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Ladi-Seyedian SS, Ghoreifi A, Konety B, Pohar K, Holzbeierlein JM, Taylor J, Kates M, Willard B, Taylor JM, Liao JC, Kaimakliotis HZ, Porten SP, Steinberg GD, Tyson MD, Lotan Y, Daneshmand S. Racial Differences in the Detection Rate of Bladder Cancer Using Blue Light Cystoscopy: Insights from a Multicenter Registry. Cancers (Basel) 2024; 16:1268. [PMID: 38610946 PMCID: PMC11011163 DOI: 10.3390/cancers16071268] [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: 03/06/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
The use of blue light cystoscopy (BLC) has been shown to improve bladder tumor detection. However, data demonstrating the efficacy of BLC across different races are limited. Herein, we aim to evaluate heterogeneity in the characteristics of BLC for the detection of malignant lesions among various races. Clinicopathologic information was collected from patients enrolled in the multi-institutional Cysview® registry (2014-2021) who underwent transurethral resection or biopsy of bladder tumors. Outcome variables included sensitivity and negative and positive predictive values of BLC and white light cystoscopy (WLC) for the detection of malignant lesions among various races. Overall, 2379 separate lesions/tumors were identified from 1292 patients, of whom 1095 (85%) were Caucasian, 96 (7%) were African American, 51 (4%) were Asian, and 50 (4%) were Hispanic. The sensitivity of BLC was higher than that of WLC in the total cohort, as well as in the Caucasian and Asian subgroups. The addition of BLC to WLC increased the detection rate by 10% for any malignant lesion in the total cohort, with the greatest increase in Asian patients (18%). Additionally, the positive predictive value of BLC was highest in Asian patients (94%), while Hispanic patients had the highest negative predictive value (86%). Our study showed that regardless of race, BLC increases the detection of bladder cancer when combined with WLC.
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Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | - Alireza Ghoreifi
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
| | | | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH 43210, USA;
| | | | - John Taylor
- Department of Urology, University of Kansas, Kansas City, KS 66045, USA; (J.M.H.); (J.T.)
| | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA;
| | | | - Jennifer M. Taylor
- Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Joseph C. Liao
- VA Palo Alto Health Care System, Palo Alto, CA 94304, USA;
| | | | - Sima P. Porten
- Department of Urology, University of California San Francisco, San Francisco, CA 94115, USA;
| | - Gary D. Steinberg
- Department of Urology, Allina Health Cancer Institute, University of Minnesota, Minneapolis, MN 55407, USA;
| | - Mark D. Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA;
| | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Siamak Daneshmand
- Department of Urology, Norris Cancer Center, University of Southern California, Los Angeles, CA 90033, USA; (S.-S.L.-S.); (A.G.)
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2
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Sussman J, Konety B, Ahmadi H. Re: Rakesh Heer, Rebecca Lewis, Thenmalar Vadiveloo, et al. A Randomized Trial of PHOTOdynamic Surgery in Non-muscle-invasive Bladder Cancer. NEJM Evid 2022;1:EVIDoa2200092. Eur Urol 2024; 85:178-179. [PMID: 37580211 DOI: 10.1016/j.eururo.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Jonathan Sussman
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA; Allina Health Cancer Institute, Minneapolis, MN, USA
| | - Hamed Ahmadi
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.
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3
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Davalieva K, Kiprijanovska S, Ivanovski O, Trifunovski A, Saidi S, Dimovski A, Popov Z. Proteomics Profiling of Bladder Cancer Tissues from Early to Advanced Stages Reveals NNMT and GALK1 as Biomarkers for Early Detection and Prognosis of BCa. Int J Mol Sci 2023; 24:14938. [PMID: 37834386 PMCID: PMC10573217 DOI: 10.3390/ijms241914938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
The high recurrence rate and invasive diagnostic and monitoring methods in bladder cancer (BCa) clinical management require the development of new non-invasive molecular tools for early detection, particularly for low-grade and low-stage BCa as well as for risk stratification. By using an in-solution digestion method and label-free data-independent LC-MS/MS coupled with ion mobility, we profiled the BCa tissues from initiation to advanced stages and confidently identified and quantified 1619 proteins (≥2 peptides). A statistically significant difference in abundance (Anova ≤ 0.05) showed 494 proteins. Significant correlation with stage with steady up or down with BCa stages showed 15 proteins. Testing of NNMT, GALK1, and HTRA1 in urine samples showed excellent diagnostic potential for NNMT and GALK1 with AUC of 1.000 (95% CI: 1.000-1.000; p < 0.0001) and 0.801 (95% CI: 0.655-0.947; p < 0.0001), respectively. NNMT and GALK1 also showed very good potential in discriminating non-invasive low-grade from invasive high-grade BCa with AUC of 0.763 (95% CI: 0.606-0.921; p = 0.001) and 0.801 (95% CI: 0.653-0.950; p < 0.0001), respectively. The combination of NNMT and GALK1 increased prognostic accuracy (AUC = 0.813). Our results broaden the range of potential novel candidates for non-invasive BCa diagnosis and prognosis.
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Affiliation(s)
- Katarina Davalieva
- Research Centre for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia; (S.K.); (A.D.)
| | - Sanja Kiprijanovska
- Research Centre for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia; (S.K.); (A.D.)
| | - Ognen Ivanovski
- Clinical Centre “Mother Theresa”, University Clinic for Urology, 1000 Skopje, North Macedonia; (O.I.); (A.T.); (S.S.)
| | - Aleksandar Trifunovski
- Clinical Centre “Mother Theresa”, University Clinic for Urology, 1000 Skopje, North Macedonia; (O.I.); (A.T.); (S.S.)
| | - Skender Saidi
- Clinical Centre “Mother Theresa”, University Clinic for Urology, 1000 Skopje, North Macedonia; (O.I.); (A.T.); (S.S.)
| | - Aleksandar Dimovski
- Research Centre for Genetic Engineering and Biotechnology “Georgi D Efremov”, Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia; (S.K.); (A.D.)
- Faculty of Pharmacy, University “St. Cyril and Methodius”, 1000 Skopje, North Macedonia
| | - Zivko Popov
- Clinical Hospital “Acibadem Sistina”, 1000 Skopje, North Macedonia;
- Medical Faculty, University “St. Cyril and Methodius”, 1000 Skopje, North Macedonia
- Macedonian Academy of Sciences and Arts, 1000 Skopje, North Macedonia
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4
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Huang H, Liu A, Liang Y, Xin Y, Liu J, Hao Y, Huang D, Chen L, Li W, Jiang G, Huang Y, Xu Y, Zhang J, Ma T, Xu D, Gao Y. A urinary assay for mutation and methylation biomarkers in the diagnosis and recurrence prediction of non-muscle invasive bladder cancer patients. BMC Med 2023; 21:357. [PMID: 37726806 PMCID: PMC10510256 DOI: 10.1186/s12916-023-03065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Currently, the clinical strategy for diagnosis of non-muscle invasive bladder cancer (NMIBC) such as cystoscopy and cytology are invasive and/or with limited accuracy. OncoUrine, a urinary assay for mutation and methylation biomarkers, have showed a high accuracy in the detection of upper tract urinary carcinoma (UTUC) patients with hematuria. The aim of this study is to evaluate the performance of OncoUrine in diagnosis of NMIBC patients. METHODS In this multicenter prospective study, a total of 203 patients were enrolled, including 60 patients present with hematuria and 143 NMIBC patients under recurrence surveillance. Urine samples were collected before cystoscopy to undergo OncoUrine test. OncoUrine performance was calculated compared to clinical standard methods in hematuria cohort and recurrence surveillance cohort, respectively. Furthermore, NMIBC patients were followed up with a median time of 20.5 months (range 0.03 to 24.03 months) to assess the predictive value of OncoUrine during recurrence monitoring. RESULTS For bladder cancer diagnosis, OncoUrine tested 47 samples and achieved a sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) of 80% (95% CI 44.2-96.5)/91.9% (95% CI 77.0-97.9)/72.7% (95% CI 39.3-92.7)/94.4% (95% CI 80.0-99.0) (kappa value 69.4%, 95% CI 44.4-94.3), indicating 72.3% of unnecessary cystoscopy. For recurrence diagnosis, OncoUrine tested 93 samples, and the sensitivity/specificity/PPV/NPV was 100% (95% CI 59.8-100.0)/68.2% (95% CI 57.1-77.7)/22.9% (95% CI 11.0-40.6)/100% (95% CI 92.3-100.0) (kappa value 27.0%, 95% CI 11.1-42.8), indicating 62.4% of spared cystoscopy. What is more, OncoUrine correctly predicted 80% (20/25) of final recurrence with 12/25 (48%) patients who were OncoUrine positive, but cystoscopy negative was followed with recurrence during follow-up. The test result of OncoUrine was also found significantly correlated with recurrence free survival (RFS) of NMIBC patients (median 34.4-month vs unreached; HR 6.0, 95% CI 2.7-13.5, P < 0.0001). CONCLUSIONS OncoUrine showed potential value to reduce the frequency of unnecessary cystoscopy and the healthcare cost of bladder cancer patients. Patients with positive test results represented a population who were at high risk of recurrence and thus should be subject to frequent surveillance to ensure timely detection of any potential recurrence. This study has been registered in ClinicalTrials.gov with the number NCT04994197 posted on August 2021.
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Affiliation(s)
- Hai Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Ao Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Yiming Liang
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Yaqun Xin
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Jiacheng Liu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Yining Hao
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Da Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Lu Chen
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Wei Li
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Guangliang Jiang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China
| | - Yuhua Huang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yaoting Xu
- Department of Urologic Surgery, Shanghai Fourth People`S Hospital Affiliated to Tongji University, No.1279, Sanmen Road, Shanghai, 200081, China
| | - Jie Zhang
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China
| | - Tonghui Ma
- Hangzhou Jichenjunchuang Medical Laboratory, Co., Ltd., Hangzhou, 310000, China.
- Department of Translational Medicine, Genecn-Biotech. Co., Ltd., Hangzhou, 310000, China.
| | - Danfeng Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China.
| | - Yi Gao
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Road No.2, Shanghai, 200025, China.
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5
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Howley R, Chandratre S, Chen B. 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy. Bioengineering (Basel) 2023; 10:bioengineering10040496. [PMID: 37106683 PMCID: PMC10136048 DOI: 10.3390/bioengineering10040496] [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: 03/15/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
5-Aminolevulinic acid (ALA) is a naturally occurring amino acid synthesized in all nucleated mammalian cells. As a porphyrin precursor, ALA is metabolized in the heme biosynthetic pathway to produce protoporphyrin IX (PpIX), a fluorophore and photosensitizing agent. ALA administered exogenously bypasses the rate-limit step in the pathway, resulting in PpIX accumulation in tumor tissues. Such tumor-selective PpIX disposition following ALA administration has been exploited for tumor fluorescence diagnosis and photodynamic therapy (PDT) with much success. Five ALA-based drugs have now received worldwide approval and are being used for managing very common human (pre)cancerous diseases such as actinic keratosis and basal cell carcinoma or guiding the surgery of bladder cancer and high-grade gliomas, making it the most successful drug discovery and development endeavor in PDT and photodiagnosis. The potential of ALA-induced PpIX as a fluorescent theranostic agent is, however, yet to be fully fulfilled. In this review, we would like to describe the heme biosynthesis pathway in which PpIX is produced from ALA and its derivatives, summarize current clinical applications of ALA-based drugs, and discuss strategies for enhancing ALA-induced PpIX fluorescence and PDT response. Our goal is two-fold: to highlight the successes of ALA-based drugs in clinical practice, and to stimulate the multidisciplinary collaboration that has brought the current success and will continue to usher in more landmark advances.
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Affiliation(s)
- Richard Howley
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Philadelphia, PA 19104, USA
| | - Sharayu Chandratre
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Philadelphia, PA 19104, USA
| | - Bin Chen
- Department of Pharmaceutical Sciences, Philadelphia College of Pharmacy, Saint Joseph's University, Philadelphia, PA 19104, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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6
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Creswell ML, Sholklapper TN, Markel MJ, Mason JB, Pianka MA, Dall CP, Ulu C, Stamatakis L. Economic Outcomes of Hexaminolevulinate Blue-Light Cystoscopy in Non-Muscle Invasive Bladder Cancer: A 5-Year, Medicare-Based Model. Bladder Cancer 2023. [DOI: 10.3233/blc-220027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
BACKGROUND: Bladder cancer is the most expensive cancer to treat on a per-patient basis. Blue light cystoscopy with hexaminolevulinate (BLC) has demonstrated improved diagnostic accuracy compared with white light cystoscopy (WLC) in non-muscle invasive bladder cancer (NMIBC). With higher upfront costs, questions remain about long-term BLC cost outcomes. OBJECTIVE: This study seeks to investigate the 5-year cost comparison of BLC and WLC from the Medicare payer perspective. METHODS: A representative 5-year NMIBC management model was constructed and Medicare reimbursement values were overlaid. The primary outcome was mean year-over-year cumulative cost discounted to present value at a 3% annual percentage rate. The secondary outcome was the rate of clinical events. RESULTS: Patients in the BLC cohort experienced fewer recurrences. On a cumulative present value cost basis, BLC was more expensive per patient in years 1, 2, and 3 than WLC, however, in years 4 and 5, BLC was economically favorable. Year 5 BLC mean cumulative cost savings was $1,172 per patient. Overall, 31.6% of all patients in the BLC group generated cumulative cost savings compared to WLC at year 1 compared with 50.9% at the end of year 5. CONCLUSIONS: Despite a higher initial annual cost, a slight cumulative economic advantage of BLC is realized after surveillance year 3. Additionally, a greater proportion of patients who received BLC achieved cost savings at the end of year 5. As novel technology emerges, economic models can help health care systems predict associated costs and quality improvements.
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Affiliation(s)
- Michael L. Creswell
- Georgetown University School of Medicine, Washington, DC, USA
- Georgetown University McDonough School of Business, Washington, DC, USA
| | | | | | - James B. Mason
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Mark A. Pianka
- Georgetown University School of Medicine, Washington, DC, USA
| | - Christopher P. Dall
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Canan Ulu
- Georgetown University McDonough School of Business, Washington, DC, USA
| | - Lambros Stamatakis
- Georgetown University School of Medicine, Washington, DC, USA
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
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7
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Pharo HD, Jeanmougin M, Ager-Wick E, Vedeld HM, Sørbø AK, Dahl C, Larsen LK, Honne H, Brandt-Winge S, Five MB, Monteiro-Reis S, Henrique R, Jeronimo C, Steven K, Wahlqvist R, Guldberg P, Lind GE. BladMetrix: a novel urine DNA methylation test with high accuracy for detection of bladder cancer in hematuria patients. Clin Epigenetics 2022; 14:115. [PMID: 36115961 PMCID: PMC9482155 DOI: 10.1186/s13148-022-01335-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cystoscopy is the gold standard for bladder cancer detection, but is costly, invasive and has imperfect diagnostic accuracy. We aimed to identify novel and accurate DNA methylation biomarkers for non-invasive detection of bladder cancer in urine, with the potential to reduce the number of cystoscopies among hematuria patients. Results Biomarker candidates (n = 32) were identified from methylome sequencing of urological cancer cell lines (n = 16) and subjected to targeted methylation analysis in tissue samples (n = 60). The most promising biomarkers (n = 8) were combined into a panel named BladMetrix. The performance of BladMetrix in urine was assessed in a discovery series (n = 112), consisting of bladder cancer patients, patients with other urological cancers and healthy individuals, resulting in 95.7% sensitivity and 94.7% specificity. BladMetrix was furthermore evaluated in an independent prospective and blinded series of urine from patients with gross hematuria (n = 273), achieving 92.1% sensitivity, 93.3% specificity and a negative predictive value of 98.1%, with the potential to reduce the number of cystoscopies by 56.4%. Conclusions We here present BladMetrix, a novel DNA methylation urine test for non-invasive detection of bladder cancer, with high accuracy across tumor grades and stages, and the ability to spare a significant number of cystoscopies among patients with gross hematuria. Supplementary Information The online version contains supplementary material available at 10.1186/s13148-022-01335-2.
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8
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Yong C, Mott SL, Steinberg RL, Packiam VT, O'Donnell MA. A longitudinal single center analysis of T1HG bladder cancer: An 18 year experience. Urol Oncol 2022; 40:491.e1-491.e9. [PMID: 35831215 DOI: 10.1016/j.urolonc.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/06/2022] [Accepted: 06/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To re-evaluate the treatment of T1HG bladder cancer by analyzing our experience over 18 years. METHODS AND MATERIALS An IRB-approved, single-institution retrospective review was performed of all patients with T1HG bladder cancer between August 1999 and July 2017. We assessed clinicopathologic characteristics, treatment history (including intravesical therapy, cystectomy, systemic chemotherapy, and radiation), and oncologic outcomes. RESULTS We identified 191 patients with T1HG. Five patients underwent cystectomy at diagnosis. The five-year recurrence-free survival (RFS) for the 186 patients who initially underwent bladder sparing treatments was 50% (95% CI: 41%-58%). There were 83 patients (45%) with disease recurrence; median time to recurrence was 6.7 months (IQR: 4.9-17.5). Disease characteristics at initial recurrence was T2 or greater in 8 patients (10%), T1HG in 19 (23%), CIS in 30 (36%), TaHG in 10 (12%), T1 low-grade (LG) in 1 (1%), and TaLG in 15 (18%). For patients with no prior recurrences, neither re-resection (P = 0.12), receipt of induction therapy (P = 0.81), prostatic urethra positivity (P = 0.51), or age (P = 0.34) were significantly associated with risk of recurrence. Similarly, patients with a single recurrence also fared well without identifiable risk factors. In fact, baseline hazard function analysis demonstrated no differences in RFS comparing patients stratified by 0, 1, and 2+ prior recurrences (P = 0.46). The five-year overall survival (OS) was 76% (95% CI: 68%-82%), and median OS was 127 months. The five-year cancer-specific survival was 86% (95% CI: 78%-91%) for the overall cohort. Five-year cystectomy-free survival for patients with BCG responsive disease and unresponsive disease was 95% (95% CI: 85%-98%) and 72% (95% CI: 52%-84%), respectively. CONCLUSION For patients who recurred after intravesical therapy, including those with recurrent T1 disease, additional induction courses of intravesical therapy did not negatively affect oncologic outcomes. Pathology of initial recurrence was not found to be a statistically significant risk factor for future recurrence. These findings suggest that BCG-unresponsive disease does not necessarily require immediate cystectomy. A multicenter, pragmatically designed evaluation in a contemporary cohort would more validly interrogate this important patient population.
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Affiliation(s)
- Courtney Yong
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center Biostatistics, College of Public Health Building, Iowa City, IA
| | - Ryan L Steinberg
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Vignesh T Packiam
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Michael A O'Donnell
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA.
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9
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Mengual L, Frantzi M, Mokou M, Ingelmo-Torres M, Vlaming M, Merseburger AS, Roesch MC, Culig Z, Alcaraz A, Vlahou A, Mischak H, Van der Heijden AG. Multicentric validation of diagnostic tests based on BC-116 and BC-106 urine peptide biomarkers for bladder cancer in two prospective cohorts of patients. Br J Cancer 2022; 127:2043-2051. [PMID: 36192490 PMCID: PMC9681771 DOI: 10.1038/s41416-022-01992-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Non-invasive urine-based biomarkers can potentially improve current diagnostic and monitoring protocols for bladder cancer (BC). Here we assess the performance of earlier published biomarker panels for BC detection (BC-116) and monitoring of recurrence (BC-106) in combination with cytology, in two prospectively collected patient cohorts. METHODS Of the 602 patients screened for BC, 551 were found eligible. For the primary setting, 73 patients diagnosed with primary BC (n = 27) and benign urological disorders, including patients with macroscopic haematuria, cystitis and/or nephrolithiasis (n = 46) were included. In total, 478 patients under surveillance were additionally considered (83 BC recurrences; 395 negative for recurrence). Urine samples were analysed with capillary electrophoresis-mass spectrometry. The biomarker score was estimated via support vector machine-based software. RESULTS Validation of BC-116 biomarker panel resulted in 89% sensitivity and 67% specificity (AUCBC-116 = 0.82). A diagnostic score based on cytology and BC-116 resulted in good (AUCNom116 = 0.85) but not significantly better performance (P = 0.5672). A diagnostic score including BC-106 and cytology was evaluated (AUCNom106 = 0.82), significantly outperforming both cytology (AUCcyt = 0.72; P = 0.0022) and BC-106 (AUCBC-106 = 0.67; P = 0.0012). CONCLUSIONS BC-116 biomarker panel is a useful test for detecting primary BC. BC-106 classifier integrated with cytology showing >95% negative predictive value, might be useful for decreasing the number of cystoscopies during surveillance.
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Affiliation(s)
- Lourdes Mengual
- Laboratory and Department of Urology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maria Frantzi
- Department of Biomarker Research, Mosaiques Diagnostics, Hannover, Germany.
| | - Marika Mokou
- Department of Biomarker Research, Mosaiques Diagnostics, Hannover, Germany
| | - Mercedes Ingelmo-Torres
- Laboratory and Department of Urology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Michiel Vlaming
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Axel S Merseburger
- University Hospital Schleswig-Holstein, Campus Lübeck, Department of Urology, Lübeck, Germany
| | - Marie C Roesch
- University Hospital Schleswig-Holstein, Campus Lübeck, Department of Urology, Lübeck, Germany
| | - Zoran Culig
- Experimental Urology, Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Antonio Alcaraz
- Laboratory and Department of Urology, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonia Vlahou
- Systems Biology Center, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Harald Mischak
- Department of Biomarker Research, Mosaiques Diagnostics, Hannover, Germany
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
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10
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“Seeing” invisible volatile organic compound (VOC) marker of urinary bladder cancer: A development from bench to bedside prototype spectroscopic device. Biosens Bioelectron 2022; 218:114764. [DOI: 10.1016/j.bios.2022.114764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/30/2022]
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11
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The use of blue-light cystoscopy in the detection and surveillance of nonmuscle invasive bladder cancer. Curr Urol 2022; 16:121-126. [PMID: 36204358 PMCID: PMC9527925 DOI: 10.1097/cu9.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022] Open
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12
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Pohar KS, Patel S, Lotan Y, Trabulsi E, Woods M, Downs T, Huang WC, Jones J, Taylor J, O'Donnell M, Bivalacqua TJ, DeCastro J, Steinberg G, Kamat AM, Resnick MJ, Konety B, Schoenberg M, Jones JS, Daneshmand S. Safety of repeat blue light cystoscopy with hexaminolevulinate (HAL) in the management of bladder cancer: Results from a phase III, comparative, multi-center study. Urol Oncol 2022; 40:382.e1-382.e6. [PMID: 35750559 DOI: 10.1016/j.urolonc.2022.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/03/2022] [Accepted: 04/25/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The therapeutic benefit of intravesical instillation of hexaminolevulinate (HAL) at the time of transurethral resection of bladder tumor (TURBT) has been demonstrated in multiple studies. The purpose of this study was to prospectively assess the safety of repeated administration of HAL from a phase III pre-trial planned analysis. MATERIALS AND METHODS All patients evaluated in the study received at least 1 dose of HAL at the time of office cystoscopy, and a subset of these patients (n = 103, 33.2%) received a second dose a few weeks later at the time of TURBT. Adverse events (AEs) were recorded, and the safety of repeat use of HAL was determined by comparing the proportion of patients with AEs considered causally related to HAL in the surveillance examination compared to the OR examination. Association between categorical variables was tested using Fisher's Exact Test, and a P < 0.05 was considered statistically significant. RESULTS HAL-related AEs were experienced by 6 patients (2.2%) during surveillance cystoscopy and 3 patients (3.4%) following TURBT (P = 0.76); 181 patients (59.5%) had prior exposure to HAL before enrolling in the study with no difference in the number of AEs when comparing prior exposure to HAL to no prior exposure (P = 0.76). Of the patients who previously received intravesical therapy, 8 (2.9%) had at least 1 AE during surveillance compared to 3 (9.7%) who had no prior intravesical therapy (P = 0.09). CONCLUSIONS Repeat use of HAL is safe even when administered within a few weeks of receiving a dose of intravesical therapy.
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Affiliation(s)
- Kamal S Pohar
- Department of Urology, The Ohio State University, Columbus, OH.
| | - Sanjay Patel
- Department of Urology, University of Oklahoma, Oklahoma City, OK
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center, Dallas, TX
| | - Edouard Trabulsi
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | | | - Tracy Downs
- Department of Urology, University of Virginia, Charlottesville, VA
| | - William C Huang
- Department of Urology, New York University School of Medicine, New York, NY
| | | | | | | | | | - Joel DeCastro
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Gary Steinberg
- Department of Urology, New York University Langone Health, New York, NY
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Siamak Daneshmand
- Department of Urology, University of Southern California, Los Angeles, CA
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13
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Deng L, Chao H, Deng H, Yu Z, Zhao R, Huang L, Gong Y, Zhu Y, Wang Q, Li F, Liu L, He L, Tang Z, Liao C, Qi Y, Wang X, Zeng T, Zou H. A novel and sensitive DNA methylation marker for the urine-based liquid biopsies to detect bladder cancer. BMC Cancer 2022; 22:510. [PMID: 35524222 PMCID: PMC9077853 DOI: 10.1186/s12885-022-09616-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Better prognostic outcome is closely correlated with early detection of bladder cancer. Current non-invasive urianalysis relies on simultaneously testing multiple methylation markers to achieve relatively high accuracy. Therefore, we have developed an easy-to-use, convenient, and accurate single-target urine-based DNA methylation test for the malignancy. Methods By analyzing TCGA data, 344 candidate markers with 424 primer pairs and probe sets synthesized were systematically screened in cancer cell lines, paired tissue specimens, and urine sediments from bladder cancer patients and normal controls. The identified marker was further validated in large case-control cohorts. Wilcoxon rank sum tests and c2 tests were performed to compare methylation levels between case-control groups and correlate methylation levels with demographic and clinical characteristics. In addition, MSP, qMSP, RT-PCR, western blot analysis, and immunohistochemistry were performed to measure levels of DNA methylation, mRNA transcription, and protein expression in cancer cell lines and tissues. Results A top-performing DMRTA2 marker identified was tested in both discovery and validation sets, showing similar sensitivity and specificity for bladder cancer detection. Overall sensitivity in the aggregate set was 82.9%(179/216). The specificity, from a control group consisting of patients with lithangiuria, prostatoplasia, and prostatitis, is 92.5%(468/506). Notably, the methylation assay had the highest sensitivities for tumors at stages of T1(90.4%) and T2(95.0%) compared with Ta (63.0%), T3(81.8%), and T4(81.8%). Furthermore, the test showed admirable detection rate of 80.0%(24/30) for recurring cancers. While methylation was observed in 39/54(72.2%) urine samples from patients with carcinomas of renal pelvis and ureter, it was detected at extremely low rate of 6.0%(8/133) in kidney and prostate cancers. Compared with SV-HUC-1, the normal bladder epithelial cell line, DMRTA2 was hypermethylated in 8/9 bladder cancer cell lines, consistent with the results of MSP and qMSP, but not correlated with mRNA and protein expression levels in these cell lines. Similarly, DMRTA2 immunostaining was moderate in some tissues but weak in others. Further studies are needed to address functional implications of DMRTA2 hypermethylation. Conclusions Our data demonstrated that a single-target DNA methylation signature, mDMRTA2, could be highly effective to detect both primary and recurring bladder cancer via urine samples. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09616-y.
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Affiliation(s)
- Leihong Deng
- The First Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, 330006, Jiangxi, China
| | - Haichao Chao
- The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China
| | - Huanhuan Deng
- Donghu Campus, Medical College of Nanchang University, 461 Bayi Dadao, Nanchang, 330006, Jiangxi, China
| | - Zhaojun Yu
- Donghu Campus, Medical College of Nanchang University, 461 Bayi Dadao, Nanchang, 330006, Jiangxi, China
| | - Rongsong Zhao
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Longwu Huang
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Yun Gong
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Yueting Zhu
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Qingping Wang
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Feng Li
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Lirong Liu
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Lei He
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Zhimin Tang
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Caizhi Liao
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Yan Qi
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Xianshu Wang
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China
| | - Tao Zeng
- The Second Affiliated Hospital of Nanchang University, No. 1, Minde Road, Nanchang, 330006, Jiangxi, China.
| | - Hongzhi Zou
- Creative Biosciences (Guangzhou) CO., Ltd, Guangzhou, 510530, Guangdong, China.
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14
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Kurumi H, Sakaguchi T, Hashiguchi K, Yamashita T, Fujii M, Ikebuchi Y, Yoshida A, Isomoto H. Photodynamic Diagnosis for the Identification of Intestinal-Type Gastric Cancers and High-Grade Adenomas. Front Oncol 2022; 12:861868. [PMID: 35586493 PMCID: PMC9108360 DOI: 10.3389/fonc.2022.861868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 04/04/2022] [Indexed: 12/11/2022] Open
Abstract
Gastric cancer is the second most common cancer in Japan. The incidence of gastric cancer remains high owing to the increase in the elderly population. Endoscopy outperforms radiography in identifying early gastric cancer (EGC). Furthermore, image-enhanced endoscopy (IEE) has been developed and implemented worldwide in clinical practice. Magnifying IEE images can help to visualize the microvascular pattern and microstructure architecture, which is used for the characterization of EGC. However, accurate endoscopic diagnosis requires the experience and skill of endoscopists, making an objective and simple diagnostic method desirable. In this retrospective study, we investigated the diagnostic yield of 5-aminolevulinic acid (5-ALA)-mediated photodynamic diagnosis (PDD) for identifying gastric cancers and high-grade adenomas. In total, 52 lesions from 43 patients were ultimately included in the study. We detected 5-ALA-mediated protoporphyrin IX fluorescence in 45 of the 52 lesions that were initially intended for PDD, resulting in a detection rate of 86.5%, whereas each signet ring cell carcinoma was negative using 5-ALA PDD. In eight of the patients with multiple lesions, 17 lesions were identified using 5-ALA PDD. Again, we took biopsies from six areas that we suspected as new lesions. While 4 lesions were gastric neoplasms resected by endoscopic submucosal dissection, two other lesions were normal. Preoperative 5-ALA-PDD could provide additional diagnostic yields to detect such multiple lesions simultaneously. No severe adverse events were observed. Prospective multicenter studies are warranted to confirm the usefulness of 5-ALA PDD for EGC identification.
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Affiliation(s)
- Hiroki Kurumi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Takuki Sakaguchi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | - Taro Yamashita
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Masashi Fujii
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Yuichiro Ikebuchi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Akira Yoshida
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, Yonago, Japan
- Department of Endoscopy, Nagasaki University Hospital, Nagasaki, Japan
- *Correspondence: Hajime Isomoto,
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15
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Freitas NR, Vieira PM, Cordeiro A, Tinoco C, Morais N, Torres J, Anacleto S, Laguna MP, Lima E, Lima CS. Detection of bladder cancer with feature fusion, transfer learning and CapsNets. Artif Intell Med 2022; 126:102275. [DOI: 10.1016/j.artmed.2022.102275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022]
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Mulawkar PM, Sharma G, Tamhankar A, Shah U, Raheem R. Role of Macroscopic Image Enhancement in Diagnosis of Non-Muscle-Invasive Bladder Cancer: An Analytical Review. Front Surg 2022; 9:762027. [PMID: 35265660 PMCID: PMC8898829 DOI: 10.3389/fsurg.2022.762027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/17/2022] [Indexed: 11/18/2022] Open
Abstract
Early diagnosis of non-muscle-invasive bladder cancer (NMIBC) is of paramount importance to prevent morbidity and mortality due to bladder cancer. Although white light imaging (WLI) cystoscopy has long been considered the gold standard in the diagnosis of bladder cancer, it can miss lesions in a substantial percentage of patients and is very likely to miss carcinoma in situ and dysplasia. Tumor margin detection by WLI can be inaccurate. Moreover, WLI could, sometimes, be inadequate in distinguishing inflammation and malignancy. To improve the diagnostic efficacy of cystoscopy, various optical image enhancement modalities have been studied. These image enhancement modalities have been classified as macroscopic, microscopic, or molecular. Photodynamic diagnosis (PDD), narrow band imaging (NBI), and Storz image 1 S enhancement (formerly known as SPIES) are macroscopic image enhancement modalities. A relevant search was performed for literature describing macroscopic image enhancement modalities like PDD, NBI, and image 1 S enhancement. The advantages, limitations, and usefulness of each of these in the diagnosis of bladder cancer were studied. Photodynamic diagnosis requires intravesical instillation of a photosensitizing agent and a special blue light cystoscope system. PDD has been shown to be more sensitive than WLI in the detection of bladder cancer. It is superior to WLI in the detection of flat lesions. Bladder tumor resection (TURBT) by PDD results in more complete resection and reduced recurrence rates. PDD-guided TURBT may have some role in reducing the risk of progression. Narrow band imaging provides increased contrast between normal and abnormal tissues based on neovascularization, thereby augmenting WLI. NBI requires a special light source. There is no need for intravesical contrast instillation. NBI is superior to WLI in the detection of bladder cancer. The addition of NBI to WLI improves the detection of flat lesions like carcinoma in situ. NBI is not useful in predicting invasive tumors or grades of tumors. NBI-directed TURBT reduces recurrence rates and recurrence free survival. But its efficacy in retarding progression is unproven. Image 1 S-enhancement utilizes software-based image enhancement modes without the need for a special light source or intravesical contrast instillation. This system provides high-quality images and identifies additional abnormal-looking areas. Another advantage of this system is simultaneous side-by-side visualization of WLI and enhanced image, providing WLI images as the control for comparison. As with PDD, S-enhancement produces a lower rate of a missed bladder cancer diagnosis. The system significantly improves the diagnosis of NMIBC. The sensitivity and negative predictive value of image 1 S enhancement increase with the increase in cancer grade. A negative test by S-enhancement effectively rules out NMIBC. All the image enhancement modalities have proven their utility in improving detection and short-term cancer control. But none of these modalities have proven their utility in delaying progression, or in long-term cancer control. Cancer progression and long-term control are governed by the biological nature of cancer cells. Early detection by optical enhancement may not be of utility in this regard. Well-designed studies are needed to establish the efficacy of these modalities in the evaluation of patients with bladder cancer. The last word, in this regard, is yet to be written.
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Affiliation(s)
- Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, India
- Tutor in Urology, University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: Prashant Motiram Mulawkar
| | | | | | - Utsav Shah
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rickaz Raheem
- Milton Keynes University Hospital, Eaglestone, United Kingdom
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17
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Electrochemical Biosensor Employing Bi2S3 Nanocrystals-Modified Electrode for Bladder Cancer Biomarker Detection. CHEMOSENSORS 2022. [DOI: 10.3390/chemosensors10020048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Bladder cancer is a kind of malignant tumor with high incidence in the urinary system, complex pathogenic causes, and the high recurrence rate. Biosensors capable of rapid, on site, and accurate bladder cancer diagnosis method continue to be lacking. Here, the electrochemical biosensor for detecting cytokeratin 18 (CK18, bladder cancer biomarker) was constructed based on the chemically modified electrode (CME). The work electrode (WE) was modified by bismuth sulfide semiconductor nanocrystals (Bi2S3 NCs), and then immobilized with CK18 antibodies and blocking agents to complete the electrode preparation. The results indicated that the interface of a flexible carbon electrode with Bi2S3 NCs film was steady with reliable charge transfer capability. With the large specific area and quantum size effect, the proposed sensor could detect CK18 antigen protein with an ultralow detection limit of 1.87 fM (fmol L−1) and wide linear dynamic range of 1–1000 pg mL−1, respectively. Detecting results could be read in less than 30 s with the portable, planar flexible CME. The sensitive and specific electrochemical biosensor possessed the characteristics of rapidity, ease-of-use, and non-invasive detection, indicating the application prospect in the early screening of bladder cancer and other diseases.
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18
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Kurumi H, Kanda T, Ikebuchi Y, Yoshida A, Kawaguchi K, Yashima K, Isomoto H. Current Status of Photodynamic Diagnosis for Gastric Tumors. Diagnostics (Basel) 2021; 11:diagnostics11111967. [PMID: 34829314 PMCID: PMC8618298 DOI: 10.3390/diagnostics11111967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 01/06/2023] Open
Abstract
Although the recent development and widespread use of image-enhanced endoscopy and magnifying endoscopy have improved endoscopic diagnosis of gastric cancer, it is somewhat complicated, requires a higher level of expertise, and is still subjective. Photodynamic endoscopic diagnosis (PDED) is based on the fluorescence of photosensitizers that accumulate in tumors, which enables objective evaluation independent of the endoscopist’s experience, and is useful for tumor detection. The objective of this work was to perform a narrative review of PDED for gastric tumors and to introduce our approach to PDED in gastric tumors in our hospital. In our review there have been case reports of PDED for gastric cancer, but its usefulness has not been established because no prospective studies evaluating its usefulness have been performed. In our previous study, 85.7% (42/49) of gastric tumors exhibited fluorescence in PDED. PDED may be useful in the diagnosis of early gastric cancer. Our previous studies were pilot studies in cancer patients; therefore, future prospective studies are required to verify the usefulness of PDED.
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Affiliation(s)
| | | | | | | | | | | | - Hajime Isomoto
- Correspondence: ; Tel.: +81-859-38-6527; Fax: +81-859-38-6529
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19
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Ahmadi H, Ladi-Seyedian SS, Konety B, Pohar K, Holzbeierlein JM, Kates M, Willard B, Taylor JM, Liao JC, Kaimakliotis HZ, Porten SP, Steinberg GD, Tyson MD, Lotan Y, Daneshmand S. Role of blue-light cystoscopy in detecting invasive bladder tumours: data from a multi-institutional registry. BJU Int 2021; 130:62-67. [PMID: 34637596 DOI: 10.1111/bju.15614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/16/2021] [Accepted: 09/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the role of blue-light cystoscopy (BLC) in detecting invasive tumours that were not visible on white-light cystoscopy (WLC). PATIENTS AND METHODS Using the multi-institutional Cysview registry database, patients who had at least one white-light negative (WL-)/blue-light positive (BL+) lesion with invasive pathology (≥T1) as highest stage tumour were identified. All WL-/BL+ lesions and all invasive tumours in the database were used as denominators. Relevant baseline and outcome data were collected. RESULTS Of the 3514 lesions (1257 unique patients), 818 (23.2%) lesions were WL-/BL+, of those, 55 (7%) lesions were invasive (48 T1, seven T2; 47 unique patients) including 28/55 (51%) de novo invasive lesions (26 unique patients). In all, 21/47 (45%) patients had WL-/BL+ concommitant carcinoma in situ and/or another T1 lesions. Of 22 patients with a WL-/BL+ lesion who underwent radical cystectomy (RC), high-risk pathological features leading to RC was only visible on BLC in 18 (82%) patients. At time of RC, 11/22 (50%) patients had pathological upstaging including four (18%) with node-positive disease. CONCLUSIONS A considerable proportion of invasive lesions are only detectable by BLC and the rate of pathological upstaging is significant. Our present findings suggest an additional benefit of BLC in the detection of invasive bladder tumours that has implications for treatment approach.
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Affiliation(s)
- Hamed Ahmadi
- Department of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Seyedeh Sanam Ladi-Seyedian
- Department of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Sima P Porten
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | | | - Mark D Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX, USA
| | - Siamak Daneshmand
- Department of Urology, USC Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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20
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Zhou X, Kurywchak P, Wolf-Dennen K, Che SP, Sulakhe D, D’Souza M, Xie B, Maltsev N, Gilliam TC, Wu CC, McAndrews KM, LeBleu VS, McConkey DJ, Volpert OV, Pretzsch SM, Czerniak BA, Dinney CP, Kalluri R. Unique somatic variants in DNA from urine exosomes of individuals with bladder cancer. Mol Ther Methods Clin Dev 2021; 22:360-376. [PMID: 34514028 PMCID: PMC8408559 DOI: 10.1016/j.omtm.2021.05.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/21/2021] [Indexed: 01/03/2023]
Abstract
Bladder cancer (BC), a heterogeneous disease characterized by high recurrence rates, is diagnosed and monitored by cystoscopy. Accurate clinical staging based on biopsy remains a challenge, and additional, objective diagnostic tools are needed urgently. We used exosomal DNA (exoDNA) as an analyte to examine cancer-associated mutations and compared the diagnostic utility of exoDNA from urine and serum of individuals with BC. In contrast to urine exosomes from healthy individuals, urine exosomes from individuals with BC contained significant amounts of DNA. Whole-exome sequencing of DNA from matched urine and serum exosomes, bladder tumors, and normal tissue (peripheral blood mononuclear cells) identified exonic and 3' UTR variants in frequently mutated genes in BC, detectable in urine exoDNA and matched tumor samples. Further analyses identified somatic variants in driver genes, unique to urine exoDNA, possibly because of the inherent intra-tumoral heterogeneity of BC, which is not fully represented in random small biopsies. Multiple variants were also found in untranslated portions of the genome, such as microRNA (miRNA)-binding regions of the KRAS gene. Gene network analyses revealed that exoDNA is associated with cancer, inflammation, and immunity in BC exosomes. Our findings show utility of exoDNA as an objective, non-invasive strategy to identify novel biomarkers and targets for BC.
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Affiliation(s)
- Xunian Zhou
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul Kurywchak
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kerri Wolf-Dennen
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sara P.Y. Che
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dinanath Sulakhe
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Mark D’Souza
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Bingqing Xie
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Natalia Maltsev
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - T. Conrad Gilliam
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Chia-Chin Wu
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen M. McAndrews
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valerie S. LeBleu
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David J. McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Olga V. Volpert
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shanna M. Pretzsch
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bogdan A. Czerniak
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P. Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Raghu Kalluri
- Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- School of Bioengineering, Rice University, Houston, TX, USA
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX, USA
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21
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Veeratterapillay R, Gravestock P, Nambiar A, Gupta A, Aboumarzouk O, Rai B, Vale L, Heer R. Time to Turn on the Blue Lights: A Systematic Review and Meta-analysis of Photodynamic Diagnosis for Bladder Cancer. EUR UROL SUPPL 2021; 31:17-27. [PMID: 34467237 PMCID: PMC8385287 DOI: 10.1016/j.euros.2021.06.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
Context White light (WL) cystoscopy and transurethral resection of bladder tumour (TURBT) comprise the current gold standard technique for detecting and grading bladder cancer. However, with WL cystoscopy, recurrence following initial TURBT is high, and identification of smaller tumours and carcinoma in situ is poor. Photodynamic diagnosis (PDD) has been developed to improve the detection of bladder. Objective To assess the effect of PDD-guided TURBT compared with WL on recurrence rates (RRs) in non-muscle-invasive bladder cancer (NMIBC). Evidence acquisition A systematic review of the literature from inception to April 2020 using Medline, EMBASE, and CENTRAL was undertaken. Randomised control trials comparing TURBT undertaken with PDD to WL that reported RRs of at least 12 mo were included in the analysis. The primary outcomes were RRs at 12 and 24 mo. The secondary outcomes were reported adverse effects. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of the evidence. Evidence synthesis Twelve randomised controlled trials (2288 patients) were included for the meta-analysis. PDD was found to reduce RRs at 12 mo (RR 0.73, confidence interval [CI] 0.60-0.88) and 24 mo (RR 0.75, CI 0.62-0.91). There was an increased risk of recurrence for patients undergoing WL at 12 mo (hazard ratio [HR] 1.14, CI 1.05-1.23) and 24 mo (HR 1.25, CI 1.15-1.35). Two studies reported recurrence data at 60 mo showing statistically significant outcomes in favour of PDD: one showed lower RRs for PDD (49% PDD vs 68% WL), whilst the other showed increased recurrence-free survival (68.2% PDD vs 57.3% WL). Adverse effects appeared to be minimal, though poorly reported. A GRADE analysis showed the evidence to be of moderate certainty overall. Conclusions This systematic review found that PDD reduced RRs and improved recurrence-free survival compared with WL in NMIBC over at least 2-yr follow-up. These effects may persist up to 5 yr. Further research in a pragmatic study looking at longer-term outcomes beyond 24 mo will help guide recommendations on clinical adoption. Patient summary This review suggests that photodynamic diagnosis, compared with white light cystoscopy, improves recurrence-free survival in non-muscle-invasive bladder cancer over at least 2 yr of follow-up. However, confirmatory pragmatic studies with longer-term outcomes are required for its clinical adoption.
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Affiliation(s)
| | | | - Arjun Nambiar
- Department of Urology, Freeman Hospital, Newcastle, UK
| | - Ameet Gupta
- Department of Urology, Freeman Hospital, Newcastle, UK
| | | | - Bhavan Rai
- Department of Urology, Freeman Hospital, Newcastle, UK
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Rakesh Heer
- Department of Urology, Freeman Hospital, Newcastle, UK
- Corresponding author. Department of Urology, Newcastle University, Newcastle, UK. Tel. 0191 233 6161.
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Kelloniemi E, Järvinen R, Hellström P, Rintala E, Aaltomaa S, Isotalo T, Innos K, Kaasinen E. Repeated 5-aminolevulinic Acid Instillations During Follow-up in Non-muscle-invasive Bladder Cancer: A Randomized Study. In Vivo 2021; 35:1561-1568. [PMID: 33910836 DOI: 10.21873/invivo.12411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/26/2021] [Accepted: 03/10/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND/AIM Non-muscle invasive bladder carcinoma (NMIBC) is highly recurrent. We studied if 5-aminolevulinic acid (5-ALA) instillations before transurethral resection of bladder tumours (TURBT) and cystoscopy extend the time to recurrence during follow-up with NMIBC patients. PATIENTS AND METHODS A prospective multicenter study enrolled 328 NMIBC patients. All TURBTs and control cystoscopies during the one-year study period were done with or without 5-ALA instillations. The primary endpoint was time to recurrence. The secondary endpoints were time to recurrence after 7.5, 10.5, and 13.5 months and the number of patients with progressive disease. RESULTS The overall median follow-up time was 80.4 and 87.0 months for the control and study groups, respectively. There was no statistical difference in time to first recurrence between the two groups. CONCLUSION We could not obtain significant differences between the control and 5-ALA groups in tumour recurrence among patients with NMIBC.
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Affiliation(s)
- Eija Kelloniemi
- Department of Urology, Helsinki University Hospital, Helsinki, Finland;
| | - Riikka Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Pekka Hellström
- Department of Urology, Oulu University Hospital, Oulu, Finland
| | - Erkki Rintala
- Department of Urology, Helsinki University Hospital, Helsinki, Finland
| | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, Kuopio, Finland
| | - Taina Isotalo
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Kalmer Innos
- Department of Surgery, Päijät-Häme Central Hospital, Lahti, Finland
| | - Eero Kaasinen
- Department of Surgery, Hyvinkää Hospital, Hyvinkää and Helsinki University Hospital, Hyvinkää, Finland
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23
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Andersson M, Berger M, Zieger K, Malmström PU, Bläckberg M. The diagnostic challenge of suspicious or positive malignant urine cytology findings when cystoscopy findings are normal: an outpatient blue-light flexible cystoscopy may solve the problem. Scand J Urol 2021; 55:263-267. [PMID: 34037496 DOI: 10.1080/21681805.2021.1928746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate whether outpatient blue-light flexible cystoscopy could solve the diagnostic challenge of positive or suspicious urine cytology findings despite normal white-light flexible cystoscopy results and normal findings on computerized tomography urography, in patients investigated for urothelial cancer. MATERIAL AND METHODS In a multicentre study, a total of 70 examinations were performed with the use of blue-light flexible cystoscopy (photodynamic diagnosis) after intravesical instillation of the fluorescence agent hexaminolevulinate. The examination started with a conventional white-light flexible cystoscopy and then the settings were switched to use blue light. Suspicious lesions were biopsied. Afterwards, the patients were interviewed regarding their experience of the examinations. RESULTS Bladder cancer was diagnosed in 29 out of 70 (41%) cases, among them 14/29 (48%) had malignant lesions seen only in blue light. The majority had carcinoma in situ (21/29). Normal findings were seen in 41 cases that underwent BLFC. During the further course, malignancy of the bladder was detected in six cases (9%) and malignancy of the upper urinary tract was detected in one case (1%). The majority of patients (93%) preferred the blue-light flexible cystoscopy performed at the outpatient clinic instead of the transurethral resection under general anaesthesia. CONCLUSION Blue-light flexible cystoscopy at the outpatient clinic may be a useful tool to solve unclear cases of a malignant or suspicious urinary cytology suggestive of bladder cancer. The procedure was well tolerated by the patients.
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Affiliation(s)
- Marie Andersson
- Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
| | - Marthe Berger
- Department of Urology, Lillebelt Hospital, Vejle, Denmark
| | - Karsten Zieger
- Department of Urology, Lillebelt Hospital, Vejle, Denmark
| | - Per-Uno Malmström
- Department of Urology, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mats Bläckberg
- Department of Urology, Helsingborg Hospital, Helsingborg, Sweden
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24
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Ahmadi H, Daneshmand S. Multiparametric cystoscopy: is the future here yet? Transl Androl Urol 2021; 10:1-6. [PMID: 33532288 PMCID: PMC7844506 DOI: 10.21037/tau-20-1012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Hamed Ahmadi
- Department of Urology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Department of Urology, University of Southern California, Norris Comprehensive Cancer Center, Los Angeles, CA, USA
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25
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Cystoscopy and Enhanced Diagnostics. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Golla V, Chamie K. Oncological Monitoring of NonMuscle Invasive Bladder Cancer (NMIBC). Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fukuhara H, Yamamoto S, Karashima T, Inoue K. Photodynamic diagnosis and therapy for urothelial carcinoma and prostate cancer: new imaging technology and therapy. Int J Clin Oncol 2020; 26:18-25. [PMID: 32451769 DOI: 10.1007/s10147-020-01704-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
Photodynamic technology using light-sensitive and fluorescent substances has an important role in an accurate diagnosis for a variety of malignancies, including bladder cancer and prostate cancer. Light-sensitive and fluorescent substances accumulate specifically in tumor cells compared to normal tissue, and by light irradiation and excitation at each specific wavelength, tumor lesion, blood flow, lymph node and so on show fluorescence. 5-Aminolevulinic acid (ALA) is converted to protoporphyrin IX (PpIX) into mitochondria. PpIX is excited by blue light, red fluorescence is emitted in the mitochondria. This phenomenon is the mechanism of ALA-mediated photodynamic diagnosis (ALA-PDD). ALA-PDD has made it possible to visualize smaller lesions and flat lesions that were previously difficult to visualize by endoscope using a white-light source. So accurate diagnosis and complete resection become possible during operation. The accumulation of PpIX in the mitochondria also induces direct mitochondrial damage and subsequent cell death by red and green light. This biological reaction is the ALA-mediate photodynamic therapy (ALA-PDT). ALA-PDT has been developed as a modality for minimum invasive cancer treatment that utilizes low-energy light and photosensitizer. Vascular-activated photosensitizer induces rapid tumor ablation by PDT involving direct tumor cell killing as well as damage to the exposed microvasculature. We summarize the clinical outcomes of PDD and PDT for urothelial carcinoma and prostate cancer.
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Affiliation(s)
- Hideo Fukuhara
- Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan.
| | - Shinkuro Yamamoto
- Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan
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28
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Abstract
PURPOSE OF REVIEW It has been firmly established that hexaminolevulinate-assisted blue light cystoscopy (HAL-BLC) reduces cancer recurrence rates. This review explores the impact of HAL-BLC on other meaningful outcomes in patients with bladder cancer, including disease progression, and earlier detection of disease at the time of surveillance cystoscopy. RECENT FINDINGS A randomized clinical trial confirmed earlier implementation of HAL-BLC at the time of surveillance cystoscopy increased identification of cancerous lesions, including those of high grade, when compared with white light cystoscopy. In addition, the evidence is evolving that the use of HAL-BLC at the time of endoscopic treatment of high-risk tumors may lead to lower rates of progression to muscle invasion, and this in part may be due to better risk stratification leading to changes in treatment plan. The clinical contexts for the use of HAL-BLC are broader than prior knowledge. It is also becoming more clear that the positive impact of HAL-BLC is likely more than just reducing cancer recurrence rates, and patients would benefit from the technology at many time points in the management and follow-up of their disease.
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Affiliation(s)
- Kamal S Pohar
- Department of Urology, The Ohio State University, Suite 3000, 915 Olentangy River Rd, Columbus, OH, 43212, USA.
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29
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5-aminolevulinic acid-mediated photodynamic diagnosis using fluorescence ureterorenoscopy for urinary upper tract urothelial carcinoma ∼Preliminary prospective single centre trial∼. Photodiagnosis Photodyn Ther 2019; 29:101617. [PMID: 31857216 DOI: 10.1016/j.pdpdt.2019.101617] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/12/2019] [Accepted: 12/05/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of 5- aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD) for upper urinary tract tumor (UTUC) including carcinoma in situ (CIS) lesions using flexible fluorescence ureterorenoscopy. METHODS A solution of ALA was orally administrated at 20 mg/kg body weight at 3 h prior to surgery. Fluorescence observation was carried out with IMAGE1S OPAL1 PDD system. Positive lesions that were identified as abnormal changes under white light and/or blue light were biopsied, followed by cold-cup biopsy of negative lesions that were normal-looking mucosa under white light and/or blue light. Diagnostic accuracy was analysed by comparing ureterorenoscopic observations under white light or blue light with pathological analysis results. RESULTS A total of 31 biopsy specimens were obtained from 10 patients. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for PDD to detect UTUC was 100 %, 50 %, 52.4 % and 100 %, respectively. The sensitivity of PDD ureterorenoscopy was significantly higher than that of white light ureterorenoscopy by statistics (p < 0.05). Especially, 5 CIS lesions were detected only by ALA-PDD ureterorenoscopy (p < 0.05). Of 10 patients, one patient (10 %) experienced hypotension during the ALA-PDD. CONCLUSIONS ALA-PDD for UTUC is a feasible and safe techniques with acceptable adverse events. Additional advantage of ALA-PDD for UTUC is the high sensitivity to detect CIS lesions with blue light mode.
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30
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Zhang N, Chen S, Wu L, Wu Y, Jiang G, Shao J, Chen L, Sun J, Na R, Wang X, Xu J. Identification of Cancer-Specific Methylation of Gene Combination for the Diagnosis of Bladder Cancer. J Cancer 2019; 10:6761-6766. [PMID: 31777606 PMCID: PMC6856882 DOI: 10.7150/jca.28192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 05/27/2019] [Indexed: 01/30/2023] Open
Abstract
Here we conducted an evidence-based study in developing and validating a urinary biomarker combination of gene methylation assays in patients with hematuria. A number of 99 urine samples were obtained and detected from Chinese patients with hematuria. The Cancer Genome Atlas cohort with methylation (HM450) beta-values and clinical data of 412 bladder cancer and 21 matching normal tissue was included as a validation series. A risk score formula was then developed and calculated by the targeted genes, weighted by their estimated regression coefficients from the multivariable binary logistic regression analyses, and evaluated by receiver operating characteristic (ROC) curves analysis. The combination assay of HOXA9, ONECUT2, PCDH17, PENK, TWIST1, VIM and ZNF154 was singled out according to the results of multivariate logistic regression analysis. The higher probability of DNA methylation of all the selected 7 genes was found in bladder cancer group than the control group. Remarkable higher DNA methylation beta-values of all the selected 7 genes were also displayed in bladder cancer tissues compared with their matching normal bladder tissues. And the AUC value of our risk score model were 0.894 and 0.851 in respective cohort, revealing highlighted predictive value of our risk score model on bladder cancer diagnosis. In conclusions, a urinary combined methylation assay of HOXA9, ONECUT2, PCDH17, PENK, TWIST1, VIM and ZNF154 displayed accurate prediction of bladder cancer in hematuria patients, which provided the guidance for the patients at early stage tumor and during the follow-up after operation. Of course, prospective study based on a hematuria cohort with a large sample size should be conducted to validate these findings in the future.
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Affiliation(s)
- Ning Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siteng Chen
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingfeng Wu
- Department of Urology, Songjiang District Central Hospital, Shanghai, China
| | - Yishuo Wu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangliang Jiang
- Department of Urology, Shengzhen Second People's Hospital, Guangdong, China
| | - Jialiang Shao
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lixin Chen
- Department of Urology, Songjiang District Central Hospital, Shanghai, China
| | - Jishan Sun
- Program for Personalized Cancer Care, Northshore University HealthSystem, Chicago, IL 60201
| | - Rong Na
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Department of Urology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianfeng Xu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, China.,Program for Personalized Cancer Care, Northshore University HealthSystem, Chicago, IL 60201
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Gederaas OA, Husebye H, Johnsson A, Callaghan S, Brunsvik A. In vitro and in vivo effects of HAL on porphyrin production in rat bladder cancer cells (AY27). J PORPHYR PHTHALOCYA 2019. [DOI: 10.1142/s1088424619500615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aminolevulinic acid and hexyl-aminolevulinate serve as biological precursors to produce photosensitive porphyrins in cells via the heme biosynthetic pathway. This pathway is integral to porphyrin-based photodynamic diagnosis and therapy. By adding exogenous hexyl-aminolevulinate to rat bladder cancer cells (AY27, in vitro) and an animal bladder cancer model (in vivo), fluorescent endogenous porphyrin production was stimulated. Lipophilic protoporphyrin IX was identified as the dominant species by reverse high-pressure liquid chromatography. Subcellular porphyrin localization in the AY27 cells was evaluated by confocal laser scanning microscopy and showed almost quantitative bleaching after 20 s. From this study, we ascertained that the protocol described herein is suitable for hexyl-aminolevulinate-mediated photodynamic therapy and diagnosis when protoporphyrin IX is the active agent.
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Affiliation(s)
- Odrun A. Gederaas
- Department of Chemistry, Faculty of Natural Science, Norwegian University of Science and Technology (NTNU), N-7489, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), N-7489, Trondheim, Norway
| | - Harald Husebye
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), N-7489, Trondheim, Norway
- Centre of Molecular Inflammation Research (CEMIR), Norwegian University of Science and Technology (NTNU), N-7489, Trondheim, Norway
| | - Anders Johnsson
- Department of Physics, Norwegian University of Science and Technology (NTNU), N-7491 Trondheim, Norway
| | - Susan Callaghan
- School of Chemistry, SFI Tetrapyrrole Laboratory, Trinity Biomedical Sciences Institute, Trinity College Dublin, the University of Dublin, 152-160 Pearse Street, Dublin 2, Ireland
| | - Anders Brunsvik
- SINTEF Industry, Department of Biotechnology and Nanomedicine, N-7489, Trondheim, Norway
- Department of Clinical Pharmacology, St. Olav’s Hospital, N-7000 Trondheim, Norway
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Bourn J, Pandey S, Uddin J, Marnett L, Cekanova M. Detection of tyrosine kinase inhibitors-induced COX-2 expression in bladder cancer by fluorocoxib A. Oncotarget 2019; 10:5168-5180. [PMID: 31497247 PMCID: PMC6718263 DOI: 10.18632/oncotarget.27125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/17/2019] [Indexed: 01/02/2023] Open
Abstract
Among challenges of targeted therapies is the activation of alternative pro-survival signaling pathways in cancer cells, resulting in an acquired drug resistance. Cyclooxygenase-2 (COX-2) is overexpressed in bladder cancer cells, making it an attractive molecular target for the detection and treatment of cancer. Fluorocoxib A is an optical imaging agent that selectively targets COX-2. In this study, we evaluated the ability of fluorocoxib A to monitor the responses of bladder cancer to targeted therapies in vivo. The effects of several tyrosine kinase inhibitors (TKIs: axitinib, AB1010, toceranib, imatinib, erlotinib, gefitinib, imatinib, sorafenib, vandetanib, SP600125, UO126, and AZD 5438) on COX-2 expression were validated in ten human and canine bladder cancer cell lines (J82, RT4, T24, UM-UC-3, 5637, SW780, TCCSUP, K9TCC#1Lillie, K9TCC#2Dakota, K9TCC#5Lilly) in vitro. The effects of TKIs on bladder cancer in vivo were evaluated using the COX-2-expressing K9TCC#5Lilly xenograft mouse model and detected by fluorocoxib A. The increased COX-2 expression was detected by all tested TKIs in at least one of the tested COX-2-expressing bladder cancer cell lines (5637, SW780, TCCSUP, K9TCC#1Lillie, K9TCC#2Dakota, and K9TCC#5Lilly) in vitro. In addition, fluorocoxib A uptake correlated with the AB1010- and imatinib-induced COX-2 expression in the K9TCC#5Lilly xenografts in vivo. In conclusion, these results indicate that fluorocoxib A could be used for the monitoring the early responses to targeted therapies in COX-2-expressing bladder cancer.
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Affiliation(s)
- Jennifer Bourn
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA.,University of Tennessee and Oak Ridge National Laboratory, Graduate School of Genome Science and Technology, The University of Tennessee, Knoxville, TN 37996, USA.,Current address: Department of Cancer Biology, College of Medicine, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Sony Pandey
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA
| | - Jashim Uddin
- A. B. Hancock, Jr., Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry and Pharmacology, Vanderbilt Institute of Chemical Biology, Center for Molecular Toxicology and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Lawrence Marnett
- A. B. Hancock, Jr., Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry and Pharmacology, Vanderbilt Institute of Chemical Biology, Center for Molecular Toxicology and Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Maria Cekanova
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, TN 37996, USA.,University of Tennessee and Oak Ridge National Laboratory, Graduate School of Genome Science and Technology, The University of Tennessee, Knoxville, TN 37996, USA
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Konecki T, Kutwin P, Łowicki R, Juszczak AB, Jabłonowski Z. Hexaminolevulinate in the Management of Nonmuscle Invasive Bladder Cancer: A Meta-Analysis. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2019; 37:551-558. [PMID: 31339825 DOI: 10.1089/photob.2019.4634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: The objective of this study was to assess the effect of photodynamic diagnosis (PDD) using hexaminolevulinate on the diagnostic and therapeutic outcomes in nonmuscle invasive bladder cancer (NMIBC) patients. Methods: PubMed, Embase, and the Cochrane Library databases together with conference proceedings were searched. Results: Recurrence-free survival was significantly higher at 3, 6, 9, and 12 months in the PDD groups than in the white light cystoscopy (WLC) groups with the cumulative values of differences in recurrence rates at different follow-up intervals ranging from 8% to 11%. PDD identified additional tumors in 25% of all NMIBC patients and in 35% of carcinoma in situ (CIS) patients. In a patient-based analysis mean sensitivity of PDD versus WLC for all tumor detection was 94% and 84%, respectively. The assessed patient-based specificity was comparable for PDD and WLC in all types of tumors (55-56%); however, in CIS it was higher for PDD (82% vs. 72%). Conclusions: The meta-analysis confirms that PDD in conjunction with WLC detects significantly more tumors than WLC alone. Better diagnostic abilities of PDD transpose to significantly lower short-term recurrence rates after transurethral resection procedure and may improve treatment of NMIBC patients.
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Affiliation(s)
- Tomasz Konecki
- 1st Department of Urology, Medical University of Lodz, Lodz, Poland
| | - Piotr Kutwin
- 1st Department of Urology, Medical University of Lodz, Lodz, Poland
| | - Roman Łowicki
- 1st Department of Urology, Medical University of Lodz, Lodz, Poland
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Lotan Y, Bivalacqua TJ, Downs T, Huang W, Jones J, Kamat AM, Konety B, Malmström PU, McKiernan J, O'Donnell M, Patel S, Pohar K, Resnick M, Sankin A, Smith A, Steinberg G, Trabulsi E, Woods M, Daneshmand S. Blue light flexible cystoscopy with hexaminolevulinate in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on optimal use in the USA - update 2018. Nat Rev Urol 2019; 16:377-386. [PMID: 31019310 PMCID: PMC7136177 DOI: 10.1038/s41585-019-0184-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blue light cystoscopy (BLC) with hexaminolevulinate (HAL) during transurethral resection of bladder cancer improves detection of non-muscle-invasive bladder cancer (NMIBC) and reduces recurrence rates. Flexible BLC was approved by the FDA in 2018 for use in the surveillance setting and was demonstrated to improve detection. Results of a phase III prospective multicentre study of blue light flexible cystoscopy (BLFC) in surveillance of intermediate-risk and high-risk NMIBC showed that 20.6% of malignancies were identified only by BLFC. Improved detection rates in the surveillance setting are anticipated to lead to improved clinical outcomes by reducing future recurrences and earlier identification of tumours that are unresponsive to therapy. Thus, BLFC has a role in surveillance cystoscopy, and determining which patients will benefit from BLFC and optimal and cost-effective ways of incorporating this technology into surveillance cystoscopy must be developed.
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Affiliation(s)
- Yair Lotan
- UT Southwestern Medical Center, Dallas, TX, USA.
| | - Trinity J Bivalacqua
- James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tracy Downs
- Department of Urology, University of Wisconsin, Madison, WI, USA
| | - William Huang
- Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Jeffrey Jones
- Genitourinary Surgery Section, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Per-Uno Malmström
- Department of Urology, Institute of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - James McKiernan
- Department of Urology, Columbia University Medical Center, New York City, NY, USA
| | | | - Sanjay Patel
- Department of Urology, University of Oklahoma, Oklahoma City, OK, USA
| | - Kamal Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
| | - Matthew Resnick
- Department of Urologic Surgery, Vanderbilt University, Nashville, TX, USA
| | - Alexander Sankin
- Department of Urology, Montefiore Medical Center, New York, NY, USA
| | - Angela Smith
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Gary Steinberg
- Department of Urology, University of Chicago, Chicago, IL, USA
| | - Edouard Trabulsi
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Woods
- Department of Urology, Loyola University Chicago, Chicago, IL, USA
| | - Siamak Daneshmand
- Department of Urology, University of Southern California, Los Angeles, CA, USA
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35
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Montalbo R, Lozano JJ, Izquierdo L, Ingelmo-Torres M, BaÑos C, Palou J, Van der Heijden AG, Medina R, Schmidbauer J, Prat A, Ribal MJ, Alcaraz A, Mengual L. Ability of a urine gene expression classifier to reduce the number of follow-up cystoscopies in bladder cancer patients. Transl Res 2019; 208:73-84. [PMID: 30771285 DOI: 10.1016/j.trsl.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
This study aimed to improve our previous urine gene expression classifiers focusing on the detection of non-high-risk non-muscle-invasive bladder cancer (NMIBC), and develop a new classifier able to decrease the frequency of cystoscopies during bladder cancer (BC) patients' surveillance. A total of 597 urines from BC patients, controls and patients in follow-up for BC (PFBC) were included. The study has 3 phases. In the urinary biomarker discovery phase, 84 urines from BC and control patients were retrospectively included and analyzed by Ribonucleic Acid (RNA) sequencing. In the classifier development phase, a total of 132 selected genes from previous phase were evaluated by nCounter in 214 prospectively collected urines from PFBC (98 with tumor). A diagnostic classifier was generated by logistic regression. Finally, in the classifier validation phase, a multicentric and international cohort of 248 urines (134 BC and 114 nonrecurrent PFBC) was used to validate classifier performance. A total of 521 genes were found differentially expressed between non-high-risk NMIBC samples and all other groups (P < 0.05). An 8-gene diagnostic classifier with an area under curve (AUC) of 0.893 was developed. Validation of this classifier in a cohort of PFBC achieved an overall sensitivity (SN) and a negative predictive value (NPV) of 96% and 97%, respectively (AUC = 0.823). Notably, this accuracy was maintained in non-high-risk NMIBC group (SN = 94%; NPV = 98%). In conclusion, this 8-gene expression classifier has high SN and NPV in a real clinical scenario. The use of this classifier can reduce the number of follow-up cystoscopies in PFBC, although assessing its final place in clinical setting is necessary.
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Affiliation(s)
- Ruth Montalbo
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain
| | | | - Laura Izquierdo
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain
| | - Mercedes Ingelmo-Torres
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain
| | - Carmen BaÑos
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | | | - Rafael Medina
- Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Joerg Schmidbauer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Aleix Prat
- Oncology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Maria J Ribal
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain
| | - Lourdes Mengual
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centre de Recerca Biomèdica CELLEX, Universitat de Barcelona, Barcelona, Spain.
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36
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Pederzoli F, Murati Amador B, Samarska I, Lombardo KA, Kates M, Bivalacqua TJ, Matoso A. Diagnosis of urothelial carcinoma in situ using blue light cystoscopy and the utility of immunohistochemistry in blue light-positive lesions diagnosed as atypical. Hum Pathol 2019; 90:1-7. [PMID: 31071342 DOI: 10.1016/j.humpath.2019.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 11/28/2022]
Abstract
Carcinoma in situ (CIS) is difficult to visualize with white light cystoscopy (WLC), whereas blue light cystoscopy (BLC) using photosensitizing agents improves detection rates. We retrospectively reviewed transurethral biopsies of bladder tumors in which both WLC and BLC evaluations were performed (n = 135 samples from 79 patients). Biopsies were classified based on the presence/absence of fluorescence under BLC and the final pathological report (CIS/benign/atypical). Forty-one (30%) cases were diagnosed as CIS; of those, 38 (93%) were BLC(+), including 23 that were WLC(-). Conversely, 51 (38%) lesions were BLC(+) but classified as non-CIS. Eleven BLC(+) cases were diagnosed as "atypical." These cases were anonymized and reviewed by 7 pathologists for concordance and then immunostained for CK20, p53, and Ki-67. Immunohistochemistry results were interpreted as consistent with CIS if there was full-thickness staining of CK20, more than 50% p53-positive cells, and more than 50% Ki-67-positive cells. Review of BLC(+)/atypical cases showed a mean agreement of 79%, and none of the cases showed staining pattern consistent with CIS. Therefore, all 11 cases of BLC(+)/atypical were considered non-CIS for the final analysis. All patients with BLC(+)/atypical lesions had a history of intravesical Bacillus Calmette-Guerin and/or mitomycin. Using final pathology as the reference, sensitivity, specificity, and negative predictive value of BLC were 93% (confidence interval [CI], 80.1%-98.5%), 46% (CI, 35.4%-56.3%), and 94% (CI, 82.5%-97.8%), respectively. The low specificity of BLC leads to BLC(+) lesions with atypical diagnosis. Morphological classification of these lesions is fairly consistent among different pathologists. Immunohistochemistry for p53/CK20/Ki-67 in this setting is only helpful to potentially avoid overcalling CIS.
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Affiliation(s)
- Filippo Pederzoli
- Vita-Salute San Raffaele University, Milan 20132, Italy; Urology, The Johns Hopkins Medical Institutions, , Baltimore, MD 21231, USA
| | - Belkiss Murati Amador
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
| | - Iryna Samarska
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA; Pathology, Maastricht University Medical Center, Maastricht, Netherlands, 6229 HX
| | - Kara A Lombardo
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD 21231, USA
| | - Max Kates
- Urology, The Johns Hopkins Medical Institutions, , Baltimore, MD 21231, USA; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD 21231, USA; Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
| | - Trinity J Bivalacqua
- Urology, The Johns Hopkins Medical Institutions, , Baltimore, MD 21231, USA; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD 21231, USA; Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
| | - Andres Matoso
- Urology, The Johns Hopkins Medical Institutions, , Baltimore, MD 21231, USA; Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA; Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD 21231, USA; Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA.
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37
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Grossman HB, Lamm D, Sjödahl G, O’Donnell M, Hahn N, Kamat A. Intravesical Therapy – BCG and Beyond. Bladder Cancer 2019. [DOI: 10.3233/blc-180198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- H. Barton Grossman
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donald Lamm
- University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Gottfrid Sjödahl
- Department of Urology, Skåne University Hospital, Lund, Sweden
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Michael O’Donnell
- University of Iowa Carver College of Medicine, Department of Urology, Iowa City, IA, USA
| | - Noah Hahn
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD, USA
| | - Ashish Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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38
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Werntz RP, Adamic B, Steinberg GD. Emerging therapies in the management of high-risk non-muscle invasive bladder cancer (HRNMIBC). World J Urol 2018; 37:2031-2040. [DOI: 10.1007/s00345-018-2592-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/28/2018] [Indexed: 01/19/2023] Open
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Abstract
PURPOSE OF REVIEW The optimal management of high-grade T1 (HGT1) urothelial carcinoma (UC) is complex given its high rate of recurrence, progression, and cancer-specific mortality as well as its clinical variability. Our current treatment paradigm has been supplemented by recent data describing the expanding options for salvage intravesical therapy, bladder preservation, and the promising role of molecular epidemiology. In the current review, we attempt to summarize and critically analyze these studies. RECENT FINDINGS Evidence describing new intravesical therapies has demonstrated an adequate safety profile and some efficacy in BCG-unresponsive patients who desire bladder preservation. However, response rates are still poor in this high-risk patient population, and it is important to keep these data in perspective when counseling patients. Concomitantly, the continued molecular characterization of non-muscle-invasive bladder cancer may suggest potential therapeutic targets as well as predictors of treatment response in the future. The integration of new intravesical therapies and molecular data into the current treatment paradigm for HGT1 urothelial carcinoma will be critical to improving oncologic outcomes in this particularly high-risk population.
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Affiliation(s)
- Peter A Reisz
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA.
| | - Aaron A Laviana
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA
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40
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Davis RM, Kiss B, Trivedi DR, Metzner TJ, Liao JC, Gambhir SS. Surface-Enhanced Raman Scattering Nanoparticles for Multiplexed Imaging of Bladder Cancer Tissue Permeability and Molecular Phenotype. ACS NANO 2018; 12:9669-9679. [PMID: 30203645 PMCID: PMC6202635 DOI: 10.1021/acsnano.8b03217] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 08/28/2018] [Indexed: 05/20/2023]
Abstract
Bladder cancer has the highest recurrence rate of all cancers due in part to inadequate transurethral resection. Inadequate resection is caused by the inability of cystoscopes to detect invisible lesions during the resection procedure. To improve detection and resection of nonmuscle invasive bladder cancer, we quantified the ability of a surface-enhanced Raman nanoparticle and endoscope system to classify bladder tissue as normal or cancerous. Both antibody-based (active) and tissue permeability-based (passive) targeting mechanisms were evaluated by topically applying nanoparticles to ex vivo human bladder tissue samples. Multiplexed molecular imaging of CD47 and Carbonic Anhydrase 9 tumor proteins gave a receiver operating characteristic area under the curve (ROC AUC of 0.93 (0.75, 1.00). Furthermore, passively targeted nanoparticles enabled tissue classification with an ROC AUC of 0.93 (0.73, 1.00). Passively targeted nanoparticles penetrated 5-fold deeper and bound to tumor tissue at 3.3-fold higher concentrations in cancer compared to normal bladder urothelium, suggesting the existence of an enhanced surface permeability and retention effect in human bladder cancer.
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Affiliation(s)
- Ryan M. Davis
- Department
of Radiology and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, United States
| | - Bernhard Kiss
- Department
of Radiology and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, United States
- Department
of Urology, Stanford University School of
Medicine, Stanford, California 94305, United States
| | - Dharati R. Trivedi
- Department
of Urology, Stanford University School of
Medicine, Stanford, California 94305, United States
- Veterans
Affairs, Palo Alto Health Care System, Palo Alto, California 94550, United States
| | - Thomas J. Metzner
- Department
of Urology, Stanford University School of
Medicine, Stanford, California 94305, United States
| | - Joseph C. Liao
- Department
of Urology, Stanford University School of
Medicine, Stanford, California 94305, United States
- Veterans
Affairs, Palo Alto Health Care System, Palo Alto, California 94550, United States
| | - Sanjiv S. Gambhir
- Department
of Radiology and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California 94305, United States
- E-mail:
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41
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Han C, Mengual L, Kang B, Lozano JJ, Yang X, Zhang C, Alcaraz A, Liang J, Ye D. Validation of Urine-based Gene Classifiers for Detecting Bladder Cancer in a Chinese Study. J Cancer 2018; 9:3208-3215. [PMID: 30210644 PMCID: PMC6134826 DOI: 10.7150/jca.24506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/15/2018] [Indexed: 11/07/2022] Open
Abstract
Background: Current standard methods used to detect and monitor bladder cancer (BC) are invasive or have low sensitivity. We have previously reported in an international European study four non-invasive tests for BC diagnosis based on the gene expression patterns of urine. Objective: to validate the tests in an independent Asian cohort. Design, setting and participants: Prospective blinded study in which consecutive voided urine samples from BC patients and controls (n=520) were collected in the Fudan University Shanghai Cancer Center from 2014-2016. Gene expression values were quantified using TaqMan Arrays. The same cut-off as previously reported for discrimination between tumours and controls was used in this validation study. Results and limitations: Finally, a total of 257 tumour and 132 control urine samples were analysed. We found a high accuracy for the four gene classifiers in this independent Asian set, the classifiers composed of 5 and 10 genes achieved the best sensitivity (80.54% and 81.32%, respectively) maintaining a high specificity (91.67% and 85.61%, respectively). Sensitivity of 5-gene (GS_D5) and 10-gene (GS_D10) expression classifiers in recurrent BC cases (78 and 79%, respectively) is comparable to that of primary BC cases (82%). Cytology and NMP22 identified 67% and 40%, respectively, of tumours that have been diagnosed with our tests. In addition, influence of each studied gene was analyzed and showed similar gene rank between Chinese and Caucasian population. Conclusions: Our study proves that our non-invasive diagnostic BC tests can be reproduced in independent cohorts and in an external laboratory. All the four gene classifiers have shown equal or superior performance to the current gold standard in the present and previously reported validation studies. Consequently, they may be taken for consideration as molecular tests applicable to clinical practice in the management of BC. Patient summary: Our gene classifiers achieve sensitivities up to 90% in HR NMIBC and MIBC patients, while this achievement is comparatively lower in LR NMIBC ones.
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Affiliation(s)
- Chengtao Han
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Lourdes Mengual
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi iSunyer, Universitat de Barcelona, Barcelona, Spain
| | - Bin Kang
- Fudan University Shanghai Cancer Center - Institut Merieux Laboratory, Cancer Institute,Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,bioMerieux (Shanghai) Company Limited, Shanghai, P.R. China
| | | | - Xiaoqun Yang
- Department of Pathology, Rui Jin Hospital, School of Medicine, Shanghai Jiao-Tong University, Shanghai, P.R. China
| | - Cuizhu Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Antonio Alcaraz
- Department and Laboratory of Urology, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi iSunyer, Universitat de Barcelona, Barcelona, Spain
| | - Ji Liang
- Fudan University Shanghai Cancer Center - Institut Merieux Laboratory, Cancer Institute,Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,bioMerieux (Shanghai) Company Limited, Shanghai, P.R. China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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42
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Clinton TN, Lotan Y. The use of blue light flexible cystoscopy with hexaminolevulinate & the diagnosis of bladder cancer. Future Oncol 2018; 14:2805-2810. [PMID: 29925279 DOI: 10.2217/fon-2018-0328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Blue light cystoscopy improves the detection of bladder cancer at time of transurethral resection of bladder tumor for nonmuscle-invasive bladder cancer. This has translated to decreased tumor recurrence. Given this improvement in rigid cystoscopy, the question remains whether the use of blue light flexible cystoscopy (BLFC) in the surveillance setting provides the same benefits. This review aims to evaluate the recently reported Phase III prospective multicenter study of BLFC which evaluated the detection of bladder cancer during surveillance, which in its earliest reporting demonstrated improved detection of bladder cancer. This study evaluated 304 patients with findings of 63 confirmed malignancies, with 13 (20.6%) only identified by BLFC (p < 0.0001). The question still remains whether the improved detection rate will translate to improved clinical outcomes. Further, studies will be necessary to determine which patients will benefit from BLFC, optimal ways to incorporate into surveillance strategies and cost-effectiveness.
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Affiliation(s)
- Timothy N Clinton
- Department of Urology, UT Southwestern Medical Center in Dallas, TX 75390, USA
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center in Dallas, TX 75390, USA
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43
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van der Heijden AG, Mengual L, Ingelmo-Torres M, Lozano JJ, van Rijt-van de Westerlo CCM, Baixauli M, Geavlete B, Moldoveanud C, Ene C, Dinney CP, Czerniak B, Schalken JA, Kiemeney LALM, Ribal MJ, Witjes JA, Alcaraz A. Urine cell-based DNA methylation classifier for monitoring bladder cancer. Clin Epigenetics 2018; 10:71. [PMID: 29854012 PMCID: PMC5975622 DOI: 10.1186/s13148-018-0496-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Background Current standard methods used to detect and monitor bladder cancer (BC) are invasive or have low sensitivity. This study aimed to develop a urine methylation biomarker classifier for BC monitoring and validate this classifier in patients in follow-up for bladder cancer (PFBC). Methods Voided urine samples (N = 725) from BC patients, controls, and PFBC were prospectively collected in four centers. Finally, 626 urine samples were available for analysis. DNA was extracted from the urinary cells and bisulfite modificated, and methylation status was analyzed using pyrosequencing. Cytology was available from a subset of patients (N = 399). In the discovery phase, seven selected genes from the literature (CDH13, CFTR, NID2, SALL3, TMEFF2, TWIST1, and VIM2) were studied in 111 BC and 57 control samples. This training set was used to develop a gene classifier by logistic regression and was validated in 458 PFBC samples (173 with recurrence). Results A three-gene methylation classifier containing CFTR, SALL3, and TWIST1 was developed in the training set (AUC 0.874). The classifier achieved an AUC of 0.741 in the validation series. Cytology results were available for 308 samples from the validation set. Cytology achieved AUC 0.696 whereas the classifier in this subset of patients reached an AUC 0.768. Combining the methylation classifier with cytology results achieved an AUC 0.86 in the validation set, with a sensitivity of 96%, a specificity of 40%, and a positive and negative predictive value of 56 and 92%, respectively. Conclusions The combination of the three-gene methylation classifier and cytology results has high sensitivity and high negative predictive value in a real clinical scenario (PFBC). The proposed classifier is a useful test for predicting BC recurrence and decrease the number of cystoscopies in the follow-up of BC patients. If only patients with a positive combined classifier result would be cystoscopied, 36% of all cystoscopies can be prevented. Electronic supplementary material The online version of this article (10.1186/s13148-018-0496-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Lourdes Mengual
- 2Laboratory and Department of Urology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.,Hospital Clínic de Barcelona, Centre de Recerca Biomèdica CELLEX, office B22, C/Casanova, 143, 08036 Barcelona, Spain
| | - Mercedes Ingelmo-Torres
- 2Laboratory and Department of Urology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan J Lozano
- 3CIBERehd, Plataforma de Bioinformática, Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | | | - Montserrat Baixauli
- 2Laboratory and Department of Urology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | - Cosmin Ene
- 4Saint John Emergency Clinical Hospital, Bucharest, Romania
| | | | | | - Jack A Schalken
- 1Department of Urology Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Maria J Ribal
- 2Laboratory and Department of Urology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - J Alfred Witjes
- 1Department of Urology Radboud University Medical Center, Nijmegen, The Netherlands
| | - Antonio Alcaraz
- 2Laboratory and Department of Urology, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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44
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Daneshmand S, Bazargani ST, Bivalacqua TJ, Holzbeierlein JM, Willard B, Taylor JM, Liao JC, Pohar K, Tierney J, Konety B. Blue light cystoscopy for the diagnosis of bladder cancer: Results from the US prospective multicenter registry. Urol Oncol 2018; 36:361.e1-361.e6. [PMID: 29859728 DOI: 10.1016/j.urolonc.2018.04.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Blue light cystoscopy (BLC) using hexaminolevulinate (HAL/Cysview/Hexvix) has been previously shown to improve detection of non-muscle-invasive bladder cancer (NMIBC). Herein, we evaluated the detection of malignant lesions in a heterogenous group of patients in the real world setting and documented the change in risk category due to upstaging or upgrading. METHODS Prospective enrollment during April 2014 to December 2016 of consecutive adult patients with suspected or known non-muscle-invasive bladder cancer based on prior cystoscopy or imaging, undergoing transurethral resection of bladder tumor at 9 different referral medical centers. HAL was instilled in the bladder for 1 to 3 hours before evacuation and inspection. Sensitivity and specificity of BLC, white light cystoscopy (WLC), and the combination of both BLC and WLC for detection of any malignancy was reported on final pathology. Number of patients with a change in American Urological Association (AUA) risk category based on BLC findings leading to a possible change in management and adverse events were recorded. RESULTS Overall, 1,632 separate samples from bladder resection or biopsy were identified from 641 BLC procedures on 533 patients: 85 (16%) underwent repeat BLC (range: 2-5). Sensitivity of WLC, BLC, and the combination for diagnosis of any malignant lesion was 76%, 91%, and 98.5%, respectively. Addition of BLC to standard WLC increased detection rate by 12% for any papillary lesion and 43% for carcinoma in-situ. Within the WLC negative group, an additional 206 lesions in 133 (25%) patients were detected exclusively with BLC. In multifocal disease, BLC resulted in AUA risk-group migration occurred in 33 (6%) patients and a change in recommended management in 74 (14%). False-positive rate was 25% for WLC and 30% for BLC. One mild dermatologic hypersensitivity reaction (0.2%). CONCLUSIONS BLC increases detection rates of carcinoma in-situ and papillary lesions over WLC alone and can change management in 14% of cases. Repeat use of HAL for BLC is safe.
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Affiliation(s)
- Siamak Daneshmand
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
| | - Soroush T Bazargani
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD
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45
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Dobbs RW, Abern MR. A novel bladder cancer urinary biomarker: can it go where no marker has gone before? Transl Androl Urol 2018; 7:S96-S97. [PMID: 29644171 PMCID: PMC5881215 DOI: 10.21037/tau.2018.01.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ryan W Dobbs
- Department of Urology, The University of Illinois at Chicago, Chicago, IL, USA
| | - Michael R Abern
- Department of Urology, The University of Illinois at Chicago, Chicago, IL, USA
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46
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Freitas NR, Vieira PM, Lima E, Lima CS. Automatic T1 bladder tumor detection by using wavelet analysis in cystoscopy images. Phys Med Biol 2018; 63:035031. [PMID: 29271350 DOI: 10.1088/1361-6560/aaa3af] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Correct classification of cystoscopy images depends on the interpreter's experience. Bladder cancer is a common lesion that can only be confirmed by biopsying the tissue, therefore, the automatic identification of tumors plays a significant role in early stage diagnosis and its accuracy. To our best knowledge, the use of white light cystoscopy images for bladder tumor diagnosis has not been reported so far. In this paper, a texture analysis based approach is proposed for bladder tumor diagnosis presuming that tumors change in tissue texture. As is well accepted by the scientific community, texture information is more present in the medium to high frequency range which can be selected by using a discrete wavelet transform (DWT). Tumor enhancement can be improved by using automatic segmentation, since a mixing with normal tissue is avoided under ideal conditions. The segmentation module proposed in this paper takes advantage of the wavelet decomposition tree to discard poor texture information in such a way that both steps of the proposed algorithm segmentation and classification share the same focus on texture. Multilayer perceptron and a support vector machine with a stratified ten-fold cross-validation procedure were used for classification purposes by using the hue-saturation-value (HSV), red-green-blue, and CIELab color spaces. Performances of 91% in sensitivity and 92.9% in specificity were obtained regarding HSV color by using both preprocessing and classification steps based on the DWT. The proposed method can achieve good performance on identifying bladder tumor frames. These promising results open the path towards a deeper study regarding the applicability of this algorithm in computer aided diagnosis.
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Affiliation(s)
- Nuno R Freitas
- CMEMS-UMinho Research Unit, University of Minho, Guimarães, Portugal
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Lee JW. Cystoscopy. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Daneshmand S, Patel S, Lotan Y, Pohar K, Trabulsi E, Woods M, Downs T, Huang W, Jones J, O'Donnell M, Bivalacqua T, DeCastro J, Steinberg G, Kamat A, Resnick M, Konety B, Schoenberg M, Jones JS. Efficacy and Safety of Blue Light Flexible Cystoscopy with Hexaminolevulinate in the Surveillance of Bladder Cancer: A Phase III, Comparative, Multicenter Study. J Urol 2017; 199:1158-1165. [PMID: 29203268 DOI: 10.1016/j.juro.2017.11.096] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared blue light flexible cystoscopy with white light flexible cystoscopy for the detection of bladder cancer during surveillance. MATERIALS AND METHODS Patients at high risk for recurrence received hexaminolevulinate intravesically before white light flexible cystoscopy and randomization to blue light flexible cystoscopy. All suspicious lesions were documented. Patients with suspicious lesions were referred to the operating room for repeat white and blue light cystoscopy. All suspected lesions were biopsied or resected and specimens were examined by an independent pathology consensus panel. The primary study end point was the proportion of patients with histologically confirmed malignancy detected only with blue light flexible cystoscopy. Additional end points were the false-positive rate, carcinoma in situ detection and additional tumors detected only with blue light cystoscopy. RESULTS Following surveillance 103 of the 304 patients were referred, including 63 with confirmed malignancy, of whom 26 had carcinoma in situ. In 13 of the 63 patients (20.6%, 95% CI 11.5-32.7) recurrence was seen only with blue light flexible cystoscopy (p <0.0001). Five of these cases were confirmed as carcinoma in situ. Operating room examination confirmed carcinoma in situ in 26 of 63 patients (41%), which was detected only with blue light cystoscopy in 9 of the 26 (34.6%, 95% CI 17.2-55.7, p <0.0001). Blue light cystoscopy identified additional malignant lesions in 29 of the 63 patients (46%). The false-positive rate was 9.1% for white and blue light cystoscopy. None of the 12 adverse events during surveillance were serious. CONCLUSIONS Office based blue light flexible cystoscopy significantly improves the detection of patients with recurrent bladder cancer and it is safe when used for surveillance. Blue light cystoscopy in the operating room significantly improves the detection of carcinoma in situ and detects lesions that are missed with white light cystoscopy.
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Affiliation(s)
| | | | - Yair Lotan
- University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Edouard Trabulsi
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael Woods
- University of North Carolina, Chapel Hill, North Carolina
| | | | - William Huang
- New York University School of Medicine, New York, New York
| | | | | | | | - Joel DeCastro
- Columbia University Medical Center, New York, New York
| | | | - Ashish Kamat
- University of Texas M. D. Anderson Cancer Center, Houston, Texas
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Hartman R, Kawashima A. Lower tract neoplasm: Update of imaging evaluation. Eur J Radiol 2017; 97:119-130. [PMID: 29102424 DOI: 10.1016/j.ejrad.2017.10.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 01/13/2023]
Abstract
Cancers of the lower urinary tract can arise from the bladder, urachus or urethra. Urothelial carcinoma of the bladder (UCB) is the most common of these. The presentation of bladder, urachal and urethral cancers can differ but many result in hematuria as an initial indication. The diagnosis and staging of these cancers often necessitate radiologic imaging often in the form of cross-section CT urography or MR urography. The following article reviews the specific nature of lower tract cancers and their imaging.
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Affiliation(s)
- Robert Hartman
- Department of Radiology, Mayo Clinic, Rochester, MN, USA.
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Lyseng-Williamson KA. Hexaminolevulinate: a profile of its use with blue-light cystoscopy in the diagnosis of bladder cancer. DRUGS & THERAPY PERSPECTIVES 2017. [DOI: 10.1007/s40267-017-0436-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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