates equivalent to those for BCG maintenance in IR-NMIBC. For adjuvant induction and maintenance, 40 mg of MMC appears to be more effective in preventing recurrence than 30 mg. We did not observe an RFS benefit for longer maintenance regimens. PATIENT SUMMARY For patients with intermediate-risk non-muscle-invasive bladder cancer, bladder treatments with a solution of a drug called mitomycin C (MMC) seem to be as effective as BCG (bacillus Calmette-Guérin) in preventing recurrence after tumor removal. Further trials are needed for stronger evidence on the best MMC dose and treatment time.
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Affiliation(s)
- Pietro Scilipoti
- Department of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Mario de Angelis
- Department of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Benjamin Pradere
- Department of Urology UROSUD, La Croix Du Sud Hospital, Quint-Fonsegrives, France
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - José Daniel Subiela
- Department of Urology, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Laura Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andrea Necchi
- Department of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Morgan Rouprêt
- Urology, GRC no. 5, Predictive Onco-Urology, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Francesco Montorsi
- Department of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Department of Experimental Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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7
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Pérez-Aizpurua X, Monzó-Gardiner JI, Popescu OB, Buendía-González E, Cuello-Sánchez L, Cañadas-Granados M, Tufet I Jaumot JJ, Ruiz de Castroviejo-Blanco J, Osorio-Ospina F, Cabello-Benavente R, González-Enguita C. A Systematic Review on the Current Landscape of T1 Bladder Cancer Substaging. Urology 2024; 194:310-326. [PMID: 39389368 DOI: 10.1016/j.urology.2024.10.013] [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: 08/29/2024] [Revised: 09/25/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVE To conduct a systematic review on the current state of T1 bladder tumor substaging. These neoplasms display significant heterogeneity in oncological behavior and prognosis, leading to the proposal of various substaging methods. Our aim was to investigate the potential diagnostic and prognostic value of substaging in stage T1 bladder cancer for better oncologic outcomes. METHODS A literature search using MEDLINE, EMBASE and Cochrane Library databases was conducted in March 2024 to identify relevant studies on T1 urothelial bladder cancer staging. A systematic review of included articles was performed following the PRISMA guideline statement. Literature search was conducted in English. RESULTS Overall, 63 studies published between 1990 and 2024 were included for final review including a total number of 8328 bladder tumor patients subject to T1 substaging. Various substaging methods have been developed, broadly classified into histometric (anatomy-based) and micrometric (semiquantitative) techniques. Advanced stages have been consistently associated with worse prognosis and need for a more radical therapeutic approach. A standardized, validated, unified substaging report system is lacking. CONCLUSION T1 substaging is a strong predictor of oncologic outcomes. Micrometric methods seem to be more reproducible and precise than histometric techniques in terms of feasibility and prognostic value. Standardization and validation of the technique could potentially enhance the bladder cancer treatment algorithm.
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Affiliation(s)
- Xabier Pérez-Aizpurua
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
| | | | - Oana Beatrice Popescu
- Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | | | | | - Felipe Osorio-Ospina
- Department of Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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8
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Khalatbari F, Moafi-Madani M, Amin A. Mixed-Grade Urothelial Carcinoma: Insights Into Clinical Behavior and Prognostic Implications Compared to Pure Low-Grade and High-Grade Urothelial Carcinomas. Arch Pathol Lab Med 2024; 148:1352-1357. [PMID: 38432312 DOI: 10.5858/arpa.2023-0367-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 03/05/2024]
Abstract
CONTEXT.— Low-grade urothelial carcinoma (LGUC) and high-grade urothelial carcinoma (HGUC) are distinguished based on architectural and cytologic features, with the anticipation that HGUC exhibits more aggressive behavior and a worse prognosis compared to LGUC. The current World Health Organization classification recognizes mixed-grade urothelial carcinoma (MGUC, for the purposes of this study) as a separate category that behaves like LGUC if the high-grade component is <5% and states that any tumor with ≥5% high-grade component should be graded as HGUC. OBJECTIVE.— To evaluate the risk of tumor recurrence, grade, and stage progression of MGUC compared to LGUC and HGUC. DESIGN.— A total of 150 de novo noninvasive polypoid urothelial carcinomas (41 cases of MGUC, 59 of LGUC, and 50 of HGUC) were included. Tumor recurrence, grade, and stage progression were compared among the MGUC, LGUC, and HGUC cases. RESULTS.— Tumor recurrence was observed in 14 of 41 (34.2%) cases of MGUC, 33 of 59 (55.9%) cases of LGUC, and 28 of 50 (56%) cases of HGUC. Grade progression occurred in 5 of 41 (12.2%) of MGUC cases and 5 of 59 (8.5%) of LGUC cases. No stage progression was observed in LGUC or MGUC cases, while 7 of 50 (14%) HGUC cases showed stage progression. MGUC was associated with lower odds and hazard of recurrence compared to LGUC. The rate of grade progression was higher in MGUC and occurred after a shorter interval compared to LGUC. CONCLUSIONS.— MGUC showed a prognosis closer to that of LGUC. Our study supports the current recommendation to classify tumors with <5% high-grade component as MGUC, as these tumors display clinical characteristics and outcomes close to that of pure LGUC.
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Affiliation(s)
- Fateme Khalatbari
- From the Departments of Pathology and Laboratory Medicine (Amin, Khalatbari) and Epidemiology (Moafi-Madani), Brown University, Providence, Rhode Island
| | - Miremad Moafi-Madani
- From the Departments of Pathology and Laboratory Medicine (Amin, Khalatbari) and Epidemiology (Moafi-Madani), Brown University, Providence, Rhode Island
| | - Ali Amin
- From the Departments of Pathology and Laboratory Medicine (Amin, Khalatbari) and Epidemiology (Moafi-Madani), Brown University, Providence, Rhode Island
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9
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Soria F, Rosazza M, Livoti S, Moschini M, De Angelis M, Giudice FD, Pichler R, Hurle R, Mancon S, Carrion DM, Krajewski W, Mertens LS, D'Andrea D, Mari A, Di Maida F, Dutto D, Colucci F, Casale G, Fertitta G, Laukhtina E, Albisinni S, Pradere B, Teoh JYC, Shariat SF, Briganti A, Kamat AM, Gontero P. Clinical Validation of the Intermediate-risk Non-muscle-invasive Bladder Cancer Scoring System and Substratification Model Proposed by the International Bladder Cancer Group: A Multicenter Young Academic Urologists Urothelial Working Group Collaboration. Eur Urol Oncol 2024; 7:1497-1503. [PMID: 38906794 DOI: 10.1016/j.euo.2024.06.004] [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: 04/19/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND AND OBJECTIVE Intermediate-risk (IR) non-muscle-invasive bladder cancer (NMIBC) encompasses a broad spectrum of disease, with heterogeneous outcomes in terms of disease recurrence and progression. The International Bladder Cancer Group (IBCG) recently proposed an updated scoring model for IR substratification that is based on five key risk factors. Our aim was to provide a clinical validation of the IBCG scoring system and substratification model for IR NMIBC. METHODS This was an international multicenter retrospective study. Patients diagnosed with IR NMIBC between 2012 and 2022 and treated with transurethral resection of the bladder and adjuvant intravesical chemotherapy were included. According to the presence or absence of risk factors, patients with IR NMIBC were further categorized in IR-low (no risk factors), IR-intermediate (1-2 risk factors), and IR-high (≥3 risk factors) groups. The 1-yr and 3-yr rates for recurrence-free survival (RFS) and progression-free survival (PFS) were evaluated for each subgroup. Cox regression analyses were used to compare oncological outcomes between the groups. KEY FINDINGS AND LIMITATIONS Of the 677 patients with IR NMIBC included in the study, 231 (34%), 364 (54%), and 82 (12%) were categorized in the IR-low, IR-intermediate, and IR-high groups, respectively. There were significant differences in RFS and PFS rates between these groups. CONCLUSIONS AND CLINICAL IMPLICATIONS We provide the first clinical validation of the IBCG scoring system and model for substratification of IR NMIBC. PATIENT SUMMARY Our study demonstrates that patients with intermediate-risk non-muscle-invasive bladder cancer can be correctly classified into three distinct subgroups according to their risk of both disease recurrence and progression. Our results support use of this scoring system in clinical practice.
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Affiliation(s)
- Francesco Soria
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy.
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Marco Moschini
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Mario De Angelis
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Renate Pichler
- Department of Urology, Comprehensive Cancer Center Innsbruck, Medical University of Innsbruck, Innsbruck, Austria
| | - Rodolfo Hurle
- Department of Urology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Stefano Mancon
- Department of Urology, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Diego M Carrion
- Department of Urology, Torrejon University Hospital, Madrid, Spain
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Dutto
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Fulvia Colucci
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Giulia Casale
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Giorgia Fertitta
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Simone Albisinni
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University of Rome, Rome, Italy
| | - Benjamin Pradere
- Department of Urology, UROSUD, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ashish M Kamat
- Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
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10
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Gontero P, Birtle A, Capoun O, Compérat E, Dominguez-Escrig JL, Liedberg F, Mariappan P, Masson-Lecomte A, Mostafid HA, Pradere B, Rai BP, van Rhijn BWG, Seisen T, Shariat SF, Soria F, Soukup V, Wood R, Xylinas EN. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ)-A Summary of the 2024 Guidelines Update. Eur Urol 2024; 86:531-549. [PMID: 39155194 DOI: 10.1016/j.eururo.2024.07.027] [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: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND AND OBJECTIVE This publication represents a summary of the updated 2024 European Association of Urology (EAU) guidelines for non-muscle-invasive bladder cancer (NMIBC), TaT1, and carcinoma in situ. The information presented herein is limited to urothelial carcinoma, unless specified otherwise. The aim is to provide practical recommendations on the clinical management of NMIBC with a focus on clinical presentation. METHODS For the 2024 guidelines on NMIBC, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of thorough diagnosis, treatment, and follow-up for patients with NMIBC. The guidelines stress the importance of defining patients' risk stratification and treating them appropriately. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2024 EAU guidelines offers valuable insights into risk factors, diagnosis, classification, prognostic factors, treatment, and follow-up of NMIBC. These guidelines are designed for effective integration into clinical practice.
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Affiliation(s)
- Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy.
| | - Alison Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Otakar Capoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | | | - Fredrik Liedberg
- Institute of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Western General Hospital, The University of Edinburgh, Edinburgh, UK
| | | | - Hugh A Mostafid
- Department of Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Benjamin Pradere
- Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Thomas Seisen
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Robert Wood
- EAU Guidelines Office, Arnhem, The Netherlands
| | - Evanguelos N Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université de Paris, Paris, France
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11
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Leyderman M, Chandrasekar T, Grivas P, Li R, Bhat S, Basnet A, Shapiro O, Jacob J, Daneshvar MA, Kord E, Bratslavsky G, Goldberg H. Metastasis development in non-muscle-invasive bladder cancer. Nat Rev Urol 2024:10.1038/s41585-024-00963-y. [PMID: 39567681 DOI: 10.1038/s41585-024-00963-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2024] [Indexed: 11/22/2024]
Abstract
Non-muscle-invasive bladder cancer (NMIBC) is the most common type of bladder cancer presentation and is characterized by a varying probability of recurrence and progression. Sporadically, patients with NMIBC might also develop tumour metastases without any pathological evidence of muscle-invasive disease within the bladder, a condition known as metastatic NMIBC. In the published literature, this phenomenon is limited to several case reports and small reviews, with few data regarding the possible aetiologies. Several possible factors can be potentially associated with metastatic NMIBC, including tumour understaging, the number of transurethral resection procedures received by the patient, the presence of circulating tumour cells, the modality used for diagnostic cystoscopy and possible gender-associated differences. In this Perspective, our aim was to integrate and report currently available data on this relatively rare entity and provide some potential aetiological explanations.
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Affiliation(s)
- Michael Leyderman
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Petros Grivas
- Department of Medicine, Division of Medical Oncology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Seetharam Bhat
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alina Basnet
- Department of Medical Oncology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Oleg Shapiro
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Joseph Jacob
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Eyal Kord
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Hanan Goldberg
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA.
- Upstate Urology at Mohawk Valley Health System (MVHS), Utica, NY, USA.
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12
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Kayama E, Uemura M, Onagi A, Meguro S, Ogawa S, Yaginuma K, Matsuoka K, Hoshi S, Koguchi T, Hata J, Sato Y, Akaihata H, Honma R, Watanabe S, Kojima Y. A Novel Gene Expression Scoring System Predicts Recurrence in Non-Muscle-Invasive Bladder Cancer Patients. Cancer Med 2024; 13:e70349. [PMID: 39540204 PMCID: PMC11561421 DOI: 10.1002/cam4.70349] [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: 04/15/2024] [Revised: 10/05/2024] [Accepted: 10/07/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND Despite the high recurrence rate of non-muscle-invasive bladder cancer (NMIBC), there are limitations in accurately predicting recurrence after transurethral resection of bladder tumor (TURBT) based on clinicopathological factors alone. However, prediction of recurrence using biomolecular characteristics of bladder tumors has not been applied to clinical practice. The objective of this study was to establish a new gene expression scoring system for identifying patients at high risk of recurrence. METHODS NMIBC and normal bladder samples were subjected to microarray analysis to obtain gene expression profiles. We identified 6 genes that were specifically upregulated in bladder cancer and also in recurrent cases. All patients were randomly grouped into a discovery cohort (n = 59) and a validation cohort (n = 30). Gene expression score (GES) was defined as the mean Z-score of the 6 genes specific for recurrent bladder cancer. RESULTS The intravesical recurrence rate of the high GES group (n = 38) was higher than the low GES group (n = 21). GES was significantly associated with recurrence-free survival in the validation cohort as well. In prognostic analysis, the European Organization for Research and Treatment of Cancer (EORTC) risk classification was not related to recurrence after TURBT in either univariate or multivariate analysis. On the other hand, the GES we developed was an independent factor for recurrence in NMIBC. CONCLUSIONS A novel gene expression scoring system was shown to predict recurrence in NMIBC patients after TURBT and might be helpful in clinical decision-making for NMIBC patients.
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Affiliation(s)
- Emina Kayama
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Motohide Uemura
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
- Department of UrologyIwase General HospitalFukushimaJapan
| | - Akifumi Onagi
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Satoru Meguro
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Soichiro Ogawa
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Kei Yaginuma
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Kanako Matsuoka
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Seiji Hoshi
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Tomoyuki Koguchi
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Junya Hata
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Yuichi Sato
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | - Hidenori Akaihata
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
| | | | - Shinya Watanabe
- Translational Research CenterFukushima Medical UniversityFukushimaJapan
| | - Yoshiyuki Kojima
- Department of UrologyFukushima Medical University School of MedicineFukushimaJapan
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Roumiguié M, Leon P, Xylinas E, Allory Y, Audenet F, Bajeot AS, Marcq G, Prost D, Thibault C, Masson-Lecomte A, Seisen T, Pradère B, Rouprêt M, Neuzillet Y. French AFU Cancer Committee Guidelines - Update 2024-2026: Non-muscle invasive bladder cancer (NMIBC). THE FRENCH JOURNAL OF UROLOGY 2024; 34:102742. [PMID: 39581667 DOI: 10.1016/j.fjurol.2024.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 11/26/2024]
Abstract
OBJECTIVE To update the CCAFU recommendations for the management of non-muscle invasive bladder cancer (NMIBC). METHODS A systematic review (Medline) of the literature from 20222024 was performed, taking into account the elements of diagnosis, treatment options and monitoring of NMIBC and evaluating references with their level of evidence. RESULTS The diagnosis of NMIBC (Ta, T1, or CIS) is made after complete and deep tumour resection. The use of bladder photodynamic diagnosis and the indication for a second TURBT (4 to 6weeks later) help to improve the initial diagnosis. The risk of recurrence and/or tumour progression is assessed via the EORTC score. By stratifying patients into low-, intermediate- and high-risk groups, adjuvant treatment can be proposed, including endovesical instillations of chemotherapy (immediate postoperative regimen), BCG (induction and maintenance regimen), or even the indication of cystectomy for unresponsive patients. CONCLUSION Updating the CCAFU's recommendations should help improve patient management, as well as the diagnosis and treatment of NMIBC.
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Affiliation(s)
- Mathieu Roumiguié
- Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France.
| | | | - Evanguelos Xylinas
- Urology Department, Hôpital Bichat-Claude-Bernard, AP-HP, Université Paris Cité, Paris, France
| | - Yves Allory
- Department of Pathology, Institut Curie, Université Paris Saclay, Saint-Cloud, France
| | - François Audenet
- Department of Urology, Hôpital européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | - Anne Sophie Bajeot
- Urology Department, Toulouse University Hospital, University of Toulouse UT3, Toulouse, France
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, CHU de Lille, Université de Lille, CNRS, Inserm, Institut Pasteur de Lille, UMR9020-U1277, Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER), 59000 Lille, France
| | - Doriane Prost
- Urology Department, Paris Saint-Joseph Hospital, Sorbonne University, Paris, France
| | - Constance Thibault
- Medical Oncology Department, Hôpital européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, Paris, France
| | | | - Thomas Seisen
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - Benjamin Pradère
- UROSUD Urology Department, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - Morgan Rouprêt
- Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Urology, Hôpital Pitié-Salpetrière, 75013 Paris, France
| | - Yann Neuzillet
- Urology Department, Hôpital Foch, Université Paris Saclay, Suresnes, France
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14
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Haas M, Kriegmair MC, Breyer J, Sikic D, Wezel F, Roghmann F, Brehmer M, Wirtz RM, Jarczyk J, Erben P, Bahlinger V, Goldschmidt F, Fechner G, Chen J, Paxinos E, Bates M, Zengerling F, Bolenz C, Burger M, Hartmann A, Eckstein M. Improving detection of carcinoma in situ in bladder cancer: urinary cytology vs the Xpert® BC Monitor. BJU Int 2024; 134:755-762. [PMID: 38717014 DOI: 10.1111/bju.16389] [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] [Indexed: 10/25/2024]
Abstract
OBJECTIVE To investigate and compare the performance of urinary cytology and the Xpert BC Monitor test in the detection of bladder cancer in various clinically significant patient cohorts, including patients with carcinoma in situ (CIS), in a prospective multicentre setting, aiming to identify potential applications in clinical practice. PATIENTS AND METHODS A total of 756 patients scheduled for transurethral resection of bladder tumour (TURBT) were prospectively screened between July 2018 and December 2020 at six German University Centres. Central urinary cytology and Xpert BC Monitor tests were performed prior to TURBT. The diagnostic performance of urinary cytology and the Xpert BC Monitor was evaluated according to sensitivity (SN), specificity (SC), negative predictive value (NPV) and positive predictive value (PPV). Statistical comparison of urinary cytology and the Xpert BC Monitor was conducted using the McNemar test. RESULTS Of 756 screened patients, 733 (568 male [78%]; median [interquartile range] age 72 [62-79] years) were included. Bladder cancer was present in 482 patients (65.8%) with 258 (53.5%) high-grade tumours. Overall SN, SC, NPV and PPV were 39%, 93%, 44% and 92% for urinary cytology, and 75%, 69%, 59% and 82% for the Xpert BC Monitor. In patients with CIS (concomitant or solitary), SN, SC, NPV and PPV were 59%, 93%, 87% and 50% for urinary cytology, and 90%, 69%, 95% and 50% for the Xpert BC Monitor. The Xpert BC Monitor missed four tumours (NPV = 98%) in patients with solitary CIS, while potentially avoiding 63.3% of TURBTs in inconclusive or negative cystoscopy and a negative Xpert result. CONCLUSION Positive urinary cytology may indicate bladder cancer and should be taken seriously. The Xpert BC Monitor may represent a useful diagnostic tool for correctly identifying patients with solitary CIS and unsuspicious or inconclusive cystoscopy.
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Affiliation(s)
- Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian C Kriegmair
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
- Urological Hospital Munich-Planegg, Munich, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Felix Wezel
- Department of Urology and Pediatric Urology, University of Ulm, Ulm, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Mirco Brehmer
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Ralph M Wirtz
- Stratifyer Molecular Pathology GmbH, Cologne, Germany
- Institute of Pathology, St. Elisabeth Hospital Köln-Hohenlind, Cologne, Germany
| | - Jonas Jarczyk
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Erben
- Department of Urology and Urosurgery, Medical Faculty Mannheim, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Veronika Bahlinger
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Franziska Goldschmidt
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Guido Fechner
- Department of Urology and Pediatric Urology, University Hospital Bonn, Bonn, Germany
| | - Jack Chen
- Biostatistics, Cepheid Inc., Sunnyvale, CA, USA
| | - Ellen Paxinos
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | - Michael Bates
- Medical and Scientific Affairs, Cepheid Inc., Sunnyvale, CA, USA
| | | | - Christian Bolenz
- Department of Urology and Pediatric Urology, University of Ulm, Ulm, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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15
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Beijert IJ, Hagberg O, Gårdmark T, Holmberg L, Häggström C, Johnston A, Trail M, Hamid S, Dreyer BA, Padovani L, Garau R, Hasan R, Ahmad I, Hendry D, Compérat EM, Burger M, Rouprêt M, Gontero P, Ribal MJ, van der Kwast TH, Babjuk M, Sylvester RJ, Mariappan P, Liedberg F, van Rhijn BWG. The Importance of Being Grade 3: A Plea for a Three-tier Hybrid Classification System for Grade in Primary Non-muscle-invasive Bladder Cancer. Eur Urol 2024; 86:391-399. [PMID: 39209674 DOI: 10.1016/j.eururo.2024.08.013] [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: 04/18/2024] [Revised: 07/10/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024]
Abstract
Grade is an important determinant of progression in non-muscle-invasive bladder cancer. Although the World Health Organization (WHO) 2004/2016 grading system is recommended, other systems such as WHO1973 and WHO1999 are still widely used. Recently, a hybrid (three-tier) system was proposed, separating WHO2004/2016 high grade (HG) into HG/grade 2 (G2) and HG/G3 while maintaining low grade. We assessed the prognostic performance of HG/G3 and HG/G2. Three independent cohorts with 9712 primary (first diagnosis) Ta-T1 bladder tumors were analyzed. Time to progression was analyzed with cumulative incidence functions and Cox regression models. Harrell's C-index was used to assess discrimination. Time to progression was significantly shorter for HG/G3 than for HG/G2 in multivariable analyses (cohort 1: hazard ratio [HR] = 1.92; cohort 2: HR = 2.51, and cohort 3: HR = 1.69). Corresponding progression risks at 5 yr were 18%, 20%, and 18% for HG/G3 versus 7.3%, 7.5%, and 9.3% for HG/G2, respectively. Cox models using hybrid grade performed better than models with WHO2004/2016 (all cohorts; p < 0.001). For the three cohorts, C-indices for WHO2004/2016 were 0.69, 0.62, and 0.75, while, for hybrid grade, C-indices were 0.74, 0.68, and 0.78, respectively. Subdividing the HG category into HG/G2 and HG/G3 stratifies time to progression and supports the recommendation to adopt the hybrid grading system for Ta/T1 bladder cancers.
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Affiliation(s)
- Irene J Beijert
- Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Christel Häggström
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Northern Registry Centre, Department of Diagnostics and Intervention, Umeå University, Umeå, Sweden
| | - Allan Johnston
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Matthew Trail
- Department of Urology, Ninewells Hospital, Dundee, UK
| | - Sami Hamid
- Department of Urology, Ninewells Hospital, Dundee, UK
| | | | - Luisa Padovani
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | - Roberta Garau
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | - Rami Hasan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; Department of Urology, University Hospital Ayr, Ayr, UK
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK; School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - David Hendry
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Eva M Compérat
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Maximilian Burger
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Morgan Rouprêt
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Pitié Salpétrière Hospital, AP-HP, GRC n°5, ONCOTYPE-URO, Sorbonne University, Paris, France
| | - Paolo Gontero
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy
| | - Maria J Ribal
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic; Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; University of Edinburgh, Edinburgh, UK.
| | - Fredrik Liedberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden; European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Department of Urology, Skåne University Hospital, Malmö, Sweden.
| | - Bas W G van Rhijn
- Surgical Oncology (Urology), Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands; Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany; Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
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16
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Alexander CE, Nathan A, Light A, Gao C, Chan V, Khadhouri S, Gallagher K, Byrnes KG, Walters M, Hughes T, Perry R, Okoth K, Magill L, Pinkney T, John JB, McGrath JS, Colquhoun A, Zhang Y, Blackmur J, Etchill E, Tang S, García Escudero D, Stewart G, Kasivisvanathan V. Understanding the long-term impact of the COVID-19 pandemic on non-muscle-invasive bladder cancer outcomes: 12-Month follow-up data from the international, prospective COVIDSurg Cancer study. BJUI COMPASS 2024; 5:1044-1051. [PMID: 39539562 PMCID: PMC11557269 DOI: 10.1002/bco2.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 08/12/2024] [Indexed: 10/21/2024] Open
Abstract
Objective The objective of this study was to report the 12-month oncological outcomes for patients with non-muscle-invasive bladder cancer (NMIBC) within the prospective, international COVIDSurg Cancer study. Patients and methods Eligible patients were aged ≥18 years and scheduled for elective surgical management of NMIBC with curative intent (transurethral resection of bladder tumour [TURBT] or bladder biopsy) from 21 January to 14 April 2020. The primary outcome was disease recurrence within 12 months of previous elective TURBT/bladder biopsy. Secondary outcomes included disease progression within 12 months of previous elective TURBT/bladder biopsy, site-declared delay to surgery from diagnosis as a consequence of COVID-19 and deviation in standard care due to COVID-19. Comparisons were made to cohorts from the pre-pandemic era. Results Bladder cancer accounted for 2.2% (n = 446) of patients in the COVIDSurg Cancer study, with data contributed by 27 centres across 12 countries internationally. Within this included cohort, 229 patients had NMIBC and 12-month follow-up data available. On application of National Institute for Health and Care Excellence (NICE) criteria, 47.2% were classified as having high-risk disease. Overall disease recurrence and progression rates were 29.3% and 9.7% at 12 months, respectively. In purely high-risk pre-pandemic cohorts, the International Bladder Cancer Group (IBCG) estimates a recurrence rate of 25% at 12 months, and the European Association of Urology (EAU) NMIBC 2021 scoring model estimates a 12-month progression rate of 3.5%. As a consequence of the COVID-19 pandemic, 10.9% of patients had site-declared delay to TURBT/bladder biopsy; 7.4% did not undergo intravesical therapy or had early discontinuation of this; 9.2% did not undergo early repeat resection for high-risk disease; and 18.3% had a delay to cystoscopic follow-up surveillance. Conclusions This prospective study indicates that there were widespread deviations in usual care for NMIBC during the pandemic and that 12-month oncological outcomes appear to be impaired compared to published pre-pandemic outcomes.
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Affiliation(s)
- Cameron E. Alexander
- Luton and Dunstable University HospitalLutonUK
- British Urology Researchers in Surgical Training (BURST)LondonUK
| | - Arjun Nathan
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Alexander Light
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Chuanyu Gao
- British Urology Researchers in Surgical Training (BURST)LondonUK
- William Harvey HospitalEast Kent Hospitals University Foundation TrustKentUK
| | - Vinson Chan
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Leeds Institute of Medical ResearchUniversity of LeedsLeedsUK
| | - Sinan Khadhouri
- British Urology Researchers in Surgical Training (BURST)LondonUK
- School of MedicineUniversity of St AndrewsSt AndrewsUnited Kingdom
| | - Kevin Gallagher
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
| | - Kevin G. Byrnes
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Michael Walters
- Birmingham Centre for Observational and Prospective StudiesUniversity of BirminghamBirminghamUK
| | - Terry Hughes
- Birmingham Centre for Observational and Prospective StudiesUniversity of BirminghamBirminghamUK
| | - Rita Perry
- Birmingham Centre for Observational and Prospective StudiesUniversity of BirminghamBirminghamUK
| | - Kelvin Okoth
- Birmingham Centre for Observational and Prospective StudiesUniversity of BirminghamBirminghamUK
| | - Laura Magill
- Birmingham Centre for Observational and Prospective StudiesUniversity of BirminghamBirminghamUK
| | - Thomas Pinkney
- Birmingham Centre for Observational and Prospective StudiesUniversity of BirminghamBirminghamUK
| | - Joseph B. John
- University of Exeter Medical SchoolExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | - John S. McGrath
- University of Exeter Medical SchoolExeterUK
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
| | | | - Yuhao Zhang
- Stepping Hill HospitalStockport NHS Foundation TrustStockportUK
| | - James Blackmur
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
| | | | - Stanley Tang
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | | | - Grant Stewart
- Royal Devon University Healthcare NHS Foundation TrustExeterUK
- Department of SurgeryUniversity of CambridgeCambridgeUnited Kingdom
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST)LondonUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
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17
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Akand M, Veys R, Ost D, Vander Eeckt K, Baekelandt F, Van Reusel R, Mattelaer P, Baekelandt L, Van Cleynenbreugel B, Joniau S, Van der Aa F. Cohort Profile: VZNKUL-NMIBC Quality Indicators Program: A Flemish Prospective Cohort to Evaluate the Quality Indicators in the Treatment of Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2024; 16:3653. [PMID: 39518090 PMCID: PMC11545168 DOI: 10.3390/cancers16213653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 10/14/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
Purpose: Bladder cancer (BC) is a heterogeneous disease with varying outcomes, influenced by disease heterogeneity and variability in treatment and follow-up. Risk groups have been established for non-muscle-invasive BC (NMIBC) to standardize therapy, and several quality control indicators (QCIs) monitor adherence to these risk group-based guidelines. However, controversial results had been obtained regarding the oncological benefits of these QCIs until recent high-quality studies from large registries showed their usefulness. To improve adherence to the European Association of Urology (EAU) Guidelines and benchmark current care in Flemish hospitals within Vlaams Ziekenhuisnetwerk-KU Leuven (VZNKUL), a QCI program for NMIBC was initiated in 2013. This study aims to describe the demographic, clinical, and treatment data of patients enrolled in this program. Participants: The VZNKUL-NMIBC Quality Indicators Program Registry is a prospective cohort including patients treated and followed up with at seven academic and non-academic Flemish hospitals since June 2013. Data collection includes patient characteristics, tumor data, treatment, and oncological outcomes. Findings to date: From June 2013 to December 2020, 4744 transurethral resections of bladder tumors (TURBTs) from 2237 unique patients were analyzed. Most patients (80%) were men with a median age of 73. The median time from diagnosis to TURBT was 19 days. A single tumor was detected in 37% of TURBTs. Tumors larger than 3 cm were found in 20.8% of cases. In 46% of TURBTs, a reTURBT was scheduled according to guidelines. The complication rates were 7.5% and 2.4% for bladder perforation and bleeding, respectively. Postoperative single intravesical instillation of chemotherapy (SIVIC) was administered to 56.9% of 1533 indicated patients with a median time to administration of 4.7 h. Among the cohort, 60.4% had NMIBC, and 9.3% had muscle-invasive BC. Of 972 high-risk patients, 60.7% received adequate BCG induction, while 39.4% received adequate maintenance. After BCG induction ± maintenance, 39.7% were tumor-free, with 17.7% recurrence and 4% progression to muscle-invasive BC. BCG treatment was terminated early for 17% of patients due to intolerance. Early cystectomy was performed for 2.4% of the BCG-naïve patients, and 27.7% of patients with BCG failure underwent a BCG rechallenge. For intermediate-risk patients, 2.1% received adequate BCG, and 23% received intravesical chemotherapy. The median follow-up was 57 months. Five-year recurrence-free, progression-free, cancer-free, overall, and cancer-specific survival rates were 53%, 91.6%, 89%, 70.6%, and 95.6%, respectively, for the NMIBC patients. Of 400 non-metastatic MIBC patients, 217 (54.3%) underwent radical cystectomy (RC), of whom 46% received neoadjuvant chemotherapy, while 18 (4.5%) refused RC, and 74 (18.5%) were considered unfit for the surgery. Future plans: The VZNKUL-NMIBC Quality Indicators Program Registry will continue collecting data to evaluate QCIs and monitor treatment quality, enabling hospitals to benchmark their performance and improve patient care. Additionally, the registry's real-world data can support research and international collaboration. Trial registration: The study was registered on ClinicalTrials.gov (NCT04167332).
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Affiliation(s)
- Murat Akand
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (M.A.); (L.B.); (B.V.C.); (S.J.)
- Laboratory of Experimental Urology, Urogenital, Abdominal and Plastic Surgery, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ralf Veys
- Department of Urology, AZ Groeninge, 8500 Kortrijk, Belgium;
| | - Dieter Ost
- Department of Urology, AZ Sint Blasius, 9200 Dendermonde, Belgium; (D.O.); (K.V.E.)
| | - Kathy Vander Eeckt
- Department of Urology, AZ Sint Blasius, 9200 Dendermonde, Belgium; (D.O.); (K.V.E.)
| | | | - Raf Van Reusel
- Department of Urology, AZ Turnhout, 2300 Turnhout, Belgium;
| | - Pieter Mattelaer
- Department of Urology, AZ Oostende Damiaan, 8400 Oostende, Belgium;
| | - Loic Baekelandt
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (M.A.); (L.B.); (B.V.C.); (S.J.)
- Laboratory of Experimental Urology, Urogenital, Abdominal and Plastic Surgery, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ben Van Cleynenbreugel
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (M.A.); (L.B.); (B.V.C.); (S.J.)
- Laboratory of Experimental Urology, Urogenital, Abdominal and Plastic Surgery, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (M.A.); (L.B.); (B.V.C.); (S.J.)
- Laboratory of Experimental Urology, Urogenital, Abdominal and Plastic Surgery, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (M.A.); (L.B.); (B.V.C.); (S.J.)
- Laboratory of Experimental Urology, Urogenital, Abdominal and Plastic Surgery, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
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18
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Li H, Sui Y, Tao Y, Cao J, Jiang X, Wang B, Du Y. Coupling Habitat Radiomic Analysis with the Diversification of the Tumor ecosystem: Illuminating New Strategy in the Assessment of Postoperative Recurrence of Non-Muscle Invasive Bladder Cancer. Acad Radiol 2024:S1076-6332(24)00685-8. [PMID: 39455346 DOI: 10.1016/j.acra.2024.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 09/16/2024] [Accepted: 09/16/2024] [Indexed: 10/28/2024]
Abstract
RATIONALE AND OBJECTIVES Non-muscle-invasive bladder cancer (NMIBC) is highly recurrent, with each recurrence potentially progressing to muscle-invasive cancer, affecting patient prognosis. Intratumoral heterogeneity plays a crucial role in NMIBC recurrence. This study investigated a novel habitat-based radiomic analysis for stratifying NMIBC recurrence risk. MATERIALS AND METHODS A retrospective collection of 382 NMIBC patients between 2015 and 2021 from two medical institutions was carried out. Patients' CT images were collected across three phases, with tumor sites delineated within the bladder. Intratumoral habitats were identified using K-means clustering on 19 texture features of the tumor sites, followed by the extraction of 107 radiomic features per habitat with PyRadiomics. These features were integrated into machine learning algorithms to develop a habitat-based model (HBM) for predicting two-year recurrence of NMIBC patients. The clinical and multiphase radiomic models were also constructed for comparison, with the Delong test comparing their diagnostic efficiency. The impact of HMB on patients' recurrence-free survival and the correlation between HBM and tumor-stroma ratio were further analyzed. RESULTS Three distinct habitats were identified within NMIBC. The HBM showed an AUC of 0.932 (95% CI: 0.906 - 0.958) in the training cohort and 0.782 (95% CI: 0.674 - 0.890) in the validation cohort for predicting two-year recurrence. With comparison between different models, The HBM is demonstrated to possess superior diagnostic efficacy to the clinical model (p < 0.001) in the training cohort. However, no significant difference was noted between the multiphase and clinical models (p = 0.130) in the training cohort. The HBM score effectively distinguished the recurrence-free survival of NIMBC patients and demonstrated a significant correlation with the tumor-stroma ratio. CONCLUSIONS Habitat-based radiomics, coupled with machine learning, efficiently predicts NMIBC recurrence. Further research on habitat-based radiomics offers potential improvement in clinical management of NMIBC.
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Affiliation(s)
- Hong Li
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China (H.L., Y.T.)
| | - Yiqun Sui
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China (Y.S.)
| | - Yongli Tao
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China (H.L., Y.T.)
| | - Jin Cao
- Department of Pathology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China (J.C., X.J.)
| | - Xiang Jiang
- Department of Pathology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China (J.C., X.J.)
| | - Bo Wang
- Department of Urology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China (B.W., Y.D.)
| | - Yiheng Du
- Department of Urology, Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou, China (B.W., Y.D.).
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19
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Huang J, Lin L, Mao D, Hua R, Guan F. Prognostic value of neutrophil-to-lymphocyte ratio in patients with non-muscle-invasive bladder cancer with intravesical Bacillus Calmette-Guérin immunotherapy: a systematic review and meta-analysis. Front Immunol 2024; 15:1464635. [PMID: 39507536 PMCID: PMC11538002 DOI: 10.3389/fimmu.2024.1464635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 10/03/2024] [Indexed: 11/08/2024] Open
Abstract
Background The predictive accuracy of the preoperative neutrophil-to-lymphocyte ratio (NLR) on the prognosis of patients with non-muscle-invasive bladder cancer (NMIBC) with intravesical Bacillus Calmette-Guérin immunotherapy (BCG) after transurethral resection of the bladder tumor (TURBT) remains unknown. Therefore, the current study performed a systematic review and meta-analysis to examine the relationship between preoperative NLR and the prognosis of patients with NMIBC with intravesical BCG immunotherapy. Methods For this systematic review and meta-analysis, articles were retrieved from PubMed, Cochrane Library, Web of Science, and Embase databases from their inception to 14 May 2024. The role of NLR in predicting recurrence and progression in NMIBC was determined using pooled hazard ratios (HRs) and 95% confidence intervals (CIs). Results Seven articles were included in this meta-analysis, involving 4,187 patients. An elevated NLR was significantly associated with recurrence (HR = 2.67, 95% CI = 1.34-5.32, P < 0.001) and progression (HR = 1.72, 95% CI = 1.13-2.60, P = 0.004) in patients with NMIBC with intravesical BCG immunotherapy. Conclusion This meta-analysis demonstrated that elevated preoperative NLR levels were significantly associated with recurrence and disease progression in patients with NMIBC who underwent intravesical BCG immunotherapy after TURBT. Systematic review registration https://inplasy.com/inplasy-2024-7-0058/, identifier 202470058.
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Affiliation(s)
- Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Li Lin
- Department of Science and Education, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Dikai Mao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Runmiao Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Feifei Guan
- Physical Examination Center, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
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20
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Lobo N, Duan Z, Sood A, Zhao H, Lindskrog SV, Dyrskjot L, Giordano SH, Williams SB, Bree KK, Kamat AM. Sex Disparity in Non-muscle-invasive Bladder Cancer: Pitfalls of Large Population-based Data Sets and Lessons from an Integrated Analysis. Eur Urol Oncol 2024:S2588-9311(24)00226-8. [PMID: 39448349 DOI: 10.1016/j.euo.2024.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 08/29/2024] [Accepted: 10/01/2024] [Indexed: 10/26/2024]
Abstract
The impact of sex on non-muscle-invasive bladder cancer (NMIBC) remains uncertain and current evidence is conflicting. To address this uncertainty, we conducted an integrative analysis using Surveillance, Epidemiology and End Results (SEER)-Medicare and UROMOL data sets to explore sex disparities in NMIBC oncological outcomes. In the SEER-Medicare cohort, females had lower risks of recurrence and progression in comparison to males, but no significant difference in BC-specific mortality was observed. Analysis of the UROMOL cohort revealed no sex-specific differences in tumour biology across genomic, transcriptomic, and spatial proteomic domains. These findings highlight the limitations of relying on just SEER-Medicare data for NMIBC, for which identification of the true incidence of recurrence and progression is challenging, and emphasise the importance of combining population-based data and molecular biology results to gain a comprehensive understanding of NMIBC. PATIENT SUMMARY: The impact of sex on non-muscle-invasive bladder cancer (NMIBC) outcomes is unclear. Our analysis of a large population-based data set showed that the risks of recurrence and progression were lower for females. However, analysis of a separate molecular dataset showed no sex-specific differences. The results highlight the importance of combining population-based data and molecular biology results for a better understanding of NMIBC.
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Affiliation(s)
- Niyati Lobo
- Cambridge University Hospitals, Cambridge, UK; University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhigang Duan
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Hui Zhao
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | | | | | - Kelly K Bree
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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21
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Basile G, Uleri A, Leni R, Cannoletta D, Afferi L, Baboudjian M, Diana P, D'Andrea D, Teoh J, Pradere B, Subiela JD, Laukhtina E, Seisen T, Rouprêt M, Briganti A, Montorsi F, Moschini M, Breda A, Gallioli A. En Bloc Versus Conventional Transurethral Resection of Bladder Tumors: A Systematic Review and Meta-analysis of Oncological, Histopathological, and Surgical Outcomes. Eur Urol Oncol 2024:S2588-9311(24)00232-3. [PMID: 39428278 DOI: 10.1016/j.euo.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 09/16/2024] [Accepted: 10/07/2024] [Indexed: 10/22/2024]
Abstract
BACKGROUND AND OBJECTIVE En bloc resection of bladder tumor (ERBT) has been introduced to enhance the quality of resection of bladder cancer. This review aims to compare the perioperative and oncological outcomes of ERBT and conventional transurethral resection of bladder tumor (cTURBT). METHODS A literature search was conducted using the PubMed/Medline, Embase, and Web of Science databases to identify randomized controlled trials published until May 2024. The primary outcomes were the risk of recurrence and progression. The secondary outcomes were detrusor muscle (DM) presence, muscularis mucosae (MM) detectability, bladder perforation and obturator nerve reflex rates, operative time, length of catheterization and hospitalization, and residual tumor at repeat transurethral resection of bladder tumor (reTURBT). KEY FINDINGS AND LIMITATIONS Seventeen studies met our inclusion criteria. No statistically significant difference was observed in 12-mo recurrence (risk ratio [RR] 0.81, 95% confidence interval [CI]: 0.65-1.02; p = 0.08), 24-mo recurrence (RR 1.02, 95% CI: 0.85-1.22; p = 0.8), and 12-mo progression (RR 0.68, 95% CI: 0.05-10.14; p = 0.8) rates. ERBT was significantly associated with a higher DM presence (RR 1.10, 95% CI: 1.01-1.20; p = 0.02), while no statistically significant difference emerged in the residual tumor at reTURBT and MM detectability (all p > 0.05). ERBT was significantly associated with a lower risk of bladder perforation (p = 0.002) and obturator nerve reflex (p < 0.001). Finally, ERBT was significantly associated with longer operative time, lower catheterization time, and lower length of hospital stay. The main limitation was heterogeneity among the included studies. CONCLUSIONS AND CLINICAL IMPLICATIONS ERBT is safer due to fewer intraoperative events, but there was no significant difference in oncological outcomes compared with cTURBT. Higher DM detection with ERBT enhances initial disease stratification, potentially improving clinical decision-making and care delivery. PATIENT SUMMARY En bloc resection of bladder tumors is associated with lower intraoperative complications than and superior histopathological information to the conventional resection technique. However, the absence of a difference in oncological outcomes underscores the influence of factors such as tumor characteristics, surgeon expertise, and postoperative care on subsequent events.
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Affiliation(s)
- Giuseppe Basile
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Alessandro Uleri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Riccardo Leni
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Donato Cannoletta
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Luca Afferi
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, AP-HM, Marseille, France
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - David D'Andrea
- European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Jeremy Teoh
- European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Department of Surgery, Faculty of Medicine, S.H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin Pradere
- European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Department of Urology UROSUD, La Croix du Sud Hôpital, Quint Fonsegrives, France
| | - José D Subiela
- Department of Urology, Hospital Universitario Ramon y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Ekaterina Laukhtina
- European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Thomas Seisen
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Morgan Rouprêt
- Urology, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Alberto Briganti
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Montorsi
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marco Moschini
- Vita-Salute San Raffaele University, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; European Association of Urology-Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
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22
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Ecke TH, Gakis G. [New therapeutic approaches for non-muscle invasive bladder cancer-is organ preservation also possible after BCG (Bacillus Calmette Guérin)?]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:977-984. [PMID: 39177781 DOI: 10.1007/s00120-024-02417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2024] [Indexed: 08/24/2024]
Abstract
Bacillus Calmette-Guérin (BCG) therapy is the standard of care in the treatment of high-risk non-muscle invasive bladder cancer (NMIBC). In the absence of a response to BCG and persistent high-grade disease, cystectomy is recommended depending on the clinical risk. A variety of targeted therapy approaches, which aim at immune- and gene-based molecular targets, such as PD-(L)1 and FGFR, are currently being investigated in randomized studies for BCG-unresponsive NMIBC. Furthermore, novel forms of application for instillation therapy, such as the TAR device, in combination with gemcitabine or erdafitinib are being investigated in clinical trials in order to extend the duration of action of the active substance on the urothelium. Thus, there are now many developments that could make bladder-preserving therapy with comparable survival data possible as an alternative to BCG or in the event of BCG failure. In the future, it will be necessary to clarify how BCG response can be predicted by using molecular markers and how to define risk groups that should primarily be given an alternative therapy to BCG.
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Affiliation(s)
- Thorsten H Ecke
- Klinik für Urologie, Helios Klinikum Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Deutschland.
- Klinik für Urologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
- Interdisziplinäre Arbeitsgruppe BlasenCarcinom (IABC), Bad Herrenalb, Bad Herrenalb, Deutschland.
| | - Georgios Gakis
- Universitätsklinik und Poliklinik für Urologie, Universitätsmedizin Halle, Halle, Deutschland
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23
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Hengky A, Lionardi SK, Kusumajaya C. Can artificial intelligence aid the urologists in detecting bladder cancer? Indian J Urol 2024; 40:221-228. [PMID: 39555437 PMCID: PMC11567573 DOI: 10.4103/iju.iju_39_24] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/23/2024] [Accepted: 07/11/2024] [Indexed: 11/19/2024] Open
Abstract
Introduction The emergence of artificial intelligence (AI)-based support system endoscopy, including cystoscopy, has shown promising results by training deep learning algorithms with large datasets of images and videos. This AI-aided cystoscopy has the potential to significantly transform the urological practice by assisting the urologists in identifying malignant areas, especially considering the diverse appearance of these lesions. Methods Four databases, the PubMed, ProQuest, EBSCOHost, and ScienceDirect were searched, along with a manual hand search. Prospective and retrospective studies, experimental studies, cross-sectional studies, and case-control studies assessing the utilization of AI for the detection of bladder cancer through cystoscopy and comparing with the histopathology results as the reference standard were included. The following terms and their variants were used: "artificial intelligence," "cystoscopy," and "bladder cancer." The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A random effects model was used to calculate the pooled sensitivity and specificity. The Moses-Littenberg model was used to derive the Summary Receiver Operating Characteristics (SROC) curve. Results Five studies were selected for the analysis. Pooled sensitivity and specificity were 0.953 (95% confidence interval [CI]: 0.908-0.976) and 0.957 (95% CI: 0.923-0.977), respectively. Pooled diagnostic odd ratio was 449.79 (95% CI: 12.42-887.17). SROC curve (area under the curve: 0.988, 95% CI: 0.982-0.994) indicated a strong discriminating power of AI-aided cystoscopy in differentiation normal or benign bladder lesions from the malignant ones. Conclusions Although the utilization of AI for aiding in the detection of bladder cancer through cystoscopy remains questionable, it has shown encouraging potential for enhancing the detection rates. Future studies should concentrate on identification of the patients groups which could derive maximum benefit from accurate identification of the bladder cancer, such as those with intermediate or high-risk invasive tumors.
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Affiliation(s)
- Antoninus Hengky
- Department of General Medicine, Fatima Hospital, Ketapang Regency, West Kalimantan, Indonesia
- Center of Health Research, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Stevan Kristian Lionardi
- Department of General Medicine, Sultan Syarif Mohamad Alkadrie Hospital, Pontianak, West Kalimantan, Indonesia
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Dewulf K, Richter K, Illy M, Branger N, Rybikowski S, Maubon T, DeLuca V, Walz J, Brunelle S, Pignot G. Can Bladder MRI Improve the Follow-Up of Non-Muscle-Invasive Bladder Cancer by Detecting Endoscopic Invisible Recurrence? Clin Genitourin Cancer 2024; 22:102136. [PMID: 38908260 DOI: 10.1016/j.clgc.2024.102136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/24/2024]
Affiliation(s)
- Karel Dewulf
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France; Department of Urology, AZ Delta Hospital, Roeselare, Belgium
| | - Konstantin Richter
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Mathias Illy
- Department of Radiology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Nicolas Branger
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Stanislas Rybikowski
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Valeria DeLuca
- Department of Radiology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes Cancer Centre, Marseille, France
| | - Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes Cancer Centre, Marseille, France.
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25
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Lobo N, Duan Z, Sood A, Tan WS, Grajales V, Contieri R, Lindskrog SV, Dyrskjøt L, Zhao H, Giordano SH, Williams SB, Bree KK, Kamat AM. Association of Age with Non-muscle-invasive Bladder Cancer: Unearthing a Biological Basis for Epidemiological Disparities? Eur Urol Oncol 2024; 7:1069-1079. [PMID: 38302322 DOI: 10.1016/j.euo.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Age disparity in patients with non-muscle-invasive bladder cancer (NMIBC) exists. Whether this is due to differences in adequate cancer care or tumour biology is unclear. OBJECTIVE To investigate age disparities in NMIBC using the Surveillance, Epidemiology, and End Results (SEER)-Medicare and UROMOL datasets. DESIGN, SETTING, AND PARTICIPANTS The SEER-Medicare data were used to identify patients with clinical stage Ta, Tis, and T1 NMIBC between 2005 and 2017 (n = 32 225). Using the UROMOL cohort (n = 834), age disparities across transcriptomic, genomic, and spatial proteomic domains were assessed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the SEER-Medicare data, multivariable competing-risk regression was used to examine the association between age and recurrence, progression, and bladder cancer-specific mortality (BCSM). For the UROMOL cohort, multivariable general linear model and multinomial logistic regression were performed to evaluate the association between age and tumour biology. RESULTS AND LIMITATIONS An analysis of the SEER-Medicare cohort revealed 5-yr recurrence rates of 55.2%, 57.4%, and 58.9%; 5-yr progression rates of 25.6%, 29.2%, and 36.9%; and 5-yr BCSM rates of 3.9%, 5.8%, and 11.8% in patients aged 66-70, 71-80, and ≥81 yr, respectively. After multivariable adjustment, age ≥81 yr was associated with a higher risk of recurrence (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.12; p = 0.001), progression (HR 1.32, p < 0.001), and BCSM (HR 2.58, p < 0.001). UROMOL2021 transcriptomic class 2a was most frequently observed in patients with advanced age (34.0% in ≥76 yr vs 21.6% in ≤65 yr; p = 0.004), a finding confirmed on multivariable analysis (risk ratio [RR] 3.86, p = 0.002). UROMOL2021 genomic class 3 was observed more frequently in patients aged ≥76 yr (4.9% vs 24.2%; p = 0.001). Limitations include the definitions used for recurrence and progression, which may lead to under- or overestimation of true rates. CONCLUSIONS Among SEER-Medicare patients with NMIBC, advanced age is associated with inferior oncological outcomes. These results reflect age-related molecular biological differences observed across transcriptomic and genomic domains, providing further evidence that innate tumour biology contributes to observed disparities in NMIBC outcomes. PATIENT SUMMARY Older patients with non-muscle-invasive bladder cancer have worse oncological outcomes than younger patients. Some of this age disparity may be due to differences in tumour biology.
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Affiliation(s)
- Niyati Lobo
- Department of Urology, Royal Free London NHS Trust, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhigang Duan
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sia V Lindskrog
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hui Zhao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Williams
- Department of Urology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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26
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Chen C, Fan G, Li P, Yang E, Jing S, Shi Y, Gong Y, Zhang L, Wang Z. Comparative study on the efficacy of low-dose and full-dose BCG bladder perfusion therapy. Clin Transl Oncol 2024:10.1007/s12094-024-03729-5. [PMID: 39325262 DOI: 10.1007/s12094-024-03729-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 09/09/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND Full-dose BCG bladder perfusion therapy is effective, but there are serious side effects. Whether a low dose of BCG can reduce the side effects of treatment while maintaining its efficacy is still inconclusive. OBJECTIVE To compare the efficacy of low-dose and full-dose BCG bladder perfusion therapy and to provide reference for individual treatment of bladder cancer. METHODS All relevant literature published in PubMed, Web of Science, and Embrase databases up to April 2024 was searched. The results and shortcomings of the existing literature are analyzed, the cognitive gaps between different studies are pointed out, and suggestions are made for future research. RESULTS A total of 32 pieces of literature were included. Twelve studies found that the efficacy of full-dose BCG perfusion was significantly better than that of low-dose BCG perfusion, and 20 studies found no statistical difference between low-dose and full-dose BCG perfusion CONCLUSION: Although there is no significant difference in the efficacy of full-dose and low-dose BCG in bladder perfusion, the trend indicates that the efficacy of full-dose BCG is still the most accurate. In cases where BCG resources are scarce or patients are intolerant, low-dose BCG bladder perfusion therapy may be an alternative to full-dose BCG bladder perfusion therapy. High-quality, large-sample prospective cohort studies (or randomized controlled studies) are still needed in the future.
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Affiliation(s)
- Chaohu Chen
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Guangrui Fan
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Pan Li
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Enguang Yang
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Suoshi Jing
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Yibo Shi
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Yuwen Gong
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Luyang Zhang
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China
| | - Zhiping Wang
- Institute of Urology, Lanzhou University Second Hospital, No.82 Linxia Road, Chengguan District, Lanzhou, 730030, China.
- Gansu Province Clinical Research Center for Urinary System Disease, Lanzhou, China.
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27
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Rodríguez Faba Ó, Fernández Gómez JM, Guerrero-Ramos F, Álvarez-Maestro M, Ledo Cepero MJ, Unda Urzaiz M, Martínez-Piñeiro L, Cózar Olmo JM, Redorta JP, Álvarez-Ossorio JL. Consensus document on the implications of standardization of BCG supply in the management of patients with non-muscle-invasive bladder cancer. Actas Urol Esp 2024:S2173-5786(24)00109-4. [PMID: 39341566 DOI: 10.1016/j.acuroe.2024.09.005] [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: 05/30/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 10/01/2024]
Abstract
Patients with non-muscle-invasive bladder cancer (NMIBC) in the intermediate and high-risk groups must receive adjuvant treatment with intravesical Bacillus Calmette-Guérin (BCG) following transurethral resection (TUR), as it reduces the risk of recurrence and presumably the risk of progression as well. Optimization of BCG efficacy is achieved by administering maintenance therapy. However, since many immunological aspects of the mechanism of action of BCG in the bladder remain unknown, the implementation of the optimal dose, number of instillations, strains and adequate maintenance regimen over the last decades has been heterogeneous. Additionally, this has hindered the interpretation of efficacy in terms of oncologic outcomes. This, together with the shortages of BCG in recent years, have forced scientific societies to adapt their clinical practice guidelines and modify their protocols of adjuvant treatment with BCG. This includes changes to strains, doses, and maintenance during this period of time. This consensus document evaluates the current status of adjuvant BCG treatment and the implications of BCG supply availability in the treatment of patients with NMIBC. It also addresses the implementation of novel therapies that will improve cancer prognosis and the quality of life of patients with NMIBC in the future.
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Affiliation(s)
- Ó Rodríguez Faba
- Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - J M Fernández Gómez
- Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - F Guerrero-Ramos
- Hospital Universitario 12 de Octubre, Madrid, ROC Clinic y Hospital Universitario HM Sanchinarro, Madrid, Spain
| | | | | | - M Unda Urzaiz
- Laboratorio Mixto de Investigación Traslacional en Cáncer de Próstata, CICbioGUNE-Basurto, IIS Biobizkaia, Spain
| | | | - J M Cózar Olmo
- Servicio de Urología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - J Palou Redorta
- Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Pijpers OM, van Hoogstraten LMC, Remmers S, Beijert IJ, Oddens JR, Alfred Witjes J, Kiemeney LA, Aben KKH, Boormans JL. Risk of Progression of High-grade Primary T1 Non-muscle-invasive Bladder cancer in a Contemporary Cohort. Eur Urol Oncol 2024:S2588-9311(24)00216-5. [PMID: 39327188 DOI: 10.1016/j.euo.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/30/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024]
Abstract
Patients with high-risk non-muscle-invasive bladder cancer (NMIBC) receive bacillus Calmette-Guérin (BCG) instillations to reduce the risk of progression. For patients with very high-risk NMIBC, immediate radical cystectomy may be considered, as patients who experience disease progression despite BCG treatment have a worse prognosis. However, guideline-recommended stratification for the risk of progression is based on data from patients who were not exposed to BCG. We evaluated the risk of progression in a contemporary cohort of patients with primary high-grade/grade 3 (HG/G3) T1 NMIBC (n = 1268) who received at least one BCG instillation and underwent at least one cystoscopic evaluation. The primary endpoint was the 1-yr risk of progression for all patients and for the subgroup that received adequate BCG, defined as at least five induction instillations and at least two instillations provided as a second BCG course within 6 mo. Progression was defined as detrusor muscle invasion or lymph node or distant metastasis. The 1-yr risk of progression was 6.5% (95% confidence interval [CI] 5.2-8.0) for patients with primary HG/G3 T1 NMIBC who started BCG treatment, and 4.6% (95% CI 3.3-6.4) 1 yr after the first instillation of the second BCG course for patients who received adequate BCG (n = 746). In conclusion, the contemporary risk of progression for patients with HG/G3 T1 NMIBC who receive BCG appears to be low, especially for patients who receive adequate BCG treatment. PATIENT SUMMARY: Our study shows that for patients with a high-grade bladder tumor who received in-bladder BCG (bacillus Calmette-Guérin), the risk of disease progression was 6.5% at 1 yr after their first BCG instillation. For patients who continued with BCG maintenance treatments, the risk of progression was 4.6% after the first BCG maintenance instillation.
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Affiliation(s)
- Olga M Pijpers
- Department of Urology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa M C van Hoogstraten
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Irene J Beijert
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lambertus A Kiemeney
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands; IQ Health Science Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands; IQ Health Science Department, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Czarnogórski MC, Koper K, Petrasz P, Vetterlein MW, Pokrywczyńska M, Juszczak K, Drewa T, Adamowicz J. Urinary bladder transplantation in humans - current status and future perspectives. Nat Rev Urol 2024:10.1038/s41585-024-00935-2. [PMID: 39304780 DOI: 10.1038/s41585-024-00935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 09/22/2024]
Abstract
Urinary bladder vascularized allograft transplantation in humans is currently extensively being investigated worldwide, owing to the theoretical potential of this approach as a therapeutic option for individuals with end-stage, non-oncological bladder conditions or congenital bladder pathologies. To date, a successful attempt at urinary bladder autotransplantation was carried out in a heart-beating brain-dead research human donor. The robot-assisted surgical technique was shown to be optimal for performing this procedure, achieving a good performance in terms of both bladder allograft collection as well as vascular, ureterovesical and vesicourethral anastomoses. The urinary bladder vascularized allograft would be an alternative to traditional urinary diversion methods that rely on the use of intestinal segments, potentially avoiding adverse effects associated with these approaches. However, different from ileal urinary diversion, bladder transplantation would require lifelong immune suppression. Clinical trials are in progress to assess the vascularized bladder allograft transplantation technique, as well as the safety of this procedure in oncological and non-oncological indications.
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Affiliation(s)
- Michał C Czarnogórski
- Department and Chair of Urology and Andrology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Krzysztof Koper
- Department of Oncology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Petrasz
- Department of Urology and Urological Oncology, Multidisciplinary Regional Hospital in Gorzów Wielkopolski, Gorzów Wielkopolski, Poland
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Marta Pokrywczyńska
- Chair of Urology, Department of Regenerative Medicine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Kajetan Juszczak
- Department and Chair of Urology and Andrology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Tomasz Drewa
- Department and Chair of Urology and Andrology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jan Adamowicz
- Department and Chair of Urology and Andrology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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Trelles Guzmán CR, Linares Espinós E, Ríos González E, Alonso Dorrego JM, Aguilera Bazán A, Jiménez Romero ME, Martínez-Piñeiro L. Randomized clinical trial on the use of IMAGE1 S LIGHT (SPIES) vs. white light in the prevention of recurrence during transurethral resection of bladder tumors: Analysis after 12-month follow-up. Actas Urol Esp 2024; 48:512-520. [PMID: 38159804 DOI: 10.1016/j.acuroe.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AIM The primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder (TUR); the secondary objective was to compare the complication rates according to Clavien-Dindo (CD) at 12 months of follow-up. METHODS Prospective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to CD were analyzed using chi-square/U Mann-Whitney tests and recurrence-free survival (RFS) using Kaplan-Meier curves. The European Association of Urology (EAU) 2021 scoring model was used. RESULTS The analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P = .080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P = .003) and a higher RFS with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P = .083). CONCLUSIONS There were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.
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Affiliation(s)
- C R Trelles Guzmán
- Servicio de Urología, Área de Gestión Sanitaria Campo de Gibraltar Este, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | | | - E Ríos González
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain
| | | | - A Aguilera Bazán
- Servicio de Urología, Hospital Universitario La Paz, Madrid, Spain
| | - M E Jiménez Romero
- Servicio de Urología, Área de Gestión Sanitaria Campo de Gibraltar Este, Spain; Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Spain
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Wang X, Zhang S, Sun Y, Cai L, Zhang J. The prognostic significance of preoperative platelet-to-lymphocyte ratio and interleukin-6 level in non-muscle invasive bladder cancer. Int J Biol Markers 2024; 39:255-264. [PMID: 38859794 DOI: 10.1177/03936155241261719] [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] [Indexed: 06/12/2024]
Abstract
BACKGROUND Non-muscle invasive bladder cancer (NMIBC) is the most prevalent type of bladder cancer, typically associated with a favorable prognosis and a risk of recurrence during the follow-up period. Inflammatory markers have been used to predict prognosis in various cancer types. The aim of this study was to explore the prognostic value of the readily accessible inflammatory markers, platelet-to-lymphocyte ratio (PLR) and interleukin-6 (IL-6), in NMIBC. METHODS The study comprised a retrospective analysis of clinical data collected from NMIBC patients diagnosed between October 2018 and October 2020. PLR was calculated using the routine preoperative blood test results, and preoperative IL-6 levels were recorded. Receiver operating characteristic (ROC) curves were generated for PLR and IL-6 level and the optimal cut-off values were determined using Youden's index. Survival curves were generated to evaluate the association between PLR and IL-6, and recurrence-free survival (RFS), and univariate and multivariate analysis were performed using the Cox proportional hazards regression model. A nomogram and calibration curve were generated to assess the clinical significance of the model. RESULTS The ROC curves demonstrated that PLR and IL-6 levels were significantly associated with tumor pathology grade, with area under the curve (AUC) values of 0.833 (95% CI 0.757, 0.910) for PLR and 0.724 (95% CI 0.622, 0.825) for IL-6 levels. PLR and IL-6 levels were also positively associated with tumor recurrence, with AUC values of 0.647 (95% CI 0.538, 0.756) and 0.846 (95% CI 0.769, 0.924), respectively. The survival curves indicated that patients with high PLR and high IL-6 levels had shorter RFS than those with low PLR and low IL-6 level (P < 0.01). Univariate Cox proportional hazards regression analysis showed that age, tumor size, tumor number, pathological grade, PLR and IL-6 were potential risk factors for NMIBC recurrence. Multivariate analysis further revealed that tumor number, smoking, PLR, and IL-6 were independent risk factors for NMIBC recurrence (P < 0.05). CONCLUSIONS Preoperative peripheral blood inflammatory markers (PLR and IL-6) are useful predictors of RFS in NMIBC patients at the time of initial diagnosis. High PLR and high IL-6 were identified as independent risk factors for tumor recurrence and could serve as potential biological markers for prediction of NMIBC recurrence.
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Affiliation(s)
- Xiangyu Wang
- Department of Urology Surgery, Nanjing Drum-Tower Hospital Group Suqian Hospital, The Affiiated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Shaoqi Zhang
- Department of Urology Surgery, Nanjing Drum-Tower Hospital Group Suqian Hospital, The Affiiated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Yongming Sun
- Department of Urology Surgery, Nanjing Drum-Tower Hospital Group Suqian Hospital, The Affiiated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Longjun Cai
- Department of Urology Surgery, Nanjing Drum-Tower Hospital Group Suqian Hospital, The Affiiated Suqian Hospital of Xuzhou Medical University, Suqian, China
| | - Jianjun Zhang
- Department of Urology Surgery, Nanjing Drum-Tower Hospital Group Suqian Hospital, The Affiiated Suqian Hospital of Xuzhou Medical University, Suqian, China
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Singh P, Sachan A, Nayak B, Nayyar R, Kumar R, Seth A. Comparative Analysis of Clinicopathologic Characteristics and Outcomes of Urothelial Bladder Cancer Between Young and Older Adults-Experience from a Tertiary Care Center. Indian J Surg Oncol 2024; 15:563-571. [PMID: 39239430 PMCID: PMC11371966 DOI: 10.1007/s13193-024-01950-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/01/2024] [Indexed: 09/07/2024] Open
Abstract
The evidence on bladder cancer in the young population remains fragmented due to lack of literature and conflicting results from the existing studies. We aim to elucidate such conflicting data and define the clinicopathologic characteristics, management trends, and outcomes of urothelial bladder carcinoma in young adults as compared to their older counterparts. This was a retrospective, single-center study involving patients with primary urothelial bladder cancer who underwent treatment at our center from March 2017 to March 2022. For analysis, patients were stratified into three subgroups based on age: group A, 18-40 years; group B, > 40 years; and group C, > 60 years. Group A with younger patients was compared with groups B and C. A total of 471 eligible patients (422 males and 49 females) were included in the study with a median age of 44 years. Group A had significantly lower recurrence and progression rates as compared to group B (31% vs 57.1%, p = 0.002 and 9.5% vs 19.2%, p = 0.04, respectively). Group A had significantly more recurrence-free survival (RFS) than group B (5-year-RFS = 68.03% vs 32.58%, p = 0.01). Similarly, group A also had lower recurrence (31% vs 62.6%, p < 0.001) and progression (9.5% vs 28.6%, p = 0.015) rates as compared to group C as well as better RFS (5-year-RFS = 68.03% vs 19.00%, p = 0.04) and progression-free survival (5-year-PFS = 83.1% vs 62.8%, p = 0.03) in comparison to group C. Age and tumor grade were found to be independent predictors of recurrence-free and progression-free survival. We concluded that high-grade disease is more common than low-grade disease both in younger and older patients. Younger patients fare better in terms of recurrence and progression when compared to their older counterparts.
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Affiliation(s)
- Prashant Singh
- Department of Urology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Ankit Sachan
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Brusabhanu Nayak
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Rishi Nayyar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India 110029
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India 110029
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Contieri R, Soloway MS, Gontero P, Herr H, Kassouf W, Mertens LS, Moschini M, O'Donnell M, Palou J, Psutka SP, Rouprêt M, Teoh JYC, Kamat AM. Deintensification of Treatment for Low-grade Bladder Tumors: A Collaborative Review by the International Bladder Cancer Group (IBCG). Eur Urol Oncol 2024:S2588-9311(24)00186-X. [PMID: 39218742 DOI: 10.1016/j.euo.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/05/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND AND OBJECTIVE Management of low-grade (LG) urothelium-confined (Ta stage) non-muscle-invasive bladder cancer (NMIBC) poses a distinct therapeutic challenge. Transurethral resection of bladder tumor (TURBT), the standard treatment, frequently has to be repeated because of high tumor recurrence rates. This places a considerable strain on both patients and health care infrastructure, underscoring the need for alternative management approaches. Herein, the IBCG (International Bladder Cancer Group), conducted a review to explore the efficacy and safety of deintensified treatment strategies for recurrent LG Ta NMIBC. METHODS We conducted a collaborative review of relevant literature in the PubMed/MEDLINE and Cochrane CENTRAL databases. Our focus was on high-quality evidence, including randomized controlled trials, systematic reviews, and meta-analyses. We also reviewed guidelines published by prominent urological associations. KEY FINDINGS AND LIMITATIONS Active surveillance, chemoablation, and office fulguration are valid treatment options for recurrent LG Ta NMIBC. These deintensified approaches offer several advantages over TURBT: lower complication rates, less morbidity, lower health care costs, and better quality of life for patients. Importantly, these benefits are achieved without compromising oncological safety. CONCLUSIONS AND CLINICAL IMPLICATIONS Our review demonstrates that less intensive treatment strategies for recurrent LG Ta NMIBC are both feasible and valuable. The IBCG recommends use of these approaches for carefully selected patients to help lower health care costs and enhance patients' quality of life. PATIENT SUMMARY We reviewed studies on less invasive management options for low-grade noninvasive bladder cancer, including active surveillance, chemical ablation, and heat treatment. Recent results confirm that these less intense treatment options can reduce the treatment burden and costs for patients and preserve their quality of life without negatively affecting cancer control outcomes.
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Affiliation(s)
- Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mark S Soloway
- Division of Urology, Urologic Oncology Memorial Physician Group, Memorial Hospital, Hollywood, FL, USA
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Harry Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wassim Kassouf
- Division of Urology, McGill University Health Centre, Montreal, Canada
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Michael O'Donnell
- Department of Urology, Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, Department of Urology, Sorbonne University, Pitie-Salpetriere Hospital, AP-HP, Paris, France
| | - Jeremy Y C Teoh
- SH Ho Urology Centre, Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Cao K, Shi H, Wu B, Lv Z, Yang R. Identification of ECM and EMT relevant genes involved in the progression of bladder cancer through bioinformatics analysis. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2024; 12:183-193. [PMID: 39308592 PMCID: PMC11411181 DOI: 10.62347/xntc7030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/16/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Bladder cancer (BC) is very common among cancers of urinary system. It was usually categorized into two types: non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). NMIBC and MIBC groupings are heterogeneous and have different characteristics. OBJECTIVES The study was aimed to find some hub genes and related signal pathways which might be engaged in the progression of BC and to investigate the relationship with clinical stages and its prognostic significance. METHODS GSE37317 datasets were acquired from Gene Expression Omnibus (GEO) database. GEO2R on-line tool was selected to screen the differentially expressed genes (DEGs) of the two different types of BC. Then, Gene Ontology (GO) enrichment and KOBAS-Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of these DEGs were conducted. A protein-protein interaction (PPI) network was employed to help us screen hub genes and find significant modules. Finally, we made analysis of gene expression and survival curve by GEPIA and Kaplan-Meier plotter database. RESULTS 224 DEGs were screened in total, with 110 showing increased expression and 114 demonstrating decreased expression. GO and KEGG pathway enrichment analysis showed that DEGs were mostly involved in collagen fibril organization, extracellular matrix (ECM) structural constituent, bHLH transcription factor binding, AGE-RAGE signaling pathway and TGF-beta signaling pathway. Only 3 hub genes (DCN, JUN, THBS1) displayed significantly higher expression compared to those in the healthy controls. These hub genes were also strongly related to clinical stages as well as overall survival (OS) of BC patients. CONCLUSIONS Taken together, most of hub genes involved in the progression of BC were related to ECM and EMT. In addition, 3 hub genes (DCN, JUN, THBS1) were strongly related with clinical stages and OS of BC patients. This study can enhance our comprehension of the progression of NMIBC and identify novel potential targets for MIBC.
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Affiliation(s)
- Kai Cao
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese MedicineNanjing 210008, Jiangsu, China
| | - Honglei Shi
- Department of Urology, Wujin Hospital Affiliated with Jiangsu UniversityChangzhou 213164, Jiangsu, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical UniversityChangzhou 213164, Jiangsu, China
| | - Bin Wu
- Department of Urology, Wujin Hospital Affiliated with Jiangsu UniversityChangzhou 213164, Jiangsu, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical UniversityChangzhou 213164, Jiangsu, China
| | - Zhong Lv
- Department of Urology, Wujin Hospital Affiliated with Jiangsu UniversityChangzhou 213164, Jiangsu, China
- Department of Urology, The Wujin Clinical College of Xuzhou Medical UniversityChangzhou 213164, Jiangsu, China
| | - Rong Yang
- Department of Urology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese MedicineNanjing 210008, Jiangsu, China
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Huang H, Huang Y, Kaggie JD, Cai Q, Yang P, Wei J, Wang L, Guo Y, Lu H, Wang H, Xu X. Multiparametric MRI-Based Deep Learning Radiomics Model for Assessing 5-Year Recurrence Risk in Non-Muscle Invasive Bladder Cancer. J Magn Reson Imaging 2024. [PMID: 39167019 DOI: 10.1002/jmri.29574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Accurately assessing 5-year recurrence rates is crucial for managing non-muscle-invasive bladder carcinoma (NMIBC). However, the European Organization for Research and Treatment of Cancer (EORTC) model exhibits poor performance. PURPOSE To investigate whether integrating multiparametric MRI (mp-MRI) with clinical factors improves NMIBC 5-year recurrence risk assessment. STUDY TYPE Retrospective. POPULATION One hundred ninety-one patients (median age, 65 years; age range, 54-73 years; 27 females) underwent mp-MRI between 2011 and 2017, and received ≥5-year follow-ups. They were divided into a training cohort (N = 115) and validation/testing cohorts (N = 38 in each). Recurrence rates were 23.5% (27/115) in the training cohort and 23.7% (9/38) in both validation and testing cohorts. FIELD STRENGTH/SEQUENCE 3-T, fast spin echo T2-weighted imaging (T2WI), single-shot echo planar diffusion-weighted imaging (DWI), and volumetric spoiled gradient echo dynamic contrast-enhanced (DCE) sequences. ASSESSMENT Radiomics and deep learning (DL) features were extracted from the combined region of interest (cROI) including intratumoral and peritumoral areas on mp-MRI. Four models were developed, including clinical, cROI-based radiomics, DL, and clinical-radiomics-DL (CRDL) models. STATISTICAL TESTS Student's t-tests, DeLong's tests with Bonferroni correction, receiver operating characteristics with the area under the curves (AUCs), Cox proportional hazard analyses, Kaplan-Meier plots, SHapley Additive ExPlanations (SHAP) values, and Akaike information criterion for clinical usefulness. A P-value <0.05 was considered statistically significant. RESULTS The cROI-based CRDL model showed superior performance (AUC 0.909; 95% CI: 0.792-0.985) compared to other models in the testing cohort for assessing 5-year recurrence in NMIBC. It achieved the highest Harrell's concordance index (0.804; 95% CI: 0.749-0.859) for estimating recurrence-free survival. SHAP analysis further highlighted the substantial role (22%) of the radiomics features in NMIBC recurrence assessment. DATA CONCLUSION Integrating cROI-based radiomics and DL features from preoperative mp-MRI with clinical factors could improve 5-year recurrence risk assessment in NMIBC. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Haolin Huang
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China
- School of Biomedical Engineering & State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Yiping Huang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Joshua D Kaggie
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Qian Cai
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Peng Yang
- Department of Health Statistics, Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jie Wei
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Lijuan Wang
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China
- School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Hongbing Lu
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Xiaopan Xu
- School of Biomedical Engineering, Fourth Military Medical University, Xi'an, Shaanxi, China
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Guigui A, Basile G, Zattoni F, Gallioli A, Verri P, Aumatell J, Gondran-Tellier B, Lechevallier E, Bastide C, Uleri A, Sica M, Long-Depaquit T, Dinoi G, Moro FD, Akiki A, Toledano H, Rajwa P, Montorsi F, Amparore D, Porpiglia F, Breda A, Moschini M, Baboudjian M. Prognostic significance of residual tumor at restaging transurethral bladder resection in high-risk non-muscle-invasive bladder cancer. World J Urol 2024; 42:480. [PMID: 39133324 DOI: 10.1007/s00345-024-05192-x] [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: 01/16/2024] [Accepted: 07/20/2024] [Indexed: 08/13/2024] Open
Abstract
PURPOSE To assess prognostic significance of residual tumor at repeat transurethral resection (reTUR) in contemporary non-muscle-invasive bladder cancer (NMIBC) patients. METHODS Patients were identified retrospectively from eight referral centers in France, Italy and Spain. The cohort included consecutive patients with high or very-high risk NMIBC who underwent reTUR and subsequent adjuvant BCG therapy. RESULTS A total of 440 high-risk NMIBC patients were screened, 29 (6%) were upstaged ≥ T2 at reTUR and 411 were analyzed (T1 stage: n = 275, 67%). Residual tumor was found in 191 cases (46%). In patients with T1 tumor on initial TURBT, persistent T1 tumor was found in 18% of reTUR (n = 49/275). In patients with high-grade Ta tumor on initial TURBT, T1 tumor was found in 6% of reTUR (n = 9/136). In multivariable logistic regression analysis, we found no statistical association between the use of photodynamic diagnosis (PDD, p = 0.4) or type of resection (conventional vs. en bloc, p = 0.6) and the risk of residual tumor. The estimated 5-yr recurrence and progression-free survival were 56% and 94%, respectively. Residual tumor was significantly associated with a higher risk of recurrence (p < 0.001) but not progression (p = 0.11). Only residual T1 tumor was associated with a higher risk of progression (p < 0.001) with an estimated 5-yr progression-free survival rate of 76%. CONCLUSIONS ReTUR should remain a standard for T1 tumors, irrespective of the use of en bloc resection or PDD and could be safely omitted in high-grade Ta tumors. Persistent T1 tumor at reTUR should not exclude these patients from conservative management, and further studies are needed to explore the benefit of a third resection in this subgroup.
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Affiliation(s)
- Alexandre Guigui
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Giuseppe Basile
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Fabio Zattoni
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Paolo Verri
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Julia Aumatell
- Urology Department, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Bastien Gondran-Tellier
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Eric Lechevallier
- Department of Urology, La Conception Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Cyrille Bastide
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Alessandro Uleri
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Michele Sica
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Thibaut Long-Depaquit
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France
| | - Giuseppe Dinoi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Fabrizio Dal Moro
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Akram Akiki
- Department of Urology, Aubagne Hospital, Aubagne, France
| | - Harry Toledano
- Department of Urology, Martigues Hospital, Martigues, France
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Medical University of Silesia, Zabrze, Poland
| | | | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michael Baboudjian
- Department of Urology, North Hospital, Aix-Marseille University, APHM, Marseille, France.
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Cicione A, Lombardo R, Nacchia A, Franco A, Simone G, Pastore A, Leonardo C, Franco G, Tubaro A, DE Nunzio C. No clinical benefit from sequential combination of mitomycin C plus bacillus Calmette-Guérin (BCG) than BCG alone in the adjuvant treatment of high risk non muscle invasive bladder cancer: result of a planned interim analysis of a prospective randomized trial. Minerva Urol Nephrol 2024; 76:458-466. [PMID: 38842053 DOI: 10.23736/s2724-6051.24.05777-x] [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: 06/07/2024]
Abstract
BACKGROUND The aim of this study was to evaluate whether the sequential use of Mitomycin C (MMC) and Bacillus Calmette-Guérin (BCG) is superior to BCG alone in reducing the risk of disease recurrence in patients with non-muscle invasive bladder cancer (NMIBC) with high risk of progression. METHODS Prospective randomized trial was conducted from March 2021 to March 2023 and included 72 patients with high risk NMIBC. Trial registration number: NCT03790384; EUDRACT Number: 2017-004540-37. Thirty-one patients underwent to BCG alone and forty-one to MMC plus BCG during the induction course. The BCG schedule comprised six weekly instillation of 81 mg Connaught strain BCG as the induction course, followed by a further three-monthly instillation at three, six and twelve months, as the maintenance course. Forty mg of MMC were administered the day prior to each weekly BCG instillation in BCG plus MMC arm. A planned interim analysis was carried out in June 2023, at the end of the 12mo follow-up period. RESULTS Six out of thirteen 6/31(19.3%) and 10/41 (24.4%) patients experienced recurrence in BCG and BCG plus MMC group (P=0.611), respectively. BCG plus MMC did not improve Disease Free Interval (HR: 1.23 95% CI:0.46-3.50; P=0.640). Patients receiving sequential treatment experienced similar AEs (P>0.05) and more urinary symptoms (P<0.05). CONCLUSIONS This interim pre-planned analysis suggested absence of clinical advantages in terms of disease recurrence rate when MMC is administered one day prior to BCG during induction course.
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Affiliation(s)
- Antonio Cicione
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Riccardo Lombardo
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Nacchia
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Antonio Franco
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy -
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Pastore
- Department of Urology, ICOT Latina, Sapienza University, Latina, Italy
| | - Costantino Leonardo
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giorgio Franco
- Department of Urology, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Finocchiaro A, Paciotti M, Contieri R, Fasulo V, Saita A, Lughezzani G, Buffi NM, Lazzeri M, Hurle R, Casale P. Assessing long-term upgrade risks in recurrent low-grade non-muscle-invasive bladder cancer, can we deintensify the treatment? BJU Int 2024; 134:195-197. [PMID: 38774951 DOI: 10.1111/bju.16406] [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] [Indexed: 07/19/2024]
Affiliation(s)
- Alessio Finocchiaro
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Nicolo Maria Buffi
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
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Haas M, Engelmann SU, Mayr R, Gossler C, Pickl C, Kälble S, Yang Y, Otto W, Hartmann V, Burger M, Hartmann A, Breyer J, Eckstein M. A novel grading approach predicts worse outcomes in stage pT1 non-muscle-invasive bladder cancer. BJU Int 2024; 134:249-257. [PMID: 38409965 DOI: 10.1111/bju.16298] [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] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To develop a prognostically relevant scoring system for stage pT1 non-muscle-invasive bladder cancer (NMIBC) incorporating tumour budding, growth pattern and invasion pattern because the World Health Organisation grading system shows limited prognostic value in such patients. PATIENTS AND METHODS The tissue specimens and clinical data of 113 patients with stage pT1 NMIBC who underwent transurethral resection of bladder tumour were retrospectively investigated. Tumour budding, and growth and invasion patterns were evaluated and categorised into two grade groups (GGs). GGs and other clinical and histopathological variables were investigated regarding recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) using univariable and multivariable Cox regression analyses. RESULTS The integration of two tumour budding groups, two growth patterns, and two invasion patterns yielded an unfavourable GG (n = 28; 24.7%) that had a high impact on oncological outcomes. The unfavourable GG was identified as an independent RFS and OS predictor (P = 0.004 and P = 0.046, respectively) and linked to worse PFS (P = 0.001) and CSS (P = 0.001), irrespective of the European Association of Urology risk group. The unfavourable GG was associated with higher rates of BCG-unresponsive tumours (P = 0.006). Study limitations include the retrospective, single-centre design, diverse therapies and small cohort. CONCLUSIONS We present a morphology-based grading system for stage pT1 NMIBC that correlates with disease aggressiveness and oncological patient outcomes. It therefore identifies a highest risk group of stage pT1 NMIBC patients, who should be followed up more intensively or receive immediate radical cystectomy. The grading incorporates objective variables assessable on haematoxylin and eosin slides and immunohistochemistry, enabling an easy-to-use low-cost approach that is applicable in daily routine. Further studies are needed to validate and confirm these results.
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Affiliation(s)
- Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Simon U Engelmann
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Roman Mayr
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christopher Gossler
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christoph Pickl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Sebastian Kälble
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Yushan Yang
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Wolfgang Otto
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Valerie Hartmann
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Zawky M, Elsayed A, Awadallah A, Abdelhalim A, Abolenein H, Shokeir A. The impact of purified protein derivative prior to intravesical bacillus Calmette-Guérin for the treatment of patients with non-muscle invasive bladder cancer. Minerva Urol Nephrol 2024; 76:474-483. [PMID: 38757774 DOI: 10.23736/s2724-6051.23.05515-5] [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: 05/18/2024]
Abstract
BACKGROUND The aim of this study is to investigate the impact of the intradermal injection of purified protein derivative (PPD) and PPD skin test reactions on the oncological outcomes of patients with non-muscle invasive bladder cancer (NMIBC) treated by trans-urethral resection of bladder tumor (TURBT) and adjuvant intravesical BCG. METHODS The study included 100 consecutive patients with NMIBC prospectively given intradermal PPD 1-2 weeks before starting BCG therapy. Another 100 patients with NMIBC not given intradermal PPD before starting BCG were chosen as a historical control. The control group was chosen to be matching with the study group regarding baseline characteristics. The study group was divided into 2 subgroups with positive and negative reaction to PPD skin test. Oncological outcomes, immunological markers (TNF-α and IL-6) changes and BCG side effects were evaluated. RESULTS There were no significant differences between patients who received PPD or not regarding the 2-year recurrence free survival (RFS) rates and progression-free survival (PFS) rates and immunological markers changes. The 2-year RFS and PFS rates were significantly higher in patients with positive reactions. Post-induction values of immunological markers increased in all patients with a significant increase in patients with positive reactions. BCG side effects were significantly higher in patients with positive reactions. CONCLUSIONS The intradermal injection of PPD before intravesical BCG has no impact on oncological outcomes of patients with NMIBC treated with TURBT and intravesical BCG. However, the PPD skin test reactions before BCG therapy can predict the oncological outcomes, BCG side effects and the immunological outcomes of patients.
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Affiliation(s)
- Mohamed Zawky
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt -
| | - Asmaa Elsayed
- Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Genetics Research Unit, Faculty of Medicine, Delta University for Science ad Technology, Gamasa, Egypt
| | - Amira Awadallah
- Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Abdelhalim
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Urology, West Virginia University, Morgantown, WV, USA
| | - Hassan Abolenein
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Shokeir
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Center of Excellence of Genome and Cancer Research, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Benderska-Söder N, Ecke T, Kleinlein L, Roghmann F, Bismarck E, van Rhijn BWG, Stenzl A, Witjes JA, Todenhöfer T, Hakenberg OW, Grimm MO, Goebell PJ, Burger M, Jensen JB, Schmitz-Dräger BJ. Simulation of the effects of molecular urine markers in follow-up of patients with high-risk non-muscle invasive bladder cancer. Urol Oncol 2024; 42:229-235. [PMID: 38403529 DOI: 10.1016/j.urolonc.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/05/2024] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
A plethora of urine markers for the management of patients with bladder cancer has been developed and studied in the past. However, the clinical impact of urine testing on patient management remains obscure. The goal of this manuscript is to identify scenarios for the potential use of molecular urine markers in the follow-up of patients with high-risk non-muscle-invasive BC (NMIBC) and estimate potential risks and benefits. Information on the course of disease of patients with high-risk NMIBC and performance data of a point-of-care test (UBC rapid™), an MCM-5 directed ELISA (ADXBLADDER™), and 2 additional novel assays targeting alterations of mRNA expression and DNA methylation (Xpert bladder cancer monitor™, Epicheck™) were retrieved from high-quality trials and/or meta-analyses. In addition, the sensitivity of white light cystoscopy (WLC) and the impact of a urine marker result on the performance of WLC were estimated based on fluorescence cystoscopy data and information from the CeFub trial. This information was applied to different scenarios in patient follow-up and sensitivity, estimated number of cystoscopies, and the numbers needed to diagnose were calculated. The sensitivity of guideline-based regular follow-up (SOC) at 1 year was calculated at 96%. For different marker-supported strategies sensitivities ranging from 77% to 97.9% were estimated. Calculations suggest that several strategies are effective for the SOC. While for the SOC 24.6 WLCs were required to diagnose 1 tumor recurrence (NND), this NND dropped below 5 in some marker-supported strategies. Based on the results of this simulation, a marker-supported follow-up of patients with HR NMIBC is safe and offers the option to significantly reduce the number of WLCs. Further research focusing on prospective randomized trials is needed to finally find a way to implement urine markers into clinical decision-making.
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Affiliation(s)
| | - Thorsten Ecke
- Department of Urology, Helios Klinikum, Bad Saarow, Germany; Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Kleinlein
- Urologie 24, St. Theresienkrankenhaus, Nürnberg, Germany
| | - Florian Roghmann
- Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Germany
| | | | - Bas W G van Rhijn
- Department Surgical Oncology (Urology), Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University of Tübingen, Tübingen, Germany
| | | | | | | | | | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Maximilian Burger
- Department of Urology, University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany
| | | | - Bernd J Schmitz-Dräger
- Urologie 24, St. Theresienkrankenhaus, Nürnberg, Germany; Studienpraxis Urologie, Nürtingen, Germany.
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Muilwijk T, Baekelandt L, Akand M, Daelemans S, Marien K, Waumans Y, van Dam PJ, Kockx M, Van den Broeck T, Van Cleynenbreugel B, Van der Aa F, Gevaert T, Joniau S. Fibroblast Activation Protein-α and the Immune Landscape: Unraveling T1 Non-muscle-invasive Bladder Cancer Progression. EUR UROL SUPPL 2024; 66:67-74. [PMID: 39044944 PMCID: PMC11263494 DOI: 10.1016/j.euros.2024.06.011] [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] [Accepted: 06/19/2024] [Indexed: 07/25/2024] Open
Abstract
Background and objective The tumor microenvironment (TME) in non-muscle-invasive bladder cancer (NMIBC) plays an important role in the anticancer response. We aimed to identify the prognostic biomarkers in the TME of patients with NMIBC for progression to ≥T2. Methods From our institutional database, 40 patients with T1 high-risk NMIBC who progressed were pair matched for Club Urologico Español de Tratamiento Oncologico (CUETO) progression variables with 80 patients who never progressed despite longer follow-up. Progression was defined as ≥T2 or extravesical disease. Patients were treated at least with bacillus Calmette-Guérin (BCG) induction (five or more of six doses). Immunohistochemical (IHC) markers for the TME were used on tissue at first T1 diagnosis: CD8-PanCK, GZMB-CD8-FOXP3, CD163, PD-L1 SP142/SP263, fibroblast activation protein-α (FAP), and CK5-GATA3. Full tissue slides were annotated digitally. Relative marker area (IHC-positive area/total area) or density (IHC-positive cells per area; n/mm2) was calculated, differentiating between regions of interest (ROIs; T1, Ta, and carcinoma in situ) and between compartments (stromal, epithelial, and combined). Differences in IHC variables were assessed using the t test, for continuous variables using analysis of variance and comparisons of more than two groups using Tukey's test. Conditional logistic regression for progression at 5-yr follow-up was performed with clusters based on pair matching. Key findings and limitations Only FAP expression (increase per 50%) in T1 (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.04-1.70) and all ROIs combined (OR: 1.62; 95% CI: 1.14-2.29) correlated significantly with progression. None of the other clinicopathological/IHC variables correlated with progression. Conclusions and clinical implications FAP is a potential prognostic biomarker for progression in high-risk NMIBC. FAP is a marker for cancer-associated fibroblasts and is linked to immunosuppression and neoangiogenesis, which makes future investigation clinically relevant. Patient summary We found that progression of high-risk non-muscle-invasive bladder cancer to muscle-invasive disease is less in patients with lower fibroblast activation protein-α (FAP) expression, which is a marker for cancer-associated fibroblasts.
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Affiliation(s)
- Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Organ Systems, KU Leuven, Leuven, Belgium
| | - Loïc Baekelandt
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Organ Systems, KU Leuven, Leuven, Belgium
| | - Murat Akand
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Organ Systems, KU Leuven, Leuven, Belgium
| | - Sofie Daelemans
- Pathology – Histology, Imaging and Quantification, CellCarta, Antwerp, Belgium
- Medical Biochemistry, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | - Koen Marien
- Pathology – Histology, Imaging and Quantification, CellCarta, Antwerp, Belgium
| | - Yannick Waumans
- Pathology – Histology, Imaging and Quantification, CellCarta, Antwerp, Belgium
| | - Pieter-Jan van Dam
- Pathology – Histology, Imaging and Quantification, CellCarta, Antwerp, Belgium
| | - Mark Kockx
- Pathology – Histology, Imaging and Quantification, CellCarta, Antwerp, Belgium
| | | | | | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Organ Systems, KU Leuven, Leuven, Belgium
| | - Thomas Gevaert
- Organ Systems, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
- Organ Systems, KU Leuven, Leuven, Belgium
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Li S, Wang J, Zhang Z, Wu Y, Liu Z, Yin Z, Liu J. Development and validation of competing risk nomograms for predicting cancer‑specific mortality in non-metastatic patients with non‑muscle invasive urothelial bladder cancer. Sci Rep 2024; 14:17641. [PMID: 39085366 PMCID: PMC11291689 DOI: 10.1038/s41598-024-68474-9] [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: 12/30/2023] [Accepted: 07/24/2024] [Indexed: 08/02/2024] Open
Abstract
We aimed to assess the cumulative incidences of cancer-specific mortality (CSM) in non-metastatic patients with non‑muscle invasive urothelial bladder cancer (NMIUBC) and establish competing risk nomograms to predict CSM. Patient data was sourced from the Surveillance, Epidemiology, and End Results database, as well as the electronic medical record system in our institution to form the external validation cohort. Sub-distribution proportional hazards model was utilized to determine independent risk factors influencing CSM in non-metastatic NMIUBC patients. Competitive risk nomograms were constructed to predict 3-year, 5-year, and 8-year cancer-specific survival (CSS) in all patients group, TURBT group and cystectomy group, respectively. The discrimination and accuracy of the model were validated through the concordance index (C-index), the area under the receiver operating characteristic curve (AUC), and calibration curves. Decision curve analysis (DCA) and a risk stratification system was employed to evaluate the clinical utility of the model. Race, age, marital status, surgery in other sites, tumor size, histological type, histological grade, T stage and N stage were identified as independent risk factors to predict CSS in all patients group. The C-index for 3-year CSS was 0.771, 0.770 and 0.846 in the training, testing and external validation sets, respectively. The ROC curves showed well discrimination and the calibration plots were well fitted and consistent. Moreover, DCA demonstrated well clinical effectiveness. Altogether, the competing risk nomogram displayed excellent discrimination and accuracy for predicting CSS in non-metastatic NMIUBC patients, which can be applied in clinical practice to help tailor treatment plans and make clinical decisions.
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Affiliation(s)
- Shan Li
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Jinkui Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Zhaoxia Zhang
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yuzhou Wu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhenyu Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhikang Yin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Junhong Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China.
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China.
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
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Kozikowski M, Zagrodzka M, Zawadzki M, Zugaj P, Osiecki R, Rzymkowski F, Śledź M, Sosnowski R, Dobruch J, Giudice FD, Krajewski W. The role of VI-RADS scoring criteria for predicting oncological outcomes in bladder cancer. World J Urol 2024; 42:438. [PMID: 39046595 PMCID: PMC11269435 DOI: 10.1007/s00345-024-05101-2] [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: 03/08/2024] [Accepted: 05/31/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE Our purpose was to evaluate the prognostic value of Vesical Imaging Reporting and Data System (VI-RADS) in bladder cancer (BCa) staging and predicting recurrence or progression. METHODS We retrospectively analyzed the prospectively collected data from 96 patients with bladder tumors who underwent VI-RADS-based multiparametric magnetic resonance imaging (mpMRI) before endourological treatment from April 2021 to December 2022. Diagnostic performance was evaluated by comparing mpMRI reports with final pathology, using logistic regression for muscle-invasive bladder cancer (MIBC) predictors. Follow-up until May 2023 included Kaplan-Meier and Cox regression analysis to assess VI-RADS predictive roles for recurrence-free survival (RFS) and progression-free survival (PFS). RESULTS A total of 96 patients (19.8% women, 80.2% men; median age 68.0 years) were included, with 71% having primary tumors and 29% recurrent BCa. Multiparametric MRI exhibited high sensitivity (92%) and specificity (79%) in predicting MIBC, showing no significant differences between primary and recurrent cancers (AUC: 0.96 vs. 0.92, P = .565). VI-RADS emerged as a key predictor for MIBC in both univariate (OR: 40.3, P < .001) and multivariate (OR: 54.6, P < .001) analyses. Primary tumors with VI-RADS ≥ 3 demonstrated significantly shorter RFS (P = .02) and PFS (P = .04). CONCLUSIONS In conclusion, mpMRI with VI-RADS has a high diagnostic value in predicting MIBC in both primary and recurrent BCa. A VI-RADS threshold ≥ 3 is a strong predictor for MIBC, and in primary tumors predicts early recurrence and progression.
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Affiliation(s)
- Mieszko Kozikowski
- Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, Piaseczno, Poland.
- Department of Diagnostic Imaging - Quadia, Piaseczno, Poland.
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland.
- Section of Urologic Oncology of Polish Urological Association, Warsaw, Poland.
| | | | - Marek Zawadzki
- Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, Piaseczno, Poland
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland
| | - Przemysław Zugaj
- Polish Center of Advanced Urology, Department of Urology, St. Anne's Hospital EMC, Piaseczno, Poland
| | - Rafał Osiecki
- Urology Clinic of Medical Postgraduate Education Centre, Department of Urology, Independent Public Hospital them. prof. W. Orlowski, Warsaw, Poland
| | | | - Mateusz Śledź
- Department of Diagnostic Imaging - Quadia, Piaseczno, Poland
| | - Roman Sosnowski
- Section of Urologic Oncology of Polish Urological Association, Warsaw, Poland
- Department of Urology and Oncological Urology, Warmian-Masurian Cancer Center, Olsztyn, Poland
| | - Jakub Dobruch
- Urology Clinic of Medical Postgraduate Education Centre, Department of Urology, Independent Public Hospital them. prof. W. Orlowski, Warsaw, Poland
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Wojciech Krajewski
- Section of Urologic Oncology of Polish Urological Association, Warsaw, Poland
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Wroclaw, Poland
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Sano T, Yoshida T, Nakamoto T, Ohe C, Taniguchi H, Yanishi M, Kinoshita H. Diagnostic performance of photodynamic diagnosis with oral 5-aminolevulinic acid for upper tract- and bladder urothelial carcinoma: a single-centre, retrospective analysis. World J Urol 2024; 42:389. [PMID: 38985343 DOI: 10.1007/s00345-024-05083-1] [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: 04/04/2024] [Accepted: 05/23/2024] [Indexed: 07/11/2024] Open
Abstract
PURPOSE To compare the diagnostic performance of photodynamic diagnosis (PDD) enhanced with oral 5-aminolaevulinic acid between the suspected upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BUC) cases. METHODS This retrospective study included 18 patients with suspected UTUC who underwent ureteroscopy (URS) with oral 5-ALA in the PDD-URS cohort between June 2018 and January 2019; and 110 patients with suspected BUC who underwent transurethral resection of bladder tumour (TURBT) in the PDD-TURBT cohort between January 2019 and March 2023. Sixty-three and 708 biopsy samples were collected during diagnostic URS and TURBT, respectively. The diagnostic accuracy of white light (WL) and PDD in the two cohorts was evaluated, and false PDD-positive samples were pathologically re-evaluated. RESULTS The area under the receiver operating characteristic curve (AUC) of PDD was significantly superior to that of WL in both cohorts. The per biopsy sensitivity, specificity, and positive and negative predictive values of PDD in patients in the PDD-URS and PDD-TURBT cohorts were 91.2 vs. 71.4, 75.9 vs. 75.3, 81.6 vs. 66.3, and 88.0 vs. 79.4%, respectively. The PDD-URS cohort exhibited a higher AUC than did the PDD-TURBT cohort (0.84 vs. 0.73). Seven of four false PDD-positive samples (57.1%) in the PDD-URS cohort showed potential precancerous findings compared with eight of 101 (7.9%) in the PDD-TURBT cohort. CONCLUSION The diagnostic performance of PDD in the PDD-URS cohort was at least equivalent to that in the PDD-TURBT cohort.
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Affiliation(s)
- Takeshi Sano
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan.
| | - Takashi Yoshida
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan
- Department of Urology, Osaka Saiseikai-Noe Hospital, Osaka, Japan
- Graduate School of Engineering, Tottori University, Tottori, Japan
- Corporate Sponsored Research Programs for Multicellular Interactions in Cancer, Kansai Medical University, Osaka, Japan
| | - Takahiro Nakamoto
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan
| | - Chisato Ohe
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan
- Department of Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan
| | - Masaaki Yanishi
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, 2-5-1 Shin-machi, Hirakata- shi, 573-1010, Osaka, Japan
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Dutto D, Livoti S, Soria F, Gontero P. Developments in conservative treatment for BCG-unresponsive non-muscle invasive bladder cancer. Expert Opin Pharmacother 2024; 25:1335-1348. [PMID: 39104019 DOI: 10.1080/14656566.2024.2380469] [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: 03/21/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024]
Abstract
INTRODUCTION To reduce the risk of disease recurrence and progression of intermediate and high-risk Non-Muscle Invasive Bladder Cancers (NMIBCs), intravesical adjuvant treatment with Bacillus Calmette-Guerin (BCG) represents the standard of care, although up to 50% of patients will eventually recur and up to 20% of them will progress to Muscle Invasive Bladder Cancer (MIBC). Radical Cystectomy (RC) is the treatment of choice in this setting; however, this represents a major and morbid surgery, thus meaning that not all NMIBCs patient could undergo or may refuse this procedure or may refuse. The search for effective bladder sparing strategies in NMIBCs BCG-unresponsive patients is a hot topic in the urologic field. AREAS COVERED We aimed to review the most important bladder-preserving strategies for BCG unresponsive disease, from those used in the past, even though rarely used nowadays (intravesical chemotherapy with single agents), to current available therapies (e.g. intravesical instillation with Gemcitabine-Docetaxel), and to future upcoming treatments (Oportuzumab Monatox). EXPERT OPINION At present, bladder-preserving treatments in BCG-unresponsive patients are represented by the use of intravesical instillations, systemic immunotherapies, both with good short-term and modest mid-term efficacy, and numerous clinical trials ongoing, with encouraging initial results, in which patients could be recruited.
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Affiliation(s)
- Daniele Dutto
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
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Brisuda A, Horňák J, Žemličková B, Háček J, Babjuk M. Intravesical thermochemotherapy in the treatment of high-risk and very high-risk non-muscle-invasive urothelial bladder cancer: a single-arm study. Int Urol Nephrol 2024; 56:2243-2250. [PMID: 38329573 PMCID: PMC11190016 DOI: 10.1007/s11255-023-03924-3] [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: 09/14/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024]
Abstract
AIM Intravesical thermochemotherapy, also known as HIVEC (Hyperthermic Intra-VEsical Chemotherapy), represents an alternative adjuvant topical treatment for non-muscle-invasive urothelial bladder cancer (NMIBC). High-risk (HR) and very HR tumors carry a substantial risk of recurrence and progression. In this study, we present our own results using HIVEC as an alternative to unavailable Bacillus Calmette-Guérin (BCG) vaccine in the treatment of such groups of patients. METHODS During the period of November 2014-June 2022, a total of 47 patients with HR and very HR NMIBC underwent treatment with HIVEC after transurethral resection. They were given an induction of 6 instillations with/without a maintenance. The aim was to evaluate the time to recurrence, event-free survival (recurrence or progression), as measured by Kaplan-Meier analysis, the effect of maintenance treatment and other factors on survival (log-rank test and multivariable Cox regression analysis), and complications. RESULTS The median follow-up for patients who did not experience an event was 32 months. The median time to HR (high grade and/or T1 tumor) recurrence in those who recurred was 15 months. The survival rate without HR recurrence at 12, 24, and 48 months was 84, 70, and 59%, respectively. Progression was detected in 10.6% of patients, which translated to 89% of patients living without progression after 24 months. Maintenance treatment (defined as more than six instillations) and presence of CIS significantly correlated with risk of HR recurrence (Hazard ratio 0.34 and 3.12, respectively). One female patient underwent salvage cystectomy due to contractory bladder, and 19.1% of patients experienced transient lower urinary tract symptoms. CONCLUSION Based on our experience, HIVEC represents an adequate and safe alternative treatment for HR and very HR NMIBC in situations where BCG is not available or radical cystectomy is not an option for the patient. However, high-quality data from prospective randomized studies are still lacking, and thus, thermochemotherapy should still be regarded as an experimental treatment modality.
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Affiliation(s)
- Antonín Brisuda
- 2nd Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic.
| | - Jakub Horňák
- 2nd Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Barbora Žemličková
- 2nd Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Jaromír Háček
- 2nd Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic
| | - Marek Babjuk
- 2nd Faculty of Medicine, Charles University, V Úvalu 84, 150 06, Prague 5, Czech Republic
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Ogreden E, Oguz U, Demirelli E, Tok DS, Aslan S, Tok B, Çiftçi OÇ, Akyol S, Altun E, Ahmadlı C, Semiz U, Batur H. The role of multiparametric magnetic resonance ımaging in the diagnosis of granulomatous prostatitis mimicking prostate cancer. Abdom Radiol (NY) 2024; 49:2305-2310. [PMID: 38652127 DOI: 10.1007/s00261-024-04288-7] [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: 02/09/2024] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Aimed to investigate the role of multiparametric magnetic resonance imaging (mp-MRI) in the diagnosis of granulomatous prostatitis caused by intravesical Bacillus Calmette-Guérin (BCG). METHODS In this prospective, single-center study, 10 male patients who were given intravesical BCG due to intermediate- and high-risk bladder cancer were included. Before transurethral resection of bladder tumors (TURB), all patients were evaluated by mp-MRI, serum prostate-specific antigen (PSA), and digital rectal examination (DRE). Serum PSA levels and DRE findings were evaluated before and after intravesical BCG treatment. Prostate mp-MRI was performed for patients with elevated levels of serum PSA and/or with abnormal DRE findings. Then, MRI fusion + systematic prostate biopsy was performed. Demographic data of the patients before and after intravesical BCG were compared. RESULTS The average age of the patients was 66.9 years (55-87 years). While PSA was 1.7 ng/ml before intravesical BCG treatment, it was 4.3 ng/ml after intravesical BCG treatment (p = 0.005). PSA density (PSAD) was 0.04 and 0.10 before and after the treatment, respectively (p = 0.012). DRE findings of all patients were normal before the treatment. However, abnormal findings were detected in 80% of them after the treatment (p = 0.008). PI-RADS ≥ 3 lesions were found to be significantly higher in all patients after intravesical BCG (p = 0.004). CONCLUSION Granulomatous prostatitis is a rare complication of intravesical BCG. High PSA, abnormal DRE, and PI-RADS ≥ 3 lesions detected after intravesical BCG should suggest granulomatous prostatitis and unnecessary biopsies may be avoided.
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Affiliation(s)
- Ercan Ogreden
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey.
| | - Ural Oguz
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Erhan Demirelli
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Doğan Sabri Tok
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Serdar Aslan
- Department of Radiology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Birgül Tok
- Department of Patology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | | | - Safa Akyol
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Ertürk Altun
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Chingiz Ahmadlı
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Uğur Semiz
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Hüseyin Batur
- Department of Urology, Faculty of Medicine, Giresun University, Giresun, Turkey
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Li Y, Xu H, Lin T, Zhang J, Ai J, Zhang S, Le W, Tan P, Zhang P, Wei Q, Zheng X, Yang L. Preoperative low plasma creatine kinase levels predict worse survival outcomes in bladder cancer after radical cystectomy. Int Urol Nephrol 2024; 56:2215-2225. [PMID: 38315281 DOI: 10.1007/s11255-024-03957-2] [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: 09/26/2023] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND AND AIMS To evaluate the prognostic significance of preoperative creatine kinase (CK) levels in bladder cancer (BCa) patients who underwent radical cystectomy (RC). MATERIALS AND METHODS 570 BCa patients with RC were identified between 2010 and 2020. 108.5 U/L of CK levels were defined as the cutoff value. Logistic regression analysis and Cox regression models were performed to evaluate the association between CK levels and oncologic outcomes. Subgroup analyses were performed to address cofounding factors. RESULTS Preoperative low CK levels were associated with worse recurrence-free survival (RFS, log-rank P = 0.001) and overall survival (OS, log-rank P = 0.002). Multivariate analysis revealed that preoperative low CK levels were an independent predictor for worse RFS (hazard ratio [HR]: 1.683; P < 0.001) and OS (HR: 1.567; P = 0.002). CONCLUSIONS The preoperative low CK level independently predicts worse survival outcomes in BCa after RC. Incorporating it into prediction models might be valuable to assist risk stratification.
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Affiliation(s)
- Yifan Li
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hang Xu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Tianhai Lin
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jiapeng Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Jianzhong Ai
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Shiyu Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weizhen Le
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ping Tan
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Peng Zhang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaonan Zheng
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, China.
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Bakula M, Hudolin T, Knezevic N, Zimak Z, Andelic J, Juric I, Gamulin M, Gnjidic M, Kastelan Z. Intravesical Gemcitabine and Docetaxel Therapy for BCG-Naïve Patients: A Promising Approach to Non-Muscle Invasive Bladder Cancer. Life (Basel) 2024; 14:789. [PMID: 39063544 PMCID: PMC11278229 DOI: 10.3390/life14070789] [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: 04/28/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle invasive bladder cancer (NMIBC) faces limitations in efficacy and significant side effects, aggravated by a recent global shortage. In this prospective clinical study, we report the outcomes of sequential intravesical administration of gemcitabine and docetaxel (Gem/Doce) as a first-line treatment for BCG-naïve patients with high-risk NMIBC (HR NMIBC). From October 2019 until April 2022, we enrolled 52 patients and followed the treatment protocol set forth by the University of Iowa. Follow-up assessments were conducted every 3 months. In this cohort, 25 (48.1%) patients were diagnosed with high-grade T1 (T1HG) bladder cancer, 10 (19.2%) patients had carcinoma in situ (CIS), and 17 (32.7%) patients had a combination of T1HG+CIS. The median time to first recurrence in the T1HG, CIS, and T1HG+CIS groups was 11, 10.5, and 8.8 months, respectively. The recurrence-free survival was 98.1%, 94.2%, and 80.8% at 6, 9, and 12 months, respectively. The rate of progression-free survival was 100%, 98.1%, and 92.3% at 6, 9, and 12 months, respectively. We demonstrated the safety and efficacy of Gem/Doce therapy in BCG-naïve patients with HR NMIBC during a one-year follow-up. Further research with extended follow-ups, as well as direct comparisons of Gem/Doce with other anticancer agents, is essential.
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Affiliation(s)
- Mirko Bakula
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia;
| | - Tvrtko Hudolin
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia;
| | - Nikola Knezevic
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia;
| | - Zoran Zimak
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
| | - Jerko Andelic
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
| | - Ilija Juric
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
| | - Marija Gamulin
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia;
- Department of Oncology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia;
| | - Milena Gnjidic
- Department of Oncology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia;
| | - Zeljko Kastelan
- Department of Urology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia; (M.B.); (N.K.); (Z.Z.); (J.A.); (I.J.); (Z.K.)
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia;
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