1
|
Moon C, Gordon M, Moon D, Reynolds T. Microsatellite Instability Analysis (MSA) for Bladder Cancer: Past History and Future Directions. Int J Mol Sci 2021; 22:ijms222312864. [PMID: 34884669 PMCID: PMC8657622 DOI: 10.3390/ijms222312864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/18/2022] Open
Abstract
Microsatellite instability (MSI), the spontaneous loss or gain of nucleotides from repetitive DNA tracts, is a diagnostic phenotype for gastrointestinal, endometrial, colorectal, and bladder cancers; yet a landscape of instability events across a wider variety of cancer types is beginning to be discovered. The epigenetic inactivation of the MLH1 gene is often associated with sporadic MSI cancers. Recent next-generation sequencing (NGS)-based analyses have comprehensively characterized MSI-positive (MSI+) cancers, and several approaches to the detection of the MSI phenotype of tumors using NGS have been developed. Bladder cancer (here we refer to transitional carcinoma of the bladder) is a major cause of morbidity and mortality in the Western world. Cystoscopy, a gold standard for the detection of bladder cancer, is invasive and sometimes carries unwanted complications, while its cost is relatively high. Urine cytology is of limited value due to its low sensitivity, particularly to low-grade tumors. Therefore, over the last two decades, several new "molecular assays" for the diagnosis of urothelial cancer have been developed. Here, we provide an update on the development of a microsatellite instability assay (MSA) and the development of MSA associated with bladder cancers, focusing on findings obtained from urine analysis from bladder cancer patients as compared with individuals without bladder cancer. In our review, based on over 18 publications with approximately 900 sample cohorts, we provide the sensitivity (87% to 90%) and specificity (94% to 98%) of MSA. We also provide a comparative analysis between MSA and other assays, as well as discussing the details of four different FDA-approved assays. We conclude that MSA is a potentially powerful test for bladder cancer detection and may improve the quality of life of bladder cancer patients.
Collapse
Affiliation(s)
- Chulso Moon
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Medical Institution, Cancer Research Building II, 5M3, 1550 Orleans Street, Baltimore, MD 21205, USA
- HJM Cancer Research Foundation Corporation, 10606 Candlewick Road, Lutherville, MD 21093, USA; (M.G.); (D.M.)
- BCD Innovations USA, 10606 Candlewick Road, Lutherville, MD 21093, USA
- Correspondence: ; Tel.: +1-(443)-370-5056
| | - Maxie Gordon
- HJM Cancer Research Foundation Corporation, 10606 Candlewick Road, Lutherville, MD 21093, USA; (M.G.); (D.M.)
- BCD Innovations USA, 10606 Candlewick Road, Lutherville, MD 21093, USA
| | - David Moon
- HJM Cancer Research Foundation Corporation, 10606 Candlewick Road, Lutherville, MD 21093, USA; (M.G.); (D.M.)
| | - Thomas Reynolds
- NEXT Bio-Research Services, LLC, 11601 Ironbridge Road, Suite 101, Chester, VA 23831, USA;
| |
Collapse
|
2
|
Bryan RT. Association between treatment of superficial bladder cancer and 10-year mortality in older adults with multiple chronic conditions. Cancer 2019; 125:652. [PMID: 30516824 DOI: 10.1002/cncr.31888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Richard T Bryan
- Bladder Cancer Research Group, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
3
|
Gills J, Moret R, Zhang X, Nelson J, Maresh G, Hellmers L, Canter D, Hudson M, Halat S, Matrana M, Marino MP, Reiser J, Shuh M, Laborde E, Latsis M, Talwar S, Bardot S, Li L. A patient-derived orthotopic xenograft model enabling human high-grade urothelial cell carcinoma of the bladder tumor implantation, growth, angiogenesis, and metastasis. Oncotarget 2018; 9:32718-32729. [PMID: 30220977 PMCID: PMC6135689 DOI: 10.18632/oncotarget.26024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/10/2018] [Indexed: 01/08/2023] Open
Abstract
High-grade urothelial cell carcinoma of the bladder has a poor prognosis when lymph nodes are involved. Despite curative therapy for clinically-localized disease, over half of the muscle-invasive urothelial cell carcinoma patients will develop metastases and die within 5 years. There are currently no described xenograft models that consistently mimic urothelial cell carcinoma metastasis. To develop a patient-derived orthotopic xenograft model to mimic clinical urothelial cell carcinoma progression to metastatic disease, the urothelial cell carcinoma cell line UM-UC-3 and two urothelial cell carcinoma patient specimens were doubly tagged with Luciferase/RFP and were intra-vesically (IB) instilled into NOD/SCID mice with or without lymph node stromal cells (HK cells). Mice were monitored weekly with bioluminescence imaging to assess tumor growth and metastasis. Primary tumors and organs were harvested for bioluminescence imaging, weight, and formalin-fixed for hematoxylin and eosin and immunohistochemistry staining. In this patient-derived orthotopic xenograft model, xenograft tumors showed better implantation rates than currently reported using other models. Xenograft tumors histologically resembled pre-implanted primary specimens from patients, presenting muscle-invasive growth patterns. In the presence of HK cells, tumor formation, tumor angiogenesis, and distant organ metastasis were significantly enhanced in both UM-UC-3 cells and patient-derived specimens. Thus, we established a unique, reproducible patient-derived orthotopic xenograft model using human high-grade urothelial cell carcinoma cells and lymph node stromal cells. It allows for investigating the mechanism involved in tumor formation and metastasis, and therefore it is useful for future testing the optimal sequence of conventional drugs or the efficacy of novel therapeutic drugs.
Collapse
Affiliation(s)
- Jessie Gills
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Ravan Moret
- Institution of Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Xin Zhang
- Institution of Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - John Nelson
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Grace Maresh
- Institution of Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Linh Hellmers
- Institution of Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Daniel Canter
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - M'Liss Hudson
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA.,Current address: Memorial Urology Associates, Houston, TX, USA
| | - Shams Halat
- Department of Pathology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Marc Matrana
- Department of Hematology and Oncology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Michael P Marino
- Division of Cellular and Gene Therapies, The Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jakob Reiser
- Division of Cellular and Gene Therapies, The Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Maureen Shuh
- Institution of Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Eric Laborde
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Maria Latsis
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Sunil Talwar
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Stephen Bardot
- Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Li Li
- Institution of Translational Research, Ochsner Clinic Foundation, New Orleans, LA, USA
| |
Collapse
|
4
|
Lenherr SM, Tsai S, Silva Neto B, Sullivan TB, Cimmino CB, Logvinenko T, Gee J, Huang W, Libertino JA, Summerhayes IC, Rieger-Christ KM. MicroRNA Expression Profile Identifies High Grade, Non-Muscle-Invasive Bladder Tumors at Elevated Risk to Progress to an Invasive Phenotype. Genes (Basel) 2017; 8:E77. [PMID: 28218662 PMCID: PMC5333066 DOI: 10.3390/genes8020077] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/10/2017] [Accepted: 02/11/2017] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to identify a panel of microRNAs (miRNAs) differentially expressed in high-grade non-muscle invasive (NMI; TaG3-T1G3) urothelial carcinoma that progress to muscle-invasive disease compared to those that remain non-muscle invasive, whether recurrence happens or not. Eighty-nine high-grade NMI urothelial carcinoma lesions were identified and total RNA was extracted from paraffin-embedded tissue. Patients were categorized as either having a non-muscle invasive lesion with no evidence of progression over a 3-year period or as having a similar lesion showing progression to muscle invasion over the same period. In addition, comparison of miRNA expression levels between patients with and without prior intravesical therapy was performed. Total RNA was pooled for microarray analysis in each group (non-progressors and progressors), and qRT-PCR of individual samples validated differential expression between non-progressive and progressive lesions. MiR-32-5p, -224-5p, and -412-3p were associated with cancer-specific survival. Downregulation of miR-203a-3p and miR-205-5p were significantly linked to progression in non-muscle invasive bladder tumors. These miRNAs include those implicated in epithelial mesenchymal transition, previously identified as members of a panel characterizing transition from the non-invasive to invasive phenotype in bladder tumors. Furthermore, we were able to identify specific miRNAs that are linked to postoperative outcome in patients with high grade NMI urothelial carcinoma of the bladder (UCB) that progressed to muscle-invasive (MI) disease.
Collapse
Affiliation(s)
- Sara M Lenherr
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| | - Sheaumei Tsai
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| | - Brasil Silva Neto
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
- Department of Urology, Hospital de Clinicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, Brazil.
| | - Travis B Sullivan
- Cell and Molecular Biology Laboratory, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| | - Cara B Cimmino
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| | - Tanya Logvinenko
- Biostatistics Research, Institute for Clinical Research Health Policy Studies, Tufts Medical Center, Boston, MA 02111, USA.
| | - Jason Gee
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| | - Wei Huang
- Department of Pathology, University of Wisconsin, Madison, WI 53726, USA.
| | - John A Libertino
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| | - Ian C Summerhayes
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
- Cell and Molecular Biology Laboratory, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
- Deceased.
| | - Kimberly M Rieger-Christ
- Department of Urology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
- Cell and Molecular Biology Laboratory, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.
| |
Collapse
|
5
|
Human epidermal growth factor receptor 2: a significant indicator for predicting progression in non-muscle-invasive bladder cancer especially in high-risk groups. World J Urol 2015; 33:1951-7. [DOI: 10.1007/s00345-015-1557-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/07/2015] [Indexed: 10/23/2022] Open
|
6
|
Gou Y, Ding W, Xu K, Wang H, Chen Z, Tan J, Xia G, Ding Q. Snail is an independent prognostic indicator for predicting recurrence and progression in non-muscle-invasive bladder cancer. Int Urol Nephrol 2014; 47:289-93. [PMID: 25388353 DOI: 10.1007/s11255-014-0874-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/29/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Snail, an inducer of the epithelial-to-mesenchymal transition, increases motility and invasiveness of cancer cells by repressing E-cadherin expression. We investigate the relationship between Snail expression and clinicopathological parameters and evaluate its prognostic significance in patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A total of 332 patients treated with transurethral resection of the bladder tumor between October 2002 and July 2010 were histopathologically confirmed to be NMIBC. Tumor recurrence and progression were followed up in all patients. Immunohistochemical staining of 332 slices was performed. The expression of Snail was evaluated by ICH and graded for intensity and area of staining. We correlated Snail scores with clinical and pathological variables, and association of Snail staining with tumor recurrence and progression was evaluated by univariate, multivariate analysis and Kaplan-Meier survival curves. RESULTS Of 332 patients with NMIBC, there was Snail positivity in 104 tumors (31.3 %), and Snail expression correlated with age, multifocality, carcinoma in situ, tumor stage and tumor grade (each p < 0.05, respectively). A multivariate Cox regression model revealed that Snail expression was an independent predictor of tumor recurrence [hazard ratio (HR) 1.95, p = 0.001] and progression (HR 2.34, p = 0.014) in patients with NMIBC. Kaplan-Meier estimates showed that Snail expression was significantly associated with recurrence and progression (log-rank test, p < 0.0001, respectively). CONCLUSIONS Analysis of Snail expression in 332 NMIBC tissue specimens revealed its potential usefulness as a biomarker to predict the NMIBC prognosis.
Collapse
Affiliation(s)
- Yuancheng Gou
- Department of Urology, Huashan Hospital Affiliated to Fudan University, No.12 Middle Urumqi Road, Shanghai, 200040, China
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Ding W, Gou Y, Sun C, Xia G, Wang H, Chen Z, Tan J, Xu K, Qiang D. Ki-67 is an independent indicator in non-muscle invasive bladder cancer (NMIBC); combination of EORTC risk scores and Ki-67 expression could improve the risk stratification of NMIBC. Urol Oncol 2014; 32:42.e13-9. [PMID: 24360660 DOI: 10.1016/j.urolonc.2013.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/05/2013] [Accepted: 05/09/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To prove the predicting role of Ki-67 expression and to demonstrate that the combination of European Organization for Research and Treatment of Cancer (EORTC) risk scores and Ki-67 staining status could improve the risk stratification in a large series of patients with non-muscle invasive bladder cancer (NMIBC). MATERIAL AND METHODS From October 2002 to July 2010, in our cohort, 332 patients who were treated with transurethral resection of the bladder tumor were diagnosed with NMIBC by histopathologic analysis. Two experienced uropathologists rereviewed the slides. The EORTC risk scores for recurrence and progression were determined. Ki-67 expression was evaluated using immunohistochemical studies and scored for intensity and area of staining. We correlated Ki-67 expression scores with clinical and pathologic variables. We evaluated the prognosis role of EORTC risk scores, Ki-67 staining, and their combination on tumor recurrence-free survival and progression-free survival (PFS) by univariate analysis, multivariate analysis, and Kaplan-Meier survival curves. RESULTS With a median follow-up of 47 (range, 2-124) months, 119 patients (35.8%) had tumor recurrence and 40 patients (12%) had tumor progression. Ki-67 positivity (Ki-67>25%) was reported in 108 tumors (32.5%), and it was significantly associated with high EORTC risk scores for both tumor recurrence and progression. In univariate analysis, multifocality, tumor size, tumor stage, tumor grade, and Ki-67 staining correlated with recurrence-free survival, whereas tumor size, tumor stage, tumor grade, concomitant CIS, and Ki-67 staining correlated with PFS. In multivariable analysis, Ki-67 expression was an independent risk factor for predicting tumor recurrence (hazard ratio, 2.14; P<0.0001) and progression (hazard ratio: 2.97, P = 0.004). Kaplan-Meier curves showed that combining EORTC risk scores and Ki-67 staining led to more accurate prediction for tumor recurrence and progression (log-rank test; P<0.0001). CONCLUSIONS Ki-67 positivity is prognostic for predicting tumor recurrence and progression. Combination of EORTC risk scores with Ki-67 expression could improve the risk stratification for both recurrence and progression in NMIBC.
Collapse
Affiliation(s)
- Weihong Ding
- Department of Urology, Fudan University, Shanghai, China
| | - Yuancheng Gou
- Department of Urology, Fudan University, Shanghai, China
| | - Chuanyu Sun
- Department of Urology, Fudan University, Shanghai, China
| | - Guowei Xia
- Department of Urology, Fudan University, Shanghai, China
| | - Hong Wang
- Department of Urology, Fudan University, Shanghai, China
| | - Zhongqing Chen
- Department of Urology, Fudan University, Shanghai, China
| | - Jun Tan
- Department of Urology, Fudan University, Shanghai, China
| | - Ke Xu
- Department of Urology, Fudan University, Shanghai, China.
| | - Ding Qiang
- Department of Urology, Fudan University, Shanghai, China
| |
Collapse
|
8
|
Bryan RT, Cheng KK, James ND, Zeegers MP, Wallace DMA. Re: defining progression in nonmuscle invasive bladder cancer: it is time for a new, standard definition. D. Lamm, R. Persad, M. Brausi, R. Buckley, J. A. Witjes, J. Palou, A. Böhle, A. M. Kamat, M. Colombel and M. Soloway J Urol 2014;191:20-27. J Urol 2014; 191:1930. [PMID: 24625761 DOI: 10.1016/j.juro.2014.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2014] [Indexed: 11/26/2022]
Affiliation(s)
- R T Bryan
- School of Cancer Sciences, and School of Health and Population Sciences, University of Birmingham, Birmingham.
| | - K K Cheng
- School of Cancer Sciences, and School of Health and Population Sciences, University of Birmingham, Birmingham
| | - N D James
- University of Warwick, Warwick, United Kingdom
| | - M P Zeegers
- Department of Complex Genetics, Cluster of Genetics and Cell Biology, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - D M A Wallace
- University of Western Australia, Fremantle Hospital, Fremantle, Perth, Western Australia
| |
Collapse
|
9
|
The 1973 WHO Classification is more suitable than the 2004 WHO Classification for predicting prognosis in non-muscle-invasive bladder cancer. PLoS One 2012; 7:e47199. [PMID: 23082147 PMCID: PMC3474808 DOI: 10.1371/journal.pone.0047199] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 09/10/2012] [Indexed: 12/04/2022] Open
Abstract
Background Predicting the recurrence and progression of Non-muscle-invasive bladder cancer(NMIBC) is critical for urologist. Histological grade provides significant prognostic information, especially for prediction of progression. Currently, the 1973 and the 2004 WHO classification co-exist. Which system is better for predicting rumor recurrence and progression still a matter for debate. Methodology/Principal Findings 348 patients diagnosed with Non-muscle invasive bladder cancer were enrolled in our retrospective study. Paraffin sections were assessed by an experienced urological pathologist according to both the 1973 and 2004 WHO classifications. Tumor recurrence and progression was followed-up in all patients. During follow-up, corresponding 5-year recurrence-free survival rates of G1, G2 and G3 were 82.1%, 55.9%, 32.1% and the 5-year progression-free survival rates were 95.9%, 84.4% and 43.3%, respectively. The 5-year recurrence-free survival rates of papillary urothelial neoplasm of low malignant potential (PUNLMP), low-grade papillary urothelial carcinoma(LGPUC) and high-grade papillary urothelial carcinoma (HGPUC) were 69.8%, 67.1% and 42.0% respectively and the 5-year progression-free survival rates were 100%, 90.9% and 54.8% respectively. In multivariate analysis, the 1973 WHO classification significantly associated with both tumor recurrence and progression(p = 0.010 and p = 0.022, respectively); the 2004 WHO classification correlated with tumor progression(p = 0.019), while was not proved to be a variable that can predict the risk of recurrence(p = 0.547). Kaplan-Meier plots showed that both the 1973 WHO and the 2004 WHO classifications were significantly associated with progression-free survival (p<0.0001, log-rank test). For prediction of recurrence, significant differences were observed between the tumor grades classified using the 1973 WHO grading system (p<0.0001, log-rank test), while a significant overlap was observed between PUNLMP and LG plots using the 2004 WHO grading system(p = 0.616, log-rank test). Conclusion/Significance Both the 1973 WHO and the 2004 WHO Classifications are effective in predicting tumor progression in Non-muscle invasive bladder cancer, while the 1973 WHO Classification is more suitable for predicting tumor recurrence.
Collapse
|
10
|
Vasdev N, Thorpe AC. Should the presence of a culture positive urinary tract infection exclude patients from rapid evaluation hematuria protocols? Urol Oncol 2011; 31:909-13. [PMID: 21917488 DOI: 10.1016/j.urolonc.2011.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/27/2011] [Accepted: 07/28/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Current rapid evaluation protocols for patients with hematuria tend to exclude those with urinary tract infection since this is assumed to be evidence of a benign treatable cause. The likelihood of a urinary tract cancer in such patients is, however, uncertain, and we have therefore analyzed a prospective hematuria clinic database to determine risk. PATIENTS AND METHODS A total of 1,740 patients were enrolled prospectively in this study at our unit's one stop fast track hematuria clinic between April 2003 and March 2006. Evaluation of patients consisted of basic demographics, history and examination, urinalysis, urine culture, urine cytology, and serum creatinine. All patients then underwent a renal ultrasound, intravenous urogram, and cystoscopy. RESULTS A total of 1,067 males and 673 females with a mean (range) age of 60.8 (16-96) years were included in the study. One hundred sixty-one patients had a positive mid-stream urine (MSU) on a specimen collected at the hematuria clinic. Amongst this group 20% (32) patients had a urologic malignancy diagnosed, of whom 12% (4) had metastatic disease at presentation. Only 1% (3) of patients had a urologic malignancy with a previous history of a treated urinary tract infection (UTI) and negative MSU at the clinic. The risk of urologic malignancy was 24% (303) in the remaining 1,249 patients with no history of a UTI prior to presentation and a negative MSU on a specimen collected at the one stop fast track hematuria clinic. CONCLUSION Despite selection bias inherent in this analysis, it appears that the presence of UTI does not decrease the likelihood of having a urologic malignancy diagnosed. Hence, there is no indication to delay prompt evaluation in patients with hematuria and a positive urine culture collected at the hematuria clinic.
Collapse
Affiliation(s)
- Nikhil Vasdev
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
| | | |
Collapse
|
11
|
Castillo-Martin M, Domingo-Domenech J, Karni-Schmidt O, Matos T, Cordon-Cardo C. Molecular pathways of urothelial development and bladder tumorigenesis. Urol Oncol 2010; 28:401-8. [PMID: 20610278 DOI: 10.1016/j.urolonc.2009.04.019] [Citation(s) in RCA: 187] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 02/07/2023]
Abstract
Bladder cancer is the fifth most common human malignancy and the second most frequently diagnosed genitourinary tumor after prostate cancer. The majority of malignant tumors arising in the urinary bladder are urothelial carcinomas. Clinically, superficial bladder tumors (stages Ta and Tis) account for 75% to 85% of neoplasms, while the remaining 15% to 25% are invasive (T1, T2-T4) or metastatic lesions at the time of initial presentation. Several studies have revealed that distinct genotypic and phenotypic patterns are associated with early vs. late stages of bladder cancer. Early superficial disease appears to segregate into 2 main pathways: (1) superficial papillary bladder tumors, which are characterized by gain-of-function mutations affecting oncogenes such as H-RAS, FGFR3, and PI3K, and deletions of the long arm of chromosome 9 (9q); (2) Carcinoma in situ, a "flat" high grade lesion considered to be a precursor of invasive cancer, is characterized by loss-of-function mutations affecting tumor suppressor genes, such as p53, RB, and PTEN. Based on these data, a model for bladder tumor progression has been proposed in which 2 separate genetic pathways characterize the evolution of early bladder neoplasms. Several molecular markers have been correlated with tumor stage, but the rationale for these 2 well-defined genetic pathways still remains unclear. Normal urothelium is a pseudo-stratified epithelium that coats the bladder, composed of 3 cell types: basal, intermediate, and superficial ("umbrella") cells. We have identified a series of markers that are differently expressed in these distinct cells types, and postulated a novel model for urothelium development and configuration. Briefly, it is our working hypothesis that 2 distinct progenitor cells are responsible for basal/intermediate cells and "umbrella" cells, respectively. Basal and intermediate cells are characterized by a p63 positive phenotype, as well as expression of high molecular weight cytokeratins (CKs), such as CK5, CK10, and CK14. On the contrary, "umbrella" cells display a p63 negative phenotype and are characterized by expression of 2 specific low molecular weight CKs: CK18 and CK20. Neither urothelial stem cells nor bladder cancer stem cells have been identified to date. In this review, we will further expand on the issues discussed above.
Collapse
Affiliation(s)
- Mireia Castillo-Martin
- Department of Pathology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY 10032, USA
| | | | | | | | | |
Collapse
|
12
|
Otto W, Denzinger S, Fritsche HM, Burger M, Wieland WF, Hofstädter F, Hartmann A, Bertz S. The WHO classification of 1973 is more suitable than the WHO classification of 2004 for predicting survival in pT1 urothelial bladder cancer. BJU Int 2010; 107:404-8. [PMID: 20707791 DOI: 10.1111/j.1464-410x.2010.09515.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To ascertain which of the currently defined World Health Organization (WHO) grading classifications of pT1 urothelial bladder cancer (BC), published in 1973 and 2004, is more suitable for predicting outcome. PATIENTS AND METHODS Transurethral resection of the bladder (TURB) specimens of 310 patients with first diagnosis of initial pT1 BC were reassessed by three urological pathologists according to the WHO classifications of 1973 and 2004. The TURB procedure was followed by either immediate cystectomy or adjuvant bacille Calmette-Guérin (BCG) instillations. Kaplan-Meier analysis was used to compare survival rates of the different tumour grades (mean follow-up was 57 months). RESULTS According to the 1973 WHO classification, none of the pT1 BC specimens were graded as G1, while 36% were graded as G2 and 64% were graded as G3. Histological reassessment according to the 2004 WHO classification highlighted only 4% low-grade and 96% high-grade tumours. The 10-year cancer-specific survival rates of high-grade tumours (85%) were intermediate between G2 (96%) and G3 (78%). CONCLUSIONS The results of the present study support the presumption that the 1973 WHO classification is more suitable for predicting outcome for pT1 tumours, by defining at least two prognostic groups. A new classification should revise the definition of low- and high-grade pT1 BC to preserve the prognostic value of tumour grading.
Collapse
Affiliation(s)
- Wolfgang Otto
- Department of Urology, University of Regensburg, Regensburg, Erlangen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Sturgeon CM, Duffy MJ, Hofmann BR, Lamerz R, Fritsche HA, Gaarenstroom K, Bonfrer J, Ecke TH, Grossman HB, Hayes P, Hoffmann RT, Lerner SP, Löhe F, Louhimo J, Sawczuk I, Taketa K, Diamandis EP. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for use of tumor markers in liver, bladder, cervical, and gastric cancers. Clin Chem 2010; 56:e1-48. [PMID: 20207771 DOI: 10.1373/clinchem.2009.133124] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Updated National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for the use of tumor markers in the clinic have been developed. METHODS Published reports relevant to use of tumor markers for 4 cancer sites--liver, bladder, cervical, and gastric--were critically reviewed. RESULTS Alpha-fetoprotein (AFP) may be used in conjunction with abdominal ultrasound for early detection of hepatocellular carcinoma (HCC) in patients with chronic hepatitis or cirrhosis associated with hepatitis B or C virus infection. AFP concentrations >200 microg/L in cirrhotic patients with typical hypervascular lesions >2 cm in size are consistent with HCC. After a diagnosis of HCC, posttreatment monitoring with AFP is recommended as an adjunct to imaging, especially in the absence of measurable disease. Although several urine markers have been proposed for bladder cancer, none at present can replace routine cystoscopy and cytology in the management of patients with this malignancy. Some may, however, be used as complementary adjuncts to direct more effective use of clinical procedures. Although carcinoembryonic antigen and CA 19-9 have been proposed for use gastric cancer and squamous cell carcinoma antigen for use in cervical cancer, none of these markers can currently be recommended for routine clinical use. CONCLUSIONS Implementation of these recommendations should encourage optimal use of tumor markers for patients with liver, bladder, cervical, or gastric cancers.
Collapse
Affiliation(s)
- Catharine M Sturgeon
- Department of Clinical Biochemistry, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Mitra AP, Cote RJ. Molecular screening for bladder cancer: progress and potential. Nat Rev Urol 2010; 7:11-20. [DOI: 10.1038/nrurol.2009.236] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
15
|
Birkhahn M, Mitra AP, Williams AJ, Lam G, Ye W, Datar RH, Balic M, Groshen S, Steven KE, Cote RJ. Predicting recurrence and progression of noninvasive papillary bladder cancer at initial presentation based on quantitative gene expression profiles. Eur Urol 2009; 57:12-20. [PMID: 19762144 DOI: 10.1016/j.eururo.2009.09.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 09/02/2009] [Indexed: 01/14/2023]
Abstract
BACKGROUND Currently, tumor grade is the best predictor of outcome at first presentation of noninvasive papillary (Ta) bladder cancer. However, reliable predictors of Ta tumor recurrence and progression for individual patients, which could optimize treatment and follow-up schedules based on specific tumor biology, are yet to be identified. OBJECTIVE To identify genes predictive for recurrence and progression in Ta bladder cancer at first presentation using a quantitative, pathway-specific approach. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of patients with Ta G2/3 bladder tumors at initial presentation with three distinct clinical outcomes: absence of recurrence (n=16), recurrence without progression (n=16), and progression to carcinoma in situ or invasive disease (n=16). MEASUREMENTS Expressions of 24 genes that feature in relevant pathways that are deregulated in bladder cancer were quantified by real-time polymerase chain reaction on tumor biopsies from the patients at initial presentation. RESULTS AND LIMITATIONS CCND3 (p=0.003) and HRAS (p=0.01) were predictive for recurrence by univariate analysis. In a multivariable model based on CCND3 expression, sensitivity and specificity for recurrence were 97% and 63%, respectively. HRAS (p<0.001), E2F1 (p=0.017), BIRC5/Survivin (p=0.038), and VEGFR2 (p=0.047) were predictive for progression by univariate analysis. Multivariable analysis based on HRAS, VEGFR2, and VEGF identified progression with 81% sensitivity and 94% specificity. Since this is a small retrospective study using medium-throughput profiling, larger confirmatory studies are needed. CONCLUSIONS Gene expression profiling across relevant cancer pathways appears to be a promising approach for Ta bladder tumor outcome prediction at initial diagnosis. These results could help differentiate between patients who need aggressive versus expectant management.
Collapse
Affiliation(s)
- Marc Birkhahn
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Recurrence at Three Months and High-grade Recurrence as Prognostic Factor of Progression in Multivariate Analysis of T1G2 Bladder Tumors. Urology 2009; 73:1313-7. [DOI: 10.1016/j.urology.2008.12.047] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/12/2008] [Accepted: 12/20/2008] [Indexed: 11/21/2022]
|
17
|
Bryan RT, Wallace DMA. Have we abandoned the "superficial" in bladder cancer? Eur Urol 2009; 56:1091. [PMID: 19345470 DOI: 10.1016/j.eururo.2009.03.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/13/2009] [Indexed: 11/27/2022]
|
18
|
López JI, Angulo JC. Growth pattern in superficial urothelial bladder carcinomas. Histological review and clinical relevance. Int Urol Nephrol 2009; 41:847-54. [PMID: 19283508 DOI: 10.1007/s11255-009-9537-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/29/2009] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The question of when an intraepithelial urothelial carcinoma becomes invasive into the lamina propria of the urinary bladder is an unresolved issue. Our objective was to analyse a series of consecutive superficial carcinomas to assess the importance of growth pattern in tumour recurrence and progression. MATERIALS AND METHODS The pathological staging of 200 superficial (pTa/pT1) bladder carcinomas was reviewed. Non-invasive lesions and tumours invading the lamina propria were distinguished. Both infiltrating and pushing patterns of growth were regarded as lamina propria invasion. RESULTS A total of 35 (17.5%) pTa and 165 (82.5%) pT1 tumours were identified. Among pT1 tumours, 39 (23.6%) displayed the infiltrating pattern of invasion and 126 (76.4%) the pushing pattern. Differences in five-year recurrence-free (P = 0.01) and progression-free (P = 0.001) survival were demonstrated between pTa and pT1 tumours, and between pT1 infiltrating and pT1 pushing subcategories. Invasive growth pattern has a 1.86 times higher risk of tumour recurrence and 3.01 times higher risk of progression. CONCLUSIONS The pT1 category of bladder carcinoma should include a group of tumours defined by its pushing pattern of growth. Some cases may have been previously considered pTa, but follow an intermediate clinical course between pTa and pT1 tumours with infiltrating growth pattern.
Collapse
Affiliation(s)
- José I López
- Department of Anatomic Pathology, Hospital Universitario de Cruces, Basque Country University, Plaza de Cruces s/n, 48903, Barakaldo, Bizkaia, Spain.
| | | |
Collapse
|
19
|
Guney S, Guney N, Canogullari Z, Ergenekon E. TA T1 Low and Intermediate Transitional Cell Carcinoma of the Bladder: Recurrence Rates and the Timing of Check Cystoscopies within the First Year. Urol Int 2008; 80:124-8. [PMID: 18362479 DOI: 10.1159/000112600] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 05/08/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Soner Guney
- Sisli Etfal Research and Training Hospital, Urology Clinic, Istanbul, Turkey.
| | | | | | | |
Collapse
|
20
|
Schultz IJ, Wester K, Straatman H, Kiemeney LA, Babjuk M, Mares J, Willems JL, Swinkels DW, Witjes JA, Malmström PU, de Kok JB. Gene Expression Analysis for the Prediction of Recurrence in Patients with Primary Ta Urothelial Cell Carcinoma. Eur Urol 2007; 51:416-22; discussion 422-3. [PMID: 16920253 DOI: 10.1016/j.eururo.2006.07.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 07/19/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The individual recurrence-free period after primary surgery of patients with Ta urothelial cell carcinoma (UCC) cannot be predicted accurately. This study aims at discriminating between patients with primary Ta UCC and long or short recurrence-free periods. METHODS We investigated mRNA expression of 23 genes in 44 primary Ta tumours (23 and 21 tumours were from patients with long [>or=4 yr] or short [<or=2 yr] recurrence-free periods, respectively), using real-time quantitative polymerase chain reaction. The genes were selected from previously published studies and showed a relationship with tumour recurrence in patients with UCC. RESULTS Differential mRNA expression between the two patient groups indicated statistical significance only for the gene survivin (p=0.0011). Its recurrence predictive value could not be increased by a combination with any of the other genes. Comparison of the receiver operating characteristic curves for survivin expression between patients with long or short recurrence-free intervals revealed an area under the curve of 0.79 (95%CI, 0.65-0.92). Using the median expression (0.84) as cut-off level, survivin identified 71.4% (95%CI, 47.8-88.7) and 69.6% (95%CI, 47.1-86.8) of the patients with long or short recurrence-free periods, respectively. CONCLUSIONS Our study identifies survivin as the most promising candidate to distinguish between patients with primary Ta UCC and long or short recurrence-free intervals. Therefore, survivin mRNA expression analysis might help the urologist to individualise patient treatment and prevent unnecessary cystoscopies in a subgroup of these patients.
Collapse
Affiliation(s)
- Iman J Schultz
- Department of Clinical Chemistry, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Mian C, Lodde M, Comploj E, Lusuardi L, Palermo S, Mian M, Maier K, Pycha A. Multiprobe fluorescence in situ hybridisation: prognostic perspectives in superficial bladder cancer. J Clin Pathol 2006; 59:984-7. [PMID: 16935973 PMCID: PMC1860484 DOI: 10.1136/jcp.2005.035394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM To establish independent prognostic factors on a chromosomal basis in superficial bladder cancer, using a multicolour fluorescence in situ hybridisation (FISH) probe mix. PATIENTS AND METHODS In 2002, voided urine from 75 consecutive patients (mean age 71.7, range 52-93) years under follow-up for superficial urothelial cancer was studied prospectively. The patients were observed for a mean (standard deviation (SD)) period of 39.3 (6.8) months (range 27-58) until July 2005. A multicolour FISH on liquid-based voided urinary cytology was carried out on all patients. Univariate analysis, using a log rank test, was used to determine the prognostic relevance of a low-risk pattern and a high-risk pattern. Progression-free survival time was calculated from the date of first diagnosis to first recurrence or progression according to the Kaplan-Meier product-limit method. RESULTS One patient was lost to follow-up. 27 of the 74 remaining (36.8%) patients showed recurrent disease. In 9 (33.3%) patients with a low-risk pattern disease recurred after a mean (SD) observation time of 29.7 (1.9) months (range 8.3-52.3, median 30.8 (12.4)). 18 (66.7%) patients with a high-risk pattern developed recurrence within a mean (SD) of 17.6 (2.0) months (range 4-38.8, median 16.7 (11.6)). The Kaplan-Meier curve for progression-free survival showed marked differences between the low-risk and the high-risk groups. CONCLUSION Patients with a high-risk chromosomal pattern have a markedly shorter disease-free survival time and higher progression rate than patients with a low-risk pattern. High-risk patients can therefore be treated more aggressively to prevent tumour spreading.
Collapse
Affiliation(s)
- C Mian
- Department of Pathology, Central Hospital of Bolzano, Bolzano, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Lascombe I, Clairotte A, Fauconnet S, Bernardini S, Wallerand H, Kantelip B, Bittard H. N-cadherin as a novel prognostic marker of progression in superficial urothelial tumors. Clin Cancer Res 2006; 12:2780-7. [PMID: 16675571 DOI: 10.1158/1078-0432.ccr-05-2387] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Loss of intercellular adhesion and increased cell motility promote tumor cell invasion and spreading. In bladder cancer, loss or reduced E-cadherin expression has been associated with poor survival, and aberrant expression of N-cadherin has been associated with the invasive phenotype of bladder carcinoma cells. The purpose of this study was to investigate whether N-cadherin expression was associated with the bladder tumor progression. EXPERIMENTAL DESIGN E-cadherin and N-cadherin expression was evaluated by immunohistochemistry in 101 tumors (pT1 and pT2-T3) and by reverse transcription-PCR analysis and immunohistochemistry in 28 other fresh frozen tumors (pT(a), pT1, and pT2-T3). RESULTS N-cadherin expression was absent in normal urothelium, appeared in stage pT1, and increased in pT2-pT3 tumors. In most cases, increased N-cadherin expression in invasive tumors was associated with loss of E-cadherin expression. Progression-free survival and multivariate analyses revealed that N-cadherin expression is an independent prognostic marker for pT1 tumor progression. Analysis of the 28 frozen tumors by immunohistochemistry and reverse transcription-PCR showed a good correlation between protein and gene expression in pT1 and pT2-T3 tumors. Interestingly, in pT(a) tumors, N-cadherin was not immunodetected, whereas mRNA was present in 50% of cases. CONCLUSION Regulatory defects in the N-cadherin promoter, abnormalities at the translational, or protein processing levels could explain the discrepancies between protein and mRNA expression. Most importantly, this study identified N-cadherin as a novel prognostic marker of progression in superficial urothelial tumors. Clearly, N-cadherin acts in an invasive mode in bladder cancer, but whether it has a primary role in urothelial neoplastic progression has yet to be investigated.
Collapse
|
23
|
|
24
|
Mariappan P, Smith G. A surveillance schedule for G1Ta bladder cancer allowing efficient use of check cystoscopy and safe discharge at 5 years based on a 25-year prospective database. J Urol 2005; 173:1108-11. [PMID: 15758711 DOI: 10.1097/01.ju.0000149163.08521.69] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE In the absence of clear evidence, surveillance of low grade superficial bladder cancer by regular check cystoscopy may continue unnecessarily, or discharge from followup may occur empirically. We review the followup during a prospective 25-year period of patients presenting with G1Ta bladder cancer, and it is this analysis on which we base a safe schedule for discharge. MATERIALS AND METHODS A prospectively kept, computerized record of bladder cancers diagnosed between 1978 and 1985 and subsequently followed up at the Western General Hospital, Edinburgh was reviewed. RESULTS A total of 115 patients with G1Ta disease were followed for a mean of 19.4 years. Tumor status at 3 months was the strongest prognostic factor for recurrence. Although the absence of tumor at 1 year was also a favorable prognostic sign, it was not for 5 years that the situation entirely stabilized (recurrence developed in 8 of 66 such patients between 1 and 5 years). Of those who did not have recurrence in 5 years, 98.3% patients remained tumor-free for 20 years. In contrast in those with recurrence at 3 months the recurrence rate was much higher. Overall 12% of patients experienced progression, mostly in year 1. None of the 8 who had their first recurrence after year 1 had disease progression. CONCLUSIONS Patients with G1Ta disease who are free of recurrence for 5 years after presentation can be safely discharged. We propose to alter the regime for patients with no recurrence in year 1 and discharge them at 5 years.
Collapse
|
25
|
Begum G, Dunn JA, Bryan RT, Bathers S, Wallace DMA. Socio-economic deprivation and survival in bladder cancer. BJU Int 2004; 94:539-43. [PMID: 15329108 DOI: 10.1111/j.1464-410x.2004.04997.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the relationship between deprivation, delay and survival from bladder cancer in the West Midlands, as socio-economic deprivation is associated with worse survival in many malignancies, and it has been suggested that treatment differences and delay in seeking care are major contributing causes. PATIENTS AND METHODS Data were prospectively collected on 1537 newly diagnosed cases of urothelial cancer presenting in the West Midlands between January 1991 and June 1992. Survival was censored at 31 July 2000, when 785 (51%) patients had died. The influence of deprivation on survival was explored using cause-specific and all-cause mortality. RESULTS Patients in less affluent groups had significantly worse survival than patients in more affluent groups when considering deaths from all causes (P = 0.02), which held true when adjusting for independent prognostic factors (age, smoking history, and tumour grade, stage, type and size). Bladder cancer-specific mortality showed no significant difference between socio-economic groups (P = 0.30). CONCLUSION Socio-economic deprivation is a significant predictor of survival when death from all causes is considered. However, this does not hold true for bladder cancer-specific death. The perceived differences in treatment and delay between socio-economic groups do not seem to occur for bladder cancer in the West Midlands.
Collapse
Affiliation(s)
- Gulnaz Begum
- Cancer Research UK Clinical Trials Unit, Institute for Cancer Studies, University of Birmingham, Birmingham, UK
| | | | | | | | | |
Collapse
|
26
|
Pycha A, Lodde M, Comploj E, Negri G, Egarter-Vigl E, Vittadello F, Lusuardi L, Palermo S, Mian C. Intermediate-risk urothelial carcinoma: an unresolved problem? Urology 2004; 63:472-5. [PMID: 15028440 DOI: 10.1016/j.urology.2003.10.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2003] [Accepted: 10/03/2003] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To perform a biologic characterization of the urothelial neoplasms of patients in the intermediate-risk group using multicolor-fluorescence in situ hybridization (FISH). A general consensus has not been reached with regard to the optimal therapy and follow-up of patients with urothelial neoplasms at intermediate risk of progression. On the basis of the chromosomal pattern, we developed a new follow-up algorithm for this group and report our preliminary results. METHODS Voided urine samples of 51 consecutive patients (mean age 72.2 years, range 52 to 93) under follow-up after complete transurethral resection of intermediate-risk urothelial carcinoma were evaluated by liquid-based cytology (ThinPrep) and uCyt+. From the residual material, Multicolor-FISH (Urovysion) was performed. Any cystoscopically suspicious lesion was biopsied or removed transurethrally. The mean follow-up time was 14.2 months (range 6 to 30, SD 5.5). RESULTS Two of the 51 patients were not evaluated because of the presence of intense granulocytosis and insufficient urothelial cells. Of the 49 remaining patients, the results of the Multicolor-FISH analysis were negative (diploid chromosomal pattern) in 14; 20 patients showed the loss of one or both alleles of p16 and/or an aneuploidy of chromosome 3, and 15 patients had aneuploidy of chromosome 7 and/or 17. Of the 14 FISH-negative patients, 2 (14.3%) had histologically verified recurrence, and 3 (15.0%) of the 20 p16/3-positive patients had recurrence and 9 (60.0%) of the 15 7/17-positive patients had either recurrence or progression. CONCLUSIONS Using the Urovysion test, it is possible to predict the biologic behavior of urothelial cancer with a significant impact on the follow-up of patients. The intermediate-risk group of urothelial cancer can be eliminated in the routine workup by classifying these patients according to their chromosomal pattern and defining those patients who can follow the low-risk scheme and those who must be monitored according to the guidelines for high-risk superficial lesions.
Collapse
Affiliation(s)
- Armin Pycha
- Department ofUrology, General Hospital of Bolzano, Bolzano, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Fujii Y, Kawakami S, Koga F, Nemoto T, Kihara K. Long-term outcome of bladder papillary urothelial neoplasms of low malignant potential. BJU Int 2003; 92:559-62. [PMID: 14511033 DOI: 10.1046/j.1464-410x.2003.04415.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the long-term outcome of bladder papillary urothelial neoplasms of low malignant potential (PUNLMP). PATIENTS AND METHODS Of 475 consecutive patients with newly diagnosed bladder tumours between 1976 and 1993, 330 (69%) had superficial (Ta and T1) tumours and 53 (11%) were diagnosed as having PUNLMP. Fifty patients (mean age at presentation 57.2 years, range 26-83; male-to-female ratio 6 : 1) who were followed for> 5 years or until they died, were included in the present study. All histological slides were reviewed, and fulfilled the diagnostic criteria of the 1998 World Health Organization/International Society of Urological Pathology classification system. RESULTS The mean (median, range) follow-up was 11.7 (10.8, 1.3-24.4) years. During the follow-up, 30 patients (60%) had local recurrences. The 2, 5 and 10-year recurrence-free rates were 66%, 51% and 36%, respectively. No patients developed high-grade or muscle-invasive (>/= T2) carcinomas, or upper urinary tract tumours, or died from the disease. At the last follow-up, 34 patients (68%) had been disease-free for> 5 years. CONCLUSIONS Despite a high recurrence rate, PUNLMP carries a very low malignant potential. We agree with the use of the term 'papillary urothelial neoplasms of low malignant potential' instead of 'superficial bladder carcinoma (cancer)' for these tumours.
Collapse
Affiliation(s)
- Y Fujii
- Urology and Reproductive Medicine, and Human Pathology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| | | | | | | | | |
Collapse
|