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Nikolaidis CG, Gyriki D, Anitsakis C, Stavropoulou E. Tailoring treatment for elderly bladder cancer: a case report of personalized management of high-grade urothelial carcinoma with papillary features. Front Oncol 2024; 14:1434795. [PMID: 39165685 PMCID: PMC11333216 DOI: 10.3389/fonc.2024.1434795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
This case study presents the diagnostic and therapeutic course of a 72-year-old male patient with a history of high-grade urothelial carcinoma with papillary features. The report outlines the patient's initial presentation, the intervention strategies employed, including transurethral resection and intravesical Bacillus Calmette-Guérin (BCG) therapy, the subsequent complications and clinical decisions following the intense symptoms post-treatment. The study highlights the challenges in managing bladder cancer in elderly patients, considering the tumor's characteristics, treatment responses, and the patient's quality of life.
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Affiliation(s)
| | - Despoina Gyriki
- Internal Medicine Department, Vostaneio-General Hospital of Mytilene, Mytilene, Greece
- Master Program in “Food, Nutrition and Microbiome”, Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Charalambos Anitsakis
- Internal Medicine Department, Vostaneio-General Hospital of Mytilene, Mytilene, Greece
| | - Elisavet Stavropoulou
- Master Program in “Food, Nutrition and Microbiome”, Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Tamalunas A, Wendt A, Springer F, Vigodski V, Trieb M, Eitelberger N, Poth H, Ciotkowska A, Rutz B, Hu S, Schulz H, Ledderose S, Rogenhofer N, Kolben T, Nössner E, Stief CG, Hennenberg M. Immunomodulatory imide drugs inhibit human detrusor smooth muscle contraction and growth of human detrusor smooth muscle cells, and exhibit vaso-regulatory functions. Biomed Pharmacother 2024; 177:117066. [PMID: 38981242 DOI: 10.1016/j.biopha.2024.117066] [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: 04/17/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND The immunomodulatory imide drugs (IMiDs) thalidomide, lenalidomide and pomalidomide may exhibit therapeutic efficacy in the prostate. In lower urinary tract symptoms (LUTS), voiding and storage disorders may arise from benign prostate hyperplasia, or overactive bladder. While current therapeutic options target smooth muscle contraction or cell proliferation, side effects are mostly cardiovascular. Therefore, we investigated effects of IMiDs on human detrusor and porcine artery smooth muscle contraction, and growth-related functions in detrusor smooth muscle cells (HBdSMC). METHODS Cell viability was assessed by CCK8, and apoptosis and cell death by flow cytometry in cultured HBdSMC. Contractions of human detrusor tissues and porcine interlobar and coronary arteries were induced by contractile agonists, or electric field stimulation (EFS) in the presence or absence of an IMID using an organ bath. Proliferation was assessed by EdU assay and colony formation, cytoskeletal organization by phalloidin staining, RESULTS: Depending on tissue type, IMiDs inhibited cholinergic contractions with varying degree, up to 50 %, while non-cholinergic contractions were inhibited up to 80 % and 60 % for U46619 and endothelin-1, respectively, and EFS-induced contractions up to 75 %. IMiDs reduced viable HBdSM cells in a time-dependent manner. Correspondingly, proliferation was reduced, without showing pro-apoptotic effects. In parallel, IMiDs induced cytoskeletal disorganization. CONCLUSIONS IMiDs exhibit regulatory functions in various smooth muscle-rich tissues, and of cell proliferation in the lower urinary tract. This points to a novel drug class effect for IMiDs, in which the molecular mechanisms of action of IMiDs merit further consideration for the application in LUTS.
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Affiliation(s)
- Alexander Tamalunas
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany; Immunoanalytics Research Group Tissue Control of Immunocytes, Helmholtz Center Munich, Munich, Germany.
| | - Amin Wendt
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Florian Springer
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Victor Vigodski
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Moritz Trieb
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | | | - Henrik Poth
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Anna Ciotkowska
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Beata Rutz
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Sheng Hu
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Heiko Schulz
- Department of Pathology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Stephan Ledderose
- Department of Pathology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Nina Rogenhofer
- Department of Obstetrics and Gynecology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Elfriede Nössner
- Immunoanalytics Research Group Tissue Control of Immunocytes, Helmholtz Center Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
| | - Martin Hennenberg
- Department of Urology, University Hospital Munich, LMU Munich, Munich, Germany
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Pyrgidis N, Schulz GB, Volz Y, Ebner B, Rodler S, Westhofen T, Eismann L, Marcon J, Stief CG, Jokisch F. The Prognostic Value of Perioperative Platelet and Leukocyte Values in Patients Undergoing Radical Cystectomy: A Prospective Long-Term Cohort Study. Urol Int 2024; 108:421-428. [PMID: 38714188 DOI: 10.1159/000539181] [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: 02/10/2024] [Accepted: 04/29/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION Studies assessing the impact of preoperative and first-day postoperative values of leukocytes, thrombocytes, and platelet/leukocyte ratio (PLR) after radical cystectomy (RC) are sparse. We aimed to assess the impact of these factors on long-term survival after RC. METHODS An analysis of patients undergoing open RC from 2004 to 2023 at our center was performed. Leukocytosis was defined as ≥8,000 leukocytes/μL and thrombocytosis as ≥400,000 thrombocytes/μL. Similarly, the cutoff for PLR was set at 28. A multivariable Cox regression analysis was performed to assess the role of leukocytosis, thrombocytosis, and PLR on long-term survival after RC. For all analyses, hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated. RESULTS A total of 1,817 patients with a median age of 70 years (interquartile range [IQR]: 62-77) were included. Overall, 804 (44%), 175 (10%), and 1,296 (71%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 preoperatively. Accordingly, 1,414 (78%), 37 (2%), and 249 (14%) patients presented with leukocytosis, thrombocytosis, and PLR ≥28 on the first day after RC. At a median follow-up of 26 months (IQR: 8-68) after RC, 896 (49%) patients died. In the multivariate Cox regression analysis after adjusting for major perioperative risk factors, only preoperative leukocytosis (HR: 1.3, 95% CI: 1.1-1.6, p = 0.01), as well as both preoperative and first-day thrombocytosis (HR: 2.1, 95% CI: 1.5-2.9, and HR: 2.8, 95% CI: 1.6-5.1, p < 0.001, accordingly) were associated with worse overall survival. CONCLUSION PLR should not be used as a prognostic marker for survival after RC. On the contrary, preoperative leukocytosis, as well as preoperative and first-day thrombocytosis should raise awareness among clinicians performing RC since they were independently associated with worse survival after RC.
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Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Munich, Germany,
| | - Gerald B Schulz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Lennert Eismann
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital, LMU Munich, Munich, Germany
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Fujiwara Y, Karol AB, Joshi H, Reford E, Izadmehr S, Doroshow DB, Galsky MD. C-reactive protein (CRP) as a prognostic biomarker in patients with urothelial carcinoma: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 197:104352. [PMID: 38614269 PMCID: PMC11219184 DOI: 10.1016/j.critrevonc.2024.104352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/21/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024] Open
Abstract
C-reactive protein (CRP) may reflect a pro-inflammatory tumor microenvironment and could represent a biomarker to select patients with urothelial carcinoma more likely to benefit from therapies directed at modulating tumor-promoting inflammation. We performed a systematic review to evaluate survival outcomes based on pre-treatment CRP values in urothelial carcinoma. The hazard ratios (HRs) of survival such as overall survival (OS) and progression-free survival (PFS) between groups with high versus low CRP values were pooled by the random-effect model meta-analyses. Overall, 28 studies comprising 6789 patients were identified for meta-analyses. High CRP levels were associated with shorter OS (HR=1.96 [95% CI: 1.64-2.33], p < 0.01), particularly in advanced disease treated with immune checkpoint blockade (ICB, HR=1.78 [1.47-2.15], p < 0.01). Similar findings were observed in ICB-treated patients with PFS. These findings suggest that CRP could be an attractive biomarker to select patients with urothelial carcinoma for strategies seeking to modulate tumor-promoting inflammation.
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Affiliation(s)
- Yu Fujiwara
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, 281 1st Ave, New York, NY 10003, USA; Department of Medicine, Roswell Park Comprehensive Cancer Center, Elm and Carlton Sts, Buffalo, NY 14263, USA.
| | - Alexander B Karol
- Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Himanshu Joshi
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA; Department of Population Health and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Emma Reford
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Sudeh Izadmehr
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
| | - Deborah B Doroshow
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
| | - Matthew D Galsky
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, New York, NY 10029, USA
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Tamalunas A, Aydogdu C, Unterrainer LM, Schott M, Rodler S, Ledderose S, Schulz GB, Stief CG, Casuscelli J. The Vanishing Clinical Value of PD-L1 Status as a Predictive Biomarker in the First-Line Treatment of Urothelial Carcinoma of the Bladder. Cancers (Basel) 2024; 16:1536. [PMID: 38672618 PMCID: PMC11049370 DOI: 10.3390/cancers16081536] [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: 03/21/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Our study endeavors to elucidate the clinical implications of PD-L1 positivity in individuals afflicted with advanced urothelial carcinoma of the bladder (UCB). METHODS Patients with advanced UCB were prospectively enrolled following a radical cystectomy (RC) performed within January 2017 to December 2022 at our tertiary referral center. The clinical outcome, defined as the progression-free survival (PFS) and overall survival (OS) on systemic treatment, was analyzed using an χ2-test, Mann-Whitney U-test, the Kaplan-Meier method, and a log-rank test. RESULTS A total of 648 patients were included following an RC performed within January 2017 to December 2022. Their PD-L1 status was analyzed with the primary PD-L1-specific antibody (clone SP263, Ventana) and defined both by the CPS and IC-score in 282 patients (43.5%) with a high risk (pT3-pT4 and/or lymph node involvement) or metastatic UCB. While the median PFS was significantly prolonged 5-fold in PD-L1+ patients, we found no difference in OS, regardless of PD-L1 status, or treatment regimen. CONCLUSIONS While PD-L1 positivity indicates prolonged PFS, the presence of PD-L1 does not influence OS rates, suggesting its limited usefulness as a prognostic biomarker in bladder cancer. However, the positive correlation between an PD-L1 status and a sustained response to ICI treatments indicates its potential role as a predictive biomarker. Further research is required to understand how the predictive value of PD-L1 positivity may extend to the use of ICIs in combination with antibody-drug conjugates.
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Affiliation(s)
- Alexander Tamalunas
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
| | - Can Aydogdu
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
| | - Lena M. Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Melanie Schott
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
| | - Severin Rodler
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
| | - Stephan Ledderose
- Department of Pathology, LMU University Hospital, LMU Munich, 81377 Munich, Germany
| | - Gerald B. Schulz
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
| | - Christian G. Stief
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
| | - Jozefina Casuscelli
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany; (C.A.); (M.S.); (S.R.); (G.B.S.); (C.G.S.); (J.C.)
- Comprehensive Cancer Center (CCC Munich LMU), LMU University Hospital, 81377 Munich, Germany
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Pyrgidis N, Schulz GB, Volz Y, Ebner B, Rodler S, Westhofen T, Eismann L, Marcon J, Stief CG, Jokisch F. The impact of perioperative risk factors on long-term survival after radical cystectomy: a prospective, high-volume cohort study. World J Urol 2024; 42:164. [PMID: 38489039 PMCID: PMC10942871 DOI: 10.1007/s00345-024-04887-5] [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: 11/14/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Radical cystectomy (RC) is the gold standard for muscle-invasive bladder cancer. Nevertheless, RC is associated with substantial perioperative morbidity and mortality. We aimed to evaluate the role of important perioperative risk factors in predicting long-term survival after RC. METHODS An analysis of the prospective cohort of patients undergoing open RC from 2004 to 2023 at our center was performed. Patients who died within one month after RC were excluded from the study. A univariate and multivariable Cox regression analysis was performed to assess the role of sex, age, urinary diversion, preoperative values of creatinine and hemoglobin, first-day postoperative values of CRP, leucocytes, and thrombocytes, perioperative Clavien-Dindo complications, perioperative chemotherapy, admission to the intensive or intermediate care unit, as well as type of histology, pathologic T-stage, positive lymph nodes, and positive surgical margins on predicting the long-term overall survival after RC. For all analyses hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated. RESULTS A total of 1,750 patients with a median age of 70 years (IQR: 62-76) were included. Of them, 1,069 (61%) received ileal conduit and 650 (37%) neobladder. Overall, 1,016 (58%) perioperative complications occurred. At a median follow-up of 31 months (IQR: 12-71), 884 (51%) deaths were recorded. In the multivariable Cox regression analysis, increasing age (HR: 1.03, 95%CI: 1.02-1.04, p < 0.001), higher preoperative creatinine values (HR: 1.27, 95%CI: 1.12-1.44, p < 0.001), lower preoperative hemoglobin values (HR: 0.93, 95%CI: 0.89-0.97, p = 0.002), higher postoperative thrombocyte values (HR: 1.01, 95%CI: 1.01-1.02, p = 0.02), Clavien-Dindo 1-2 complications (HR: 1.26, 95%CI: 1.03-1.53, p = 0.02), Clavien-Dindo 3-4 complications (HR: 1.55, 95%CI: 1.22-1.96, p < 0.001), locally advanced bladder cancer (HR: 1.29, 95%CI: 1.06-1.55, p = 0.009), positive lymph nodes (HR: 1.74, 95%CI: 1.45-2.11, p < 0.001), and positive surgical margins (HR: 1.61, 95%CI: 1.29-2.01, p < 0.001) negatively affected long-term survival. CONCLUSION Beside increased age and worse oncological status, impaired renal function, lower preoperative hemoglobin values, higher postoperative thrombocyte values, and perioperative complications are independent risk factors for mortality in the long term in patients undergoing open RC.
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Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Gerald B Schulz
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Severin Rodler
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Thilo Westhofen
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Lennert Eismann
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julian Marcon
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Yoo D, Min KW, Pyo JS, Kim NY. Diagnostic and Prognostic Roles of GATA3 Immunohistochemistry in Urothelial Carcinoma. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1452. [PMID: 37629741 PMCID: PMC10456966 DOI: 10.3390/medicina59081452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
This study aimed to evaluate the diagnostic and prognostic roles of GATA-binding protein 3 (GATA3) immunohistochemistry in urothelial carcinoma (UC) using a meta-analysis. We investigated GATA3 immunohistochemical expression rates and performed a subgroup analysis based on tumor site, study location, and histological subtypes. The overall survival rates of patients with GATA3-positive and -negative UC were compared. The estimated GATA3 expression rate was 0.748 (95% confidence interval [CI]: 0.704-0.787). GATA3 expression rates in the urinary bladder and urinary tract were 0.775 (95% CI: 0.727-0.818) and 0.614 (95% CI: 0.426-0.774), respectively. The GATA3 expression rates of noninvasive and invasive UCs were 0.965 (95% CI: 0.938-0.980) and 0.644 (95% CI: 0.581-0.702), respectively. In invasive UCs, there was a significant difference in GATA3 expression between non-muscular invasion and muscular invasion subgroups (0.937, 95% CI: 0.883-0.967 vs. 0.753, 95% CI: 0.645-0.836). GATA3 expression was the highest in the microcytic subtype among the histologic subtypes (0.952, 95% CI: 0.724-0.993). There was a significant correlation between GATA3 expression and better prognosis (hazard ratio: 0.402, 95% CI: 0.311-0.521). Taken together, GATA3 expression significantly correlated with low-stage and better prognosis in UC. GATA3 expression is highly variable across histological subtypes, and one should be careful while interpreting GATA3 expression.
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Affiliation(s)
- Daeseon Yoo
- Department of Urology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Republic of Korea;
| | - Kyueng-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea;
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea;
| | - Nae Yu Kim
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea
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Xu H, Lin T, Ai J, Zhang J, Zhang S, Li Y, Zheng X, Zhang P, Wei Q, Tan P, Yang L. Utilizing the Lactate Dehydrogenase-to-Albumin Ratio for Survival Prediction in Patients with Bladder Cancer After Radical Cystectomy. J Inflamm Res 2023; 16:1733-1744. [PMID: 37096127 PMCID: PMC10122464 DOI: 10.2147/jir.s384338] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/18/2023] [Indexed: 04/26/2023] Open
Abstract
Purpose Previous studies have suggested that the preoperative lactate dehydrogenase-to-albumin ratio (LAR) is correlated with survival in several cancers except bladder cancer (BCa). This study aimed to determine the prognostic value of the LAR in patients with urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). Patients and Methods A total of 595 UCB patients with RC in West China Hospital from December 2010 to May 2020 were enrolled. A receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of the LAR. Kaplan-Meier curves and Cox regression analyses were applied to evaluate the association of the LAR with overall survival (OS) and recurrence-free survival. Independent factors in multivariate analyses were selected to construct nomograms. Calibration curves, ROC curves, concordance index (C-index) and decision curve analyses were used to evaluate the performance of the nomograms. Results The optimal cutoff value of the LAR was determined to be 3.8. Preoperative low LAR was associated with decreased OS (P < 0.001) and RFS (P < 0.001), especially in patients with ≥ pT2 disease. LAR was an independent factor for OS (hazard ratio [HR]: 1.719; P <0.001) and RFS (HR: 1.429; P = 0.012). The addition of the LAR into nomograms could result in better prediction performance. The areas under the curves of the nomograms were 0.821 and 0.801 for the prediction of 3-year OS and RFS, respectively. The C-indexes of the nomograms were 0.760 and 0.741 for the prediction of OS and RFS, respectively. Conclusion The preoperative LAR is a novel and reliable independent prognostic biomarker for survival in UCB after RC.
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Affiliation(s)
- Hang Xu
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Tianhai Lin
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Jianzhong Ai
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Jiapeng Zhang
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Shiyu Zhang
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Yifan Li
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Xiaonan Zheng
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Peng Zhang
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Ping Tan
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Correspondence: Ping Tan; Lu Yang, Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China, Tel +86 18980606829; +86 15208212056, Email ;
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
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9
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Pan S, Li S, Zhan Y, Chen X, Sun M, Liu X, Wu B, Li Z, Liu B. Immune status for monitoring and treatment of bladder cancer. Front Immunol 2022; 13:963877. [PMID: 36159866 PMCID: PMC9492838 DOI: 10.3389/fimmu.2022.963877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022] Open
Abstract
The high recurrence rate of non-muscle invasive bladder cancer (BC) and poor prognosis of advanced BC are therapeutic challenges that need to be solved. Bacillus Calmette-Guerin (BCG) perfusion was the pioneer immunotherapy for early BC, and the discovery of immune checkpoint inhibitors has created a new chapter in the treatment of advanced BC. The benefit of immunotherapy is highly anticipated, but its effectiveness still needs to be improved. In this review, we collated and analysed the currently available information and explored the mechaisms by which the internal immune imbalance of BC leads to tumour progression. The relationship between immunity and progression and the prognosis of BC has been explored through tests using body fluids such as blood and urine. These analytical tests have attempted to identify specific immuyne cells and cytokines to predict treatment outcomes and recurrence. The diversity and proportion of immune and matrix cells in BC determine the heterogeneity and immune status of tumours. The role and classification of immune cells have also been redefined, e.g., CD4 cells having recognised cytotoxicity in BC. Type 2 immunity, including that mediated by M2 macrophages, Th2 cells, and interleukin (IL)-13, plays an important role in the recurrence and progression of BC. Pathological fibrosis, activated by type 2 immunity and cancer cells, enhances the rate of cancer progression and irreversibility. Elucidating the immune status of BC and clarifying the mechanisms of action of different cells in the tumour microenvironment is the research direction to be explored in the future.
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Affiliation(s)
- Shen Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shijie Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yunhong Zhan
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ming Sun
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuefeng Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhenhua Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Bitian Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Bitian Liu, ;
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10
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Crettenand F, M’Baya O, Grilo N, Valerio M, Dartiguenave F, Cerantola Y, Roth B, Rouvé JD, Blanc C, Lucca I. ERAS® protocol improves survival after radical cystectomy: A single-center cohort study. Medicine (Baltimore) 2022; 101:e30258. [PMID: 36107599 PMCID: PMC9439815 DOI: 10.1097/md.0000000000030258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To evaluate Enhanced recovery after surgery (ERAS®) protocol on oncological outcomes for patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). METHODS A prospectively maintained single-institutional database comprising 160 consecutive UCB patients who underwent open RC from 2012 to 2020 was analyzed. Patients receiving chemotherapy and those with a urinary diversion other than ileal conduit were excluded. Patients were divided into two groups according to the perioperative management (ERAS® and pre-ERAS®). The study aimed to evaluate the impact of the ERAS® protocol on survival at five years after surgery using a Kaplan-Meier log-rank test. A multivariable Cox proportional hazards model was used to identify prognostic factors for cancer-specific (CSS) and overall survival (OS). RESULTS Of the 107 patients considered for the final analysis, 74 (69%) were included in the ERAS® group. Median follow-up for patients alive at last follow-up was 28 months (interquartile range [IQR] 12-48). Five-years CSS rate was 74% for ERAS® patients, compared to 48% for the control population (P = 0.02), while 5-years OS was 31% higher in the ERAS® (67% vs. 36%, P = .003). In the multivariable analysis, ERAS® protocol and tumor stage were independent factors of CSS, while ERAS®, tumor stage so as total blood loss were independent factors for OS. DISCUSSION A dedicated ERAS® protocol for UCB patients treated with RC has a significant impact on survival. Reduction of stress after a major surgery and its potential improvement of perioperative patient's immunity may explain these data.
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Affiliation(s)
- François Crettenand
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
- * Correspondence: François Crettenand, Department of Urology, University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland (e-mail: )
| | - Olivier M’Baya
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
| | - Nuno Grilo
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
| | - Massimo Valerio
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
| | | | - Yannick Cerantola
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
| | - Beat Roth
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
| | - Jean-Daniel Rouvé
- Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland
| | - Catherine Blanc
- Department of Anaesthesiology, University Hospital CHUV, Lausanne, Switzerland
| | - Ilaria Lucca
- Department of Urology, University Hospital CHUV, Lausanne, Switzerland
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11
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Zhao F, Qi N, Shen X, Xiong Z, Xue N, Xu Y, Wang J, Zhu H. Free Ferrous Protoporphyrin and Reactive Oxygen Species Status of Voided Urine Predicts Higher Stage in Urothelial Carcinoma. Cancer Manag Res 2022; 14:615-621. [PMID: 35210858 PMCID: PMC8857996 DOI: 10.2147/cmar.s352127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/03/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study was conducted to evaluate the correlation between the free ferrous protoporphyrin and reactive oxygen species (FH and ROS) combined test and the tumor grade and stage in a pathologically confirmed uroepithelial carcinoma (UC) patient population. Patients and Methods In this retrospective study, we enrolled patients newly diagnosed with UC between May 2020 and June 2021. All patients were classified as FH(+) and ROS(+), FH(+) and ROS(-), or FH(-) and ROS(-), based on the FH and ROS combined test of voided urine. Demographic information, pathological results, and status of the FH and ROS combined test were reviewed retrospectively. The relationship between FH and ROS combined test status and tumor stage and grade was evaluated using logistic regression. Results This study included 120 UC patients with a median age of 69 years (interquartile range [IQR] 62–77 years). Eighteen patients (15%) were diagnosed with upper tract urothelial carcinoma, and the others (85%) were diagnosed with bladder cancer. The pathological stages for those with FH(+) and ROS(+) at diagnosis were 25.0% Ta, 45.8% T1, and 29.2% ≥T2. The pathological stages for those with FH(+) and ROS(-) at diagnosis were 23.5% Ta, 35.3% T1, and 41.2% ≥T2. The pathological stages for those with FH(-) and ROS(-) at diagnosis were 52.6% Ta, 26.3% T1, and 21.1% ≥T2. After adjusting for clinical factors, including age, sex, and smoking history, FH(+) and ROS(-) were independent risk factors for muscle-invasive UC (≥T2 stage) at diagnosis (odds ratio [OR] 3.379; 95% confidence interval [CI] 1.103–10.355; P=0.033) in the univariate and multivariate logistic regression analyses. Conclusion Among patients with newly diagnosed UC, FH(+) and ROS(-) might have an association with a more advanced pathological stage. This finding may help differentiate between patients with aggressive diseases and those who may benefit from organ-sparing surgery.
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Affiliation(s)
- Fangzheng Zhao
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Nienie Qi
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Xihao Shen
- The First Clinical Medical College of Nanjing Medical University, NanJing, People’s Republic of China
| | - Zhuang Xiong
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Ning Xue
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Yang Xu
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
| | - Junqi Wang
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
- Correspondence: Junqi Wang; Haitao Zhu, Department of Urology, the Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Quanshan District, Xuzhou, 221100, People’s Republic of China, Tel +86-18761389113, Fax +86051685609999, Email ;
| | - Haitao Zhu
- Department of Urology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, People’s Republic of China
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12
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Dosne AG, Valade E, Goeyvaerts N, De Porre P, Avadhani A, O'Hagan A, Li LY, Ouellet D, Perez Ruixo JJ. Exposure-response analyses of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma. Cancer Chemother Pharmacol 2022; 89:151-164. [PMID: 34977972 PMCID: PMC8807442 DOI: 10.1007/s00280-021-04381-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
Background Exposure–response analyses were conducted to explore the relationship between selected efficacy and safety endpoints and serum phosphate (PO4) concentrations, a potential biomarker of efficacy and safety, in locally advanced or metastatic urothelial carcinoma patients with FGFR alterations treated with erdafitinib. Methods Data from two dosing regimens of erdafitinib in a phase 2 study (NCT02365597), 6 and 8-mg/day with provision for pharmacodynamically guided titration per serum PO4 levels, were analyzed using Cox proportional hazard or logistic regression models. Efficacy endpoints were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Safety endpoints were adverse events typical for FGFR inhibitors. Results Exposure-efficacy analyses on 156 patients (6-mg = 68; 8-mg = 88) showed that patients with higher serum PO4 levels within the first 6 weeks showed better OS (hazard ratio 0.57 [95% CI 0.46–0.72] per mg/dL of PO4; p = 0.01), PFS (hazard ratio 0.80 [0.67–0.94] per mg/dL of PO4; p = 0.01), and ORR (odds ratio 1.38 [1.02–1.86] per mg/dL of PO4; p = 0.04). Exposure-safety analyses on 177 patients (6-mg = 78; 8-mg = 99) showed that the incidence of selected adverse events associated with on-target off-tumor effects significantly rose with higher PO4. Conclusions The exploratory relationship between serum PO4 levels and efficacy/safety outcomes supported the use of pharmacodynamically guided dose titration to optimize erdafitinib’s therapeutic benefit/risk ratio. Clinical trial registration number NCT02365597. Supplementary Information The online version contains supplementary material available at 10.1007/s00280-021-04381-4.
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Affiliation(s)
| | | | | | | | | | - Anne O'Hagan
- Janssen Research and Development, Spring House, PA, USA
| | - Lilian Y Li
- Janssen Research and Development, Spring House, PA, USA
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13
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Lee J, Choo MS, Yoo S, Cho MC, Son H, Jeong H. Intravesical Prostatic Protrusion and Prognosis of Non-Muscle Invasive Bladder Cancer: Analysis of Long-Term Data over 5 Years with Machine-Learning Algorithms. J Clin Med 2021; 10:jcm10184263. [PMID: 34575374 PMCID: PMC8468209 DOI: 10.3390/jcm10184263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 12/28/2022] Open
Abstract
We aim to investigate the significance of intravesical prostate protrusion (IPP) on the prognosis of non-muscle invasive bladder cancer (NMIBC) after the transurethral resection of bladder tumors (TURBT). For newly diagnosed NMIBC, we retrospectively analyzed the association between prognosis and IPP for at least a 5-year follow-up. A degree of IPP over 5 mm in a preoperative CT scan was classified as severe. The primary endpoint was recurrence-free survival, and the secondary endpoint was progression-free survival. The machine learning (ML) algorithm of a support vector machine was used for predictive model development. Of a total of 122 patients, ultimately, severe IPP was observed in 33 patients (27.0%). IPP correlated positively with age, BPH, recurrence, and prognosis. Severe IPP was significantly higher in the recurrence group and reduced in the recurrence-free survival group (p = 0.038, p = 0.032). Severe IPP independently increased the risk of intravesical recurrence by 2.6 times. The addition of IPP to the known oncological risk factors in the prediction model using the ML algorithm improved the predictability of cancer recurrence by approximately 6%, to 0.803. IPP was analyzed as a potential independent risk factor for NMIBC recurrence and progression after TURBT. This anatomical feature of the prostate could affect the recurrence of bladder tumors.
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14
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O'Brian D, Prunty M, Hill A, Shoag J. The Role of C-Reactive Protein in Kidney, Bladder, and Prostate Cancers. Front Immunol 2021; 12:721989. [PMID: 34512646 PMCID: PMC8429489 DOI: 10.3389/fimmu.2021.721989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 11/13/2022] Open
Abstract
C-Reactive Protein (CRP) is associated with diverse outcomes in patients with, or suspected to have, genitourinary malignancies. CRP levels have been shown to be associated with the probability of a prostate cancer diagnosis in patients with elevated PSA, the probability of biochemical recurrence following definitive treatment for localized prostate cancer, and decreased overall survival for patients with advanced disease. In patients with bladder and kidney cancers, CRP levels have been associated with disease progression, stage, and cancer-specific survival. Despite the abundance of correlative studies, the relationship between CRP levels and genitourinary cancer pathogenesis is not clearly understood. Here, we review the evidence for CRP as a biomarker in genitourinary (GU) cancers, with specific focus on potential clinical applications.
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Affiliation(s)
- Daniel O'Brian
- Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Megan Prunty
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Alexander Hill
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jonathan Shoag
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.,Case Western Reserve University School of Medicine, Cleveland, OH, United States
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15
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Ferro M, Lucarelli G, de Cobelli O, Dolce P, Terracciano D, Musi G, Porreca A, Busetto GM, Del Giudice F, Soria F, Gontero P, Cantiello F, Damiano R, Crocerossa F, Abu Farhan AR, Autorino R, Vartolomei MD, Marchioni M, Mari A, Minervini A, Longo N, Celentano G, Chiancone F, Perdonà S, Del Prete P, Ditonno P, Battaglia M, Zamboni S, Antonelli A, Greco F, Russo GI, Hurle R, Crisan N, Manfredi M, Porpiglia F, Ribera D, De Placido P, Facchini S, Scafuri L, Verde A, Di Lorenzo G, Cosimato V, Luciano A, Caputo VF, Crocetto F, Buonerba C. A risk-group classification model in patients with bladder cancer under neoadjuvant cisplatin-based combination chemotherapy. Future Oncol 2021; 17:3987-3994. [PMID: 34278815 DOI: 10.2217/fon-2020-1298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of the current research was to explore the potential prognostic value of readily available clinical and pathologic variables in bladder cancer. The novel association found between cholesterol levels and prognosis may provide the rationale for exploring novel treatments. Patients included had histologically confirmed urothelial bladder cancer and were treated with at least 3 cycles of cisplatin-based neoadjuvant chemotherapy before radical cystectomy with lymphadenectomy. A total of 245 patients at low, intermediate and high risk, presenting with 0-1, 2 or 3-4 risk factors, including positive lymph nodes, Hb <12.8, NLR ≥2.7 and cholesterol levels ≥199, were included. Five-year cancer-specific survival rate was 0.67, 0.78 and 0.94 at high, intermediate and low risk, respectively. Total cholesterol levels at the time of cystectomy may represent a commonly assessable prognostic factor and may be incorporated in a clinically meaningful risk-group classification model.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, European Institute of Oncology, IRCCS, Milan 80131, Italy
| | | | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, IRCCS, Milan 80131, Italy
| | - Pasquale Dolce
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, Naples 80131, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, IRCCS, Milan 80131, Italy
| | - Angelo Porreca
- Department of Urology, Abano Terme Hospital, Padua 35031, Italy
| | | | | | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin 10121, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin 10121, Italy
| | - Francesco Cantiello
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
| | | | - Riccardo Autorino
- Division of Urology, VCU Health System, Virginia Commonwealth University, Richmond, VA 23219, USA
| | - Mihai Dorin Vartolomei
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria.,Department of Cell & Molecular Biology, University of Medicine, Pharmacy, Sciences & Technology, Targu Mures 540139, Romania
| | - Michele Marchioni
- Department of Medical, Oral & Biotechnological Sciences, G. d'Annunzio University of Chieti, Chieti, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Nicola Longo
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | - Sisto Perdonà
- Division of Urology, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale," Naples, Italy
| | - Paola Del Prete
- Scientific Directorate, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale," Naples, Italy
| | - Pasquale Ditonno
- Department of Emergency & Organ Transplantation-Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari 70124, Italy
| | - Michele Battaglia
- Department of Emergency & Organ Transplantation-Urology, Andrology & Kidney Transplantation Unit, University of Bari, Bari 70124, Italy
| | - Stefania Zamboni
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy.,Department of Urology, University of Verona, Verona, Italy
| | | | | | - Rodolfo Hurle
- Department of Urology, Humanitas Hospital, Milan, Italy
| | - Nicolae Crisan
- Department of Urology, University of Medicine & Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Dario Ribera
- Department of Clinical Medicine & Surgery, University Federico II of Naples, Via Pansini 5, Naples 80131, Italy
| | - Pietro De Placido
- Department of Clinical Medicine & Surgery, University Federico II of Naples, Via Pansini 5, Naples 80131, Italy
| | - Sergio Facchini
- Medical Oncology, Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, Naples 80131, Italy
| | - Luca Scafuri
- Department of Clinical Medicine & Surgery, University Federico II of Naples, Via Pansini 5, Naples 80131, Italy
| | - Antonio Verde
- Department of Clinical Medicine & Surgery, University Federico II of Naples, Via Pansini 5, Naples 80131, Italy
| | - Giuseppe Di Lorenzo
- Oncology Unit, Andrea Tortora Hospital, ASL Salerno, Pagani, Italy.,Vincenzo Tiberio, Department of Medicine & Health Sciences, University of Molise, Campobasso, Italy
| | - Vincenzo Cosimato
- Division of Onco-hematology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Angelo Luciano
- Department of Clinical Medicine & Surgery, University Federico II of Naples, Via Pansini 5, Naples 80131, Italy
| | - Vincenzo Francesco Caputo
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Felice Crocetto
- Department of Neurosciences, Human Reproduction & Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Carlo Buonerba
- Regional Reference Center for Rare Tumors, Department of Oncology & Hematology, AOU Federico II of Naples, Naples 80131, Italy.,Centro di Referenza Nazionale per l'Analisi e Studio di Correlazione tra Ambiente, Animale e Uomo, Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Naples, Italy
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16
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Kang Y, Zhu X, Wang X, Liao S, Jin M, Zhang L, Wu X, Zhao T, Zhang J, Lv J, Zhu D. Identification and Validation of the Prognostic Stemness Biomarkers in Bladder Cancer Bone Metastasis. Front Oncol 2021; 11:641184. [PMID: 33816287 PMCID: PMC8017322 DOI: 10.3389/fonc.2021.641184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/29/2021] [Indexed: 12/22/2022] Open
Abstract
Background Bladder urothelial carcinoma (BLCA) is one of the most common urinary system malignancies with a high metastasis rate. Cancer stem cells (CSCs) play an important role in the occurrence and progression of BLCA, however, its roles in bone metastasis and the prognostic stemness biomarkers have not been identified in BLCA. Method In order to identify the roles of CSC in the tumorigenesis, bone metastasis and prognosis of BLCA, the RNA sequencing data of patients with BLCA were retrieved from The Cancer Genome Atlas (TCGA) databases. The mRNA expression-based stemness index (mRNAsi) and the differential expressed genes (DEGs) were evaluated and identified. The associations between mRNAsi and the tumorigenesis, bone metastasis, clinical stage and overall survival (OS) were also established. The key prognostic stemness-related genes (PSRGs) were screened by Lasso regression, and based on them, the predict model was constructed. Its accuracy was tested by the area under the curve (AUC) of the receiver operator characteristic (ROC) curve and the risk score. Additionally, in order to explore the key regulatory network, the relationship among differentially expressing TFs, PSRGs, and absolute quantification of 50 hallmarks of cancer were also identified by Pearson correlation analysis. To verify the identified key TFs and PSRGs, their expression levels were identified by our clinical samples via immunohistochemistry (IHC). Results A total of 8,647 DEGs were identified between 411 primary BLCAs and 19 normal solid tissue samples. According to the clinical stage, mRNAsi and bone metastasis of BLCA, 2,383 stage-related DEGs, 3,680 stemness-related DEGs and 716 bone metastasis-associated DEGs were uncovered, respectively. Additionally, compared with normal tissue, mRNAsi was significantly upregulated in the primary BLCA and also associated with the prognosis (P = 0.016), bone metastasis (P < 0.001) and AJCC clinical stage (P < 0.001) of BLCA patients. A total of 20 PSRGs were further screened by Lasso regression, and based on them, we constructed the predict model with a relatively high accuracy (AUC: 0.699). Moreover, we found two key TFs (EPO, ARID3A), four key PRSGs (CACNA1E, LINC01356, CGA and SSX3) and five key hallmarks of cancer gene sets (DNA repair, myc targets, E2F targets, mTORC1 signaling and unfolded protein response) in the regulatory network. The tissue microarray of BLCA and BLCA bone metastasis also revealed high expression of the key TFs (EPO, ARID3A) and PRSGs (SSX3) in BLCA. Conclusion Our study identifies mRNAsi as a reliable index in predicting the tumorigenesis, bone metastasis and prognosis of patients with BLCA and provides a well-applied model for predicting the OS for patients with BLCA based on 20 PSRGs. Besides, we also identified the regulatory network between key PSRGs and cancer gene sets in mediating the BLCA bone metastasis.
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Affiliation(s)
- Yao Kang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Xiaojun Zhu
- Department of Musculoskeletal Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xijun Wang
- State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Department of Head and Neck Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Shiyao Liao
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Mengran Jin
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Li Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Xiangyang Wu
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Tingxiao Zhao
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Jun Lv
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
| | - Danjie Zhu
- Department of Orthopedics, Zhejiang Provincial People's Hospital, Hangzhou, China.,Department of Orthopedics, Hangzhou Medical College People's Hospital, Hangzhou, China
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Zhao Z, Xie S, Feng B, Zhang S, Sun Y, Guo H, Yang R. Preoperative Risk Classification Using Neutrophil-to-Lymphocyte Ratio and Albumin for Upper Tract Urothelial Carcinoma Treated with Radical Nephroureterectomy. Cancer Manag Res 2020; 12:9023-9032. [PMID: 33061597 PMCID: PMC7526009 DOI: 10.2147/cmar.s274332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/03/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To improve the preoperative prediction of the outcomes of patients diagnosed with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU), we explored various preoperative laboratory factors and established a prognostic risk stratification method. Patients and Methods We retrospectively reviewed 232 UTUC patients who underwent RNU from September 2010 to October 2019 and analyzed their comprehensive clinicopathologic data and preoperative blood-based biomarkers. Kaplan–Meier analysis, receiver-operating characteristic (ROC) curves analysis and Cox regression analysis were performed to assess the relationship between these factors and the prognosis. Results The median follow-up and age were 24 months and 68.5 years, respectively. Preoperative elevated neutrophil-to-lymphocyte ratio (NLR > 3.44) and decreased albumin (ALB < 39.8 g/L) were negatively correlated with progression-free survival (PFS), cancer-specific survival (CSS) and overall survival (OS) in both univariate and multivariate analyses. Patients were sorted into three groups based on their NLR and ALB: the low-risk group (neither elevated NLR nor decreased ALB), intermediate-risk group (either elevated NLR or decreased ALB) and high-risk group (elevated NLR and decreased ALB). Their 5-year PFS rates were 77.8%, 52.6% and 32.3%; their 5-year CSS rates were 97.7%, 71.4% and 32.9%; and their 5-year OS rates were 92.7%, 70.4% and 29.2%, respectively (all P < 0.0001). ROC curves analysis showed that NLR plus ALB had a more accurate prognostic value (P < 0.05). Conclusion Preoperative risk classification using NLR and ALB was identified as an independent prognostic factor for patients with UTUC. The combination of NLR and ALB may help to determine the most appropriate treatment options before RNU.
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Affiliation(s)
- Zihan Zhao
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Shangxun Xie
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Baofu Feng
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Yifan Sun
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
| | - Rong Yang
- Department of Urology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Institute of Urology, Nanjing University, Nanjing, People's Republic of China
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