1
|
Liu Z, Bi H, He W, Zhu X, He J, Lu M, Lu J. Preoperative Metabolic Syndrome and HDL-C Level Predict the Prognosis of Patients Following Radical Cystectomy: A Propensity Score Matching Study. Front Oncol 2022; 12:833305. [PMID: 35463353 PMCID: PMC9022107 DOI: 10.3389/fonc.2022.833305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the prognostic significance of metabolic syndrome (MetS) and its components in patients with bladder cancer (BCa) treated with radical cystectomy (RC). Methods A total of 335 BCa patients who underwent RC between 2004 and 2019 at Peking University Third Hospital (PUTH) were analyzed retrospectively. The Kaplan-Meier method with the log-rank test was performed to assess overall survival (OS) and progression-free survival (PFS). Univariate and multivariate Cox proportional hazard models were conducted to identify the prognostic factors of OS and PFS before and after propensity score matching (PSM). Results Enrolled patients were allocated into two groups according to the presence or absence of MetS (n=84 MetS vs n=251 non-MetS), and 82 new matched pairs were identified to balance the baseline characteristics after 1:1 PSM. In the Kaplan-Meier analysis, MetS was associated with better OS (P=0.031) than the group without MetS. In addition, a body mass index (BMI) ≥ 25 was associated with better OS (P=0.011) and PFS (P=0.031), while low high-density lipoprotein cholesterol (HDL-C) was associated with worse OS (P=0.033) and PFS (P=0.010). In all patients, multivariate Cox analysis showed that hemoglobin, pathologic tumor stage and lymph node status were identified as independent prognostic factors for both OS and PFS, while age, MetS and HDL-C were independent prognostic factors only for OS. Reproducible results of multivariate analysis can still be observed in propensity matched patients. The results of further subgroup analysis revealed that the association of MetS with increased OS (P=0.043) and BMI ≥25 with increased OS (P=0.015) and PFS (P=0.029) was observed in non-muscle invasive bladder cancer (NMIBC) patients. Conclusions MetS was independently associated with better OS in BCa patients after RC, and HDL-C was the only component of MetS that was independently associated with worse OS. MetS and HDL-C may become reliable prognostic biomarkers of OS in BCa patients after RC to provide individualized prognostication and assist in the formulation of clinical treatment strategies.
Collapse
Affiliation(s)
- Zenan Liu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Hai Bi
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Wei He
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Xuehua Zhu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jide He
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China.,NHC Key Laboratory of Metabolic Cardiovascular Diseases Research, Ningxia Medical University, Yinchuan, China
| |
Collapse
|
2
|
Bhanvadia RR, Lotan Y. Progress in the development of tissue-based biomarkers for urothelial cancer. Expert Rev Anticancer Ther 2022; 22:605-619. [PMID: 35459430 DOI: 10.1080/14737140.2022.2070154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION As the understanding of molecular mechanisms of bladder cancer advances, molecularly-guided precision medicine becomes increasingly relevant. Biomarkers play a critical role in this setting, predicting treatment response and identifying candidates for targeted therapies. AREAS COVERED Current literature on biomarkers in their role in disease prognosis, and response to neoadjuvant and adjuvant therapies. In non-muscle invasive bladder cancer, particular focus is on markers of disease progression, and response to intravesical therapy. In muscle invasive and advanced bladder cancer, particular emphasis is on markers associated with neoadjuvant chemotherapy, as well as systemic immunotherapy. We discuss current shortcomings and pitfalls in contemporary markers, and future avenues of prospective research. EXPERT OPINION The focus on biomarkers has moved from immunohistochemical analysis and tumor-related phenotypic changes to examining genetic alterations. Single marker analysis has been shown to be insufficient in predicting both disease course and response to therapy, and studies have shifted towards examining marker combinations and genetic classifiers. Ultimately, significant progress in implementing biomarkers into clinical guidelines remains elusive, largely due to lack of prospective studies in well-defined patient cohorts and with clinically-meaningful endpoints. Until then, despite their promising value, tissue markers should be limited to experimental settings and clinical trials.
Collapse
Affiliation(s)
- Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, Texas 75390
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern, Dallas, Texas 75390
| |
Collapse
|
3
|
Tian J, Sun J, Fu G, Xu Z, Chen X, Shi Y, Jin B. Population-based outcome of muscle-invasive bladder cancer following radical cystectomy: who can benefit from adjuvant chemotherapy? Transl Androl Urol 2021; 10:356-373. [PMID: 33532324 PMCID: PMC7844522 DOI: 10.21037/tau-20-960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The benefit of adjuvant chemotherapy remains controversial in muscle-invasive bladder cancer (MIBC) after radical cystectomy. The present study’s primary objective was to construct a predictive tool for the reasonable application of adjuvant chemotherapy. Methods All of the patients analyzed in the present study were recruited from the Surveillance Epidemiology and End Results program between 2004 and 2015. Propensity score matching (PSM) was used to reduce inherent selection bias. Cox proportional hazards models were applied to identify the independent prognostic factors of overall survival (OS) and cancer-specific survival (CSS), which were further used to construct prognostic nomogram and risk stratification systems to predict survival outcomes. The prognostic nomogram’s performance was assessed by concordance index (C-index), receiver-operating characteristic (ROC) and calibration curves. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of the prognostic nomogram. Results A total of 6,384 patients with or without adjuvant chemotherapy were included after PSM. Several independent predictors for OS and CSS were identified and further applied to establish a nomogram for 3-, 5- and 10-year, respectively. The nomogram showed favorable discriminative ability for the prediction of OS and CSS, with a C-index of 0.709 [95% confidence interval (CI): 0.699–0.719] for OS and 0.728 (95% CI: 0.718–0.738) for CSS. ROC and calibration curves showed satisfactory consistency. The DCA revealed high clinical positive net benefits of the prognostic nomogram. The different risk stratification systems showed that adjuvant chemotherapy resulted in better OS (P<0.001) and CSS (P<0.001) than without adjuvant chemotherapy for high-risk patients; while the OS (P=0.350) and CSS (P=0.260) for low-risk patients were comparable. Conclusions We have constructed a predictive model and different risk stratifications for selecting a population that could benefit from postoperative adjuvant chemotherapy. Adjuvant chemotherapy was found to be beneficial for high-risk patients, while low-risk patients should be carefully monitored.
Collapse
Affiliation(s)
- Junjie Tian
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junjie Sun
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanghou Fu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhijie Xu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyi Chen
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Shi
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
4
|
del Pozo Jiménez G, Herranz Amo F, Subirá Ríos D, Rodríguez Fernández E, Bueno Chomón G, Moralejo Gárate M, Durán Merino R, Escribano Patiño G, Carballido Rodríguez J, Hernández Fernández C. Mortality prediction model for patients with bladder urothelial tumor after radical cystectomy. Actas Urol Esp 2020; 44:215-223. [PMID: 32035808 DOI: 10.1016/j.acuro.2019.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 07/02/2019] [Accepted: 08/27/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Based on preoperative clinical and postoperative pathological variables, we aim to build a prediction model of cancer specific mortality (CSM) at 1, 3, and 5 years for patients with bladder transitional cell carcinoma treated with RC. MATERIAL AND METHODS Retrospective analysis of 517 patients with diagnosis of cell carcinoma treated by RC (1986-2009). Demographic, clinical, surgical and pathological variables were collected, as well as complications and evolution after RC. Comparative analysis included Chi square test and ANOVA technique. Survival analysis was performed using Kaplan-Meier method and log-rank test. Univariate and multivariate analyses were performed using logistic regression to identify the independent predictors of CSM. The individual probability of CSM was calculated at 1, 3 and 5 years according to the general equation (logistic function). Calibration was obtained by the Hosmer-Lemeshow method and discrimination with the elaboration of a ROC curve (area under the curve). RESULTS BC was the cause of death in 225 patients (45%). One, three and five-year CSM were 17%, 39.2% and 46.3%, respectively. The pT and pN stages were identified as independent prognostic variables of CSM at 1, 3 and 5 years. Three prediction models were built. The predictive capacity was 70.8% (CI 95% 65-77%, p=.000) for the 1st year, 73.9% (CI95% 69.2-78.6%, p=.000) for the third and 73.2% (CI% 68.5-77.9%, p=.000) for the 5th. CONCLUSIONS The prediction model allows the estimation of CSM risk at 1, 3 and 5 years, with a reliability of 70.8, 73.9 and 73.2%, respectively.
Collapse
|
5
|
Minato A, Noguchi H, Tomisaki I, Fukuda A, Kubo T, Nakayama T, Fujimoto N. Clinical Significance of Squamous Differentiation in Urothelial Carcinoma of the Bladder. Cancer Control 2019; 25:1073274818800269. [PMID: 30213195 PMCID: PMC6144505 DOI: 10.1177/1073274818800269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The prognostic value of squamous differentiation (SD) in urothelial carcinoma (UC) of the bladder is unclear. The aim of this study was to identify the clinical significance of SD in UC in terms of oncological outcomes in patients undergoing radical cystectomy (RC). We evaluated consecutive patients with muscle-invasive bladder cancer (MIBC; clinical T2-4aN0M0) treated with RC at our institution from March 2003 to March 2017. We enrolled 20 and 81 patients with UC with SD (UCSD) and pure UC, respectively. Postoperative survival outcomes were compared between the patients with UCSD and pure UC using the Kaplan-Meier method. Pre- and postcystectomy factors that influenced the overall survival (OS) and recurrence-free survival (RFS) were investigated in these patients. Multivariate Cox regression models were used to identify the predictors of OS and RFS. With a median follow-up time of 31 months, the 5-year OS rate of the UCSD and pure UC groups was 41.1% and 69.7% (P = .002) and the 5-year RFS rate was 51.8% and 59.5% (P = .027), respectively. The shape of the Kaplan-Meier curves for UCSD suggested a more rapid course of the disease within the first 2 years than observed in pure UC. Multivariate analyses suggested that SD in UC was significantly associated with OS (hazard ratio [HR]: 4.22; 95% confidence interval [CI]: 1.20-14.8; P = .024) and close to significance for a lower RFS (HR: 2.13, 95% CI: 0.74-6.15, P = .064). Our results indicate that SD may be an independent predictor of OS and RFS in UC of MIBC in patients undergoing RC.
Collapse
Affiliation(s)
- Akinori Minato
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hirotsugu Noguchi
- 2 Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ikko Tomisaki
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Atsushi Fukuda
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuhiko Kubo
- 2 Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Toshiyuki Nakayama
- 3 Department of Pathology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naohiro Fujimoto
- 1 Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| |
Collapse
|
6
|
Stubendorff B, Wilhelm K, Posselt K, Catto J, Hartmann A, Bertz S, Füssel S, Novotny V, Toma M, Gajda M, Lehmann J, Wunderlich H, Grimm MO, Stöckle M, Junker K. A three-gene methylation marker panel for the nodal metastatic risk assessment of muscle-invasive bladder cancer. J Cancer Res Clin Oncol 2019; 145:811-820. [PMID: 30603903 DOI: 10.1007/s00432-018-02829-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE In this study, we aimed to identify a DNA methylation pattern suitable for prognosis assessment of muscle-invasive bladder cancer and to investigate metastasis-associated processes regulated by DNA methylation. METHODS Genome-wide methylation analysis was performed on 23 muscle-invasive bladder tumors by microarray analysis. Validation was performed by the qAMP technique in two different patient cohorts (n = 32 and n = 100). mRNA expression was analyzed in 12 samples. Protein expression was determined using tissue microarrays of 291 patients. Bladder cancer cell lines T24 and 253JB-V were used for functional analyses. RESULTS Microarray analyses revealed KISS1R, SEPT9 and CSAD as putative biomarkers with hypermethylation in node-positive tumors. The combination of the three genes predicted the metastatic risk with sensitivity of 73% and specificity of 71% in cohort 1, and sensitivity of 82% and specificity of 54% in cohort 2. mRNA expression differences were detected for KISS1R (p = 0.04). Protein expression of KISS1R was significantly reduced (p < 0.001). Knockdown of SEPT9v3 resulted in increased cell migration by 28% (p = 0.04) and increased invasion by 22% (p = 0.004). KISS1R overexpression resulted in decreased cell migration (25%, p = 0.1). CONCLUSIONS We identified a methylation marker panel suitable to differentiate between patients with positive and negative lymph nodes at time of cystectomy. This enables a risk assessment for patients who potentially benefit from extended lymph node resection as well as from neoadjuvant chemotherapy and could improve the survival rates. Furthermore, we examined the impact of putative markers on tumor behavior. Hence, KISS1R and SEPT9 could represent a starting point for the development of novel therapy approaches.
Collapse
Affiliation(s)
- Beatrice Stubendorff
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421, Homburg/saar, Germany
- Department of Urology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Kerstin Wilhelm
- Department of Urology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Kathleen Posselt
- Department of Urology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - James Catto
- The Medical School, University of Sheffield, Institute for Cancer Studies, Beech Hill Rd, S10 2RX, Sheffield, UK
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Simone Bertz
- Institute of Pathology, University Hospital Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany
| | - Susanne Füssel
- Department of Urology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Vladimir Novotny
- Department of Urology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Marieta Toma
- Institute of Pathology, University Hospital Carl Gustav Carus, Dresden University of Technology, Fetscherstraße 74, 01307, Dresden, Germany
| | - Mieczyslaw Gajda
- Institute of Pathology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Jan Lehmann
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421, Homburg/saar, Germany
- Urologische Gemeinschaftspraxis Prüner Gang, Prüner Gang 15, 24103, Kiel, Germany
- Department of Urology, Städtisches Krankenhaus, Chemnitzstraße 33, 24116, Kiel, Germany
| | - Heiko Wunderlich
- Clinic of Urology, St. Georg Hospital, Mühlhäuser Str. 94 -95, 99817, Eisenach, Germany
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421, Homburg/saar, Germany
| | - Kerstin Junker
- Department of Urology and Pediatric Urology, Saarland University, Kirrberger Strasse, 66421, Homburg/saar, Germany.
| |
Collapse
|
7
|
Moudouni SM, Latabi AF, Aarab M, Lakmichi MA, Dahami Z, Sarf I. [Oncological results of a series of 93 laparoscopic radical cystectomies: 5 years of follow-up]. Prog Urol 2018; 29:86-94. [PMID: 30584022 DOI: 10.1016/j.purol.2018.09.006] [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: 04/09/2018] [Revised: 06/06/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report oncological results at 5 years after laparoscopic radical cystectomy (LRC) with lymph node dissection for bladder cancer (BC). PATIENTS AND METHODS This is a retrospective single-center study of all patients who underwent LRC for BC by the same surgeon from February 2007 to March 2016. Demographic, perioperative and oncologic data were collected. We reported overall survival rate (OS), cancer specific (CSS) and recurrence-free survival (SSR), as primary indicators of oncologycal outcomes. These survival rates were estimated according to the Kaplan-Meier method. Log-rank tests were used to explore overall survival according tumor stage, lymph node involvement and surgical margins status. RESULTS In all, 93 patients (82 men and 11 women) underwent LRC. Mean age was 59 years. Minor complications (Clavien I-II) occurred in 24.7%. Major complications (Clavien IIIa-V) were observed in 8.6%. No patients received neoadjuvant chemotherapy. Median lymph node (LN) yield was 15 and 26.5% patients had positive LN. The positive surgical margins (SMs) rate was 5.3%. Median follow-up for the entire patients was 50 months (19-84 months). Forty-three patients (46.2%) were followed for at least 71 months. Five year RFS, CSS and OS were 67%, 85% and 79%, respectively. Non organ confined desease, positive LN and positive SMs were associated with poorer OS (P<0.039, P<0.016 and P<0.001). CONCLUSION LRC was associated with acceptable long-term oncologic outcomes, similar to those currently reported after open cystectomy for BC. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- S M Moudouni
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - A F Latabi
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc.
| | - M Aarab
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - M A Lakmichi
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - Z Dahami
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| | - I Sarf
- Centre hospitalier universitaire de Marrakech, avenue Ibn Sina Amerchich, BP 2360, Marrakech-principal, Maroc
| |
Collapse
|
8
|
Ornstein MC, Diaz-Montero CM, Rayman P, Elson P, Haywood S, Finke JH, Kim JS, Pavicic PG, Lamenza M, Devonshire S, Dann P, Schach K, Stephenson A, Campbell S, Emamekhoo H, Ernstoff MS, Hoimes CJ, Gilligan TD, Rini BI, Garcia JA, Grivas P. Myeloid-derived suppressors cells (MDSC) correlate with clinicopathologic factors and pathologic complete response (pCR) in patients with urothelial carcinoma (UC) undergoing cystectomy. Urol Oncol 2018; 36:405-412. [DOI: 10.1016/j.urolonc.2018.02.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 01/29/2018] [Accepted: 02/27/2018] [Indexed: 12/24/2022]
|
9
|
Ritch CR, Balise R, Prakash NS, Alonzo D, Almengo K, Alameddine M, Venkatramani V, Punnen S, Parekh DJ, Gonzalgo ML. Propensity matched comparative analysis of survival following chemoradiation or radical cystectomy for muscle-invasive bladder cancer. BJU Int 2018; 121:745-751. [DOI: 10.1111/bju.14109] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Chad R. Ritch
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Raymond Balise
- Division of Biostatistics; Department of Public Health Sciences; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | | | - David Alonzo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Katherine Almengo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mahmoud Alameddine
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Vivek Venkatramani
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Sanoj Punnen
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Dipen J. Parekh
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| | - Mark L. Gonzalgo
- Department of Urology; University of Miami Leonard M. Miller School of Medicine; Miami FL USA
| |
Collapse
|
10
|
Role of Non-Coding RNAs in the Etiology of Bladder Cancer. Genes (Basel) 2017; 8:genes8110339. [PMID: 29165379 PMCID: PMC5704252 DOI: 10.3390/genes8110339] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 12/21/2022] Open
Abstract
According to data of the International Agency for Research on Cancer and the World Health Organization (Cancer Incidence in Five Continents, GLOBOCAN, and the World Health Organization Mortality), bladder is among the top ten body locations of cancer globally, with the highest incidence rates reported in Southern and Western Europe, North America, Northern Africa and Western Asia. Males (M) are more vulnerable to this disease than females (F), despite ample frequency variations in different countries, with a M:F ratio of 4.1:1 for incidence and 3.6:1 for mortality, worldwide. For a long time, bladder cancer was genetically classified through mutations of two genes, fibroblast growth factor receptor 3 (FGFR3, for low-grade, non-invasive papillary tumors) and tumor protein P53 (TP53, for high-grade, muscle-invasive tumors). However, more recently scientists have shown that this disease is far more complex, since genes directly involved are more than 150; so far, it has been described that altered gene expression (up- or down-regulation) may be present for up to 500 coding sequences in low-grade and up to 2300 in high-grade tumors. Non-coding RNAs are essential to explain, at least partially, this ample dysregulation. In this review, we summarize the present knowledge about long and short non-coding RNAs that have been linked to bladder cancer etiology.
Collapse
|
11
|
Pouessel D, Bastuji-Garin S, Houédé N, Vordos D, Loriot Y, Chevreau C, Sevin E, Beuzeboc P, Taille ADL, Le Thuaut A, Allory Y, Culine S. Adjuvant Chemotherapy After Radical Cystectomy for Urothelial Bladder Cancer: Outcome and Prognostic Factors for Survival in a French Multicenter, Contemporary Cohort. Clin Genitourin Cancer 2016; 15:e45-e52. [PMID: 27554584 DOI: 10.1016/j.clgc.2016.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND In the past decade, adjuvant chemotherapy (AC) after radical cystectomy (RC) was preferred worldwide for patients with muscle-invasive urothelial bladder cancer. In this study we aimed to determine the outcome of patients who received AC and evaluated prognostic factors associated with survival. PATIENTS AND METHODS We retrospectively analyzed 226 consecutive patients treated in 6 academic hospitals between 2000 and 2009. Multivariate Cox proportional hazards regression adjusted for center to estimate adjusted hazard ratios (HRs) with 95% confidence intervals were used. RESULTS The median age was 62.4 (range, 35-82) years. Patients had pT3/pT4 and/or pN+ in 180 (79.6%) and 168 patients (74.3%), respectively. Median lymph node (LN) density was 25% (range, 3.1-100). Median time between RC and AC was 61.5 (range, 18-162) days. Gemcitabine with cisplatin, gemcitabine with carboplatin, and MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) regimens were delivered in 161 (71.2%), 49 (21.7%), and 12 patients (5.3%) of patients, respectively. The median number of cycles was 4 (range, 1-6). Thirteen patients (5.7%) with LN metastases also received adjuvant pelvic radiotherapy (ART). After a median follow-up of 4.2 years, 5-year overall survival (OS) was 40.7%. In multivariate analysis, pT ≥3 stage (HR, 1.73; P = .05), LN density >50% (HR, 1.94; P = .03), and number of AC cycles <4 (HR, 4.26; P = .001) were adverse prognostic factors for OS. ART (HR, 0.30; P = .05) tended to provide survival benefit. CONCLUSION Classical prognostic features associated with survival are not modified by the use of AC. Patients who derived benefit from AC had a low LN density and received at least 4 cycles of treatment.
Collapse
Affiliation(s)
- Damien Pouessel
- Inserm U955 Hôpital Henri Mondor, Team 7 Translational Research of Genito-Urinary Oncogenesis, Créteil, France; Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France.
| | - Sylvie Bastuji-Garin
- CEpiA (Clinical Epidemiology and Ageing), Unit EA 4393, Paris Est University, Créteil, France; Public Health Department, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Nadine Houédé
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Dimitri Vordos
- Department of Urology, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Yohann Loriot
- Department of Cancer Medicine and INSERM U981, Gustave Roussy, Cancer Campus, Grand Paris, Villejuif, France
| | - Christine Chevreau
- Département d'Oncologie Médicale, Institut Claudius Regaud, IUCT-O, Toulouse, France
| | - Emmanuel Sevin
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Alexandre de la Taille
- Inserm U955 Hôpital Henri Mondor, Team 7 Translational Research of Genito-Urinary Oncogenesis, Créteil, France; Department of Urology, Hôpital Henri Mondor, AP-HP, Créteil, France; Paris Est University, Créteil, France
| | - Aurélie Le Thuaut
- CEpiA (Clinical Epidemiology and Ageing), Unit EA 4393, Paris Est University, Créteil, France; Public Health Department, Hôpital Henri-Mondor, AP-HP, Créteil, France
| | - Yves Allory
- Inserm U955 Hôpital Henri Mondor, Team 7 Translational Research of Genito-Urinary Oncogenesis, Créteil, France; Paris Est University, Créteil, France; Department of Pathology and Tissue Biobank Unit, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Stéphane Culine
- Department of Medical Oncology, Hôpital Saint-Louis, AP-HP, Paris, France; Paris Diderot University, Paris, France
| |
Collapse
|
12
|
Outcome of Muscle-Invasive Urothelial Bladder Cancer After Radical Cystectomy. Clin Genitourin Cancer 2016; 14:e43-7. [DOI: 10.1016/j.clgc.2015.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/22/2015] [Accepted: 07/30/2015] [Indexed: 11/23/2022]
|
13
|
Albisinni S, Rassweiler J, Abbou CC, Cathelineau X, Chlosta P, Fossion L, Gaboardi F, Rimington P, Salomon L, Sanchez-Salas R, Stolzenburg JU, Teber D, van Velthoven R. Long-term analysis of oncological outcomes after laparoscopic radical cystectomy in Europe: results from a multicentre study by the European Association of Urology (EAU) section of Uro-technology. BJU Int 2014; 115:937-45. [DOI: 10.1111/bju.12947] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Simone Albisinni
- Department of Urology; Hopital Erasme; Brussels Belgium
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| | | | | | | | - Piotr Chlosta
- Department of Urology; Jagiellonian University; Krakow Poland
| | - Laurent Fossion
- Department of Urology; Maxima Medisch Centrum; Eindhoven The Netherlands
| | | | - Peter Rimington
- Department of Urology; East Sussex Healthcare NHS Trust; Eastbourne UK
| | | | | | | | - Dogu Teber
- Department of Urology; University of Heidelberg; Heidelberg Germany
| | - Roland van Velthoven
- Department of Urology; Institut Jules Bordet; Université Libre de Bruxelles; Brussels Belgium
| |
Collapse
|
14
|
Ahmadi N, Delprado WJ, Brooks AJ, Brenner PC, Coombes GM, Grant A, Patel MI. Pathological evaluation and quality of surgery in radical cystectomy in New South Wales, Australia. ANZ J Surg 2014; 85:145-9. [DOI: 10.1111/ans.12383] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nariman Ahmadi
- Urological Cancer Outcomes Centre and Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| | - Warick J. Delprado
- Department of Pathology; Douglass Hanly Moir Pathology; Sydney New South Wales Australia
| | - Andrew J. Brooks
- Urology Department; Westmead Hospital; The University of Sydney; Sydney New South Wales Australia
| | - Phillip C. Brenner
- Urology Department; St Vincent's Hospital; Sydney New South Wales Australia
| | - Graham M. Coombes
- Urology Department; Concord Repatriation General Hospital; Sydney New South Wales Australia
| | - Alexander Grant
- Department of Urology; John Hunter Hospital; Newcastle New South Wales Australia
| | - Manish I. Patel
- Urological Cancer Outcomes Centre and Discipline of Surgery; The University of Sydney; Sydney New South Wales Australia
| |
Collapse
|
15
|
Expressions of p16 and p27 in urothelial carcinoma and their prognostic value. Kaohsiung J Med Sci 2014; 30:453-8. [DOI: 10.1016/j.kjms.2014.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/16/2014] [Accepted: 01/22/2014] [Indexed: 01/01/2023] Open
|
16
|
External validation of existing nomograms predicting lymph node metastases in cystectomized patients. Int J Clin Oncol 2014; 20:164-70. [PMID: 24722886 DOI: 10.1007/s10147-014-0693-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/28/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Karakiewicz et al. and Green et al. created pre-cystectomy nomograms to predict lymph node involvement. The aim of the study was to externally validate these two nomograms in intermediate-volume institutions in Europe. PATIENTS AND METHODS Data from a Serbian single-centre cystectomy series comprising 183 patients with bladder cancer were used for the validation of two US nomograms, which were originally based on data from 726 and 201 patients, respectively. A multivariate regression model assessed the value of the clinical parameters integrated in the two nomograms. The expected predictive accuracy, calibration and clinical utility according to the nomograms were calculated. RESULTS Comparison of our dataset with the previously published data shows differences in nearly all underlying risk variables. Overall, 109 (59.6 %) patients had lymph node metastases. The analysis demonstrated that hydronephrosis and status of lymph nodes on computed tomography have independent prognostic value. The performance of the nomograms deteriorated from the development set, and the predictive accuracies for the two models showed moderate discriminatory ability (61.2-69.1 %). In the decision curve analysis, only the Green et al. model predicting lymph node positivity provided net benefit. CONCLUSIONS The Green et al. nomogram seems applicable to patients from Europe, despite varying risk factors in the validation dataset. Acceptance of such a tool into daily clinical management may lead to more appropriate decision-making. Nevertheless, further improvement and implementation of novel statistical models with enhanced predictive accuracy is needed.
Collapse
|
17
|
Kim H, Kim M, Kwak C, Kim HH, Ku JH. Prognostic significance of lymphovascular invasion in radical cystectomy on patients with bladder cancer: a systematic review and meta-analysis. PLoS One 2014; 9:e89259. [PMID: 24586637 PMCID: PMC3931717 DOI: 10.1371/journal.pone.0089259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 01/16/2014] [Indexed: 12/26/2022] Open
Abstract
Purpose The objective of the present study was to conduct a systematic review and meta-analysis of published literature to appraise the prognostic value of lymphovascular invasion (LVI) in radical cystectomy specimens. Materials and Methods Following the PRISMA statement, PubMed, Cochrane Library, and SCOPUS database were searched from the respective dates of inception until June 2013. Results A total of 21 articles met the eligibility criteria for this systematic review, which included a total of 12,527 patients ranging from 57 to 4,257 per study. LVI was detected in 34.6% in radical cystectomy specimens. LVI was associated with higher pathological T stage and tumor grade, as well as lymph node metastasis. The pooled hazard ratio (HR) was statistically significant for recurrence-free survival (pooled HR, 1.61; 95% confidence interval [CI], 1.26–2.06), cancer-specific survival (pooled HR, 1.67; 95% CI, 1.38–2.01), and overall survival (pooled HR, 1.67; 95% CI, 1.38–2.01), despite the heterogeneity among included studies. On sensitivity analysis, the pooled HRs and 95% CIs were not significantly altered when any one study was omitted. The funnel plot for overall survival demonstrated a certain degree of asymmetry, which showed slight publication bias. Conclusions This meta-analysis indicates that LVI is significantly associated with poor outcome in patients with bladder cancer who underwent radical cystectomy. Adequately designed prospective studies are required to provide the precise prognostic significance of LVI in bladder cancer.
Collapse
Affiliation(s)
- Hwanik Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Myong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
18
|
Lv S, Turlova E, Zhao S, Kang H, Han M, Sun HS. Prognostic and clinicopathological significance of survivin expression in bladder cancer patients: a meta-analysis. Tumour Biol 2013; 35:1565-74. [DOI: 10.1007/s13277-013-1216-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 09/16/2013] [Indexed: 01/17/2023] Open
|
19
|
Bolenz C, Martini T, Michel MS. [Invasion patterns and metastasis of urothelial carcinoma. A challenge for translational research]. Urologe A 2013; 52:1242-7. [PMID: 23979445 DOI: 10.1007/s00120-013-3309-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Local invasion of cancer cells occurs early during the progression of urothelial carcinoma. Micrometastatic disease and the presence of nodal metastases are major causes of cancer-specific mortality following radical surgery. Only surrogate markers for aggressive and micrometastatic disease have been identified. The metastatic cascade is complex, including multiple steps from initial invasion to colonization and proliferation at distant sites. The initial mechanisms of cancer cell dissemination in urothelial carcinoma are poorly understood. Various proteases, chemokines and growth factors are involved in this process and alterations of the lymphatic system may promote systemic spread. There is a high demand for therapeutic targeting of the metastatic process. Functional preclinical studies in representative models are therefore required to better elucidate the multiple steps of progression. We review the current knowledge on factors associated with metastasis in urothelial carcinoma. Preclinical approaches to identify key player molecules for invasion and to develop new therapeutic strategies are discussed.
Collapse
Affiliation(s)
- C Bolenz
- Klinik für Urologie, Universitätsmedizin Mannheim, Fakultät für Medizin der Universität Heidelberg, Theodor-Kutzer-Ufer 1, 68167, Mannheim, Deutschland,
| | | | | |
Collapse
|
20
|
Ku JH, Byun SS, Jeong H, Kwak C, Kim HH, Lee SE. Lymphovascular invasion as a prognostic factor in the upper urinary tract urothelial carcinoma: A systematic review and meta-analysis. Eur J Cancer 2013; 49:2665-80. [PMID: 23721778 DOI: 10.1016/j.ejca.2013.04.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/06/2013] [Accepted: 04/22/2013] [Indexed: 12/30/2022]
|
21
|
Di Pierro GB, Gulia C, Cristini C, Fraietta G, Marini L, Grande P, Gentile V, Piergentili R. Bladder cancer: a simple model becomes complex. Curr Genomics 2013; 13:395-415. [PMID: 23372425 PMCID: PMC3401896 DOI: 10.2174/138920212801619232] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 06/11/2012] [Accepted: 06/12/2012] [Indexed: 12/12/2022] Open
Abstract
Bladder cancer is one of the most frequent malignancies in developed countries and it is also characterized by a high number of recurrences. Despite this, several authors in the past reported that only two altered molecular pathways may genetically explain all cases of bladder cancer: one involving the FGFR3 gene, and the other involving the TP53 gene. Mutations in any of these two genes are usually predictive of the malignancy final outcome. This cancer may also be further classified as low-grade tumors, which is always papillary and in most cases superficial, and high-grade tumors, not necessarily papillary and often invasive. This simple way of considering this pathology has strongly changed in the last few years, with the development of genome-wide studies on expression profiling and the discovery of small non-coding RNA affecting gene expression. An easy search in the OMIM (On-line Mendelian Inheritance in Man) database using "bladder cancer" as a query reveals that genes in some way connected to this pathology are approximately 150, and some authors report that altered gene expression (up- or down-regulation) in this disease may involve up to 500 coding sequences for low-grade tumors and up to 2300 for high-grade tumors. In many clinical cases, mutations inside the coding sequences of the above mentioned two genes were not found, but their expression changed; this indicates that also epigenetic modifications may play an important role in its development. Indeed, several reports were published about genome-wide methylation in these neoplastic tissues, and an increasing number of small non-coding RNA are either up- or down-regulated in bladder cancer, indicating that impaired gene expression may also pass through these metabolic pathways. Taken together, these data reveal that bladder cancer is far to be considered a simple model of malignancy. In the present review, we summarize recent progress in the genome-wide analysis of bladder cancer, and analyse non-genetic, genetic and epigenetic factors causing extensive gene mis-regulation in malignant cells.
Collapse
Affiliation(s)
- Giovanni Battista Di Pierro
- Dipartimento di Scienze Ginecologico-Ostetriche e Scienze Urologiche, Policlinico Umberto I, Sapienza - Università di Roma
| | | | | | | | | | | | | | | |
Collapse
|
22
|
A systematic review of the tools available for predicting survival and managing patients with urothelial carcinomas of the bladder and of the upper tract in a curative setting. World J Urol 2012; 31:109-16. [DOI: 10.1007/s00345-012-1008-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 12/07/2012] [Indexed: 11/26/2022] Open
|
23
|
Conde D, Fernández MA, Rueda C, Salvador B. Classification of samples into two or more ordered populations with application to a cancer trial. Stat Med 2012; 31:3773-86. [PMID: 22815224 DOI: 10.1002/sim.5476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 05/14/2012] [Indexed: 11/11/2022]
Abstract
In many applications, especially in cancer treatment and diagnosis, investigators are interested in classifying patients into various diagnosis groups on the basis of molecular data such as gene expression or proteomic data. Often, some of the diagnosis groups are known to be related to higher or lower values of some of the predictors. The standard methods of classifying patients into various groups do not take into account the underlying order. This could potentially result in high misclassification rates, especially when the number of groups is larger than two. In this article, we develop classification procedures that exploit the underlying order among the mean values of the predictor variables and the diagnostic groups by using ideas from order-restricted inference. We generalize the existing methodology on discrimination under restrictions and provide empirical evidence to demonstrate that the proposed methodology improves over the existing unrestricted methodology. The proposed methodology is applied to a bladder cancer data set where the researchers are interested in classifying patients into various groups.
Collapse
Affiliation(s)
- D Conde
- Departamento de Estadística e Investigación Operativa, Universidad de Valladolid, Spain
| | | | | | | |
Collapse
|
24
|
Xi RC, Sheng YR, Chen WH, Sheng L, Gang JJ, Tong Z, Shan Z, Ying GH, Dong LC. Expression of survivin and livin predicts early recurrence in non-muscle invasive bladder cancer. J Surg Oncol 2012; 107:550-4. [DOI: 10.1002/jso.23272] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 09/04/2012] [Indexed: 12/14/2022]
|
25
|
Fajkovic H, Cha EK, Jeldres C, Robinson BD, Rink M, Xylinas E, Chromecki TF, Breinl E, Svatek RS, Donner G, Tagawa ST, Tilki D, Bastian PJ, Karakiewicz PI, Volkmer BG, Novara G, Joual A, Faison T, Sonpavde G, Daneshmand S, Lotan Y, Scherr DS, Shariat SF. Extranodal extension is a powerful prognostic factor in bladder cancer patients with lymph node metastasis. Eur Urol 2012; 64:837-45. [PMID: 22877503 DOI: 10.1016/j.eururo.2012.07.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Lymph node metastasis (LNM) is the most powerful pathologic predictor of disease recurrence after radical cystectomy (RC). However, the outcomes of patients with LNM are highly variable. OBJECTIVE To assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of 748 patients with urothelial carcinoma of the bladder and LNM treated with RC and lymphadenectomy without neoadjuvant therapy at 10 European and North American centers (median follow-up: 27 mo). INTERVENTION All subjects underwent RC and bilateral pelvic lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Each LNM was microscopically evaluated for the presence of ENE. The number of LNs removed, number of positive LNs, and LN density were recorded and calculated. Univariable and multivariable analyses addressed time to disease recurrence and cancer-specific mortality after RC. RESULTS AND LIMITATIONS A total of 375 patients (50.1%) had ENE. The median number of LNs removed, number of positive LNs, and LN density were 15, 2, and 15, respectively. The rate of ENE increased with advancing pT stage (p<0.001). In multivariable Cox regression analyses that adjusted for the effects of established clinicopathologic features and LN parameters, ENE was associated with disease recurrence (hazard ratio [HR]: 1.89; 95% confidence interval [CI], 1.55-2.31; p<0.001) and cancer-specific mortality (HR: 1.90; 95% CI, 1.52-2.37; p<0.001). The addition of ENE to a multivariable model that included pT stage, tumor grade, age, gender, lymphovascular invasion, surgical margin status, LN density, number of LNs removed, number of positive LNs, and adjuvant chemotherapy improved predictive accuracy for disease recurrence and cancer-specific mortality from 70.3% to 77.8% (p<0.001) and from 71.8% to 77.8% (p=0.007), respectively. The main limitation of the study is its retrospective nature. CONCLUSIONS ENE is an independent predictor of both cancer recurrence and cancer-specific mortality in RC patients with LNM. Knowledge of ENE status could help with patient counseling, clinical decision making regarding inclusion in clinical trials of adjuvant therapy, and tailored follow-up scheduling after RC.
Collapse
Affiliation(s)
- Harun Fajkovic
- Department of Urology, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA; Department of Urology, General Hospital Sankt Poelten, Sankt Poelten, Austria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Todenhöfer T, Renninger M, Schwentner C, Stenzl A, Gakis G. A new prognostic model for cancer-specific survival after radical cystectomy including pretreatment thrombocytosis and standard pathological risk factors. BJU Int 2012; 110:E533-40. [PMID: 22578156 DOI: 10.1111/j.1464-410x.2012.11231.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
UNLABELLED Study Type - Prognosis (cohort series) Level of Evidence 2a What's known on the subject? and What does the study add? Preoperative thrombocytosis has been identified as a predictor of poor outcome in various cancer types. However, the prognostic role of platelet count in patients with invasive bladder cancer undergoing radical cystectomy is unknown. The present study demonstrates that preoperative thrombocytosis is an independent risk factor for decreased cancer-specific survival after radical treatment of invasive bladder cancer. We developed a new prognostic scoring model for cancer-specific outcomes after radical cystectomy including platelet count and established pathological risk factors. Consideration of platelet count in the final model increased its predictive accuracy significantly. Thrombocytosis may be a useful parameter to include within established international bladder cancer nomograms. OBJECTIVE • To investigate the oncological significance of preoperative thrombocytosis in patients with invasive bladder cancer undergoing radical cystectomy, as it has been reported as a marker for aggressive tumour biology in a variety of solid tumours. PATIENTS AND METHODS • The series comprised 258 patients undergoing radical cystectomy between 1999 and 2010 in whom different clinical and histopathological parameters were assessed. • Elevated platelet count was defined as >450 × 10(9) /L. • Based on regression estimates of significant parameters in multivariable analysis a new weighted scoring model was developed to predict cancer-specific outcomes. RESULTS • The median follow-up was 30 months (6-116). • Of the 258 patients, 26 (10.1%) had elevated and 232 (89.9%) had normal platelet count. The 3-year cancer-specific survival in patients with normal and elevated platelet count was 61.5% and 32.7%, respectively (P < 0.001). • In multivariable analysis, cancer-specific survival was significantly lower in patients with locally advanced disease (≥pT3a) (relative risk 2.91, 1.54-5.65; P= 0.001), positive soft tissue surgical margins (4.03, 1.99-7.92; P= 0.001) and thrombocytosis (2.68, 1.26-5.14; P= 0.011). • The 3-year cancer-specific survival in patients with a score 0 (low risk), 1-2 (intermediate risk) and 3-5 (high risk) was 81.0%, 54.8% and 8.2%, respectively (P < 0.001). • Consideration of preoperative platelet count in the final model increased its predictive accuracy by 1.8% with a concordance index of 0.745 (P= 0.040). CONCLUSIONS • The presence of thrombocytosis at radical cystectomy portends unfavourable prognosis. • We constructed a simple weighted prognostic model for cancer-specific outcomes after radical cystectomy based on pretreatment platelet count and established pathological risk factors. • These data warrant external validation and may allow for tailored monitoring and selection of appropriate patients for neoadjuvant and adjuvant trials.
Collapse
|
27
|
Shariat SF, Karakiewicz PI, Godoy G, Lerner SP. Use of nomograms for predictions of outcome in patients with advanced bladder cancer. Ther Adv Urol 2011; 1:13-26. [PMID: 21789050 DOI: 10.1177/1756287209103923] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Accurate estimates of risk are essential for physicians if they are to recommend a specific management to patients with bladder cancer. In this review, we discuss the criteria for the evaluation of nomograms and review current available nomograms for advanced bladder cancer. METHODS A retrospective review of the Pubmed database between 2002 and 2008 was performed using the keywords 'nomogram' and 'bladder'. We limited the articles to advanced bladder cancer. We recorded input variables, prediction form, number of patients used to develop the prediction tools, the outcome being predicted, prediction tool-specific features, predictive accuracy, and whether validation was performed. RESULTS We discuss the characteristics needed to evaluate nomograms such as predictive accuracy, calibration, generalizability, level of complexity, effect of competing risks, conditional probabilities, and head-to-head comparison with other prediction methods. The predictive accuracies of the pre-cystectomy tools (n = 2) range from ∼65-75% and that of the post-cystectomy tools (n = 5) range from ∼75-80%. While some of these nomograms are well-calibrated and outperform AJCC staging, none has been externally validated. To date, four studies demonstrated a statistically significant improvement in predictive accuracy of nomograms by including biomarkers. CONCLUSIONS Nomograms provide accurate individualized estimates of outcomes. They currently represent the most accurate and discriminatory decision-making aids tools for predicting outcomes in patients with bladder cancer. Use of current nomograms could improve current selection of patients for standard therapy and investigational trial design by ensuring homogeneous groups. The addition of biological markers to the currently available nomograms using clinical and pathologic data holds the promise of improving prediction and refining management of patients with bladder cancer.
Collapse
Affiliation(s)
- Shahrokh F Shariat
- Division of Urology; Sidney Kimmel Center for Prostate and Urologic Cancer, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Box 27, New York, NY 10065, USA
| | | | | | | |
Collapse
|
28
|
Abstract
Upper urinary tract urothelial carcinoma (UTUC) is a rare disease, which means there are little evidence-based data available to guide clinical decision-making. Although diagnosis and treatment of UTUC have improved significantly over the last 5 years, accurate risk stratification remains a challenge owing to the difficulty of clinical staging. A number of potential prognostic factors have been identified, encompassing clinical characteristics, pathological factors and molecular markers. Tumor stage and lymph node status are the most important predictors of survival in patients with UTUC. Preoperative evaluation for hydronephrosis can identify patients at risk of non-organ-confined disease. In the subgroup of patients with stage ≥pT2 disease, a longer interval between diagnosis and radical nephroureterectomy is associated with a higher risk of disease recurrence and cancer-specific mortality. Extensive tumor necrosis, sessile tumor architecture and lymphovascular invasion are independent predictors of clinical outcomes for patients with UTUC treated with radical nephroureterectomy. The incorporation of such prognosticators into clinical prediction models might help to guide decision-making with regard to timing of surveillance, type of treatment, performance of lymphadenectomy, and consideration of neoadjuvant or adjuvant systemic therapies.
Collapse
|
29
|
Gakis G, Todenhöfer T, Renninger M, Schilling D, Sievert KD, Schwentner C, Stenzl A. Development of a new outcome prediction model in carcinoma invading the bladder based on preoperative serum C-reactive protein and standard pathological risk factors: the TNR-C score. BJU Int 2011; 108:1800-5. [DOI: 10.1111/j.1464-410x.2011.10234.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
30
|
Lee K, Jung ES, Choi YJ, Lee KY, Lee A. Expression of pRb, p53, p16 and cyclin D1 and their clinical implications in urothelial carcinoma. J Korean Med Sci 2010; 25:1449-55. [PMID: 20890425 PMCID: PMC2946654 DOI: 10.3346/jkms.2010.25.10.1449] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 04/20/2010] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to assess immunohistochemical expression of p53, pRb, p16, and cyclin D1, alone or in combination, as prognostic indicators and to investigate their correlation with clinocopathologic features of urothelial carcinoma. Immunohistochemical staining for p53, pRb, p16, and cyclin D1 was performed on a tissue microarray from 103 patients with urothelial carcinoma who underwent radical cystectomy. Of the patient samples analyzed, 36 (35%), 61 (59%), 47 (46%) and 30 (29%) had altered expression of p53, pRb, p16, and cyclin D1, respectively. Abnormal expression of p53 and pRb correlated with depth of invasion (P=0.040 and P=0.044, respectively). Cyclin D1 expression was associated with tumor stage and recurrence (P=0.017 and P=0.036, respectively). Altered pRb was significantly correlated with overall survival (P=0.040). According to the expression pattern of pRb and p53, p53/pRb (altered/normal) had worse survival than p53/pRb (normal/altered) (P=0.022). Alteration of all markers had worse survival than all normal (P=0.029). As determined by multivariate analysis, tumor stage, lymph node metastasis and the combined expression of p53 and pRb are independent prognostic factors. In conclusion, immunohistochemical evaluation of cell cycle regulators, especially the p53/pRb combination, might be useful in planning appropriate treatment strategies.
Collapse
Affiliation(s)
- Kyungji Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Jin Choi
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ahwon Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
31
|
Jeldres C, Sun M, Lughezzani G, Isbarn H, Shariat SF, Widmer H, Graefen M, Montorsi F, Perrotte P, Karakiewicz PI. Highly predictive survival nomogram after upper urinary tract urothelial carcinoma. Cancer 2010; 116:3774-84. [DOI: 10.1002/cncr.25122] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
32
|
Bolenz C, Herrmann E, Bastian PJ, Michel MS, Wülfing C, Tiemann A, Buchner A, Stief CG, Fritsche HM, Burger M, Wieland WF, Höfner T, Haferkamp A, Hohenfellner M, Müller SC, Ströbel P, Trojan L. Lymphovascular invasion is an independent predictor of oncological outcomes in patients with lymph node-negative urothelial bladder cancer treated by radical cystectomy: a multicentre validation trial. BJU Int 2010; 106:493-9. [DOI: 10.1111/j.1464-410x.2009.09166.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Zaak D, Burger M, Otto W, Bastian PJ, Denzinger S, Stief CG, Buchner H, Hartmann A, Wieland WF, Shariat SF, Fritsche HM. Predicting individual outcomes after radical cystectomy: an external validation of current nomograms. BJU Int 2009; 106:342-8. [PMID: 20002664 DOI: 10.1111/j.1464-410x.2009.09138.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine whether published nomograms, i.e. The International Bladder Cancer Nomogram Consortium (IBCNC) and the Bladder Cancer Research Consortium (BCRC) statistical models for predicting disease recurrence and survival of patients after radical cystectomy, are feasible for routine use in intermediate-volume institutions in Europe, as although these nomograms had high accuracy by internal validation tests, they stem from high-volume centres and have not been validated elsewhere and thus their general applicability remains unproven. PATIENTS AND METHODS We externally validated the published nomograms. Information about treatments, pathological details, and recurrence and survival status was retrospectively collected from 246 patients. The expected survival according to the nomograms was calculated. The predictive accuracy of the proposed models was calculated by Harrell's concordance indices. To assess the independent prognostic value of the variables proposed by IBCNC and BCRC, stepwise multivariable Cox regressions based on Akaike's Information Criterion (AIC) for the different endpoints were used. A best model for prediction was created on the basis of our data. RESULTS The IBCNC and the BCRC nomograms showed an improvement in the predictive accuracy of recurrence, all-cause and bladder-cancer-specific survival after radical cystectomy of up to 4% compared to Tumour-Node-Metastasis stage-based predictions. According to the calculated AIC values for the different models, all nomograms performed better than the TNM classification. CONCLUSIONS The BCRC and IBCNC nomograms provided accurate predictions when they were applied to an external cohort of patients from low- to intermediate-volume centres. The prediction of recurrence and survival based on the addressed nomograms is better than TNM stage-based prediction. The application of such nomograms can be supported on a sound basis, but further amendments are warranted.
Collapse
Affiliation(s)
- Dirk Zaak
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Van Rhijn BW, Van Der Kwast TH, Kakiashvili DM, Fleshner NE, Van Der Aa MN, Alkhateeb S, Bangma CH, Jewett MA, Zlotta AR. Pathological stage review is indicated in primary pT1 bladder cancer. BJU Int 2009; 106:206-11. [DOI: 10.1111/j.1464-410x.2009.09100.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
|
36
|
Margulis V, Lotan Y, Karakiewicz PI, Fradet Y, Ashfaq R, Capitanio U, Montorsi F, Bastian PJ, Nielsen ME, Muller SC, Rigaud J, Heukamp LC, Netto G, Lerner SP, Sagalowsky AI, Shariat SF. Multi-Institutional Validation of the Predictive Value of Ki-67 Labeling Index in Patients With Urinary Bladder Cancer. J Natl Cancer Inst 2009; 101:114-9. [DOI: 10.1093/jnci/djn451] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|