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Finocchiaro A, Paciotti M, Contieri R, Fasulo V, Saita A, Lughezzani G, Buffi NM, Lazzeri M, Hurle R, Casale P. Assessing long-term upgrade risks in recurrent low-grade non-muscle-invasive bladder cancer, can we deintensify the treatment? BJU Int 2024; 134:195-197. [PMID: 38774951 DOI: 10.1111/bju.16406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Alessio Finocchiaro
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Marco Paciotti
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Roberto Contieri
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Vittorio Fasulo
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Alberto Saita
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Nicolo Maria Buffi
- Department of Biomedical Science, Humanitas University, Milan, Italy
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Rodolfo Hurle
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
| | - Paolo Casale
- Department of Urology, IRCCS - Humanitas Research Hospital, Milan, Italy
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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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Kustrimovic N, Bilato G, Mortara L, Baci D. The Urinary Microbiome in Health and Disease: Relevance for Bladder Cancer. Int J Mol Sci 2024; 25:1732. [PMID: 38339010 PMCID: PMC10855347 DOI: 10.3390/ijms25031732] [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: 12/19/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Bladder cancer (BC) constitutes one of the most diagnosed types of cancer worldwide. Advancements in and new methodologies for DNA sequencing, leading to high-throughput microbiota testing, have pinpointed discrepancies in urinary microbial fingerprints between healthy individuals and patients with BC. Although several studies suggest an involvement of microbiota dysbiosis in the pathogenesis, progression, and therapeutic response to bladder cancer, an established direct causal relationship remains to be elucidated due to the lack of standardized methodologies associated with such studies. This review compiles an overview of the microbiota of the human urinary tract in healthy and diseased individuals and discusses the evidence to date on microbiome involvement and potential mechanisms by which the microbiota may contribute to the development of BC. We also explore the potential profiling of urinary microbiota as a biomarker for risk stratification, as well as the prediction of the response to intravesical therapies and immunotherapy in BC patients. Further investigation into the urinary microbiome of BC patients is imperative to unravel the complexities of the role played by host-microbe interactions in shaping wellness or disease and yield valuable insights into and strategies for the prevention and personalized treatment of BC.
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Affiliation(s)
- Natasa Kustrimovic
- Center for Translational Research on Autoimmune and Allergic Disease—CAAD, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Giorgia Bilato
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
| | - Lorenzo Mortara
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
| | - Denisa Baci
- Immunology and General Pathology Laboratory, Department of Biotechnology and Life Sciences, University of Insubria, 21100 Varese, Italy;
- Molecular Cardiology Laboratory, IRCCS—Policlinico San Donato, 20097 Milan, Italy
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Lobo N, Duan Z, Sood A, Tan WS, Grajales V, Contieri R, Lindskrog SV, Dyrskjøt L, Zhao H, Giordano SH, Williams SB, Bree KK, Kamat AM. Association of Age with Non-muscle-invasive Bladder Cancer: Unearthing a Biological Basis for Epidemiological Disparities? Eur Urol Oncol 2024:S2588-9311(24)00036-1. [PMID: 38302322 DOI: 10.1016/j.euo.2024.01.011] [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: 10/28/2023] [Revised: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Age disparity in patients with non-muscle-invasive bladder cancer (NMIBC) exists. Whether this is due to differences in adequate cancer care or tumour biology is unclear. OBJECTIVE To investigate age disparities in NMIBC using the Surveillance, Epidemiology, and End Results (SEER)-Medicare and UROMOL datasets. DESIGN, SETTING, AND PARTICIPANTS The SEER-Medicare data were used to identify patients with clinical stage Ta, Tis, and T1 NMIBC between 2005 and 2017 (n = 32 225). Using the UROMOL cohort (n = 834), age disparities across transcriptomic, genomic, and spatial proteomic domains were assessed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS For the SEER-Medicare data, multivariable competing-risk regression was used to examine the association between age and recurrence, progression, and bladder cancer-specific mortality (BCSM). For the UROMOL cohort, multivariable general linear model and multinomial logistic regression were performed to evaluate the association between age and tumour biology. RESULTS AND LIMITATIONS An analysis of the SEER-Medicare cohort revealed 5-yr recurrence rates of 55.2%, 57.4%, and 58.9%; 5-yr progression rates of 25.6%, 29.2%, and 36.9%; and 5-yr BCSM rates of 3.9%, 5.8%, and 11.8% in patients aged 66-70, 71-80, and ≥81 yr, respectively. After multivariable adjustment, age ≥81 yr was associated with a higher risk of recurrence (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03-1.12; p = 0.001), progression (HR 1.32, p < 0.001), and BCSM (HR 2.58, p < 0.001). UROMOL2021 transcriptomic class 2a was most frequently observed in patients with advanced age (34.0% in ≥76 yr vs 21.6% in ≤65 yr; p = 0.004), a finding confirmed on multivariable analysis (risk ratio [RR] 3.86, p = 0.002). UROMOL2021 genomic class 3 was observed more frequently in patients aged ≥76 yr (4.9% vs 24.2%; p = 0.001). Limitations include the definitions used for recurrence and progression, which may lead to under- or overestimation of true rates. CONCLUSIONS Among SEER-Medicare patients with NMIBC, advanced age is associated with inferior oncological outcomes. These results reflect age-related molecular biological differences observed across transcriptomic and genomic domains, providing further evidence that innate tumour biology contributes to observed disparities in NMIBC outcomes. PATIENT SUMMARY Older patients with non-muscle-invasive bladder cancer have worse oncological outcomes than younger patients. Some of this age disparity may be due to differences in tumour biology.
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Affiliation(s)
- Niyati Lobo
- Department of Urology, Royal Free London NHS Trust, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhigang Duan
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akshay Sood
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei Shen Tan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Valentina Grajales
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto Contieri
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sia V Lindskrog
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Hui Zhao
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen B Williams
- Department of Urology, University of Texas Medical Branch, Galveston, TX, USA
| | - Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Scheipner L, Zurl H, Altziebler JV, Pichler GP, Schöpfer-Schwab S, Jasarevic S, Gaisl M, Pohl KC, Pemberger K, Andlar S, Hutterer GC, Bele U, Leitsmann C, Leitsmann M, Augustin H, Zigeuner R, Ahyai S, Mischinger J. Charlson-Deyo Comorbidity Index as a Novel Predictor for Recurrence in Non-Muscle-Invasive Bladder Cancer. Cancers (Basel) 2023; 15:5770. [PMID: 38136315 PMCID: PMC10742244 DOI: 10.3390/cancers15245770] [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: 11/04/2023] [Revised: 11/19/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
PURPOSE To test the association between the Charlson-Deyo Comorbidity Index (CCI) and the recurrence of non-muscle-invasive bladder cancer (NMIBC). METHODS NMIBC (Ta, T1, TIS) patients who underwent transurethral resection of bladder tumor (TURB) between 2010 and 2018 were identified within a retrospective data repository of a large university hospital. Kaplan-Meier estimates and uni- and multivariable Cox regression models tested for differences in risk of recurrence according to low vs. high comorbidity burden (CCI ≤ 4 vs. >4) and continuously coded CCI. RESULTS A total of 1072 NMIBC patients were identified. The median follow-up time of the study population was 55 months (IQR 29.6-79.0). Of all 1072 NMIBC patients, 423 (39%) harbored a low comorbidity burden vs. 649 (61%) with a high comorbidity burden. Overall, the rate of recurrence was 10% at the 12-month follow-up vs. 22% at the 72-month follow-up. In low vs. high comorbidity burden groups, rates of recurrence were 6 vs. 12% at 12 months and 18 vs. 25% at 72 months of follow-up (p = 0.02). After multivariable adjustment, a high comorbidity burden (CCI > 4) independently predicted a higher risk of recurrence (HR 1.42, 95% confidence interval (CI) 1.06-1.92, p = 0.018). After multivariable adjustment, the hazard of recurrence increased by 5% per each one-unit increase on the CCI scale (HR 1.05, 95% CI 1.00-1.10, p = 0.04). CONCLUSIONS Comorbidities in NMIBC patients are common. Our data suggest that patients with higher CCI have an increased risk of BC recurrence. As a consequence, patients with a high comorbidity burden should be particularly encouraged to adhere to NMIBC guidelines and conform to follow-up protocols.
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Affiliation(s)
- Lukas Scheipner
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Hanna Zurl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Julia V. Altziebler
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Georg P. Pichler
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Stephanie Schöpfer-Schwab
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Samra Jasarevic
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Michael Gaisl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Klara C. Pohl
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Karl Pemberger
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Stefan Andlar
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Georg C. Hutterer
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Uros Bele
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Conrad Leitsmann
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Marianne Leitsmann
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
- Institute for Applied Quality Improvement and Research in Health Care, 37073 Goettingen, Germany
| | - Herbert Augustin
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Richard Zigeuner
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Sascha Ahyai
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
| | - Johannes Mischinger
- Department of Urology, Medical University of Graz, 8010 Graz, Austria; (H.Z.); (J.V.A.); (G.P.P.); (S.S.-S.); (S.J.); (M.G.); (K.C.P.); (K.P.); (S.A.); (G.C.H.); (U.B.); (C.L.); (M.L.); (H.A.); (R.Z.); (S.A.); (J.M.)
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