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Wei X, Chai Y, Li Z, Che X, Zhang Y, Zhou Z, Wang X. Up-regulated serum lactate dehydrogenase could become a poor prognostic marker in patients with bladder cancer by an evidence-based analysis of 2,182 patients. Front Oncol 2023; 13:1233620. [PMID: 37601656 PMCID: PMC10435851 DOI: 10.3389/fonc.2023.1233620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Background A growing number of studies have considered serum lactate dehydrogenase (LDH) as an indicator of bladder cancer (BC) prognosis. However, a meta-analysis of the serum LDH's influence on BC prognosis is still missing. Methods PubMed, EMBASE, Web of Science and Cochrane Library were exhaustively searched for studies comparing oncological outcomes between high-LDH and low-LDH patients. Standard cumulative analyses using hazard ratios (HR) with 95% confidence intervals (CI) were performed using Review Manager (version 5.3) for overall survival (OS) in patients with BC. Results Six studies involving 2,182 patients were selected according to predefined eligibility criteria. The results showed that serum LDH level was significantly associated with OS (HR = 1.86, 95%CI = 1.54-2.25, p<0.0001) in BC. Sensitivity analysis showed the stability of the results. Subgroup analysis revealed that the levels of serum LDH had a significant impact on the OS of BC patients among different groups including publication time, research country, sample size, tumor stage, LDH cut-off value, therapy and follow-up time (all HR>1 and p<0.05), revealing that the ability of serum LDH is not affected by other factors. Conclusion Our findings indicated that a high level of serum LDH was associated with inferior OS in patients with BC. However, caution must be taken before recommendations are given because this interpretation is based upon very few clinical studies and a small sample.
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Affiliation(s)
- Xiaoyu Wei
- Department of Oncology, Tianjin Binhai New Area Hospital of Traditional Chinese Medicine, Tianjin, China
| | - Yumeng Chai
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Zhouyue Li
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Xuanyan Che
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Xiang Wang
- Department of Urology, Tengzhou Central People’s Hospital, Tengzhou, China
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Gu S, Yang C. Serum lactate dehydrogenase level predicts the prognosis in bladder cancer patients. BMC Urol 2023; 23:65. [PMID: 37098538 PMCID: PMC10127081 DOI: 10.1186/s12894-023-01239-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/07/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Recently, several studies investigated the association between lactate dehydrogenase (LDH) level and the prognosis of urothelial carcinoma. However, no studies explored the role of serum LDH level in the survival of overall bladder cancer (BC). In this study, we intended to address the association of LDH level with the prognosis of BC. METHODS 206 patients with BC were included in this study. The clinical data and blood samples of patients were collected. The overall survival and progression-free survival were used. Kaplan-Meier method and Log rank test were used to evaluate the effects of LDH level on the survival of BC. Univariate and multivariate Cox regression analyses were utilized to identify prognosis predictors of BC. RESULTS Data indicated that serum LDH level in the BC patients was significantly higher than those in controls. In addition, this study suggested that serum LDH level was associated with T stage, N stage, tumor size, M stage, pathological type, and lymphovascular invasion. The Kaplan-Meier analysis found significant differences in the OS and PFS rate between lower and higher serum LDH level groups (LDH ≥ 225 U/L and < 225 U/L). Multivariate Cox regression indicated that pathological type, T2-3, and higher level of LDH were independently associated with adverse prognosis in BC patients. CONCLUSION The higher serum LDH level (≥ 225 U/L) is associated with poor prognosis in patients with BC. Serum LDH level could be used as a novel predictive biomarker for BC patients.
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Affiliation(s)
- Shuo Gu
- Department of Urology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, 223300, China.
| | - Chao Yang
- Department of Urology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Jiangsu, 223300, China
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Yahya A, Rajab Alhamadani ZA, Mundher M. Immunohistochemical Expression of Retinoblastoma Gene Product and p53 Protein in Transitional Cell Carcinoma of the Urinary Bladder and its Relationship to Different Clinicopathological Parameters. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Carcinoma of urinary bladder is one of the most common malignancies worldwide and constitutes a major health problem. Multiple risk factors are associated with this tumor and its prognosis will depend on different clinicopathological parameters. Over expression of P53 protein and mutant Rb gene is associated with more aggressive clinical and histopathological features of the tumor such as advanced stage and higher grade.
AIM: The immunohistochemical expression of Rb gene and P53 gene will be assessed through their protein products in transitional cell carcinoma (TCC) of the urinary bladder and then will be correlated with other well-known risk factors and prognostic parameters of bladder TCC, such as grading, tumor size, smoking, alcohol drinking, and family history.
METHODS: Patients were recruited from the uro-surgical department/Surgical Subspecialties Teaching Hospital during the period from November 2020 through April 2021. In this study, patients enrolled were those suspected to have bladder carcinoma. The work up included a full history and clinical examination. Surgical samples were taken from the patients for histopathological evaluation; the study’s samples represented either endoscopic cup biopsy, transurethral resection of the tumor, or radical cystectomy. Sections obtained from these samples were stained with the conventional hematoxylin and eosin stain. Then, immunohistochemical staining for P53 and pRB was applied only for patients diagnosed with TCC.
RESULTS: The differences between low-grade and high-grade tumors regarding pRb percentage score were statistically significant (p = 0.026), but were not significant regarding the intensity score (p = 0.094). There were significant correlations between tumor stage and both pRb intensity and percentage scores (p = 0.044 and 0.042, respectively). Differences between low-grade and high-grade tumors regarding p53 intensity score were significant (p = 0.022). The differences between low-grade and high-grade tumors regarding p53 percentage score were significant (p = 0.049). The differences between different tumor stages regarding p53 intensity score were significant (p = 0.018). The differences between different tumor stages regarding P53 percentage score were significant (p = 0.019).
CONCLUSIONS: Tumor’s grade was found to be correlated with the tumor stage with no correlation with the age, gender, smoking, family history of TCC, history of urinary tract infection, bladder stones, nor the recurrence of the tumor. The pRb intensity and the percentage scores were correlated to each other and to tumor’s grade and stage, except for the pRb intensity which showed no correlation with the tumor’s grade. The P53 intensity and percentage scores were correlated to each other and also to tumor’s grade and stage, so that P53 is over-expressed in tumors with higher grade and stage.
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Prognostic significance of serum lactate dehydrogenase in patients undergoing radical cystectomy for bladder cancer. Urol Oncol 2020; 38:852.e1-852.e9. [PMID: 32624424 DOI: 10.1016/j.urolonc.2020.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND To investigate the prognostic significance of preoperative serum lactate dehydrogenase (LDH) in patients undergoing radical cystectomy for bladder cancer (BCa). PATIENTS AND METHODS A cohort of 263 patients undergoing open or laparoscopic radical cystectomy between 2011 and 2016 was studied. Baseline characteristics, hematological variables, follow-up data were collected. Kaplan-Meier curves and Cox proportional hazard regression model were applied to assess the relationship between LDH and overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). RESULTS After a median 34.2 (22.9-45.8) months follow-up, all-cause death, cancer-specific death, and disease recurrence occurred in 66 patients, 50 patients, and 91 patients. The elevation of serum LDH was associated with several unfavorable parameters, including advanced age, continent cutaneous urinary diversion, increased neutrophil-to-lymphocyte ratio, decreased lymphocyte-to-monocyte ratio. Patients with a higher serum LDH (> 220 U/L) had a worse OS (P < 0.001), CSS (P < 0.001) and DFS (P < 0.001). Multivariate Cox analysis suggested that elevated LDH was an independent predictor for OS (hazard ratio [HR]: 3.113, 95% confidence interval [CI]: 1.524-6.358; P = 0.002), CSS (HR: 4.564, 95% CI: 2.008-10.373; P < 0.001), DFS (HR: 2.051, 95% CI: 1.125-3.739; P = 0.019). Medical history of diabetes, high pT stage, and positive lymph node also were adverse predictors for oncological outcomes of BCa patients in multivariate analysis. CONCLUSIONS Preoperative serum LDH is an independent prognostic biomarker for OS, CSS, and DFS in patients undergoing radical cystectomy for BCa, which can be incorporated into prognostic models.
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Mori K, Miura N, Mostafaei H, Quhal F, Motlagh RS, Lysenko I, Kimura S, Egawa S, Karakiewicz PI, Shariat SF. Prognostic value of preoperative hematologic biomarkers in urothelial carcinoma of the bladder treated with radical cystectomy: a systematic review and meta-analysis. Int J Clin Oncol 2020; 25:1459-1474. [PMID: 32451768 PMCID: PMC7392936 DOI: 10.1007/s10147-020-01690-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/27/2020] [Indexed: 12/21/2022]
Abstract
This systematic review and meta-analysis aimed to assess the prognostic value of preoperative hematologic biomarkers in patients with urothelial carcinoma of the bladder treated with radical cystectomy. PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in September 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in patients with urothelial carcinoma of the bladder with and without pretreatment laboratoryabnormalities. Formal meta-analyses were performed for this outcome. The systematic review identified 36 studies with 23,632 patients, of these, 32 studies with 22,224 patients were eligible for the meta-analysis. Several preoperative hematologic biomarkers were significantly associated with cancer-specific survival as follows: neutrophil − lymphocyte ratio (pooled hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.11–1.29), hemoglobin (pooled HR: 0.87, 95% CI 0.82–0.94), C-reactive protein (pooled HR: 1.44, 95% CI 1.26–1.66), De Ritis ratio (pooled HR: 2.18, 95% CI 1.37–3.48), white blood cell count (pooled HR: 1.05, 95% CI 1.02–1.07), and albumin-globulin ratio (pooled HR: 0.26, 95% CI 0.14–0.48). Several pretreatment laboratory abnormalities in patients with urothelial carcinoma of the bladder were associated with cancer-specific mortality. Therefore, it might be useful to incorporate such hematologic biomarkers into prognostic tools for urothelial carcinoma of the bladder. However, given the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.
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Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Noriyoshi Miura
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Reza Sari Motlagh
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Ivan Lysenko
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
- Department of Urology, Weill Cornell Medical College, New York, NY, USA.
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA.
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Department of Urology, University of Jordan, Amman, Jordan.
- European Association of Urology Research Foundation, Arnhem, The Netherlands.
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Wu M, Lin P, Xu L, Yu Z, Chen Q, Gu H, Liu C. Prognostic Role of Serum Lactate Dehydrogenase in Patients With Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:677. [PMID: 32509573 PMCID: PMC7252225 DOI: 10.3389/fonc.2020.00677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background: To investigate the potential prognostic role of serum lactate dehydrogenase (LDH) in patients with urothelial carcinoma (UC) using the method of systematic review and meta-analysis. Materials and Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science for eligible studies up to February 2020. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were used to estimate the relationship. Results: A total of 14 studies including 4,009 patients with UC were incorporated. The results showed that a high pretreatment serum LDH was associated with an inferior overall survival (OS, HR 1.61, 95% CI 1.39–1.87, p < 0.001), cancer-specific survival (CSS, HR 1.41, 95% CI 1.05–1.90, p = 0.022), and disease-free survival (DFS, HR 1.64, 95% CI 1.04–2.59, p = 0.034) in UC. Subgroup analyses identified that a high pretreatment serum LDH was associated with a poor OS (HR 1.97, 95% CI 1.02–3.81, p = 0.042) and DFS (HR 1.64, 95% CI 1.04–2.59, p = 0.034) in upper tract urothelial carcinoma, a short OS (HR 1.71, 95% CI 1.37–2.15, p < 0.001) in urothelial carcinoma of bladder. Conclusion: Our findings indicated that a high level of pretreatment serum LDH was associated with inferior OS, CSS, and DFS in patients with UC. This biomarker can be an important factor incorporated into the prognostic models for UC.
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Affiliation(s)
- Minhong Wu
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Pengxiu Lin
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Lifang Xu
- Department of Medical Record Management, Chinese Air Force Specialty Medical Center, Beijing, China
| | - Zhiling Yu
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Qingsheng Chen
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Hongyong Gu
- Department of Urology, Yichun People's Hospital, Yichun, China
| | - Cailing Liu
- Department of Urology, Yichun People's Hospital, Yichun, China
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Yu J, Li G, Wang A, Luo Q, Liu Z, Niu Y, Mei Y. Impact of squamous differentiation on intravesical recurrence and prognosis of patients with upper tract urothelial carcinoma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:377. [PMID: 31555691 DOI: 10.21037/atm.2019.07.31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The prognostic role of squamous differentiation in upper urinary tract urothelial carcinoma (UTUC) is still unclear. This article describes the impact of squamous differentiation on prognosis and intravesical recurrence of patients with primary UTUC treated with radical nephroureterectomy (RNU). Methods Totally, we retrieved (I) 669 histologically confirmed UTUC patients without histologic variants; (II) 101 UTUC patients with squamous differentiation in our institution, dating from April 2003 to April 2016. The clinical pathological characteristics and survival outcomes were compared between these two cohorts. Results In our study, 13% UTUC patients were detected with squamous differentiation. The mean age of all the patients examined was 66, of whom 70% were males. Squamous differentiation significantly associated with tumor stage, tumor grade and lymphovascular invasion. The Kaplan-Meier and Cox regression analyses showed that presence of squamous differentiation was correlated with shorter cancer specific survival of UTUC patients. The 5-year cancer specific survival rates were 47% for squamous differentiation-present patients and 63% for squamous differentiation-absent patients. UTUC patients with squamous differentiation showed a higher frequency of high-grade disease in advanced stage (pT2/pT3/pT4), while the discrepancy was not shown in early stage (pTa/pT1). Intravesical recurrence was observed in 27% patients. We found that intravesical recurrence had little impact on the cancer specific survival of squamous differentiation-present patients, yet it tended to decrease cancer specific survival among squamous differentiation-absent patients. Conclusions The presence of squamous differentiation in UTUC patients was a vital prognostic factor for cancer specific survival and correlated with intravesical recurrence after receiving RNU.
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Affiliation(s)
- Jianpeng Yu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Gang Li
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Aixiang Wang
- Department of Pathology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Qiang Luo
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Zihao Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yuanjie Niu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yanhui Mei
- Department of Urology, Binzhou Medical University Hospital, Binzhou 256603, China
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Şefik E, Çelik S, Günlüsoy B, Basmacı İ, Yarımoğlu S, Bozkurt İH, Değirmenci T, Dinçel Ç. Influence of preoperative hydronephrosis and ureteral orifice involvement in the survival of patients undergoing radical cystectomy: A retrospective comparative study. Turk J Urol 2019; 45:S49-S55. [PMID: 30978166 DOI: 10.5152/tud.2019.09515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 11/26/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the influence of preoperative hydronephrosis and ureteral orifice involvement (UOI) on survival of patients undergoing radical cystectomy (RC) for bladder cancer (BC). MATERIAL AND METHODS A total of 162 patients with BC underwent RC between January 2006 and March 2017. Patients were divided into two groups for both presences of preoperative hydronephrosis and orifice involvement at final pathology. Additionally, tumors with orifice involvement were subgrouped histopathologically after RC as those with only UOI and those with invasive to the ureter with an additional concurrent site at final pathology. RESULTS Preoperative hydronephrosis was detected in 57 patients. Preoperative and postoperative creatinine on month 3 were higher in the preoperative hydronephrosis (+) group (p<0.001). In addition, postoperative T stage, surgical margin positivity, invasion of urethra, and pathological upstaging were higher in this group. Cancer-specific survival (CSS) and overall survival (OS) were better in the hydronephrosis (-) group than in the hydronephrosis (+) group (p=0.001 and p=0.001, respectively). Preoperative hydronephrosis was found to be an independent factor in pathological upstaging. Patients were divided into two groups according to the presence of UOI. Group 1 consisted of patients without UOI, and group 2 with UOI. Preoperative hydronephrosis, hydronephrosis grade, and T stage were statistically higher in tumors with UOI. Moreover, CSS and OS were lower in group 2 than in group 1. CONCLUSION Preoperative hydronephrosis and UOI are predicting factors on survival of patients undergoing RC for BC. Preoperative hydronephrosis was found to be an independent factor in pathological upstaging.
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Affiliation(s)
- Ertuğrul Şefik
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Serdar Çelik
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Bülent Günlüsoy
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - İsmail Basmacı
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Serkan Yarımoğlu
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - İbrahim Halil Bozkurt
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Tansu Değirmenci
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Çetin Dinçel
- Department of Urology, Health Sciences University, Bozyaka Training and Research Hospital, İzmir, Turkey
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9
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Preoperative chronic kidney disease is predictive of oncological outcome of radical cystectomy for bladder cancer. World J Urol 2017; 36:249-256. [PMID: 29185045 DOI: 10.1007/s00345-017-2141-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/24/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes after radical cystectomy (RC) for bladder cancer. METHODS We reviewed the medical records of patients with urothelial bladder carcinoma who underwent RC with curative intent at seven hospitals between 1990 and 2013. After excluding patients with a history of upper urinary tract urothelial cancer or neoadjuvant chemotherapy, we analyzed 594 cases for the study. Preoperative estimated glomerular filtration rate (eGFR) was calculated using the three-variable Japanese equation for GFR estimation from serum creatinine level and age. Patients were divided into four groups of different CKD stages based on eGFR values (mL/min/1.73 m2), i.e., ≥ 60 (CKD stages G1-2), 45-60 (G3a), 30-45 (G3b), and < 30 (G4-5). Survival was estimated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards regression analyses addressed survivals after RC. RESULTS Median age of patients was 67 years. Patients were classified into CKD stages: G1-2 (n = 388; 65.3%), G3a (n = 122; 20.5%), G3b (n = 51; 8.6%), and G4-5 (n = 33; 5.6%). During a median follow-up of 4.0 years, 200 and 164 patients showed cancer progression and died of bladder cancer, with the 5-year progression-free survival (PFS) and cancer-specific survival (CSS) of 64.9 and 70.2%, respectively. On multivariate analyses, CKD stages of G3b or greater, advanced pT stage, lymph node metastasis, and positive lymphovascular invasion were independent poor prognostic factors for PFS and CSS. CONCLUSIONS We demonstrated that the advanced preoperative CKD stage was significantly associated with poor oncological outcomes of the bladder cancer after RC.
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10
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Kodama H, Hatakeyama S, Fujita N, Iwamura H, Anan G, Fukushi K, Narita T, Tanaka T, Kubota Y, Horiguchi H, Momota M, Kido K, Matsumoto T, Soma O, Hamano I, Yamamoto H, Tobisawa Y, Yoneyama T, Yoneyama T, Hashimoto Y, Koie T, Ito H, Yoshikawa K, Sasaki A, Kawaguchi T, Sato M, Ohyama C. Preoperative chronic kidney disease predicts poor oncological outcomes after radical nephroureterectomy in patients with upper urinary tract urothelial carcinoma. Oncotarget 2017; 8:83183-83194. [PMID: 29137333 PMCID: PMC5669959 DOI: 10.18632/oncotarget.20554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 07/28/2017] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy. Methods A total of 426 patients who underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017 were retrospectively examined. Oncological outcomes, including intravesical recurrence-free, visceral recurrence-free, cancer-specific, and overall survival rates (intravesical RFS, visceral RFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD) were investigated. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and a prognostic factor-based risk stratification nomogram was developed. Results Of the 426 patients, 250 (59%) were diagnosed with CKD before radical nephroureterectomy. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS after radical nephroureterectomy were significantly shorter in the CKD group than in the non-CKD group. Background-adjusted IPTW analysis demonstrated that preoperative CKD was significantly associated with poor visceral RFS, CSS, and OS after radical nephroureterectomy. Intravesical RFS was not significantly associated with preoperative CKD. The nomogram for predicting 5-year visceral RFS and CSS probability demonstrated a significant correlation with actual visceral RFS and CSS (c-index = 0.85 and 0.83, respectively). Conclusions Upper tract urothelial carcinoma patients with preoperative CKD had a significantly lower survival probability than those without CKD.
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Affiliation(s)
- Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Go Anan
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ken Fukushi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toshikazu Tanaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuka Kubota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koichi Kido
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Matsumoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Osamu Soma
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | | | - Atsushi Sasaki
- Department of Urology, Tsugaru General Hospital, Goshogawara, Japan
| | - Toshiaki Kawaguchi
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Makoto Sato
- Department of Urology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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11
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Xu H, Xie L, Liu X, Zhang Y, Shen Z, Chen T, Qiu X, Sha N, Xing C, Wu Z, Hu H, Wu C. Impact of squamous and/or glandular differentiation on recurrence and progression following transurethral resection for non-muscle invasive urothelial carcinoma of bladder. Oncol Lett 2017; 14:3522-3528. [PMID: 28927108 PMCID: PMC5587993 DOI: 10.3892/ol.2017.6581] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/03/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of the present study was to investigate the impact of squamous and/or glandular differentiation on the recurrence and progression in patients with nonmuscle invasive urothelial carcinoma of bladder (NMIUCB) following transurethral resection (TURBT). A total of 869 patients with NMIUCB who had been treated with TURBT at The Second Hospital of Tianjin Medical University (Tianjin, China) between January 2006 and January 2011 were retrospectively selected for the present analysis. Associations among squamous and/or glandular differentiation with other clinical and pathological features were assessed by the χ2 test. Recurrence-free survival (RFS) and progression-free survival (PFS) curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed through a Cox's proportional hazards regression model. Among the 869 patients, 232 (26.7%) patients had squamous and/or glandular differentiation. High grade tumors were more common in patients with squamous and/or glandular differentiation compared with those with pure urothelial carcinoma of bladder (P<0.001). Associations between age (P=0.115), sex (P=0.184), tumor size (P=0.223), tumor multiplicity (P=0.108), pathological tumor stage (P=0.909) and squamous and/or glandular differentiation were not observed to be statistically significant. There was a significant tendency towards higher recurrence rate and shorter RFS time in patients with squamous and/or glandular differentiation. However, no statistically significant differences were observed in progression rate and PFS between the two groups. The multivariate Cox regression analysis, identified squamous and/or glandular differentiation as an independent prognostic predictor of recurrence (hazard ratio =1.46, 95% confidence interval=1.10–1.92, P=0.008). In the present study, the presence of squamous and/or glandular differentiation was associated with a higher recurrence rate and shorter RFS time in patients with NMIUCB. Squamous and/or glandular differentiation is therefore an independent prognostic predictor of recurrence.
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Affiliation(s)
- Hao Xu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Linguo Xie
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Xiaoteng Liu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Yu Zhang
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Zhonghua Shen
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Tao Chen
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Xiaoyu Qiu
- College of Management and Economics, Tianjin University, Nankai, Tianjin 300072, P.R. China
| | - Nan Sha
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Chen Xing
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Zhouliang Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Hailong Hu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
| | - Changli Wu
- Department of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China.,Tianjin Key Laboratory of Urology, Tianjin Institute of Urology, Second Hospital of Tianjin Medical University, Hexi, Tianjin 300211, P.R. China
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12
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Hamano I, Hatakeyama S, Iwamurau H, Fujita N, Fukushi K, Narita T, Hagiwara K, Kusaka A, Hosogoe S, Yamamoto H, Tobisawa Y, Yoneyama T, Yoneyama T, Hashimoto Y, Koie T, Ito H, Yoshikawa K, Kawaguchi T, Ohyama C. Preoperative chronic kidney disease predicts poor oncological outcomes after radical cystectomy in patients with muscle-invasive bladder cancer. Oncotarget 2017; 8:61404-61414. [PMID: 28977873 PMCID: PMC5617433 DOI: 10.18632/oncotarget.18248] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/17/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy. METHODS A total of 581 patients who underwent radical cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram. RESULTS Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively). CONCLUSIONS Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.
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Affiliation(s)
- Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamurau
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ken Fukushi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kazuhisa Hagiwara
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ayumu Kusaka
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shogo Hosogoe
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, Hachinohe, Japan
| | | | - Toshiaki Kawaguchi
- Department of Urology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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13
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Cao J, Zhao X, Zhong Z, Zhang L, Zhu X, Xu R. Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis. Sci Rep 2016; 6:35214. [PMID: 27725745 PMCID: PMC5057078 DOI: 10.1038/srep35214] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/27/2016] [Indexed: 02/05/2023] Open
Abstract
The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11–2.19), 1.59 (95% CI, 1.14–2.05) and 1.45 (95% CI, 1.19–1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42–3.12), 1.02 (95% CI, 0.47–1.57) and 1.52 (95% CI, 1.05–1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied.
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Affiliation(s)
- Jian Cao
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China.,MRC Centre for Reproductive Health, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Zhaohui Zhong
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Xuan Zhu
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan 410011, P.R. China
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14
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Mitra AP, Bartsch CC, Bartsch G, Miranda G, Skinner EC, Daneshmand S. Does presence of squamous and glandular differentiation in urothelial carcinoma of the bladder at cystectomy portend poor prognosis? An intensive case-control analysis. Urol Oncol 2013; 32:117-27. [PMID: 23477878 DOI: 10.1016/j.urolonc.2012.08.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/15/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The prognostic significance of squamous and glandular elements, the most common histologic variants of urothelial carcinoma of the bladder (UCB), is unclear. This study aimed to examine the sole influence of squamous or glandular or both differentiation on UCB outcome following cystectomy and to identify factors that explain the relatively poor prognosis observed in UCB patients with these differentiation elements. MATERIALS AND METHODS A total of 2,444 patients who underwent radical cystectomy with extended lymph node dissection at a single referral center between 1976 and 2008 were considered. We identified 141, 97, and 21 patients with squamous, glandular, and squamous + glandular differentiation elements, respectively ("cases"). Pure UCB patients without differentiation were matched 1:1 to these cases for demographic, tumor, and treatment characteristics ("controls"). Cases were also compared with an independent cohort of 1,244 pure UCB controls. Recurrence-free and overall survivals were compared between cohorts using univariable and multivariable Cox proportional hazards analyses. RESULTS Median follow-up for cases, controls, and independent control cohort was 15.2, 11.0, and 12.2 years, respectively. Cases were matched to controls for pathologic stage (chi-square P = 1.00) and administration of intravesical agents (P≥0.85), neoadjuvant (P≥0.31), and adjuvant (P≥0.96) chemotherapy. Cases were also balanced with controls for age, gender, and race (P≥0.30). Following this intensive matching, no differences in outcomes between cases and controls were observed (log-rank P≥0.12). Pathologic stage was predictive of outcome in cases with differentiation by multivariable analysis (P≤0.004). When compared to an independent control cohort, cases with differentiation were observed to present with higher pathologic stage at cystectomy (chi-square P≤0.005). CONCLUSIONS Outcomes of UCB patients with squamous or glandular or both differentiation are similar to those of patients with pure UCB, given comparable demographic, clinicopathologic, and management characteristics. However, UCB with differentiation present with higher pathologic stage, thus explaining the aggressive clinical course in these patients.
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Affiliation(s)
- Anirban P Mitra
- Department of Pathology and Center for Personalized Medicine, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Claudia C Bartsch
- Department of Urology, Johann Wolfgang Goethe University Hospital and Faculty of Medicine, Frankfurt, Germany
| | - Georg Bartsch
- Department of Urology, Johann Wolfgang Goethe University Hospital and Faculty of Medicine, Frankfurt, Germany
| | - Gus Miranda
- Institute of Urology, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Eila C Skinner
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California Keck School of Medicine and Norris Comprehensive Cancer Center, Los Angeles, CA.
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15
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Gondo T, Nakashima J, Ozu C, Ohno Y, Horiguchi Y, Namiki K, Yoshioka K, Ohori M, Hatano T, Tachibana M. Risk stratification of survival by lymphovascular invasion, pathological stage, and surgical margin in patients with bladder cancer treated with radical cystectomy. Int J Clin Oncol 2011; 17:456-61. [DOI: 10.1007/s10147-011-0310-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 08/13/2011] [Indexed: 12/01/2022]
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16
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Chalasani V, Chin JL, Izawa JI. Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder cancer. Can Urol Assoc J 2011; 3:S193-8. [PMID: 20019984 DOI: 10.5489/cuaj.1195] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bladder cancer can be classified histologically as urothelial or non-urothelial. Urothelial cancer has a propensity for divergent differentiation, which has increasingly been recognized in recent years due to heightened awareness and improved immunohistochemistry techniques. Furthermore, the recent World Health Organization classification of urothelial cancers improved clarity on this issue, with its listing of 13 histologic variants of urothelial cancer. The divergent differentiation patterns include, amongst others, squamous, glandular, micropapillary, nested, lymphepithelioma-like, plasmacytoid and sarcomatoid variants of urothelial cancer. Attempts to quantify the amount of divergent differentiation present, such as using the nonconventional differentiation number, have been made recently, which will improve the ability to compare publications from different centres. Genetic-based studies have indicated that the histologic variants of urothelial cancer arise from a common clonal precursor. Mostly, the current evidence suggests that urothelial cancer with divergent differentiation has a worse prognosis when compared with pure urothelial cancer. This article will review the current literature on variant histologies of urothelial cancer, and well as new developments in pure squamous cell carcinoma, small cell carcinoma and adenocarcinoma of the bladder.
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Affiliation(s)
- Venu Chalasani
- Departments of Surgery & Oncology, Divisions of Urology & Surgical Oncology, London Health Sciences Centre-Victoria Hospital, London, ON
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17
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Tseng SF, Chuang YC, Yang WC. Long-term outcome of radical cystectomy in ESDR patients with bladder urothelial carcinoma. Int Urol Nephrol 2011; 43:1067-71. [PMID: 21516473 DOI: 10.1007/s11255-011-9960-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Accepted: 03/30/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE The prevalence of urothelial carcinoma is high in dialysis patients. Radical cystectomy is an invasive procedure for patients with recurrent, multiple, or invasive bladder cancer. However, the prognosis of radical cystectomy in dialysis patients has rarely been reported. This study investigates the long-term outcome of radical cystectomy in dialysis patients with bladder urothelial carcinoma. MATERIALS AND METHODS Clinical data of 193 dialysis patients with bladder urothelial carcinoma were reviewed. Among them, 45 patients received radical cystectomy. Thirty-two patients who received radical cystectomy with concurrent nephroureterectomy were in a stable chronic dialysis condition. In contrast, we performed radical cystectomy without concurrent nephroureterectomy for patients (N = 13) at high surgical risk, such as tumors combined with infection, or hemodynamically unstable. Survival was evaluated using the Kaplan-Meier method. RESULTS The overall survival rates were 86.7, 80.0, 62.2, 44.4, and 35.6% at 3-months, 6-months, 1-year, 3-years, and 5-years, respectively. Patients who received concurrent nephroureterectomy had a higher mortality rate (13%) than radical cystectomy alone (0.0%) under operative 3 months. However, the patients who received concurrent nephroureterectomy had a higher 5-year survival rate than the group without concurrent nephroureterectomy (43.7 vs. 15.4%). The causes of death included dialysis complications (N = 19, 42.1%), infection (N = 7, 36.8%), and disease metastasis (N = 4, 21.1%). CONCLUSION Dialysis patients in a stable chronic dialysis condition with recurrent or invasive bladder urothelial carcinoma could have survival benefits in receiving concurrent nephroureterectomy.
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Affiliation(s)
- Shu-Fen Tseng
- Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, No 123, Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan
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18
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Sakano S, Matsuyama H, Takai K, Yoshihiro S, Kamiryo Y, Shirataki S, Kaneda Y, Hashimoto O, Joko K, Suga A, Yamamoto M, Hayashida S, Baba Y, Aoki A. Risk group stratification to predict recurrence after transurethral resection in Japanese patients with stage Ta and T1 bladder tumours: validation study on the European Association of Urology guidelines. BJU Int 2010; 107:1598-604. [DOI: 10.1111/j.1464-410x.2010.09850.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Preoperative Hydronephrosis Predicts Extravesical and Node Positive Disease in Patients Undergoing Cystectomy for Bladder Cancer. J Urol 2010; 183:1732-7. [DOI: 10.1016/j.juro.2010.01.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Indexed: 11/17/2022]
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20
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Kim DS, Cho KS, Lee YH, Cho NH, Oh YT, Hong SJ. High-grade hydronephrosis predicts poor outcomes after radical cystectomy in patients with bladder cancer. J Korean Med Sci 2010; 25:369-73. [PMID: 20191034 PMCID: PMC2826737 DOI: 10.3346/jkms.2010.25.3.369] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/14/2009] [Indexed: 11/20/2022] Open
Abstract
We examined whether the presence and severity of preoperative hydronephrosis have prognostic significance in patients who underwent radical cystectomy for transitional cell carcinoma of the bladder. The medical records of 457 patients who underwent radical cystectomy for bladder cancer between 1986 and 2005 were retrospectively reviewed. Following the Society for Fetal Urology grading system, patients were divided into low-, and high-grade hydronephrosis groups. Clinicopathologic factors associated with preoperative hydronephrosis and survival were evaluated. Of a total of 406 patients, unilateral hydronephrosis was found in 74 (18.2%), bilateral hydronephrosis in 11 (2.7%), and no hydronephoris in 321 (79.1%). Low-grade hydronephrosis was found in 57 (12.2%) patients and high-grade hydronephrosis in 28 (6%). Preoperative hydronephrosis was related to higher pT stage and lymph node invasion. In univariate analysis, the presence of hydronephrosis, hydronephrosis grade, age, pT and pN stage, tumor grade, surgical margin, number of retrieved nodes, carcinoma in situ, and lymphovascular invasion were significant prognostic factors for cancer-specific survival. In multivariate analysis, bilateral hydronephrosis and high-grade hydronephrosis remained significant predictors for decreased survival. The presence of preoperative hydronephrosis, and high-grade hydronephrosis are significant prognostic factors in patients with bladder cancer after radical cystectomy.
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Affiliation(s)
- Dong Suk Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Taek Oh
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
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21
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Chapman DM, Pohar KS, Gong MC, Bahnson RR. Preoperative hydronephrosis as an indicator of survival after radical cystectomy. Urol Oncol 2009; 27:491-5. [DOI: 10.1016/j.urolonc.2008.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 06/08/2008] [Accepted: 06/10/2008] [Indexed: 12/27/2022]
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22
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Antunes AA, Nesrallah LJ, Dall'Oglio MF, Maluf CE, Camara C, Leite KR, Srougi M. The role of squamous differentiation in patients with transitional cell carcinoma of the bladder treated with radical cystectomy. Int Braz J Urol 2007; 33:339-45; discussion 346. [PMID: 17626650 DOI: 10.1590/s1677-55382007000300006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE We aim at determining the prognostic value of squamous differentiation in patients with transitional cell carcinoma (TCC) of the bladder that were treated with radical cystectomy. MATERIALS AND METHODS From January 1993 to January 2005, we retrospectively selected 113 patients. Correlations among squamous differentiation with other clinical and pathological features were assessed by both chi-square and Fisher tests. The Kaplan-Meier method was used to evaluate survival curves and statistical significance was determined by the log-rank test. Multivariate analysis was performed through a Cox proportional hazards regression model. RESULTS Squamous differentiation was observed in 25 (22.1%) of the 113 patients. This finding was significantly related only to the pathological stage. Mean follow-up after cystectomy was 31.7 +/- 28.5 months. Disease recurrence occurred in 16 (64%) and 30 (34%) patients with and without squamous differentiation (log-rank test, p = 0.001), and mortality occurred in 10 (40%) and 14 (16%) of the patients with and without squamous differentiation respectively. Univariate analysis revealed that pathological stage, squamous differentiation, tumor size and lymph node involvement were significant predictors of cancer-specific survival. However, only squamous differentiation and tumor size were independent prognostic variables on multivariate analysis. CONCLUSIONS Squamous differentiation was an independent prognostic factor for cancer specific survival in patients with bladder cancer treated with radical cystectomy. Further studies with a larger number of patients are necessary to confirm these results.
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Affiliation(s)
- Alberto A Antunes
- Division of Urology, University of Sao Paulo Medical School, Sao Paulo, Brazil and Hospital Sìrio Libanes, Sao Paulo, Brazil.
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23
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Antunes AA, Nesrallah LJ, Dall'Oglio MF, Ferreira YA, Passerotti CC, Leite KR, Ortiz V, Srougi M. Analysis of prognostic factors in patients with transitional cell carcinoma of the bladder treated with radical cystectomy. Int Braz J Urol 2006; 32:35-42. [PMID: 16519826 DOI: 10.1590/s1677-55382006000100006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the results of the treatment of transitional cell carcinoma (TCC) of the bladder with radical cystectomy and determine which prognostic factors can be utilized as disease-free survival and cancer-specific survival independent variables. MATERIALS AND METHODS Medical records of 113 patients submitted to radical cystectomy and bilateral iliac lymphadenectomy between 1993 and 2005 were reviewed. The risk factors analyzed were age, sex, pathological stage, tumor grade, presence of carcinoma in situ and the presence of lymph nodes involvement. RESULTS After a mean follow-up of 31.7 +/- 28.5 months, 46 patients (40.7%) presented recurrence and 24 patients (21.2%) died due to cancer. Only pathological stage and the lymph nodes involvement became independent variables for recurrence and survival. Patients with T4 stage presented 9.6 times the risk of recurrence of the disease when compared with stage T0 patients (p = 0.010) and the patients with lymph node involvement presented 2.5 times the risk of recurrence (p = 0.047) and 3.1 times the risk of death (p = 0.022) when compared to patients without lymph nodes involvement. CONCLUSIONS Pathological stage and the involvement of lymph nodes represented more important prognostic variables, and in the presence of advanced stage tumors (T3/T4) and involvement of lymph nodes, the institution of adjuvant treatment should be considered.
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Bartsch GC, Kuefer R, Gschwend JE, de Petriconi R, Hautmann RE, Volkmer BG. Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy-only series. Eur Urol 2006; 51:690-7; discussion 697-8. [PMID: 16904815 DOI: 10.1016/j.eururo.2006.07.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 07/11/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Hydronephrosis in patients with bladder cancer is caused by tumour at the ureteral orifice, secondary ureteral tumours, intramural or extravesical tumour infiltration, or compression of the ureter. This study investigated the prognostic impact of hydronephrosis in bladder cancer. METHODS A series of 788 patients were treated with radical cystectomy with curative intent for transitional cell carcinoma of the bladder without neoadjuvant/adjuvant radiotherapy/chemotherapy between January 1986 and September 2003. All patients had a complete follow-up until death or until the study's end date. Survival rates were calculated using the Kaplan-Meier method. A multivariate analysis with a Cox regression model was performed with respect to potential influencing factors. RESULTS A total of 108 patients (13.7%) had unilateral and 25 patients (3.2%) had bilateral hydronephrosis. The rate of organ-confined tumours was significantly higher in patients without hydronephrosis (67.9% vs. 37.6%; p<0.001). Forty-three (32.3%) of the 133 hydronephrotic patients had a tumour involving the ureteral orifice. In this group the rate of organ-confined tumours was significantly higher than in the other patients with hydronephrosis (53.5% vs. 30.0%; p=0.009). In the multivariate analysis, preoperative hydronephrosis was determined as an independent prognostic marker for recurrence-free survival besides the pT classification and lymph node status (p=0.0015). The etiology of hydronephrosis did not affect the tumour-specific survival. CONCLUSIONS Hydronephrosis at the time of diagnosis of bladder cancer is associated with a high probability of advanced tumours. It is an independent prognostic factor for recurrence-free survival.
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Affiliation(s)
- Georg C Bartsch
- Department of Urology, Faculty of Medicine, University of Ulm, Ulm, Germany.
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Novara G, Ficarra V, Alrabi N, Dalpiaz O, Martignoni G, Galfano A, Cavalleri S, Artibani W. Prognostic Factors in a Recent Series of Patients Treated with Radical Cystectomy for Bladder Cancer. Urol Int 2005; 75:10-6. [PMID: 16037701 DOI: 10.1159/000085920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 02/02/2005] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To identify the clinical and pathological prognostic factors in a homogeneous series of patients with bladder cancer who had undergone radical cystectomy in the late 1990s. MATERIALS AND METHODS We retrospectively analyzed the clinical data of 156 patients who had undergone radical cystectomy and iliac-obturator lymphadenectomy for bladder carcinoma at our department between 1995 and 2001. RESULTS The mean follow-up was 39.71 +/- 26.2 months. The 5-year overall and cancer-specific survival rates were 47.2 and 54.7%, respectively. Upper urinary tract obstruction (p = 0.03), clinical stage of both the primary tumor (p = 0.0001) and loco-regional lymph nodes (p = 0.04), pathological stage (2002 TNM) of the primary tumor (p < 0.0001), pathological loco-regional lymph node involvement (p < 0.0001), and vascular embolization (p = 0.005) were significant on univariate analysis. Pathological lymph node involvement (p = 0.001) and both pathological (p = 0.022) and clinical stages of the primary tumor (p = 0.002) turned out to be independent predictors of cancer-specific survival. CONCLUSION Pathological lymph node involvement, clinical and pathological stage of the primary tumor were the cancer-specific, survival-independent, predictors in our series. Our multivariate analysis data identified pT3-4 and pN+ patients as those with the worst prognosis.
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