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Aizpurua XP, Gardiner JIM, Popescu OB, González EB, Sánchez LC, Granados MC, I Jaumot JJT, de Castroviejo Blanco JR, Ospina FO, Benavente RC, Enguita CG. A Systematic Review on the Current Landscape of T1 Bladder Cancer Substaging. Urology 2024:S0090-4295(24)00880-X. [PMID: 39389368 DOI: 10.1016/j.urology.2024.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 09/25/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
OBJECTIVE To conduct a systematic review on the current state of T1 bladder tumor substaging. These neoplasms display significant heterogeneity in oncological behavior and prognosis, leading to the proposal of various substaging methods. Our aim was to investigate the potential diagnostic and prognostic value of substaging in stage T1 bladder cancer for better oncologic outcomes. METHODS A literature search using MEDLINE, EMBASE and Cochrane Library databases was conducted in March 2024 to identify relevant studies on T1 urothelial bladder cancer staging. A systematic review of included articles was performed following the PRISMA guideline statement. Literature search was conducted in English. RESULTS Overall, 63 studies published between 1990 and 2024 were included for final review including a total number of 8207 bladder tumor patients subject to T1 substaging. Various substaging methods have been developed, broadly classified into histometric (anatomy-based) and micrometric (semiquantitative) techniques. Advanced stages have been consistently associated with worse prognosis and need for a more radical therapeutic approach. A standardized, validated, unified substaging report system is lacking. CONCLUSIONS T1 substaging is a strong predictor of oncologic outcomes. Micrometric methods seem to be more reproducible and precise than histometric techniques in terms of feasibility and prognostic value. Standardization and validation of the technique could potentially enhance the bladder cancer treatment algorithm. We would like to provide an explanation regarding why our systematic review was not prospectively registered in the PROSPERO database. Initially, this review was conceived as part of a doctoral thesis (PhD) project, and there was no intention to publish it. Although we strictly adhered to the PRISMA guidelines from the beginning, the decision to publish the review was made only after most of the data had been extracted. At that point, retrospectively registering it in PROSPERO would have been somewhat unethical, which is why we chose not to register it. We fully recognize the importance of actively registering systematic reviews, as it is the proper and ethical way to proceed in these cases. We remain committed to transparency and best practices in research and believe that prospective registration is crucial for ensuring the integrity and credibility of systematic reviews.
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Affiliation(s)
- Xabier Pérez Aizpurua
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain.
| | - Juan Ignacio Monzó Gardiner
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - Oana Beatrice Popescu
- Department of Pathology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - Elena Buendía González
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - Leslie Cuello Sánchez
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - María Cañadas Granados
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - Jaime Jorge Tufet I Jaumot
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | | | - Felipe Osorio Ospina
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - Ramiro Cabello Benavente
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
| | - Carmen González Enguita
- Department of Urology. Hospital Universitario Fundación Jiménez Díaz, Avda. Reyes Católicos 2 28040 Madrid, Spain
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Niegisch G, Bolenz C, Doehn C, Gakis G, Hartmann A, Müller-Huesmann H, Reis H, Roghmann F, Schwamborn K, Tiemann K, Retz M. [German expert consensus on programmed cell death ligand 1 (PD-L1) testing in perioperative systemic therapy of muscle invasive bladder cancer]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:1019-1027. [PMID: 39186130 PMCID: PMC11458694 DOI: 10.1007/s00120-024-02416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Abstract
The risk of recurrence in patients with muscle invasive bladder cancer (MIBC) after radical cystectomy depends on the pathological tumor stage. In particular, patients with lymph node metastasis (pN+), locally advanced (≥pT3), or residual muscle invasive tumor despite neoadjuvant chemotherapy are at high risk. Currently, the importance of adjuvant therapy with immune checkpoint inhibitors is increasing in the context of perioperative systemic therapeutic concepts. The indication for the PD‑1 inhibitor nivolumab currently approved in the European Union requires testing of PD-L1 (programmed cell death ligand 1) protein expression by immunochemistry in tumor tissue. Focusing on MIBC patients at high risk of recurrence, new questions arise regarding the implementation and interpretation of PD-L1 testing. An interdisciplinary group of experts from Germany has discussed relevant issues from a clinicopathological point of view and developed practical recommendations to facilitate the implementation of validated and quality-assured PD-L1 testing for the approved indications in daily clinical practice.
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Affiliation(s)
- G Niegisch
- Klinik für Urologie, Universitätsklinikum und Medizinische Fakultät der Heinrich-Heine-Universität, Düsseldorf, Deutschland.
- Centrum für Integrierte Onkologie (CIO) Düsseldorf, CIO Aachen-Bonn-Köln-Düsseldorf, Düsseldorf, Deutschland.
- Medizinische Fakultät, Klinik für Urologie, Heinrich-Heine-Universität, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - C Bolenz
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - C Doehn
- Urologikum Lübeck, Lübeck, Deutschland
| | - G Gakis
- Klinik für Urologie, Universitätsklinik/Poliklinik und Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - A Hartmann
- Urologische Praxis Celle, Celle, Deutschland
| | - H Müller-Huesmann
- MVZ im MediCo für Hämatologie und Onkologie, Innere Medizin, Palliativmedizin, Paderborn, Deutschland
| | - H Reis
- Dr. Senckenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - F Roghmann
- Translationale Uro-Onkologie am Prostatakarzinomzentrum, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - K Schwamborn
- Institut für Pathologie, Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - K Tiemann
- Institut für Hämatopathologie Hamburg, Hamburg, Deutschland
| | - M Retz
- Urologische Klinik und Poliklinik, des Universitätsklinikum rechts der Isar der Technischen Universität München, München, Deutschland
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Kläger J, Koeller MC, Oszwald A, Wasinger G, D'Andrea D, Compérat E. A single-center retrospective comparison of pT1 substaging methods in bladder cancer. Virchows Arch 2024:10.1007/s00428-024-03907-4. [PMID: 39222123 DOI: 10.1007/s00428-024-03907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/26/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Substaging of T1 urothelial cancer is associated with tumor progression and its reporting is recommended by international guidelines. However, it has not been integrated in risk stratification tools and there is no agreement on the best method to use for its reporting. We aimed to investigate the applicability, interobserver variability, and prognostic value of histological landmark based and micrometric (aggregate linear length of invasive carcinoma (ALLICA), microscopic vs. extensive system, Rete Oncologica Lombarda (ROL) system) substaging methods. A total of 79 patients with the primary diagnosis of T1 urothelial cancer treated with conventional transurethral resection and adjuvant BCG therapy between 2000 and 2020 at the Medical University of Vienna were included. The anatomical and metrical substaging systems were evaluated using agreement rate, Cohen's kappa, Kendall's tau, and Spearman rank correlation. Prognostic value for high-grade recurrence or T2 progression was evaluated in uni- and multivariable analysis. Applicability and reproducibility were good to moderate and varied between substaging methods. Obstacles are mainly due to fragmentation of samples. Anatomical substaging was associated with progression in univariable and multivariable analysis. In our cohort, we could only identify anatomical landmark-based substaging to be prognostic for T2 progression. A major obstacle for proper pathological assessment is fragmentation of samples due to operational procedure. Avoiding such fragmentation might improve reproducibility and significance of pathological T1 substaging of urothelial cancer.
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Affiliation(s)
- Johannes Kläger
- Department of Pathology, Medical University of Vienna, Vienna, Austria.
| | | | - André Oszwald
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Wasinger
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Eva Compérat
- Department of Pathology, Medical University of Vienna, Vienna, Austria
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4
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Claps F, Biasatti A, Di Gianfrancesco L, Ongaro L, Giannarini G, Pavan N, Amodeo A, Simonato A, Crestani A, Cimadamore A, Hurle R, Mertens LS, van Rhijn BWG, Porreca A. The Prognostic Significance of Histological Subtypes in Patients with Muscle-Invasive Bladder Cancer: An Overview of the Current Literature. J Clin Med 2024; 13:4349. [PMID: 39124615 PMCID: PMC11313590 DOI: 10.3390/jcm13154349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
Bladder cancer (BC) is the tenth most commonly diagnosed malignancy worldwide. In approximately 25% of cases, it presents as a muscle-invasive disease, requiring a radical treatment. Traditionally, the mainstay of treatment has been radical cystectomy (RC), but in the last decade, bladder-sparing treatments have been gaining growing interest. In particular, trimodal therapy (TMT) seems to yield survival results comparable to RC with less morbidity and better quality of life (QoL) outcomes. In this scenario, we aimed at shedding light on the role of the histological subtypes (HS) of BC and their prognostic significance in muscle-invasive BC (MIBC), treated either surgically or with TMT. We performed a narrative review to provide an overview of the current literature on this topic. When compared with patients diagnosed with conventional urothelial carcinoma (UC) of the same disease stage, survival did not appear to be significantly worse across the reports. But when sub-analyzed for separate subtype, some appeared to be independently associated with adverse survival outcomes such as the micropapillary, plasmacytoid, small-cell, and sarcomatoid subtypes, whereas others did not. Moreover, the optimal management remains to be defined, also depending on the therapeutic susceptibility of each histology. From this perspective, multi-disciplinary assessment alongside the routine inclusion of such entities in randomized clinical trials appears to be essential.
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Affiliation(s)
- Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, 1006 BE Amsterdam, The Netherlands; (L.S.M.); (B.W.G.v.R.)
- Department of Urology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Arianna Biasatti
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Luca Di Gianfrancesco
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, 35128 Padua, Italy; (L.D.G.); (A.A.); (A.P.)
| | - Luca Ongaro
- Department of Urology, Royal Free London NHS Foundation Trust, London NW3 2QG, UK;
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.G.); (A.C.)
| | - Nicola Pavan
- Urology Clinic, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, 90127 Palermo, Italy; (N.P.); (A.S.)
| | - Antonio Amodeo
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, 35128 Padua, Italy; (L.D.G.); (A.A.); (A.P.)
| | - Alchiede Simonato
- Urology Clinic, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, 90127 Palermo, Italy; (N.P.); (A.S.)
| | - Alessandro Crestani
- Urology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (G.G.); (A.C.)
| | - Alessia Cimadamore
- Institute of Pathological Anatomy, Department of Medicine, University of Udine, 33100 Udine, Italy;
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Laura S. Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, 1006 BE Amsterdam, The Netherlands; (L.S.M.); (B.W.G.v.R.)
| | - Bas W. G. van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, 1006 BE Amsterdam, The Netherlands; (L.S.M.); (B.W.G.v.R.)
| | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, 35128 Padua, Italy; (L.D.G.); (A.A.); (A.P.)
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Yanagisawa T, Sato S, Hayashida Y, Okada Y, Matsukawa A, Iwatani K, Shimoda M, Takahashi H, Kimura T, Shariat SF, Miki J. Prognostic value of micrometric substaging in pT1 bladder cancer patients treated with en-bloc transurethral resection. Histopathology 2024; 85:92-103. [PMID: 38477374 DOI: 10.1111/his.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
AIMS We aimed to assess the oncological impact of micrometric extent of invasion in patients with pT1 bladder cancer (BCa) who underwent en-bloc resection for bladder tumour (ERBT). METHODS AND RESULTS We retrospectively analysed the records and specimens of 106 pT1 high-grade BCa patients who underwent ERBT. The extent of invasion, such as depth from basal membrane, number of invasive foci, maximum width of invasive focus, muscularis mucosae invasion and infiltration pattern (pattern A: solid sheet-like, nodular or nested growth, pattern B: trabecular, small cluster or single-cell pattern) were evaluated by a single genitourinary pathologist. The end-points were recurrence-free (RFS) and progression-free survival (PFS). Within a median follow-up of 23 months, overall, 36 patients experienced recurrence and 13 patients experienced disease progression. The 2-year PFS differed significantly depending on depth from basal membrane (< 1.3 mm: 94.8% versus ≧ 1.3 mm: 65.2%, P = 0.005), maximum width of invasive focus (< 4 mm: 91.7% versus ≧ 4 mm: 62.3%, P < 0.001), muscularis mucosae (MM) invasion (above MM = 96.1% versus into or beyond MM = 64.8%, P = 0.002) and infiltration pattern (pattern A: 100% versus pattern B: 83.3%, P = 0.037). In a multivariable analysis, MM invasion [hazard ratio (HR) = 4.54, 95% confidence interval (CI) = 1.25-16.5] and maximum width of invasive focus ≧ 4 mm (HR = 4.79, 95% CI = 1.25-16.5) were independent prognostic factors of progression. CONCLUSIONS En-bloc resection facilitates the evaluation of pathologic variables that might be useful in predicting disease recurrence and progression. In particular, not only the MM invasion but also the maximum width of invasion focus, reflecting the invasive volume, appear to be reliable prognosticators for disease progression.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Yohei Okada
- Department of Urology, Saitama Medical Center, Saitama, Japan
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Shimoda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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Ji J, Zhang T, Zhu L, Yao Y, Mei J, Sun L, Zhang G. Using machine learning to develop preoperative model for lymph node metastasis in patients with bladder urothelial carcinoma. BMC Cancer 2024; 24:725. [PMID: 38872141 PMCID: PMC11170799 DOI: 10.1186/s12885-024-12467-4] [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: 09/25/2023] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Lymph node metastasis (LNM) is associated with worse prognosis in bladder urothelial carcinoma (BUC) patients. This study aimed to develop and validate machine learning (ML) models to preoperatively predict LNM in BUC patients treated with radical cystectomy (RC). METHODS We retrospectively collected demographic, pathological, imaging, and laboratory information of BUC patients who underwent RC and bilateral lymphadenectomy in our institution. Patients were randomly categorized into training set and testing set. Five ML algorithms were utilized to establish prediction models. The performance of each model was assessed by the area under the receiver operating characteristic curve (AUC) and accuracy. Finally, we calculated the corresponding variable coefficients based on the optimal model to reveal the contribution of each variable to LNM. RESULTS A total of 524 and 131 BUC patients were finally enrolled into training set and testing set, respectively. We identified that the support vector machine (SVM) model had the best prediction ability with an AUC of 0.934 (95% confidence interval [CI]: 0.903-0.964) and accuracy of 0.916 in the training set, and an AUC of 0.855 (95%CI: 0.777-0.933) and accuracy of 0.809 in the testing set. The SVM model contained 14 predictors, and positive lymph node in imaging contributed the most to the prediction of LNM in BUC patients. CONCLUSIONS We developed and validated the ML models to preoperatively predict LNM in BUC patients treated with RC, and identified that the SVM model with 14 variables had the best performance and high levels of clinical applicability.
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Affiliation(s)
- Junjie Ji
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianwei Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ling Zhu
- Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Yao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingchang Mei
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Guiming Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Contieri R, Tan WS, Grajales V, Hensley PJ, Martini A, Bree K, Myers A, Nogueras-Gonzalez G, Navai N, Dinney CP, Guo C, Kamat AM. Influence of lamina propria invasion extension on T1 high-grade non-muscle-invasive bladder cancer in patients undergoing BCG or radical cystectomy. BJU Int 2024; 133:733-741. [PMID: 38374533 DOI: 10.1111/bju.16293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To evaluate the prognostic value of T1 substaging in patients treated with bacillus Calmette-Guérin (BCG) or immediate radical cystectomy (iRC). MATERIALS AND METHODS We performed an institutional review board-approved retrospective study analysing non-muscle-invasive bladder cancer (NMIBC) patients with pT1 disease treated with either BCG or iRC between 2000 and 2020. Lamina propria (LP) invasion characteristics were extracted from the pathology report. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS) and metastasis-free survival (MFS). Multivariable Cox models were used to determine the association between progression-free survival (PFS) and characteristics in the BCG cohort. A logistic regression model explored the relationship between T1 substaging and upstaging to >pT2 at iRC. RESULTS A total of 411 T1 high-grade patients were identified. LP invasion characteristics were as follows: not specified: 115 (28%); focal/superficial (F/S): 147 (35.8%); and extensive/multifocal (E/M): 149 (36.2%). Overall, 303 patients (73.7%) received BCG, and 108 patients (26.3%) underwent iRC. The median (interquartile range) follow-up was 53 (32-96) months. Patients with E/M LP invasion were significantly more likely to undergo iRC (34% vs. 19%; P = 0.003). Patients with E/M LP invasion showed poorer MFS and CSS compared to those with F/S LP invasion when treated with BCG but not when treated with iRC. Among BCG-treated patients, progression occurred in 41 patients and E/M LP invasion was independently associated with progression after BCG (hazard ratio 5.3, 95% confidence interval [CI] 2.2-13.1; P < 0.001). T1 substaging was not associated with upstaging at RC (odds ratio 3.15, 95% CI 0.82-12.12; P = 0.095). CONCLUSIONS Extensive/multifocal LP invasion was associated with poor PFS, MFS and CSS in patients treated with BCG. T1 substaging provides valuable prognostic information and should be reported in pathology reports.
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Affiliation(s)
- Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick J Hensley
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Alberto Martini
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kelly Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amanda Myers
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Charles Guo
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Vlachou E, Johnson BA, Baraban E, Nadal R, Hoffman-Censits J. Current Advances in the Management of Nonurothelial Subtypes of Bladder Cancer. Am Soc Clin Oncol Educ Book 2024; 44:e438640. [PMID: 38870453 DOI: 10.1200/edbk_438640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Urothelial cancer (UC) is the most common histology seen in bladder tumors. The 2022 WHO classification of urinary tract tumors includes a list of less common subtypes (formerly known as variants) for invasive UC which are considered high-grade tumors. This review summarizes the most recent advances in the management of selected nonurothelial subtypes of bladder cancer: squamous cell carcinoma, small cell carcinoma, sarcomatoid urothelial carcinoma, micropapillary carcinoma, plasmacytoid carcinoma, adenocarcinoma, and urachal carcinoma. The role of neoadjuvant and adjuvant chemotherapy has not been well characterized for most of these histologies, and prospective data are extremely limited. Participation in clinical trials is recommended in advanced disease.
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Affiliation(s)
- Evangelia Vlachou
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Burles Avner Johnson
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Ezra Baraban
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD
| | - Rosa Nadal
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jean Hoffman-Censits
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD
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9
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Akbulut D, Al-Ahmadie H. Updates on Urinary Bladder Tumors With Neuroendocrine Features. Adv Anat Pathol 2024; 31:169-177. [PMID: 38523484 PMCID: PMC11006587 DOI: 10.1097/pap.0000000000000433] [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] [Indexed: 03/26/2024]
Abstract
The most common neuroendocrine tumor in the urinary bladder is small cell carcinoma, which can be pure or mixed with components of urothelial or other histologic subtypes. Large cell neuroendocrine carcinoma of the bladder is rare and remains ill-defined but is increasingly recognized. Well-differentiated neuroendocrine tumor and paraganglioma can arise in the bladder but are very rare in this location. Recent advances in molecular characterization allowed for better classification and may offer improved stratification of these tumors.
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Affiliation(s)
- Dilara Akbulut
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center New York, NY
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10
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Lobo J, Tenace NP, Cañete-Portillo S, Carneiro I, Henrique R, Lucianò R, Harik LR, Magi-Galluzzi C. Aberrant expression of GATA3 in metastatic adenocarcinoma of the prostate: an important pitfall. Histopathology 2024; 84:507-514. [PMID: 37965687 DOI: 10.1111/his.15094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/10/2023] [Accepted: 10/28/2023] [Indexed: 11/16/2023]
Abstract
AIMS The distinction of high-grade prostate cancer (PCa) from poorly differentiated urothelial carcinoma (UC) can be somewhat challenging on clinical and morphological grounds alone, yet it is of great importance for prognostication and choice of treatment. GATA3 is a useful immunohistochemical marker to confirm urothelial origin. However, recent works report strong GATA3 immunoexpression in primary high-grade PCa. The aim of this study was to explore GATA3 expression specifically in metastatic PCa. METHODS AND RESULTS The pathology databases of four tertiary institutions were queried for cases of metastatic PCa. Available slides and clinical records were reviewed by experienced genitourinary pathologists. Prostatic markers (PSA, PSAP, NKX3.1) and GATA3 immunohistochemistry were performed. A total of 163 metastatic PCa cases were included. At least one prostate marker was positive in each case of non-regional distant metastasis, confirming prostatic origin. GATA3 strong staining was found in four (2.5%) cases: two liver, one bone and one non-regional lymph-node metastases. All four patients had Grade Group 5 PCa at the initial diagnosis. The metastatic prostatic adenocarcinomas were solid, either with no gland formation (n = 3) or with only focal cribriforming (n = 1). CONCLUSIONS To our knowledge, this is the first study exploring GATA3 expression specifically in metastatic PCa. Despite being infrequent, GATA3 positivity in high-grade PCa may lead to misdiagnosis, with clinical implications. We recommend a panel of immunohistochemical markers, both prostatic and urothelial, for ruling out UC, either in primary tumour samples or in the event of metastases of unknown primary, when a genitourinary origin is suspected.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC), Porto, Portugal
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Nazario P Tenace
- Department of Pathology, Università Vita-Salute San Raffaele, Milano, Italy
| | - Sofia Cañete-Portillo
- Department of Pathology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isa Carneiro
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC), Porto, Portugal
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC), Porto, Portugal
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto)/Porto Comprehensive Cancer Center Raquel Seruca (P.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal
- Department of Pathology and Molecular Immunology, ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Roberta Lucianò
- Department of Pathology, Università Vita-Salute San Raffaele, Milano, Italy
| | - Lara R Harik
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Cristina Magi-Galluzzi
- Department of Pathology, Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Ji J, Yao Y, Sun L, Yang Q, Zhang G. Development and validation of a preoperative nomogram to predict lymph node metastasis in patients with bladder urothelial carcinoma. J Cancer Res Clin Oncol 2023; 149:10911-10923. [PMID: 37318590 PMCID: PMC10423104 DOI: 10.1007/s00432-023-04978-7] [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: 05/17/2023] [Accepted: 06/07/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE Predicting lymph node metastasis (LNM) in patients with bladder urothelial carcinoma (BUC) before radical cystectomy aids clinical decision making. Here, we aimed to develop and validate a nomogram to preoperatively predict LNM in BUC patients. METHODS Patients with histologically confirmed BUC, who underwent radical cystectomy and bilateral lymphadenectomy, were retrospectively recruited from two institutions. Patients from one institution were enrolled in the primary cohort, while those from the other were enrolled in the external validation cohort. Patient demographic, pathological (using transurethral resection of the bladder tumor specimens), imaging, and laboratory data were recorded. Univariate and multivariate logistic regression analyses were performed to explore the independent preoperative risk factors and develop the nomogram. Internal and external validation was conducted to assess nomogram performance. RESULTS 522 and 215 BUC patients were enrolled in the primary and external validation cohorts, respectively. We identified tumor grade, infiltration, extravesical invasion, LNM on imaging, tumor size, and serum creatinine levels as independent preoperative risk factors, which were subsequently used to develop the nomogram. The nomogram showed a good predictive accuracy, with area under the receiver operator characteristic curve values of 0.817 and 0.825 for the primary and external validation cohorts, respectively. The corrected C-indexes, calibration curves (after 1000 bootstrap resampling), decision curve analysis results, and clinical impact curves demonstrated that the nomogram performed well in both cohorts and was highly clinically applicable. CONCLUSION We developed a nomogram to preoperatively predict LNM in BUC, which was highly accurate, reliable, and clinically applicable.
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Affiliation(s)
- Junjie Ji
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Yao
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijiang Sun
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qingya Yang
- Department of Urology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
| | - Guiming Zhang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, China.
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12
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Yanagisawa T, Matsukawa A, Iwatani K, Sato S, Hayashida Y, Okada Y, Yorozu T, Fukuokaya W, Sakanaka K, Urabe F, Kimura S, Tsuzuki S, Shimoda M, Takahashi H, Miki J, Shariat SF, Kimura T. En Bloc Resection Versus Conventional TURBT for T1HG Bladder Cancer: A Propensity Score-Matched Analysis. Ann Surg Oncol 2023; 30:3820-3828. [PMID: 36897417 DOI: 10.1245/s10434-023-13227-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/23/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND We aimed to assess the clinical, oncological, and pathological impact of en bloc resection of bladder tumors (ERBT) compared with conventional transurethral resection of bladder tumors (cTURBT) for pT1 high-grade (HG) bladder cancer. PATIENTS AND METHODS We retrospectively analyzed the record of 326 patients (cTURBT: n = 216, ERBT: n = 110) diagnosed with pT1 HG bladder cancer at multiple institutions. The cohorts were matched by one-to-one propensity scores based on patient and tumor demographics. Recurrence-free survival (RFS), progression-free survival (PFS), cancer-specific survival (CSS), and perioperative and pathologic outcomes were compared. The prognosticators of RFS and PFS were analyzed using the Cox proportional hazard model. RESULTS After matching, 202 patients (cTURBT: n = 101, ERBT: n = 101) were retained. There were no differences in perioperative outcomes between the two procedures. The 3-year RFS, PFS, and CSS were not different between the two procedures (p = 0.7, 1, and 0.7, respectively). Among patients who underwent repeat transurethral resection (reTUR), the rate of any residue on reTUR was significantly lower in the ERBT group (cTURBT: 36% versus ERBT: 15%, p = 0.029). Adequate sampling of muscularis propria (83% versus 93%, p = 0.029) and diagnostic rates of pT1a/b substaging (90% versus 100%, p < 0.001) were significantly better in ERBT specimen compared with cTURBT specimen. On multivariable analyses, pT1a/b substaging was a prognosticator of disease progression. CONCLUSIONS In patients with pT1HG bladder cancer, ERBT had similar perioperative and mid-term oncologic outcomes compared with cTURBT. However, ERBT improves the quality of resection and specimen, yielding less residue on reTUR and yielding superior histopathologic information such as substaging.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Yohei Okada
- Department of Urology, Saitama Medical Center, Saitama, Japan
| | - Takashi Yorozu
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Shimoda
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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13
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Mau B, Johnson B, Hansel DE, McConkey DJ. The Many Faces of Muscle-Invasive Bladder Cancer: Histopathological and Molecular Characterization. Semin Radiat Oncol 2023; 33:1-11. [PMID: 36517188 DOI: 10.1016/j.semradonc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Brian Mau
- Department of Pathology & Laboratory Medicine, Oregon Health & Science University, Portland, OR
| | - Burles Johnson
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Donna E Hansel
- Department of Pathology & Laboratory Medicine, Oregon Health & Science University, Portland, OR; Present address: Division Head, Pathology and Laboratory Medicine, U.T. M.D. Anderson Cancer Center, Houston, Texas 77030 USA
| | - David J McConkey
- Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD.
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14
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Yang T, Fan J, Pei X, Liang H, Fan J. Combination of Two T1 Substaging Systems (T1a/b/c and T1m/e) Better Predicts Tumor Outcomes in Patients with T1 High Grade Bladder Cancer. Bladder Cancer 2022; 8:371-378. [PMID: 38994183 PMCID: PMC11181756 DOI: 10.3233/blc-220007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/23/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND T1 substaging is a predictive factor for non-muscle-invasive bladder cancer, and two types of T1 substaging systems (T1a/b/c and T1m/e) are currently in use. However, the predictive ability of both systems is poor, and there is debate over which system is better. OBJECTIVE To confirm whether combination of two T1 substaging systems can improve the predictive ability of T1 substaging for tumor outcomes. METHODS Patients with primary pT1 high-grade bladder cancer from three centers were included. All tumors were assessed with T1a/b/c and T1m/e substaging. A new variable named COMB was developed in which patients were stratified into T1a/b&T1m, T1a/b&T1e, T1c&T1m or T1c&T1e subgroups. A time-dependent receiver operating characteristic curve (ROC) analysis was used to test whether the accuracy of prediction could be improved with COMB. RESULTS A total of 239 patients with primary pT1HG were analyzed. No tumor was T1c&T1m, and therefore, only three types of combinations were evaluated: T1a/b&T1m (62 patients), T1a/b&T1e (124 patients) and T1c&T1e (53 patients). Regardless of all patients or those treated with Re-TURBt and adequate BCG, patients with T1a/b&T1m have the best prognosis, and those with T1c&T1e have the poorest prognosis. The time-dependent ROC showed that, for both recurrence and progression, COMB had a higher AUC than T1a/b/c and T1m/e, regardless of population. CONCLUSIONS Compared with either system alone, the combination of two T1 substaging systems improves the predictive ability of T1 substaging for tumor outcomes.
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Affiliation(s)
- Tao Yang
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, P.R. China
| | - Junjie Fan
- Department of Urology, Baoji Central Hospital, Baoji, P.R. China
| | - Xinqi Pei
- Department of Urology, Shaanxi Provincial People's Hospital, Xi'an, P.R. China
| | - Hua Liang
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R.China
| | - Jinhai Fan
- Department of Urology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
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15
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Zhou M. Towards Precision Genitourinary Pathology. Surg Pathol Clin 2022; 15:xv-xvi. [PMID: 36344190 DOI: 10.1016/j.path.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Ming Zhou
- Department of Anatomic and Clinical Pathology, Tufts University School of Medicine, Department of Pathology and Laboratory Medicine, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
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16
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Gandhi J, Chen JF, Al-Ahmadie H. Urothelial Carcinoma: Divergent Differentiation and Morphologic Subtypes. Surg Pathol Clin 2022; 15:641-659. [PMID: 36344181 PMCID: PMC9756812 DOI: 10.1016/j.path.2022.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Urothelial carcinoma (UC) is known to encompass a wide spectrum of morphologic features and molecular alterations. Approximately 15% to 25% of invasive UC exhibits histomorphologic features in the form of "divergent differentiation" along other epithelial lineages, or different "subtypes" of urothelial or sarcomatoid differentiation. It is recommended that the percentage of divergent differentiation and or subtype(s) be reported whenever possible. Recent advances in molecular biology have led to a better understanding of the molecular underpinning of these morphologic variations. In this review, we highlight histologic characteristics of the divergent differentiation and subtypes recognized by the latest version of WHO classification, with updates on their molecular and clinical features.
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Affiliation(s)
- Jatin Gandhi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Jie-Fu Chen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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17
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Varma M, Williamson S. Clinical utility of histopathology data: urological cancers. J Clin Pathol 2022; 75:506-513. [PMID: 35853652 DOI: 10.1136/jclinpath-2022-208186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/04/2022]
Abstract
Cancer datasets recommend standardised reporting of histopathological data items with elements categorised as either core (required) or non-core (recommended), irrespective of the clinical scenario. However, the clinical significance of a data item in an individual case would depend on the clinicopathological setting as well as local management guidelines. A data item that is critical for patient management in one clinical scenario may be largely irrelevant in another patient. Pathologists must understand how their data are used in clinical practice so that they can focus their limited resources appropriately. We briefly review the use of histopathological data in the management of urological cancers, highlighting scenarios where a data item may be of limited clinical utility.
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Affiliation(s)
- Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Sean Williamson
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Manole B, Damian C, Giusca SE, Caruntu ID, Porumb-Andrese E, Lunca C, Dorneanu OS, Iancu LS, Ursu RG. The Influence of Oncogenic Viruses in Renal Carcinogenesis: Pros and Cons. Pathogens 2022; 11:757. [PMID: 35890003 PMCID: PMC9319782 DOI: 10.3390/pathogens11070757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/05/2023] Open
Abstract
Viral infections are major contributors to the global cancer burden. Recent advances have revealed that known oncogenic viruses promote carcinogenesis through shared host cell targets and pathways. The aim of this review is to point out the connection between several oncogenic viruses from the Polyomaviridae, Herpesviridae and Flaviviridae families and renal carcinogenesis, highlighting their involvement in the carcinogenic mechanism. We performed a systematic search of the PubMed and EMBASE databases, which was carried out for all the published studies on RCC in the last 10 years, using the following search algorithm: renal cell carcinoma (RCC) and urothelial carcinoma, and oncogenic viruses (BKPyV, EBV, HCV, HPV and Kaposi Sarcoma Virus), RCC and biomarkers, immunohistochemistry (IHC). Our analysis included studies that were published in English from the 1st of January 2012 to the 1st of May 2022 and that described and analyzed the assays used for the detection of oncogenic viruses in RCC and urothelial carcinoma. The virus most frequently associated with RCC was BKPyV. This review of the literature will help to understand the pathogenic mechanism of the main type of renal malignancy and whether the viral etiology can be confirmed, at a minimum, as a co-factor. In consequence, these data can contribute to the development of new therapeutic strategies. A virus-induced tumor could be efficiently prevented by vaccination or treatment with oncolytic viral therapy and/or by targeted therapy.
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Affiliation(s)
- Bianca Manole
- Department of Morphofunctional Sciences I-Histolgy, Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.M.); (S.-E.G.); (I.D.C.)
| | - Costin Damian
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.S.D.); (L.S.I.); (R.G.U.)
| | - Simona-Eliza Giusca
- Department of Morphofunctional Sciences I-Histolgy, Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.M.); (S.-E.G.); (I.D.C.)
| | - Irina Draga Caruntu
- Department of Morphofunctional Sciences I-Histolgy, Pathology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (B.M.); (S.-E.G.); (I.D.C.)
| | - Elena Porumb-Andrese
- Department of Dermatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Catalina Lunca
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.S.D.); (L.S.I.); (R.G.U.)
| | - Olivia Simona Dorneanu
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.S.D.); (L.S.I.); (R.G.U.)
| | - Luminita Smaranda Iancu
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.S.D.); (L.S.I.); (R.G.U.)
| | - Ramona Gabriela Ursu
- Department of Microbiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (O.S.D.); (L.S.I.); (R.G.U.)
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Nonmuscle-invasive bladder cancer, old problems, new insights. Curr Opin Urol 2022; 32:352-357. [PMID: 35749782 DOI: 10.1097/mou.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nonmuscle-invasive bladder cancer (NMIBC) is the most frequent bladder cancer and represents around 75% of bladder cancers. This review will discuss known challenges and recent advances in staging, grading and treatment stratification based on pathology. RECENT FINDINGS Pathological staging and grading in NMIBC remains challenging and different techniques exist. Substaging has been shown to be of prognostic relevance and to help predict treatment response in patients receiving Bacillus Calmette-Guérin (BCG) therapy, which is the treatment of choice for high-grade NMIBC. Recent advances in molecular classification and artificial intelligence were also able to show promising results in the stratification of patients. SUMMARY Many challenges in the diagnosis of NMIBC are still unresolved and ask for more prospective research. New technologies, molecular insights and AI will help in the upcoming years to better stratify and manage these patients.
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Abstract
PURPOSE OF REVIEW This review will discuss micropapillary urothelial carcinoma with respect to biology, histopathologic characteristics, genetic and molecular features, diagnosis, clinical management, and future directions of research. RECENT FINDINGS Recent consensus opinion study showed only moderate interobserver reproducibility in the diagnostic criteria. The most reproducible criteria with the highest consensus were multiple nests in the same lacunar spaces. There are recent reports of high rates of intratumoral heterogeneity of ERBB2 amplification within tumor containing both micropapillary and classic urothelial components. Micropapillary urothelial carcinoma is a well-documented highly aggressive variant of urothelial carcinoma with proven worse outcomes. Accurate recognition and reporting of this pattern is critical for optimal management. Newer therapeutic strategies related to the molecular and genetic findings seen in MPUC remain to be explored further.
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21
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The Genitourinary Pathology Society Update on Classification of Variant Histologies, T1 Substaging, Molecular Taxonomy, and Immunotherapy and PD-L1 Testing Implications of Urothelial Cancers: Erratum. Adv Anat Pathol 2022; 29:47. [PMID: 34879039 DOI: 10.1097/pap.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Compérat E. Latest Developments and Current Problems in Bladder Cancer. World J Urol 2021; 39:4009-4010. [PMID: 34643773 DOI: 10.1007/s00345-021-03857-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Eva Compérat
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris VI, Paris, France.
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23
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Updated pathology reporting standards for bladder cancer: biopsies, transurethral resections and radical cystectomies. World J Urol 2021; 40:915-927. [PMID: 34554298 PMCID: PMC8994708 DOI: 10.1007/s00345-021-03831-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/01/2021] [Indexed: 12/28/2022] Open
Abstract
Aim Optimal management of bladder cancer requires an accurate, standardised and timely pathological diagnosis, and close communication between surgeons and pathologists. Here, we provide an update on pathology reporting standards of transurethral resections of the bladder and cystectomies. Methods We reviewed recent literature, focusing on developments between 2013 and 2021. Results Published reporting standards developed by pathology organizations have improved diagnosis and treatment. Tumor sub-staging and subtyping has gained increased attention. Lymph nodes continue to be an area of debate, and their staging has seen minor modifications. Several tasks, particularly regarding specimen preparation (“grossing”), are not yet standardized and offer opportunity for improvement. Molecular classification is rapidly evolving, but currently has only limited impact on management. Conclusion Pathological reporting of bladder cancer is continuously evolving and remains challenging in some areas. This review provides an overview of recent major developments, with a particular focus on published reporting standards.
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