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Cañizo CG, Guerrero-Ramos F, Perez Escavy M, Lodewijk I, Suárez-Cabrera C, Morales L, Nunes SP, Munera-Maravilla E, Rubio C, Sánchez R, Rodriguez-Izquierdo M, Martínez de Villarreal J, Real FX, Castellano D, Martín-Arriscado C, Lora Pablos D, Rodríguez Antolín A, Dueñas M, Paramio JM, Martínez VG. Characterisation of the tumour microenvironment and PD-L1 granularity reveals the prognostic value of cancer-associated myofibroblasts in non-invasive bladder cancer. Oncoimmunology 2025; 14:2438291. [PMID: 39698899 DOI: 10.1080/2162402x.2024.2438291] [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: 06/11/2024] [Revised: 10/29/2024] [Accepted: 11/29/2024] [Indexed: 12/20/2024] Open
Abstract
High-risk non-muscle-invasive bladder cancer (NMIBC) presents high recurrence and progression rates. Despite the use of Bacillus Calmette-Guérin gold-standard immunotherapy and the recent irruption of anti-PD-1/PD-L1 drugs, we are missing a comprehensive understanding of the tumor microenvironment (TME) that may help us find biomarkers associated to treatment outcome. Here, we prospectively analyzed TME composition and PD-L1 expression of tumor and non-tumoral tissue biopsies from 73 NMIBC patients and used scRNA-seq, transcriptomic cohorts and tissue micro-array to validate the prognostic value of cell types of interest. Compared to non-tumoral tissue, NMIBC presented microvascular alterations, increased cancer-associated fibroblast (CAF) and myofibroblast (myoCAF) presence, and varied immune cell distribution, such as increased macrophage infiltration. Heterogeneous PD-L1 expression was observed across subsets, with macrophages showing the highest expression levels, but cancer cells as the primary potential anti-PD-L1 binding targets. Unbiased analysis revealed that myoCAF and M2-like macrophages are specifically enriched in high-grade NMIBC tumors. The topological distribution of these two cell types changed as NMIBC progresses, as shown by immunofluorescence. Only myoCAFs were associated with higher rates of progression and recurrence in three independent cohorts (888 total patients), reaching prediction values comparable to transcriptomic classes, which we further validated using tissue micro-array. Our study provides a roadmap to establish the landscape of the NMIBC TME, highlighting myoCAFs as potential prognostic markers.
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Affiliation(s)
- Carmen G Cañizo
- Urology Department, University Hospital '12 de Octubre', Madrid, Spain
| | | | - Mercedes Perez Escavy
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Iris Lodewijk
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Cristian Suárez-Cabrera
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Lucía Morales
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Sandra P Nunes
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
- Cancer Biology and Epigenetics Group, Research Center of IPO Porto (CI-IPOP)/CI-IPOP@RISE (Health Research Network) Porto Comprehensive Cancer Center Raquel Seruca (Porto.CCC), Porto, Portugal
| | - Ester Munera-Maravilla
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Carolina Rubio
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Rebeca Sánchez
- Cell Technology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Madrid, Spain
| | | | - Jaime Martínez de Villarreal
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Epithelial Carcinogenesis Group, Spanish National Cancer Centre-CNIO, Madrid, Spain
| | - Francisco X Real
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Epithelial Carcinogenesis Group, Spanish National Cancer Centre-CNIO, Madrid, Spain
- Departament de Medicina i Ciències de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Daniel Castellano
- Oncology Department, University Hospital '12 de Octubre', Madrid, Spain
| | | | - David Lora Pablos
- Scientific Support Unit, Research Institute I+12, University Hospital 12 de Octubre, Madrid, Spain
| | | | - Marta Dueñas
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Jesús M Paramio
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
| | - Victor G Martínez
- Molecular and Translational Oncology Division, Biomedical Innovation Unit, CIEMAT, Madrid, Spain
- Centro de Investigación Biomédica en Red Cáncer (CIBERONC), Madrid, Spain
- Institute of Biomedical Research, University Hospital '12 de Octubre', Madrid, Spain
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2
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Lydom LN, Lauridsen SV, Joensen UN, Tønnesen H. The Potential for Lifestyle Intervention Among Patients Undergoing Transurethral Resection of Bladder Tumour Based on Patient Needs Including Smoking and Other Risky Lifestyle Factors: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1633. [PMID: 39767473 PMCID: PMC11675626 DOI: 10.3390/ijerph21121633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Revised: 12/03/2024] [Accepted: 12/04/2024] [Indexed: 01/11/2025]
Abstract
Bladder cancer is the tenth most common cancer worldwide, with non-muscle invasive bladder cancer (NMIBC) accounting for 75% of cases. Transurethral resection of bladder tumours (TURBT) is the standard treatment, but it is associated with significant risks of complications and recurrence. Risky lifestyle factors, including smoking, malnutrition, obesity, risky alcohol use, and physical inactivity (collectively termed SNAP factors), may worsen surgical outcomes and increase cancer recurrence. Prehabilitation programmes targeting these modifiable risk factors could improve patient outcomes. This cross-sectional study assessed 100 TURBT patients at a Danish university hospital to determine the prevalence of SNAP factors and the potential for lifestyle interventions. Data were collected via structured interviews, and intervention scenarios were projected based on efficacy rates of 5-100%. In total, 58% of patients had at least one risky SNAP factor, with smoking (29%) being the most prevalent, followed by physical inactivity (19%) and risky alcohol use (18%). Obesity (7%) and malnutrition (8%) were less common. Seventeen percent had multiple SNAP factors. No significant demographic indicators were associated with the presence of SNAP factors. TURBT patients with NMIBC show a high prevalence of risky lifestyle factors, including smoking and obesity, with over half affected. Systematic screening and targeted interventions could significantly improve patient outcomes and long-term health.
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Affiliation(s)
- Line Noes Lydom
- WHO-CC/Clinical Health Promotion Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark
| | - Susanne Vahr Lauridsen
- WHO-CC/Clinical Health Promotion Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark
- Centre for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, 2730 Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Urology, Copenhagen University Hospital Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Hanne Tønnesen
- WHO-CC/Clinical Health Promotion Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2000 Frederiksberg, Denmark
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Wolff I, Kravchuk AP, Wirtz RM, Schlomm T, Rabien A, Rong D, Hofbauer SL, Labonté FK, Barski D, Otto T, Gössl A, Brookman-May SD, Gilfrich CP, Ecke TH, May M. Real-world performance of Uromonitor® in urothelial bladder cancer detection: a multicentric trial. BJU Int 2024; 134:992-1000. [PMID: 38923777 DOI: 10.1111/bju.16450] [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: 06/28/2024]
Abstract
OBJECTIVES To compare Uromonitor® (U-Monitor Lda, Porto, Portugal), a multitarget DNA assay that detects mutated proto-oncogenes (telomerase reverse transcriptase [TERT], fibroblast growth factor receptor 3 [FGFR-3], Kirsten rat sarcoma viral oncogene homologue [KRAS]), with urine cytology in the urine-based diagnosis of urothelial carcinoma of the bladder (UCB) within a multicentre real-world setting. PATIENTS AND METHODS This multicentre, prospective, double-blind study was conducted across four German urological centres from 2019 to 2024. We evaluated the diagnostic performance of Uromonitor compared to urine cytology in a cohort of patients with UCB and in healthy controls within a real-world setting. Sensitivity, specificity, positive-predictive value (PPV), negative-predictive value (NPV), and accuracy of the tests were measured, in addition to multivariate analyses to assess the ability of individual proto-oncogene mutations in detecting UCB. The biometric sample size was designed to achieve a 10% difference in sensitivity. RESULTS Patients with UCB comprised 63.7% (339/532) of the study group. Uromonitor showed a sensitivity, specificity, PPV, NPV, accuracy, and an area-under-the-curve of 49.3%, 93.3%, 92.8%, 51.1%, 65.2%, and 0.713%, respectively. These metrics did not demonstrate statistical superiority over urine cytology in terms of sensitivity (44.6%; P = 0.316). Moreover, the comparison of additional test parameters, as well as the comparison within various sensitivity analyses, yielded no significant disparity between the two urinary tests. Multivariate logistic regression underscored the significant predictive value of a positive Uromonitor for detecting UCB (odds ratio [OR] 9.03; P < 0.001). Furthermore, mutations in TERT and FGFR-3 were independently associated with high odds of UCB detection (OR 13.30 and 7.04, respectively), while KRAS mutations did not exhibit predictive capability. CONCLUSION Despite its innovative approach, Uromonitor fell short of confirming the superior results anticipated from previous studies in this real-world setting. The search for an optimal urine-based biomarker for detecting and monitoring UCB remains ongoing. Results from this study highlight the complexity of developing non-invasive diagnostic tools and emphasise the importance of continued research efforts to refine these technologies.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Anton P Kravchuk
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Ralph M Wirtz
- STRATIFYER Molecular Pathology GmbH, Cologne, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anja Rabien
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dezhi Rong
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian L Hofbauer
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Flora K Labonté
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dimitri Barski
- Department of Urology, Rheinland Clinic Neuss, Neuss, Germany
| | - Thomas Otto
- Department of Urology, Rheinland Clinic Neuss, Neuss, Germany
- Medical School, University of Duisburg-Essen, Essen, Germany
| | - Andreas Gössl
- Department of Urology, Rheinland Clinic Neuss, Neuss, Germany
| | - Sabine D Brookman-May
- Department of Urology, University of Munich, LMU, Munich, Germany
- Johnson and Johnson Innovative Medicine, Research & Development, Spring House, PA, USA
| | - Christian P Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
| | - Thorsten H Ecke
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Urology, Helios Hospital, Bad Saarow, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, Brothers of Mercy Hospital, Straubing, Germany
- Teaching Hospital of the University Clinic Regensburg, Chair of Urology at the Caritas St. Josef Medical Center, Regensburg, Germany
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Totev TI, Ireland A, Shah A, Tardif-Samson A, Lefebvre P, Pilon D. Overall burden and impact on health-related quality of life associated with intravesical treatment of patients with non-muscle invasive bladder cancer in the United States. Curr Med Res Opin 2024; 40:2003-2011. [PMID: 39360373 DOI: 10.1080/03007995.2024.2411424] [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] [Received: 08/05/2024] [Revised: 09/24/2024] [Accepted: 09/27/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND This study aimed to describe the life impacts of intravesical therapies for non-muscle invasive bladder cancer (NMIBC) from a patient perspective. METHODS A cross-sectional online survey design was used. Adults with NMIBC (and no other cancer) treated intravesically in the prior 12 months were recruited from US patient online communities. Individuals participating in a clinical trial or treated with erdafitinib were excluded. Participants' treatment experiences were evaluated using a questionnaire comprising (a) custom questions reported on 11-point numerical rating scales and (b) validated patient reported outcome (PRO) measures for bladder symptom burden and work productivity. RESULTS Among 171 survey participants, most received bacillus Calmette-Guérin (BCG) (83%), intravesical gemcitabine (28%), or gemcitabine + docetaxel (13%) during the past year. Participants generally felt adequately informed about treatment, felt expectation of treatment matched actual experience, and expressed intent to complete the full treatment course and willingness to try different treatments if needed. Participants reported disease symptom burden of 42.6/72 on the NFBlSI-18 scale. Employed participants reported 51% work impairment and 59% overall work productivity loss due to NMIBC. CONCLUSIONS Participants recently treated with intravesical therapies expressed intent to complete the full treatment course and willingness to try new therapies if needed. Participants reported high NMIBC symptom burden and work impairment negatively impacting their well-being, despite receiving intravesical treatment.
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Affiliation(s)
| | - Andrea Ireland
- Janssen Scientific Affairs, LLC, a Johnson & Johnson company, Horsham, Pennsylvania, USA
| | - Aditi Shah
- Analysis Group, Inc, Montreal, Quebec, Canada
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Beeren I, Klerks NE, Aben KK, Oddens JR, Witjes JA, Kiemeney LA, Vrieling A. Health-related Quality of Life During the First 4 Years After Non-Muscle-invasive Bladder Cancer Diagnosis: Results of a Large Multicentre Prospective Cohort. Eur Urol Oncol 2024; 7:829-837. [PMID: 37996278 DOI: 10.1016/j.euo.2023.11.007] [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: 07/12/2023] [Revised: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The health-related quality of life (HRQoL) of patients with non-muscle-invasive bladder cancer (NMIBC) may be impaired due to the chronic and burdensome disease course, but longitudinal data are limited. OBJECTIVE To evaluate HRQoL outcomes during the first 4 yr after NMIBC diagnosis, and to compare HRQoL across patient characteristics and with a normative population. DESIGN, SETTING, AND PARTICIPANTS Patients with NMIBC (n = 1019) were included from the multicentre prospective cohort UroLife. Data were collected at 6 wk (baseline), and 3, 15, and 51 mo after diagnosis. Longitudinal reference data were obtained from an age- and sex-matched normative population (n = 490). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer- and NMIBC-specific HRQoL outcomes (range 0-100) were evaluated by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-NMIBC24 questionnaires, respectively. Linear mixed modelling was used to analyse within-group changes and between-group differences. RESULTS AND LIMITATIONS The majority of HRQoL outcomes remained stable over time. Observed changes were only of small clinical relevance. Improvements were noted in insomnia, social functioning, and three NMIBC-specific symptoms, while minor deteriorations in appetite and diarrhoea lasted until 51 mo. HRQoL in some domains was worse for high-grade NMIBC, high European Association of Urology (EAU) risk group, initial Bacillus Calmette-Guérin (BCG) treatment, being female, and being younger (<65 yr); yet differences were few, small, and temporary. No differences were observed across recurrence status. Compared with a normative population, clinically relevant worse scores were observed for six of 15 outcomes, which mostly recovered at 51 mo, except for minor symptoms of appetite loss and diarrhoea. CONCLUSIONS No remarkable changes in HRQoL were observed during the first 4 yr after NMIBC diagnosis. Grade, EAU risk group, initial treatment, recurrence, sex, and age did not importantly affect HRQoL. HRQoL was largely comparable with that of the general population, especially after 4 yr. PATIENT SUMMARY Quality of life is not largely affected during the first 4 yr after non-muscle-invasive bladder cancer diagnosis.
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Affiliation(s)
- Ivy Beeren
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nena E Klerks
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.
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Schubach K, Niyonsenga T, Turner M, Paterson C. Identifying the supportive care needs of people affected by non-muscle invasive bladder cancer: An integrative systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01558-7. [PMID: 38520600 DOI: 10.1007/s11764-024-01558-7] [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: 12/20/2023] [Accepted: 02/22/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To understand supportive care needs among people with non-muscle invasive bladder cancer (NMIBC). METHODS An integrative systematic review was reported using the Preformed Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Seven electronic databases were searched for relevant studies, including all quantitative, qualitative, and mixed methods studies, irrespective of research design. The review process was managed by Covidence systematic review software. Two reviewer authors independently performed data extraction using eligibility criteria. Quality appraisal was conducted, and a narrative synthesis was performed. RESULTS A total of 1129 articles were screened, of which 21 studies met the inclusion criteria. The findings revealed that the frequency of supportive care needs reported by NMIBC participants included psychological/emotional (16/21:76%), physical (16/21:76%), practical (8/21:38%), interpersonal/intimacy (7/21:33%), family-related (7/21:33%), health system/information (5/21:23%), social (4/21:19%), patient-clinician communication (3/21:14%), spiritual (1/21:5%) and daily needs (1/21:5%). CONCLUSION People affected by NMIBC experience anxiety, depression, uncertainty, and fear of recurrence. The physical symptoms reported included urinary issues, pain, sleeping disorders and fatigue. These supportive care needs persist throughout the participants' treatment trajectory and can impact their quality of life. IMPLICATIONS FOR CANCER SURVIVORS Identifying supportive care needs within the NMIBC population will help inform future interventions to provide patient-centred care to promote optimal well-being and self-efficacy for people diagnosed with NMIBC.
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Affiliation(s)
- Kathryn Schubach
- Caring Futures Institute, Flinders University, Adelaide, Australia.
| | - Theo Niyonsenga
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Murray Turner
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Catherine Paterson
- Caring Futures Institute, Flinders University, Adelaide, Australia
- Central Adelaide Local Health Network, Adelaide, Australia
- Robert Gordon University, Aberdeen, Scotland, UK
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7
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Shah CP, Lord-McKenzie T, Makris A, Trail M, Gray J, Smith G, Mariappan P. The Value of Negative Urinary Dipstick Tests for Haematuria in Patients Undergoing Surveillance for Low-grade Ta Urothelial Cancer: A Two-stage Prospective Clinical Study in 524 Patients. EUR UROL SUPPL 2024; 60:24-31. [PMID: 38375346 PMCID: PMC10874875 DOI: 10.1016/j.euros.2023.12.006] [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] [Accepted: 12/22/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objective The risk of first recurrence beyond 5 yr for patients with low-grade (LG) Ta non-muscle-invasive bladder cancer (NMIBC) is low enough to consider discontinuing cystoscopic surveillance at that point. However, a positive urinary dipstick test for haematuria (UDH) during and beyond the period of cystoscopic surveillance can disrupt plans to cease surveillance because the association between UDH positivity and recurrence in LG Ta NMIBC is unknown. In a two-stage study, we evaluated this association and explored the role of UDH negativity in predicting the absence of recurrence. Methods Because of previously demonstrated changes in recurrence patterns over time, two prospective cohorts were assessed: an "exploratory" cohort (January 2007-March 2008) and a "validation" cohort (November 2017-August 2018). UDH was performed before flexible cystoscopy. Patient, operative, and surveillance data have been recorded prospectively using standard pro forma sheets since 1978 in our institution. Only patients with primary LG Ta pTa NMIBC were included for analysis. Key findings and limitations We assessed 231 patients in the exploratory group and 293 in the validation group. The proportion of smokers (67% vs 70%; p = 0.5) and mean follow-up (72.2 vs 79.9 mo; p = 0.2) were similar between the groups. The recurrence rate was higher in the exploratory group (19% vs 11%; p = 0.009), as was the UDH positivity rate (37% vs 11%; p < 0.001). The specificity and negative predictive value were 64% and 83% in the exploratory group, and 90% and 90%, respectively, in the validation group. These values increased further for the subgroup with solitary primary tumours the subgroup without recurrence for 3 yr. Conclusions and clinical implications UDH negativity has a high probability of being associated with the absence of recurrence in small LG Ta NMIBC and could be an inexpensive adjunct during surveillance. Ongoing validation, which started in 2019, is being performed in a now-nationalised Scottish protocol in which UDH replaces cystoscopy in years 2 and 4 for patients in the low-risk group. Patient summary We investigated the accuracy of a dipstick test for blood in the urine for patients undergoing surveillance for low-grade noninvasive bladder cancer. We found that a negative dipstick test result was highly associated with the absence of tumour recurrence, particularly for patients with the lowest risk. These findings have been introduced into a national protocol designed to reduce the frequency of telescopic inspection of the bladder during surveillance to reduce the burden for patients.
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Affiliation(s)
- Chandrarajan Premal Shah
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
| | - Tanya Lord-McKenzie
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Antonios Makris
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Matthew Trail
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Jennifer Gray
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
| | - Gordon Smith
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
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8
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Caño Velasco J, Polanco Pujol L, Moreno Cortés JC, Lafuente Puentedura A, Hernández Fernández C. Bladder Epicheck® for surveillance in high-risk non-muscle-invasive bladder cancer: Initial experience and follow-up proposal. Actas Urol Esp 2023; 47:471-473. [PMID: 37391165 DOI: 10.1016/j.acuroe.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 07/02/2023]
Affiliation(s)
- J Caño Velasco
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - L Polanco Pujol
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J C Moreno Cortés
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A Lafuente Puentedura
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C Hernández Fernández
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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van Liere ELSA, Jacobs IL, Dekker E, Jacobs MAJM, de Boer NKH, Ramsoekh D. Colonoscopy surveillance in Lynch syndrome is burdensome and frequently delayed. Fam Cancer 2023; 22:403-411. [PMID: 37171677 PMCID: PMC10176312 DOI: 10.1007/s10689-023-00333-4] [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: 02/21/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
Individuals with Lynch syndrome have an increased colorectal cancer risk, hence, biennial colonoscopy surveillance is recommended. We aimed to investigate patients' perception and preferences regarding surveillance, and to further explore compliance behaviour. Individuals with Lynch syndrome received a validated survey evaluating experiences of their three most recent colonoscopies. Individuals were non-compliant to surveillance if the interval between colonoscopies differed ≥ 6 months from the recommended interval. In total, 197 of 291 (68%) invited individuals returned the survey. They mostly underwent colonoscopy biennially (99%), under mild sedation (79%) and with bowel preparation performed by Moviprep® (99%). Surveillance was perceived as impacting quality of life in 21%, and as moderately to extremely burdensome in 57%, particularly in those below age 40. To lower the burden, patients prioritised improvements in volume and taste of bowel preparation, laxation-related bowel movements, waiting times, and a more personal and respectful approach of endoscopic staff. Additionally, many individuals (60%) would favour less-invasive surveillance modalities such as biomarkers. In total, 28% of individuals had delayed colonoscopy surveillance, predominantly for patient-related reasons. An additional 10% considered quitting/postponing surveillance. Upon multivariable analysis, patient-related delay was associated with low and medium education, history of ≤ 4 colonoscopies and having no hospital recall-system. Colonoscopy surveillance in Lynch syndrome is often experienced as burdensome, and frequently delayed. We identified determinants of surveillance behaviour in this population, and present potential interventions to reduce the burden and non-compliance rates.
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Affiliation(s)
- Elsa L S A van Liere
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands.
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Imke L Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten A J M Jacobs
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
| | - Dewkoemar Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism (AGEM) Research Institute, Amsterdam, The Netherlands
- School of Medicine, Vrije Universiteit, Amsterdam, The Netherlands
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10
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Stewart R, Richards HL, Houghton S, Sweeney P, Fortune DG. 'I Had It. I Don't Think I Have It…But I Do Feel It Will Come Back Somewhere': A Qualitative Investigation of the Experience of People With Non-Muscle Invasive Bladder Cancer. QUALITATIVE HEALTH RESEARCH 2023; 33:969-982. [PMID: 37485658 DOI: 10.1177/10497323231170089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Very little is known about the impact of living with non-muscle invasive bladder cancer (NMIBC). NMIBC patients' experiences of their illness-in terms of their perceptions, coping strategies and psychological wellbeing-were explored. This study describes an interpretative phenomenological analysis (IPA) of individuals' accounts of living with NMIBC while on routine surveillance for cancer recurrence. Ten individuals took part in face-to-face semi-structured interviews. Three superordinate themes were derived from the data. The first theme, Being Diagnosed and Treated for NMIBC, concerned the observation that participants considered the physical implications, timeline and practicalities of their illness of primary importance and focused less on its psychological aspects. The second theme, Grappling with the Illness, outlined the impact of the doctor-patient relationship. The final theme, 'I don't treat it as a problem. I treat it as an issue', delineated how participants managed difficult emotions in the context of the illness. Findings from this study demonstrated that participants generally found effective ways to cope with their illness and experience of ongoing surveillance, though delay of emotional responses was common. Clinical implications for healthcare professionals are outlined including the importance of high-quality communication with the urology team.
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Affiliation(s)
- Ruth Stewart
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Helen L Richards
- Department of Psychology, University of Limerick, Limerick, Ireland
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
- Department of Clinical Health Psychology, Mercy University Hospital, Cork, Ireland
| | - Sharon Houghton
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Paul Sweeney
- Department of Uro-Oncology, Mercy University Hospital, Cork, Ireland
| | - Donal G Fortune
- Department of Psychology, University of Limerick, Limerick, Ireland
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11
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Grabe-Heyne K, Henne C, Mariappan P, Geiges G, Pöhlmann J, Pollock RF. Intermediate and high-risk non-muscle-invasive bladder cancer: an overview of epidemiology, burden, and unmet needs. Front Oncol 2023; 13:1170124. [PMID: 37333804 PMCID: PMC10272547 DOI: 10.3389/fonc.2023.1170124] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/20/2023] Open
Abstract
Bladder cancer ranks among the most common cancers globally. At diagnosis, 75% of patients have non-muscle-invasive bladder cancer (NMIBC). Patients with low-risk NMIBC have a good prognosis, but recurrence and progression rates remain high in intermediate- and high-risk NMIBC, despite the decades-long availability of effective treatments for NMIBC such as intravesical Bacillus Calmette-Guérin (BCG). The present review provides an overview of NMIBC, including its burden and treatment options, and then reviews aspects that counteract the successful treatment of NMIBC, referred to as unmet treatment needs. The scale and reasons for each unmet need are described based on a comprehensive review of the literature, including insufficient adherence to treatment guidelines by physicians because of insufficient knowledge, training, or access to certain therapy options. Low rates of lifestyle changes and treatment completion by patients, due to BCG shortages or toxicities and adverse events as well as their impact on social activities, represent additional areas of potential improvement. Highly heterogeneous evidence for the effectiveness and safety of some treatments limits the comparability of results across studies. As a result, efforts are underway to standardize treatment schedules for BCG, but intravesical chemotherapy schedules remain unstandardized. In addition, risk-scoring models often perform unsatisfactorily due to significant differences between derivation and real-world cohorts. Reporting in clinical trials suffers from a lack of consistent outcomes reporting in bladder cancer clinical trials, paired with an under-representation of racial and ethnic minorities in many trials.
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Affiliation(s)
| | | | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Department of Urology, Western General Hospital, Edinburgh, United Kingdom
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12
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Vidra N, Beeren I, van Zutphen M, Aben KK, Kampman E, Witjes JA, van der Heijden AG, Kiemeney LA, Vrieling A. Longitudinal associations of adherence to lifestyle recommendations and health-related quality of life in patients with non-muscle invasive bladder cancer. Int J Cancer 2023; 152:2032-2042. [PMID: 36594579 DOI: 10.1002/ijc.34418] [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: 09/23/2022] [Revised: 12/11/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
Although the role of lifestyle in health-related quality of life (HRQoL) outcomes has been increasingly recognized for various types of cancer, evidence in patients with non-muscle invasive bladder cancer (NMIBC) is very limited. We aimed to evaluate the longitudinal association between adherence to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) lifestyle recommendations and HRQoL in patients with NMIBC. This study included 1029 patients with NMIBC recruited between May 2014 and April 2017 from the Dutch multi-centre prospective cohort study UroLife. Lifestyle and HRQoL data were collected at 6 weeks (baseline), 3 months and 15 months after diagnosis. Information on body mass index (BMI), physical activity, diet and alcohol was used to compute the standardized WCRF/AICR adherence score (0-7). HRQoL outcomes were evaluated by the EORTC QLQ-C30. Linear mixed models were used to assess longitudinal confounder-adjusted associations between the WCRF/AICR adherence score and HRQoL outcomes. Adherence to each additional WCRF/AICR recommendation was associated with better global quality of life, physical, role and social functioning, and less fatigue. We found stronger inter-individual than intra-individual associations, suggesting that associations were mainly driven by between-subject differences. Higher adherence to the BMI, physical activity and dietary recommendations was associated with better scores for most HRQoL outcomes, while adherence to the alcohol recommendation (ie, non-consumption) was associated with worse HRQoL. Following the WCRF/AICR lifestyle recommendations may improve HRQoL in patients with NMIBC. Intervention studies are needed to establish whether the association between lifestyle and HRQoL is causal.
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Affiliation(s)
- Nikoletta Vidra
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ivy Beeren
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Moniek van Zutphen
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Nishikawa R, Miyake M, Morizane S, Shimizu R, Teraoka S, Honda M, Iida K, Nishimura N, Sazuka T, Kimura T, Ito A, Shiga K, Taoka R, Kojima T, Kobayashi T, Nishiyama N, Kitamura H, Nishiyama H, Fujimoto K, Takenaka A. C-reactive protein as a prognostic predictor for non-muscle invasive bladder cancer after intravesical bacillus Calmette-Guérin therapy: A Japan Urological Oncology Group study analysis. Int J Urol 2023; 30:299-307. [PMID: 36448522 DOI: 10.1111/iju.15106] [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: 02/04/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To investigate the involvement of pretreatment C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in the prognosis of patients who underwent intravesical bacillus Calmette-Guérin (BCG) therapy for non-muscle invasive bladder cancer (NMIBC). METHODS The clinicopathological data of 1709 patients with NMIBC who underwent initial intravesical BCG therapy after transurethral resection of bladder tumor were retrospectively analyzed to evaluate the outcome of intravesical BCG therapy in a multicenter study conducted by the Japan Urological Oncology Group. The prognoses of these patients were analyzed to determine whether the biomarkers (CRP and NLR) could predict the efficacy of intravesical BCG therapy. Patients were divided into two groups according to the pretreatment CRP and NLR, with cutoff values defined as CRP ≥ 0.5 mg/dl and NLR ≥ 2.5, based on several previous reports. RESULTS In the univariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence, cancer-specific survival, and bladder cancer (BC) progression, while NLR ≥ 2.5 was not significantly associated with patient prognosis. In the multivariable analysis, CRP ≥ 0.5 mg/dl was significantly associated with intravesical recurrence and BC progression. The concordance index was used to examine the accuracy in predicting recurrence and progression events. While CRP was slightly, though not statistically significant, inferior to the European Association of Urology risk classification, the combination of them showed improved predictive accuracy. CONCLUSION This study suggests that CRP can be a prognostic factor after intravesical BCG therapy and may provide useful data for determining treatment and follow-up strategies for patients with NMIBC.
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Affiliation(s)
- Ryoma Nishikawa
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Masashi Honda
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
| | - Kota Iida
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Tomokazu Sazuka
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Chiba City, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Minato-ku, Japan
| | - Akihiro Ito
- Department of Urology, Tohoku University Graduates School of Medicine, Miyagi, Sendai, Japan
| | - Kenichiro Shiga
- Department of Urology, Harasanshin Hospital, Fukuoka City, Fukuoka, Japan
| | - Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center, Nagoya City, Aichi, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama City, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, Tottori, Yonago, Japan
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14
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Caulley L, Whelan J, Khoury M, Mavedatnia D, Sahlollbey N, Amrani L, Eid A, Doyle MA, Malcolm J, Alkherayf F, Ramsay T, Moher D, Johnson-Obaseki S, Schramm D, Hunink MGM, Kilty SJ. Post-operative surveillance for somatotroph, lactotroph and non-functional pituitary adenomas after curative resection: a systematic review. Pituitary 2023; 26:73-93. [PMID: 36422846 DOI: 10.1007/s11102-022-01289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
CONTEXT Pituitary tumors are the third most common brain tumor and yet there is no standardization of the surveillance schedule and assessment modalities after transsphenoidal surgery. EVIDENCE ACQUISITION OVID, EMBASE and the Cochrane Library databases were systematically screened from database inception to March 5, 2020. Inclusion and exclusion criteria were designed to capture studies examining detection of pituitary adenoma recurrence in patients 18 years of age and older following surgical resection with curative intent. EVIDENCE SYNTHESIS A total of 7936 abstracts were screened, with 812 articles reviewed in full text and 77 meeting inclusion criteria for data extraction. A pooled analysis demonstrated recurrence rates at 1 year, 5 years and 10 years for non-functioning pituitary adenomas (NFPA; N = 3533 participants) were 1%, 17%, and 33%, for prolactin-secreting adenomas (PSPA; N = 1295) were 6%, 21%, and 28%, and for growth-hormone pituitary adenomas (GHPA; N = 1257) were 3%, 8% and 13%, respectively. Rates of recurrence prior to 1 year were 0% for NFPA, 1-2% for PSPA and 0% for GHPA. The mean time to disease recurrence for NFPA, PSPA and GHPA were 4.25, 2.52 and 4.18 years, respectively. CONCLUSIONS This comprehensive review of the literature quantified the recurrence rates for commonly observed pituitary adenomas after transsphenoidal surgical resection with curative intent. Our findings suggest that surveillance within 1 year may be of low yield. Further clinical trials and cohort studies investigating cost-effectiveness of surveillance schedules and impact on quality of life of patients under surveillance will provide further insight to optimize follow-up.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.
- Department of Epidemiology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Jonathan Whelan
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Michel Khoury
- Department of Otolaryngology-Head and Neck Surgery, Université de Montréal, Montreal, Canada
| | - Dorsa Mavedatnia
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Nick Sahlollbey
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Lisa Amrani
- Department of Undergraduate Medicine, University of Ottawa, Ottawa, Canada
| | - Anas Eid
- Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Mary-Anne Doyle
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
| | - Janine Malcolm
- Department of Medicine, Endocrinology and Metabolism, University of Ottawa, Ottawa, Canada
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Fahad Alkherayf
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Neurosurgery, University of Ottawa, Ottawa, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Knowledge Synthesis and Application Unit, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Center for Journalology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - David Schramm
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G M Hunink
- Department of Epidemiology and Biostatistics and Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Shaun J Kilty
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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15
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Yuen JW, Wu RW, Ching SS, Ng CF. Impact of Effective Intravesical Therapies on Quality of Life in Patients with Non-Muscle Invasive Bladder Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10825. [PMID: 36078542 PMCID: PMC9518426 DOI: 10.3390/ijerph191710825] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Conventional and newly emerged intravesical modalities have demonstrated prophylactic effectiveness that may improve quality of life (QoL) in non-muscle invasive bladder cancer. The purpose of this study is to analyze existing QoL evidence in patients receiving any form of intravesical therapy. METHODS A PubMed search without time restriction was conducted to identify all relevant studies in accordance with the PICOT question. Additionally, a search was also performed in the Cochrane library database, Internet, and citation. The CONSORT 2010 checklist and STROBE statement checklist were used to evaluate the risk of bias of the included studies. RESULTS A total of 24 eligible articles were included, which consisted of 11 interventional and 13 observational studies. Intravesical therapy with Bacillus Calmette-Guérin (BCG) or certain chemotherapeutic agents worsens symptom burdens and functional performance during the initial induction phase while continuous improved is observed throughout the maintenance treatment and beyond. Hyperthermia has shown a positive trend in enhancing QoL of patients receiving intravesical chemotherapy, which requires more investigations. However, QoL data were unavailable for other forms of immunotherapy, immune checkpoint inhibitors, electromotive drug administration, and photodynamic therapy. CONCLUSIONS Limited studies suggested the long-term positive impact of intravesical BCG immunotherapy and chemotherapy. However, existing evidence was lacking to clarify the impact of many emerging intravesical therapies that have suggested to be effective and safe, which demands treatment-specific QoL studies.
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Affiliation(s)
- John W. Yuen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Ricky W. Wu
- Biological and Biomedical Sciences, Glasgow Caledonian University, Glasgow G4 OBA, UK
| | - Shirley S. Ching
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Chi-Fai Ng
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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16
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Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity? Curr Opin Urol 2022; 32:567-574. [DOI: 10.1097/mou.0000000000001028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Contieri R, Lughezzani G, Buffi NM, Taverna G, Giacobbe A, Micheli E, Barra S, Colombo P, Vanni E, Guazzoni G, Lazzeri M, Hurle R. Could We Safely Avoid a Second Resection in Selected Patients With T1 Non-Muscle-Invasive Bladder Cancer? Preliminary Results of Cost-Effectiveness Study From HUmanitas New Indications for ReTUR (HuNIRe) Multicenter Prospective Trial. Front Oncol 2022; 12:879399. [PMID: 35664755 PMCID: PMC9157494 DOI: 10.3389/fonc.2022.879399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study is to assess whether restaging transurethral resection (ReTUR) could be safely replaced with urine cytology (UC) and in-office fiexible cystoscopy in selected T1 non-muscle-invasive bladder cancer (NMIBC). Materials and Methods This is an ongoing prospective multicenter trial enrolling patients diagnosed with T1 BC from 5 Italian centers. Patients with a macroscopically incomplete initial resection or absence of detrusor muscle were subjected to ReTUR according to European Association of Urology (EAU) guidelines. Conversely, those with a complete tumor resection at initial TUR underwent UC at 3-4 weeks and in-office fiexible white-light and narrow-band cystoscopy at 4-6 weeks. In case of positive UC, or evidence of recurrence at cystoscopy, ReTUR was performed within 2 weeks. Otherwise, patients started Bacillus Calmette-Guérin (BCG) induction course without ReTUR. The primary endpoint was to determine the feasibility and the clinical utility of not performing ReTUR in selected T1 NMIBC patients. The secondary endpoint was to perform a cost-benefit analysis of this alternative approach. Results Since May 2020, among 87 patients presenting with T1, 76 patients were enrolled. Nineteen (25%) patients underwent standard ReTUR after initial resection, 10 (13.2%) due to the absence of the detrusor muscle and 9 (11.8%) due to a macroscopically incomplete initial TUR. Overall, 57 (75%) patients initially avoided immediate ReTUR and underwent UC plus in-office flexible cystoscopy. Among them, 38 (66.7%) had no evidence of residual disease and immediately started the BCG induction course. Nineteen patients (33.3%) underwent "salvage" ReTUR due to either positive UC (7; 12.3%) or suspicious cystoscopy (12; 21%). Considering only the patients who initially avoided the ReTUR, disease recurrence was observed in 10/57. The saving of resource for each safely avoided ReTUR was estimated to be 1,759 €. Considering the entire sample, we estimated a saving of 855 € per patient if compared with the EAU guideline approach. Conclusion The preliminary results of our trial suggested that ReTUR might be safely avoided in highly selected T1 BC patients with a complete resection at first TUR. Longer follow-up and larger sample size are needed to investigate the long-term oncological outcomes of this alternative approach.
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Affiliation(s)
- Roberto Contieri
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giovanni Lughezzani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Maria Buffi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gianluigi Taverna
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy,Urology Unit, Humanitas Mater Domini, Varese, Italy
| | - Alessandro Giacobbe
- Struttura Complessa (SC) Urology and Reconstructive Andrology, Humanitas Gradenigo Hospital, Turin, Italy
| | | | - Sabato Barra
- Department of Urology, Azienda Socio Sanitarie Territoriali (ASST) Melegnano-Martesana, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Pathology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Vanni
- Business Operations Office, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Guazzoni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy,*Correspondence: Massimo Lazzeri,
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Milan, Italy
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