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He F, Zhang F, Liao Y, Tang MS, Wu XR. Structural or functional defects of PTEN in urothelial cells lacking P53 drive basal/squamous-subtype muscle-invasive bladder cancer. Cancer Lett 2022; 550:215924. [PMID: 36195293 PMCID: PMC9813857 DOI: 10.1016/j.canlet.2022.215924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/10/2022] [Accepted: 09/19/2022] [Indexed: 01/07/2023]
Abstract
Muscle-invasive bladder cancer (MIBC) exhibits strong inter- and intra-tumor heterogeneity that affects biological behaviors, therapeutic responses, and prognoses. Mutations that activate RTK-RAS-PI3K and inactivate P19-P53-P21 coexist in 60-70% of MIBC. By time-controlled ablation of Tp53 and Pten, singly or combined, in adult mouse urothelium, we found that Tp53 loss alone produced no abnormality. While Pten loss elicited hyperplasia, it synergized with Tp53 loss to trigger 100% penetrant MIBC that exhibited basal/squamous features that resembled its human counterpart. Furthermore, PTEN was inactivated in human MIBC cell lines and specimens primarily by hyperphosphorylation of the C-terminus. Mutated or tailless PTEN incapable of C-terminal phosphorylation demonstrated increased inhibition of proliferation and invasion than full-length PTEN in cultured MIBC cells. In xenograft and transgenic mice, tailless PTEN, but not full-length PTEN, prevented further growth in established tumors. Collectively, deficiencies of both PTEN and P53 drive basal/squamous subtype MIBC. PTEN is inactivated by C-terminal hyperphosphorylation, and this modification may serve as a biomarker for subtyping MIBC and predicting tumor progression. Tailless PTEN is a potential molecular therapeutic for tumors, such as bladder cancer (BC), that can be readily accessed.
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Affiliation(s)
- Feng He
- Department of Urology, New York University School of Medicine, New York, NY, 10016, USA; Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, New York, NY, 10010, USA
| | - Fenglin Zhang
- Department of Urology, New York University School of Medicine, New York, NY, 10016, USA
| | - Yi Liao
- Department of Urology, New York University School of Medicine, New York, NY, 10016, USA
| | - Moon-Shong Tang
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10010, USA
| | - Xue-Ru Wu
- Department of Urology, New York University School of Medicine, New York, NY, 10016, USA; Department of Pathology, New York University School of Medicine, New York, NY, 10016, USA; Veterans Affairs New York Harbor Healthcare System, Manhattan Campus, New York, NY, 10010, USA.
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Tian Z, Meng L, Wang X, Diao T, Hu M, Wang M, Zhang Y, Liu M. Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer. Front Oncol 2021; 11:690324. [PMID: 34222019 PMCID: PMC8242250 DOI: 10.3389/fonc.2021.690324] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Lymph node metastasis (LNM) is an important prognostic factor for bladder cancer (BCA) and determines the treatment strategy. This study aimed to determine related clinicopathological factors of LNM and analyze the prognosis of BCA. A total of 10,653 eligible patients with BCA were randomly divided into training or verification sets using the 2004-2015 data of the Surveillance, Epidemiology, and End Results database. To identify prognostic factors for the overall survival of BCA, we utilized the Cox proportional hazard model. Independent risk factors for LNM were evaluated via logistic regression analysis. T-stage, tumor grade, patient age and tumor size were identified as independent risk factors for LNM and were used to develop the LNM nomogram. The Kaplan-Meier method and competitive risk analyses were applied to establish the influence of lymph node status on BCA prognosis. The accuracy of LNM nomogram was evaluated in the training and verification sets. The areas under the receiver operating characteristic curve (AUC) showed an effective predictive accuracy of the nomogram in both the training (AUC: 0.690) and verification (AUC: 0.704) sets. In addition, the calibration curve indicated good consistency between the prediction of deviation correction and the ideal reference line. The decision curve analysis showed that the nomogram had a high clinical application value. In conclusion, our nomogram displayed high accuracy and reliability in predicting LNM. This could assist the selection of the optimal treatment for patients.
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Affiliation(s)
- Zijian Tian
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Maolin Hu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaqun Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Ding H, Fan N, Ning Z, Ma D. Trimodal Therapy vs. Radical Cystectomy for Muscle-Invasive Bladder Cancer: A Meta-Analysis. Front Oncol 2020; 10:564779. [PMID: 33154943 PMCID: PMC7591759 DOI: 10.3389/fonc.2020.564779] [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: 05/22/2020] [Accepted: 08/27/2020] [Indexed: 11/13/2022] Open
Abstract
Background: To compare the difference between trimodal therapy (TMT) and radical cystectomy (RC) in treating muscle-invasive bladder cancer, we performed a meta-analysis for data from the following database. Methods: We searched PubMed, Chinese biomedicine literature database, the Cochrane Library, China National Knowledge Internet databases, Wanfang databases, and Google Scholar up to December 2019. The main outcome measures assessed were overall survival (OS), cancer-specific survival (CSS), mortality, and Charlson comorbidity score (CCS). Two authors independently evaluated the study quality and extracted data. All data were analyzed using Review Manager (version 5.3). Results: After database retrieval, article selection, data extraction, and quality assessment, nine articles comprising 5,721 cases from the TMT group and 48,262 cases from the RC group were included in this study. The data showed that there was no statistical difference between TMT and RC at <10 years OS [pooled hazard ratio (HR) = 1.26, 95% confidence interval (CI): 0.92–1.73, Z = 1.46, P = 0.14], while OS of the RC group was higher than that of the TMT group at more than 10 years (pooled HR = 1.34, 95% CI: 1.18–1.54, Z = 4.33, P < 0.0001). As for CSS, compared with the TMT group, the patients in the RC group had longer CSS (pooled HR = 1.50, 95% CI: 1.29–1.76, Z = 5.15, P < 0.00001). Compared with RC, TMT is linked to an obvious increase in all-cause mortality and bladder-specific cancer mortality (pooled HR = 1.30, 95% CI: 1.16–1.46, Z = 4.55, P < 0.00001; pooled HR = 1.32, 95% CI: 1.15–1.51, Z = 3.92, P < 0.0001). The bladder cancer patients belonging to CCS “0” score preferred RC [pooled relative risk (OR) = 0.94, 95% CI: 0.89–0.98, Z = 2.79, P = 0.005], while CCS “2” score's patients were prone to TMT (pooled OR = 1.40, 95% CI: 1.29–1.53, Z = 7.73, P < 0.00001). Conclusions: Overall, this meta-analysis suggests that the efficacy of TMT is non-inferior to that of RC at <10-year OS, and RC is superior to TMT at more than 10-year OS. Therefore, TMT may be a reasonable treatment option in well-selected patients who are unsuitable for surgery or are not willing to experience surgery. In the future, more high-quality, large-sample randomized controlled trials (RCTs) are needed to verify the results.
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Affiliation(s)
- Hui Ding
- Key Laboratory of Diseases of Urological System Gansu Province, Department of Urology, Gansu Nephro-Urological Clinical Center, Lanzhou University Second Hospital, Lanzhou, China.,Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Ning Fan
- Key Laboratory of Diseases of Urological System Gansu Province, Department of Urology, Gansu Nephro-Urological Clinical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhongyun Ning
- Key Laboratory of Diseases of Urological System Gansu Province, Department of Urology, Gansu Nephro-Urological Clinical Center, Lanzhou University Second Hospital, Lanzhou, China
| | - Deyuan Ma
- The Second Clinical College of Lanzhou University, Lanzhou, China
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Tian Z, Meng L, Wang X, Diao T, Hu M, Wang M, Liu M, Wang J. Young age increases the risk of lymph-node metastasis in patients with muscle-invasive bladder urothelial carcinoma. BMC Cancer 2020; 20:851. [PMID: 32887577 PMCID: PMC7650299 DOI: 10.1186/s12885-020-07354-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of positive lymph nodes in patients with muscle-invasive bladder urothelial carcinoma (MIBC) can be used to guide treatment recommendations. However, little is known about the effect of age on lymph node positivity (LN+). This study aimed to evaluate the effect of age on LN+ in MIBC. METHODS We analyzed patients with stage T2-T4 bladder urothelial carcinoma who had not received preoperative radiotherapy, had at least one lymph node examined, and underwent cystectomy between 1998 and 2015. The Cochran-Armitage trend test and logistic univariate and multivariate analyses were used to evaluate the effect of age on LN+ in all T stages. RESULTS In total, 15,624 patients with MIBC were identified, including 747 patients aged ≤50 years (4.78%), 2614 patients aged 50-59 years (16.73%), 4914 patients aged 60-69 years (31.45%), 5225 patients aged 70-79 years old (33.44%), and 2124 patients aged > 80 years (13.59%). In T2-T4 staging, LN+ was negatively correlated with age. After adjustment for several covariates, multivariate logistic regression analysis revealed that age was an independent risk factor for LN+. CONCLUSIONS In this large SEER analysis, Young patients with MIBC have a higher risk of lymph node metastasis. This finding is worthy of further study and may eventually affect the treatment decisions of young patients.
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Affiliation(s)
- Zijian Tian
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xin Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Maolin Hu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Jianye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Wu SX, Huang J, Liu ZW, Chen HG, Guo P, Cai QQ, Zheng JJ, Qin HD, Zheng ZS, Chen X, Zhang RY, Chen SL, Lin TX. A Genomic-clinicopathologic Nomogram for the Preoperative Prediction of Lymph Node Metastasis in Bladder Cancer. EBioMedicine 2018; 31:54-65. [PMID: 29655996 PMCID: PMC6014062 DOI: 10.1016/j.ebiom.2018.03.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/29/2018] [Accepted: 03/29/2018] [Indexed: 02/05/2023] Open
Abstract
Preoperative lymph node (LN) status is important for the treatment of bladder cancer (BCa). Here, we report a genomic-clinicopathologic nomogram for preoperatively predicting LN metastasis in BCa. In the discovery stage, 325 BCa patients from TCGA were involved and LN-status-related mRNAs were selected. In the training stage, multivariate logistic regression analysis was used to developed a genomic-clinicopathologic nomogram for preoperative LN metastasis prediction in the training set (SYSMH set, n=178). In the validation stage, we validated the nomogram using two independent sample sets (SYSUCC set, n=142; RJH set, n=104) with respect to its discrimination, calibration and clinical usefulness. As results, we identified five LN-status-related mRNAs, including ADRA1D, COL10A1, DKK2, HIST2H3D and MMP11. Then, a genomic classifier was developed to classify patients into high- and low-risk groups in the training set. Furthermore, a nomogram incorporating the five-mRNA-based classifier, image-based LN status, transurethral resection (TUR) T stage, and TUR lymphovascular invasion (LVI) was constructed in the training set, which performed well in the training and validation sets. Decision curve analysis demonstrated the clinical value of our nomogram. Thus, our genomic-clinicopathologic nomogram shows favorable discriminatory ability and may aid in clinical decision-making, especially for cN-patients.
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Affiliation(s)
- Shao-Xu Wu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China; Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhuo-Wei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hai-Ge Chen
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Qing-Qing Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jun-Jiong Zheng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Hai-De Qin
- Guangdong Province Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Research Center of Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zao-Song Zheng
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xin Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui-Yun Zhang
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Si-Liang Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tian-Xin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
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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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May M, Protzel C, Vetterlein MW, Gierth M, Noldus J, Karl A, Grimm T, Wullich B, Grimm MO, Nuhn P, Bastian PJ, Roigas J, Hadaschik B, Gilfrich C, Burger M, Fisch M, Brookman-May S, Aziz A, Hakenberg OW. Is there evidence for a close connection between side of intravesical tumor location and ipsilateral lymphatic spread in lymph node-positive bladder cancer patients at radical cystectomy? Results of the PROMETRICS 2011 database. Int Urol Nephrol 2016; 49:247-254. [DOI: 10.1007/s11255-016-1469-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
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Makino K, Nakagawa T, Kanatani A, Kawai T, Taguchi S, Otsuka M, Matsumoto A, Miyazaki H, Fujimura T, Fukuhara H, Kume H, Homma Y. Biphasic decline in renal function after radical cystectomy with urinary diversion. Int J Clin Oncol 2016; 22:359-365. [PMID: 27747456 DOI: 10.1007/s10147-016-1053-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated short- and long-term renal function in patients after radical cystectomy with urinary diversion and identified risk factors for the deterioration of renal function. METHODS This retrospective study comprised 91 patients who underwent radical cystectomy and urinary diversion for bladder cancer and survived ≥3 years after surgery. The estimated glomerular filtration rate (eGFR) was calculated, and longitudinal changes of eGFR were assessed. Deterioration in renal function in early and late postoperative years was defined as a ≥25 % decrease in the eGFR from preoperative to postoperative year one, and a reduction in the eGFR of >1 mL/min/1.73 m2 annually in subsequent years, respectively. Univariate and multivariate logistic regression analyses were used to evaluate its association with clinicopathologic features. RESULTS The median follow-up period after surgery was 7 years (range 3-26). The mean eGFR decreased from preoperative 65.1 to 58.9 mL/min/1.73 m2 1 year after the surgery, followed by a continuous decline of ~1.0 mL/min/1.73 m2 per year thereafter. Multivariate analyses identified ureteroenteric stricture as the sole risk factor associated with early renal function deterioration [odds ratio (OR) 4.22, p = 0.037]. Diabetes mellitus (OR 8.24, p = 0.015) and episodes of pyelonephritis (OR 4.89, p = 0.038) were independently associated with the gradual decline in the late postoperative period. CONCLUSION In cystectomy patients with urinary diversion, the rapid deterioration of renal function observed during the first year after surgery and the gradual but continuous decline in function thereafter were found to be associated with different risk factors.
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Affiliation(s)
- Katsuhiro Makino
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Atsushi Kanatani
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masafumi Otsuka
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akihiko Matsumoto
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Kang M, Jeong CW, Kwak C, Kim HH, Ku JH. The Prognostic Significance of the Early Postoperative Neutrophil-to-Lymphocyte Ratio in Patients with Urothelial Carcinoma of the Bladder Undergoing Radical Cystectomy. Ann Surg Oncol 2016; 23:335-342. [PMID: 26152275 DOI: 10.1245/s10434-015-4708-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
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10
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Kwon T, Jeong IG, Lee C, You D, Hong B, Hong JH, Ahn H, Kim CS. Acute Kidney Injury After Radical Cystectomy for Bladder Cancer is Associated with Chronic Kidney Disease and Mortality. Ann Surg Oncol 2015; 23:686-93. [PMID: 26442922 DOI: 10.1245/s10434-015-4886-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study was to investigate the prevalence of acute kidney injury (AKI) after radical cystectomy, and evaluate its impact on chronic kidney disease (CKD) and mortality. METHODS The medical records of 866 patients who underwent radical cystectomy for bladder cancer were reviewed. AKI was assessed within 7 days after surgery according to the Acute Kidney Injury Network criteria. The prevalence of AKI after surgery was examined, and the significance of AKI for CKD and mortality was analyzed. RESULTS Of 866 patients, 269 (31.1 %) developed AKI in the first week after surgery. Of these, 231 (85.9 %) were at stage 1, 32 (11.9 %) at stage 2, and 6 (2.2 %) at stage 3. Of 722 patients with a preoperative Modification of Diet in Renal Disease estimated glomerular filtration rate (eGFR) of >60 ml/min/1.73 m(2), CKD developed in 23.0 % (118/513) of patients in the non-AKI group and 32.5 % (68/209) of patients in the AKI group. Independent factors predicting new-onset CKD were a preoperative eGFR (p < 0.001), age (p = 0.011), urinary tract complication (p < 0.001) and AKI (p = 0.015). In all, 297 patients died (191 in the non-AKI group and 106 in the AKI group). AKI also correlated significantly with overall survival (p = 0.001). CONCLUSIONS AKI is not only commonly encountered after radical cystectomy but is also associated with higher CKD rates and mortality. There is a critical need for strategies to increase the identification of patients at risk of postoperative AKI, and to improve the management of patients, with an aim toward preventing AKI and improving the treatment of AKI once it occurs.
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Affiliation(s)
- Taekmin Kwon
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.,Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chunwoo Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Historical trends of radiotherapy use in prevalent malignancies over 38 years in SEER. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s13566-015-0182-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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12
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Eapen R, Liew MS, Tafreshi A, Papa N, Lawrentschuk N, Azad A, Davis ID, Bolton D, Sengupta S. Lymphadenectomy with radical cystectomy at an Australian tertiary referral institution: time trends and impact on oncological outcomes. ANZ J Surg 2014; 85:535-9. [PMID: 25040795 DOI: 10.1111/ans.12772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Lymph node dissection (LND) with radical cystectomy (RC) for surgical treatment of invasive urothelial carcinoma of the bladder can improve staging and has possible therapeutic benefit. The aim of this study was to assess utilization and extent of LND with RC at our institution and determine its impact on oncological outcomes. METHODS Using surgical databases and hospital coding, clinical and histopathological characteristics of 87 patients who underwent RC at Austin Health between 2004 and 2011 were retrospectively analysed. Associations of predictor variables with LND use and lymph node (LN) status were analysed using logistic regression. Survival analyses were undertaken using Cox proportional hazard models. RESULTS Fifty-eight (65.9%) patients underwent LND, with a clear trend over time in the proportion of patients undergoing LND (three of seven in 2004 up to 10 of 10 in 2011, P < 0.001) and the median (range) of LN yield from five (2-19) in 2004 to 18 (7-35) in 2011 (P < 0.001). Year of treatment was the only significant predictor (univariately and multivariately) of a patient undergoing LND. Multivariately, a significant association with nodal metastases was found for cN stage and planned extent of LND preoperatively, and pT stage postoperatively. LN status was associated significantly with recurrence-free survival with best outcomes in patients who were node-negative on a pelvic LND. A similar trend was seen for cancer-specific survival (P = 0.053). CONCLUSIONS Over the study period, there was an increase in the use of pelvic LND and LN numbers retrieved during RC. LN status appears to impact on recurrence-free survival, and possibly cancer-specific survival.
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Affiliation(s)
- Renu Eapen
- Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Mun Sem Liew
- Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.,Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Ali Tafreshi
- Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Urology, Austin Health, Melbourne, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.,Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arun Azad
- Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia
| | - Ian D Davis
- Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.,Joint Austin-Ludwig Oncology Unit, Austin Health, Melbourne, Victoria, Australia.,Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.,Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.,Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Urology, Austin Health, Melbourne, Victoria, Australia.,Ludwig Institute for Cancer Research, Melbourne, Victoria, Australia.,Austin Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
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Murphy CR, Karnes RJ. Bladder Cancer in Males: A Comprehensive Review of Urothelial Carcinoma of the Bladder. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.3503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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14
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Long-term changes in renal function outcomes following radical cystectomy and urinary diversion. Int J Clin Oncol 2014; 19:1105-11. [DOI: 10.1007/s10147-014-0661-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
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15
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Lymphadenectomy for bladder cancer at the time of radical cystectomy. Eur Urol 2013; 64:266-76. [PMID: 23648149 DOI: 10.1016/j.eururo.2013.04.036] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/19/2013] [Indexed: 11/21/2022]
Abstract
CONTEXT Although the importance of lymphadenectomy during radical cystectomy (RC) in high-risk non-muscle-invasive and muscle-invasive bladder cancer (BCa) is well accepted, the optimal extent of lymphadenectomy, number of lymph nodes (LNs) to be retrieved, and prognostic and therapeutic role of lymphadenectomy remain debated issues. OBJECTIVE In this review, we summarize the existing data on the value of lymphadenectomy for staging and outcome of BCa patients undergoing RC and lymphadenectomy. EVIDENCE ACQUISITION A systematic Medline/PubMed literature search of peer-reviewed scientific articles published from 1998 and 2012, concerning the role of lymphadenectomy in BCa patients, was carried out. The terms and permutations used were lymphadenectomy, bladder cancer/carcinoma, urothelial carcinomas, radical cystectomy, lymph node metastasis, lymph node dissection, bladder, recurrence, and survival. Selective older articles were included. EVIDENCE SYNTHESIS Bilateral pelvic lymphadenectomy is an integral part of RC for BCa. The literature regarding the role of lymphadenectomy in BCa patients in general is retrospective, nonstandardized, and of low-level quality in regard to evidence. Prospective randomized trials designed to define the optimal template of lymphadenectomy and its impact on oncologic outcome are advocated. Some of these studies are ongoing, and their completion and analyses are necessary to resolve controversies. CONCLUSIONS Many consistent and concordant observations, although of low level of evidence, document that the extent of lymphadenectomy may influence disease-free survival after RC independent of the status of LNs and the pathologic stage of BCa. Lymphadenectomy standardization at the time of RC to create evidence-based guidelines is essential for further improvement of surgical quality and BCa patient survival.
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16
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Raghavan D, Burgess E, Gaston KE, Haake MR, Riggs SB. Neoadjuvant and adjuvant chemotherapy approaches for invasive bladder cancer. Semin Oncol 2012; 39:588-97. [PMID: 23040255 DOI: 10.1053/j.seminoncol.2012.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Deeply invasive bladder cancer, representing approximately 20% of incident cases, is cured by radical cystectomy or radiotherapy in less than 50% of cases. In an effort to improve cure rates, based on objective response rates in metastatic disease of 40%-70% from combination chemotherapy regimens, systemic chemotherapy has been incorporated into programs of definitive treatment for this disease. Several randomized trials and a meta-analysis have confirmed a survival benefit from neoadjuvant chemotherapy followed by definitive local treatment, reflecting both median survival figures and cure rates. Despite several promising phase II trials, no randomized trial of classical adjuvant chemotherapy for bladder cancer has demonstrated an overall survival benefit, despite increments in disease-free survival. Molecular prognostication has been studied in an effort to improve the utility of systemic therapy for invasive non-metastatic bladder cancer, but randomized trials have not shown associated survival benefit. Despite level 1 evidence of a survival benefit from neoadjuvant MVAC (methotrexate, vinblastine, doxorubicin [Adriamycin], cisplatin) or cisplatin, methotrexate, and vinblastine (CMV) chemotherapy, more than 50% of incident cases do not receive such treatment.
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Affiliation(s)
- Derek Raghavan
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
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