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Tse RTH, Zhao H, Wong CYP, Kong AWY, Chan RCK, To KF, Ng CF, Teoh JYC. In vitro assessment of intra-operative and post-operative environment in reducing bladder cancer recurrence. Sci Rep 2022; 12:22. [PMID: 34997063 PMCID: PMC8741939 DOI: 10.1038/s41598-021-04035-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/07/2021] [Indexed: 01/11/2023] Open
Abstract
Urinary bladder cancer is a common cancer worldwide. Currently, the modality of treating and monitoring bladder cancer is wide. Nonetheless, the high recurrence rate of non-muscle-invasive bladder cancer after surgical resection is still unsatisfactory. Hereby, our study demonstrated whether the intra-operative and post-operative environments will affect bladder cancer recurrence utilizing in vitro cell line model. Bladder cancer cell lines were submerged in four different irrigating fluids for assessing their tumorigenic properties. Our results showed that sterile water performed the best in terms of the magnitude of cytotoxicity to cell lines. Besides, we also investigated cytotoxic effects of the four irrigating agents as well as mitomycin C (MMC) in normothermic and hyperthermic conditions. We observed that sterile water and MMC had an increased cytotoxic effect to bladder cancer cell lines in hyperthermic conditions. Altogether, our results could be translated into clinical practice in the future by manipulating the intra-operative and post-operative conditions in order to lower the chance of residual cancer cells reimplant onto the bladder, which in turns, reducing the recurrence rate of bladder cancers.
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Affiliation(s)
- Ryan Tsz-Hei Tse
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Hongda Zhao
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Christine Yim-Ping Wong
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Angel Wing-Yan Kong
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Ronald Cheong-Kin Chan
- grid.10784.3a0000 0004 1937 0482Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Fai To
- grid.10784.3a0000 0004 1937 0482Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Fai Ng
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China
| | - Jeremy Yuen-Chun Teoh
- grid.10784.3a0000 0004 1937 0482Department of Surgery, S.H. Ho Urology Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F LCW Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, China ,European Association of Urology-Young Academic Urologists (EAU-YAU) Urothelial Cancer Working Group, Amsterdam, The Netherlands
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Chiancone F, Fabiano M, Carrino M, Fedelini M, Meccariello C, Fedelini P. Impact of systemic inflammatory markers on the response to Hyperthermic IntraVEsical Chemotherapy (HIVEC) in patients with non-muscle-invasive bladder cancer after bacillus Calmette-Guérin failure. Arab J Urol 2021; 19:86-91. [PMID: 33763253 PMCID: PMC7954479 DOI: 10.1080/2090598x.2021.1874627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the impact of pre- and post-treatment systemic inflammatory markers on the response to Hyperthermic IntraVEsical Chemotherapy (HIVEC) treatment in a cohort of patients with high-grade non-muscle-invasive bladder cancer with bacillus Calmette–Guérin (BCG) failure or intolerance who were unsuitable or unwilling to undergo early radical cystectomy. As a secondary endpoint, we assessed the influence of some demographic, clinical and pathological factors on the response to chemo-hyperthermia. Patients and methods: Between March 2017 and December 2019, 72 consecutive patients were retrospectively analysed. Patients with diseases or conditions that could interfere with systemic inflammatory status or full blood count were excluded. The HIVEC protocol consisted of six weekly intravesical treatments with 40 mg Mitomycin-C diluted in 50 mL distilled water. The drug was heated to a temperature of 43°C. Association of categorical variables with response to HIVEC was evaluated using Yates’ chi-squared test and differences in continuous variable were analysed using the Mann–Whitney test. Logistic regression analysis was performed to define independent predictors of response to HIVEC. Results: Patients who failed HIVEC were more likely to have multiple tumours (P = 0.039) at transurethral resection of bladder and a recurrence rate of >1/year (P = 0.046). Lower post-HIVEC inflammatory indices [C-reactive protein (P = 0.021), erythrocyte sedimentation rate (P = 0.027)] and lower pre- (P = 0.014) and post-treatment (P = 0.004) neutrophil-to-lymphocyte ratio (NLR) values were significantly associated with the response to the HIVEC regimen (no bladder cancer recurrence or progression). In the multivariate analysis, patients with a recurrence rate of >1/year were eight-times more likely to experience failure of HIVEC (P = 0.007). Higher pre- (P = 0.023) and post-treatment NLR values (P = 0.046) were associated with a worse response to the HIVEC regimen. Conclusions: The recurrence rate and systemic inflammatory response markers could be useful tools to predict the likelihood of obtaining a response with the HIVEC regimen. These markers might help to guide patients about the behaviour of the tumour after BCG failure, predicting failure or success of a conservative treatment. Abbreviations: CHT: chemo-hyperthermia; CIS: carcinoma in situ; CRP: C-reactive protein; EAU: European Association of Urology; ESR: erythrocyte sedimentation rate; HG: high grade; HIVEC: Hyperthermic IntraVEsical Chemotherapy; ICD: immunogenic cell death; IL: interleukin; MMC: Mitomycin-C; NK: natural killer; NLR: neutrophil-to-lymphocyte ratio; NMIBC: non-muscle-invasive bladder cancer; PLR: platelet-to-lymphocyte ratio; RC: radical cystectomy; SIR: systemic inflammatory response; TURB: transurethral resection of bladder
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Affiliation(s)
- Francesco Chiancone
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy
| | - Marco Fabiano
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy
| | - Maurizio Carrino
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy
| | - Maurizio Fedelini
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy
| | - Clemente Meccariello
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy
| | - Paolo Fedelini
- Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy
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