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Antonov P, Raycheva G, Ivanov G, Ivanov A, Uchikov P, Popov V, Tzigarovski G, Timev A, Grudeva Z. Hybrid Bladder Tumor: Urothelial Carcinoma With Squamous Cell Differentiation, Urothelial Sarcomatoid Carcinoma, and Concurrent Primary Mucinous Adenocarcinoma With Metastasis to the Penis. Cureus 2024; 16:e68894. [PMID: 39258104 PMCID: PMC11384649 DOI: 10.7759/cureus.68894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2024] [Indexed: 09/12/2024] Open
Abstract
The most common histological variants of bladder cancer include urothelial, squamous, and adenocarcinoma. In high-grade, invasive urothelial carcinoma, divergent differentiation can be observed, including glandular, squamous, trophoblastic, and small-cell types. Urothelial sarcomatoid carcinoma is characteristic of advanced carcinomas and is considered a possible common end route for all epithelial carcinomas. Adenocarcinoma of the bladder refers exclusively to true glandular carcinomas. Hybrid tumors are extremely rare and consist of more than one tumor type within the total tumor mass. Penile metastases are extremely uncommon, and there are no reported cases of metastatic adenocarcinoma of the bladder in the literature.
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Affiliation(s)
- Petar Antonov
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | - Gabriela Raycheva
- Department of Clinical Oncology, Medical University of Plovdiv, Plovdiv, BGR
| | - Georgi Ivanov
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv, BGR
| | - Atanas Ivanov
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | - Petar Uchikov
- Department of Special Surgery, Medical University of Plovdiv, Plovdiv, BGR
| | - Veselin Popov
- Department of Clinical Oncology, Medical University of Plovdiv, Plovdiv, BGR
| | - Georgi Tzigarovski
- Department of Urology and General Medicine, Medical University of Plovdiv, Plovdiv, BGR
| | - Alexandar Timev
- Department of Urology, Medical University of Sofia, Sofia, BGR
| | - Zhanet Grudeva
- Department of Clinical Oncology, Medical University of Plovdiv, Plovdiv, BGR
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Arita Y, Woo S, Kwee TC, Shigeta K, Ueda R, Nalavenkata S, Edo H, Miyai K, Das J, Andrieu PIC, Vargas HA. Pictorial review of multiparametric MRI in bladder urothelial carcinoma with variant histology: pearls and pitfalls. Abdom Radiol (NY) 2024; 49:2797-2811. [PMID: 38847848 DOI: 10.1007/s00261-024-04397-3] [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: 04/05/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 08/06/2024]
Abstract
Bladder cancer (BC), predominantly comprising urothelial carcinomas (UCs), ranks as the tenth most common cancer worldwide. UCs with variant histology (variant UC), including squamous differentiation, glandular differentiation, plasmacytoid variant, micropapillary variant, sarcomatoid variant, and nested variant, accounting for 5-10% of cases, exhibit more aggressive and advanced tumor characteristics compared to pure UC. The Vesical Imaging-Reporting and Data System (VI-RADS), established in 2018, provides guidelines for the preoperative evaluation of muscle-invasive bladder cancer (MIBC) using multiparametric magnetic resonance imaging (mpMRI). This technique integrates T2-weighted imaging (T2WI), dynamic contrast-enhanced (DCE)-MRI, and diffusion-weighted imaging (DWI) to distinguish MIBC from non-muscle-invasive bladder cancer (NMIBC). VI-RADS has demonstrated high diagnostic performance in differentiating these two categories for pure UC. However, its accuracy in detecting muscle invasion in variant UCs is currently under investigation. These variant UCs are associated with a higher likelihood of disease recurrence and require precise preoperative assessment and immediate surgical intervention. This review highlights the potential value of mpMRI for different variant UCs and explores the clinical implications and prospects of VI-RADS in managing these patients, emphasizing the need for careful interpretation of mpMRI examinations including DCE-MRI, particularly given the heterogeneity and aggressive nature of variant UCs. Additionally, the review addresses the fundamental MRI reading procedures, discusses potential causes of diagnostic errors, and considers future directions in the use of artificial intelligence and radiomics to further optimize the bladder MRI protocol.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, USA
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, Netherlands
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Ueda
- Office of Radiation Technology, Keio University Hospital, Tokyo, Japan
| | - Sunny Nalavenkata
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Hiromi Edo
- Department of Radiology, National Defense Medical Collage, Saitama, Japan
| | - Kosuke Miyai
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Jeeban Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Mehrnoush V, Brennan L, Ismail A, Zakaria A, Elmansy H, Shahrour W, Prowse O, Kotb A. Radical cystectomy for bladder urothelial carcinoma with aggressive variant histology. Arch Ital Urol Androl 2022; 94:291-294. [DOI: 10.4081/aiua.2022.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: The aim of this study is to report our experience in managing bladder cancer in patients with variant pathology. Methods: Retrospective data collection for all patients managed by radical cystectomy over the last 3 years for a variant pathol-ogy was completed. We specifically included micropapillary and nested variants. Results: Ten patients were identified, with eight having micropapillary carcinoma (MPC) and two having nested vari-ants. Nine patients were male. The median age was 75. The two patients with nested variant were 56 and 62 years old, respec-tively, whereas all patients with MPC were over the age of 70. Upon cystectomy of all micropapillary cases, three patients(37.5%) had positive lymph node invasion and the final patholo-gy was T2 (two patients), T3 (two patients), and T4 (four patients). Barring a grade III complication Clavien-Dindo classi-fication due to wound dehiscence that necessitated secondary surgical closure, there were no specific perioperative complica-tions. Given the urethral invasion, cystourethrectomy was per-formed on the female patient. Within a median 13-month fol-low-up, three patients developed local recurrence, including two urethral and one new lateral pelvic mass. Conclusions: Considering the muscle invasive nature of micropapillary and nested bladder cancer, aggressive surgical management should not be postponed. Moreover, due to notable prevalence of concurrent and/or recurrent urethral involvement, initial urethrectomy or early and frequent postoperative ure-throscopy should be provided. Patients with variant histology bladder cancer may benefit from early radical cystectomy when compared to bladder sparing protocols and prostate sparing cystectomy treatment options.
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Laymon M, Mosbah A, Hashem A, Mahmoud O, Harraz AM, Elsawy AA, Abol-Enein H. Oncologic Outcomes of Squamous Cell Carcinoma Versus Urothelial Carcinoma With Squamous Differentiation After Radical Cystectomy for Bladder Carcinoma. Clin Genitourin Cancer 2021; 20:148-154. [PMID: 34998698 DOI: 10.1016/j.clgc.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In this study we aim to compare clinicopathological characteristics and cancer specific survival between patients treated with radical cystectomy for pure squamous cell carcinoma (SCC) and urothelial carcinoma with squamous differentiation (SqD). PATIENTS AND METHODS We reviewed data of 1737 consecutive patients treated with radical cystectomy and urinary diversion between January 2004 and February 2014. Only patients with pure SCC or SqD were included in the analysis. Squamous differentiation was defined as intercellular bridges or keratinization in the tumor. Clinicopathological data and recurrence free survival (RFS) were compared between patients diagnosed with SCC and SqD. RESULTS SCC and SqD were found in 318 and 223 patients, respectively. Mean age was 57 ± 8.3 years in SCC and 58.8 ± 7.8 in SqD (P = .008). A higher proportion of female patients was observed in SCC group compared to SqD (31.8% vs. 22% P < .0001). Patients with SqD were more likely to have extravesical (58.3% vs. 46.2%: P = .006) and nodal positive disease (34.5% vs. 14.5%: P < .0001) than pure SCC patients. Bilharzial eggs were found in 61% of SCC vs. 46% of SqD (P = .001).; The median (IQR) follow up period for SCC and SqD was 63 (12-112) months and 23 months (9-74.7), respectively. The 5-year RFS for SCC and SqD were 77% and 59.8 %, respectively (P < .0001).; Multivariate cox regression analysis identified advanced pT stage (OR: 1.9, 95% CI: 1.3-2.86, P = .0001), nodal positive disease (OR: 1.6, 95% CI: 1.1-2.48, P = .01) and SqD histology (OR: 1.6, 95% CI: 1.14-2.31, P = .007 as independent predictors of 5-year RFS. CONCLUSION Patient with SCC had significantly higher 5-year RFS in comparison to SqD. The higher rate of extravesical disease and lymph node metastasis in SqD patients is indicative of aggressive behavior of this histologic type.
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Affiliation(s)
- Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Ahmed Mosbah
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Abdelwahab Hashem
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Osama Mahmoud
- Urology Department, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed M Harraz
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr A Elsawy
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Metastatic Mimics of Primary Cutaneous Lesions: Averting Diagnostic Pitfalls With Significant Repercussions. Am J Dermatopathol 2021; 42:865-871. [PMID: 32649344 DOI: 10.1097/dad.0000000000001726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cutaneous metastases by solid malignancies often signify advanced disease and portend severely limited survival. Appropriate diagnosis of these lesions is particularly hampered when they closely resemble primary cutaneous tumors. In this article, we present two diagnostically challenging cases of metastatic lesions to the scalp bearing striking histologic resemblance to primary cutaneous neoplasms. One case of a metastatic urothelial carcinoma showed epidermotropism as well as histologic and immunohistochemical features virtually indistinguishable from those of a poorly differentiated squamous cell carcinoma. Next generation sequencing was performed on both the primary urothelial carcinoma and scalp malignancy revealing an identical BRAF p. S467L somatic mutation, confirming the diagnosis. Another case of metastatic renal cell carcinoma showed clinical and histomorphologic features highly reminiscent of a pyogenic granuloma. These cases demonstrate the potential of metastatic lesions to assume a myriad array of innocuous disguises and underscore the vigilance required to avoid misdiagnosis. In addition, we highlight the emerging role of molecular strategies in resolving these problematic cases.
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Kim HJ, Chun J, Kim TH, Yang G, Shin SJ, Kim JS, Yang J, Ham WS, Koom WS. Patterns of Locoregional Recurrence after Radical Cystectomy for Stage T3-4 Bladder Cancer: A Radiation Oncologist's Point of View. Yonsei Med J 2021; 62:569-576. [PMID: 34164953 PMCID: PMC8236349 DOI: 10.3349/ymj.2021.62.7.569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/02/2021] [Accepted: 04/23/2021] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Adjuvant radiotherapy (RT) has been performed to reduce locoregional failure (LRF) following radical cystectomy for locally advanced bladder cancer; however, its efficacy has not been well established. We analyzed the locoregional recurrence patterns of post-radical cystectomy to identify patients who could benefit from adjuvant RT and determine the optimal target volume. MATERIALS AND METHODS We retrospectively reviewed 160 patients with stage ≥ pT3 bladder cancer who were treated with radical cystectomy between January 2006 and December 2015. The impact of pathologic findings, including the stage, lympho-vascular invasion, perineural invasion, margin status, nodal involvement, and the number of nodes removed on failure patterns, was assessed. RESULTS Median follow-up period was 27.7 months. LRF was observed in 55 patients (34.3%), 12 of whom presented with synchronous local and regional failures as the first failure. The most common failure pattern was distant metastasis (40%). Among LRFs, the most common recurrence site was the cystectomy bed (15.6%). Patients with positive resection margins had a significantly higher recurrence rate compared to those without (28% vs. 10%, p=0.004). The pelvic nodal recurrence rate was < 5% in pN0 patients; the rate of recurrence in the external and common iliac nodes was 12.5% in pN+ patients. The rate of recurrence in the common iliac nodes was significantly higher in pN2-3 patients than in pN0-1 patients (15.2% vs. 4.4%, p=0.04). CONCLUSION Pelvic RT could be beneficial especially for those with positive resection margins or nodal involvement after radical cystectomy. Radiation fields should be optimized based on the patient-specific risk factors.
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Affiliation(s)
- Hyun Ju Kim
- Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jaehee Chun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Gowoon Yang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jaemoon Yang
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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Shee K, Seigne JD, Karagas MR, Marsit CJ, Hinds JW, Schned AR, Pettus JR, Armstrong DA, Miller TW, Andrew AS. Identification of Let-7f-5p as a novel biomarker of recurrence in non-muscle invasive bladder cancer. Cancer Biomark 2021; 29:101-110. [PMID: 32623385 DOI: 10.3233/cbm-191322] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Among patients diagnosed with non-muscle invasive bladder cancer (NMIBC), 30% to 70% experience recurrences within 6 to 12 years of diagnosis. The need to screen for these events every 3 to 6 months and ultimately annually by cystoscopy makes bladder cancer one of the most expensive malignancies to manage. OBJECTIVE The purpose of this study was to identify reproducible prognostic microRNAs in resected non-muscle invasive bladder tumor tissue that are predictive of the recurrent tumor phenotype as potential biomarkers and molecular therapeutic targets. METHODS Two independent cohorts of NMIBC patients were analyzed using a biomarker discovery and validation approach, respectively. RESULTS miRNA Let-7f-5p showed the strongest association with recurrence across both cohorts. Let-7f-5p levels in urine and plasma were both found to be significantly correlated with levels in tumor tissue. We assessed the therapeutic potential of targeting Lin28, a negative regulator of Let-7f-5p, with small-molecule inhibitor C1632. Lin28 inhibition significantly increased levels of Let-7f-5p expression and led to significant inhibition of viability and migration of HTB-2 cells. CONCLUSIONS We have identified Let-7f-5p as a miRNA biomarker of recurrence in NMIBC tumors. We further demonstrate that targeting Lin28, a negative regulator of Let-7f-5p, represents a novel potential therapeutic opportunity in NMIBC.
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Affiliation(s)
- Kevin Shee
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John D Seigne
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Margaret R Karagas
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Carmen J Marsit
- Department of Environmental Health and of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - John W Hinds
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alan R Schned
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jason R Pettus
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - David A Armstrong
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Todd W Miller
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.,Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Angeline S Andrew
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Aziz M, Khatri G, Hess D, Zimmern P. Anterior enterocele as an etiology for anterior vaginal wall prolapse: a magnetic resonance defecography case series. Abdom Radiol (NY) 2021; 46:1390-1394. [PMID: 31728611 DOI: 10.1007/s00261-019-02327-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pelvic floor hernias from the posterior cul-de-sac most often contain small bowel and are called enteroceles, however may contain sigmoid colon (sigmoidocele) or only peritoneal fat (peritoneocele). These cul-de-sac hernias typically cause bulging of the posterior vaginal wall, while anterior vaginal wall bulges are typically secondary to bladder prolapse in patients with pelvic floor deficiency. We report a series of seven patients who presented with anterior vaginal wall "mass" or bulge after cystectomy and were found on magnetic resonance defecography (MRD) to have enteroceles or sigmoidoceles in the anterior rather than posterior compartment. MRD was instrumental for diagnoses in these patients and to exclude local recurrence of bladder malignancy. We also report five additional patients that were found to have bowel herniation anterior to the vaginal apex, but without history of cystectomy.
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Sanguedolce F, Calò B, Mancini V, Zanelli M, Palicelli A, Zizzo M, Ascani S, Carrieri G, Cormio L. Non-Muscle Invasive Bladder Cancer with Variant Histology: Biological Features and Clinical Implications. Oncology 2021; 99:345-358. [PMID: 33735905 DOI: 10.1159/000514759] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The most common bladder cancer (BC) histotype is pure urothelial carcinoma (UC), which may undergo divergent differentiation in some cases. Variant histology (VH) presents along variable morphologies, either single or combined between them or with pure UC. From a clinical standpoint, the vast majority of BC is diagnosed at non-invasive or minimally invasive stages, namely as non-muscle invasive BC (NMIBC). There is a wide range of therapeutic options for patients with NMIBC, according to their clinical and pathological features. However, current risk stratification models do not show optimal effectiveness. Evidence from the literature suggests that VH has peculiar biological features, and may be associated with poorer survival outcomes compared to pure UC. SUMMARY In order to describe the biological features and prognostic/predictive role of VH in NMIBC, and to discuss current treatment options, we performed a systematic literature search through multiple databases (PubMed/Medline, Google Scholar) for relevant articles according to the following terms, single and/or in combination: "non-muscle invasive bladder cancer," "variant histology," "micropapillary variant," "glandular differentiation," "squamous differentiation," "nested variant," "plasmacytoid variant," and "sarcomatoid variant." We extracted 99 studies including original articles, reviews, and systematic reviews, and subsequently analyzed data from 16 studies reporting on the outcome of NMIBC with VH. We found that the relative rarity of these forms as well as the heterogeneity in study populations and therapeutic protocols results in conflicting findings overall. Key Messages: The presence of VH should be taken into account when counseling a patient with NMIBC, since it may upgrade the disease to high-risk tumor and thus warrant a more aggressive treatment.
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Affiliation(s)
| | - Beppe Calò
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
| | - Vito Mancini
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
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Pignot G, Sargos P. [Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer]. Prog Urol 2020; 31:158-168. [PMID: 33358467 DOI: 10.1016/j.purol.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Locoregional relapse (LRR) after cystectomy is a common early event associated with poor prognosis. The role of radiotherapy as an adjunct to radical cystectomy is not well-defined. The aim of this critical literature review is to provide an overview of the elements in favor of adjuvant radiation for patients treated for muscle-invasive bladder cancer. MATERIAL AND METHODS An exhaustive review of the literature was carried out using the Pubmed search tool with the following keywords: "radiotherapy" [Mesh], "adjuvant" [Mesh], "local recurrence" [Mesh], "Bladder cancer" [Mesh]. RESULTS Several recent publications have led to the development of a nomogram that predicts the risk of LRR, in order to identify patients for which adjuvant radiotherapy could be beneficial. Several randomized trials seem to suggest a benefit of radiotherapy, in particular when combined with chemotherapy, in terms of reducing LRR, and may even improve overall survival, with good safety profile. However, there are many biases and the interest of adjuvant radiotherapy in urothelial carcinomas remains debated. CONCLUSION Prospective trials evaluating adjuvant radiotherapy with current techniques should be undertaken.
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Affiliation(s)
- G Pignot
- Service de chirurgie oncologique 2, institut Paoli-Calmettes, Marseille, France.
| | - P Sargos
- Département de radiothérapie, institut Bergonié, Bordeaux, France
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11
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Guo L, Zhang L, Wang J, Zhang X, Zhu Z. Pelvic Lymph Node Dissection During Cystectomy for Patients With Bladder Carcinoma With Variant Histology: Does Histologic Type Matter? Front Oncol 2020; 10:545921. [PMID: 33194603 PMCID: PMC7604421 DOI: 10.3389/fonc.2020.545921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Adding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants. Methods Within the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type. Results Histologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557-0.634 [P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494-0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107-0.504 [P < 0.001]), whereas no significant differences in OS were observed in other histological subsets. Discussion Our analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated.
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Affiliation(s)
- Lijuan Guo
- Department of Disease Prevention and Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lianghao Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiange Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaowei Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Ruplin AT, Spengler AMZ, Montgomery RB, Wright JL. Downstaging of Muscle-Invasive Bladder Cancer Using Neoadjuvant Gemcitabine and Cisplatin or Dose-Dense Methotrexate, Vinblastine, Doxorubicin, and Cisplatin as Single Regimens or as Switch Therapy Modalities. Clin Genitourin Cancer 2020; 18:e557-e562. [PMID: 32201105 DOI: 10.1016/j.clgc.2020.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Consensus guidelines recommend gemcitabine and cisplatin (GC) or dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) as equally preferable neoadjuvant chemotherapy before cystectomy for muscle-invasive bladder cancer. This study sought to compare the ability of GC and ddMVAC to achieve pathologic response; and to evaluate the benefit of switching regimens after 1 or 2 cycles of the other. PATIENTS AND METHODS Patients aged ≥ 18 with muscle-invasive bladder cancer (≥ cT2) and who had received either GC or ddMVAC as neoadjuvant chemotherapy followed by cystectomy were retrospectively evaluated using the electronic medical record. Patients who received 1 or 2 cycles of one regimen followed by several cycles of the other regimen before cystectomy were classified as switch therapy patients. This study assessed the rates of pathologic complete response (pCR) and any degree of downstaging. RESULTS Among 109 patients who received GC or ddMVAC, 7 (21%) of 33 ddMVAC patients demonstrated pCR, and 19 (25%) of 76 GC patients demonstrated pCR (odds ratio, 1.24; 95% confidence interval, 0.46-3.31; P = .67). Downstaging rates were 39% for ddMVAC and 50% for GC (P = .31). Thirty-three of 36 patients aged ≥ 70 years received GC (P < .001). Four of 7 patients treated with switch therapy showed downstaging, and 2 of 7 experienced pCR. CONCLUSION There was no difference in pCR rates between GC and ddMVAC, and patients were most often able to receive 3 or 4 cycles of treatment. Switch therapy may be of benefit in patients whose disease has a poor initial response.
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Affiliation(s)
- Andrew T Ruplin
- University of Washington Medical Center (UW Medicine), Seattle, WA; Seattle Cancer Care Alliance (UW Medicine), Seattle, WA; Department of Pharmacy, UW Medicine, Seattle, WA.
| | - Anne M Z Spengler
- University of Washington Medical Center (UW Medicine), Seattle, WA; Seattle Cancer Care Alliance (UW Medicine), Seattle, WA; Department of Pharmacy, UW Medicine, Seattle, WA
| | - Robert B Montgomery
- University of Washington Medical Center (UW Medicine), Seattle, WA; Seattle Cancer Care Alliance (UW Medicine), Seattle, WA; Department of Urology, UW Medicine, Seattle, WA
| | - Jonathan L Wright
- University of Washington Medical Center (UW Medicine), Seattle, WA; Seattle Cancer Care Alliance (UW Medicine), Seattle, WA; Department of Urology, UW Medicine, Seattle, WA
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14
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Witjes JA, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Der Kwast TV, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, De Blok W, J L De Visschere P, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Mir MC, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, J G Oyen W, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Lauridsen SV, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Rivera FAV, Wiegel T, Wiklund P, Williams A, Zigeuner R, Horwich A. EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort †: Under the Auspices of the EAU-ESMO Guidelines Committees. Eur Urol 2020; 77:223-250. [PMID: 31753752 DOI: 10.1016/j.eururo.2019.09.035] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/26/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach. PATIENT SUMMARY This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marek Babjuk
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Joaquim Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, Massachusetts, USA
| | - H Maxim Bruins
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Maria De Santis
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen, Switzerland; University of Bern, Bern, Switzerland
| | - Nicholas James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Juan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tom Powles
- The Royal Free NHS Trust, London, UK; Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Maria J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Spain
| | - Shahrokh F Shariat
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, New York, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Theo Van Der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Paris Descartes University, Paris, France
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, Utah, USA
| | - Tom Arends
- Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, The Netherlands
| | - Aristotle Bamias
- 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - Alison Birtle
- Division of Cancer Sciences, University of Manchester, Manchester, UK; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
| | - Peter C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, British Colombia, Canada
| | - Bernard H Bochner
- Department of Urology, Weill Cornell Medical College, New York, New York, USA; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michel Bolla
- Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France
| | - Joost L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alberto Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Iris Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Max Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Daniel Castellano
- Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain
| | - Richard Cathomas
- Departement Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Research Hospital, Milan, Italy
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - Eva Compérat
- Department of Pathology, Tenon hospital, HUEP, Paris, France; Sorbonne University, Paris, France
| | - Simon Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - Stephane Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris, France
| | - Berardino De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - Willem De Blok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter J L De Visschere
- Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Italy
| | - Valerie Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Jurgen J Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Georgios Gakis
- Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany
| | - Bogdan Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Paolo Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | | | - Shaista Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Donna E Hansel
- Department of Urology, University of California, San Diego Pathology, La Jolla, California, USA
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Dickon Hayne
- Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia
| | - Ann M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Virginia Hernandez
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Harry Herr
- Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Barbara A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Rob Jones
- Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Ashish M Kamat
- Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Vincent Khoo
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne; Monash University, Melbourne, Australia
| | - Anne E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Susanne Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Pedro C Lara
- Department of Oncology, Hospital Universitario San Roque; Universidad Fernando Pessoa, Canarias, Spain
| | - Annemarie Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Vibeke Løgager
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Yohann Loriot
- Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Richard Meijer
- UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands
| | - M Carmen Mir
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | | | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Andrea Necchi
- Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
| | - Yann Neuzillet
- Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands
| | - Jan Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Susanne Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wim J G Oyen
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Luís Pacheco-Figueiredo
- Department of Urology, Centro Hospitalar São João, Porto, Portugal; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Helle Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Manish I Patel
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - Bradley R Pieters
- Department Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Karin Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | - Mesut Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Margitta Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Jonathan Richenberg
- Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - Jonathan E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Weill Cornell Medical College, New York, New York, USA
| | - Morgan Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Rouvière
- Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon, France; Université de Lyon, Université Lyon 1, faculté de médecine Lyon Est, Lyon, France
| | - Carl Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Belgium
| | - Antti Salminen
- Department of Urology, University Hospital of Turku, Finland
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - Shomik Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå university, Umeå, Sweden
| | - Robert J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anita Smits
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - George N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Bertrand Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Susanne Vahr Lauridsen
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Riccardo Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Mihai D Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Antoni Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Spain
| | - Franklin A Vives Rivera
- Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter Wiklund
- Icahn School of Medicine, Mount Sinai Health System New York City, New York, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Andrew Williams
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - Richard Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - Alan Horwich
- Emeritus Professor, The Institute of Cancer Research, London, UK
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15
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Histological Subtypes and Response to PD-1/PD-L1 Blockade in Advanced Urothelial Cancer: A Retrospective Study. J Urol 2020; 204:63-70. [PMID: 31971495 DOI: 10.1097/ju.0000000000000761] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Urinary tract cancer can be pure urothelial carcinoma, pure nonurothelial carcinoma or variant urothelial carcinoma (defined here as mixed urothelial carcinoma). Little is known regarding outcomes for patients with variant urothelial carcinoma receiving immune checkpoint inhibitors. We hypothesized that variant urothelial carcinoma does not compromise immune checkpoint inhibitor efficacy in patients with advanced urothelial carcinoma. MATERIALS AND METHODS We performed a retrospective cohort study across 18 institutions. Demographic, clinicopathological, treatment and outcomes data were collected for patients with advanced urothelial carcinoma who received immune checkpoint inhibitors. Patients were divided into pure vs variant urothelial carcinoma subgroups, with variant urothelial carcinoma further divided by type of variant (ie squamous, neuroendocrine etc). We compared overall response rate using univariate and multivariate logistic regression and progression-free survival and overall survival using Kaplan-Meier and univariate and multivariate Cox proportional hazards. RESULTS Overall 519 patients were identified, with 395, 406 and 403 included in overall response rate, overall survival and progression-free survival analyses, respectively. Overall response rate to immune checkpoint inhibitors between patients with pure vs variant urothelial carcinoma was comparable (28% vs 29%, p=0.90) without significant differences for individual subtypes vs pure urothelial carcinoma. Median overall survival for patients with pure urothelial carcinoma was 11.0 months vs 10.1 months for variant urothelial carcinoma (p=0.60), but only 4.6 months for patients with neuroendocrine features (9 patients, HR 2.75, 95% CI 1.40-5.40 vs pure urothelial carcinoma, p=0.003). Median progression-free survival was 4.1 months for pure vs 5.2 months for variant urothelial carcinoma (p=0.43) and 3.7 months for neuroendocrine features (HR 1.87, 95% CI 0.92-3.79 vs pure urothelial carcinoma, p=0.09). CONCLUSIONS Overall response rate to immune checkpoint inhibitors was comparable across histological types. However, overall survival was worse for patients with tumors containing neuroendocrine features. Variant urothelial carcinoma should not exclude patients from receiving immune checkpoint inhibitors.
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Horwich A, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Van Der Kwast T, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, DeBlok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Carmen Mir M, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Vahr Lauridsen S, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Vives Rivera FA, Wiegel T, Wiklund P, Williams A, Zigeuner R, Witjes JA. EAU-ESMO consensus statements on the management of advanced and variant bladder cancer-an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees†. Ann Oncol 2019; 30:1697-1727. [PMID: 31740927 PMCID: PMC7360152 DOI: 10.1093/annonc/mdz296] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. SETTING Online Delphi survey and consensus conference. PARTICIPANTS The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS Overall, 116 statements were included in the Delphi survey. Of these, 33 (28%) statements achieved level 1 consensus and 49 (42%) statements achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time where further evidence is available to guide our approach.
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Affiliation(s)
- A Horwich
- Emeritus Professor, The Institute of Cancer Research, London, UK; Emeritus Professor, The Institute of Cancer Research, London, UK.
| | - M Babjuk
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - J Bellmunt
- IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Harvard Medical School, Boston, USA
| | - H M Bruins
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - T M De Reijke
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - M De Santis
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Charité University Hospital, Berlin, Germany
| | - S Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Division of Oncology and Haematology, Kantonsspital St Gallen, St Gallen; University of Bern, Bern, Switzerland
| | - N James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| | - S Maclennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - J Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Powles
- The Royal Free NHS Trust, London; Barts Cancer Institute, Queen Mary University of London, London, UK
| | - M J Ribal
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - S F Shariat
- Depatment of Urology, 2nd Faculty of Medicine, Hospital Motol, Charles University, Prague, Czech Republic; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern Medical Center, Dallas, USA; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - T Van Der Kwast
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris; Paris Descartes University, Paris, France
| | - N Agarwal
- Huntsman Cancer Institute, University of Utah (NCI-CCC), Salt Lake City, USA
| | - T Arends
- Urology Department, Canisius-Wilhelmina Ziekenhuis Nijmegen, Nijmegen, The Netherlands
| | - A Bamias
- 2nd Propaedeutic Dept of Internal Medicine, Medical School, National & Kapodistrian University of Athens, Athens, Greece
| | - A Birtle
- Division of Cancer Sciences, University of Manchester, Manchester; Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK
| | - P C Black
- Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - B H Bochner
- Department of Urology, Weill Cornell Medical College, New York; Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M Bolla
- Emeritus Professor of Radiation Oncology, Grenoble - Alpes University, Grenoble, France
| | - J L Boormans
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Bossi
- Department of Radiation Oncology, Gustave Roussy Institute, Villejuif, France
| | - A Briganti
- Department of Urology, Urological Research Institute, Milan; Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - I Brummelhuis
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - M Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - D Castellano
- Medical Oncology Department, 12 de Octubre University Hospital (CIBERONC), Madrid, Spain
| | - R Cathomas
- Department Innere Medizin, Abteilung Onkologie und Hämatologie, Kantonsspital Graubünden, Chur, Switzerland
| | - A Chiti
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK
| | - E Compérat
- Department of Pathology, Tenon Hospital, HUEP, Paris; Sorbonne University, Paris, France
| | - S Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Culine
- Department of Cancer Medicine, Hôpital Saint Louis, Paris
| | - B De Bari
- Radiation Oncology Department, Centre Hospitalier Régional Universitaire "Jean Minjoz" of Besançon, INSERM UMR 1098, Besançon, France; Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Lausanne, Switzerland
| | - W DeBlok
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P J L De Visschere
- Department of Radiology and Nuclear Medicine, Division of Genitourinary Radiology and Mammography, Ghent University Hospital, Ghent
| | - K Decaestecker
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - K Dimitropoulos
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J L Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - S Fanti
- Department of Nuclear Medicine, Policlinico S Orsola, University of Bologna, Bologna, Italy
| | - V Fonteyne
- Department of Radiotherapy Oncology, Ghent University Hospital, Ghent, Belgium
| | - M Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - J J Futterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Gakis
- Department of Urology and Paediatric Urology, University Hospital of Würzburg, Julius-Maximillians University, Würzburg, Germany
| | - B Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - P Gontero
- Division of Urology, Molinette Hospital, University of Studies of Torino, Torino, Italy
| | - B Grubmüller
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D E Hansel
- Department of Urology, University of California, San Diego Pathology, La Jolla, USA
| | - A Hartmann
- Institute of Pathology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - D Hayne
- Department of Urology, UWA Medical School, University of Western Australia, Perth, Australia
| | - A M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - V Hernandez
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - H Herr
- Urology Service, Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - K Herrmann
- Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester; The Christie NHS Foundation Trust, Manchester, UK; Mount Vernon Centre for Cancer Treatment, London, UK
| | - J Huguet
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan; Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - R Jones
- Institute of Cancer Sciences, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - A M Kamat
- Department of Urology - Division of Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA
| | - V Khoo
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London; Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK; Department of Medicine, University of Melbourne, Melbourne; Monash University, Melbourne, Australia
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - S Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - S Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - P C Lara
- Department of Oncology, Hospital Universitario San Roque, Canarias; Universidad Fernando Pessoa, Canarias, Spain
| | - A Leliveld
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - V Løgager
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
| | - A Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Y Loriot
- Département de Médecine Oncologique, Gustave Roussy, INSERM U981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - R Meijer
- UMC Utrecht Cancer Center, MS Oncologic Urology, Utrecht, The Netherlands
| | - M Carmen Mir
- Servicio de Urología, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - M Moschini
- Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - H Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - A-C Müller
- Department of Radiation Oncology, Eberhard Karls University, Tübingen, Germany
| | - C R Müller
- Cancer Treatment Centre, Sorlandet Hospital, Kristiansand, Norway
| | - J N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A Necchi
- Department of Medical Oncology, Istituto Nazionale Tumori of Milan, Milan, Italy
| | - Y Neuzillet
- Department of Urology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - J R Oddens
- Department of Urology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Osanto
- Department of Clinical Oncology, Leiden University Medical Center, Leiden
| | - W J G Oyen
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Research Hospital, Milan, Italy; Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiology and Nuclear Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - L Pacheco-Figueiredo
- Department of Urology, Centro Hospitalar São João, Porto; Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - H Pappot
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - M I Patel
- Department of Urology, Westmead Hospital, University of Sydney, Sydney, Australia
| | - B R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam
| | - K Plass
- EAU Guidelines Office, Arnhem, The Netherlands
| | - M Remzi
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - M Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - J Richenberg
- Department of Imaging and Nuclear Medicine, Royal Sussex County Hospital, Brighton; Brighton and Sussex Medical School, Brighton, UK
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - F Roghmann
- Department of Urology, Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | - J E Rosenberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York, USA
| | - M Rouprêt
- Department of Urology, Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris
| | - O Rouvière
- Hospices Civils de Lyon, Service d'Imagerie Urinaire et Vasculaire, Hôpital Edouard Herriot, Lyon; Université de Lyon, Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - C Salembier
- Department of Radiation Oncology, Europe Hospitals Brussels, Brussels, Belgium
| | - A Salminen
- Department of Urology, University Hospital of Turku, Turku, Finland
| | - P Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux, France
| | - S Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne; Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - A Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - R J Smeenk
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Smits
- Department of Urology, Radboud University Medical Center, Nijmegen
| | - A Stenzl
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - G N Thalmann
- Department of Urology, Inselspital, Bern University Hospital, Berne, Switzerland
| | - B Tombal
- Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium
| | - B Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, USA
| | - S Vahr Lauridsen
- Department of Urology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Valdagni
- Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - H Van Poppel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - M D Vartolomei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Targu Mures, Romania
| | - E Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - A Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - F A Vives Rivera
- Clinica HematoOncologica Bonadona Prevenir, Universidad Metropolitana, Clinica Club de Leones, Barranquilla, Colombia
| | - T Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - P Wiklund
- Icahn School of Medicine, Mount Sinai Health System, New York City, USA; Department of Urology, Karolinska Institutet, Stockholm, Sweden
| | - A Williams
- Department of Urology, Auckland City Hospital, Auckland, New Zealand
| | - R Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - J A Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen
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Grant CM, Amdur R, Whalen MJ. Trends in the use of neoadjuvant chemotherapy for bladder cancer with nonurothelial variant histology: An analysis of the National Cancer Database. Indian J Urol 2019; 35:291-298. [PMID: 31619869 PMCID: PMC6792420 DOI: 10.4103/iju.iju_142_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The aim of this study is to evaluate the trends in the use of neoadjuvant chemotherapy (NAC) over time (2006-2014) for patients diagnosed with muscle-invasive bladder cancer (MIBC) with nonurothelial variant histology (NUVH) in the National Cancer Database. Materials and Methods We queried the NCDB for patients with muscle-invasive (i.e. cT2-4N0-3M0/X) urothelial carcinoma (UC) of the bladder. We examined demographic, clinical, and pathologic features associated with NAC, also substratifying into pure UC and NUVH. Tests of association were performed using Chi-square/Fisher's exact test for categorical variables and t-tests, ANOVA, or Kruskal-Wallis test for continuous variables. Outcomes were examined with Cox proportional hazards and 90-day mortality with the Kaplan-Meier method. Results Totally 22,320 patients met our inclusion criteria, of whom 22.6% received NAC. The proportion of NAC increased significantly over time in the neuroendocrine and urothelial cell categories with 57.1% and 34.1% of patients in 2014 receiving NAC vs. 44% and 10.6% in 2006. No other variant histology showed a significant increase across the time sampled. Patients receiving NAC were more likely to have downstaging to pT0 (13.4% vs. 2.7%), negative surgical margin (89.1% vs. 86%), and pN0 (63.2% vs. 60.5%) and were less likely to have 30-day (1.4% vs. 3%) or 90-day (5% vs. 8.3%) mortality. Rates of downstaging to pT0 after NAC were similar among histologies. Conclusion Neoadjuvant chemotherapy utilization continues to slowly increase in patients with MIBC. Patients with variant histology lag behind in terms of receiving NAC but appear to derive as much benefit as patients with pure urothelial cell bladder cancer.
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Affiliation(s)
- Campbell M Grant
- Department of Urology, George Washington University Hospital, Washington, DC, USA
| | - Richard Amdur
- Department of Surgery, George Washington University Hospital, Washington, DC, USA
| | - Michael J Whalen
- Department of Urology, George Washington University Hospital, Washington, DC, USA
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Yu J, Li G, Wang A, Luo Q, Liu Z, Niu Y, Mei Y. Impact of squamous differentiation on intravesical recurrence and prognosis of patients with upper tract urothelial carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:377. [PMID: 31555691 DOI: 10.21037/atm.2019.07.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The prognostic role of squamous differentiation in upper urinary tract urothelial carcinoma (UTUC) is still unclear. This article describes the impact of squamous differentiation on prognosis and intravesical recurrence of patients with primary UTUC treated with radical nephroureterectomy (RNU). Methods Totally, we retrieved (I) 669 histologically confirmed UTUC patients without histologic variants; (II) 101 UTUC patients with squamous differentiation in our institution, dating from April 2003 to April 2016. The clinical pathological characteristics and survival outcomes were compared between these two cohorts. Results In our study, 13% UTUC patients were detected with squamous differentiation. The mean age of all the patients examined was 66, of whom 70% were males. Squamous differentiation significantly associated with tumor stage, tumor grade and lymphovascular invasion. The Kaplan-Meier and Cox regression analyses showed that presence of squamous differentiation was correlated with shorter cancer specific survival of UTUC patients. The 5-year cancer specific survival rates were 47% for squamous differentiation-present patients and 63% for squamous differentiation-absent patients. UTUC patients with squamous differentiation showed a higher frequency of high-grade disease in advanced stage (pT2/pT3/pT4), while the discrepancy was not shown in early stage (pTa/pT1). Intravesical recurrence was observed in 27% patients. We found that intravesical recurrence had little impact on the cancer specific survival of squamous differentiation-present patients, yet it tended to decrease cancer specific survival among squamous differentiation-absent patients. Conclusions The presence of squamous differentiation in UTUC patients was a vital prognostic factor for cancer specific survival and correlated with intravesical recurrence after receiving RNU.
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Affiliation(s)
- Jianpeng Yu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Gang Li
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Aixiang Wang
- Department of Pathology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Qiang Luo
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Zihao Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yuanjie Niu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou 256603, China
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The clinicopathological characteristics and prognostic value of squamous differentiation in patients with bladder urothelial carcinoma: a meta-analysis. World J Urol 2019; 38:323-333. [PMID: 31011874 DOI: 10.1007/s00345-019-02771-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/15/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Urothelial carcinoma with squamous differentiation (UCSD) is the most common histologic variant in bladder cancer (BCa). Previously, some studies have linked the presence of UCSD with the risk of worse survival outcomes in BCa patients. However, such association is still controversial. In this study, we performed a meta-analysis to clarify the clinicopathological characteristics and to further investigate the prognostic value of UCSD in BCa. METHODS A systematic literature search was performed in electronic databases including PubMed, Embase, Chinese National Knowledge Infrastructure and Wanfang Data until October 2018. Subgroup analyses were performed according to different treatments and study outcomes. RESULTS Total of 13,284 patients were enrolled in 19 studies which were included in this meta-analysis. The percentage of female patients with UCSD was significantly higher than those with pure urothelial carcinoma. UCSD was correlated with tumor stage T3/T4, tumor grade 3, positive surgical margin, and lymph node involvement. Moreover, the recurrence rate was higher in patients with UCSD after surgery. UCSD was associated with poorer disease-free survival (DFS). No significant difference of cancer-specific survival (CSS) or overall survival (OS) was found on multivariable analysis between the two groups. CONCLUSIONS Our study demonstrated that UCSD in BCa was associated not only with unfavorable clinicopathological features, but also with high risk of recurrence and poorer prognosis for DFS. However, UCSD is not independently significant for CSS and OS. Well-designed randomized study with larger sample size is warranted to verify the findings and to further explore the role of UCSD in BCa.
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Hosseini A, Ebbing J, Collins J. Clinical outcomes of robot-assisted radical cystectomy and continent urinary diversion. Scand J Urol 2019; 53:81-88. [DOI: 10.1080/21681805.2019.1598486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Abolfazl Hosseini
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institut, Stockholm, Sweden
| | - Jan Ebbing
- Urology, Universitat Basel Medizinische Fakultat, Basel, Switzerland
| | - Justin Collins
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institut, Stockholm, Sweden
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21
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Minato A, Noguchi H, Tomisaki I, Fukuda A, Kubo T, Nakayama T, Fujimoto N. Clinical Significance of Squamous Differentiation in Urothelial Carcinoma of the Bladder. Cancer Control 2019; 25:1073274818800269. [PMID: 30213195 PMCID: PMC6144505 DOI: 10.1177/1073274818800269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The prognostic value of squamous differentiation (SD) in urothelial carcinoma (UC) of the bladder is unclear. The aim of this study was to identify the clinical significance of SD in UC in terms of oncological outcomes in patients undergoing radical cystectomy (RC). We evaluated consecutive patients with muscle-invasive bladder cancer (MIBC; clinical T2-4aN0M0) treated with RC at our institution from March 2003 to March 2017. We enrolled 20 and 81 patients with UC with SD (UCSD) and pure UC, respectively. Postoperative survival outcomes were compared between the patients with UCSD and pure UC using the Kaplan-Meier method. Pre- and postcystectomy factors that influenced the overall survival (OS) and recurrence-free survival (RFS) were investigated in these patients. Multivariate Cox regression models were used to identify the predictors of OS and RFS. With a median follow-up time of 31 months, the 5-year OS rate of the UCSD and pure UC groups was 41.1% and 69.7% (P = .002) and the 5-year RFS rate was 51.8% and 59.5% (P = .027), respectively. The shape of the Kaplan-Meier curves for UCSD suggested a more rapid course of the disease within the first 2 years than observed in pure UC. Multivariate analyses suggested that SD in UC was significantly associated with OS (hazard ratio [HR]: 4.22; 95% confidence interval [CI]: 1.20-14.8; P = .024) and close to significance for a lower RFS (HR: 2.13, 95% CI: 0.74-6.15, P = .064). Our results indicate that SD may be an independent predictor of OS and RFS in UC of MIBC in patients undergoing RC.
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Affiliation(s)
- Akinori Minato
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hirotsugu Noguchi
- 2 Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ikko Tomisaki
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Atsushi Fukuda
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuhiko Kubo
- 2 Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiyuki Nakayama
- 3 Department of Pathology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naohiro Fujimoto
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
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22
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Zhao G, Wang C, Tang Y, Liu X, Liu Z, Li G, Mei Y. Glandular differentiation in pT1 urothelial carcinoma of bladder predicts poor prognosis. Sci Rep 2019; 9:5323. [PMID: 30926888 PMCID: PMC6441090 DOI: 10.1038/s41598-019-41844-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/19/2019] [Indexed: 12/19/2022] Open
Abstract
To evaluate the effect of glandular differentiation (GD) on tumor recurrence and progression of pT1 bladder urothelial carcinoma (UC). We performed a retrospective analysis of 82 bladder urothelial carcinoma with glandular differentiation (UCGD) patients which was pathologically diagnosed as pT1, 166 patients of pT1 UC of bladder without histologic variants served as controls. Patients of UCGD were more likely to have higher recurrence (P = 0.002) rate and higher progression rate (P < 0.001). Moreover, UCGD and a poor 5 -year overall survival (OS) (P = 0.02) while there was no difference in cancer-specific survival (CSS) (P = 0.062) between two groups. According to univariate analysis, largest tumor size (HR 1.502, CI 1.158–1.861, P = 0.029), UCGD (HR 1.787, CI 1.298–2.552, P = 0.001), lymphovascular invasion (LVI) (HR 1.226, CI 1.013–1.945, P = 0.039). UCGD (HR 1.367, CI 1.115–1.853, P = 0.038) and LVI (HR 1.416, CI 1.120–2.254, P = 0.013) were prognostic factors associated with disease recurrence and progression, respectively. Additionally, Additionally, UCGD significantly influence disease recurrence (HR 1.871, CI 1.338–2.589, P < 0.001) and progression (HR 1.462, CI 1.138–2.393, p = 0.007). Similarly, LVI significantly influence disease recurrence (HR 1.356, CI 1.053–2.174, P = 0.042) and progression (HR 1.348, CI 1.052–1.944, p = 0.022) in multivariate analysis. UCGD is significantly associated with higher recurrence and progression rate in patients with newly diagnosed pT1. Recurrent cases should be performed radical cystectomy (RC) earlier.
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Affiliation(s)
- Guobin Zhao
- Department of Urology, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, 07500, China.
| | - Chao Wang
- Department of Urology, Fifth Central Hospital of Tianjin, Tianjin, 300450, China
| | - Yuhong Tang
- College of Laboratory Medicine, Hebei North University, Zhangjiakou City, Hebei Province, 07500, China
| | - Xin Liu
- Department of Urology, The First Affiliated Hospital of Hebei North University, Zhangjiakou City, Hebei Province, 07500, China
| | - Zihao Liu
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Gang Li
- Department of Urology, Tianjin Institute of Urology, The second hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou, 256603, China
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23
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Andrew AS, Karagas MR, Schroeck FR, Marsit CJ, Schned AR, Pettus JR, Armstrong DA, Seigne JD. MicroRNA Dysregulation and Non-Muscle-Invasive Bladder Cancer Prognosis. Cancer Epidemiol Biomarkers Prev 2019; 28:782-788. [PMID: 30700445 DOI: 10.1158/1055-9965.epi-18-0884] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/20/2018] [Accepted: 01/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The high rate of non-muscle-invasive bladder cancer recurrence is a major challenge in patient management. miRNAs functionally regulate tumor cell proliferation and invasion, and have strong potential as biomarkers because they are robust to degradation. The objective of this project was to identify reproducible prognostic miRNAs in resected non-muscle-invasive bladder tumor tissue that are predictive of the recurrent tumor phenotype. METHODS We utilized patients diagnosed with primary non-muscle-invasive bladder cancer in three independent cohorts for a biomarker discovery/validation approach. Baseline tumor tissue from patients with the clinically challenging, non-muscle-invasive primary low stage (Ta), high grade, and T1 tumors (tumors extending into the lamina propria) comprised the discovery cohort (n = 38). We isolated the tumor tissue RNA and assessed a panel of approximately 800 miRNAs. RESULTS miR-26b-5p was the top-ranking prognostic tumor tissue miRNA, with a time-to-recurrence HR 0.043 for levels above versus below median, (P adj = 0.0003). miR-26b-5p was related to a dose-response reduction in tumor recurrence, and levels above the median were also associated with reduced time-to-progression (P adj = 0.02). We used two independent longitudinal cohorts that included both low-grade and high-grade Ta and T1 tumors for validation and found a consistent relationship between miR-26b-5p and recurrence and progression. CONCLUSIONS Our results suggest that miR-26b-5p levels may be prognostic for non-muscle-invasive bladder cancer recurrence, and can feasibly be assessed in baseline tumor tissue from a wide variety of clinical settings. IMPACT Early identification of those non-muscle-invasive bladder tumor patients with refractory phenotypes would enable individualized treatment and surveillance.
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Affiliation(s)
- Angeline S Andrew
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - Margaret R Karagas
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Florian R Schroeck
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and White River Junction VA Medical Center, White River Junction, Vermont
| | - Carmen J Marsit
- Department of Environmental Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Alan R Schned
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jason R Pettus
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - David A Armstrong
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - John D Seigne
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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24
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Bateni ZH, Pearce SM, Zainfeld D, Ballas L, Djaladat H, Schuckman AK, Daneshmand S. National Practice Patterns and Overall Survival After Adjuvant Radiotherapy Following Radical Cystectomy for Urothelial Bladder Cancer in the USA, 2004-2013. Eur Urol Oncol 2018; 3:343-350. [PMID: 31317867 DOI: 10.1016/j.euo.2018.11.010] [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] [Received: 06/28/2018] [Revised: 11/19/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Adjuvant radiation therapy (ART) after radical cystectomy (RC) for urothelial bladder cancer (UBC) may play a role in the management of muscle-invasive BC, particularly in patients with locally advanced disease and adverse pathologic features (pT3/4 or positive surgical margins [PSMs]). Evidence regarding the effect of ART on overall survival (OS) is lacking. OBJECTIVE To evaluate national practice patterns for the use of ART and assess its impact on OS for patients with adverse pathologic features (APF) after RC. DESIGN, SETTING, AND PARTICIPANTS Using the National Cancer Data Base, we analyzed all UBC cases with APF after RC from 2004 to 2013. Patients were divided into ART and no-ART groups. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Relationships with oncological outcomes were analyzed using multivariable Cox regression and log-rank analyses. RESULTS AND LIMITATIONS Use of ART decreased during the study period from 3.1% in 2004 to 1.7% in 2013 (p=0.03). ART was administered in 1.4%, 4.0% and 5.2% of patients with pT3 UBC, pT4 UBC, and PSMs (any pT stage), respectively. The rate of ART was significantly higher among younger ages, female sex, low-volume hospitals, nonacademic community care centers, higher stages, PSMs, perioperative chemotherapy, and lymph node-positive disease. Predictors of ART receipt were PSMs (odds ratio [OR] 3.4; p<0.0001), pT4 (OR 2.6; p=0.02), community based centers (OR 2.1; p<0.0001), and female sex (OR 1.8; p<0.0001). Risk factors for worse OS included age, higher tumor stage and comorbidities, PSMs, positive nodes, and suboptimal lymph node dissection (<10 nodes removed; all p<0.001). ART was not independently associated with better OS in the full cohort (p=0.54). However, subgroup analyses suggested an OS benefit for patients with PSMs (hazard ratio 0.73; p=0.047). Limitations include the retrospective design and limited details regarding cancer-specific survival. CONCLUSIONS Use of ART for APF following RC is not common in the USA and the rate of ART has been decreasing over time. ART may have an OS benefit after RC for patients with PSMs. PATIENT SUMMARY In this report we looked at the outcomes for patients with locally advanced bladder cancer receiving adjuvant radiation therapy following cystectomy in a large US population. We found that adding radiation therapy after removing the bladder cancer may have some survival benefits for patients with positive surgical margins.
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Affiliation(s)
- Zhoobin H Bateni
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Shane M Pearce
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Daniel Zainfeld
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Leslie Ballas
- Department of Radiation Oncology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anne K Schuckman
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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25
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Liu Y, Bui MM, Xu B. Urothelial Carcinoma with Squamous Differentiation is Associated with High Tumor Stage and Pelvic Lymph-Node Metastasis. Cancer Control 2018; 24:78-82. [DOI: 10.1177/107327481702400113] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yunguang Liu
- Department of Pathology and Laboratory Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Roswell Park Cancer Institute, Buffalo, New York, Cytopathology Fellowship Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Indian River Medical Center, Vero Beach, Florida
| | - Marilyn M. Bui
- University of South Florida Morsani College of Medicine, Tampa, Florida, and the Department of Anatomic Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Bo Xu
- Department of Pathology and Laboratory Medicine, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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26
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Miao X, Gao H, Liu S, Chen M, Xu W, Ling X, Deng X, Rao C. Down-regulation of microRNA-224 -inhibites growth and epithelial-to-mesenchymal transition phenotype -via modulating SUFU expression in bladder cancer cells. Int J Biol Macromol 2017; 106:234-240. [PMID: 28780419 DOI: 10.1016/j.ijbiomac.2017.07.184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 07/29/2017] [Accepted: 07/31/2017] [Indexed: 02/07/2023]
Abstract
Aberrant expression of miR-224 is usually found in cancer studies; however, the role of miR-224 has seldom been reported in bladder cancer (BC). We explored miR-224's function and the underlying mechanism in BC. It was found that miR-224 expression was significantly up-regulated in BC tissues and cell lines. Knockdown of miR-224 decreased BC cell growth and invasion both in vitro and in vivo. We identified the SUFU protein as a downstream target of miR-224 by using luciferase and western blot assays. We proposed that miR-224 promoted BC cell growth and invasion via sustaining the activity of Hedgehog pathway, which was negatively regulated by SUFU. Taken together, our study demonstrated that miR-224 may function as an onco-miR in BC and suggested that miR-224 may be a potential therapeutic target for BC patients.
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Affiliation(s)
- Xiaobo Miao
- Radiotherapy & Chemotherapy Dept. 2, Ningbo NO. 2 Hospital, Zhejiang, China
| | - Hai Gao
- Health and Human Service Department, Xiamen Xianyue Hospital, Xiamen, China
| | - Shiyong Liu
- Department of Urology, Guangdong Province Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Meijuan Chen
- State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Department of Hepatology Unit and Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenwen Xu
- Department of Outpatient Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xuguang Ling
- Department of Emergency Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xubin Deng
- Cancer Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Chuangzhou Rao
- Radiotherapy & Chemotherapy Dept. 2, Ningbo NO. 2 Hospital, Zhejiang, China.
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27
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Minato A, Fujimoto N, Kubo T. Squamous Differentiation Predicts Poor Response to Cisplatin-Based Chemotherapy and Unfavorable Prognosis in Urothelial Carcinoma of the Urinary Bladder. Clin Genitourin Cancer 2017; 15:e1063-e1067. [PMID: 28803791 DOI: 10.1016/j.clgc.2017.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 07/13/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The efficacy of chemotherapy on UCSD is not known. This study was conducted to investigate the efficacy of cisplatin-based chemotherapy and prognosis of patients with UC with or without SD of the bladder. METHODS Patients with invasive bladder cancer (clinical T3-4aN0M0) who were treated between March 2003 and March 2015 with 2 or 3 cycles of neoadjuvant chemotherapy followed by radical cystectomy were retrospectively evaluated. Treatment outcomes were compared for each pathologic type in UCSD and pure UC. The primary end point was pathologic response in the cystectomy specimens. Disease-free survival and overall survival were secondary end points. RESULTS We evaluated 9 patients with UCSD and 29 patients with pure UC. In the cystectomy specimens, pathologic complete response without residual tumors was not seen in any patients with UCSD, but evident in 10 patients (34.5%) with pure UC. The proportion of pathologic downstaging was significantly lower in patients with UCSD than in those with pure UC (11.1% vs. 51.7%; P = .031). Patients with UCSD had poorer disease-free survival (P < .001) and overall survival (P = .001) than those with pure UC. On multivariate Cox regression analysis, SD in UC was an independent predictor of recurrence (hazard ratio, 4.43; 95% confidence interval, 1.44-13.6, P = .009) and mortality (hazard ratio, 3.51; 95% confidence interval, 1.11-11.1, P = .032). CONCLUSIONS UCSD of the bladder is less sensitive to cisplatin-based chemotherapy and has poor prognosis.
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Affiliation(s)
- Akinori Minato
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
| | - Naohiro Fujimoto
- Department of Urology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuhiko Kubo
- Department of Public Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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28
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Xu H, Xie L, Liu X, Zhang Y, Shen Z, Chen T, Qiu X, Sha N, Xing C, Wu Z, Hu H, Wu C. Impact of squamous and/or glandular differentiation on recurrence and progression following transurethral resection for non-muscle invasive urothelial carcinoma of bladder. Oncol Lett 2017; 14:3522-3528. [PMID: 28927108 PMCID: PMC5587993 DOI: 10.3892/ol.2017.6581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/03/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of the present study was to investigate the impact of squamous and/or glandular differentiation on the recurrence and progression in patients with nonmuscle invasive urothelial carcinoma of bladder (NMIUCB) following transurethral resection (TURBT). A total of 869 patients with NMIUCB who had been treated with TURBT at The Second Hospital of Tianjin Medical University (Tianjin, China) between January 2006 and January 2011 were retrospectively selected for the present analysis. Associations among squamous and/or glandular differentiation with other clinical and pathological features were assessed by the χ2 test. Recurrence-free survival (RFS) and progression-free survival (PFS) curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed through a Cox's proportional hazards regression model. Among the 869 patients, 232 (26.7%) patients had squamous and/or glandular differentiation. High grade tumors were more common in patients with squamous and/or glandular differentiation compared with those with pure urothelial carcinoma of bladder (P<0.001). Associations between age (P=0.115), sex (P=0.184), tumor size (P=0.223), tumor multiplicity (P=0.108), pathological tumor stage (P=0.909) and squamous and/or glandular differentiation were not observed to be statistically significant. There was a significant tendency towards higher recurrence rate and shorter RFS time in patients with squamous and/or glandular differentiation. However, no statistically significant differences were observed in progression rate and PFS between the two groups. The multivariate Cox regression analysis, identified squamous and/or glandular differentiation as an independent prognostic predictor of recurrence (hazard ratio =1.46, 95% confidence interval=1.10–1.92, P=0.008). In the present study, the presence of squamous and/or glandular differentiation was associated with a higher recurrence rate and shorter RFS time in patients with NMIUCB. Squamous and/or glandular differentiation is therefore an independent prognostic predictor of recurrence.
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Affiliation(s)
- Hao Xu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Linguo Xie
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Xiaoteng Liu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Yu Zhang
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Zhonghua Shen
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Tao Chen
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Xiaoyu Qiu
- College of Management and Economics, Tianjin University, Nankai, Tianjin 300072, P.R. China
| | - Nan Sha
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Chen Xing
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Zhouliang Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Hailong Hu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Changli Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
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29
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Orré M, Latorzeff I, Fléchon A, Roubaud G, Brouste V, Gaston R, Piéchaud T, Richaud P, Chapet O, Sargos P. Adjuvant radiotherapy after radical cystectomy for muscle-invasive bladder cancer: A retrospective multicenter study. PLoS One 2017; 12:e0174978. [PMID: 28384195 PMCID: PMC5383060 DOI: 10.1371/journal.pone.0174978] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/19/2017] [Indexed: 12/03/2022] Open
Abstract
Objectives Radical cystectomy (RC) and pelvic lymph-node dissection (LND) is standard treatment for non-metastatic muscle-invasive urothelial bladder cancer (MIBC). However, loco-regional recurrence (LRR) is a common early event associated with poor prognosis. We evaluate 3-year LRR-free (LRRFS), metastasis-free (MFS) and overall survivals (OS) after adjuvant radiotherapy (RT) for pathological high-risk MIBC. Material and methods We retrospectively reviewed data from patients in 3 institutions. Inclusion criteria were MIBC, histologically-proven urothelial carcinoma treated by RC and adjuvant RT. Patients with conservative surgery were excluded. Outcomes were evaluated by Kaplan-Meier method. Acute toxicities were recorded according to CTCAE V4.0 scale. Results Between 2000 and 2013, 57 patients [median age 66.3 years (45–84)] were included. Post-operative pathological staging was ≤pT2, pT3 and pT4 in 16%, 44%, and 39%, respectively. PLND revealed 28% pN0, 26% pN1 and 42% pN2. Median number of lymph-nodes retrieved was 10 (2–33). Forty-eight patients (84%) received platin-based chemotherapy. For RT, clinical target volume 1 (CTV 1) encompassed pelvic lymph nodes for all patients. CTV 1 also included cystectomy bed for 37 patients (65%). CTV 1 median dose was 45 Gy (4–50). A boost of 16 Gy (5–22), corresponding to CTV 2, was administered for 30 patients, depending on pathological features. One third of patients received intensity-modulated RT. With median follow-up of 40.4 months, 8 patients (14%) had LRR. Three-year LRRFS, MFS and OS were 45% (95%CI 30–60), 37% (95%CI 24–51) and 49% (95%CI 33–63), respectively. Five (9%) patients had acute grade ≥3 toxicities (gastro-intestinal, genito-urinary and biological parameters). One patient died with intestinal fistula in a septic context. Conclusions Because of poor prognosis, an effective post-operative standard of care is needed for pathological high-risk MIBC. Adjuvant RT is feasible and may have oncological benefits. Prospective trials evaluating this approach with current RT techniques should be undertaken.
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Affiliation(s)
- Mathieu Orré
- Department of Radiotherapy, Institut Bergonié, Bordeaux,France
| | - Igor Latorzeff
- Department of Radiotherapy, Groupe Oncorad Garonne, Clinique Pasteur, Toulouse, France
| | - Aude Fléchon
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Véronique Brouste
- Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France
| | - Richard Gaston
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Thierry Piéchaud
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France
| | - Pierre Richaud
- Department of Radiotherapy, Institut Bergonié, Bordeaux,France
| | - Olivier Chapet
- Department of Radiotherapy, CHU de Lyon-Sud, Lyon, France
| | - Paul Sargos
- Department of Radiotherapy, Institut Bergonié, Bordeaux,France
- * E-mail:
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Reddy AV, Christodouleas JP, Wu T, Smith ND, Steinberg GD, Liauw SL. External Validation and Optimization of International Consensus Clinical Target Volumes for Adjuvant Radiation Therapy in Bladder Cancer. Int J Radiat Oncol Biol Phys 2017; 97:740-746. [DOI: 10.1016/j.ijrobp.2016.11.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 11/16/2022]
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Baumann BC, Sargos P, Eapen LJ, Efstathiou JA, Choudhury A, Bahl A, Murthy V, Ballas LK, Fonteyne V, Richaud PM, Zaghloul MS, Christodouleas JP. The Rationale for Post-Operative Radiation in Localized Bladder Cancer. Bladder Cancer 2017; 3:19-30. [PMID: 28149931 PMCID: PMC5271478 DOI: 10.3233/blc-160081] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Local-regional recurrence for patients with ≥pT3 disease after radical cystectomy is a significant problem. Chemotherapy has not been shown to reduce the risk of local-regional recurrences in randomized prospective trials, and salvage therapies for local-regional failure are rarely successful. There is promising evidence, particularly from a recent Egyptian NCI trial, that radiation therapy plus chemotherapy can significantly reduce local recurrences compared to chemotherapy alone, and that this improvement in local-regional control may translate to meaningful improvements in disease-free and overall survival with acceptable toxicity. In light of the high rates of local failure following cystectomy for locally advanced disease and the progress that has been made in identifying patients at high risk of failure and the patterns of failure in the pelvis, the NCCN guidelines were revised in 2016 to include post-operative radiotherapy as an option to consider for patients with ≥pT3 disease. Despite advances in our understanding of the problem of local-regional failure after cystectomy and the potential role of adjuvant radiotherapy, the question of whether adjuvant radiotherapy should have a defined role for patients with locally advanced urothelial carcinoma has not yet been determined. The results of the NRG, European, Indian, and Egyptian trials on adjuvant radiotherapy are eagerly awaited. While none of these trials on their own may provide definitive conclusions, their aggregate outcomes will help clarify whether this treatment should have a role in the management of patients with locally advanced bladder cancer.
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Affiliation(s)
- Brian C Baumann
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA; Washington University in Saint Louis, Saint Louis, MO, USA
| | | | | | | | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust , Bristol, UK
| | | | | | | | | | - Mohamed S Zaghloul
- National Cancer Institute, Cairo University, Cairo, Egypt; Children's Cancer Hospital, Cairo, Egypt
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Chung AD, Schieda N, Flood TA, Cagiannos I, Mai KT, Malone S, Morash C, Hakim SW, Breau RH. Plasmacytoid urothelial carcinoma (PUC): Imaging features with histopathological correlation. Can Urol Assoc J 2017; 11:E50-E57. [PMID: 28163816 DOI: 10.5489/cuaj.3789] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Plasmacytoid urothelial carcinoma (PUC) is a high-grade variant of conventional urothelial cell carcinoma. This study is the first to describe the imaging findings of PUC, which are previously unreported, using clinical and histopathological correlation. METHODS With internal review board approval, we identified 22 consecutive patients with PUC from 2007-2014. Clinical parameters, including age, gender, therapy, surgical margins, and long-term outcome, were recorded. Baseline imaging was reviewed by an abdominal radiologist who evaluated for tumour detectability/location/morphology, local staging, and presence/location of metastases. Pelvic peritoneal spread of tumour (defined as >5mm thick soft tissue spreading along fascial planes) was also evaluated. Followup imaging was reviewed for presence of local recurrence or metastases. RESULTS Median age at presentation was 74 years (range 51-86), with only three female patients. Imaging features of the primary tumour in this study were not unique for PUC. Muscle-invasive disease was present on pathology in 19/22 (86%) of tumours, with distant metastases in 2/22 (9%) at baseline imaging. Pelvic peritoneal spread of tumour was radiologically present in 4/20 (20%) at baseline. During followup, recurrent/residual tumour was documented in 16/22 (73%) patients and 7/16 (44%) patients eventually developed distant metastases. Median time to disease recurrence in patients who underwent curative surgery was three months (range 0-19). CONCLUSIONS PUC is an aggressive variant of urothelial carcinoma with poor prognosis. Pelvic peritoneal spread of tumour as thick sheets extending along fascial planes may represent a characteristic imaging finding of locally advanced PUC.
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Affiliation(s)
- Andrew D Chung
- Department of Medical Imaging; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Schieda
- Department of Medical Imaging; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ilias Cagiannos
- Department of Surgery, Division of Urology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Kien T Mai
- Department of Anatomical Pathology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Shawn Malone
- Department of Radiation Oncology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Christopher Morash
- Department of Surgery, Division of Urology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Shaheed W Hakim
- Department of Anatomical Pathology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- Department of Surgery, Division of Urology; The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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Yang R, Liu M, Liang H, Guo S, Guo X, Yuan M, Lian H, Yan X, Zhang S, Chen X, Fang F, Guo H, Zhang C. miR-138-5p contributes to cell proliferation and invasion by targeting Survivin in bladder cancer cells. Mol Cancer 2016; 15:82. [PMID: 27978829 PMCID: PMC5159976 DOI: 10.1186/s12943-016-0569-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/07/2016] [Indexed: 01/08/2023] Open
Abstract
Background Survivin (encoded by the gene BIRC5) plays an important role in the carcinogenesis of bladder cancer. Identifying miRNAs that target Survivin in the setting of bladder cancer will help to develop Survivin-based therapies for bladder cancer. Methods The expression levels of miR-138-5p and Survivin protein were measured in 12 resected bladder cancer specimens. The correlation between miR-138-5p and Survivin was further examined by evaluating Survivin expression in human bladder cancer cell lines that either overexpressed or knocked down miR-138-5p. A luciferase reporter assay was performed to test the direct binding of miR-138-5p to the target gene BIRC5. We also investigated the biological role of miR-138-5p targeting to Survivin in bladder cancer cell lines both in vivo and in vitro. Results In this study, we found that the Survivin protein was either absent or weakly expressed in normal adjacent tissues and consistently up-regulated in bladder cancer tissues; however, the mRNA levels did not vary as much, suggesting that a post-transcriptional mechanism was involved. Because microRNAs are powerful post-transcriptional regulators of gene expression, we used bioinformatic analyses to search for microRNAs that could potentially target BIRC5 in the setting of bladder cancer. We identified 2 specific targeting sites for miR-138-5p in the 3′ untranslated region (3′-UTR) of BIRC5. We further identified an inverse correlation between miR-138-5p and Survivin protein levels in bladder cancer tissue samples. By overexpressing or knocking down miR-138-5p in bladder cancer cells, we experimentally confirmed that miR-138-5p directly recognizes the 3′-UTR of the BIRC5 transcript and regulates Survivin expression. Furthermore, the biological consequences of the targeting of BIRC5 by miR-138-5p were examined in vitro via cell proliferation and invasion assays and in vivo using a mouse xenograft tumor model. We demonstrated that BIRC5 repression by miR-138-5p suppressed the proliferative and invasive characteristics of bladder cancer cells and that miR-138-5p exerted an anti-tumor effect by negatively regulating BIRC5 in a xenograft mouse model. Conclusions Taken together, our findings provide the first clues regarding the role of miR-138-5p as a tumor suppressor in bladder cancer by inhibiting BIRC5 translation. Electronic supplementary material The online version of this article (doi:10.1186/s12943-016-0569-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rong Yang
- Department of Urology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.,Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
| | - Minghui Liu
- Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
| | - Hongwei Liang
- Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
| | - Suhan Guo
- School of Public Health, Nanjing Medical University, 101 longmian Avenue, Nanjing, Jiangsu, 211166, China
| | - Xu Guo
- Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
| | - Min Yuan
- Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
| | - Huibo Lian
- Department of Urology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Xiang Yan
- Department of Urology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Shiwei Zhang
- Department of Urology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China
| | - Xi Chen
- Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China.
| | - Feng Fang
- Department of Pharmacology, Nanjing Medical University, 101 longmian Avenue, Nanjing, Jiangsu, 211166, China.
| | - Hongqian Guo
- Department of Urology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, Jiangsu, 210008, China.
| | - Chenyu Zhang
- Jiangsu Engineering Research Center for microRNA Biology and Biotechnology, State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, 210093, China
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Maj M, Bajek A, Nalejska E, Porowinska D, Kloskowski T, Gackowska L, Drewa T. Influence of Mesenchymal Stem Cells Conditioned Media on Proliferation of Urinary Tract Cancer Cell Lines and Their Sensitivity to Ciprofloxacin. J Cell Biochem 2016; 118:1361-1368. [DOI: 10.1002/jcb.25794] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/14/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Malgorzata Maj
- Chair of Urology, Department of Tissue Engineering; Collegium Medicum; Nicolaus Copernicus University; Karlowicza 24 85-092 Bydgoszcz Poland
| | - Anna Bajek
- Chair of Urology, Department of Tissue Engineering; Collegium Medicum; Nicolaus Copernicus University; Karlowicza 24 85-092 Bydgoszcz Poland
| | - Ewelina Nalejska
- Chair of Urology, Department of Tissue Engineering; Collegium Medicum; Nicolaus Copernicus University; Karlowicza 24 85-092 Bydgoszcz Poland
| | - Dorota Porowinska
- Department of Biochemistry; Nicolaus Copernicus University; Gagarina 7 87-100 Torun Poland
| | - Tomasz Kloskowski
- Chair of Urology, Department of Regenerative Medicine; Collegium Medicum, Nicolaus Copernicus University; Sklodowskiej-Curie 9 85-094 Bydgoszcz Poland
| | - Lidia Gackowska
- Department of Immunology; Collegium Medicum; Nicolaus Copernicus University; Sklodowskiej-Curie 9 85-094 Bydgoszcz Poland
| | - Tomasz Drewa
- Chair of Urology, Clinic of General and Oncological Urology; Collegium Medicum, Nicolaus Copernicus University; Sklodowskiej-Curie 9 85-094 Bydgoszcz Poland
- Department of Urology; Nicolaus Copernicus Hospital; Batorego 17/19 87-100 Torun Poland
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Satkunasivam R, Wallis CJD, Nam RK, Desai M, Gill IS. Contemporary evidence for robot-assisted radical cystectomy for treating bladder cancer. Nat Rev Urol 2016; 13:533-9. [DOI: 10.1038/nrurol.2016.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Patterns and prognostic significance of clinical recurrences after radical cystectomy for bladder cancer: A 20-year single center experience. Eur J Surg Oncol 2016; 42:735-43. [DOI: 10.1016/j.ejso.2016.02.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/30/2016] [Accepted: 02/11/2016] [Indexed: 11/20/2022] Open
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MicroRNA-542-3p suppresses cellular proliferation of bladder cancer cells through post-transcriptionally regulating survivin. Gene 2016; 579:146-52. [DOI: 10.1016/j.gene.2015.12.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 12/09/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022]
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Patterns of Failure After Radical Cystectomy for pT3-4 Bladder Cancer: Implications for Adjuvant Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 94:1031-9. [DOI: 10.1016/j.ijrobp.2015.10.051] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 10/16/2015] [Accepted: 10/26/2015] [Indexed: 11/17/2022]
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Kitajima K, Yamamoto S, Fukushima K, Yamakado K, Katsuura T, Igarashi Y, Kawanaka Y, Mouri M, Hirota S. FDG-PET/CT as a post-treatment restaging tool in urothelial carcinoma: Comparison with contrast-enhanced CT. Eur J Radiol 2016; 85:593-8. [DOI: 10.1016/j.ejrad.2015.12.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 11/25/2022]
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Al-Marrawi MY, Mackley HB, Ali S, Wagner H, Joshi M, Holder S, Kaag M, Mallon C, Talamo G, Drabick JJ. Consolidation With Radiation or Concurrent Chemo-Radiation After Chemotherapy Results in Durable Complete Remissions of Isolated Nodal Recurrences of Urothelial Cancer: A Case Series and Review. Clin Genitourin Cancer 2016; 14:e393-9. [PMID: 26877063 DOI: 10.1016/j.clgc.2016.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mhd Yaser Al-Marrawi
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA.
| | - Heath B Mackley
- Division of Radiation Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Suhail Ali
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Henry Wagner
- Division of Radiation Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Monika Joshi
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Sheldon Holder
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Mathew Kaag
- Division of Urological Surgery, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Carol Mallon
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Giampaolo Talamo
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Joseph J Drabick
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
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Warrick JI, Kaag M, Raman JD, Chan W, Tran T, Kunchala S, DeGraff D, Chen G. Squamous Dysplasia of the Urinary Bladder. Int J Surg Pathol 2016; 24:306-14. [DOI: 10.1177/1066896916629783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Squamous dysplasia of the urinary bladder is uncommon and may represent a precursor to invasive squamous cell carcinoma. Though significant focus has been devoted to squamous differentiation in invasive bladder cancer, relatively little attention has been given to squamous dysplasia. We methodically reviewed microscopic slides from a consecutive cystectomy series at our institution (n = 303; 2001-2014), with special attention given to squamous dysplasia and squamous differentiation within association invasive carcinoma. Of these 303 cases, 3% (9 cases) had squamous dysplasia. The majority (89%; 8/9) had a similar morphological appearance to squamous dysplasia of the head and neck (ie, cytological atypia, architectural disturbances, and abnormal keratinization). Invasive carcinoma was present in 230 of the cystectomy cases. Of these 230 cases with invasive carcinoma, 4% (8 cases) also had squamous dysplasia. The invasive carcinoma had evidence of squamous differentiation in all cases with concurrent squamous dysplasia. Concurrent flat urothelial carcinoma in situ was present in 3 of the 8 cases with both invasive carcinoma and squamous dysplasia. Squamous dysplasia was not associated with clinical outcomes data, including death from bladder cancer and bladder cancer recurrence. The data from this study indicate that squamous dysplasia is uncommon in the cystectomy setting, frequently has the morphology of head and neck dysplasia, and is often associated with invasive carcinoma with squamous differentiation.
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Affiliation(s)
- Joshua I. Warrick
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Matthew Kaag
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jay D. Raman
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Wilson Chan
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Truc Tran
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sudhir Kunchala
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - David DeGraff
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Guoli Chen
- Penn State University School of Medicine and Milton S. Hershey Medical Center, Hershey, PA, USA
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Systemic Inflammatory Response Based on Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker in Bladder Cancer. DISEASE MARKERS 2016; 2016:8345286. [PMID: 26880857 PMCID: PMC4736380 DOI: 10.1155/2016/8345286] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/04/2015] [Indexed: 12/18/2022]
Abstract
A growing body of evidence suggests that systemic inflammatory response (SIR) in the tumor microenvironment is closely related to poor oncologic outcomes in cancer patients. Over the past decade, several SIR-related hematological factors have been extensively investigated in an effort to risk-stratify cancer patients to improve treatment selection and to predict posttreatment survival outcomes in various types of cancers. In particular, one readily available marker of SIR is neutrophil-to-lymphocyte ratio (NLR), which can easily be measured on the basis of absolute neutrophils and absolute lymphocytes in a differential white blood cell count performed in the clinical setting. Many investigators have vigorously assessed NLR as a potential prognostic biomarker predicting pathological and survival outcomes in patients with urothelial carcinoma (UC) of the bladder. In this paper, we aim to present the prognostic role of NLR in patients with UC of the bladder through a thorough review of the literature.
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Andrew AS, Marsit CJ, Schned AR, Seigne JD, Kelsey KT, Moore JH, Perreard L, Karagas MR, Sempere LF. Expression of tumor suppressive microRNA-34a is associated with a reduced risk of bladder cancer recurrence. Int J Cancer 2015; 137:1158-66. [PMID: 25556547 PMCID: PMC4485975 DOI: 10.1002/ijc.29413] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 12/20/2022]
Abstract
Bladder cancer is the fourth most common cancer among men in the United States and more than half of patients experience recurrences within 5 years after initial diagnosis. Additional clinically informative and actionable biomarkers of the recurrent bladder cancer phenotypes are needed to improve screening and molecular therapeutic approaches for recurrence prevention. MicroRNA-34a (miR-34a) is a short noncoding regulatory RNA with tumor suppressive attributes. We leveraged our unique, large, population-based prognostic study of bladder cancer in New Hampshire, United States to evaluate miR-34a expression levels in individual tumor cells to assess prognostic value. We collected detailed exposure and medical history data, as well as tumor tissue specimens from bladder patients and followed them long-term for recurrence, progression and survival. Fluorescence-based in situ hybridization assays were performed on urothelial carcinoma tissue specimens (n = 229). A larger proportion of the nonmuscle invasive tumors had high levels of miR-34a within the carcinoma cells compared to those tumors that were muscle invasive. Patients with high miR-34a levels in their baseline nonmuscle invasive tumors experienced lower risks of recurrence (adjusted hazard ratio 0.57, 95% confidence interval 0.34-0.93). Consistent with these observations, we demonstrated a functional tumor suppressive role for miR-34a in cultured urothelial cells, including reduced matrigel invasion and growth in soft agar. Our results highlight the need for further clinical studies of miR-34a as a guide for recurrence screening and as a possible candidate therapeutic target in the bladder.
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Affiliation(s)
- Angeline S. Andrew
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Carmen J. Marsit
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Alan R. Schned
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - John D. Seigne
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Karl T. Kelsey
- Department of Epidemiology & Department of Pathology and Laboratory Medicine, Center for Environmental Health and Technology, Brown University, Providence, RI
| | - Jason H. Moore
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Laurent Perreard
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Margaret R. Karagas
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Lorenzo F. Sempere
- Center for Translational Medicine, Van Andel Research Institute, Grand Rapids, MI
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Raza SJ, Wilson T, Peabody JO, Wiklund P, Scherr DS, Al-Daghmin A, Dibaj S, Khan MS, Dasgupta P, Mottrie A, Menon M, Yuh B, Richstone L, Saar M, Stoeckle M, Hosseini A, Kaouk J, Mohler JL, Rha KH, Wilding G, Guru KA. Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2015; 68:721-8. [PMID: 25985883 DOI: 10.1016/j.eururo.2015.04.021] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/14/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. OBJECTIVE Report survival outcomes of patients who underwent RARC ≥5 yr ago. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. INTERVENTION RARC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. RESULTS AND LIMITATIONS Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p<0.001 and p<0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. CONCLUSIONS The largest multi-institutional series to date reported long-term survival outcomes after RARC. PATIENT SUMMARY Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.
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Affiliation(s)
| | - Timothy Wilson
- City of Hope and Beckman Research Institute, Duarte, CA, USA
| | | | | | | | | | - Shiva Dibaj
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | | | | | - Mani Menon
- Henry Ford Health System, Detroit, MI, USA
| | - Bertram Yuh
- City of Hope and Beckman Research Institute, Duarte, CA, USA
| | - Lee Richstone
- Arthur Smith Institute for Urology, New Hyde Park, NY, USA
| | | | | | | | - Jihad Kaouk
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Koon-Ho Rha
- Yonsei University Health Systems Severance Hospital, Seoul, Korea
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Orré M, Latorzeff I, Fléchon A, Xylinas E, Roubaud G, Chapet O, Richaud P, Sargos P. Radiothérapie périopératoire dans la prise en charge des tumeurs urothéliales infiltrantes de la vessie (TVIM) : une indication à reconsidérer ? ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
STUDY DESIGN Resident's case problem. BACKGROUND Groin pain represents a diagnostic challenge and requires a diagnostic process that rules out life-threatening illness or disease processes. Osteomyelitis is a potential fatal disease process that requires accurate diagnosis and medical management. Osteomyelitis presents a problem for the outpatient physical therapist, as the described physical findings for the diagnosis of osteomyelitis are nonspecific. DIAGNOSIS A 67-year-old man with groin and bilateral medial thigh pain was referred for physical therapy care to address right adductor weakness and generalized deconditioning. He had undergone extensive treatment for bladder cancer, with a recent radical cystoprostatectomy and cutaneous urinary diversion with an Indiana pouch. Postsurgical magnetic resonance imaging indicated normal findings, and the patient was currently being managed by an orthopaedic surgeon, who diagnosed the patient as having obturator nerve palsy. The physical therapist's examination produced findings inconsistent with this diagnosis. Subsequently, nuclear medicine studies revealed pubic symphysitis/osteomyelitis with secondary myositis, predominantly affecting the right adductor muscles. DISCUSSION Osteomyelitis represents a difficult problem for the outpatient physical therapist. Careful consideration of red-flag symptoms and inconclusive physical testing indicate the need for further medical work-up. In this case, appropriate medical management led to improvement in patient function, highlighting the need for early diagnosis. LEVEL OF EVIDENCE Differential diagnosis, level 4.
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Kucuk U, Pala EE, Cakır E, Sezer O, Bayol U, Divrik RT, Cakmak O. Clinical, demographic and histopathological prognostic factors for urothelial carcinoma of the bladder. Cent European J Urol 2015; 68:30-6. [PMID: 25914835 PMCID: PMC4408388 DOI: 10.5173/ceju.2015.01.465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/17/2014] [Accepted: 11/23/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Our aim is to evaluate the influence of clinical and histopathological parameters, including age, gender, tumor stage, grade, tumor differentiation, necrosis, lymphovascular/perineural invasion (LVI/PNI) and concomitant carcinoma in situ (CIS), on outcomes of patients with urothelial carcinoma of the bladder (UCB). MATERIAL AND METHODS A total of 84 patients who underwent radical cystectomy (RC) (n = 11) and radical cystoprostatectomy (n = 73) for muscle-invasive bladder cancer at our hospital between 2007-2013, were included in the study. RESULTS The mean age of patients at diagnosis was 66.1, of whom 75 were males and 9 were females. Of the 84 patients, 38 were ≤65 years and 46 were >65 years. Mean tumor diameter was 3.66 cm. There were 38 cases which showed divergent differentiations. Concomitant CIS was observed in 30 tumors, 41 cases showed tumor necrosis, 44 PNI and 61 LVI. The rate of overall survival (OS) in patients aged ≤65 years was statistically significantly higher than in those aged >65 years. A negative statistical relationship was found between OS with lymph node metastasis (LNM) and tumor differentiation. On the other hand, necrosis did not remain significant on multivariate analysis. No statistically significant relationship was found between smoking, tumor stage, PNI, LVI and concomitant CIS and OS. CONCLUSIONS In this study, advanced age, LNM, tumor differentiation were found to be independent prognostic risk factors associated with OS after RC. These additional factors, which may explain the different clinical course in patients with similar tumor stage and lymph node status, should be taken into consideration in treatment planning.
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Affiliation(s)
- Ulku Kucuk
- Izmir Tepecik Research and Training Hospital, Department of Pathology, Izmir, Turkey
| | - Emel Ebru Pala
- Izmir Tepecik Research and Training Hospital, Department of Pathology, Izmir, Turkey
| | - Ebru Cakır
- Izmir Tepecik Research and Training Hospital, Department of Pathology, Izmir, Turkey
| | - Ozlem Sezer
- Izmir Tepecik Research and Training Hospital, Department of Pathology, Izmir, Turkey
| | - Umit Bayol
- Izmir Tepecik Research and Training Hospital, Department of Pathology, Izmir, Turkey
| | - Rauf Taner Divrik
- Sifa Universitiy Medical Faculty, Department of Urology, Izmir, Turkey
| | - Ozgur Cakmak
- Izmir Tepecik Research and Training Hospital, Department of Urology, Izmir, Turkey
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Pietzak EJ, Sterling ME, Smith ZL, Malkowicz SB, Guzzo TJ. Outcomes of radical cystectomy in potential candidates for bladder preservation therapy. Urology 2015; 85:869-75. [PMID: 25681831 DOI: 10.1016/j.urology.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/15/2014] [Accepted: 01/03/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the outcomes of patients with urothelial-type bladder cancer (UBC) who optimally met selection criteria for bladder preservation therapy (BPT) but were treated with radical cystectomy (RC) instead. METHODS We identified consecutive patients with clinical stage cT2N0M0 UBC who underwent RC with curative intent at our center. Patients without carcinoma in situ, hydronephrosis, multifocality, or mixed histology were classified as BPT eligible. Patients with ≥1 contraindications were considered BPT ineligible. Clinicopathologic characteristics and survival outcomes for BPT-eligible patients were compared with those of the ineligible patients. RESULTS Of the 275 patients who had cT2N0M0 UBC, 157 (57.1%) were BPT ineligible (carcinoma in situ = 54; hydronephrosis = 77; multifocality = 29; mixed histology = 55; ≥2 contraindications = 51). BPT-eligible and -ineligible patients did not statistically differ with regard to age, sex, race, or neoadjuvant chemotherapy. Of the BPT-eligible patients, 24.1% had occult positive lymph nodes and 36.4% had pT3 or pT4 tumors at RC. On multivariate analysis, mixed histology (odds ratio = 3.18; 95% confidence interval [CI], 1.18-8.56) and progression from noninvasive disease to cT2 (odds ratio = 4.81 [95% CI, 1.67-13.85]) were independently associated with upstaging. Two-year overall survival was higher in BPT-eligible patients (76.7% vs 57.1%; P = .003; hazard ratio = 0.48 [95% CI, 0.3-0.78]). BPT-eligible patients also had better cancer-specific mortality on competing risk analysis (sub-hazard ratio = 0.46 [95% CI = 0.29-0.72]; P = .001). CONCLUSION Substantial clinicopathologic stage discrepancies occurred even in patients seemingly ideal for BPT, which may provide insight into BPT failures. Furthermore, substantial survival discrepancies existed for BPT-eligible and BPT-ineligible patients, underscoring the heterogeneity of cT2 disease. In the absence of randomized trials, comparisons between RC and BPT must factor in selection bias.
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Affiliation(s)
- Eugene J Pietzak
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Matthew E Sterling
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - S Bruce Malkowicz
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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Novotny V, Froehner M, May M, Protzel C, Hergenröther K, Rink M, Chun FK, Fisch M, Roghmann F, Palisaar RJ, Noldus J, Gierth M, Fritsche HM, Burger M, Sikic D, Keck B, Wullich B, Nuhn P, Buchner A, Stief CG, Vallo S, Bartsch G, Haferkamp A, Bastian PJ, Hakenberg OW, Propping S, Aziz A. Risk stratification for locoregional recurrence after radical cystectomy for urothelial carcinoma of the bladder. World J Urol 2015; 33:1753-61. [DOI: 10.1007/s00345-015-1502-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/25/2015] [Indexed: 10/24/2022] Open
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Andrew AS, Gui J, Hu T, Wyszynski A, Marsit CJ, Kelsey KT, Schned AR, Tanyos SA, Pendleton EM, Ekstrom RM, Li Z, Zens MS, Borsuk M, Moore JH, Karagas MR. Genetic polymorphisms modify bladder cancer recurrence and survival in a USA population-based prognostic study. BJU Int 2015; 115:238-47. [PMID: 24666523 PMCID: PMC4533837 DOI: 10.1111/bju.12641] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To identify genetic variants that modify bladder cancer prognosis focusing on genes involved in major biological carcinogenesis processes (apoptosis, proliferation, DNA repair, hormone regulation, immune surveillance, and cellular metabolism), as nearly half of patients with bladder cancer experience recurrences reliable predictors of this recurrent phenotype are needed to guide surveillance and treatment. PATIENTS AND METHODS We analysed variant genotypes hypothesised to modify these processes in 563 patients with urothelial-cell carcinoma enrolled in a population-based study of incident bladder cancer conducted in New Hampshire, USA. After diagnosis, patients were followed over time to ascertain recurrence and survival status, making this one of the first population-based studies with detailed prognosis data. Cox proportional hazards regression was used to assess the relationship between single nucleotide polymorphisms (SNPs) and prognosis endpoints. RESULTS Patients with aldehyde dehydrogenase 2 (ALDH2) variants had a shorter time to first recurrence (adjusted non-invasive hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.29-2.78). There was longer survival among patients with non-invasive tumours associated with DNA repair X-ray repair cross-complementing protein 4 (XRCC4) heterozygous genotype compared with wild-type (adjusted HR 0.53, 95% CI 0.38-0.74). Time to recurrence was shorter for patients who had a variant allele in vascular cellular adhesion molecule 1 (VCAM1) and were treated with immunotherapy (P interaction < 0.001). CONCLUSIONS Our analysis suggests candidate prognostic SNPs that could guide personalised bladder cancer surveillance and treatment.
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Affiliation(s)
| | - Jiang Gui
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Ting Hu
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Asaf Wyszynski
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Carmen J. Marsit
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Karl T. Kelsey
- Epidemiology and Pathology and Laboratory Medicine Brown University Providence, RI 02912
| | - Alan R. Schned
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Sam A. Tanyos
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Eben M. Pendleton
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | | | - Zhongze Li
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Michael S. Zens
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Mark Borsuk
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
| | - Jason H. Moore
- Norris Cotton Cancer Center Geisel School of Medicine Lebanon, NH 03756
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