Radical transurethral resection alone, robotic or partial cystectomy, or extended lymphadenectomy: can we select patients with muscle invasion for less or more surgery?

Clinical Efficacy and Quality of Life Assessment of Partial Cystectomy and Plasmakinetic Transurethral Resection of Tumor in Bladder Cancer Patients

OBJECTIVE

Bladder cancer is a common malignant tumor of the urinary system, with an incidence ranking the first in the urinary system. Without timely and effective treatment, the tumor may spread to other parts of the body. Traditional partial cystectomy (PC) and plasmakinetic transurethral resection of bladder tumor (PKRBT) are common surgical methods for superficial bladder cancer (SBC). This study aims to clarify the clinical efficacy of bladder carcinoma (BC) patients treated by either PC or PKRBT and their effects on the quality of life (QOL) of patients.

METHODS

A total of 142 patients with SBC treated in Wenzhou Central Hospital and Bei da huang Industry Group General Hospital from March 2018 to June 2020 were analyzed retrospectively. According to the surgical method, patients undergoing PKRBT were included in the research group (n = 74) while those treated by PC were included in the control group (n = 69). Surgical indicators (intraoperative blood loss, IBL; operating time, OT; bladder irrigation time; catheter retention time; length of hospital stay, LOS), postoperative complication rate, and one-year recurrence rate were compared between the two groups. Besides, the levels of inflammatory factors [tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, IL-10], psychological and emotional scores (Self-Rating Anxiety Scale, SAS; Self-Rating Depression Scale, SDS), and living conditions (Pittsburgh Sleep Quality Index, PSQI) before and after treatment were compared.

RESULTS

Compared with the control group, patients in the research group had 1) less IBL, less time of OT, bladder irrigation and indwelling catheter time, as well as shorter postoperative LOS; 2) lower contents of inflammatory factors TNF-α, IL-6 and IL-8, and higher IL-10; 3) lower SAS and SDS scores and higher PSQI; and 4) fewer postoperative complications and lower one-year recurrence rate.

CONCLUSION

Compared with PC, PKRBT contributes to higher efficacy and better postoperative QOL in patients SBC.

The Adequacy of Pelvic Lymphadenectomy During Radical Cystectomy for Carcinoma Urinary Bladder: A Narrative Review of Literature

An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.

Bladder cancer stage-associated hub genes revealed by WGCNA co-expression network analysis

Background

Bladder cancer was a malignant disease in patients, our research aimed at discovering the possible biomarkers for the diseases.

Results

The gene chip GSE31684, including 93samples, was downloaded from the GEO datasets and co-expression network was constructed by the data. Molecular complex detection(MCODE) was used to identify hub genes. The most significant cluster including 16 genes: CDH11, COL3A1, COL6A3, COL5A1, AEBP1, COL1A2, NTM, COL11A1, THBS2, COL8A1, COL1A1, BGN, MMP2, PXDN, THY1, and TGFB1I1 was identified. After annotated by BiNGO, they were suggested associated with collagen fibril organization and blood vessel development. In addition, the Kaplan Meier curves were obtained by UALCAN. The high expression of THY1, AEBP1, CDH11, COL1A1, COL1A2, COL11A1, MMP2, PXDN, BGN, COL5A1, COL8A1, and TGFB1I1 indicated poor prognosis of the patients(P < 0.05). Finally, we examined genes’ expression between low and high tumor stage by the Wilcoxon test(P < 0.05), TGFB1I1 was excluded.

Conclusion

THY1, AEBP1, CDH11, COL1A1, COL1A2, COL11A1, MMP2, PXDN, BGN, COL5A1, COL8A1 associated with the tumor stage as well as tumor patients’ prognosis. COL5A1, COL8A1(P < 0.01) may serve as therapeutic targets for the disease.

Treatment of Muscle-Invasive Bladder Cancer in Older Patients

Treatment of muscle-invasive bladder cancer in older patients is challenging. Definitive therapy of localized disease requires either surgery or radiation therapy, ideally combined with systemic chemotherapy. However, current population data suggest that less than half of patients older than age 70 are offered such treatments. We will review tools available to assess the fitness of older patients for surgery, alternatives, and tips for perioperative patient treatment.