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Bree KK, Janes JL, Hensley PJ, Srinivasan A, De Hoedt AM, Das S, Freedland SJ, Williams SB. Racial disparities in stage at bladder cancer diagnosis in the US Veterans Affairs healthcare system. BJU Int 2024; 134:473-483. [PMID: 38680113 DOI: 10.1111/bju.16380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To describe patient characteristics and pathological stage at bladder cancer (BCa) diagnosis in a diverse population within a national, equal-access healthcare system. METHODS This retrospective cohort study identified 15 966 men diagnosed with BCa in the Veterans Affairs (VA) healthcare system from 2000 to 2020. The primary outcome was pathological stage at diagnosis, determined by index transurethral resection of bladder tumour. Logistic regression was used to assess the relationship between race and stage. Competing risk models tested the association between race and BCa-specific mortality with cumulative incidence estimates. RESULTS Of 15 966 BCa patients, 12 868 (81%), 1726 (11%), 493 (3%) and 879 (6%) were White, Black, Hispanic and Other race, respectively. Black patients had significantly higher muscle-invasive bladder cancer (MIBC) rates than White patients (35% vs 32%; P = 0.009). In multivariable analysis, the odds of presenting with MIBC did not differ significantly between Black and White patients (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.98-1.22) or between Hispanic patients (OR 0.82, 95% CI 0.67-1.01) and White patients. Compared to White patients, Black patients had a similar risk of BCa-specific mortality (hazard ratio [HR] 0.89, 95% CI 0.75-1.06), whereas Hispanic patients had a lower risk (HR 0.56, 95% CI 0.38-0.82). CONCLUSIONS Black patients presented with the highest rates of de novo MIBC. However, in a large, equal-access healthcare system, this did not result in a difference in BCa-specific mortality. In contrast, Hispanic patients had lower risks of MIBC and BCa-specific mortality.
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Affiliation(s)
- Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jessica L Janes
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Patrick J Hensley
- Department of Urology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Aditya Srinivasan
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Amanda M De Hoedt
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sanjay Das
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Urology, University of California-Los Angeles, Los Angeles, CA, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Freedland
- Division of Urology, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Center for Integrated Research on Cancer and Lifestyle, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen B Williams
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA
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Mitsui Y, Okawa M, Hori S, Uetani M, Kasahara M, Yamabe F, Kobayashi H, Nagao K, Nakajima K. Effectiveness of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin as compared to gemcitabine-based regimens as neoadjuvant chemotherapy for oncologic outcomes in muscle-invasive bladder cancer cases-Single-center study in Japan. Int J Urol 2024; 31:1030-1037. [PMID: 38819073 DOI: 10.1111/iju.15509] [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: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
OBJECTIVES To compare the efficacy and safety of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) with gemcitabine-based regimens for neoadjuvant chemotherapy (NAC) in muscle-invasive bladder cancer (MIBC) patients treated in Japan. METHODS Data for MIBC patients who received NAC-dd-MVAC followed by a radical cystectomy from June 2019 to May 2023 performed at our hospital were analyzed. For comparisons, data for MIBC patients who received NAC gemcitabine and cisplatin (GC) or gemcitabine and carboplatin (GCarbo) therapy between January 2010 and March 2019 were also obtained. Rates of ypT1N0 or less, progression-free survival (PFS), overall survival (OS), and NAC adverse effects were compared between the GC/GCarbo and dd-MVAC regimens. RESULTS Results for 32 patients who received dd-MVAC and 30 who received GC/GCarbo NAC therapy were analyzed. ypT1N0 or less was noted in 40.7% of the dd-MVAC and 40.0% of the GC/GCarbo groups, while ypT0N0 rates were 25% and 10%, respectively, with no statistical differences noted. However, Kaplan-Meier analysis of the total cohort demonstrated that dd-MVAC was associated with significantly better PFS and OS rates than GG/GCarbo (hazard ratios: 0.33, p = 0.0237, and 0.23, p = 0.0127, respectively). Propensity-matched models also showed similar results for both PFS and OS. Adverse effects of dd-MVAC were acceptable and the incidence of hematologic toxicity was lower as compared with GC/GCarbo therapy. CONCLUSION The present study is the first to show that dd-MVAC as NAC can provide better survival as compared with a gemcitabine-based regimen for patients with MIBC treated in Japan.
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Affiliation(s)
- Yozo Mitsui
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mizuho Okawa
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Shunsuke Hori
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masato Uetani
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Mizuki Kasahara
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Fumito Yamabe
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hideyuki Kobayashi
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Koichi Nagao
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Koichi Nakajima
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
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Hausmann J, Grunewald CM. [Can muscle invasive bladder cancer be treated without cystectomy in the future? : New data on trimodal therapy and bladder preservation after systemic therapy alone]. UROLOGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00120-024-02420-5. [PMID: 39143395 DOI: 10.1007/s00120-024-02420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/16/2024]
Abstract
Muscle invasive bladder cancer is generally an aggressive disease. Radical cystectomy (RC) is traditionally the treatment of choice. Due to possible advantages in morbidity, peri-interventional mortality, and quality of life, bladder-preserving treatment strategies are of interest. Here, trimodal therapy (TMT) consisting of maximum transurethral resection and subsequent radiochemotherapy with subsequent cystoscopic follow-up plays an important role. Current cohort analyses indicate equivalent oncological results of TMT to RC in selected patients. However, the use of systemic therapy alone with combined chemo-/immunotherapy or cytotoxic combination therapy also shows promising efficacy both in early surrogate parameters and in oncological endpoints. Overall, studies to date suggest that bladder preservation is possible without compromising oncologic outcomes. Future developments aim to refine patient selection by combining different risk factors and biomarkers to further improve outcomes.
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Affiliation(s)
- Jan Hausmann
- Klinik für Strahlentherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Camilla M Grunewald
- Klinik für Urologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Sakura Y, Yamashita R, Notsu A, Usui K, Shinsaka H, Nakamura M, Matsuzaki M, Niwakawa M. Effectiveness of adjuvant chemotherapy for patients who undergo radical cystectomy without neoadjuvant chemotherapy: A retrospective cohort study of 115 advanced bladder cancer patients with pathological lymph node classification. Int J Urol 2024; 31:785-792. [PMID: 38606834 DOI: 10.1111/iju.15465] [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: 10/28/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES We investigated the clinical outcomes of radical cystectomy without cisplatin-based neoadjuvant chemotherapy (NAC) and identified factors affecting the effectiveness of cisplatin-based adjuvant chemotherapy (AC). METHODS Between September 2002 and February 2020, 288 bladder cancer patients who did not receive NAC underwent radical cystectomy. We retrospectively analyzed the recurrence rates, primary recurrence sites, recurrence-free survival (RFS), and overall survival (OS) of 115 advanced bladder cancer patients (pT3-4 or pN1-3) who were divided into the AC and observation groups. Subgroup analysis was performed, focusing on pathological stage. RESULTS In total, 51 patients received AC, and 64 patients were observed. The median follow-up duration was 95 months. The recurrence rate was lower in the AC group than in the observation group (35.3% vs. 54.7%, p = 0.041). The rate of recurrences in the lymph node area (dissection site and proximal lymph nodes) was lower in the AC group (9.8% vs. 26.6%; p = 0.031). In the subgroup analysis of patients with pN1, the probability of RFS and OS was higher in the AC group than in the observation group. The hazard ratio for RFS and OS was 0.243 (95% confidence interval [CI]: 0.077-0.768) and 0.259 (95% CI: 0.082-0.816), respectively. The 5-year RFS and OS were significantly higher in the AC group (80.0% and 79.4%) than in the observation group (35.7% and 42.9%; p < 0.008 and p < 0.012, respectively). CONCLUSIONS AC improved RFS and OS in patients with pN1 disease who did not receive NAC and should be considered for this population.
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Affiliation(s)
- Yuma Sakura
- Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Ryo Yamashita
- Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kimitsugu Usui
- Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideo Shinsaka
- Division of Urology, Shizuoka Cancer Center, Shizuoka, Japan
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Liu MA, Li JW, Runcie K. Management of Oligometastatic and Locally Recurrent Urothelial Carcinoma. Curr Oncol Rep 2024; 26:496-503. [PMID: 38602581 DOI: 10.1007/s11912-024-01523-8] [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] [Accepted: 03/25/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE OF REVIEW To summarize and evaluate the literature on treatment approaches for oligometastatic and locally recurrent urothelial cancer. RECENT FINDINGS There is no clear definition for oligometastatic urothelial cancers due to limited data. Studies focusing on oligometastatic and locally recurrent urothelial cancer have been primarily retrospective. Treatment options include local therapy with surgery or radiation, and generalized systemic therapy such as chemotherapy or immunotherapy. Oligometastatic and locally recurrent urothelial cancers remain challenging to manage, and treatment requires an interdisciplinary approach. Systemic therapy is nearly always a component of current care in the form of chemotherapy, but the role of immunotherapy has not been explored. Consideration of surgical and radiation options may improve outcomes, and no studies have compared directly between the two localized treatment options. The development of new prognostic and predictive biomarkers may also enhance the treatment landscape in the future.
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Affiliation(s)
- Michael A Liu
- Division of Hematology and Oncology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA
| | - Jennifer W Li
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Karie Runcie
- Division of Hematology and Oncology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, New York, NY, 10032, USA.
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Jaganmurugan R, Arora A, Chandankhede U, Prakash G, Bakshi G, Joshi A, Menon S, Murthy V, Pal M. Prognostic Significance of Lymph Node Density in Pathological Node Positive Urothelial Carcinoma of the Bladder -Upfront Surgery and Post Neoadjuvant Chemotherapy Cohorts. Clin Genitourin Cancer 2024; 22:385-393. [PMID: 38245435 DOI: 10.1016/j.clgc.2023.12.009] [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: 05/20/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 01/22/2024]
Abstract
AIM To validate the role of lymph node density as a prognostic marker in patients undergoing primary surgery and postneoadjuvant therapy in pathological node-positive urothelial bladder carcinoma. MATERIALS AND METHODS Retrospective analysis of 503 patients who underwent radical cystectomy from 2006 to 2019 for muscle-invasive urothelial bladder carcinoma, of which 152 patients with pathological node-positive disease were analyzed. Demographic details, pathological findings, treatment details, disease-free, and overall survival were documented. X tile program analysis was used to divide patients with positive lymph nodes into 3 groups: LD1: <= 7, LD2 :>7 to <15, LD3: >15, and the optimal cut-off value obtained was 15%. To evaluate the impact of lymph node ratio, patients with positive lymph nodes into 3 categories for each cut-off point estimation method, the application generates the histogram, Kaplan-Meier plot and calculates hazard ratio, confidence intervals and P-values. Univariate and multivariate cox regression analysis was done with a P-value of <.05, considered significant. RESULTS One hundred fifty-two patients (30.2%) had pathological nodal metastasis, with 87 of them having perinodal extension. Ninety-six underwent primary surgery, and 56 were postneoadjuvant chemotherapy. The median follow-up was 55.42 months. 68 of the 152 node-positive patients died of the disease. Median number of lymph nodes removed was 17.11. Lymph node density divided into tertiles were LD1 <7%, LD2 7-<15%, LD3 >15% showed 5-year RFS 40.5%,29.3%, 22.6% and 5 year OS was 55.5%, 42.4%,32.1% respectively. Cox regression analysis showed that age less than 55 years ,higher tumor stage, lymphovascular invasion, and higher lymph node ratio were significant in univariate and multivariate analysis. The lymph node density cut-off value of 15% was substantial among node-positive patients (P = .027), and subgroup analysis in upfront surgery with the adjuvant treatment group and postneoadjuvant chemotherapy group was also significant (P =.021). CONCLUSION Pathological higher T stage, Age <55 years, Lymphovascular invasion, adjuvant chemotherapy , adjuvant radiation treatment and lymph node density had prognostic significance in both cohorts of patients who underwent upfront surgery and neoadjuvant chemotherapy. Lymph node density cut-off value of <15% was prognostically significant.
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Affiliation(s)
- Ramamurthy Jaganmurugan
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amandeepsingh Arora
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Udhay Chandankhede
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Gagan Prakash
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Ganesh Bakshi
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Santhosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Mahendra Pal
- Division of Urooncology, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
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7
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Huang Y, Liao C, Shen Z, Zou Y, Xie W, Gan Q, Yao Y, Zheng J, Kong J. A bibliometric insight into neoadjuvant chemotherapy in bladder cancer: trends, collaborations, and future avenues. Front Immunol 2024; 15:1297542. [PMID: 38444854 PMCID: PMC10912866 DOI: 10.3389/fimmu.2024.1297542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Background Neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) remains the cornerstone of treatment for muscle-invasive bladder cancer (MIBC). While platinum-based regimens have demonstrated benefits in tumor downstaging and improved long-term survival for selected patients, they may pose risks for those who are ineligible or unresponsive to chemotherapy. Objective We undertook a bibliometric analysis to elucidate the breadth of literature on NAC in bladder cancer, discern research trajectories, and underscore emerging avenues of investigation. Methods A systematic search of the Web of Science Core Collection (WoSCC) was conducted to identify articles pertaining to NAC in bladder cancer from 1999 to 2022. Advanced bibliometric tools, such as VOSviewer, CiteSpace, and SCImago Graphica, facilitated the examination and depicted the publication trends, geographic contributions, institutional affiliations, journal prominence, author collaborations, and salient keywords, emphasizing the top 25 citation bursts. Results Our analysis included 1836 publications spanning 1999 to 2022, indicating a growing trend in both annual publications and citations related to NAC in bladder cancer. The United States emerged as the predominant contributor in terms of publications, citations, and international collaborations. The University of Texas was the leading institution in publication output. "Urologic Oncology Seminars and Original Investigations" was the primary publishing journal, while "European Urology" boasted the highest impact factor. Shariat, Shahrokh F., and Grossman, H.B., were identified as the most prolific and co-cited authors, respectively. Keyword analysis revealed both frequency of occurrence and citation bursts, highlighting areas of concentrated study. Notably, the integration of immunochemotherapy is projected to experience substantial growth in forthcoming research. Conclusions Our bibliometric assessment provides a panoramic view of the research milieu surrounding neoadjuvant chemotherapy for bladder cancer, encapsulating the present state, evolving trends, and potential future directions, with a particular emphasis on the promise of immunochemotherapy.
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Affiliation(s)
- Yi Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Chengxiao Liao
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zefeng Shen
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Yitong Zou
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Weibin Xie
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qinghua Gan
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yuhui Yao
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - JunJiong Zheng
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Jianqiu Kong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
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Kayar R, Bastug Y, Tokuc E, Topaktas R, Akyurek EA, Kayar K, Artuk I, Ozturk M. Pan-immune-inflammation value as a prognostic tool for overall survival and disease-free survival in non-metastatic muscle-invasive bladder cancer. Int Urol Nephrol 2024; 56:509-518. [PMID: 37773579 DOI: 10.1007/s11255-023-03812-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
PURPOSE To evaluate the association between preoperative pan-immune inflammation value (PIV) and overall survival (OS) and disease-free survival (DFS) in patients who underwent radical cystectomy for non-metastatic muscle-invasive bladder cancer. METHODS A total of 119 patients with non-metastatic muscle-invasive bladder cancer who underwent radical cystectomy at our institution between January 2014 and January 2022 were included in this retrospective study. PIV was calculated using the formula (monocyte count × neutrophil count × platelet count)/lymphocyte count. Ideal cut-off values for PIV were determined using ROC curve analysis. Kaplan-Meier analysis was used to evaluate the impact of PIV on survival outcomes. RESULTS The mean age of patients was 65 ± 14 years, and the mean follow-up duration was 36 months. The ideal cutoff value for PIV was determined to be 406.29, and a PIV above this value was associated with poorer OS (p < 0.001) (73 months vs. 21 months) and DFS (p = 0.002) (35 months vs 19 months). Higher neutrophil-to-lymphocyte ratio (NLR) values were also associated with poorer OS (p < 0.001) and DFS (p < 0.001), with similar effectiveness to PIV. PIV was found to be significantly more effective than platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) in predicting DFS. CONCLUSION Preoperative PIV may serve as an independent prognostic factor for OS in patients who undergo radical cystectomy with non-metastatic muscle-invasive bladder cancer. A high PIV value was associated with poorer survival outcomes. Prospective multicenter studies are needed to further validate the relationship between PIV and histopathological features of bladder cancer.
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Affiliation(s)
- Ridvan Kayar
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Tıbbiye Str. No: 40, Uskudar, Istanbul, Turkey
| | - Yavuz Bastug
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Tıbbiye Str. No: 40, Uskudar, Istanbul, Turkey
| | - Emre Tokuc
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Tıbbiye Str. No: 40, Uskudar, Istanbul, Turkey.
| | - Ramazan Topaktas
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Tıbbiye Str. No: 40, Uskudar, Istanbul, Turkey
| | - Elif Atag Akyurek
- Faculty of Medicine, Department of Medical Oncology, Dokuz Eylul University, Izmir, Turkey
| | - Kemal Kayar
- Urology Clinic, Kilis Prof.Dr. Alaeddin Yavasca State Hospital, Kilis, Turkey
| | - Ilker Artuk
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Tıbbiye Str. No: 40, Uskudar, Istanbul, Turkey
| | - Metin Ozturk
- Department of Urology, University of Health Sciences, Haydarpasa Numune SUAM, Tıbbiye Str. No: 40, Uskudar, Istanbul, Turkey
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Sun R, Zhang M, Yang L, Yang S, Li N, Huang Y, Song H, Wang B, Huang C, Hou F, Wang H. Preoperative CT-based deep learning radiomics model to predict lymph node metastasis and patient prognosis in bladder cancer: a two-center study. Insights Imaging 2024; 15:21. [PMID: 38270647 PMCID: PMC10811316 DOI: 10.1186/s13244-023-01569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/09/2023] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE To establish a model for predicting lymph node metastasis in bladder cancer (BCa) patients. METHODS We retroactively enrolled 239 patients who underwent three-phase CT and resection for BCa in two centers (training set, n = 185; external test set, n = 54). We reviewed the clinical characteristics and CT features to identify significant predictors to construct a clinical model. We extracted the hand-crafted radiomics features and deep learning features of the lesions. We used the Minimum Redundancy Maximum Relevance algorithm and the least absolute shrinkage and selection operator logistic regression algorithm to screen features. We used nine classifiers to establish the radiomics machine learning signatures. To compensate for the uneven distribution of the data, we used the synthetic minority over-sampling technique to retrain each machine-learning classifier. We constructed the combined model using the top-performing radiomics signature and clinical model, and finally presented as a nomogram. We evaluated the combined model's performance using the area under the receiver operating characteristic, accuracy, calibration curves, and decision curve analysis. We used the Kaplan-Meier survival curve to analyze the prognosis of BCa patients. RESULTS The combined model incorporating radiomics signature and clinical model achieved an area under the receiver operating characteristic of 0.834 (95% CI: 0.659-1.000) for the external test set. The calibration curves and decision curve analysis demonstrated exceptional calibration and promising clinical use. The combined model showed good risk stratification performance for progression-free survival. CONCLUSION The proposed CT-based combined model is effective and reliable for predicting lymph node status of BCa patients preoperatively. CRITICAL RELEVANCE STATEMENT Bladder cancer is a type of urogenital cancer that has a high morbidity and mortality rate. Lymph node metastasis is an independent risk factor for death in bladder cancer patients. This study aimed to investigate the performance of a deep learning radiomics model for preoperatively predicting lymph node metastasis in bladder cancer patients. KEY POINTS • Conventional imaging is not sufficiently accurate to determine lymph node status. • Deep learning radiomics model accurately predicted bladder cancer lymph node metastasis. • The proposed method showed satisfactory patient risk stratification for progression-free survival.
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Affiliation(s)
- Rui Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Meng Zhang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Lei Yang
- Department of Radiology, Qingdao Center Hospital, Qingdao, 266042, Shandong, China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250000, Shandong, China
| | - Na Li
- Department of Radiology, The People's Hospital of Zhangqiu Area, Jinan, 250200, Shandong, China
| | - Yonghua Huang
- Department of Radiology, The Puyang Oilfield General Hospital, Puyang, 457001, Henan, China
| | - Hongzheng Song
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Bo Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China
| | - Chencui Huang
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, 100080, China
| | - Feng Hou
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
| | - Hexiang Wang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, China.
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Li R, Naidu S, Fan W, Rose K, Huelster H, Grass GD, Vosoughi A, Dhillon J, Kim Y, Gupta S, Jain RK, Zhang J, Zemp L, Yu A, Poch MA, Spiess PE, Pow-Sang J, Gilbert SM, Sexton WJ. Effectiveness of perioperative chemotherapy and radical cystectomy in treating bladder cancer. Urol Oncol 2023; 41:457.e17-457.e24. [PMID: 37880002 DOI: 10.1016/j.urolonc.2023.09.017] [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: 03/05/2023] [Revised: 09/04/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Despite abundant evidence supporting the use of perioperative chemotherapy from clinical trials, no study to date has comprehensively evaluated its use in the treatment of muscle-invasive bladder cancer (MIBC) in the real-world setting. Little is known regarding the impact of pretreatment disease stage and real-world factors such as patient comorbidities preventing timely completion of therapy on its effectiveness. This study aims to assess the usage of perioperative chemotherapy and examines its impact on pathologic downstaging rates and recurrence free survival in patients undergoing radical cystectomy. METHODS A retrospective review was conducted in 805 patients with muscle invasive bladder cancer undergoing radical cystectomy with no perioperative chemotherapy, 761 with presurgical chemotherapy followed by radical cystectomy, and 134 radical cystectomy followed by adjuvant chemotherapy. Relevant clinicopathologic features were reviewed. Recurrence-free survival and Overall Survival probability estimates were calculated using the Kaplan-Meier method and compared using the Log-rank or Gehan-Breslow tests. The prognostic effects of presurgical chemotherapy and adjuvant chemotherapy regimens were evaluated by estimating hazard ratio and 95% confidence interval from an adjusted Cox proportional hazards model. Statistical tests were 2-sided, and significance was defined as P-value < 0.05. RESULTS In this contemporary, real-world cohort, 5-yr RFS was found to be 65.6% in pT0, 59.1%in pT2, and 10.8% in pN+ patients. Presurgical chemotherapy increased pathologic downstaging rates from 27.5% to 41.1% in patients with ≥cT2 BCa. Stratified by clinical T-stage, only cT2 patients derived recurrence-free survival (Median 45.3 months vs. 29.0 months, P < 0.01) and overall survival (Median 62.3 months vs. 41.9 months, P < 0.001) benefits. In patients with adverse pathologic features (≥pT3 or pN+), adjuvant chemotherapy improved recurrence-free survival (Median 22.8 months vs. 10.0 months, P < 0.0001) and overall survival (Median OS 32.4 months vs. 16.3 months, P < 0.0001). CONCLUSIONS We report real-world outcomes from a large cohort of muscle-invasive bladder cancer patients undergoing surgical treatment with/out perioperative chemotherapy. Pathologic response rates to pre-surgical chemotherapy were modest and led to clinical benefit only in cT2 patients. Adjuvant chemotherapy provided survival benefit for pathologically advanced MIBC patients irrespective of pT/N staging.
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Affiliation(s)
- Roger Li
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL.
| | - Shreyas Naidu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Immunology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Wenyi Fan
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Kyle Rose
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Heather Huelster
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - George Daniel Grass
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Aram Vosoughi
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jasreman Dhillon
- Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Youngchul Kim
- Biostatistics and Bioinformatics Shared Resource, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Shilpa Gupta
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH
| | - Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jingsong Zhang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Logan Zemp
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Alice Yu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Michael A Poch
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Julio Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL
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11
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Moon S, Pandya V, McDonald A, Basu A, Bae S, Ferguson JE. Analysis of treatment of muscle invasive bladder cancer using the national cancer database: Factors associated with receipt of aggressive therapy. Urol Oncol 2023; 41:456.e13-456.e20. [PMID: 37640572 DOI: 10.1016/j.urolonc.2023.08.003] [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: 02/14/2023] [Revised: 06/20/2023] [Accepted: 08/04/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To characterize the treatments received by muscle-invasive bladder cancer (MIBC) patients, analyze their use according to sociodemographic, clinical, pathologic, and facility variables, and identify possibilities for improvement in care, with the understanding that patients with MIBC face a potentially lethal disease, yet often do not receive guideline-concordant potentially curative therapies. MATERIALS AND METHODS Using the National Cancer Data Base (NCDB), we analyzed 102,119 patients with MIBC diagnosed from 2009 to 2018. Treatments included cystectomy, radiation, chemotherapy (CT), or observation. Treatments including cystectomy or radiotherapy (RT) ≥50 Gy were considered aggressive therapy (AT). A multivariable generalized estimating equation model was used to assess the impact of the independent variables with receiving AT, using SAS version 9.4. RESULTS The median age was 73 years, with 72.9% male, 84.3% White, and 7.1% Black. Stage distribution was 59.4% stage II, 23.0% stage III, and 17.6% stage IV. Overall, 55.2% of patients received AT, while 41.1% did not, with 26.6% receiving observation alone after transurethral resection of bladder tumor. 45.4% received cystectomy, 9.8% received RT, and 12.8% received CT as primary treatment. Notably, over 30% of patients ages 50 to 70 did not receive aggressive therapy. On multivariate analysis, factors associated with nonreceipt of AT included age >70 (OR < 0.79, P < 0.0001), Black race (OR 0.70, P < 0.0001), underinsured status (OR 0.62, P < 0.0001), high comorbidity (OR 0.74, P < 0.0001), and treatment at low volume (OR 0.72 P < 0.0001) or nonacademic cancer program (OR 0.54, P < 0.0001). Long-term trends included increases in utilization of perioperative CT (17.5% in 2009 to 46.7% in 2018, P < 0.001), and chemoradiation (5.4% in 2009 to 8.8% in 2018, P < 0.001). Using Cox regression analysis to control for confounding variables, receipt of aggressive therapy was associated with improved overall survival. CONCLUSIONS Over a third of patients did not receive AT for MIBC, with many of these patients seemingly eligible by age and comorbidity status. Prospective studies are needed to determine why these patients do not receive AT. A better understanding of patient vs. access to care vs. provider factors will help to focus efforts to improve care for MIBC patients.
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Affiliation(s)
- Sol Moon
- Department of Urology, University of Alabama Birmingham, Birmingham, AL
| | - Vishruti Pandya
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL
| | - Andrew McDonald
- Department of Radiation Oncology, University of Alabama Birmingham, Birmingham, AL; Institute for Cancer Outcomes and Survivorship, University of Alabama Birmingham, Birmingham, AL
| | - Arnab Basu
- Department of Medicine, Division of Hematology-Oncology, University of Alabama Birmingham, Birmingham, AL
| | - Sejong Bae
- Department of Medicine, Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, Birmingham, AL
| | - James E Ferguson
- Department of Urology, University of Alabama Birmingham, Birmingham, AL; Birmingham Veterans Affairs Medical Center, Birmingham, AL; O'Neal Comprehensive Cancer Center, Birmingham, AL.
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12
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van Dorp J, van der Heijden MS. The bladder cancer immune micro-environment in the context of response to immune checkpoint inhibition. Front Immunol 2023; 14:1235884. [PMID: 37727793 PMCID: PMC10505825 DOI: 10.3389/fimmu.2023.1235884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 09/21/2023] Open
Abstract
Treatment with neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy is the default treatment for muscle-invasive bladder cancer (BC). However, with the encouraging results of immune checkpoint inhibitiors (ICI) directed against PD-1/PD-L1 and CTLA-4 in recent years, the treatment landscape of BC is rapidly changing. In addition, it is becoming clear that the effect of ICI is highly dependent on the interaction between tumor cells and the tumor immune micro-environment (TIME). Different immune cells are involved in an anti-tumor response in BC. Cytotoxic CD8+ T-cells are the main effector cells, aided by other immune cells including other T-cells, B-cells and pro-inflammatory macrophages. As part of the ongoing anti-tumor immune response, lymphocytes aggregate in clusters called tertiary lymphoid structures (TLS). Tumor mutational burden (TMB) and infiltration of immune cells into the tumor are both important factors for establishing an anti-tumor immune response. In contrast, transforming growth factor beta (TGF-β) signaling in cancer-associated fibroblasts (CAFs) prevents infiltration of lymphocytes and potentially has an immunosuppressive effect. In conclusion, the effect of ICI seems to be reliant on a combination of tumor-intrinsic and TIME-related parameters. More research is needed to fully understand the underlying biological mechanisms to further improve patient care.
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Affiliation(s)
- Jeroen van Dorp
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michiel S. van der Heijden
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
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13
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Nikulainen I, Salminen AP, Seikkula H, Högerman M, Perez IM, Koskinen I, Sairanen J, Nikkola J, Murtola TJ, Vaarala MH, Jousmäki S, Nykopp TK, Isotalo T, Marttila T, Alibeto A, Seppänen M, Palmberg C, Boström PJ. Nationwide analysis of survival after radical cystectomy for bladder cancer in Finland. Acta Oncol 2023; 62:829-835. [PMID: 37377029 DOI: 10.1080/0284186x.2023.2228446] [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: 03/22/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Population-based survival results after radical cystectomy (RC) are limited. Our objective was to report short and long-term survival results after RC for bladder cancer from Finland in a population-based setting. MATERIALS AND METHODS The Finnish National Cystectomy Database containing retrospectively collected essential RC data covering the years 2005-2017 was combined with the survival data from the Finnish Cancer Registry. Kaplan-Meier plots were used to estimate survival and the survival graphs were illustrated according to the final pathological staging. Centers were divided according to operational volume, and the results were then compared using Pearsons's Chi-squared test. RESULTS A total of 2047 patients were included in the study. 30-, and 90-day mortality was 1.3%, and 3.8%, respectively. The OS of the entire RC population at 5- and 10 years was 66% and 55%, and CSS was 74% and 72%, respectively. Center volume did not significantly associate with surgical mortality or long-term survival. The 5- and 10-year OS according to pT-category was 87% and 74% for pT0, 85% and 69% for pTa-pTis-pT1, 70% and 58% for pT2, 50% and 42% for pT3 and 41% and 30% for pT4. The corresponding 5- and 10-year CSS rates were 96% and 93% for pT0, 91% and 90% for pTa-pTis-pT1, 78% and 75% for pT2, 56% and 55% for pT3 and 47% and 44% for pT4. The 5- and 10-year OS rates in patients with no lymph node metastases (pN-) were 74% and 62%, and CSS 82% and 80%, respectively. If lymph nodes were positive (pN+), the corresponding OS rates were 44% and 34% and CSS 49% and 48%, respectively. CONCLUSION RC survival results have improved in contemporary series and are associated with the pTNM-status. The nationwide results from Finland demonstrate outcome comparable to high volume single-center series.
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Affiliation(s)
- Ilkka Nikulainen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Antti P Salminen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Heikki Seikkula
- Department of Surgery, Division of Urology, Central Hospital of Jyväskylä, Jyväskylä, Finland
| | - Mikael Högerman
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Ileana Montoya Perez
- Department of Information Technology, University of Turku, Turku, Finland
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Ilmari Koskinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Sairanen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Nikkola
- Department of Urology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Teemu J Murtola
- Department of Urology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Markku H Vaarala
- Department of Urology, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Senja Jousmäki
- Department of Urology, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Timo K Nykopp
- Department of Urology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Taina Isotalo
- Department of Surgery, Division of Urology, Central Hospital of Lahti, Lahti, Finland
| | - Timo Marttila
- Department of Surgery, Division of Urology, Central Hospital of Seinäjoki, Seinäjoki, Finland
| | - Abdiwahid Alibeto
- Department of Surgery, Division of Urology, Central Hospital of Mikkeli, Mikkeli, Finland
| | - Marjo Seppänen
- Department of Surgery, Division of Urology, Central Hospital of Pori, Pori, Finland
| | - Christian Palmberg
- Department of Surgery, Division of Urology, Central Hospital of Vaasa, Vaasa, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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14
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Kumar A, Kumar M, Semwal MK, Singh U, Mishra N. Management of surgically inoperable muscle-invasive bladder cancer in a resource constraint setting at a tertiary care center by bladder preservation protocol: Case series. J Cancer Res Ther 2023; 19:725-730. [PMID: 37470601 DOI: 10.4103/jcrt.jcrt_1661_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Introduction Urinary bladder cancer is a major cause of morbidity and mortality worldwide. As per the data from the US cancer registry, it was diagnosed in nearly 71,000 patients and led to 14000 deaths in 2013. The Indian data in this regard are lacking with few case reports and epidemiological data only. The paucity of treatment data in this regard led us to undertake this prospective study at our radiation oncology canter. Carcinoma urinary bladder is a heterogeneous disease with variable natural history. Male preponderance and association with cigarette smoking appears to be the foremost in natural history of the disease. Our data analyzed the management of muscle-invasive medically and surgically inoperable carcinoma urinary bladder in a resource constraint setting at a tertiary care center by bladder preservation protocol (BPP). Materials and Methods This prospective study was aimed to evaluate the treatment outcome in surgically inoperable muscle-invasive carcinoma urinary bladder in a resource constraint setting at a tertiary care center by BPP. All patients were treated with telecobalt 60 machine up to a dose of 60-66 Gy along with concurrent chemotherapy. Interim assessment was done at 40 Gy. Results A total of nine patients were taken up for treatment with BPP. All patients were evaluated with standard evaluation protocol. All patients were followed up till any event occurred and till 6 years. Out of nine patients treated, six patients are still alive without any progression of disease and are disease free with standard evaluation on follow-up. Two patients died during the 1st year of follow-up. One patient progressed with lung and abdominal metastases 5 months after the completion of treatment and one patient was lost to follow-up. Conclusion BPP using trimodality therapy is a suitable alternative to radical cystectomy in medically and surgically inoperable carcinoma urinary bladder. These patients should be highly compliant for regular follow-up, and acute and long-term toxicity should be evaluated in detail at each visit. BPP gives a ray of hope in such settings and should be done with caution. In our study, we treated all these patients in our resource constraint settings with good results and high survival rates. Our integrated team of radiation oncologists, medical oncologists, and urologists closely followed up these patients in order to optimize outcomes.
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Affiliation(s)
- Ashok Kumar
- Department of Radiation Oncology, Army Hospital R&R, New Delhi, India
| | - Manish Kumar
- Department of Radiation Oncology, Army Hospital R&R, New Delhi, India
| | - M K Semwal
- Department of Radiation Oncology, Army Hospital R&R, New Delhi, India
| | - Uday Singh
- Command Hospital CC, Lucknow, Uttar Pradesh, India
| | - Nilima Mishra
- Department of Radiation Oncology, Army Hospital RR Delhi, New Delhi, India
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15
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Subiela JD, González-Padilla DA, Huguet J, Aumatell J, Rodríguez-Faba O, Krajewski W, Feliu AH, Mínguez C, Plaza JL, Artiles Medina A, Gajate P, Jiménez Cidre MÁ, Burgos Revilla J, Breda A, Palou J. Oncological and Renal Function Outcomes in Patients Who Underwent Simultaneous Radical Cystectomy and Nephroureterectomy for Synchronous or Metachronous Panurothelial Carcinoma. Urology 2023; 172:157-164. [PMID: 36436672 DOI: 10.1016/j.urology.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/21/2022] [Accepted: 08/29/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess clinical outcomes of patients who underwent simultaneous radical cystectomy (RC) and radical nephroureterectomy (RNU) for panurothelial carcinoma (PanUC). MATERIALS AND METHODS A retrospective analysis of 67 patients who underwent simultaneous RC and unilateral RNU for PanUC, from 1996 to 2017. Kaplan-Meier estimates for remnant urothelium recurrence-free survival, metastasis-free survival, overall survival (OS), and cancer-specific survival (CSS) were performed. Cox multivariate models were constructed. RESULTS The median follow-up was 38 months, 29.8% of patients had a recurrence, 34.3% had metastasis, 67.2% of patients died from any cause, and 37.3% died from urothelial carcinoma. Overall survival and CSS rates at 5 years were 44% and 61%, respectively. In multivariate analysis, progression to muscle-invasive bladder cancer before surgery, presence of muscle-invasive stages at RC and/or RNU, and prostatic urethra involvement were predictors for worse metastasis-free survival and CSS. Forty-one patients (61.2%) had an estimated glomerular filtration rate (eGFR) <60 mL/min before surgery and the number rose to 56 (83.5%) after surgery; 29.8% patients needed renal function replacement therapy after surgery (16 haemodialysis and 4 renal transplant). CONCLUSION Patients with PanUC who undergo simultaneous surgery have adverse oncological (only 4 out of every 10 remain alive at 5 years) and functional outcomes (1 out of 3 will need renal function replacement therapy after surgery). Up to a third of the patients had a recurrence (urethra or contralateral kidney) within 18 months, justifying close surveillance or considering prophylactic urethrectomy. These data should help in counsel on morbidity and life expectancy.
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Affiliation(s)
- José Daniel Subiela
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain.
| | | | - Jorge Huguet
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona; Department of Surgery, Barcelona, Spain
| | - Júlia Aumatell
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona; Department of Surgery, Barcelona, Spain
| | - Oscar Rodríguez-Faba
- Urooncology Unit, Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona; Department of Surgery, Barcelona, Spain
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Department of Public Health, Wrocław Medical University, Wrocław, Poland
| | | | - Cesar Mínguez
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - José López Plaza
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Pablo Gajate
- Medical Oncology Department, Hospital Ramón y Cajal, IRYCIS and CIBERONC, Madrid, Spain
| | - Miguel Ángel Jiménez Cidre
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcala, Madrid, Spain
| | - Alberto Breda
- Department of Urology, Clínica Universidad de Navarra, Madrid, Spain
| | - Joan Palou
- Department of Urology, Clínica Universidad de Navarra, Madrid, Spain
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16
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Ballas L, Singh P, Lerner SP. Targeting barriers to wider use of trimodality therapy in localized muscle invasive bladder cancer. Urol Oncol 2023; 41:35-38. [PMID: 33153882 DOI: 10.1016/j.urolonc.2020.10.005] [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: 07/08/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 11/18/2022]
Abstract
Radical cystectomy with bilateral pelvic lymphadenectomy and trimodality bladder-sparing therapy or TMT, are both curative options for patients with nonmetastatic muscle invasive bladder cancer. Patients should be afforded the opportunity for a multidisciplinary evaluation with equipoise in discussing these options for eligible patients. We discuss the barriers to broader acceptance and utilization of TMT and encourage support of clinical trials of TMT.
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Affiliation(s)
- Leslie Ballas
- Department of Radiation Oncology University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Parminder Singh
- Division of Hematology and Oncology Mayo Clinic College of Medicine, Scottsdale, AZ
| | - Seth P Lerner
- Baylor College of Medicine, Dan L Duncan Cancer Center, Houston, TX.
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17
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Kachanov M, Vetterlein MW, Soave A, Karakiewicz PI, Liakos N, Jankowski T, Pose RM, Mandrek M, Fisch M, Witt JH, Graefen M, Leyh-Bannurah SR. Oncologic impact of concomitant prostate cancer characteristics at the time of radical cystoprostatectomy for bladder cancer: a population-based analysis. Aging Male 2022; 25:54-61. [PMID: 35179092 DOI: 10.1080/13685538.2022.2040982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic impact of concomitant prostate cancer (PCa) of the cancer-specific mortality (CSM) in the aging patient's papulation with bladder cancer (BCa) treated with radical cystoprostatectomy (RCP). MATERIALS AND METHODS Within the SEER database (2004-2015), 1468 patients were treated with RCP for BCa harboring histopathological PCa findings. To account for other cause mortality (OCM), multivariable competing risk regression (CRR) tested for potential BCa-CSM differences according to PCa characteristics risk factors predicting CSM. RESULTS CRR analysis revealed that only following BCa characteristics, as high pathological tumor stages(Ta/Tis/T1 [REF.] vs. T2; HR 2.03, 95% CI: 1.16-3.57, p = 0.014 vs. T3; HR 4.32, 95% CI: 2.45-7.61, p < 0.001 vs. T4; HR 5.06, 95% CI: 2.77-9.22, p < 0.001), as well unfavorable BCa grade IV (Grade I-II [REF.] vs. Grade IV; HR 0.58, 95% CI: 0.35-0.98, p < 0.041) achieved independent predictor status of CSM. With regard to PCa characteristics, none of the covariates yielded independent predictor status of CSM. CONCLUSIONS Our study, based on the largest population cohort, demonstrates that even in organ-confined BCa patients, concomitant PCa as second malignancy does not represent a risk factor for survival.
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Affiliation(s)
- Mykyta Kachanov
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Armin Soave
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Thomas Jankowski
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Randi M Pose
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mikolaj Mandrek
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jorn H Witt
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Markus Graefen
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Paediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
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18
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Urothelial carcinoma of the bladder with isolated lymph node metastasis: Natural history and outcomes following surgical resection. Urol Oncol 2022; 41:255.e7-255.e14. [PMID: 36470805 DOI: 10.1016/j.urolonc.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/03/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Although pathologic lymph node involvement carries a poor prognosis in patients with urothelial carcinoma of the bladder (UCB), a subset of patients may demonstrate durable survival following surgical resection. To this end, there are limited contemporary data describing the natural history of UCB in patients with isolated lymph node involvement (cN0pN+) following radical cystectomy (RC) with pelvic lymph node dissection (PLND). We therefore utilized a large, nationwide oncology dataset to examine the natural history and outcomes of cN0 pN+ UCB after surgical resection. MATERIALS AND METHODS We identified patients in the National Cancer Database (NCDB) with cN0 pN+ cM0 UCB from 2006 to 2015 treated with RC and PLND. The associations of baseline characteristics with all-cause mortality (ACM) were evaluated using Cox regression. RESULTS A total of 2,884 patients formed the study cohort, including 42% with pN1 and 58% with pN2-3 disease. Of these, 606 (21%) received multiagent neoadjuvant chemotherapy, while 1,172 (41%) received postoperative adjuvant chemotherapy. A median of 15 (IQR 9-23) LNs were removed during PLND. The 5- and 7-year OS for the entire cohort were 20% and 17%, respectively. Compared to the overall cohort, patients surviving ≤5 years had lower pN stage (59% vs. 42% pN1) and lower pT stage (41% vs. 22% ≤pT2). On multivariable analysis, higher pT stage (HR 2.85, 95% CI 1.52-5.36 for pT3, HR 3.27, 95% CI 1.73-6.18 for pT4 vs. pT0), higher pN stage (HR 1.17, 95% CI 1.05-1.31 for pN2-3 vs. pN1), and increasing LN density (HR 2.37, 95% CI 1.88-2.99) were most strongly associated with increased ACM, while receipt of adjuvant chemotherapy (HR 0.61, 95% CI 0.55-0.68) was associated with reduced ACM. CONCLUSIONS Although OS for patients with cN0 pN+ M0 UCB is poor, a subset of patients demonstrates durable long-term survival with 5- and 7-year OS of 20% and 17%, respectively. pT and pN stage represent important prognostic characteristics, while administration of adjuvant chemotherapy represents a potential therapeutic intervention associated with improved ACM.
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Shiraishi Y, Maehama T, Nishio M, Otani J, Hikasa H, Mak TW, Sasaki T, Honma T, Kondoh Y, Osada H, Yoshida M, Fujisawa M, Suzuki A. N-(3,4-dimethoxyphenethyl)-6-methyl-2,3,4,9-tetrahydro-1H-carbazol-1-amine inhibits bladder cancer progression by suppressing YAP1/TAZ. Genes Cells 2022; 27:602-612. [PMID: 36054428 DOI: 10.1111/gtc.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/30/2022]
Abstract
Bladder cancer (BlC) is the fourth most common cancer in males worldwide, but few systemic chemotherapy options for its effective treatment exist. The development of new molecularly-targeted agents against BlC is therefore an urgent issue. The Hippo signaling pathway, with its upstream LATS kinases and downstream transcriptional co-activators YAP1 and TAZ, plays a pivotal role in diverse cell functions, including cell proliferation. Recent studies have shown that overexpression of YAP1 occurs in advanced BlCs and is associated with poor patient prognosis. Accessing data from our previous screening of a chemical library of compounds targeting the Hippo pathway, we identified DMPCA (N-(3,4-dimethoxyphenethyl)-6-methyl-2,3,4,9-tetrahydro-1H-carbazol-1-amine) as an agent able to induce the phosphorylation of LATS1 and YAP1/TAZ in BlC cells, thereby suppressing their viability both in vitro and in mouse xenografts. Our data indicate that DMPCA has a potent anti-tumor effect, and raise the possibility that this agent may represent a new and effective therapeutic option for BlC.
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Affiliation(s)
- Yusuke Shiraishi
- Division of Molecular and Cellular Biology, Kobe University Graduate School of Medicine, Kobe, Japan.,Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomohiko Maehama
- Division of Molecular and Cellular Biology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Miki Nishio
- Division of Molecular and Cellular Biology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junji Otani
- Division of Molecular and Cellular Biology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Hikasa
- Department of Biochemistry, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Tak Wah Mak
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Immunology, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Pathology, LKS Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Takehiko Sasaki
- Department of Biochemical Pathophysiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Teruki Honma
- RIKEN Center for Biosystems Dynamics Research, Yokohama, Japan
| | - Yasumitsu Kondoh
- Chemical Biology Research Group, RIKEN Center for Sustainable Resource Science, Wako, Japan
| | - Hiroyuki Osada
- Chemical Biology Research Group, RIKEN Center for Sustainable Resource Science, Wako, Japan.,Department of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Minoru Yoshida
- Chemical Genomics Research Group, RIKEN Center for Sustainable Resource Science, Wako, Japan.,Department of Biotechnology, Graduate School of Agricultural and Life Sciences, University of Tokyo, Tokyo, Japan
| | - Masato Fujisawa
- Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Suzuki
- Division of Molecular and Cellular Biology, Kobe University Graduate School of Medicine, Kobe, Japan
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20
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Kochergin M, Fahmy O, Esken L, Goetze T, Xylinas E, Stief CG, Gakis G. Systematic Review and Meta-Analysis on the Role of Perioperative Blood Transfusion in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma. Bladder Cancer 2022; 8:315-327. [PMID: 38993684 PMCID: PMC11181769 DOI: 10.3233/blc-201534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radical cystectomy (RC) is the standard of care in patients with muscle-invasive bladder cancer. The impact of perioperative red blood cell (RBC) transfusion on oncological outcomes after RC is not clearly established as the existing publications show conflicting results. OBJECTIVES The aim of this systematic review and meta-analysis was to investigate the prognostic role of perioperative RBC transfusion on oncological outcomes after RC. METHODS Systematic online search on PubMed was conducted, based on PRISMA criteria for publications reporting on RBC transfusion during RC. Publications with the following criteria were included: (I) reported data on perioperative blood transfusion; (II) Reported Hazard ratio (HR) and 95% -confidence interval (CI) for the impact of transfusion on survival outcomes. Primary outcome was the impact of perioperative RBC transfusion on recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Risk of bias assessment was performed using Newcastle-Ottawa Scale. Statistical analysis was performed using Revman 5.4 software. RESULTS From 27 primarily identified publications, 19 eligible articles including 22897 patients were selected. Perioperative RBC transfusion showed no impact on RFS (Z = 1.34; p = 0,18) and significant negative impact on CSS (Z = 2.67; p = 0.008) and OS (Z = 3.22; p = 0.001). Intraoperative RBC transfusion showed no impact on RFS (Z = 0.58; p = 0.56) and CSS (Z = 1.06; p = 0.29) and OS (Z = 1.47; p = 0.14).Postoperative RBC transfusion showed non-significant trend towards improved RFS (Z = 1.89; p = 0.06) and no impact on CSS (Z = 1.56; p = 0.12) and OS (Z = 0.53 p = 0.60). CONCLUSION In this meta-analysis, we found perioperative blood transfusion to be a significant predictor only for worse CSS and OS but not for RFS. This effect may be determined by differences in tumor stages and patient comorbidities for which this meta-analysis cannot control due to lack of respective raw data.
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Affiliation(s)
- Maxim Kochergin
- Department of Urology and Neurourology, BG Unfallkrankenhaus Berlin, Berlin, Germany
| | - Omar Fahmy
- Department of Urology, Universiti Putra Malaysia (UPM), Selangor, Malaysia
| | - Lisa Esken
- Department of Urology and Pediatric Urology, Nordwest Hospital, Frankfurt am Main, Germany
| | - Thorsten Goetze
- Institute of Clinical Cancer Research, Nordwest Hospital, Frankfurt am Main, Germany
| | - Evanguelos Xylinas
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Christian G. Stief
- Department of Urology, University Hospital Ludwig-Maximilians-University, Munich, Germany
| | - Georgios Gakis
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
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21
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Howard JM, Cook GS, Tverye A, Nandy K, Margulis V, Woldu SL, Lotan Y. Outcomes of Patients with Bacillus Calmette-Guérin (BCG)-Unresponsive Non-Muscle Invasive Bladder Cancer as Defined by the U.S. Food and Drug Administration. Bladder Cancer 2022; 8:303-314. [PMID: 38993682 PMCID: PMC11181681 DOI: 10.3233/blc-211657] [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: 12/20/2021] [Accepted: 05/31/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Limited data are available on the outcomes of patients with non-muscle invasive bladder cancer (NMIBC) unresponsive to intravesical bacillus Calmette-Guérin (BCG), as defined by the United States Food and Drug Administration. OBJECTIVE To define the outcomes of patients with BCG-unresponsive NMIBC. METHODS This was a retrospective, single-institution observational cohort study. Records of patients managed at our institution for BCG-unresponsive NMIBC between 2005 and 2020 were reviewed and clinical outcomes evaluated. RESULTS The study included 149 patients. Management was with initial radical cystectomy in 60 patients (40%) and initial bladder-sparing therapy (BST) in 89 patients (60%). Overall survival was greater among patients undergoing RC than BST (HR 1.83, 95% CI 1.04-3.22, p = 0.036), potentially due to patient selection, as no significant difference was noted for metastasis-free or cancer-specific survival. Patients opting for initial BST had high rates of treatment failure, with estimated 5-year cystectomy-free survival of only 42%. Patients who received additional lines of BST after a subsequent failure were at increased risk of having ≥pT3 or pN+ disease at cystectomy (42% for ≥2 lines BST, versus 18% for 1 line BST and 15% for initial cystectomy, p = 0.038). CONCLUSION Among patients who underwent initial BST for BCG-unresponsive NMIBC, rates of treatment failure were very high. Patients who underwent delayed cystectomy after ≥2 lines of BST had elevated rates of extravesical disease. Our observations emphasize the importance of recent and ongoing clinical trials in this clinical space.
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Affiliation(s)
- Jeffrey M Howard
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Urology, Maine Medical Center, Portland, ME, USA
| | - Grayden S Cook
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Division of Urology, Brigham and Women's Hospital / Harvard Medical School, Boston, MA, USA
| | - Aaron Tverye
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Karabi Nandy
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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22
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Yao Z, Zhang H, Zhang X, Zhang Z, Jie J, Xie K, Li F, Tan W. Identification of tumor microenvironment-related signature for predicting prognosis and immunotherapy response in patients with bladder cancer. Front Genet 2022; 13:923768. [PMID: 36147509 PMCID: PMC9485450 DOI: 10.3389/fgene.2022.923768] [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: 04/19/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
The tumor microenvironment (TME) not only provides fertile soil for tumor growth and development but also widely involves immune evasion as well as the resistance towards therapeutic response. Accumulating interest has been attracted from the biological function of TME to its effects on patient outcomes and treatment efficacy. However, the relationship between the TME-related gene expression profiles and the prognosis of bladder cancer (BLCA) remains unclear. The TME-related genes expression data of BLCA were collected from The Cancer Genome Atlas (TCGA) database. NFM algorithm was used to identify the distinct molecular pattern based on the significantly different TME-related genes. LASSO regression and Cox regression analyses were conducted to identify TME-related gene markers related to the prognosis of BLCA and to establish a prognostic model. The predictive efficacy of the risk model was verified through integrated bioinformatics analyses. Herein, 10 TME-related genes (PFKFB4, P4HB, OR2B6, OCIAD2, OAS1, KCNJ15, AHNAK, RAC3, EMP1, and PRKY) were identified to construct the prognostic model. The established risk scores were able to predict outcomes at 1, 3, and 5 years with greater accuracy than previously known models. Moreover, the risk score was closely associated with immune cell infiltration and the immunoregulatory genes including T cell exhaustion markers. Notably, the predictive power of the model in immunotherapy sensitivity was verified when it was applied to patients with metastatic urothelial carcinoma (mUC) undergoing immunotherapy. In conclusion, TME risk score can function as an independent prognostic biomarker and a predictor for evaluating immunotherapy response in BLCA patients, which provides recommendations for improving patients' response to immunotherapy and promoting personalized tumor immunotherapy in the future.
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Affiliation(s)
| | | | | | | | | | | | - Fei Li
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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23
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Li X, Li H, Gao XS, Fang D, Qin S, Zhang Z, Zhou L, Li X, Wang D. Effectiveness of adjuvant radiotherapy for high recurrence risk patients with upper tract urothelial carcinoma. Urol Oncol 2022; 40:410.e1-410.e10. [DOI: 10.1016/j.urolonc.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 11/16/2022]
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24
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Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer. Cancers (Basel) 2022; 14:cancers14153797. [PMID: 35954460 PMCID: PMC9367342 DOI: 10.3390/cancers14153797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: The purpose of this study is to compare perioperative and oncological outcomes of upfront vs. delayed early radical cystectomy (eRC) for high-risk non-muscle-invasive bladder cancer (HR-NMIBC). Methods: All consecutive HR-NMIBC patients who underwent eRC between 2001 and 2020 were retrospectively included and divided into upfront and delayed groups, according to the receipt or not of BCG. Perioperative outcomes were evaluated and the impact of upfront vs. delayed eRC on pathological upstaging, defined as ≥pT2N0 disease at final pathology, was assessed using multivariable logistic regression. Recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) were compared between upfront and delayed eRC groups using inverse probability of treatment weighting (IPTW)-adjusted Cox model. Results: Overall, 184 patients received either upfront (n = 87; 47%) or delayed (n = 97; 53%) eRC. No difference was observed in perioperative outcomes between the two treatment groups (all p > 0.05). Pathological upstaging occurred in 55 (30%) patients and upfront eRC was an independent predictor (HR = 2.65; 95% CI = (1.23−5.67); p = 0.012). In the IPTW-adjusted Cox analysis, there was no significant difference between upfront and delayed eRC in terms of RFS (HR = 1.31; 95% CI = (0.72−2.39); p = 0.38), CSS (HR = 1.09; 95% CI = (0.51−2.34); p = 0.82) and OS (HR = 1.19; 95% CI = (0.62−2.78); p = 0.60). Conclusion: our results suggest similar perioperative outcomes between upfront and delayed eRC, with an increased risk of upstaging after upfront eRC that did impact survival, as compared to delayed eRC.
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25
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Fasanella D, Marchioni M, Domanico L, Franzini C, Inferrera A, Schips L, Greco F. Neobladder "Function": Tips and Tricks for Surgery and Postoperative Management. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081193. [PMID: 36013372 PMCID: PMC9409805 DOI: 10.3390/life12081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/21/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
Abstract
Orthotopic neobladder (ONB) reconstruction is a continent urinary diversion procedure increasingly used in patients with muscle-invasive bladder cancer following radical cystectomy (RC). It represents a valid alternative to the ileal duct in suitable patients who do not prefer a stoma and are motivated to undergo adequate training of the neobladder. Careful patient selection, taking into account the absolute and relative contraindications for ONB as well as an adequate recovery protocol after surgery are integral to the success of this procedure and the oncological and functional outcomes. The objective of this review is to summarize the current data on RC with ONB in terms of patient selection, preoperative preparation, surgical techniques and functional (continence and sexual activity) and oncological outcomes, with particular attention to the management of complications and the impact on quality of life (QoL).
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Affiliation(s)
- Daniela Fasanella
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Michele Marchioni
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Luigi Domanico
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Claudia Franzini
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Antonino Inferrera
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
| | - Luigi Schips
- Urology Unit, Department of Medical, Oral and Biotechnological Sciences, G. d’Annunzio University of Chieti, SS Annunziata Hospital, 66100 Chieti, Italy
| | - Francesco Greco
- Urology Unit, Centro Salute Uomo, Via Palma il Vecchio 4a, 24122 Bergamo, Italy
- Correspondence: ; Tel.: +39-3317918535
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26
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Mally D, Pfister D, Heidenreich A, Albers P, Niegisch G. [Does robotic radical cystectomy affect oncological outcomes in bladder cancer patients?]. Aktuelle Urol 2022; 53:153-158. [PMID: 35345013 DOI: 10.1055/a-1745-8521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Robot-assisted surgery in urology is now being used in a wide range of procedures. In addition to reconstructive procedures, tumour surgery such as radical cystectomy is of particular importance. While studies on the perioperative quality of robotic-assisted radical cystectomy suggest a favorable impact on morbidity (and thus mortality), the question remains as to what extent the oncological quality is influenced by this procedure in terms of recurrence-free and overall survival.In this context, following a comprehensive literature review, this paper presents data from retrospective cohort comparisons of open and robotic cystectomy, registry data and single centre series on robotic and open cystectomy, and the results of prospective randomised trials.In summary, from an oncological point of view, robotic cystectomy is not inferior to open cystectomy. Overall survival, cancer-specific survival, and progression-free survival data do not differ in retrospective cohort studies, in indirect comparisons of registry data and/or large series, or in prospective studies to date. With regard to the occurrence of atypical metastases after robotic cystectomy, prospective data are currently lacking and retrospective analysis produce conflicting data. However, general oncological outcome seems not to be affected.Thus, robotic-assisted cystectomy is also from an oncological point of view a good option for patients who have an indication for radical cystectomy.
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Affiliation(s)
- David Mally
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - David Pfister
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Axel Heidenreich
- Klinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Köln, Germany
| | - Peter Albers
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Klinik für Urologie, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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27
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Grunewald CM, Feldmeier V, Supprian T, Albers P, Giessing M, Niegisch G. Cognitive function in patients undergoing cystectomy for bladder cancer – results from a prospective observational study. Ther Adv Urol 2022; 14:17562872221087660. [PMID: 35356753 PMCID: PMC8958686 DOI: 10.1177/17562872221087660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/25/2022] [Indexed: 12/16/2022] Open
Abstract
Background: Impaired cognitive function of bladder cancer patients plays a role in coping with the kind of urinary diversion and may impact perioperative morbidity. In this study we therefore aimed to assess the prevalence of mild cognitive impairment in patients undergoing radical cystectomy. Secondary objectives included correlation of common cognition tests, assessment of the admitting physician, and perioperative complication rates. Methods: Patients undergoing radical cystectomy for bladder cancer were prospectively screened by neuropsychological tests including cognition tests [DemTect (Dementia Detection test), MMSE (Mini-Mental State Examination), clock drawing test] prior to surgery. Besides, clinical characteristics and perioperative outcomes were documented. Frequency of mild cognitive impairment as assessed by DemTect was correlated with the results of MMSE and clock drawing test, the occurrence of anxiety and depression, the assessment of the admitting physician, and perioperative complication rates as calculated by Spearman rank correlation coefficient. Comparative analysis (parametric and nonparametric) of patient characteristics (nonpathological versus pathological DemTect suggestive of mild cognitive impairment) was performed. Results: A total of 51 patients (80% male, median age 69 years) were analyzed. DemTect was suspicious of mild cognitive impairment in 27% (14/51) of patients, whereas MMSE and clock drawing test showed pathological results only in 10/51 and 6/51 patients, respectively. We found no correlation between mild cognitive impairment and anxiety/depression status. In all, 5/20 patients (25%) with suspicious DemTect results were considered suitable for a continent diversion neobladder by the admitting physician. Suspicious DemTect results were predictive for higher perioperative complication rates (29% versus 5%). Study limitations include small sample size and missing long-term follow-up. Conclusions: Mild cognitive impairment was observed in more than a quarter of radical cystectomy patients prior to surgery. Preoperative assessment should be supplemented by neuropsychological testing such as the DemTect as mild cognitive impairment is often underestimated and associated with significantly higher perioperative complication rates.
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Affiliation(s)
- Camilla M. Grunewald
- Department of Urology, Medical Faculty, Heinrich Heine University, Moorenstr. 5, 40225 Duesseldorf, Germany
| | - Vera Feldmeier
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tillmann Supprian
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Peter Albers
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Markus Giessing
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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28
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van Hauen MB, Maibom SL, Thind PO, Martin Poulsen A, Joensen UN, Røder MA. Risk of recurrence and long-term mortality following radical cystectomy for bladder cancer. Scand J Urol 2022; 56:149-154. [PMID: 35068354 DOI: 10.1080/21681805.2022.2028897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the risk of recurrence and long-term mortality after radical cystectomy (RC) for bladder cancer (BC) at a high-volume tertiary referral center in Denmark over 19 years. MATERIALS AND METHODS Patients undergoing RC between the 1st of January 2000 to 31st of December 2018 were included. Patient data were manually retrieved from electronic patient files. Follow-up ended 18th of May 2020. Cumulative incidences were used to assess risk of recurrence and mortality using competing risk modelling. Cause-specific Cox regression models were used for multivariable analysis. RESULTS A total of 1267 patients underwent RC of which 1042 were eligible for analysis. Overall mortality was 40% and 56% after 5 and 10 years, respectively. The cumulative incidence of recurrence and BC specific mortality was high within the first 2 years. Only 3.2% of the patients with recurrence were alive at the end of follow-up. The cumulative incidence of BC mortality after 5 years was 6.7% (95% CI 3.6-9.9) and 10% (95% CI 6.8-14) for patients with ≤ pT1bN0 and pT2N0, respectively. For patients with lymph node positive disease the cumulative incidence of BC mortality after 5 years was 65% (95% CI 58-71). CONCLUSIONS We found a significant risk of recurrence and disease-specific mortality following RC for BC, especially within the first 2 years following surgery. Our data seem comparable to other large cohorts. The chance of long-term survival following recurrence is low and there is a continuous need to improve adjuvant or salvage strategies following RC.
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Affiliation(s)
- Matilde Bangsbo van Hauen
- Urological Research Unit, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sophia Liff Maibom
- Urological Research Unit, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Peter Ole Thind
- Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Urological Research Unit, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Urological Research Unit, Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Obarzanowski M, Kopczynski J, Jaskulski J, Domagala A, Macek P, Gozdz S, Salagierski M. Is ERCC1 a prognostic biomarker for urothelial cancer following radical cystectomy? A long-term analysis. Cent European J Urol 2021; 74:348-354. [PMID: 34729224 PMCID: PMC8552925 DOI: 10.5173/ceju.2021.0043] [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: 02/13/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Excision repair cross-complementation 1 protein (ERCC1) plays a vital role in cancer cells enabling DNA repair via nucleotide excision repair. Thus, we hypothesized whether expression of this protein may be utilized as a prognostic marker in patients after radical cystectomy. MATERIAL AND METHODS The final analysis involved 123 patients with urothelial bladder carcinoma who underwent radical cystectomy with bilateral lymphadenectomy. The median follow-up time was equal to 853 days. ERCC1 status was evaluated immunohistochemically with the application of tissue microarrays. RESULTS Positive ERCC1 expression was noted in 46% of the studied cases. Among the analyzed clinical and pathological factors, we could not establish a statistically significant correlation with ERCC1. Similarly, survival curves were statistically indifferent in patients with tumors categorized according to both expression categories. We did not confirm a prognostic value of ERCC1 in the multivariate regression analysis. CONCLUSIONS ERCC1 expression does not influence the overall survival of patients with urothelial bladder carcinoma after radical cystectomy.
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Affiliation(s)
- Mateusz Obarzanowski
- Institute of Medical Scienes, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Urology, Holycross Cancer Center, Kielce, Poland
| | - Janusz Kopczynski
- Institute of Medical Scienes, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Pathology, Holycross Cancer Center, Kielce, Poland
| | - Jaroslaw Jaskulski
- Institute of Medical Scienes, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Urology, Holycross Cancer Center, Kielce, Poland
| | - Antoni Domagala
- Institute of Medical Scienes, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Urology, Holycross Cancer Center, Kielce, Poland
| | - Pawel Macek
- Institute of Medical Scienes, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Cancer Epidemiology and Cancer Control, Holycross Cancer Center, Kielce, Poland
| | - Stanislaw Gozdz
- Institute of Medical Scienes, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
- Department of Clinical Oncology, Holycross Cancer Center, Kielce, Poland
| | - Maciej Salagierski
- Department of Urology, Collegium Medicum, University of Zielona Góra, Poland
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Impact of preoperative chemotherapy on pathologic nodal status in muscle-invasive bladder cancer: optimal lymphadenectomy in the preoperative chemotherapy era. J Cancer Res Clin Oncol 2021; 148:2507-2515. [PMID: 34557987 DOI: 10.1007/s00432-021-03789-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the impact of preoperative chemotherapy (pCTX) on pathologic nodal (pN) status and evaluate the optimal lymphadenectomy method according to clinical nodal (cN) status in patients with muscle-invasive bladder cancer who received pCTX. MATERIALS AND METHODS We retrospectively reviewed 449 patients with muscle-invasive bladder cancer who underwent radical cystectomy. Among them, 139 (31.0%) received pCTX. We analyzed overall survival among three groups (cN-pCTX-, cN-pCTX+, and cN+pCTX+); the impact of lymphadenectomy extent according to the history of pCTX in cN- patients (n = 393); and the pN status which includes number of positive lymph nodes, and lymph node density in cN- patients who underwent extended lymphadenectomy (n = 222). RESULTS Overall survival was significantly dependent on cN status, and pCTX had no survival advantage although it decreased the percentage of pN+ patients and the number of positive lymph nodes in cN- patients. Lymph node density showed a significant prognostic effect on overall survival in Cox regression analysis both in cN- and cN+ patients. In cN- patients, there was no significant survival difference according to lymphadenectomy extent regardless of receiving pCTX. CONCLUSIONS pCTX can control micrometastases but not overt metastases, despite decreasing the number of positive lymph nodes in patients with muscle-invasive bladder cancer. Although extended lymphadenectomy is a reasonable diagnostic strategy in the pCTX era, standard dissection is as therapeutic as extended dissection in patients with cN- disease.
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Dracham CB, Kumar N, Kumar S, Elangovan A, Yadav BS, Mavuduru RS, Lal A, Gupta PK, Kapoor R. A phase II study of neoadjuvant chemotherapy followed by organ preservation in patients with muscle-invasive bladder cancer. Asian J Urol 2021; 9:318-328. [PMID: 36035340 PMCID: PMC9399551 DOI: 10.1016/j.ajur.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 09/04/2020] [Accepted: 02/03/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Conservative approaches in muscle-invasive bladder cancer (MIBC) have been evolved to avoid aggressive surgery, but are limited to elderly, frail, and patients medically unfit for surgery. Our study aimed to assess the response rate of neoadjuvant chemotherapy (NACT) before radiotherapy (RT) in MIBC patients. Methods Forty patients with urothelial carcinoma of stage T2–T4a, N0, M0 were enrolled between November 2013 and November 2015, and treated with three cycles of NACT with gemcitabine-cisplatin. Post-NACT response was assessed using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Patients who achieved complete response (CR) and partial response (PR) >50% were treated with radical RT, and those who had PR <50%, stable disease (SD), and progressive disease (PD) underwent radical cystectomy (RC). Survival analysis was done with Kaplan-Meier method and point-to-time events were analyzed with Cox-proportional hazards regression model. Results After NACT, 35 (87.5%) patients achieved either PR >50% or CR, and were treated with RT. Five (12.5%) patients who had PR <50%, SD, or PD underwent RC. All patients who received radiation showed CR after 6 weeks. Median follow-up was 43 months (range: 10–66 months) and median overall survival (OS) was not reached. Three-year OS, local control, and disease-free survival were 70.1%, 60.9%, 50.6%, respectively, and 50% of patients preserved their functioning bladder. Three-year OS rate was 88.9% in patients who achieved CR to NACT, 73.1% in patients with PR ≥50% and 40% in patients with PR <50%. Conclusion NACT followed by RT provides a high probability of local response with bladder preservation in CR patients. Appropriate use of this treatment regimen in carefully selected patients may omit the need for morbid surgery.
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Ham WS, Rha KH, Han WK, Kwon TG, Kim TH, Jeon SH, Lee SH, Kang SH, Kang SG, Nam JK, Kim W, Jeong BC, Ku JH, Oh JJ, Lee SC, Lee JY, Hong SH, Lee YG, Lee YS, Park SY, Yoon YE, Kim J. Oncologic Outcomes of Intracorporeal vs Extracorporeal Urinary Diversion After Robot-Assisted Radical Cystectomy: A Multi-Institutional Korean Study. J Endourol 2021; 35:1490-1497. [PMID: 33678003 DOI: 10.1089/end.2021.0067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to compare the oncologic outcomes of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) in patients diagnosed with bladder cancer. Materials and Methods: Medical records of 730 patients who underwent RARC between April 2007 and May 2019 in 11 tertiary referral centers were retrospectively reviewed. We assessed recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in the two groups using the Kaplan-Meier method. Cox regression models were used to identify factors associated with RFS, CSS, and OS. Results: Among 591 patients, neobladder diversion was performed more frequently in the ICUD group (70.8% vs 52.5%, p = 0.001). The median follow-up duration was shorter in the ICUD group than in the ECUD group (16 vs 26 months, p < 0.001). The rates of overall recurrence (36.5% vs 25.5%, p = 0.013) and pelvic recurrence (12.1% vs 5.9%, p = 0.031) were higher in the ECUD group. However, no differences in 5-year RFS (43.2% vs 58.4%, p = 0.516), CSS (79.3% vs 89.7%, p = 0.392), and OS (74.3% vs 81.4%, p = 0.411) were noted between the two groups. Multivariable analysis revealed that when compared to ICUD, ECUD was not associated with RFS (hazard ratio [HR], 0.982; p = 0.920), CSS (HR, 0.568; p = 0.126), and OS (HR, 0.642; p = 0.124). Conclusion: Although there was a difference in recurrence rate between the two groups, multivariable analysis indicated that the diversion technique after RARC did not affect the oncologic outcomes. Large prospective studies with long-term follow-up are warranted to verify the oncologic outcomes of ICUD and ECUD following RARC.
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Affiliation(s)
- Won Sik Ham
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seung Hyun Jeon
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Hyup Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Wansuk Kim
- Department of Urology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Byung Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ja Hyun Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Chul Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Yeol Lee
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Goo Lee
- Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Yong Seong Lee
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Sung Yul Park
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Eun Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Korea
| | - Jongchan Kim
- Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Urology, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
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Tumedei MM, Ravaioli S, Matteucci F, Celli M, De Giorgi U, Gunelli R, Puccetti M, Paganelli G, Bravaccini S. Spotlight on PSMA as a new theranostic biomarker for bladder cancer. Sci Rep 2021; 11:9777. [PMID: 33963223 PMCID: PMC8105396 DOI: 10.1038/s41598-021-89160-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
Bladder cancer (BCa) patients are diagnosed by cytology and cystoscopy. However, these diagnostic tests bear some limitations. We sought for reliable biomarkers to better determine BCa extension. Prostate-specific membrane antigen (PSMA) appears to fulfill this requirement in prostate cancer but its role in BCa has not been established yet. We then analyzed 87 bladder tissue samples from 74 patients assessing PSMA expression by immunohistochemistry. The median PSMA expression, exclusively found in tumor neovasculature, in terms of H-score significantly differed between non-tumor samples and tumor samples (p = 0.00288) showing a higher neovasculature-related PSMA expression. No differences were observed in relation to tumor type, grade and stage. BCa neovasculature-related PSMA overexpression may be useful in defining the degree of extension of the neoplasm. In addition, testing PSMA expression by immunohistochemistry may hold theranostic implications both considering anti-angiogenesis agents and radio-labelled PSMA ligands for intracavitary radionuclide therapy. In our opinion, BCa neovasculature-related PSMA overexpression may be considered an apt target for anti-angiogenesis and radionuclide treatment in BCa, once the evaluation of tumor-retention time for the appropriateness of long half-life therapeutic PSMA ligands as radionuclide treatment will be performed.
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Affiliation(s)
- Maria Maddalena Tumedei
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Sara Ravaioli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy.
| | - Federica Matteucci
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Monica Celli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Ugo De Giorgi
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Roberta Gunelli
- Department of Urology, Morgagni Pierantoni Hospital, Forli, Italy
| | | | - Giovanni Paganelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Via P. Maroncelli 40, 47014, Meldola, Italy
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Maas M, Rausch S, Guttenberg T, Seiler R, Hennenlotter J, Oo HZ, Fazli L, Kühs U, Gakis G, Stenzl A, Schwentner C, Black PC, Todenhöfer T. Receptor Activator of NF Kappa B (RANK) Expression Indicates Favorable Prognosis in Patients with Muscle-invasive Bladder Cancer. Eur Urol Focus 2021; 8:718-727. [PMID: 33962883 DOI: 10.1016/j.euf.2021.04.015] [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: 02/02/2021] [Revised: 04/01/2021] [Accepted: 04/15/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Receptor activator of NF kappa B (RANK) and its ligand have an essential role in T-cell regulation and the development of bone metastases. The role of RANK expression in muscle-invasive bladder cancer (MIBC) is unknown. OBJECTIVE To assess the relevance of RANK expression in patients with MIBC. DESIGN, SETTING, AND PARTICIPANTS Expression of RANK was assessed via immunohistochemistry of benign urothelium, MIBC tissue, and lymph node metastases from 153 patients undergoing radical cystectomy. Expression data from The Cancer Genome Atlas (TCGA) cohort were analyzed for potential associations with molecular subtypes and outcome. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS RANK expression was correlated with clinical and pathological parameters and to individual data for the clinical course of MIBC. RESULTS AND LIMITATIONS Expression of RANK was significantly higher in both primary tumors (p = 0.02) and lymph node metastases (p = 0.01) compared to normal urothelium. In tumor tissue, RANK expression was significantly lower in patients with locally advanced disease and lymph node involvement compared to those with organ-confined disease (p = 0.0009) and node-negative MIBC (p = 0.0002). In univariable and multivariable analyses, high expression of RANK was associated with a longer time to recurrence (p = 0.0005 and 0.01) and better cancer-specific (p = 0.0004 and 0.007) and overall survival (p = 0.002 and 0.04). High expression of RANK was associated with better outcome for patients with luminal infiltrated tumors in the TCGA cohort. CONCLUSIONS RANK expression is increased in bladder cancer tissue compared to benign urothelium, with higher expression in organ-defined compared to locally advanced disease. High RANK expression indicates a favorable prognosis in MIBC. The prognostic role differs in tumors of different molecular subtypes. PATIENT SUMMARY Expression of a protein involved in bone turnover regulation (RANK) is higher in bladder cancer tissue than in benign bladder tissue. However, high levels of RANK on tumor cells indicate favorable prognosis for patients with bladder cancer that invades the muscle layer of the bladder.
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Affiliation(s)
- Moritz Maas
- Department of Urology, University Hospital, Tübingen, Germany
| | - Steffen Rausch
- Department of Urology, University Hospital, Tübingen, Germany
| | | | - Roland Seiler
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada; Department of Urology, University Hospital, Bern, Switzerland
| | | | - Htoo Zarni Oo
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Ladan Fazli
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Ursula Kühs
- Department of Urology, University Hospital, Tübingen, Germany
| | - Georgios Gakis
- Department of Urology, University Hospital, Würzburg, Germany
| | - Arnulf Stenzl
- Department of Urology, University Hospital, Tübingen, Germany
| | | | - Peter C Black
- Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada
| | - Tilman Todenhöfer
- Department of Urology, University Hospital, Tübingen, Germany; Vancouver Prostate Centre, University of British Columbia, Vancouver, Canada; Clinical Trials Unit, Studienpraxis Urologie, Nürtingen, Germany.
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Nechifor-Boilă IA, Loghin A, Nechifor-Boilă A, Decaussin-Petrucci M, Voidăzan S, Chibelean BC, Martha O, Borda A. PD-L1 Expression in Muscle Invasive Urothelial Carcinomas as Assessed via Immunohistochemistry: Correlations with Specific Clinical and Pathological Features, with Emphasis on Prognosis after Radical Cystectomy. Life (Basel) 2021; 11:life11050404. [PMID: 33925149 PMCID: PMC8146852 DOI: 10.3390/life11050404] [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: 03/19/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 12/24/2022] Open
Abstract
In the present study, we analyzed Programmed Death Ligand-1 (PD-L1) expression in radical cystectomy (RC) specimens from patients with muscle-invasive urothelial carcinoma (UC), in order to assess any correlations with specific clinicopathological features and its potential prognostic value. A multi-institutional study was performed within the departments of urology and pathology at the Mureș County Hospital, Romania, and Centre Hospitalier Lyon Sud, France. Sixty-nine patients with MIBC were included, for whom tumor histology (conventional versus histological variant/differentiation), tumor extension (T), lymph node involvement (N), and distant metastases (M) were recorded. PD-L1 immunostaining was performed using the 22C3 clone and was interpreted using the combined positive score (CPS) as recommended (Dako Agilent, Santa Clara, CA, USA). Positive PD-L1 immunostaining was more prevalent among UCs with squamous differentiation compared to conventional UCs and trended towards an improved OS (p = 0.366). We found the T stage to be a risk factor for poor survival in PD-L1-positive patients (HR 2.9, p = 0.021), along with the N stage in PD-L1-negative patients (HR 1.98, p = 0.007). No other clinicopathological factor was found to be significantly associated with PD-L1 positivity. Thus, we confirm the need for PD-L1 immunostaining prior to initiating immune checkpoint inhibitor therapy for a more accurate assessment of the patients’ chances of responding to treatment.
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Affiliation(s)
- Ioan Alin Nechifor-Boilă
- Department of Anatomy and Embryology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 540142 Târgu-Mures, Romania;
- Department of Urology, Mureș County Hospital, 540142 Târgu-Mures, Romania;
| | - Andrada Loghin
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 540142 Târgu-Mures, Romania; (A.L.); (A.N.-B.); (A.B.)
- Department of Pathology, Mureș County Hospital, 540011 Târgu-Mureș, Romania
| | - Adela Nechifor-Boilă
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 540142 Târgu-Mures, Romania; (A.L.); (A.N.-B.); (A.B.)
- Department of Pathology, Mureș County Hospital, 540011 Târgu-Mureș, Romania
| | - Myriam Decaussin-Petrucci
- Centre Hospitalier Lyon Sud, Department of Pathology, Universite Claude Bernard Lyon 1, 69310 Pierre-Bénite, France;
| | - Septimiu Voidăzan
- Department of Epidemiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 540142 Târgu-Mures, Romania;
| | - Bogdan Călin Chibelean
- Department of Urology, Mureș County Hospital, 540142 Târgu-Mures, Romania;
- Correspondence:
| | - Orsolya Martha
- Department of Urology, Mureș County Hospital, 540142 Târgu-Mures, Romania;
| | - Angela Borda
- Department of Histology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, 540142 Târgu-Mures, Romania; (A.L.); (A.N.-B.); (A.B.)
- Department of Pathology, Emergency Mureș County Hospital, 540136 Târgu Mureș, Romania
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Li S, Lu S, Liu X, Chen X. Association Between the Pretreatment Albumin-to-Alkaline Phosphatase Ratio and Clinical Outcomes in Patients With Bladder Cancer Treated With Radical Cystectomy: A Retrospective Cohort Study. Front Oncol 2021; 11:664392. [PMID: 33959511 PMCID: PMC8093628 DOI: 10.3389/fonc.2021.664392] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/30/2021] [Indexed: 12/14/2022] Open
Abstract
Objective Serum albumin-to-alkaline phosphatase ratio (AAPR) has been proven to be a prognostic indicator of many malignant tumors. However, whether it can predict the prognosis of bladder cancer (BC) patients who underwent radical cystectomy (RC) remains unclear. This study was designed to assess the relationship between AAPR and clinical outcomes in patients with BC treated with RC. Methods The clinicopathological data of 199 BC patients receiving RC in our institution from January 2012 to December 2017 were retrospectively collected and analyzed. They were divided into three groups based on the optimal cut-off values and the association between AAPR groups and their clinical outcomes were evaluated. Results The average age of the patients was (64.0 ± 8.7) years and 79.9% were male. Based on the cut-off values of AAPR, patients were divided into three groups: low-AAPR group (AAPR < 0.37, n = 35), medium-AAPR group (AAPR = 0.37-0.59, n = 61) and high-AAPR group (AAPR > 0.59, n = 103). The median overall survival (OS) of each AAPR group was 12.5, 24, and 29 months, respectively (P value <0.0001). After adjusting the Cox proportional hazards model, medium- and high- AAPR groups showed a reduced risk trend of death, with a risk ratio of 0.44 (95% CI = 0.21-0.91) and 0.25 (95% CI = 0.12-0.49), respectively (P for trend <0.001). No nonlinear relationship was identified by smooth fitting curve between AAPR and OS. By subgroup analysis, we observed that compared to the low-AAPR group, the trends of the HRs in the medium- and high-AAPR group were decreased across nearly all subgroups after stratification. Moreover, the AAPR-based nomograms for OS, CSS and RFS were also constructed. The C-index showed a good predictive accuracy (OS, C-index 0.728, 95% CI 0.663-0.793; CSS, C-index 0.792, 95% CI 0.748-0.838; RFS, C-index 0.784, 95% CI 0.739-0.829). Conclusion Pretreatment AAPR is significantly associated with the prognosis of BC patients receiving RC, which can be conducive to the clinical decision-making and risk stratification in those patients. The nomogram based on AAPR is a reliable model for predicting survival of BC patients after RC.
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Affiliation(s)
- Shijie Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shiyang Lu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuefeng Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaonan Chen
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
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Abstract
The cornerstone for diagnosis and treatment of bladder and upper tract urothelial carcinoma involves surgery. Transurethral resection of bladder tumors forms the basis of further management. Radical cystectomy for invasive bladder carcinoma provides good oncologic outcomes. However, it can be a morbid procedure, and advances such as minimally invasive surgery and early recovery after surgery need to be incorporated into routine practice. Diagnostic ureteroscopy for upper tract carcinoma is needed in cases of doubt after cytology and imaging studies. Low-risk cancers can be managed with conservative endoscopic surgery without compromising oncological outcomes; however, high-risk disease necessitates radical nephroureterectomy.
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Abstract
There are many risk factors for bladder cancer. During an initial assessment of a patient with bladder cancer, a careful discussion and history assessment is important. Particular focus should include social history with details regarding occupational background and discussion of any environmental exposure history.
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Affiliation(s)
- Matthew Mossanen
- Division of Urology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA.
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Narain TA, Tosh JM, Gautam G, Talwar HS, Panwar VK, Mittal A, Mandal AK. Neoadjuvant Therapy for Cisplatin Ineligible Muscle Invasive Bladder Cancer Patients: A Review of Available Evidence. Urology 2021; 154:8-15. [PMID: 33775784 DOI: 10.1016/j.urology.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Neoadjuvant chemotherapy followed by radical cystectomy is the standard of care for muscle invasive non-metastatic bladder cancer patients. While cisplatin based neoadjuvant chemotherapy has been recommended, systemic therapy in a neoadjuvant setting for cisplatin ineligible patients still needs to be addressed. Various strategies like split dosing cisplatin chemotherapy, carboplatin based chemotherapy and taxanes based chemotherapy have been tried as neoadjuvant therapy for cisplatin ineligible patients. Immunotherapy is a promising tool in this regard with a need for the development of predictive and prognostic biomarkers which can bring out the true potential of these immunotherapeutic agents.
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Affiliation(s)
- Tushar Aditya Narain
- Robotic Pelvic Oncology, Department of Urology, University College London Hospital, London
| | | | - Gagan Gautam
- Urological Oncology and Robotic Surgery, Max Institute of Cancer Care, Saket, New Delhi.
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Maffezzini M, Fontana V, Pacchetti A, Dotta F, Cerasuolo M, Chiappori D, Guano G, Mantica G, Terrone C. Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients. ACTA ACUST UNITED AC 2021; 93:15-20. [PMID: 33754602 DOI: 10.4081/aiua.2021.1.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC). METHODS 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC. RESULTS Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed. CONCLUSIONS Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes.
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Affiliation(s)
- Massimo Maffezzini
- Department of Urology, Ospedale Nuovo Legnano, Ospedale Fornaroli Magenta, Milano.
| | - Vincenzo Fontana
- Clinical Epidemiology Unit, IRCCS Policlinico San Martino, University of Genova.
| | - Andrea Pacchetti
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Federico Dotta
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Mattia Cerasuolo
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Davide Chiappori
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Giovanni Guano
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Guglielmo Mantica
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
| | - Carlo Terrone
- Department of Urology, IRCCS Policlinico San Martino, University of Genova.
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Abrahamsson J, Kollberg P, Almquist H, Bläckberg M, Brändstedt J, Lyttkens K, Simoulis A, Sjödahl G, Sörenby A, Trägårdh E, Liedberg F. Complete metabolic response with [ 18 F]fluorodeoxyglucose-positron emission tomography/computed tomography predicts survival following induction chemotherapy and radical cystectomy in clinically lymph node positive bladder cancer. BJU Int 2021; 129:174-181. [PMID: 33626220 DOI: 10.1111/bju.15374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine whether repeated [18 F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET-CT) scans can predict increased cancer-specific survival (CSS) after induction chemotherapy followed by radical cystectomy (RC). PATIENTS AND METHODS Between 2007 and 2018, 86 patients with clinically lymph node (LN)-positive bladder cancer (T1-T4, N1-N3, M0-M1a) were included and underwent a repeated FDG-PET-CT during cisplatin-based induction chemotherapy. The 71 patients that had a response to chemotherapy underwent RC. Response to chemotherapy was evaluated in LNs through repeated FDG-PET-CT and stratified as partial response or complete response using three different methods: maximum standardised uptake value (SUVmax ), adapted Deauville criteria, and total lesion glycolysis (TLG). Progression-free survival (PFS) and CSS were analysed for all three methods by Cox regression analysis. RESULTS After a median follow-up of 40 months, 15 of the 71 patients who underwent RC had died from bladder cancer. Using SUVmax and the adapted Deauville criteria, multivariable Cox regression analyses adjusting for age, clinical tumour stage and LN stage showed that complete response was associated with increased PFS (hazard ratio [HR] 3.42, 95% confidence interval [CI] 1.20-9.77) and CSS (HR 3.30, 95% CI 1.02-10.65). Using TLG, a complete response was also associated with increased PFS (HR 5.17, 95% CI 1.90-14.04) and CSS (HR 6.32, 95% CI 2.06-19.41). CONCLUSIONS Complete metabolic response with FDG-PET-CT predicts survival after induction chemotherapy followed by RC in patients with LN-positive bladder cancer and comprises a novel tool in evaluating response to chemotherapy before surgery. This strategy has the potential to tailor treatment in individual patients by identifying significant response to chemotherapy, which motivates the administration of a full course of induction chemotherapy with a higher threshold for suspending treatment due to toxicity and side-effects.
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Affiliation(s)
- Johan Abrahamsson
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Petter Kollberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Helen Almquist
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Mats Bläckberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Johan Brändstedt
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Kerstin Lyttkens
- Department of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Athanasios Simoulis
- Institution of Translational Medicine, Lund University, Malmö, Sweden.,Department of Pathology, Skåne University Hospital, Malmö, Sweden
| | - Gottfrid Sjödahl
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Anne Sörenby
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Elin Trägårdh
- Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
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42
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Tamura K, Watanabe K, Matsushita Y, Watanabe H, Motoyama D, Ito T, Sugiyama T, Otsuka A, Miyake H. Enhanced Sensitivity to NVP-BEZ235 by Inhibition of p62/SQSTM1 in Human Bladder Cancer KoTCC-1 Cells Both In Vitro and In Vivo. In Vivo 2021; 34:1001-1008. [PMID: 32354885 DOI: 10.21873/invivo.11868] [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] [Received: 12/15/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIM The prognosis of patients with invasive bladder cancer remains poor. The objective of this study was to evaluate the efficacy of NVP-BEZ235 (NVP), a dual PI3K/mTOR inhibitor, combined with the inactivation of p62/SQSTM1 (p62) in a human bladder cancer KoTCC-1 model. MATERIALS AND METHODS An expression plasmid with short hairpin RNA targeted against p62 was transfected into KoTCC-1 cells (KoTCC-1/sh-p62). The antitumor effects of NVP on KoTCC-1/sh-p62 were investigated in comparison with those on KoTCC-1 transfected with a control plasmid alone (KoTCC-1/C). RESULTS KoTCC-1/sh-p62 showed significantly higher sensitivity to NVP than KoTCC-1/C. Treatment of both cell lines with NVP markedly inactivated the PI3K/Akt/mTOR signaling pathway. However, NVP treatment stimulated the autophagic pathway in KoTCC-1/C, but not in KoTCC-1/sh-p62. Furthermore, compared with KoTCC-1/C, NVP treatment induced apoptosis of KoTCC-1/sh-p62 cells, which was accompanied by significant downregulation of c-IAP-1 and XIAP as well as upregulation of Bax. Moreover, the in vivo growth of KoTCC-1/sh-p62 tumors was significantly suppressed by treatment with NVP compared to KoTCC-1/C tumors. CONCLUSION Inhibition of p62 expression combined with NVP may represent an effective therapeutic approach for patients with invasive bladder cancer.
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Affiliation(s)
- Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kyohei Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiromitsu Watanabe
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Daisuke Motoyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takayuki Sugiyama
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Atsushi Otsuka
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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43
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Murthy V, Bakshi G, Manjali JJ, Prakash G, Pal M, Joshi A, Dholakia K, Bhattacharjee A, Talole S, Puppalwar A, Srinivasan S, Panigrahi G, Salunkhe R, Menon S, Noronha V, Prabhash K, Krishnatry R. Locoregional recurrence after cystectomy in muscle invasive bladder cancer: Implications for adjuvant radiotherapy. Urol Oncol 2021; 39:496.e9-496.e15. [PMID: 33573998 DOI: 10.1016/j.urolonc.2021.01.015] [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] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE We report the patterns of locoregional recurrence (LRR) in muscle invasive bladder cancer (MIBC), and propose a risk stratification to predict LRR for optimizing the indication for adjuvant radiotherapy. MATERIALS AND METHODS The study included patients of urothelial MIBC who underwent radical cystectomy with standard perioperative chemotherapy between 2013 and 2019. Recurrences were classified into local and/or cystectomy bed, regional, systemic, or mixed. For risk stratification modelling, T stage (T2, T3, T4), N stage (N0, N1/2, N3) and lymphovascular invasion (LVI positive or negative) were given differential weightage for each patient. The cohort was divided into low risk (LR), intermediate risk (IR) and high risk (HR) groups based on the cumulative score. RESULTS Of the 317 patients screened, 188 were eligible for the study. Seventy patients (37.2%) received neoadjuvant chemotherapy (NACT) while 128 patients (68.1%) had T3/4 disease and 66 patients (35.1%) had N+ disease. Of the 55 patients (29%) who had a recurrence, 31 (16%) patients had a component of LRR (4% cystectomy bed, 11.5% regional 0.5% locoregional). The median time to LRR was 8.2 (IQR 3.3-18.8) months. The LR, IR and HR groups for LRR based on T, N and LVI had a cumulative incidence of 7.1%, 21.6%, and 35% LRR, respectively. The HR group was defined as T3, N3, LVI positive; T4 N1/2, LVI positive; and T4, N3, any LVI. The odds ratio for LRR was 3.37 (95% CI 1.16-9.73, P = 0.02) and 5.27 (95% CI 1.87-14.84, P = 0.002) for IR and HR respectively, with LR as reference. CONCLUSION LRR is a significant problem post radical cystectomy with a cumulative incidence of 35% in the HR group. The proposed risk stratification model in our study can guide in tailoring adjuvant radiotherapy in MIBC.
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Affiliation(s)
- Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India.
| | - Ganesh Bakshi
- Department of Surgery, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Jifmi Jose Manjali
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Gagan Prakash
- Department of Surgery, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Mahendra Pal
- Department of Surgery, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Kunal Dholakia
- Department of Surgery, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Atanu Bhattacharjee
- Department of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Sanjay Talole
- Department of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Abhinav Puppalwar
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Shashank Srinivasan
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Gitanjali Panigrahi
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India
| | - Rohan Salunkhe
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre (TMH/ACTREC), Mumbai, India; Homi Bhabha National Institute (HBNI), Anushakti Nagar, Mumbai, India
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Maisch P, Lunger L, Düwel C, Schmid SC, Horn T, Gschwend JE, Sauter A, Heck MM. Outcomes of palliative cystectomy in patients with locally advanced pT4 bladder cancer. Urol Oncol 2021; 39:368.e11-368.e17. [PMID: 33431328 DOI: 10.1016/j.urolonc.2020.11.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/13/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Radical cystectomy (Cx) is the standard of care for muscle-invasive bladder cancer (BCa). In locally advanced pT4 BCa the oncologic outcome is inexplicit but Cx may be necessary for palliation. OBJECTIVES The aim of this retrospective study was to evaluate the outcomes of Cx performed in patients with locally advanced pT4 BCa and to identify patient subgroups with improved outcome. METHODS Between 2008 and 2017, we identified 76 of 905 patients who underwent Cx for pT4 BCa at a single tertiary referral center. The physical patients' status was estimated according to the American Society of Anesthesiologists (ASA) classification. For the classification of postoperative complication rates, the Clavien-Dindo grading was used. Time-to-event variables with log-rank statistics were calculated with the use of the Kaplan-Meier method. RESULTS Median age was 74 years (range 42-90). Preoperatively, the physical status was estimated poor in 40 (52%) patients (ASA-score of ≥3). Overall, 19 (25%) patients had pT4b BCa, 41 (54%) patients were lymph node positive (c/pN+) and 14 (18%) patients had distant metastases (c/pM+). Within 30 and 90 days after surgery, 21% and 30% of the patients, respectively, developed severe complications (Clavien-Dindo grade ≥3). Overall, 30- and 90-day mortality rates were 9% and 11%, respectively. Moreover, 86% and 75% of patients who died within 30 and 90 days after surgery, respectively, had an ASA-score ≥3. At a median postoperative follow-up of 8 months (range 0-85), 53 (70%) patients have died. During the follow-up period, 46% of the patients died due to progressive disease, 16% died of a noncancer-specific cause, and for 8% of the patients, the reason remains unknown. Median overall survival (OS) and cancer-specific survival were 13.0 and 16.0 months, respectively. In subgroup analyses ASA-score ≥3 and hemoglobin <11.7 g/dl was significantly associated with poor OS. No statistically significant differences were detected between subgroups. CONCLUSION Cx performed in patients with locally advanced pT4 BCa is associated with an increased mortality rate within 90 days postoperatively. Our study revealed that the ASA-score is a relevant and easily available tool to rate the patient´s condition and estimate postoperative outcome.
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Affiliation(s)
- Phillipp Maisch
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany.
| | - Lukas Lunger
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Sebastian C Schmid
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Thomas Horn
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Andreas Sauter
- Department of Radiology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
| | - Matthias M Heck
- Department of Urology, Technical University of Munich, Rechts der Isar Medical Center, Munich, Germany
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Uemura T, Ishibashi T, Pae S, Shirakawa N, Somoto T, Shinohara M, Kobayashi M, Komaru A, Fukasawa S. [CLINICAL STUDY OF OPEN RADICAL CYSTECTOMY AND ILEAL CONDUIT CONSTRUCTION FOR BLADDER CANCER: RESULTS OF 15-YEAR SINGLE CENTER EXPERIENCE]. Nihon Hinyokika Gakkai Zasshi 2021; 112:89-95. [PMID: 35444087 DOI: 10.5980/jpnjurol.112.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
(Objective) We retrospectively analyzed clinical outcome, prognostic factors and adjuvant chemotherapy for bladder cancer patients with open radical cystectomy (ORC) combined with ileal conduit construction (ICC). (Patients and methods) From February 2005 to February 2019, 179 patients underwent ORC and ICC for invasive bladder cancer or BCG unresponsive non-muscle invasive bladder cancer. We investigated intraoperative and early postoperative complications, overall survival (OS), cancer-specific survival (CSS), and poor prognostic factors affecting OS. Furthermore, we evaluated the prognosis of patients with pT3,4 or pN1-3 depending on adjuvant chemotherapy. (Results) Clavien-Dindo Grade 4 or 5 complications were not occurred. The 5-year and 10-year OS probability were 71.1% and 57.4%, respectively, while the 5-year and 10-year CSS probability were 76.5% and 71.5%, respectively. Multivariate analysis revealed that male (HR = 2.70, 95%CI [0.97-7.51]), pT3,4 (HR = 1.83, 95%CI [1.05-3.21]), and pN1-3 (HR = 2.85, 95%CI [1.62-5.03]) were independent poor prognostic factors. Adjuvant chemotherapy significantly improved OS (p = 0.03) and CSS (p = 0.017) in pN1-3 patients. (Conclusion) ORC combined with ICC was an effective operative method, and good results were obtained. Adjuvant chemotherapy may be effective for patients with positive regional lymph nodes.
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Affiliation(s)
| | | | - Sangjon Pae
- Prostate Center and Division of Urology, Chiba Cancer
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46
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Radical Cystectomy. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Stadler WM, Heiss BL. Adjuvant Chemotherapy in Bladder Cancer. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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Risk Stratification of Patients: Risk Tables and Assessment – NMIBC and MIBC. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Krebs M, Sokolakis I, Seiler R, Daneshmand S, Grivas P, Gakis G. Adjuvant Treatment of Residual Disease Following Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle Invasive Bladder Cancer. Bladder Cancer 2020. [DOI: 10.3233/blc-200341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Cisplatin-based neoadjuvant chemotherapy (NAC) has shown overall survival benefit for patients with muscle invasive bladder cancer (MIBC). In contrast, there is limited data for adjuvant treatment options in patients with residual muscle invasive disease after NAC followed by radical cystectomy (RC). OBJECTIVE: This systematic review aims to give an overview of studies examining adjuvant treatment options for patients with residual MIBC at RC despite NAC. METHODS: We systematically searched the PubMed database and Clinicaltrials.gov (end point August 2019) for publications and registered trials combining NAC, RC, and adjuvant treatment options. RESULTS: After removal of duplicates, 659 articles and registered trials were further analyzed. Finally, 10 studies and 7 registered clinical trials met inclusion criteria. While 5 publications did not further characterize NAC and adjuvant regimens, the remaining 5 studies reported mainly platinum-based regimens. Altogether, the selected studies showed conflicting results regarding the potential role of adjuvant treatment strategies in the setting of residual disease after NAC and RC. CONCLUSION: Although there is an urgent need for adjuvant treatment options for patients with MIBC after NAC and residual muscle invasive disease at RC, there has been very limited evidence available. Inclusion of such patients into ongoing adjuvant clinical trials is urgently needed; active surveillance is strongly recommended in the absence of trials.
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Affiliation(s)
- Markus Krebs
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | - Siamak Daneshmand
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Petros Grivas
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University Hospital Würzburg, Würzburg, Germany
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50
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Ahmed Y, Hussein AA, May PR, Ahmad B, Khan A, Benkowski J, Durrani A, Khan S, Kozlowski J, Saar M, Wijburg CJ, Richstone L, Wagner A, Yuh B, Redorta JP, Dasgupta P, Khan MS, Menon M, Peabody JO, Hosseini A, Gaboardi F, Pini G, Schanne F, Mottrie A, Rha KH, Hemal A, Stockle M, Kelly J, Tan WS, Maatman TJ, Poulakis V, Kaouk J, Canda AE, Balbay MD, Wiklund P, Guru KA. Quality of surgical care can impact survival in patients with bladder cancer after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although pathological factors remain the main determinate of survival for patients with bladder cancer, quality of surgical care is crucial for satisfactory outcomes. Using a validated quality score, we investigated the impact of surgical factors on the overall survival (OS), recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with locally advanced and organ-confined disease (OCD). Retrospective review of IRCC database includes 2460 patients from 29 institutions across 11 countries. The final cohort included 1343 patients who underwent RARCs between 2005 and 2016. Patients with locally advanced disease (LAD) (> pT2 and/or N +) were compared with OCD (≤ pT2/N0). Validated Quality Cystectomy Score (QCS) based on four sets of quality metrics was used to compare surgical performance. Kaplan–Meier method was used to compute RFS, CSS and OS rates. Multivariable stepwise logistic regression was used to evaluate variables associated with RFS, DSS and OS.
Results
48% had LAD. When compared to patients with OCD, they received neobladders less frequently (17% vs. 28%, p < 0.001) and experienced higher estimated blood loss (513 vs. 376 ml, p = 0.05). Postoperatively, more patients in the LAD group received adjuvant chemotherapy (24% vs. 4%, p < 0.001) and positive surgical margins (14% vs. 2%, p < 0.001) and had higher 90-day mortality (6% vs. 2%, p < 0.001). On multivariable analysis, female gender, higher QCS score, intracorporeal diversion, pT stage, positive lymph node status and recurrence are considered as predictors of survival. Patients with OCD exhibited better RFS, DSS and OS than patients with LAD. For patients with OCD, higher QCS was associated with improved OS but not RFS or DSS. On the other hand, patients with LAD and higher QCS exhibited higher RFS, DSS and OS when compared to those with lower QCS.
Conclusion
Quality of surgical care can affect disease control and OS in patients with bladder cancer treated with robot-assisted radical cystectomy.
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