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Santoni M, Massari F, Takeshita H, Tapia JC, Dionese M, Pichler R, Rizzo M, Lam ET, Grande E, Kemp R, Molina-Cerrillo J, Calabrò F, Tural D, Küronya Z, Kucharz J, Fiala O, Seront E, Kopp RM, Abahssain H, Kopecky J, Martignetti A, Kanesvaran R, Zakopoulou R, Ansari J, Landmesser J, Mollica V, Porta C, Bellmunt J, Salah S, Santini D. Bone targeting agents, but not radiation therapy, improves survival in patients with bone metastases from advanced urothelial carcinoma receiving pembrolizumab: results from the ARON-2 study. Clin Exp Med 2023; 23:5413-5422. [PMID: 37917218 DOI: 10.1007/s10238-023-01235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
The ARON-2 study (NCT05290038) aimed to assess the real-world efficacy of pembrolizumab in patients recurred or progressed after platinum-based chemotherapy. This retrospective analysis reports the outcomes of urothelial carcinoma (UC) patients with bone metastases (BM). Medical records of patients with documented metastatic UC treated by pembrolizumab as second-line therapy were reviewed from60 institutions in 20 countries. Patients were assessed for Overall Response Rate (ORR), Progression-Free Survival (PFS), and Overall Survival (OS). Univariate and multivariate analyses were used to explore the association of variables of interest with OS and PFS. 881 patients were included; of them, 263 (30%) presented BM. Median follow-up time was 22.7 months. Patients with BM showed both shorter median OS (5.9 months vs 13.1 months, p < 0.001) and PFS (3.5 months, vs 7.3 months, p < 0.001) compared to patients without BM. Patients who received bone targeted agents (BTAs) showed a significantly longer median OS (8.5 months vs 4.6 months, p = 0.003) and PFS (6.1 months vs 3.2 months, p = 0.003), while no survival benefits were observed among patients who received radiation therapy for BM during pembrolizumab treatment compared to those who did not. In multivariate analysis, performance status, concomitant liver metastases, and the lack of use of BTAs were significantly associated with worse OS and PFS. Bone involvement in UC patients treated with pembrolizumab predicts inferior survival. Poor performance status and liver metastases may further worsen outcomes, while the use of BTAs is associated with improved outcomes.
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Affiliation(s)
- Matteo Santoni
- Oncology Unit, Macerata Hospital, via Santa Lucia 2, 62100, Macerata, Italy
| | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni - 15, Bologna, Italy
| | - Hideki Takeshita
- Department of Urology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Jose Carlos Tapia
- Department of Medical Oncology, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creui Sant Pau, Barcelona, Spain
| | - Michele Dionese
- Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV - IRCCS, 35128, Padua, Italy
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Mimma Rizzo
- Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
| | - Elaine T Lam
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Enrique Grande
- Department of Medical Oncology, MD Anderson Cancer Center Madrid, Madrid, Spain
| | - Robert Kemp
- Southampton Experimental Cancer Medicine Centre, University of Southampton, Southampton, UK
| | | | - Fabio Calabrò
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Deniz Tural
- Department of Medical Oncology, Bakirköy Dr.SadiKonuk Training and Research Hospital, Zuhuratbaba District, TevfikSaglam St. No: 11, Bakirkoy, Istanbul, Turkey
| | - Zsófia Küronya
- Department of Genitourinary Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - Jakub Kucharz
- Department of Uro-Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Ondrej Fiala
- Department of Oncology and Radiotherapeutics, Faculty of Medicine and University Hospital in Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, alejSvobody 76, Pilsen, Czech Republic
| | - Emmanuel Seront
- Department of Medical Oncology, Centre Hospitalier de Jolimont, Haine Saint Paul, La Louvière, Belgium
| | - Ray Manneh Kopp
- Clinical Oncology, Sociedad de Oncología y Hematología del Cesar, Valledupar, Colombia
| | - Halima Abahssain
- Medicine and Pharmacy Faculty, National Institute of Oncology, Medical Oncology Unit, Mohamed V University, Rabat, Morocco
| | - Jindrich Kopecky
- Department of Clinical Oncology and Radiotherapy, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Angelo Martignetti
- Dipartimento oncologico usl sud-est toscana-area senese, Località Campostaggia s.n.c., 53036, Poggibonsi, Italy
| | | | - Roubini Zakopoulou
- 2nd Propaedeutic Department of Internal Medicine, School of Medicine, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jawaher Ansari
- Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Veronica Mollica
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni - 15, Bologna, Italy.
| | - Camillo Porta
- Chair of Oncology, Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Joaquim Bellmunt
- Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Samer Salah
- Department of Medical Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Daniele Santini
- UOC Oncologia A, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
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2
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Tian G, Li Y, Nie L, Liu S, Li W, Cao J, An K, Zhao R. Cervical lymph node metastasis of bladder cancer: a case report and review of literature. Aging Male 2023; 26:2205935. [PMID: 37162757 DOI: 10.1080/13685538.2023.2205935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To report an extremely rare case of bladder cancer patient with cervical lymph nodes, abdominal lymph nodes, and bone metastases at the same time. METHODS AND RESULTS The case was investigated by follow-up and immunohistochemistry was used in the pathological part. RESULT The patient was diagnosed with bladder cancer (high-grade urothelial metastatic epithelial cell carcinoma) by pathology and immunohistochemistry after transurethral resection of bladder tumor (TURBT) and metastatic bladder cancer by pathology and immunohistochemistry after cervical lymph node aspiration due to neck lymph node enlargement 1 year later, and a CT of the chest and abdomen suggested that the patient also had abdominal lymph node and bone metastases.At the 2.5-year regular chemotherapy follow-up, the patient showed that the abdominal lymph node metastasis disappeared, the cervical lymph node fusion shrank, and the bone metastasis still existed. CONCLUSION 1. Regular postoperative review is particularly important; 2.For patients with UCB who undergo TURBT, a effective regular perfusion program should be performed throughout the postoperative period; 3. For patients with postoperative metastatic symptoms of UCB, Complex treatment has a positive effect on patient prognosis; 4.The presence of enlarged head and neck lymph nodes in patients with bladder cancer should also be considered as metastatic of UCB.
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Affiliation(s)
- Guolin Tian
- School of Clinical Medicine, Ningxia Medical University, Yin Chuan, China
| | - Yajie Li
- Department of Urology, General Hospital of Ningxia Medical University, YinChuan, China
| | - Lihong Nie
- School of Clinical Medicine, Ningxia Medical University, Yin Chuan, China
| | - Shiyu Liu
- School of Clinical Medicine, Ningxia Medical University, Yin Chuan, China
| | - Weihao Li
- School of Clinical Medicine, Ningxia Medical University, Yin Chuan, China
| | - Jiahui Cao
- School of Clinical Medicine, Ningxia Medical University, Yin Chuan, China
| | - Kangjie An
- School of Clinical Medicine, Ningxia Medical University, Yin Chuan, China
| | - Ruining Zhao
- Department of Urology, General Hospital of Ningxia Medical University, YinChuan, China
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3
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Coe C, Chirputkar K, Joseph L, Jude EB. Pedal acrometastasis secondary to urothelial carcinoma masquerading as Charcot arthropathy in a patient with diabetes. BMJ Case Rep 2023; 16:e254468. [PMID: 37730428 PMCID: PMC10514597 DOI: 10.1136/bcr-2022-254468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
A woman in her 80s with known diabetes mellitus and bladder cancer presented to her general practitioner (GP) with pain and swelling in her left foot following trauma. Initial radiographs were reported as normal, prompting a diagnosis of a simple sprain and conservative management. Three months later, the patient was referred to the orthopaedic team due to progressively increasing pain and swelling. Repeat X-rays revealed lytic lesions in both the talus and navicular bones; MRI confirmed the presence of a lytic and proliferative defect in the mid-foot, which was reported as acute Charcot arthropathy with superimposed infection. This was also considered the most likely diagnosis when imaging was reviewed in two separate multidisciplinary team) meetings. However, biopsy demonstrated that the cause of the presentation was in fact acrometastasis from urothelial carcinoma, an infrequently described entity.
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Affiliation(s)
- Calvin Coe
- Endocrinology and Diabetes, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Kedar Chirputkar
- Trauma and Orthopaedic Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Leena Joseph
- Histopathology, Manchester University NHS Foundation Trust, Manchester, UK
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4
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Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma. Nucl Med Commun 2022; 43:675-679. [PMID: 35414637 DOI: 10.1097/mnm.0000000000001559] [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
BACKGROUND Accurate staging is crucial to determine the type of treatment for patients with bladder cancer (BCa), especially in high-risk cases. We aimed to assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC). MATERIAL AND METHODS Forty-five patients with MIBC were referred to our tertiary clinic to perform a technetium 99m-methyl diphosphonate (Tc99m-MDP) bone scan from January 2019 to March 2020. The patients underwent bone scintigraphy with pelvic SPECT/CT before radical cystectomy. Whole-body scanning was performed 4 hours after Tc99m-MDP injection in both anterior and posterior views. Since the most common bone involvement site in these patients is the pelvic bones and the spine, pelvic SPECT/CT was performed in all patients. RESULTS Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient's age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant. CONCLUSION Bone scan has higher diagnostic performance than conventional imaging methods for detecting bone metastases. It changed the management plan in 8.8% of our patients, so we conclude that performing a whole-body bone scan in the initial staging of MIBC would be helpful.
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5
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Soe MZ, Bong CP, Thevarajah S, Teah KM, Yeap BT. A rare occurrence of a metastatic urothelial carcinoma to the thoracic vertebra: A case report. Ann Med Surg (Lond) 2022; 74:103297. [PMID: 35127072 PMCID: PMC8802879 DOI: 10.1016/j.amsu.2022.103297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/14/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background Urothelial carcinoma (UC) is a common urinary tract malignancy that predominantly affect the urinary bladder with a low recurrence rate after surgical removal. It usually metastasizes to the lungs, regional lymph nodes, and liver. However, it rarely spread to the thoracic spine and bones, especially in the Asian populations. Case presentation A 50-years-old Asian man, with a one-year history of surgically resected UC, presented to us with a complaint of worsening upper back pain for three months. Magnetic resonance imaging (MRI) showed a destructed second thoracic (T2) vertebra with lytic lesion. A thoracic vertebrectomy was performed and histopathological examination (HPE) showed high-grade infiltrating metastatic malignant UC. Postoperatively, he was well and did not have any back pain. He was followed up under combined spine and oncology clinic regularly and was planned for chemoradiotherapy. Discussion UC commonly metastasizes to the lungs, liver, and lymph nodes. In young Asians, thoracic spinal metastases are rare. Urgent palliative spinal surgery is indicated to prevent further deterioration of function. Intraoperative usage of targeted controlled infusion (TCI) of remifentanil and propofol as maintenance of anaesthesia are gold standard in assisting spine surgeons who are guided by neuromuscular monitoring. Conclusion Spinal metastasis to the thoracic vertebra is rare among young Asian men. Patients presented with acute neurological deficits and back pain are indicated for spinal surgery. Multidisciplinary approach is needed for management of patients with spinal metastasis. Targeted controlled infusion (TCI) of remifentanil and propofol are gold standard for maintenance of anaesthesia for spine surgeries which are guided by somatosensory, and motor evoked potential monitoring. Urothelial carcinoma (UC) is a common urinary tract malignancy. Metastatic spread of UC to the thoracic vertebra is extremely rare among Asian men. Patients presented with acute neurological deficits are indicated for palliative spinal surgery. Judicious anaesthetic and surgical preparations are needed to avoid severe complications.
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Affiliation(s)
- May Zaw Soe
- Department of Medical Education, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Chin Pei Bong
- Department of Orthopaedics, Hospital Queen Elizabeth, 88350, Kota Kinabalu, Sabah, Malaysia
| | - Shankaran Thevarajah
- Department of Urology, Hospital Queen Elizabeth, 88350, Kota Kinabalu, Sabah, Malaysia
| | - Kai Ming Teah
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Boon Tat Yeap
- Department of Anaesthesiology and Intensive Care, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
- Corresponding author.
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6
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Stellato M, Santini D, Cursano MC, Foderaro S, Tonini G, Procopio G. Bone metastases from urothelial carcinoma. The dark side of the moon. J Bone Oncol 2021; 31:100405. [PMID: 34934613 DOI: 10.1016/j.jbo.2021.100405] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/01/2021] [Accepted: 11/24/2021] [Indexed: 10/19/2022] Open
Abstract
Bone metastases are common in genitourinary cancers, but they are underreported and not well researched. Synchronous bone metastases occur in 1.39-5.5% of bladder cancer patients, while 30-40% of cases are metachronous. Bone morphogenetic proteins (BMPs) play a key role in regulating proliferation, migration and invasion of tumor cells in bone microenvironment of bone metastases from metastatic urothelial carcinoma (mUC). Bone metastases represent a poor prognostic factor due to high morbidity and mortality correlated to skeletal-related events (SREs). The incidence rate of SREs in bladder, renal pelvis, and ureteral cancer varies from 39 to 68%. Radiotherapy is the most frequent treatment for SREs. The early use of bone targeted therapies (BTT), zoledronic acid and denosumab, improves SREs incidence and morbidity and it seems to improve overall survival (OS). To date, several new agents (immunotherapy and targeted drugs) demonstrated efficacy in mUC. However, subgroup analysis for bone metastases is often not available, due to difficulties in analysing bone samples, non-RECIST lesions and delay in systemic treatment due to SREs that limit the enrolment of bone mUC patients in clinical trials. Larger solid tumor studies that included UC patients are the main source of data for the management of mUC patients with bone metastases. For these patients, multidisciplinary approach should be preferred, involving orthopaedics, radiotherapists and rehabilitation to improve outcome and quality of life. New prospective trials should characterize clinical and molecular features of patients with bone metastases and the impact of new drugs on this poor prognostic metastatic site.
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Affiliation(s)
- Marco Stellato
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.,Meet-URO: Italian Network For Research In Urologic-Oncology, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.,Meet-URO: Italian Network For Research In Urologic-Oncology, Italy
| | - Maria Concetta Cursano
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.,Meet-URO: Italian Network For Research In Urologic-Oncology, Italy
| | - Simone Foderaro
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.,Meet-URO: Italian Network For Research In Urologic-Oncology, Italy
| | - Giuseppe Tonini
- Department of Medical Oncology, Campus Bio-Medico University of Rome, Rome, Italy.,Meet-URO: Italian Network For Research In Urologic-Oncology, Italy
| | - Giuseppe Procopio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Meet-URO: Italian Network For Research In Urologic-Oncology, Italy
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7
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Raggi D, Giannatempo P, Marandino L, Pierantoni F, Maruzzo M, Lipari H, Banna GL, De Giorgi U, Casadei C, Naglieri E, Buti S, Bersanelli M, Stellato M, Santini D, Vignani F, Roviello G, Veccia A, Caffo O, Losanno T, Calabrò F, Mucciarini C, Pignata S, Necchi A, Maio MD. Role of Bone Metastases in Patients Receiving Immunotherapy for Pre-Treated Urothelial Carcinoma: The Multicentre, Retrospective Meet-URO-1 Bone Study. Clin Genitourin Cancer 2021; 20:155-164. [PMID: 35000876 DOI: 10.1016/j.clgc.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/06/2021] [Accepted: 12/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Considerable numbers of patients with metastatic urothelial carcinoma (mUC) develop bone metastases (BoM). Their impact on the efficacy of immune-checkpoint inhibitors (ICIs) is not yet investigated. METHODS Between July 2014 and August 2020 data on pts treated with single-agent ICIs after failure of at least 1 previous line of chemotherapy for advanced disease, were retrospectively collected across 14 Italian centers. Overall survival (OS) and progression-free survival (PFS) were analyzed using the Kaplan-Meier method. Cox regression analysis was performed evaluating potential prognostic factors for OS and PFS. Each factor was evaluated in univariable (UVA) and multivariable analysis (MVA). RESULTS A total of 208 evaluable patients treated with ICIs were identified, including 122 (59%) without BoM (BoM-) and 86 (41%) with bone metastases (BoM+). After a median follow-up of 22.3 months, BoM+ patients showed shorter OS (median 3.9 vs 7.8 months, HR 1.59 [95%CI, 1.15-2.20], P = .005) and shorter PFS (median 2.0 vs 2.6 months, HR 1.76 [95%CI, 1.31-2.37], P < .001). Probability of being alive was 62% vs 40% after 6 months, 38% vs 23% after 1 year and 24% vs 13% after 2 years, in BoM- and BoM+ respectively. Within each Bellmunt score, OS and PFS of BoM+ patients were shorter. Both presence of BoM and higher Bellmunt risk score were significantly associated with shorter OS and PFS in UVA and MVA. CONCLUSION Patients treated with single-agent ICIs for BoM+ mUC have a dismal prognosis compared to BoM-. Further research is needed to understand the mechanism behind these outcomes.
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Affiliation(s)
- Daniele Raggi
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Patrizia Giannatempo
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Laura Marandino
- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Marco Maruzzo
- Department of Oncology, Istituto Oncologico Veneto, Padova, Italy
| | - Helga Lipari
- Department of Oncology, Medical Oncology Cannizzaro Hospital, Catania, Italy
| | - Giuseppe L Banna
- Department of Oncology, Medical Oncology Cannizzaro Hospital, Catania, Italy
| | - Ugo De Giorgi
- Department of Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Chiara Casadei
- Department of Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
| | - Emanuele Naglieri
- Department of Oncology, Policlinico di Bari Ospedale Giovanni XXIII, Bari, Italy
| | - Sebastiano Buti
- Department of Oncology, University Hospital of Parma, Parma, Italy
| | | | - Marco Stellato
- Department of Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Daniele Santini
- Department of Oncology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesca Vignani
- Department of Oncology, University of Turin, Mauriziano Umberto I Hospital, Turin, Italy
| | | | | | - Orazio Caffo
- Department of Oncology, Santa Chiara Hospital, Trento, Italy
| | - Tania Losanno
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Fabrizio Calabrò
- Department of Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Sandro Pignata
- Department of Urology and Gynecology, Oncologia Medica Uro-Ginecologica, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy
| | - Andrea Necchi
- Deptartment of Oncology from Vita-Salute University IRCCS San Raffaele, Milan, Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Mauriziano Umberto I Hospital, Turin, Italy
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- Department of Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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8
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Rosiello G, Palumbo C, Deuker M, Stolzenbach LF, Martin T, Tian Z, Gallina A, Montorsi F, Black P, Kassouf W, Shariat SF, Saad F, Briganti A, Karakiewicz PI. Sex- and age-related differences in the distribution of bladder cancer metastases. Jpn J Clin Oncol 2021; 51:976-983. [PMID: 33558890 DOI: 10.1093/jjco/hyaa273] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Our objective was to investigate age- and sex-related differences in the distribution of metastases in patients with metastatic bladder cancer. METHODS Within the National Inpatient Sample database (2008-2015), we identified 7040 patients with metastatic bladder cancer. Trend test and Chi-square test analyses were used to evaluate the relationship between age and site of metastases, according to sex. RESULTS Of 7040 patients with metastatic bladder cancer, 5226 (74.2%) were men and 1814 (25.8%) were women. Thoracic, abdominal, bone and brain metastases were present in 19.5 vs. 23.0%, 43.6 vs. 46.9%, 23.9 vs. 18.7% and 2.4 vs. 2.9% of men vs. women, respectively. Bone was the most common metastatic site in men (23.9%) vs. lung in women (22.4%). Increasing age was associated with decreasing rates of abdominal (from 44.9 to 40.2%) and brain (from 3.2 to 1.4%) metastases in men vs. decreasing rates of bone (from 21.0 to 13.3%) and brain (from 5.1 to 2.0%) metastases in women (all P < 0.05). Finally, rates of metastases in multiple organs also decreased with age, in both men and women. CONCLUSIONS The distribution of metastases in bladder cancer varies according to sex. Moreover, differences exist according to patient age and these differences are also sex-specific. In consequence, patient age and sex should be considered in the interpretation of imaging, especially when findings are indeterminate.
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Affiliation(s)
- Giuseppe Rosiello
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Urology Unit, ASST Spedali Civili of Brescia. Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Marina Deuker
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lara Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Martin
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Andrea Gallina
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Peter Black
- Department of Urology, University of British Columbia, Vancouver, Canada
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute of Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, Urological Research Institute, IBCAS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
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9
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Brenneman RJ, Gay HA, Christodouleas JP, Sargos P, Arora V, Fischer-Valuck B, Huang J, Knoche E, Pachynski R, Picus J, Reimers M, Roth B, Michalski JM, Baumann BC. Review: Brain Metastases in Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Nearly 50% of bladder cancer patients either present with metastatic disease or relapse distantly following initial local therapy. Prior to platinum-based chemotherapy, the incidence of bladder cancer central nervous system metastases was approximately 1%; however, their incidence has increased to 3–16% following definitive treatment as platinum-based regimens have changed the natural history of the disease. Bladder cancer brain metastases are generally managed similarly to those from more common malignancies such as non-small cell lung cancer, with surgery +/–adjuvant radiotherapy, or radiotherapy alone using stereotactic radiosurgery or whole brain radiotherapy. Limited data suggest that patients with inoperable urothelial carcinoma brain metastases who are not candidates for stereotactic radiosurgery may benefit from shorter whole brain radiation therapy courses compared to other histologies, but data is hypothesis-generating. Given improvements in the efficacy of systemic therapy and supportive care strategies for metastatic urothelial carcinoma translating in improved survival, the incidence of intracranial failures may increase. Immune checkpoint blockade therapy may benefit cisplatin-ineligible metastatic urothelial carcinoma patients as first-line therapy; however, the effectiveness of immune checkpoint blockade to treat central nervous system disease has not been established. In this review, we discuss the incidence and management of bladder cancer brain metastases and considerations regarding variations in management relative to more commonly encountered non-urothelial histologies.
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Affiliation(s)
- Randall J. Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Hiram A. Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - John P. Christodouleas
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Vivek Arora
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jiayi Huang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric Knoche
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Russell Pachynski
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Joel Picus
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Reimers
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Bruce Roth
- Division of Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeff M. Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Brian C. Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Abstract
The recent genomic characterization of urothelial carcinoma by the Cancer Genome Atlas Project, made possible by the introduction of high throughput, reduced cost, and sequence analysis, has shed new insights on the biology of advanced disease. In addition, studies on imaging of advanced urothelial carcinoma have widened the knowledge on disease presentation and on pattern of metastatic spread and their correlation with the underlying biology of urothelial carcinoma. The wide range of treatments for advanced urothelial cancer, including combined chemotherapy regimens and immune checkpoint inhibitors, each result in treatment class-specific patterns of response and adverse events. Results of studies point to the need for a reliable biomarker, perhaps with imaging, that predicts prognosis and treatment response to systemic treatment, and can be used to select the most effective treatment while minimizing toxicity. This review of advanced urothelial cancer introduces the latest advances in genetic profiling, the current role of imaging, the radiographic appearance of treatment response and their toxicities, and details potential future areas of imaging research.
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11
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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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12
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Yang DY, Frank I, Avant RA, Miller AR, Thapa P, Boorjian SA, Tollefson MK. Incidence and risk factors for peritoneal carcinomatosis following open radical cystectomy. Urol Oncol 2019; 37:886-892. [PMID: 31427158 DOI: 10.1016/j.urolonc.2019.06.017] [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: 04/06/2019] [Revised: 05/30/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To characterize the frequency and risk factors of peritoneal carcinomatosis (PC) in patients undergoing open radical cystectomy (RC). METHODS We identified 3,285 patients with urothelial carcinoma treated with RC for curative intent between 1980 and 2016. At last follow-up, 72.1% (2,370/3,285) of patients had died, with a median follow-up of 8.6 years (Interquartile Range, (IQR) 3.7, 14.1). PC was defined as any recurrence involving the omentum, small bowel, and mesentery. Overall-specific survival (OSS) and cancer-specific survival (CSS) was evaluated using Kaplan-Meier methodology and log-rank test. Risk factors for mortality and recurrence were performed using Cox proportional hazards regression models. RESULTS One hundred and twenty nine (3.9%) patients were diagnosed with PC, while a total of 1,148 (34.9%) patients experienced recurrence at other sites. Median time to PC vs. other-site recurrence was 1.3 (IQR 1.3, 2.3) and 0.9 (IQR 0.5, 2.1) years, respectively (P= 0.04). Only increasing pathologic stage on multivariable analysis was associated with developing PC (pT1 HR 2.51, 95CI 1.14-5.55, P= 0.02; pT2 OR 2.82, 95CI 1.47-5.43, P= 0.002; pT3+ 2.40, 95CI 1.31-4.42, P= 0.005) over other recurrence patterns. Nodal status and tumor margin status were not associated. Patients with PC experienced worse OSS and CSS than other types of recurrence (P< 0.001). CONCLUSION PC was identified in almost 4% of patients undergoing open RC. PC is a rare occurrence after RC and primarily impacts patients with locally advanced disease.
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Affiliation(s)
- David Y Yang
- Mayo Clinic, Department of Urology, Rochester, MN
| | - Igor Frank
- Mayo Clinic, Department of Urology, Rochester, MN
| | - Ross A Avant
- Mayo Clinic, Department of Urology, Rochester, MN
| | | | - Prabin Thapa
- Mayo Clinic, Division of Biomedical Statistics and Informatics, Rochester, MN
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13
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Shyu S, Burke AP, Papadimitriou JC. Late-onset solitary metastasis of urothelial bladder carcinoma mimicking primary lung adenocarcinoma with a lepidic component. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Skeletal-related events and prognosis in urothelial cancer patients with bone metastasis. Int J Clin Oncol 2017; 22:548-553. [DOI: 10.1007/s10147-016-1075-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
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15
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Daniels CJ, Wakefield PJ, Bub GA. Bladder metastasis presenting as neck, arm and thorax pain: a case report. Chiropr Man Therap 2016; 24:14. [PMID: 27148441 PMCID: PMC4855475 DOI: 10.1186/s12998-016-0097-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 04/03/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A case of metastatic carcinoma secondary to urothelial carcinoma presenting as musculoskeletal pain is reported. A brief review of urothelial and metastatic carcinoma including clinical presentation, diagnostic testing, treatment and chiropractic considerations is discussed. CASE PRESENTATION This patient presented in November 2014 with progressive neck, thorax and upper extremity pain. Computed tomography revealed a destructive soft tissue mass in the cervical spine and additional lytic lesion of the 1st rib. Prompt referral was made for surgical consultation and medical management. CONCLUSION Distant metastasis is rare, but can present as a musculoskeletal complaint. History of carcinoma should alert the treating chiropractic physician to potential for serious disease processes.
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Affiliation(s)
- Clinton J Daniels
- Chiropractic Clinic, VA St. Louis Healthcare System, 1 Jefferson Barracks Rd, Saint Louis, MO USA ; Logan University, College of Chiropractic, 1851 Schoettler Rd, Chesterfield, MO USA ; 811 Rowell St., Steilacoom, WA 98388 USA
| | - Pamela J Wakefield
- Chiropractic Clinic, VA St. Louis Healthcare System, 1 Jefferson Barracks Rd, Saint Louis, MO USA ; Logan University, College of Chiropractic, 1851 Schoettler Rd, Chesterfield, MO USA
| | - Glenn A Bub
- Chiropractic Clinic, VA St. Louis Healthcare System, 1 Jefferson Barracks Rd, Saint Louis, MO USA ; Logan University, College of Chiropractic, 1851 Schoettler Rd, Chesterfield, MO USA
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16
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Taguchi S, Nakagawa T, Uemura Y, Matsumoto A, Nagase Y, Kawai T, Tanaka Y, Yoshida K, Yamamoto S, Enomoto Y, Nose Y, Sato T, Ishikawa A, Fujimura T, Fukuhara H, Kume H, Homma Y. Validation of major prognostic models for metastatic urothelial carcinoma using a multi-institutional cohort of the real world. World J Urol 2015; 34:163-71. [PMID: 26135306 DOI: 10.1007/s00345-015-1631-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/23/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Several prognostic models predicting survival of patients with metastatic urothelial carcinoma (UC) have been developed; however, of them, the first model by Bajorin in 1999 is still the most representative and widely used, and validations of newer models are lacking. This study aimed to validate three major prognostic models for metastatic UC constructed based on clinical trials. METHODS We reviewed 200 patients with metastatic UC who received first-line chemotherapy at our five affiliate institutions between 2003 and 2011. Using this multi-institutional cohort, we validated the following models: the "Bajorin model," a model consisting of visceral metastasis and performance status; the "Apolo model," a nomogram including visceral metastasis, performance status, albumin and hemoglobin; and the "Galsky model," a nomogram including leukocyte count, number of sites of visceral metastases, site of primary tumor, performance status and lymph node metastasis. Harrell's c-index was calculated for each model. Cox proportional hazards regression model was used for multivariate analysis. RESULTS Among 200 patients, 171 (85.5%) died during the follow-up, with a median survival of 12.0 months. Multivariate analysis demonstrated ECOG performance status, visceral metastasis and leukocyte count to be independent predictors of overall survival. C-index results (95% confidence interval) were Bajorin: 0.86 (0.74-0.95); Apolo: 0.89 (0.78-0.98); and Galsky: 0.82 (0.69-0.93). CONCLUSIONS All models were demonstrated to have high external validities in real-world patients, and of them, the "Apolo model" achieved the highest c-index in the present population. Further studies with larger populations are needed for establishment of the next standard model.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Yukari Uemura
- Central Coordinating Unit, Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Akihiko Matsumoto
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasushi Nagase
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yoshinori Tanaka
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Kanae Yoshida
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Sachi Yamamoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yutaka Enomoto
- Division of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yorito Nose
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshikazu Sato
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Akira Ishikawa
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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17
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Vulvar metastasis from bladder cancer. Case Rep Obstet Gynecol 2015; 2015:324634. [PMID: 26000184 PMCID: PMC4426944 DOI: 10.1155/2015/324634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 11/17/2022] Open
Abstract
Vulvar metastasis of urothelial carcinoma of the bladder is a very rare entity; few cases are reported in the English literature. In this paper, we describe the clinical and pathological characteristics, evolution, and treatment of a patient with vulvar metastasis of urothelial carcinoma of the bladder followed by a brief review of the reported cases in the literature.
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18
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McInnes MDF, Siemens DR, Mackillop WJ, Peng Y, Wei S, Schieda N, Booth CM. Utilisation of preoperative imaging for muscle-invasive bladder cancer: a population-based study. BJU Int 2015; 117:430-8. [PMID: 25561020 DOI: 10.1111/bju.13034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To test the hypotheses that: (i) use of preoperative imaging for muscle-invasive bladder cancer (MIBC) conforms to practice guidelines; (ii) preoperative imaging, through more accurate staging is associated with improved outcomes. PATIENT AND METHODS In this population-based cohort study, records of treatment were linked to the Ontario Cancer Registry to identify all patients with MIBC treated with cystectomy from 1994 to 2008. Utilisation of chest, abdomen-pelvis and bone imaging were evaluated. Trends were evaluated over time. Logistic regression was used to analyse factors associated with utilisation. Cox model analyses were used to explore associations between imaging and survival. RESULTS In all, 2 802 patients with MIBC underwent cystectomy during 1994-2008. Over the three 5-year study periods there was an increase in the proportion of patients having preoperative: chest X-ray (55%, 64%, 63%, P < 0.001), computed tomography (CT) of the chest (10%, 10%, 21%, P < 0.001), bone scan (30%, 34%, 36%; P = 0.04) and CT/magnetic resonance imaging/ultrasonography abdomen/pelvis (80%, 87%, 90%, P ≤ 0.001). Use of chest imaging was associated with age (odds ratio [OR] 1.24-1.59 compared with the youngest age group), N-stage (OR 0.79 for the NX group compared with the N+ group), surgeon volume (OR 0.47-0.53 compared with the highest volume quartile) and geographic region (OR 0.47-2.19 compared with the largest region). Use of bone scan was associated with N-stage (OR 0.57 for the NX group compared with the N+ group) and geographic region (OR 0.71-1.34 compared with the largest region). In adjusted analyses, we found that patients who did not have preoperative chest imaging had inferior overall survival (OS), hazard ratio (HR) 1.12 (95% confidence interval [CI] 1.01-1.25) but not cancer specific survival (CSS), HR 1.09 (95% CI 0.97-1.22); those who did not have preoperative bone scan had inferior OS (HR 1.11, 95% CI 1.01-1.22) and CSS (HR 1.09, 95% CI 1.01-1.25). Survival in the abdomen and pelvis imaging group was not evaluated due to lack of a suitable control group. CONCLUSION In routine clinical practice there is considerable variation in use of preoperative chest, body, and bone imaging. Preoperative chest and bone imaging is associated with improved outcomes; this association probably reflects better patient selection for cystectomy.
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Affiliation(s)
- Matthew D F McInnes
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Robert Siemens
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada
| | - William J Mackillop
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.,Department of Oncology, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Yingwei Peng
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Shelly Wei
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada.,Department of Urology, Queen's University, Kingston, ON, Canada.,Department of Public Health Sciences, Queen's University, Kingston, ON, Canada
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19
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TAT-RhoGDI2, a novel tumor metastasis suppressor fusion protein: expression, purification and functional evaluation. Appl Microbiol Biotechnol 2014; 98:9633-41. [DOI: 10.1007/s00253-014-6021-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 01/03/2023]
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20
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Lim JH, Jeon SH, Lee JM, Kim L, Cho JH, Ryu JS, Kwak SM, Lee HL, Nam HS. Late-onset distant metastatic upper urinary tract urothelial carcinoma mimicking lung adenocarcinoma. Tuberc Respir Dis (Seoul) 2013; 75:32-5. [PMID: 23946757 PMCID: PMC3741472 DOI: 10.4046/trd.2013.75.1.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/14/2013] [Accepted: 01/17/2013] [Indexed: 12/11/2022] Open
Abstract
Urothelial carcinomas (UCs) can occur in the upper urinary tract or lower urinary tract. Upper urinary tract urothelial carcinoma (UUT-UC) is relatively a rare disease and accounts for only about 5% of UC cases. Sporadic cases of late-onset metastasis, associated with UC of the bladder, have occasionally been reported. In contrast, no late-onset distant metastatic UUT-UC without local recurrence has, to the best of our knowledge, been reported in the English literature. We report an extremely rare case of distant metastatic UC, mimicking lung adenocarcinoma that originated from UUT-UC 12 years previously.
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Affiliation(s)
- Jun-Hyeok Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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21
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Huang CC, Michael CW. Cytomorphological features of metastatic squamous cell carcinoma in serous effusions. Cytopathology 2013; 25:112-9. [DOI: 10.1111/cyt.12065] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2013] [Indexed: 01/26/2023]
Affiliation(s)
- C. C. Huang
- Department of Pathology; University of Michigan; Ann Arbor MI USA
| | - C. W. Michael
- Department of Pathology; Case Western Reserve University/University Hospitals; Case Medical Centre; Cleveland OH USA
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22
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Metachronous occurrence of triple malignancies of kidneys, prostate, and breast. A case report and review of the literature. Case Rep Urol 2013; 2013:194620. [PMID: 23533925 PMCID: PMC3606744 DOI: 10.1155/2013/194620] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/06/2013] [Indexed: 12/21/2022] Open
Abstract
Multiple consecutive cancers involving different organs in a male individual are presented.
Case Presentation. Herein, we present a rare case of primary right renal cell carcinoma (RCC), in which two different organ malignancies of prostate and breast were occurred consecutively. After proper treatment of each organ tumor, the patient experienced metachronous occurrence of its final tumor in his remained left kidney as left side RCC. Discussions. Multiple primary cancers are defined as occurrence of two or more malignancies, synchronous or metachronous, in different organs without any relation to each other. For primary and secondary tumors of the male genitourinary system, the most common occurrence was tumors of bladder and prostate followed by tumors of the kidney. Our case was a rare presentation of consecutive occurrence of multiple organ tumors: right side RCC, adenocarcinoma of prostate, and ductal cell carcinoma of the left breast, followed by left side RCC. Conclusions. In any case of primary malignancy of any organ, not only primary tumor recurrence but also tumoral growth of other nonrelated organs should be evaluated, especially in high risk patients or patients with positive familial history.
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23
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DeGraff DJ, Robinson VL, Shah JB, Brandt WD, Sonpavde G, Kang Y, Liebert M, Wu XR, Taylor JA. Current preclinical models for the advancement of translational bladder cancer research. Mol Cancer Ther 2012; 12:121-30. [PMID: 23269072 DOI: 10.1158/1535-7163.mct-12-0508] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bladder cancer is a common disease representing the fifth most diagnosed solid tumor in the United States. Despite this, advances in our understanding of the molecular etiology and treatment of bladder cancer have been relatively lacking. This is especially apparent when recent advances in other cancers, such as breast and prostate, are taken into consideration. The field of bladder cancer research is ready and poised for a series of paradigm-shifting discoveries that will greatly impact the way this disease is clinically managed. Future preclinical discoveries with translational potential will require investigators to take full advantage of recent advances in molecular and animal modeling methodologies. We present an overview of current preclinical models and their potential roles in advancing our understanding of this deadly disease and for advancing care.
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Affiliation(s)
- David J DeGraff
- 1Vanderbilt University Medical Center, Nashville,Tennessee, USA
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24
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Kamby C, Sengeløv L. Assessment of functional status in patients with invasive carcinoma of the urothelial tract. Urol Oncol 2012; 2:43-51. [PMID: 21224135 DOI: 10.1016/s1078-1439(96)00049-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Performance status score is an important prognostic factor for response and survival for patients entering clinical trials. Evaluation of the functional status of the patients should be considered when retrospective studies on prognostic factors are performed. However, the methodologic problems of evaluating performance status retrospectively are unknown. The aim of this study was to evaluate the reliability and validity of retrospective assessment of performance status based on information from patient records. The level of performance status was analyzed in relation to duration of survival after primary or recurrent carcinoma of the urinary tract. The records of 149 patients with primary urothelial carcinoma and 53 patients with recurrent disease were blindly scored twice by two investigators according to the World Health Organization (WHO) performance status scale. The median time of observation was 109 months (range 3-219); 13 patients were alive at the time of follow-up. When scores of the performance were compared for patients separated in two groups, good performance (WHO scores 0 and 1) versus poor performance status (score >1), the intraobserver overall agreement for the assessments varied from 82% to 89%, whereas the interobserver agreement varied from 76% to 86%. The range of the intra- and interobserver kappa coefficients (95% CI) were 63% to 72% (52% to 83%) and 49% to 68% (40% to 79%), respectively. All four assessments were significantly related to survival (p < 10(-4)). Multivariable proportional hazard regression analysis showed that gender, platelet count, level of liver enzymes, and each of the four assessments of performance status (analyzed in four separate statistical models) were significant prognostic factors. Retrospective scoring of performance status is a reproducible and reliable tool that provides additional prognostic information. Optimal retrospective evaluation of the simultaneous effect of multiple prognostic factors should therefore include an assessment of the functional status of the patient.
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Affiliation(s)
- C Kamby
- Department of Oncology, Copenhagen University Hospital Herlev, Copenhagen, Denmark
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25
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Sclerotic osseous metastases from renal cell carcinoma. Skeletal Radiol 2012; 41:1169-75. [PMID: 22576970 DOI: 10.1007/s00256-012-1424-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 04/19/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
This case series describes and illustrates three cases of sclerotic osseous metastases from untreated renal cell carcinoma (RCC). RCC is commonly metastatic to the skeleton but almost always produces lytic metastases, with only three prior reports of sclerotic metastases identified in the literature. Sclerotic metastasis causing low back pain was the initial disease presentation in two of the three patients in this case series and the first manifestation of metastatic disease in one. The most common metastatic sites of RCC, i.e., retroperitoneal lymph nodes, lung, and liver, were not identified in any of the cases, and skeletal involvement with epidural extension was the only site of metastasis in two. Pathologic specimens from all three cases revealed RCC of high nuclear grade.
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Wu K, Fan J, Zhang L, Ning Z, Zeng J, Zhou J, Li L, Chen Y, Zhang T, Wang X, Hsieh JT, He D. PI3K/Akt to GSK3β/β-catenin signaling cascade coordinates cell colonization for bladder cancer bone metastasis through regulating ZEB1 transcription. Cell Signal 2012; 24:2273-82. [PMID: 22906492 DOI: 10.1016/j.cellsig.2012.08.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/12/2012] [Indexed: 11/29/2022]
Abstract
Muscle-invasive bladder cancer is associated with a high frequency of metastasis, and bone is the most common metastatic site outside the pelvis. To clarify its organ-specific characteristics, we generated a successive bone metastatic T24-B bladder cancer subline following tail vein injection of metastatic T24-L cells. Compared with parental T24-L cells, epithelial-like T24-B cells displayed increased adhesion but decreased migration or invasion abilities as well as up-regulation of cytokeratins and down-regulation of vimentin, N-cadherin and MMP2. Mechanically, phosphatidylinositol 3-kinase (PI3K)/Akt targets glycogen synthase kinase-3β (GSK3β)/β-catenin to control ZEB1 gene transcription, and then subsequently regulates the expression of cytokeratins, vimentin and MMP2. Importantly, ZEB1 is essential for bladder cancer invasion in vitro and distant metastasis in vivo, and ZEB1 overexpression was highly correlated with the expression of those downstream markers in clinical tumor samples. Overall, this study reveals a novel mechanism facilitating metastatic bladder cancer cell re-colonization into bone, and confirms the significance of mesenchymal-to-epithelial transition (MET) in formation of bone metastasis.
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Affiliation(s)
- Kaijie Wu
- Department of Urology, First Affiliated Hospital of Medical School, Xi'an Jiaotong University, Xi'an 710061, PR China
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Cheng Huang C, Attele A, Michael CW. Cytomorphologic features of metastatic urothelial carcinoma in serous effusions. Diagn Cytopathol 2012; 41:569-74. [DOI: 10.1002/dc.22896] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 06/07/2012] [Indexed: 11/12/2022]
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Ricardo-Gonzalez RR, Nguyen M, Gokden N, Sangoi AR, Presti JC, McKenney JK. Plasmacytoid Carcinoma of the Bladder: A Urothelial Carcinoma Variant With a Predilection for Intraperitoneal Spread. J Urol 2012; 187:852-5. [DOI: 10.1016/j.juro.2011.10.145] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Indexed: 11/25/2022]
Affiliation(s)
| | - Michael Nguyen
- Department of Pathology, Stanford University Medical Center, Stanford, California
| | - Neriman Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ankur R. Sangoi
- Department of Pathology, Stanford University Medical Center, Stanford, California
- Department of Pathology, El Camino Hospital, Mountain View, California
| | - Joseph C. Presti
- Department of Urology, Stanford University Medical Center, Stanford, California
| | - Jesse K. McKenney
- Department of Pathology, Stanford University Medical Center, Stanford, California
- Department of Urology, Stanford University Medical Center, Stanford, California
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Konala P, Schaefer TK, Iranpour F, Friederich NF, Hirschmann MT. An unusual case of persistent groin pain after total hip arthroplasty: a case report. J Med Case Rep 2011; 5:67. [PMID: 21324110 PMCID: PMC3049745 DOI: 10.1186/1752-1947-5-67] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/15/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Arthroplasty is a well-established routine elective surgical procedure in orthopaedics. To a great extent, diagnosis, treatment and post-operative rehabilitation in these patients is standardised. In a busy clinic, surgeons from time to time tend to focus their attention on common causes of joint pain, but it may lead them to overlook sinister but less common pathologies. Here we report a case of a patient with groin pain due to pre-operatively undetected pelvic metastases from a pyeloureteral carcinoma who underwent total hip arthroplasty. There are several case reports which deal with primary or secondary tumours which were either discovered at the time of replacement surgery or developed at the site of prosthesis years after total hip or knee replacement. To the best of our knowledge, this is the first case report in which a metastatic cancer was missed pre-operatively and intra-operatively both by the radiologist and by the orthopaedic surgeon and should be reported so that surgeons are reminded to be careful when dealing with seemingly routine cases. CASE PRESENTATION A 79-year-old Caucasian woman presented to the arthroplasty clinic with groin pain. Initial radiographs showed subtle bilateral abnormalities in the pelvis. Neither the radiologist nor the orthopaedic surgeon recognized it. A diagnosis of osteoarthritis of the hip was established, and she underwent total hip arthroplasty. Despite initial improvement, the patient came back with worsening hip pain three months later. Further radiological examination revealed multiple metastatic lesions throughout the pelvis due to a pyeloureteral carcinoma. CONCLUSIONS This case report emphasizes the importance of meticulous, unbiased pre-operative assessment of patients and their radiographs, even in so-called routine clinical cases. Often subtle radiological changes are classed as normal, especially if they are bilateral. Further radiological imaging should be recommended in all cases where unexplained clinical features or radiological findings are present.
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Affiliation(s)
- Praveen Konala
- Musculoskeletal Surgery Department, Imperial College, London, UK.
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Metastatic pattern of bladder cancer: correlation with the characteristics of the primary tumor. AJR Am J Roentgenol 2011; 196:117-22. [PMID: 21178055 DOI: 10.2214/ajr.10.5036] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the metastatic pattern of muscle-invasive bladder cancer and to correlate the findings with the characteristics of the primary tumor. MATERIALS AND METHODS From a clinic population of 392 patients with muscle-invasive (pT2-4) bladder cancer seen at our institution from January 2004 through December 2009, we studied the cases of 150 consecutively registered patients with pathologically proven metastatic disease. The metastasis-free intervals and metastatic patterns of different T categories were compared by Kruskal-Wallis test and Freeman-Halton extension of Fisher's exact test. Patients were divided into two histologic categories, those with transitional cell carcinoma and those with atypical histologic features. The metastasis-free interval and metastatic pattern of these two groups were compared by Mann-Whitney test and Fisher's exact test. RESULTS The study group consisted of 150 patients (116 men [77%], 34 women [23%]; median age, 64 years). The transitional cell carcinoma group consisted of 94 (63%) patients and the atypical histologic features group of 56 (37%) patients. The most common metastatic sites were lymph nodes (104 patients, 69%), bone (71 patients, 47%), lung (55 patients, 37%), liver (39 patients, 26%), and peritoneum (24 patients, 16%). Patients with tumors of a more advanced T category had shorter metastasis-free intervals (p = 0.001, df = 2). There was no significant difference in the metastatic patterns of tumors in the different T categories. Patients with atypical histologic features had a shorter median metastasis-free interval (3 months; range, 0-29 months) than patients with transitional cell carcinoma (12 months; range, 0-192 months) (p = 0.0001). Patients with atypical histologic features had a significantly higher incidence of peritoneal metastasis (p < 0.0002). CONCLUSION Lymph nodes, bones, lung, liver, and peritoneum are the most common sites of metastasis from bladder cancer. Tumors in a more advanced T category and those with atypical histologic features metastasize earlier. Tumors with atypical histologic features also have a higher frequency of peritoneal metastasis.
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Moon KS, Jung S, Lee KH, Hwang EC, Kim IY. Intracranial metastasis from primary transitional cell carcinoma of female urethra: case report & review of the literature. BMC Cancer 2011; 11:23. [PMID: 21244713 PMCID: PMC3033851 DOI: 10.1186/1471-2407-11-23] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 01/19/2011] [Indexed: 11/16/2022] Open
Abstract
Background Transitional cell carcinoma (TCC) of the female urethra is a rare urological malignancy, and intracranial metastasis of this cancer has not yet been reported in the literature. This review is intended to present a case of multiple intracranial metastasis in a female patient with a remote history of primary urethral TCC. Case Presentation A 49-year-old woman, presented with a prolapsed mass in urethral orifice that was diagnosed as primary urethral TCC with distant lung and multiple bone metastases. The patient subsequently underwent chemotherapy under various regimens. A year later, the patient developed headache and vomiting which as was found to be due to multiple intracranial metastasis. The patient underwent surgical resection of the largest lesion located on the cerebellum, and consecutively gamma knife radiosurgery was performed for other small-sized lesions. Pathological examination of the resected mass revealed a metastatic carcinoma from a known urethral TCC. Serial work-up of systemic metastasis revealed concomitant aggravation of lung, spleen, and liver metastasis. The patient died of lung complication 2 months after the diagnosis of brain metastasis. Conclusion To the best of our knowledge, this is the first reported case of cerebral metastasis from primary urethral TCC, with pathological confirmation. As shown in intracranial metastasis of other urinary tract carcinoma, this case occurred in the setting of uncontrolled systemic disease and led to dismal prognosis in spite of aggressive interventional modalities.
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Affiliation(s)
- Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, 160 Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, South Korea
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Abstract
Urothelial carcinoma (UC) is the most common type of bladder cancer in Western nations. Most patients present with the non-muscle-invasive (NMIUC) form of the disease, while up to a third harbour the invasive form (MIUC). Specifically, the aetiology of NMIUC appears to be multifactorial and very different from that of MIUC. Loss of specific tumour suppressor genes as well as gain-of-function mutations in proteins within defined cellular signalling pathways have been implicated in NMIUC aetiology. The regions of chromosome 9 that harbour CDKN2A, CDKN2B, TSC1, PTCH1 and DBC1 are frequently mutated in NMIUC, resulting in functional loss; in addition, HRAS and FGFR3, which are both proto-oncogenes encoding components of the Ras-MAPK signalling pathway, have been found to harbour activating mutations in a large number of NMIUCs. Interestingly, some of these molecular events are mutually exclusive, suggesting functional equivalence. Since several of these driving changes are amenable to therapeutic targeting, understanding the signalling events in NMIUC may offer novel approaches to manage the recurrence and progression of this disease.
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Abstract
The greatest risk for morbidity and mortality caused by bladder cancer is due to metastasis. For this reason, we have developed a paradigm for discovering the molecular mechanisms underlying bladder cancer progression to an invasive and metastatic phenotype. Results of microarray gene expression analysis of a cell culture model were parsed by identifying overlapping genes that correlate with increasing stage and grade of human tumors. One gene identified by this method, RhoGDI2, was tested in various in vitro and in vivo model systems and confirmed to be a metastasis suppressor gene. Using a similar strategy of gene identification by concordance of microarray gene expression results from cells expressing RhoGDI2 and human bladder cancers, two molecular effectors of RhoGDI2 signaling were identified. These targets, endothelin-1 and Neuromedin U are excellent potential targets for therapeutic intervention in the metastatic cascade.
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Affiliation(s)
- Michael A Harding
- Department of Urology, University of Virginia, Charlottesville, VA 22908, USA
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Abstract
OBJECTIVE An older man with a history of urothelial cancer presented with an incidental right atrial mass. Cardiac MRI showed a pedunculated right atrial mass that was homogeneous and of intermediate signal intensity on T1- and T2-weighted images. No signal drop-out was seen on fat-suppressed images. The mass did not exhibit enhancement on the first-pass perfusion and delayed contrast-enhanced images. CONCLUSION A myxoma is the most common benign primary intracavitary cardiac mass. Although the MRI features are not pathognomonic, certain features such as location, presence of a stalk, and noninfiltrating nature may help to distinguish a myxoma from other intracavitary masses such as a thrombus, metastases, and primary cardiac malignancy. The final pathologic diagnosis was a right atrial myxoma.
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Affiliation(s)
- Anil K Attili
- Department of Radiology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI 48109, USA.
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Donat SM. Staged based directed surveillance of invasive bladder cancer following radical cystectomy: valuable and effective? World J Urol 2006; 24:557-64. [PMID: 17009050 DOI: 10.1007/s00345-006-0117-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- S Machele Donat
- Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA.
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36
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Nguyen BD. Urothelial nodal metastasis with direct vertebral invasion: PET/CT imaging. Clin Nucl Med 2006; 31:630-2. [PMID: 16985372 DOI: 10.1097/01.rlu.0000237964.65268.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ba D Nguyen
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona 85259, USA.
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37
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Joudi FN, Dahmoush L, Spector DM, Konety BR. Complete response of bony metastatic bladder urothelial cancer to neoadjuvant chemotherapy and cystectomy. Urol Oncol 2006; 24:403-6. [PMID: 16962489 DOI: 10.1016/j.urolonc.2005.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Revised: 12/19/2005] [Accepted: 12/22/2005] [Indexed: 11/16/2022]
Abstract
We report on a 38-year-old male diagnosed with biopsy-proven bladder urothelial carcinoma metastatic to the bone, who had a complete response to neoadjuvant chemotherapy consisting of carboplatin and gemcitabine. The final pathology of his radical cystoprostatectomy revealed no residual cancer. The patient continues to be without evidence of disease 2 years postoperatively. This case shows that neoadjuvant chemotherapy with nonstandard regimens can yield responses in patients with bone metastases.
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Affiliation(s)
- Fadi N Joudi
- Department of Urology, University of Iowa, Iowa City, IA 52242-1089, USA.
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Cotta CV, Konoplev S, Medeiros LJ, Bueso-Ramos CE. Metastatic tumors in bone marrow: histopathology and advances in the biology of the tumor cells and bone marrow environment. Ann Diagn Pathol 2006; 10:169-92. [PMID: 16730315 DOI: 10.1016/j.anndiagpath.2006.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The nonhematopoietic tumors most often diagnosed in the bone marrow are metastatic. Currently, accurate diagnosis of tumor metastasis requires integration of the clinical findings; morphological features; and results of immunohistochemical stains, cytogenetics, and molecular studies. This review focuses on a practical approach to the diagnosis of metastatic tumors in the bone marrow according to current standards of practice and discusses recent advances in understanding of tumor metastasis and the interaction between tumors and the bone marrow environment.
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Affiliation(s)
- Claudiu V Cotta
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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39
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Mallén Mateo E, Gil Martínez P, Gil Sanz MJ, Sancho Serrano C, Pascual Regueriro D, Rioja Sanz LA. Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie. Actas Urol Esp 2006; 30:763-71. [PMID: 17078573 DOI: 10.1016/s0210-4806(06)73533-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. MATERIALS AND METHODS between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. RESULTS In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progression-free survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126), since the date of the cistectomia. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy, with a cancer-specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). CONCLUSION In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection (T3, 32 months) and the ganglionary affectation (pN+ 45 months).
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Affiliation(s)
- E Mallén Mateo
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza.
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40
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Chaffer CL, Dopheide B, McCulloch DR, Lee AB, Moseley JM, Thompson EW, Williams ED. Upregulated MT1-MMP/TIMP-2 axis in the TSU-Pr1-B1/B2 model of metastatic progression in transitional cell carcinoma of the bladder. Clin Exp Metastasis 2005; 22:115-25. [PMID: 16086232 DOI: 10.1007/s10585-005-5141-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 03/25/2005] [Indexed: 10/25/2022]
Abstract
Muscle invasive transitional cell carcinoma (TCC) of the bladder is associated with a high frequency of metastasis, resulting in poor prognosis for patients presenting with this disease. Models that capture and demonstrate step-wise enhancement of elements of the human metastatic cascade on a similar genetic background are useful research tools. We have utilized the transitional cell carcinoma cell line TSU-Pr1 to develop an in vivo experimental model of bladder TCC metastasis. TSU-Pr1 cells were inoculated into the left cardiac ventricle of SCID mice and the development of bone metastases was monitored using high resolution X-ray. Tumor tissue from a single bone lesion was excised and cultured in vitro to generate the TSU-Pr1-B1 subline. This cycle was repeated with the TSU-Pr1-B1 cells to generate the successive subline TSU-Pr1-B2. DNA profiling and karyotype analysis confirmed the genetic relationship of these three cell lines. In vitro, the growth rate of these cell lines was not significantly different. However, following intracardiac inoculation TSU-Pr1, TSU-Pr1-B1 and TSU-Pr1-B2 exhibited increasing metastatic potential with a concomitant decrease in time to the onset of radiologically detectable metastatic bone lesions. Significant elevations in the levels of mRNA expression of the matrix metalloproteases (MMPs) membrane type 1-MMP (MT1-MMP), MT2-MMP and MMP-9, and their inhibitor, tissue inhibitor of metalloprotease-2 (TIMP-2), across the progressively metastatic cell lines, were detected by quantitative PCR. Given the role of MT1-MMP and TIMP-2 in MMP-2 activation, and the upregulation of MMP-9, these data suggest an important role for matrix remodeling, particularly basement membrane, in this progression. The TSU-Pr1-B1/B2 model holds promise for further identification of important molecules.
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Affiliation(s)
- Christine L Chaffer
- Bernard O'Brien Institute of Microsurgery, University of Melbourne, Australia
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Titus B, Frierson HF, Conaway M, Ching K, Guise T, Chirgwin J, Hampton G, Theodorescu D. Endothelin Axis Is a Target of the Lung Metastasis Suppressor Gene RhoGDI2. Cancer Res 2005; 65:7320-7. [PMID: 16103083 DOI: 10.1158/0008-5472.can-05-1403] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Half of patients treated for locally advanced bladder cancer relapse with often fatal metastatic disease to the lung. We have recently shown that reduced expression of the GDP dissociation inhibitor, RhoGDI2, is associated with decreased survival of patients with advanced bladder cancer. However, the effectors by which RhoGDI2 affects metastasis are unknown. Here we use DNA microarrays to identify genes suppressed by RhoGDI2 reconstitution in lung metastatic bladder cancer cell lines. We identify such RNAs and focus only on those that also increase with tumor stage in human bladder cancer samples to discover only clinically relevant targets of RhoGDI2. Levels of endothelin-1 (ET-1), a potent vasoconstrictor, were affected by both RhoGDI2 reconstitution and tumor stage. To test the hypothesis that the endothelin axis is important in lung metastasis, lung metastatic bladder carcinoma cells were injected in mice treated with the endothelin receptor-specific antagonist, atrasentan, thereby blocking engagement of the up-regulated ET-1 ligand with its cognate receptor. Endothelin antagonism resulted in a dramatic reduction of lung metastases, similar to the effect of reexpressing RhoGDI2 in these metastatic cells. Taken together, these experiments show a novel approach of identifying therapeutic targets downstream of metastasis suppressor genes. The data also suggest that blockade of the ET-1 axis may prevent lung metastasis, a new therapeutic concept that warrants clinical evaluation.
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Affiliation(s)
- Brian Titus
- Department of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville, Virginia 22908, USA
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Delaney G, Jacob S, Barton M. Estimating the optimal external-beam radiotherapy utilization rate for genitourinary malignancies. Cancer 2005; 103:462-73. [PMID: 15612081 DOI: 10.1002/cncr.20789] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Benchmark radiotherapy utilization rates for genitourinary malignancies are largely unknown, despite the finding that genitourinary cancers comprise approximately 19% of all registered malignancies in Australia. METHODS To develop an evidence-based benchmark of the optimal proportion of patients with genitourinary malignancies who should receive at least one course of radiotherapy at some time during their illness, the authors studied treatment guidelines and treatment reviews regarding genitourinary malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes that indicated possible benefit from radiotherapy based on evidence. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with genitourinary cancer for whom radiotherapy was considered appropriate. RESULTS The proportion of patients with genitourinary malignancies for whom radiotherapy was indicated at some point in their illness, according to the best available evidence, was estimated to be 27% of patients with renal cancer, 58% of patients with bladder cancer, 60% of patients with prostate cancer, and 49% of patients with testicular cancer. The occurrence of ureteric and penile cancers among patients was too rare, and, therefore, these patients were not included in the current study. CONCLUSIONS There was a large discrepancy between actual radiotherapy utilization and the evidence-based optimal rate. The authors recommended strategies to implement the evidence-based guidelines. Evidence-based benchmarks for radiotherapy utilization rates such as the ones described in the current study were important in the evaluation of the appropriate use of radiotherapy.
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Affiliation(s)
- Geoff Delaney
- Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney, Australia.
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Mydlo JH, Gerstein M. Patients with urologic cancer and other nonurologic malignancies: analysis of a sample and review of the literature. Urology 2001; 58:864-9. [PMID: 11744447 DOI: 10.1016/s0090-4295(01)01394-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To describe our experience with patients with urologic cancers who also have malignancies of nonurologic origin, before, after, or simultaneously, to review the literature, and to suggest treatment options. METHODS We reviewed our institutions' tumor registry from 1995 to 2000 to discover how many patients had a urologic malignancy and another nonurologic cancer (antecedent, subsequent, or synchronous). We reviewed Medline from 1966 to 2000 and also questioned several urologists at major centers in the United States concerning this clinical dilemma. RESULTS We encountered 18 patients during a 6-year period with a urologic cancer and another primary malignancy. Thirteen patients had their second cancer detected during the workup of their primary urologic tumor. Two patients developed a second tumor within 1 year of treatment of the primary urologic tumor. Another patient was referred with two primaries already diagnosed, and another had renal carcinoma detected during her colon cancer workup. We found that multiple tumors, although very rare, are usually detected during the preoperative workup of the primary tumor, usually by physical examination and improved radiologic imaging, or during the follow-up examinations. Most reports suggest that treatment should be performed simultaneously, especially if the lesions are relatively small and require a single incision, and the patient's medical condition allows longer anesthesia exposure. If these prerequisites are not met, most investigators agree that treatment should be directed at the more aggressive lesion first, which may improve the condition and/or survival, and thus, if a second operation is warranted, it will be possible. CONCLUSIONS Although patients with multiple malignancies are rare, the urologist and/or other specialist should be alerted to this possibility when evaluating patients for the initially presenting symptoms and/or detected tumor, as well as during the follow-up evaluations.
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Affiliation(s)
- J H Mydlo
- Department of Urology, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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Abstract
Radical cystectomy provides excellent local control of the disease in cancer patients, although specific 5-year mortality is about 50%. Additionally, nearly half the patients show complications after surgery usually due to urinary by-pass. Patients should undergo periodical monitoring for life. For rescue treatment to be as effective as possible, follow-up schemes should allow for early detection of relapsing-recurrent tumours, metastasis and complications. Knowledge of the "natural evolution" in these patients allows to optimise the frequency of visits and complementary examinations based on each patient's risk at specific time-points. Cost-efficacy relationship will also be optimised. We analyze here the current literature and our own experience of what we know as "natural evolution" of these patients and propose a follow-up scheme for patients with cancer of the bladder treated with radical cystectomy and urinary by-pass.
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45
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 30-1999. An 86-year-old man with gastrointestinal bleeding and small-bowel obstruction. N Engl J Med 1999; 341:1063-71. [PMID: 10502597 DOI: 10.1056/nejm199909303411408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
MESH Headings
- Aged
- Aged, 80 and over
- Diagnosis, Differential
- Gastrointestinal Hemorrhage/etiology
- Humans
- Ileal Neoplasms/complications
- Ileal Neoplasms/pathology
- Ileum/pathology
- Intestinal Obstruction/etiology
- Intestine, Small/diagnostic imaging
- Intestines/blood supply
- Ischemia/diagnosis
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Tomography, X-Ray Computed
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SENGELOV LISA, von der MAASE HANS, KAMBY CLAUS, JENSEN LISEINGEMANN, RASMUSSEN FINN, HORN THOMAS, NIELSEN STEENLEVIN, STEVEN KENNETH. ASSESSMENT OF PATIENTS WITH METASTATIC TRANSITIONAL CELL CARCINOMA OF THE URINARY TRACT. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68556-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tefilli MV, Gheiler EL, Tiguert R, Grignon DJ, Forman JD, Pontes JE, Wood DP. Urinary diversion-related outcome in patients with pelvic recurrence after radical cystectomy for bladder cancer. Urology 1999; 53:999-1004. [PMID: 10223496 DOI: 10.1016/s0090-4295(98)00623-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the impact of urinary diversion on disease status, complications, and subsequent treatment in patients with pelvic tumor recurrence after radical cystectomy for bladder cancer. METHODS A retrospective review of 201 consecutive cases of radical cystectomy for bladder cancer, performed at our institution between March 1991 and March 1996, identified 33 patients (16.4%) with disease recurrence in the pelvis with or without systemic metastasis. Urinary diversion in patients with tumor recurrence was an ileal conduit, continent cutaneous diversion, or orthotopic neobladder in 19, 3, and 11 patients, respectively. The mean follow-up for all patients undergoing cystectomy was 25.9 months (range 8 to 75). The mean time to diagnosis of local disease recurrence after cystectomy was 13.9 months (range 5 to 50). RESULTS In 21 (63.6%) of 33 patients, pelvic recurrence and systemic metastasis were present simultaneously. Disease recurrence was associated with poor outcome: only 8 patients (24.2%) were alive and disease free, 7 of whom had isolated local recurrence without evidence of systemic metastasis. There was no difference in overall survival or type of therapy delivered once disease recurrence was diagnosed between patients with an orthotopic neobladder and those with a cutaneous (continent or incontinent) urinary diversion. The only diversion-related complication resulting from pelvic recurrence was 1 case of tumor invasion into an orthotopic neobladder, requiring conversion to an ileal conduit. CONCLUSIONS The type of urinary diversion did not impact a patient's risk of complications, the ability to receive salvage treatment, or overall survival once pelvic recurrence was diagnosed. Patients at high risk of pelvic recurrence should not be excluded from receiving an orthotopic urinary diversion.
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Affiliation(s)
- M V Tefilli
- Department of Urology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute, Detroit, Michigan 48201, USA
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