Inherited Germline Cancer Susceptibility Gene Variants in Individuals with Non-Muscle-Invasive Bladder Cancer

Inherited Germline Variants in Urinary Tract Cancer: A Multicenter Whole-Exome Sequencing Analysis and Correlation With Clinical Features and Tumor Genomics

PURPOSE

This study investigates a real-world multicenter cohort of patients with urinary tract cancer (UTC), with primary disease sites including the bladder, urethra, and upper tract, who enrolled for research molecular testing of their germline and tumor. The purpose of this study was to evaluate factors that could affect the likelihood of identifying a clinically actionable germline pathogenic variant (PV).

METHODS

Patients with UTC were identified from 10 cancer institutes of the Oncology Research Information Exchange Network consortium. The data set comprised abstracted clinical data with germline and tumor genomic data, and comparative analyses were conducted.

RESULTS

Clinically actionable germline PVs in cancer predisposition genes were identified in 16 (4.5%) of 354 patients. A higher proportion of patients with the urethra and the upper tract as the primary sites of disease had PVs with a prevalence of 11% (5/45), compared with only 3.6% (11/308) in those with the bladder as the primary site of disease (P = .04). There were no significant differences in markers of genomic instability (such as tumor mutational burden, microsatellite instability [MSI], and loss of heterozygosity, copy number, and chromosomal instability) between those with PVs and those without (P > .05). Of the PVs identified, 10 (62%) were in homologous recombination repair (HRR) genes, three (19%) in mismatch repair (MMR) genes, and three (19%) in genes associated with other pathways.

CONCLUSION

Tissue-based assessment of genomic instability, such as MSI, does not reliably indicate germline PV. A comprehensive clinical germline testing approach that includes HRR genes in addition to MMR genes is likely to yield PVs in approximately one of 10 patients with nonbladder primary disease sites such as the upper tract and the urethra.

Genome-wide analyses reveals an association between invasive urothelial carcinoma in the Shetland sheepdog and NIPAL1

Naturally occurring canine invasive urinary carcinoma (iUC) closely resembles human muscle invasive bladder cancer in terms of histopathology, metastases, response to therapy, and low survival rate. The heterogeneous nature of the disease has led to the association of large numbers of risk loci in humans, however most are of small effect. There exists a need for new and accurate animal models of invasive bladder cancer. In dogs, distinct breeds show markedly different rates of iUC, thus presenting an opportunity to identify additional risk factors and overcome the locus heterogeneity encountered in human mapping studies. In the association study presented here, inclusive of 100 Shetland sheepdogs and 58 dogs of other breeds, we identify a homozygous protein altering point mutation within the NIPAL1 gene which increases risk by eight-fold (OR = 8.42, CI = 3.12-22.71), accounting for nearly 30% of iUC risk in the Shetland sheepdog. Inclusion of six additional loci accounts for most of the disease risk in the breed and explains nearly 75% of the phenotypes in this study. When combined with sequence data from tumors, we show that variation in the MAPK signaling pathway is an overarching cause of iUC susceptibility in dogs.

The Role of Hypoxia-inducible Factor-1 in Bladder Cancer

Bladder cancer (BC) is one of the most common malignant tumors worldwide and poses a significant hazard to human health. During the development of BC, hypoxia plays a crucial role. Hypoxia-inducible factor (HIF) is a key transcription factor for hypoxic adaptation, which regulates the transcription of various genes, including inflammation, angiogenesis, and glycolytic metabolism. Recent studies have shown the precise role of HIF in various biological behaviors of BC. More importantly, a new antitumor medication targeting HIF-2 has been used to treat renal cancer. However, therapies targeting HIF-1 in BC have not yet been developed. In this review, we discussed how HIF-1 is expressed and affects the growth, metastasis, and angiogenesis of BC. At the same time, we investigated several HIF-1 inhibitors that provide new perspectives for targeting HIF-1.

Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice

Bladder cancer is among the ten most common cancers globally, causes considerable morbidity and mortality and is, therefore, a substantial burden for health-care systems. The incidence of bladder cancer is affected by demographic trends, most notably population growth and ageing, as well as exposure to risk factors, especially tobacco smoking. Consequently, the incidence has not been stable throughout the world over time, nor will it be in the near future. Further primary prevention efforts are of the utmost importance to reduce the medical and financial burden of bladder cancer on populations and health-care systems. Simultaneously, less-invasive and lower-cost approaches for the diagnosis of both primary and recurrent bladder cancers are required to address challenges posed by the increasing shortage of health-care professionals and limited financial resources worldwide. In this regard, urinary biomarkers have demonstrated promising diagnostic accuracy and efficiency. Awareness of the risk factors and symptoms of bladder cancer should also be increased in society, particularly among health-care professionals and high-risk groups. Studies investigating the associations between lifestyle factors and bladder cancer outcomes are scarce and should be a research priority. In this Review, we outline global trends in bladder cancer incidence and mortality, and discuss the main risk factors influencing bladder cancer occurrence and outcomes. We then discuss the implications, challenges and opportunities of these epidemiological trends for public health and clinical practice.

Effects of Nursing Care for the Treatment of Patients with Bladder Cancer: A Systematic Review and Meta-analysis

Purpose. In this study, a systematic review and meta-analysis were used to examine the effectiveness of nursing care in the treatment of bladder cancer patients. The platforms of PubMed, Embase, Cochrane Library, and Web of Science were used to conduct a thorough literature search. Methods. The searching approach was used to find the fundamental characteristics of 5 studies. Sample size ranged from 52 to 131,852, and total sample size was 151,166. The study was looked up in PubMed, Embase, and Web of Science, with the most recent search being done in July 2022. Utilizing a standardized form, two independent reviewers gathered pertinent information from research that qualified as literature (17). Review Manager 5.3 used the data to examine the literature. Statistics were deemed significant at $p<0.05$ . Results. We discovered that more bladder cancer patients with T1+T2 tumor stages were receiving nursing care than those with T1+T2 tumor stages were receiving control care (mean difference =1.27, 95% CI: 1.20-1.35, $p<0.00001$ ). The proportion of bladder cancer patients with T3+T4 tumor stage in the nursing care group was lower than the proportion of patients with T3+T4 tumor stage in the control group (mean difference = 1.07; 95% CI: 1.01-1.14; $p<0.00001$ ). The difference between the number of bladder cancer patients receiving radiotherapy in the nursing care group and the control group was not statistically significant (mean difference = 1.07, 95% confidence interval [CI]: 0.99-1.16, $p=0.11$ ). There were fewer patients with bladder cancer receiving chemotherapy in the nursing care group than that in the control group (mean difference = -0.02, 95% CI: -0.0-0.02, $p<0.00001$ ). The incidence rate of patients with bladder cancer with major complications in nursing care group was lower than that of patients with bladder cancer with major complications in control group (mean difference = 0.41 95% CI: 0.18-0.93, $p=0.03$ ). When compared to patients with bladder cancer who had serious complications in the control group, the hospital death rate for nursing care patients had a greater incidence of bladder cancer patients (mean difference = 4.64 95% CI: 4.46-4.82, $p<0.00001$ ). Conclusion. This study demonstrated that the effects of nursing care reduced the incidence rate of chemotherapy and the frequency of severe problems in bladder cancer patients.