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Antar RM, Xu VE, Adesanya O, Drouaud A, Longton N, Gordon O, Youssef K, Kfouri J, Azari S, Tafuri S, Goddard B, Whalen MJ. Income Disparities in Survival and Receipt of Neoadjuvant Chemotherapy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer. Curr Oncol 2024; 31:2566-2581. [PMID: 38785473 PMCID: PMC11119047 DOI: 10.3390/curroncol31050192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Muscle-invasive bladder cancer (MIBC) is a potentially fatal disease, especially in the setting of locally advanced or node-positive disease. Adverse outcomes have also primarily been associated with low-income status, as has been reported in other cancers. While the adoption of neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (RC) and pelvic lymph node dissection (PLND) has improved outcomes, these standard-of-care treatments may be underutilized in lower-income patients. We sought to investigate the economic disparities in NAC and PLND receipt and survival outcomes in MIBC. Methods: Utilizing the National Cancer Database, a retrospective cohort analysis of cT2-4N0-3M0 BCa patients with urothelial histology who underwent RC was conducted. The impact of income level on overall survival (OS) and the likelihood of receiving NAC and PLND was evaluated. Results: A total of 25,823 patients were included. This study found that lower-income patients were less likely to receive NAC and adequate PLND (≥15 LNs). Moreover, lower-income patients exhibited worse OS (Median OS 55.9 months vs. 68.2 months, p < 0.001). Our findings also demonstrated that higher income, treatment at academic facilities, and recent years of diagnosis were associated with an increased likelihood of receiving standard-of-care modalities and improved survival. Conclusions: Even after controlling for clinicodemographic variables, income independently influenced the receipt of standard MIBC treatments and survival. Our findings identify an opportunity to improve the quality of care for lower-income MIBC patients through concerted efforts to regionalize multi-modal urologic oncology care.
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Affiliation(s)
- Ryan M. Antar
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Vincent E. Xu
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | | | - Arthur Drouaud
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Noah Longton
- College of Medicine, Drexel University, Philadelphia, PA 19104, USA;
| | - Olivia Gordon
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Kirolos Youssef
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Jad Kfouri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sarah Azari
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sean Tafuri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Briana Goddard
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Michael J. Whalen
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
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Huelster HL, Mason NT, Davaro F, Naqvi SMH, Kim Y, Gilbert SM. Cost-utility of Initial Management of High-grade T1 Bladder Cancer With Intravesical BCG vs Immediate Radical Cystectomy. Urology 2024; 187:106-113. [PMID: 38467285 DOI: 10.1016/j.urology.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/27/2024] [Accepted: 02/21/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To compare the cost-utility of initial management of high-grade T1 non-muscle invasive bladder cancer (HGT1 NMIBC) with intravesical BCG vs immediate radical cystectomy. High-risk NMIBC patients may climb a costly ladder of treatments, culminating in radical cystectomy for oncologic or symptomatic benefit in up to one-third. This high healthcare resource utilization presents a challenging dilemma in balancing sufficiently aggressive management with cost, toxicity, and quality-of-life. METHODS Cost-utility of initially managing HGT1 with intravesical BCG and early radical cystectomy with ileal conduit urinary diversion was compared using decision-analytic Markov models. Five-year oncologic outcomes, adverse event rates, and published utility values were extracted from literature. Costs were calculated from a US Medicare perspective in 2021 US dollars. Sensitivity analysis identified drivers of cost and break-even points for recurrence and progression. RESULTS Mean costs were $26,093 for intravesical BCG and $39,720 for immediate radical cystectomy, though cystectomy generated a gain of 2.2 quality-adjusted life years (QALYs) compared to intravesical BCG. Immediate cystectomy was a more cost-effective management strategy for HGT1 NMIBC with an incremental CE ratios (ICER) of $7120/QALY. The costs associated with cystectomy, TURBT, and BCG toxicity had the greatest impact on ICER. One-way sensitivity analysis demonstrated that intravesical BCG became a cost-effective management strategy if the 5-year recurrence rate of HG T1 was less than 56% or the 5-year progression rate to MIBC was less than 4%. CONCLUSION At current prices, treatment of high-grade T1 NMIBC with early radical cystectomy is more cost-effective management strategy than initial treatment with intravesical BCG.
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Affiliation(s)
- Heather L Huelster
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Department of Urology, Indiana University Health, Indianapolis, IN.
| | - Neil T Mason
- Department of Individualized Cancer Medicine, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Facundo Davaro
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Youngchul Kim
- Department of Biostatistics, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Fan Z, Deng J, Wang Y, Fan X, Xie J. Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection. Vaccines (Basel) 2024; 12:150. [PMID: 38400134 PMCID: PMC10893107 DOI: 10.3390/vaccines12020150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
Bladder cancer, a common malignancy of the urinary system, is routinely treated with radiation, chemotherapy, and surgical excision. However, these strategies have inherent limitations and may also result in various side effects. Immunotherapy has garnered considerable attention in recent years as a novel therapeutic approach. It harnesses and activates the patient's immune system to recognize and eliminate cancer cells, which not only prolongs therapeutic efficacy but also minimizes the toxic side effects. Several immune checkpoint inhibitors and cancer vaccines have been developed for the treatment of bladder cancer. Whereas blocking immune checkpoints on the surface of tumor cells augments the effect of immune cells, immunization with tumor-specific antigens can elicit the production of anti-tumor immune effector cells. However, there are several challenges in applying immunotherapy against bladder cancer. For instance, the efficacy of immunotherapy varies considerably across individual patients, and only a small percentage of cancer patients are responsive. Therefore, it is crucial to identify biomarkers that can predict the efficacy of immunotherapy. Pelvic lymph nodes are routinely dissected from bladder cancer patients during surgical intervention in order to remove any metastatic tumor cells. However, some studies indicate that pelvic lymph node dissection may reduce the efficacy of immunotherapy by damaging the immune cells. Therefore, the decision to undertake pelvic lymph node removal should be incumbent on the clinical characteristics of individual patients. Thus, although immunotherapy has the advantages of lower toxic side effects and long-lasting efficacy, its application in bladder cancer still faces challenges, such as the lack of predictive biomarkers and the effects of pelvic lymph node dissection. Further research is needed to explore these issues in order to improve the efficacy of immunotherapy for bladder cancer.
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Affiliation(s)
- Zhongru Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Junpeng Deng
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Yutao Wang
- Department of Urology, Peking Union Medical Hospital, Beijing 100005, China
| | - Xin Fan
- Department of Radiology, The Second Affiliated Hospital of Dalian, Medical University, Dalian 116044, China
| | - Jianjun Xie
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
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Huang L, Jia K, Yao K, Liu D, Xu Y, Liu Q. Effect of neoadjuvant chemotherapy on survival in patients with T1 high-grade non-muscle-invasive bladder cancer who underwent radical cystectomy. Medicine (Baltimore) 2023; 102:e34501. [PMID: 37543821 PMCID: PMC10402986 DOI: 10.1097/md.0000000000034501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2023] Open
Abstract
Patients with non-muscle-invasive bladder cancer (NMIBC) who are at high and very high risk of disease progression are recommended for radical cystectomy (RC). However, the impact of neoadjuvant chemotherapy (NAC) on survival outcomes in NMIBC patients undergoing RC remains unclear. Patients diagnosed with T1 high-grade NMIBC who underwent RC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) was assessed using the Kaplan-Meier technique, and multivariable Cox regression analysis was conducted to determine the independent factors of OS. A total of 1268 T1 high-grade NMIBC patients who underwent RC between 2004 and 2015 were included in the study. NAC was administered to 76 (6.0%) patients. At a median follow-up of 75 months, there was no significant difference in the OS between the NAC and non-NAC groups (HR = 0.89, 95% CI 0.61-1.30, P = .539). However, in the multivariate Cox regression model, NAC demonstrated a more pronounced improvement in OS approaching statistical significance (HR = 0.7, 95% CI 0.47-1.05, P = .088). Subgroup analysis revealed a survival benefit of NAC in patients with lymph node metastasis. In summary, the results of this study suggest that NAC has the potential to confer a survival advantage in patients diagnosed with T1 high-grade NMIBC who undergo RC, but additional studies are needed. Nonetheless, the survival benefits of NAC in patients with lymph node involvement are apparent.
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Extent of lymph node dissection and impact on survival in radical cystectomy for advanced bladder cancer. Curr Opin Urol 2022; 32:607-613. [PMID: 36101521 DOI: 10.1097/mou.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In patients with muscle invasive bladder cancer (MIBC) or unresectable non-MIBC, radical cystectomy is routinely combined with bilateral pelvic lymph node dissection (LND) owing to the oncological benefits found in recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) compared with radical cystectomy alone. However, the optimal anatomic extent of LND is still unclear. RECENT FINDINGS Retrospective studies were consistent in reporting oncological benefits of extended LND over nonextended LND. A recent RCT (the LEA trial) failed to demonstrate any benefit in terms of RFS, CSS and OS of super-extended LND over standard LND. Several confounding factors hindered the interpretation of the results, leaving the question of the right extent for LND still open. Results of a similar study, the SWOG S1011 are, therefore, highly anticipated. This study differed from the LEA study in several aspects but might also turn out to be a negative study. SUMMARY There are still no firm data on the oncological benefit brought by more extended LND in patients with MIBC. Survival benefits seem limited, at least in the general population. Other factors could influence the impact of LND on survival, including the administration of adjuvant and neoadjuvant chemotherapies.
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Tang Y, Wu K, Li X. Contemporary use trends and effect on survival of pelvic lymph node dissection for non-muscle-invasive bladder cancer. Front Surg 2022; 9:961430. [PMID: 36034399 PMCID: PMC9403057 DOI: 10.3389/fsurg.2022.961430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Patients diagnosed with non-muscle-invasive bladder cancer (NMIBC) who are at a very high risk of disease progression and failure of Bacillus Calmette-Guerin treatment are recommended to undergo immediate radical cystectomy (RC). The role and optimal degree of pelvic lymph node dissection (PLND) during RC for NMIBC patients, however, have not been well investigated. Patients and methods The Surveillance, Epidemiology, and End Results (SEER) database was used to identify patients. Overall survival (OS) was assessed with the Kaplan–Meier technique. Multivariable Cox regression analysis was conducted to determine independent factors of OS. Results A total of 1,701 patients were identified in the SEER database from 2004 to 2015. Any level of PLND (>0 lymph nodes examined) was performed in 1,092 patients (64.2%). The median number of lymph nodes examined was 8 (interquartile range, 0–20) in T1, 0 (interquartile range, 0–11) in Ta, and 0 (interquartile range, 0–14) in Tia patients. Compared with non-PLND, any level of PLND improved OS in T1 but not in Ta or Tis patients. Compared to limited (1–9 lymph nodes examined) and non-PLND, extensive PLND (lymph nodes examined ≥10) resulted in better OS only in T1 patients (all p < 0.001, adjusted significance level = 0.017). PLND was identified as a independent protective factor for OS. Conclusion Based on the SEER database, we found that PLND during RC led to better OS and extensive PLND was associated with better OS in T1 but not in Ta or Tis patients. The implementation of PLND was insufficient both in population proportions and scope.
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Radiologic Diagnosis and Staging of Bladder Cancer: An Update. J Comput Assist Tomogr 2022; 46:530-544. [PMID: 35723651 DOI: 10.1097/rct.0000000000001322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although cystoscopic biopsy is the standard of care for initial diagnosis and local staging of bladder cancer, radiologic imaging plays a major role in identifying local invasion, nodal status, distant metastasis, and posttreatment surveillance. Recent development of the Vesical Imaging-Reporting and Data System for interpretation of multiparametric magnetic resonance imaging of the bladder has expanded the role diagnostic imaging in the management of bladder cancer. This article reviews multimodality imaging appearances, staging, and differential diagnosis of bladder cancer.
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Loh-Doyle JC, Bhanvadia SK, Han J, Ghodoussipour S, Cai J, Wayne K, Schuckman AK, Djaladat H, Daneshmand S. Patient Reported Sexual Function Outcomes in Male Patients Following Open Radical Cystoprostatectomy and Urinary Diversion. Urology 2021; 157:161-167. [PMID: 34298032 DOI: 10.1016/j.urology.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To report sexual health outcomes in male patients undergoing open radical cystoprostatectomy using a validated questionnaire. MATERIALS AND METHODS Beginning in 2017, male patients were asked to complete a validated questionnaire during scheduled post-cystectomy clinic visits that assessed sexual function using the 5 item International Index of Erectile Function (IIEF-5) and supplemental questions which evaluated libido, orgasm, partner interest, and adequacy of pre-operative counselling. Baseline data and functional outcomes were compared and multivariable analysis performed. RESULTS A total of 134 patients who met inclusion criteria completed the questionnaire. Pre-operative IIEF-5 was available in 78 patients with a median score of 16 (IQR:5-23). In those patients, median age at cystectomy was 68.9 years (IQR:60.2-72.4) and median duration of follow-up was 17.3 months (IQR:6.3-28.7). Median IIEF-5 score at time of survey completion was 1 (IQR:1-11). Increasing age, shorter follow-up duration, insufficient counselling, and absence of partner interest were predictive of lower scores. Younger age, pre-operative erectile function, and neurovascular preservation were predictive of a higher IIEF-5 score on univariate and multivariate analysis. Median libido score was 2 "low" (IQR:1-3) and ability to orgasm was reported by 34 (43.6%) patients. Neurovascular preservation (OR:3.03 95% CI:1.10-8.26, P = .03) and sufficient preoperative counselling (OR:3.078 95% CI:1.17-8.098, P = .02) were associated with preserved ability to orgasm. Libido was influenced by partner interest (OR 11.7, 95% CI:3.793-6.14, P <.0001). CONCLUSION Sexual dysfunction after radical cystoprostatectomy is prevalent with many contributing factors. As such, establishing appropriate expectations and goals during preoperative counseling, performing neurovascular preservation when appropriate, and readily identifying and treating dysfunction in follow-up may improve sexual recovery.
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Affiliation(s)
- Jeffrey C Loh-Doyle
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA.
| | - Sumeet K Bhanvadia
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jullet Han
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Saum Ghodoussipour
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jie Cai
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Kevin Wayne
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Anne K Schuckman
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Hooman Djaladat
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- Department of Urology, USC Institute of Urology, USC/Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA
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Lu H, Mei C, Yang L, Zheng J, Tong J, Duan F, Liang H, Hong L. PPM-18, an Analog of Vitamin K, Induces Autophagy and Apoptosis in Bladder Cancer Cells Through ROS and AMPK Signaling Pathways. Front Pharmacol 2021; 12:684915. [PMID: 34305598 PMCID: PMC8299005 DOI: 10.3389/fphar.2021.684915] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023] Open
Abstract
PPM-18, identified as a novel analog of vitamin K, has been reported to play a critical role in the suppression of seizures. However, the concerns that whether PPM-18, like vitamin K, exerts anticancer activity remain to be further investigated. Here, we found that PPM-18 remarkably suppressed the proliferation and induced apoptosis in bladder cancer cells. Furthermore, a significant autophagic effect of PPM-18 on bladder cancer cells was also demonstrated, which profoundly promoted apoptotic cell death. Mechanistically, PPM-18 activated AMP-activated protein kinase (AMPK), whereas it repressed PI3K/AKT and mTORC1 pathways in bladder cancer cells. Inhibition of AMPK markedly relieved PPM-18–induced autophagy and apoptosis, indicating that PPM-18 is able to induce autophagy and apoptosis in bladder cancer cells via AMPK activation. Moreover, reactive oxygen species (ROS) were notably accumulated in PPM-18–treated bladder cancer cells, and treatment with ROS scavengers not only eliminated ROS production but also abrogated AMPK activation, which eventually rescued bladder cancer cells from PPM-18–triggered autophagy and apoptotic cell death. In bladder cancer xenografts, the anticancer activities of PPM-18, including suppressing the growth of tumors and inducing autophagy and apoptosis in tumor cells, were also established. Collectively, this study was the first to demonstrate the anticancer effect of PPM-18 on bladder cancer cells in vitro and in vivo through eliciting autophagy and apoptosis via ROS and AMPK pathways, which might provide new insights into the potential utilization of PPM-18 for future bladder cancer treatment.
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Affiliation(s)
- Huiai Lu
- Department of Biology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China.,National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlei Mei
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Luhao Yang
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junyan Zheng
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwei Tong
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengsen Duan
- Department of Biology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
| | - Huageng Liang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Hong
- Department of Biology, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, China
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Packiam VT, Tsivian M, Boorjian SA. The evolving role of lymphadenectomy for bladder cancer: why, when, and how. Transl Androl Urol 2020; 9:3082-3093. [PMID: 33457281 PMCID: PMC7807370 DOI: 10.21037/tau.2019.06.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Radical cystectomy (RC) represents a standard treatment for non-metastatic muscle-invasive and select high-risk non-muscle invasive bladder cancer. Lymphadenectomy performed at time of RC identifies nodal metastases in up to 25% of patients despite normal imaging. There has been an increasing utilization of pelvic lymph node dissection (PLND) with RC since 1950, and in fact lymph node dissection is now recommended in contemporary National Comprehensive Cancer Network (NCCN) guidelines. Benefits of removing of nodal disease include improved staging, guidance for adjuvant treatment, and potentially improved oncologic outcomes. Advantages of dissection have been suggested among both node-negative and node-positive patients. Numerous studies have attempted to define the optimal dissection characteristics of lymphadenectomy with regard to nodal yield and anatomic boundaries of dissection. The ideal extent of lymphadenectomy remains uncertain due to the retrospective and non-randomized nature of the majority of existing reports, which are thereby limited by significant confounding and selection bias. Two randomized controlled trials have investigated this issue, one of which LEA AUO AB 25/02 recently reported its outcomes, demonstrating no significant improvement in 5-year outcomes with an extended dissection. Meanwhile, the Southwest Oncology Group 1011 trial has completed enrollment and data are maturing. While current data preclude definitive recommendations, herein we review the why, when, and how to perform a PLND for bladder cancer.
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Defant J, Huff S, Henningsen J, Krishnamurthy A. Long-Term Survival of Metastatic Bladder Cancer Treated With Chemotherapy, Radiation, and Arthroplasty: A Case Report. JBJS Case Connect 2020; 10:e2000098. [PMID: 32960019 DOI: 10.2106/jbjs.cc.20.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 64-year-old man suffered a pathologic left femoral neck fracture. Biopsy demonstrated metastatic urothelial cancer with a nonmuscle invasive bladder cancer primary confirmed by cystoscopy. The patient underwent hemiarthroplasty, chemotherapy, radiation, and eventually, a conversion to total hip arthroplasty. Today, over a decade from the initial surgery, the patient remains alive and highly functional. To our knowledge, this is the only report of bone metastatic bladder cancer with over 10-year survival. CONCLUSION Combined chemotherapy, radiation, and surgical resection of metastasis with reconstruction may confer a survival benefit in bony oligometastatic bladder cancer.
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Affiliation(s)
- John Defant
- 1Wright State University College of Medicine, Dayton, Ohio 2Department of Orthopedic Surgery, Wright State University, Miami Valley Hospital, Dayton, Ohio 3Department of Orthopedics, Dayton VA Medical Center, Dayton, Ohio
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Lenis AT, Lec PM, Michel J, Brisbane W, Golla V, Sharma V, Gollapudi K, Blumberg J, Chamie K. Predictors of adequate lymph node dissection in patients with non-muscle invasive bladder cancer undergoing radical cystectomy and effect on survival. Urol Oncol 2020; 38:796.e7-796.e14. [PMID: 32446641 DOI: 10.1016/j.urolonc.2020.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Radical cystectomy (RC) is the standard of care for refractory high-risk non-muscle invasive bladder cancer (NMIBC). We aim to identify predictors of adequate lymph node dissection (LND) in a cohort of NMIBC patients undergoing RC, as well as its impact on clinical outcomes. METHODS The National Cancer Database was queried for patients who underwent RC for urothelial cell carcinoma for clinical stage Tis/a/1 N0M0 disease between 2004 and 2013. Patients were stratified by LND: none, inadequate (<10) or adequate (≥10 nodes). Factors associated with LND were analyzed. Inverse-probability weighted propensity score matching was used to assess the impact of adequate LND on overall survival. RESULTS The final cohort of 3,226 patients had a median follow-up of 39.0 months, had a mean age of 65.3 years, was 70% male, and was 81% Caucasian. Overall, 16.6% received no LND, 28.5% inadequate LND, and 55.0% adequate LND. Treatment at an academic facility, Charlson-Deyo Comorbidity score of 1, and later year of treatment were significantly associated with adequate LND. Overall survival was significantly higher with adequate LND compared to a matched-cohort of inadequate LND patients (68.7% vs. 60.6% at 5 years, P < 0.01). CONCLUSIONS Nearly half of NMIBC patients undergoing RC do not receive an adequate LND, despite an association with increased overall survival. Treatment at an academic facility was associated with increased likelihood of adequate LND. Initiatives to improve adequate LND in this population may be warranted.
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Affiliation(s)
- Andrew T Lenis
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA.
| | - Patrick M Lec
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Joaquin Michel
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Wayne Brisbane
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Vishnukamal Golla
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Vidit Sharma
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
| | - Kiran Gollapudi
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremy Blumberg
- Division of Urology, Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA
| | - Karim Chamie
- Department of Urology, David Geffen School of Medicine, Institute of Urologic Oncology (IUO), University of California, Los Angeles, CA
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13
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Kamat AM, Shore N, Hahn N, Alanee S, Nishiyama H, Shariat S, Nam K, Kapadia E, Frenkl T, Steinberg G. KEYNOTE-676: Phase III study of BCG and pembrolizumab for persistent/recurrent high-risk NMIBC. Future Oncol 2020; 16:507-516. [PMID: 32162533 DOI: 10.2217/fon-2019-0817] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Nonmuscle-invasive bladder cancer (NMIBC) is the most common form of bladder cancer, with high rates of disease recurrence and progression. Current treatment for high-risk NMIBC involves Bacillus Calmette-Guérin (BCG) therapy, but treatment options are limited for patients with recurrent or BCG-unresponsive disease. Aberrant programmed death 1 signaling has been implicated in BCG resistance and bladder cancer recurrence and progression, and pembrolizumab has shown efficacy in patients with BCG-unresponsive high-risk NMIBC. Aim: To describe the rationale and design for the randomized, comparator-controlled Phase III KEYNOTE-676 study, which will evaluate the efficacy and safety of pembrolizumab in combination with BCG in patients with persistent/recurrent high-risk NMIBC after BCG induction therapy. Trial registration number: NCT03711032.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC 29572, USA
| | - Noah Hahn
- Department of Oncology & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Shaheen Alanee
- Department of Urology, Henry Ford Hospital, Detroit, MI 48202, USA
| | | | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, 1090 Vienna, Austria
| | - Kijoeng Nam
- Department of Biostatistics and Research Decision Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Ekta Kapadia
- Department of Oncology, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Tara Frenkl
- Department of Oncology, Merck & Co., Inc., Kenilworth, NJ 07033, USA
| | - Gary Steinberg
- Department of Urology, NYU Langone Health, New York, NY 10017, USA
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14
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[Usefulness of frozen section exams during radical cystectomy for urothelial carcinoma]. Prog Urol 2019; 30:51-57. [PMID: 31843294 DOI: 10.1016/j.purol.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/12/2019] [Accepted: 09/28/2019] [Indexed: 11/22/2022]
Abstract
AIM To determine the usefulness of the frozen section exams of lymph nodes dissection, ureteral and urethral section during radical cystectomy for urothelial carcinoma and define the impact on the surgical procedure. METHOD A retrospective, single-center study of data collected from 182 patients who underwent radical cystectomy for an cT=3bN0M0 urothelial bladder cancer between 2016 and 2018. Bladder cancer extension was determined by thoracoabdominal CT with contrast enhancement and urography and an 18-FDG PET scanner. No patient received neoadjuvant chemotherapy. The diagnostic performance of the frozen section exams was related to final examinations. The impact of the result on the initial intervention was determined. RESULTS The frozen section were positive in 29 lymph nodes dissections (15.9 %), 59 (16.6 %) ureteral and 20 (10.9 %) ureteral recessions. With lymph nodes exams, sensitivity, specificity and positive and negative predictive values were 93.5 %, 100 %, 100 %, and 98.7 %, respectively. With ureteral sections exams the same values were 91.5 %, 100 %, 100 %, and 98.4 % respectively. With urethral section exams, all the values were of 100 %. Finally, all the procedure has been modified for all patients with positive frozen section exam except one positive urethral section that did not give rise to radical urethrectomy. CONCLUSION Frozen section exams were useful to the urologist during radical cystectomy for urothelial carcinoma. The performances of the frozen section exams carried out were excellent. The information of the urologist of the positive frozen section leeds to modify its management during the intervention in all the studied cases with the exception of one case.
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15
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Garrido-Abad P, Martín LG, Zarra KV, Menéndez AD, Arjona MF. Metastatic non-muscle invasive bladder can-cer with cervical lymph node metastasis. Int Braz J Urol 2019; 45:1270-1274. [PMID: 31808417 PMCID: PMC6909866 DOI: 10.1590/s1677-5538.ibju.2018.0421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 01/08/2019] [Indexed: 11/21/2022] Open
Abstract
Bladder cancer is a common cancer that may present as superficial, invasive, or metastatic disease. Non-muscle-invasive bladder cancer (NMIBC) represents the majority of bladder cancer diagnoses, but represents a spectrum of disease with a variable clinical course, notably for significant risk of recurrence and potential for progression. NMIBC metastasis to distant organs without local invasion or regional metastasis is a very rare occurrence, so there are limi-ted case reports about early metastasis in the literature.
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Affiliation(s)
- Pablo Garrido-Abad
- Department of Urology, Hospital Universitario del Henares, Coslada, Universidad Francisco de Vitoria, Madrid, Spain
| | - Luis García Martín
- Department of Urology, Hospital Universitario del Henares, Coslada, Universidad Francisco de Vitoria, Madrid, Spain
| | - Karen Villar Zarra
- Department of Pathology, Hospital Universitario del Henares, Coslada, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ariel Díaz Menéndez
- Department of Pathology, Hospital Universitario del Henares, Coslada, Universidad Francisco de Vitoria, Madrid, Spain
| | - Manuel Fernández Arjona
- Department of Urology, Hospital Universitario del Henares, Coslada, Universidad Francisco de Vitoria, Madrid, Spain
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16
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Garrido-Abad P, Martín LG, Zarra KV, Menéndez AD, Arjona MF. Metastatic non-muscle invasive bladder cancer with cervical lymph node metastasis. Int Braz J Urol 2019. [PMID: 31808417 PMCID: PMC6909866 DOI: 10.1590/s1677-5538.ibju.2018.0863] [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: 12/04/2022] Open
Abstract
Bladder cancer is a common cancer that may present as superficial, invasive, or metastatic disease. Non-muscle-invasive bladder cancer (NMIBC) represents the majority of bladder cancer diagnoses, but represents a spectrum of disease with a variable clinical course, notably for significant risk of recurrence and potential for progression. NMIBC metastasis to distant organs without local invasion or regional metastasis is a very rare occurrence, so there are limited case reports about early metastasis in the literature.
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Affiliation(s)
- Pablo Garrido-Abad
- Hospital Universitario del Henares, Spain; Universidad Francisco de Vitoria, Spain
| | - Luis García Martín
- Hospital Universitario del Henares, Spain; Universidad Francisco de Vitoria, Spain
| | - Karen Villar Zarra
- Hospital Universitario del Henares, Spain; Universidad Francisco de Vitoria, Spain
| | - Ariel Díaz Menéndez
- Hospital Universitario del Henares, Spain; Universidad Francisco de Vitoria, Spain
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17
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Liu C, Ge M, Ma J, Zhang Y, Zhao Y, Cui T. Homeobox A10 promotes the proliferation and invasion of bladder cancer cells via regulation of matrix metalloproteinase-3. Oncol Lett 2019; 18:49-56. [PMID: 31289471 PMCID: PMC6539663 DOI: 10.3892/ol.2019.10312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/31/2019] [Indexed: 01/26/2023] Open
Abstract
Homeobox A10 (HOXA10) belongs to the family of HOX genes, which are closely connected with embryonic development and serve important roles in various tumors. However, the role of HOXA10 in bladder cancer (BC) remains unclear. In the present study, the role of HOXA10 in BC and the underlying mechanisms by which it promotes the disease progression were investigated. Immunohistochemical analysis demonstrated that the expression of the HOXA10 protein was significantly higher in BC tissues as compared with that in adjacent normal tissues. Subsequent statistical analysis revealed that upregulation of HOXA10 was significantly associated with the pathological grade and clinical stage of BC patients. In the BC cell lines T24 and 5637, silencing of HOXA10 by small interfering RNA transfection suppressed the proliferation, migration and invasion of BC cells, and led to decreased matrix metalloproteinase-3 expression. Taken together, overexpression of HOXA10 may be associated with poor prognosis in BC, and may serve as a novel antitumor therapy target for the treatment of this disease.
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Affiliation(s)
- Chunlei Liu
- Department of Urology, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
| | - Mingzhu Ge
- Department of Ultrasound, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
| | - Jun Ma
- Department of Urology, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
| | - Yanhui Zhang
- Department of Urology, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
| | - Yanhui Zhao
- Department of Urology, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
| | - Tao Cui
- Department of Urology, Qingdao Central Hospital, Qingdao, Shandong 266042, P.R. China
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18
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Ghandour R, Singla N, Lotan Y. Treatment Options and Outcomes in Nonmetastatic Muscle Invasive Bladder Cancer. Trends Cancer 2019; 5:426-439. [PMID: 31311657 DOI: 10.1016/j.trecan.2019.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/23/2019] [Accepted: 05/30/2019] [Indexed: 12/26/2022]
Abstract
Muscle-invasive bladder cancer (MIBC) represents 25% of newly diagnosed bladder cancer. MIBC is aggressive and requires timely management. The current standard of care is neoadjuvant chemotherapy followed by radical cystectomy, an approach that could result in significant morbidities. Modifications in the chemotherapy regimens, as well as in perioperative care and surgical approach, have resulted in better overall toxicity profile and faster recovery. However, bladder-preservation in carefully selected patients can lead to acceptable oncological outcomes and better quality of life. Optimization of bladder-preservation protocols and proper identification of patients who tolerate and respond to various treatment modalities will significantly impact patient survival in the coming future.
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Affiliation(s)
- Rashed Ghandour
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
| | - Nirmish Singla
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9110, USA.
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19
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The Role and Importance of Timely Radical Cystectomy for High-Risk Non-muscle-Invasive Bladder Cancer. Cancer Treat Res 2019; 175:193-214. [PMID: 30168123 DOI: 10.1007/978-3-319-93339-9_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Non-muscle-invasive bladder cancer accounts for the majority of incident bladder cancers but is a heterogeneous disease with variation in clinical presentation, course, and outcomes. Risk stratification techniques have attempted to identify those at highest risk of cancer recurrence and progression to help personalize and individualize treatment options. Radical cystectomy during the optimal window of curability could improve cancer outcomes; however, identifying the disease and patient characteristics as well as the correct timing to intervene remains difficult. We review the natural history of non-muscle-invasive bladder cancer, discuss different risk-stratification techniques and how they can help identify those most likely to benefit from radical treatment, and examine the evidence supporting the benefit of timely cystectomy.
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20
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Cattaneo F, Motterle G, Zattoni F, Morlacco A, Dal Moro F. The Role of Lymph Node Dissection in the Treatment of Bladder Cancer. Front Surg 2018; 5:62. [PMID: 30349822 PMCID: PMC6187970 DOI: 10.3389/fsurg.2018.00062] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/17/2018] [Indexed: 11/13/2022] Open
Abstract
Lymph node dissection (LND; PLND: pelvic LND) is an essential component of radical cystectomy (RC) for bladder cancer (BC). However, the optimal anatomical extent of LND and its potential therapeutic role are still controversial: as we will explain, the extent of LND dissection is a predictor of survival and local recurrence but what is an adequate extension is still unclear. Moreover, there is large uncertainty about the role of surgery in patients with clinically-positive nodes. In this review we will provide a synthesis of the available evidence on this highly debated topic. Overall, the studies presented in this work support the idea that extended lymphadenectomy could provide optimal diagnostic and possibly therapeutic results in cN- patients. In cN+ patients, post chemotherapy surgery may be considered especially in subjects who have a good response to CHT, although definitive evidence is still needed. Finally, the final results of randomized trials are eagerly awaited to draw definitive conclusions of the role of PLND in BC.
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Affiliation(s)
- Francesco Cattaneo
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Giovanni Motterle
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Filiberto Zattoni
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Alessandro Morlacco
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy
| | - Fabrizio Dal Moro
- Clinica Urologica, Dipartimento di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy.,Clínica Urologica, Ospedale "Santa Maria della Misericordia", Università di Udine, Udine, Italy
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21
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Liu TJ, Zhang JC, Gao XZ, Tan ZB, Wang JJ, Zhang PP, Cheng AB, Zhang SB. Clinical research of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer. J Cancer Res Ther 2018; 14:S173-S179. [PMID: 29578169 DOI: 10.4103/0973-1482.183206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective The aim of this study is to investigate the clinical effect of goal-directed fluid therapy in elderly patients with radical resection of bladder cancer. Materials and Methods Seventy-six elderly patients with radical resection of bladder cancer were selected from October 2012 to October 2014 and randomly divided into two groups, in which 38 patients received routine treatment as the control group and 38 patients received goal-directed fluid therapy based on routine treatment as the observation group. The treatment effect was compared between two groups. Results The cardiac index, stroke volume variability, mean arterial pressure, central venous pressure, central venous oxygen saturation, oxygen supply index, oxygen consumption index, and oxygen uptake rate in observation group were distinctly higher than those in control group at T1, T2, T3, and T4 while the artery serum lactate and S100-β were apparently lower than those in control group at T1, T2, T3, and T4. The urine volume and colloidal infusion were obviously elevated when compared with those in control group at T1, T2, T3, and T4 while the crystalloid infusion volume, total liquid infusion volume, hospitalization time, and expenses were significantly less than those in control group; further, similar tendency was also found regarding the complication incidences of nausea, vomiting, or hypotension in observation group. The postoperative flatus and postoperative food-taking times were visibly earlier than those in control group (both P < 0.05). Conclusion The goal-directed fluid therapy is beneficial for stabilization of hemodynamic status and maintenance of oxygen balance of supply and demand, and it is worthy of clinical expansion for good microcirculation perfusion, reduction in therapeutic time and expenses of patients, and less complications and superior security.
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Affiliation(s)
- Tie-Jun Liu
- Department of Anesthesia, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Jin-Cun Zhang
- Department of Urology Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Xiao-Zeng Gao
- Department of Anesthesia, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Zhi-Bin Tan
- Department of Anesthesia, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Jian-Jun Wang
- Department of Critical Care Medicine, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Pan-Pan Zhang
- Department of Respiratory Medicine, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Ai-Bin Cheng
- Department of Critical Care Medicine, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
| | - Shu-Bo Zhang
- Department of Anesthesia, The Affiliated Hospital of North China University of Science and Technology, Tangshan 063000, Hebei, P.R. China
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22
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Cogorno Wasylkowski L, Ríos-González E, Linares Espinós E, Leibar Tamayo A, Martínez-Piñeiro Lorenzo L. Indication for early cystectomy in nonmuscle-invasive bladder cancer. Literature review. Actas Urol Esp 2018; 42:17-24. [PMID: 28238343 DOI: 10.1016/j.acuro.2016.12.004] [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: 12/17/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT High-risk nonmuscle-invasive bladder cancer is a disease that includes a heterogeneous group of patients, for whom close follow-up is recommended due to the risk of progression to a muscle-invasive tumour. The treatment of choice for these tumours is transurethral resection of the bladder tumour followed by a programme of bacillus Calmette-Guerin instillations. There is a subgroup of patients who have a greater risk of progression and who benefit from early radical treatment. OBJECTIVE To identify which patient group with nonmuscle-invasive bladder cancer will benefit from early radical treatment. SEARCHING THE EVIDENCE We performed a literature review to identify the risk factors for progression for these patients and thereby recommend a treatment that improves their survival rate. SYNTHESIS OF THE EVIDENCE We identified the various prognostic factors associated with tumour progression: the persistence of T1 tumour in re-resection of the bladder tumour, the presence of carcinoma in situ, patients refractory to bacillus Calmette-Guerin treatment, patients older than 70 years, tumours larger than 3cm, the substaging of T1 tumours, the presence of lymphovascular invasion and the presence of a tumour in the prostatic urethra. Similarly, we comment on the advantages of radical versus conservative treatment, considering that the performance of an early cystectomy due to a high-risk noninvasive vesical tumour has a better cancer prognosis than those in which the operation is deferred until the progression. CONCLUSIONS In this disease, it is important to individualise the patients to provide them personalized treatment. For patients with the previously mentioned characteristics, it is recommended that early cystectomy not be delayed.
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23
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Radical Cystectomy (RC) with Urinary Diversion. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Teyssonneau D, Daste A, Dousset V, Hoepffner JL, Ravaud A, Gross-Goupil M. Metastatic non-muscle invasive bladder cancer with meningeal carcinomatosis: case report of an unexpected response. BMC Cancer 2017; 17:323. [PMID: 28494780 PMCID: PMC5425980 DOI: 10.1186/s12885-017-3309-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 05/01/2017] [Indexed: 11/17/2022] Open
Abstract
Background Non-muscle invasive bladder cancer (NMIBC) is usually treated with local therapy including transurethral resection of the bladder tumor and intravesical therapy depending on the stage of the tumor. NMIBC is a rarely a metastatic diseases with lymph node invasion in less of 10%. In the other hand meningeal carcinomatosis is a rare location for metastases with extremely poor outcomes. We described a case report of a patient presenting a metastatic disease to bones and meninges, several years after the treatment of NMIBC, which had been in complete response (CR) for 4 years after chemotherapy treatment. Case presentation A 63-years old men was treated by TURBT in 2008 for a high grade NMIBC, pT1b. Three years later he presented an acute binocular diplopy with right trochlear nerve paralysis, and labial hypoesthesia. Brain scan and MRI were performed finding a clivus infiltration and a pachymeningitis. A vertebral biopsy was performed finding an invasive carcinoma, CK7+/CK20+, TTF1-, PSA-, Thyroglobulin- and GATA3+. The metastatic event was in relation to the high grade NMIBC treated 3 years previously. Palliative chemotherapy was started with cisplatin gemcitabine. After 6 cycles and to date, 4 years later, the patient is therefore considered in complete response. Conclusion Metastasis in non-muscle invasive urothelial carcinoma is rare. Meningeal carcinomatosis outcome is poor, usually appearing in widely metastatic and progressive cancers but also because most systemic agents fail to pass the blood-brain barrier and penetrate into the cerebrospinal fluid. We described an unexpected response with complete response after chemotherapy for meningeal carcinomatosis of non muscle invasive urothelial carcinoma.
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Affiliation(s)
- Diego Teyssonneau
- Department of Medical Oncology, Saint-André hospital, University Hospital-CHU Bordeaux, 1 Rue Jean Burguet, 33000, Bordeaux, France
| | - Amaury Daste
- Department of Medical Oncology, Saint-André hospital, University Hospital-CHU Bordeaux, 1 Rue Jean Burguet, 33000, Bordeaux, France. .,University of Bordeaux, Bordeaux, France.
| | - Vincent Dousset
- University of Bordeaux, Bordeaux, France.,Neuroradiology Department, Bordeaux University Hospital, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Alain Ravaud
- Department of Medical Oncology, Saint-André hospital, University Hospital-CHU Bordeaux, 1 Rue Jean Burguet, 33000, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Saint-André hospital, University Hospital-CHU Bordeaux, 1 Rue Jean Burguet, 33000, Bordeaux, France
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25
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Hugen CM, Duddalwar V, Daneshmand S. Preoperative Imaging for Clinical Staging Prior to Radical Cystectomy. Curr Urol Rep 2016; 17:62. [PMID: 27432379 DOI: 10.1007/s11934-016-0618-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The importance of patient selection for quality outcomes following radical cystectomy is critical. Clinical staging is one of the key elements necessary for patient selection, and staging relies on accurate preoperative imaging. Many imaging modalities are available and have been utilized for preoperative staging with published operating characteristics. In this update, we review recently published literature for advances in preoperative imaging prior to radical cystectomy.
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Affiliation(s)
- Cory M Hugen
- University of Southern California Institute of Urology, 1441 Eastlake Ave MS 7416, Los Angeles, CA, 90033, USA
| | - Vinay Duddalwar
- University of Southern California Department of Radiology, 1441 Eastlake Ave, Los Angeles, CA, 90033, USA
| | - Siamak Daneshmand
- University of Southern California Institute of Urology, 1441 Eastlake Ave MS 7416, Los Angeles, CA, 90033, USA.
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26
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Kamat AM, Agarwal P, Bivalacqua T, Chisolm S, Daneshmand S, Doroshow JH, Efstathiou JA, Galsky M, Iyer G, Kassouf W, Shah J, Taylor J, Williams SB, Quale DZ, Rosenberg JE. Collaborating to Move Research Forward: Proceedings of the 10th Annual Bladder Cancer Think Tank. Bladder Cancer 2016; 2:203-213. [PMID: 27376139 PMCID: PMC4927866 DOI: 10.3233/blc-169007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The 10th Annual Bladder Cancer Think Tank was hosted by the Bladder Cancer Advocacy Network and brought together a multidisciplinary group of clinicians, researchers, representatives and Industry to advance bladder cancer research efforts. Think Tank expert panels, group discussions, and networking opportunities helped generate ideas and strengthen collaborations between researchers and physicians across disciplines and between institutions. Interactive panel discussions addressed a variety of timely issues: 1) data sharing, privacy and social media; 2) improving patient navigation through therapy; 3) promising developments in immunotherapy; 4) and moving bladder cancer research from bench to bedside. Lastly, early career researchers presented their bladder cancer studies and had opportunities to network with leading experts.
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Affiliation(s)
- Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center , Houston, TX, USA
| | - Piyush Agarwal
- Section of Urological Surgery, National Cancer Institute , Bethesda, MD, USA
| | - Trinity Bivalacqua
- Brady Urological Institute , Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Sia Daneshmand
- Institute of Urology, University of Southern California , Los Angeles, CA, USA
| | - James H Doroshow
- Section of Urological Surgery, National Cancer Institute , Bethesda, MD, USA
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
| | - Matthew Galsky
- Department of Medicine, Mount Sinai School of Medicine , New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Genitourinary Oncology, Memorial Sloan Kettering Cancer Center , New York, NY, USA
| | - Wassim Kassouf
- Department of Urology, McGill University , Montreal, QC, Canada
| | - Jay Shah
- Department of Urology, MD Anderson Cancer Center , Houston, TX, USA
| | - John Taylor
- Division of Urology, University of Connecticut Health , Farmington, CT, USA
| | | | | | - Jonathan E Rosenberg
- Department of Medicine, Genitourinary Oncology, Memorial Sloan Kettering Cancer Center , New York, NY, USA
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27
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Lymph node dissection in bladder cancer: Where do we stand? World J Urol 2015; 35:527-533. [PMID: 26712616 DOI: 10.1007/s00345-015-1751-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022] Open
Abstract
Radical cystectomy with lymphadenectomy remains the standard-of-care treatment for muscle-invasive bladder cancer. Lymphadenectomy is a central component of the operation because it continues to play both diagnostic and therapeutic roles. Routinely available preoperative imaging has limited diagnostic accuracy as it relies mostly on size to identify nodal metastasis increasing the value of lymphadenectomy. While the merits of lymphadenectomy are not in question, the extent of lymphadenectomy required to provide maximum benefit while limiting morbidity remains controversial. Furthermore, although robotic-assisted surgery has gained popularity in many centers, concern remains regarding the learning curve required and skill needed to replicate the quality of an open lymphadenectomy. Research efforts have been focused on these unresolved issues, and several trials are currently ongoing to help address these knowledge deficit areas. In this update, we will focus on the current state of lymphadenectomy for bladder cancer and highlight recent advances.
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Kassouf W, Traboulsi SL, Kulkarni GS, Breau RH, Zlotta A, Fairey A, So A, Lacombe L, Rendon R, Aprikian AG, Siemens DR, Izawa JI, Black P. CUA guidelines on the management of non-muscle invasive bladder cancer. Can Urol Assoc J 2015; 9:E690-704. [PMID: 26664503 PMCID: PMC4662433 DOI: 10.5489/cuaj.3320] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | | | | | - Andrew Fairey
- Division of Urology, University of Alberta, Edmonton, AB
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | | | | | | | | | | | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Casey RG, Catto JW, Cheng L, Cookson MS, Herr H, Shariat S, Witjes JA, Black PC. Diagnosis and Management of Urothelial Carcinoma In Situ of the Lower Urinary Tract: A Systematic Review. Eur Urol 2015; 67:876-88. [DOI: 10.1016/j.eururo.2014.10.040] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/24/2014] [Indexed: 12/28/2022]
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Wang L, Zeng Y, Liu Y, Hu X, Li S, Wang Y, Li L, Lei Z, Zhang Z. Fucoxanthin induces growth arrest and apoptosis in human bladder cancer T24 cells by up-regulation of p21 and down-regulation of mortalin. Acta Biochim Biophys Sin (Shanghai) 2014; 46:877-84. [PMID: 25187415 DOI: 10.1093/abbs/gmu080] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Fucoxanthin, a natural carotenoid, has been reported to have anti-cancer activity in human colon cancer cells, human prostate cancer cells, human leukemia cells, and human epithelial cervical cancer cells. This study was undertaken to evaluate the molecular mechanisms of fucoxanthin against human bladder cancer T24 cell line. MTT analysis results showed that 5 and 10 μM fucoxanthin inhibited the proliferation of T24 cells in a dose- and time-dependent manner accompanied by the growth arrest at G0/G1 phase of cell cycle, which is mediated by the up-regulation of p21, a cyclin-dependent kinase (CDK)-inhibitory protein and the down-regulation of CDK-2, CDK-4, cyclin D1, and cyclin E. In addition, 20 and 40 μM fucoxanthin induced apoptosis of T24 cells by the abrogation of mortalin-p53 complex and the reactivation of nuclear mutant-type p53, which also had tumor suppressor function as wild-type p53. All these results demonstrated that the anti-cancer activity of fucoxanthin on T24 cells was associated with cell cycle arrest at G0/G1 phase by up-regulation of p21 at low doses and apoptosis via decrease in the expression level of mortalin, which is a stress regulator and a member of heat shock protein 70, followed by up-regulation of cleaved caspase-3 at high doses.
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Affiliation(s)
- Linbo Wang
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Yang Zeng
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Ye Liu
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Xuansheng Hu
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Shuhong Li
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Yuepeng Wang
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan Natural Product Industry of Tsukuba Co., Ltd, E-26, 1187-80 (Kenkyugakuen C43-3) East Hiratuka, Tsukuba, Ibaraki 305-0812, Japan
| | - Ling Li
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Zhongfang Lei
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Zhenya Zhang
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8572, Japan
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Developments and controversies in the management of noninvasive bladder cancer. Curr Opin Oncol 2014; 26:299-304. [PMID: 24638080 DOI: 10.1097/cco.0000000000000067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To summarize recent developments and controversies in the diagnosis and management of nonmuscle invasive bladder cancer (NMIBC). RECENT FINDINGS The majority of incident bladder cancer diagnoses are noninvasive. The mainstay of diagnosis remains cystoscopy and transurethral resection, with enhanced optical techniques potentially improving detection of nascent disease. Intravesical chemotherapeutic and immunotherapeutic agents reduce the likelihood of recurrence and progression, with novel agents showing promise. The identification of variant histology with aggressive phenotypes permits identification of patients unlikely to respond to intravesical agents, in whom early cystectomy is advocated. Risk stratification of patients with NMIBC continues to improve and should be used to inform surveillance and treatment paradigms. Tobacco cessation may improve disease-specific endpoints and overall mortality. SUMMARY NMIBC encompasses a variety of tumors with heterogeneous natural histories, making clinical management challenging. Improved detection with novel technologies and optimization of existing treatment modalities hold promise of improving oncologic outcomes in the future.
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Goldsmith B, Baumann BC, He J, Tucker K, Bekelman J, Deville C, Vapiwala N, Vaughn D, Keefe SM, Guzzo T, Malkowicz SB, Christodouleas JP. Occult pelvic lymph node involvement in bladder cancer: implications for definitive radiation. Int J Radiat Oncol Biol Phys 2014; 88:603-10. [PMID: 24411628 DOI: 10.1016/j.ijrobp.2013.11.211] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE To inform radiation treatment planning for clinically staged, node-negative bladder cancer patients by identifying clinical factors associated with the presence and location of occult pathologic pelvic lymph nodes. METHODS AND MATERIALS The records of patients with clinically staged T1-T4N0 urothelial carcinoma of the bladder undergoing radical cystectomy and pelvic lymphadenectomy at a single institution were reviewed. Logistic regression was used to evaluate associations between preoperative clinical variables and occult pathologic pelvic or common iliac lymph nodes. Percentages of patient with involved lymph node regions entirely encompassed within whole bladder (perivesicular nodal region), small pelvic (perivesicular, obturator, internal iliac, and external iliac nodal regions), and extended pelvic clinical target volume (CTV) (small pelvic CTV plus common iliac regions) were calculated. RESULTS Among 315 eligible patients, 81 (26%) were found to have involved pelvic lymph nodes at the time of surgery, with 38 (12%) having involved common iliac lymph nodes. Risk of occult pathologically involved lymph nodes did not vary with clinical T stage. On multivariate analysis, the presence of lymphovascular invasion (LVI) on preoperative biopsy was significantly associated with occult pelvic nodal involvement (odds ratio 3.740, 95% confidence interval 1.865-7.499, P<.001) and marginally associated with occult common iliac nodal involvement (odds ratio 2.307, 95% confidence interval 0.978-5.441, P=.056). The percentages of patients with involved lymph node regions entirely encompassed by whole bladder, small pelvic, and extended pelvic CTVs varied with clinical risk factors, ranging from 85.4%, 95.1%, and 100% in non-muscle-invasive patients to 44.7%, 71.1%, and 94.8% in patients with muscle-invasive disease and biopsy LVI. CONCLUSIONS Occult pelvic lymph node rates are substantial for all clinical subgroups, especially patients with LVI on biopsy. Extended coverage of pelvic lymph nodes up to the level of the common iliac nodes may be warranted in subsets of patients.
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Affiliation(s)
- Benjamin Goldsmith
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian C Baumann
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jiwei He
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kai Tucker
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Curtiland Deville
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Vaughn
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Keefe
- Department of Medical Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Guzzo
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Bruce Malkowicz
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John P Christodouleas
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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