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Llano A, Chan A, Kuk C, Kassouf W, Zlotta AR. Carcinoma In Situ (CIS): Is There a Difference in Efficacy between Various BCG Strains? A Comprehensive Review of the Literature. Cancers (Basel) 2024; 16:245. [PMID: 38254736 PMCID: PMC10813486 DOI: 10.3390/cancers16020245] [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: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Introduction: Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy is the standard of care for high-risk and intermediate-risk non-muscle-invasive bladder cancer (NMIBC) as well as for Carcinoma in situ (CIS). Evidence supports that the different BCG strains, despite genetic variability, are equally effective clinically for preventing the recurrence and progression of papillary NMIBC. The available evidence regarding possible differences in clinical efficacy between various BCG strains in CIS is lacking. Methods: We reviewed the literature on the efficacy of different BCG strains in patients with CIS (whether primary, secondary, concomitant, or unifocal/multifocal), including randomized clinical trials (RCTs), phase II/prospective trials, and retrospective studies with complete response rates (CRR), recurrence-free survival (RFS), or progression-free survival (PFS) as endpoints. Results: In most studies, being RCTs, phase II prospective trials, or retrospective studies, genetic differences between BCG strains did not translate into meaningful differences in clinical efficacy against CIS, regardless of the CIS subset (primary, secondary, or concurrent) or CIS focality (unifocal or multifocal). CRR, RFS, and PFS were not statistically different between various BCG strains. None of these trials were designed as head-to-head comparisons between BCG strains focusing specifically on CIS. Limitations include the small sample size of many studies and most comparisons between strains being indirect rather than head-to-head. Conclusions: This review suggests that the clinical efficacy of the various BCG strains appears similar, irrespective of CIS characteristics. However, based on the weak level of evidence available and underpowered studies, randomized studies in this space should be encouraged as no definitive conclusion can be drawn at this stage.
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Affiliation(s)
- Andres Llano
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
| | - Amy Chan
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
| | - Cynthia Kuk
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, QU H4A 3J1, Canada;
| | - Alexandre R. Zlotta
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Sinai Health System, University of Toronto, Toronto, ON M5G 2N2, Canada; (A.L.)
- Division of Urology, Department of Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Heath Network, University of Toronto, Toronto, ON M5G 2C4, Canada
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Checcucci E, Piramide F, Pecoraro A, Amparore D, Campi R, Fiori C, Elhage O, Kotecha P, Vyakarnam A, Serni S, Dasgupta P, Porpiglia F. The vaccine journey for COVID-19: a comprehensive systematic review of current clinical trials in humans. Panminerva Med 2022; 64:72-79. [PMID: 32456404 DOI: 10.23736/s0031-0808.20.03958-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Since December 2019, there has been an outbreak of a novel beta-Coronavirus (SARS-CoV-2) in Wuhan, China. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 as a pandemic, with over 118,000 cases in more than 110 countries around the world. In response to the global Coronavirus disease 2019 (COVID-19) emergency, clinical trial research assessing the efficacy and safety of experimental vaccines to prevent COVID-19 are emerging at an unprecedented rate. The aim of this systematic review was to summarize the preliminary experiences and ongoing clinical trials of the major candidates and challenges of the vaccine strategies in humans. EVIDENCE ACQUISITION After a-priori protocol registration with PROSPERO (181483), systematic research of the published literature was conducted on April 24, 2020, using Medline (via PubMed), Embase (via Ovid), and WHO databases. Moreover, to explore the more recent literature we also searched the preprint server medRxiv. Finally, we scrutinized the Cochrane COVID-19 study register and the COVID-19 section of ClinicalTrials.gov database to identify relevant ongoing clinical trials. Thereafter we selected the articles according to the PRISMA Guidelines. Animal or in-vitro experimental studies were excluded. Moreover editorials, commentaries, abstracts, reviews, book chapters, and articles not in English were not included. EVIDENCE SYNTHESIS Our search identified 1359 published papers, 478 preprint articles and 367 ongoing clinical trials. Finally, only ten ongoing clinical trials met the inclusion criteria. Specifically, seven developed vaccines for the S protein of SARS-CoV-2 and three clinical trials assessed the protective role of BCG vaccine against COVID-19. The first group included phase I/II trials with different types of molecules (DNA or mRNA vaccine, bacterial plasmid or viral vectors), the latter were phase III/IV trials designed on the basis of a heterologous lymphocyte activation by the BCG vaccine. CONCLUSIONS This new disease is pushing the scientific community to develop swiftly a safe and effective vaccine. Notwithstanding the limitations of our analysis, given by the absence of available results, we try to provide a comprehensive view of the ongoing clinical trials in humans. Our analysis reveals a worldwide effort of both scientists and enterprises to achieve one of the most challenging goals of our century.
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Affiliation(s)
- Enrico Checcucci
- School of Medicine, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Federico Piramide
- School of Medicine, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Angela Pecoraro
- School of Medicine, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- School of Medicine, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Cristian Fiori
- School of Medicine, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Oussama Elhage
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
| | - Pinky Kotecha
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
| | - Annapurna Vyakarnam
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Prokar Dasgupta
- King's College London, Faculty of Life Sciences and Medicine, Guy's Hospital, London, UK
| | - Francesco Porpiglia
- School of Medicine, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
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3
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Lonati C, Esperto F, Scarpa RM, Papalia R, Gómez Rivas J, Alvarez-Maestro M, Afferi L, Fankhauser CD, Mattei A, Colombo R, Montorsi F, Briganti A, Krajewski W, Carando R, Laukhtina E, Teoh JY, Zamboni S, Simeone C, Moschini M. Bladder perforation during transurethral resection of the bladder: a comprehensive algorithm for diagnosis, management and follow up. Minerva Urol Nephrol 2021; 74:570-580. [PMID: 34263743 DOI: 10.23736/s2724-6051.21.04436-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic reviews focusing on this issue. We aimed to investigate incidence, diagnosis, therapy, and prognosis after BP during TURB for BCa; therapy was distinguished between conservative (without the need for bladder repair) and surgical management (requiring bladder wall closure). EVIDENCE ACQUISITION A systematic search was conducted up to April 2021 using PubMed, Scopus, Cochrane Database of Systematic Reviews, and Web of Science to identify articles focusing on incidence, detection, management, or survival outcomes after iatrogenic BP. The selection of articles followed the Preferred Reporting Items for Systematic Review and Meta-Analyses process. EVIDENCE SYNTHESIS We included 41 studies, involving 21,174 patients. Overall, 521 patients experienced BP during TURB for BCa, with a mean incidence of 2.4%, up to 58.3% when post-operative cystography is routinely performed after all TURB procedures. Risk factors were low body mass index (BMI) (p=0.01), resection depth (p=0.006 and p=0.03), and low surgical experience (p=0.006). Extraperitoneal BP (68.5%) were treated conservatively in 97.5% of patients; intraperitoneal BP were managed with surgical bladder closure in 56% of cases. Overall, three immediate BP-related deaths were recorded due to septic complications. Extravesical tumour seeding was observed after 6 intraperitoneal and 1 extraperitoneal BP (median time: 6.2 months). Intraperitoneal BP (p=0.0003) and bladder closure (p<0.001) were found as independent predictors of extravesical tumour recurrence. CONCLUSIONS BP is more frequent than expected when proper diagnosis is routinely performed after all TURB procedures. Risk factors include low BMI, resection depth, and unexperienced surgeon. The risk of sepsis after BP suggests empirical antibiotic prophylaxis after BP.
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Affiliation(s)
- Chiara Lonati
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy - .,Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland -
| | - Francesco Esperto
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | | | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Renzo Colombo
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Roberto Carando
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Clinica Luganese Moncucco, Lugano, Switzerland.,Clinica S.Anna, Swiss Medical Group, Sorengo, Switzerland.,Clinica Santa Chiara, Locarno, Switzerland
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Jeremy Y Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Stefania Zamboni
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili of Brescia, Brescia, Italy
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
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Garczyk S, Bischoff F, Schneider U, Golz R, von Rundstedt FC, Knüchel R, Degener S. Intratumoral heterogeneity of surrogate molecular subtypes in urothelial carcinoma in situ of the urinary bladder: implications for prognostic stratification of high-risk non-muscle-invasive bladder cancer. Virchows Arch 2021; 479:325-335. [PMID: 33650041 PMCID: PMC8364543 DOI: 10.1007/s00428-021-03054-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 12/24/2022]
Abstract
Reliable factors predicting the disease course of non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) are unavailable. Molecular subtypes have potential for prognostic stratification of muscle-invasive bladder cancer, while their value for CIS patients is unknown. Here, the prognostic impact of both clinico-pathological parameters, including CIS focality, and immunohistochemistry-based surrogate subtypes was analyzed in a cohort of high-risk NMIBC patients with CIS. In 128 high-risk NMIBC patients with CIS, luminal (KRT20, GATA3, ERBB2) and basal (KRT5/6, KRT14) surrogate markers as well as p53 were analyzed in 213–231 biopsies. To study inter-lesional heterogeneity of CIS, marker expression in independent CIS biopsies from different bladder localizations was analyzed. Clinico-pathological parameters and surrogate subtypes were correlated with recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Forty-six and 30% of CIS patients exhibited a luminal-like (KRT20-positive, KRT5/6-negative) and a null phenotype (KRT20-negative, KRT5/6-negative), respectively. A basal-like subtype (KRT20-negative, KRT5/6-positive) was not observed. A significant degree of inter-lesional CIS heterogeneity was noted, reflected by 23% of patients showing a mixed subtype. Neither CIS surrogate subtype nor CIS focality was associated with patient outcome. Patient age and smoking status were the only potentially independent prognostic factors predicting RFS, PFS, OS, and PFS, respectively. In conclusion, further clarification of heterogeneity of surrogate subtypes in HR NMIBC and their prognostic value is of importance with regard to potential implementation of molecular subtyping into clinical routine. The potential prognostic usefulness of patient age and smoking status for high-risk NMIBC patients with CIS needs further validation.
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Affiliation(s)
- Stefan Garczyk
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Felix Bischoff
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Ursula Schneider
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Reinhard Golz
- Institute of Pathology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Ruth Knüchel
- Institute of Pathology, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Stephan Degener
- Department of Urology, Helios University Hospital Wuppertal, Wuppertal, Germany
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Ferro M, Marchioni M, Lucarelli G, Vartolomei MD, Soria F, Terracciano D, Mistretta FA, Luzzago S, Buonerba C, Cantiello F, Mari A, Minervini A, Veccia A, Antonelli A, Musi G, Hurle R, Busetto GM, Del Giudice F, Chung BI, Berardinelli F, Perdonà S, Del Prete P, Mirone V, Borghesi M, Porreca A, Bove P, Autorino R, Crisan N, Abu Farhan AR, Battaglia M, Ditonno P, Russo GI, Muto M, Damiano R, Manfredi M, Porpiglia F, DE Cobelli O, Schips L. Association of statin use and oncological outcomes in patients with first diagnosis of T1 high grade non-muscle invasive urothelial bladder cancer: results from a multicenter study. Minerva Urol Nephrol 2021; 73:796-802. [PMID: 33439571 DOI: 10.23736/s2724-6051.20.04076-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to test the hypothesis that the immune-modulatory effect of statins may improve survival outcomes in patients with non-muscle invasive bladder cancer (NMIBC). We focused on a cohort of patients diagnosed with high risk NMIBC, that were treated with intravesical BCG immunotherapy. METHODS We included patients at first diagnosis of T1 high grade NMIBC after transurethral resection of bladder (TURB). All procedures were performed at 18 different tertiary institutions between January 2002 and December 2012. Univariable and multivariable models were used to test differences in terms of residual tumor, disease recurrence, disease progression and overall mortality (OM) rates. RESULTS Overall, 1510 patients with T1 high grade NMIBC at TURB were included in our analyses. Of these, 402 (26.6%) were statin users. At multivariable analysis, statin use was associated with a higher rate of high-grade BC at re-TURB (OR: 1.37, 95%CI: 1.04-1.78; P=0.022), while at follow-up it was not independently associated with OM (HR: 0.71, 95%CI: 0.50-1.03; P=0.068) and disease progression rates (HR: 0.97, 95%CI: 0.79-1.19; P=0.753). Conversely, statin use has been shown to be independently associated with a lower risk of recurrence (HR:0.80, 95%CI: 0.67-0.95; P=0.009). The median recurrence-free survival was 47 (95%CI 40-49) months for those classified as non-statin users vs. 53 (95%CI 48-68) months in those classified as statin users. CONCLUSIONS Statin daily intake do not compromise oncological outcomes in high risk NMIBC patients treated with BCG. Moreover, statin may have a beneficial effect on recurrence rates in this cohort of patients.
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Affiliation(s)
- Matteo Ferro
- Division of Urology, IRCCS European Institute of Oncology, Milan, Italy -
| | - Michele Marchioni
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Giuseppe Lucarelli
- Section of Urology, Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Mihai D Vartolomei
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania
| | - Francesco Soria
- School of Medicine, Division of Urology, Department of Surgical Sciences, Turin, Italy
| | - Daniela Terracciano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Stefano Luzzago
- Division of Urology, IRCCS European Institute of Oncology, Milan, Italy
| | - Carlo Buonerba
- CRTR Rare Tumors Reference Center, University of Naples Federico II, Naples, Italy
| | | | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Alessandro Veccia
- Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA
| | | | - Gennaro Musi
- Division of Urology, IRCCS European Institute of Oncology, Milan, Italy
| | | | | | | | | | - Francesco Berardinelli
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
| | - Sisto Perdonà
- Department Uro-Gynecology, IRCCS G. Pascale Foundation, National Institute for the Study and Treatment of Cancer, Naples, Italy
| | - Paola Del Prete
- Scientific Directorate, IRCCS G. Pascale Foundation, National Institute for the Study and Treatment of Cancer, Naples, Italy
| | - Vincenzo Mirone
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Marco Borghesi
- Department of Urology, University of Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Robotic Urologic Surgery, Abano Terme Hospital, Abano Terme, Padua, Italy
| | - Pierluigi Bove
- Division of Urology, Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health System, Richmond, VA, USA
| | - Nicolae Crisan
- Department of Urology, University of Medicine and Pharmacy Iuliu Haţieganu, Cluj-Napoca, Romania
| | | | - Michele Battaglia
- Section of Urology, Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Pasquale Ditonno
- Section of Urology, Unit of Andrology and Kidney Transplantation, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giorgio I Russo
- Department of Urology, University of Catania, Catania, Italy
| | - Matteo Muto
- Unit of Radiotherapy, Moscati University Hospital, Avellino, Italy
| | - Rocco Damiano
- Department of Urology, Magna Graecia University, Catanzaro, Italy
| | - Matteo Manfredi
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- School of Medicine, Division of Urology, Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Luigi Schips
- Unit of Urology, Department of Medical, Oral and Biotechnological Sciences, SS. Annunziata Hospital, G. D'Annunzio University, Chieti, Italy
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6
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Afferi L, Moschini M, Cumberbatch MG, Catto JW, Scarpa RM, Porpiglia F, Mattei A, Sanchez-Salas R, Esperto F. Biomarkers predicting oncological outcomes of high-risk non-muscle-invasive bladder cancer. MINERVA UROL NEFROL 2020; 72:265-278. [PMID: 32298067 DOI: 10.23736/s0393-2249.20.03786-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) scoring systems show limited accuracy for the prediction of disease recurrence and progression of non-muscle-invasive bladder cancer (NMIBC). This aspect is even more relevant in the category of HR NMIBC. Biomarkers might potentially help to further categorize the outcomes of these patients. Therefore, we sought to review the evidence available on tissue-based, urinary, and serum biomarkers for the prediction of recurrence, progression, and survival in HR NMIBC. EVIDENCE ACQUISITION A systematic literature review without time restrictions was performed using PubMed/EMBASE, Web of Science, SCOPUS, and the Cochrane Libraries. The search was filtered for articles in the English, Italian, German, French, and Spanish languages, involving patients with more than 18 years of age. Relevant papers on tissue-based, serum and urinary biomarkers related to the prediction of oncological outcomes for high-risk bladder cancer patients were included in the analyses. EVIDENCE SYNTHESIS Overall, 71 studies were eligible for inclusion in this review. The majority of the investigations performed so far focused on immunohistochemical analyses on tumoral tissue. Overall, p53 was the most studied biomarker, but results regarding its prognostic and predictive role were contradictory. Ki67 seems to be a promising biomarker in the prediction of recurrence. Recently, PD-L1 has been associated with the prediction of recurrence free survival and of treatment-refractory disease. Markers developed un urine samples are focused on commercially available kits, which currently do not unequivocally show strongly superior levels of accuracy to cytology. However, they have demonstrated to be potentially helpful in the prediction of recurrence. Blood-based biomarkers represent an emerging reality with promising future applications. CONCLUSIONS Despite a long history of attempts to discover accurate biomarkers predicting oncological outcomes for HR NMIBC, contradictory or uncertain findings render the adoption of this ancillary techniques in clinical practice still unlikely. Future attempts should be directed to the development of prospective trials and the definition of standardized cut-off levels to render findings worthy of comparison.
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Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland - .,Department of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - James W Catto
- Unit of Academic Urology, University of Sheffield, Sheffield, UK
| | - Roberto M Scarpa
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris and Universitè Paris Descartes, Paris, France
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