1
|
Chiujdea S, Ferro M, Vartolomei MD, Lucarelli G, Bekku K, Matsukawa A, Parizi MK, Klemm J, Tsuboi I, Fazekas T, Mancon S, Shariat SF. Epirubicin and Non-Muscle Invasive Bladder Cancer Treatment: A Systematic Review. J Clin Med 2024; 13:3789. [PMID: 38999355 PMCID: PMC11242503 DOI: 10.3390/jcm13133789] [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: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
(1) Background: Intravesical chemotherapy is the standard of care in intermediate-risk non-muscleinvasive bladder cancer (NMIBC). Different agents are used across the world based on availability, cost, and practice patterns. Epirubicin (EPI), one of these agents, has been used by many centers over many decades. However, its true differential efficacy compared to other agents and its tolerability are still poorly reported. We aimed to assess the differential efficacy and safety of intravesical EPI in NMIBC patients. (2) Methods: This study aimed to systematically review the efficacy and safety profile of Epirubicin (EPI) in the management of non-muscle invasive bladder cancer (NMIBC) compared to other adjuvant therapies. A systematic search of the PUBMED, Web of Science, clinicaltrials.gov, and Google Scholar databases was conducted on 31 December 2023, using relevant terms related to EPI, bladder cancer, and NMIBC. The inclusion criteria targeted studies that evaluated patients treated with EPI following the transurethral resection of bladder tumors (TURBT) for NMIBC and compared oncological outcomes such as recurrence and progression with other adjuvant therapies, including Mitomycin C (MMC), Gemcitabine (GEM), and Bacillus Calmette-Guérin (BCG). Additionally, studies investigating the safety profile of EPI administered intravesically at room temperature and under hyperthermia, as well as oncological outcomes associated with hyperthermic intravesical EPI administration, were included. (3) Results: Eleven studies reported adverse events after adjuvant intravesical instillations with EPI; the most frequently reported adverse events included cystitis (34%), dysuria, pollakiuria, hematuria, bladder irritation/spasms, fever, nausea and vomiting, and generalized skin rash (2.3%). Nine studies compared EPI to BCG in terms of recurrence and progression rates; BCG instillations showed a lower recurrence rate compared to EPI, with limited or non-significant differences in progression rates. Two studies found no significant differences between EPI and MMC regarding progression and recurrence rates. One study showed statistically significant lower recurrence and progression rates with GEM in high-risk NMIBC patients. Another study found no significant differences between EPI and GEM regarding recurrence and progression. (4) Conclusions: EPI exhibits similar oncological performances to Gemcitabine and Mitomycin C currently used for adjuvant therapy in NMIBC. Novel delivery mechanisms such as hyperthermia are interesting newcomers.
Collapse
Affiliation(s)
- Sever Chiujdea
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania; (S.C.); (M.F.)
| | - Matteo Ferro
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania; (S.C.); (M.F.)
- Urology Department, European Institute of Oncology, 20122 Milan, Italy
| | - Mihai Dorin Vartolomei
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Târgu Mureș, Romania; (S.C.); (M.F.)
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area Urology, Andrology and Kidney Transplantation Unit, 70124 Bari, Italy;
| | - Kensuke Bekku
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan;
| | - Akihiro Matsukawa
- Department of Urology, Jikei University School of Medicine, Tokyo 143-8541, Japan;
| | - Mehdi Kardoust Parizi
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran 14878-92855, Iran;
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20359 Hamburg, Germany;
| | - Ichiro Tsuboi
- Department of Urology, Shimane University Faculty of Medicine, Shimane 693-8501, Japan;
| | - Tamas Fazekas
- Department of Urology, Semmelweis University, 1085 Budapest, Hungary;
| | - Stefano Mancon
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Italy;
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Special Surgery, Division of Urology, Jordan University Hospital, The University of Jordan, Amman 11942, Jordan
- Karl Landsteiner Society, Karl Landsteiner Institute of Urology and Andrology, 1090 Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX 75390, USA
- Research Center for Evidence Medicine, Urology Department Tabriz University of Medical Sciences, Tabriz 51656-65811, Iran
| |
Collapse
|
2
|
Nishimura N, Miyake M, Miyamoto T, Shimizu T, Fujii T, Morizawa Y, Hori S, Gotoh D, Nakai Y, Torimoto K, Tanaka N, Fujimoto K. Routine Surveillance of Upper Urinary Tract Imaging for Diagnosing Upper Urinary Tract Urothelial Cancer Recurrence in Patients with Nonmuscle Invasive Bladder Cancer. Adv Urol 2024; 2024:5894288. [PMID: 38807901 PMCID: PMC11132829 DOI: 10.1155/2024/5894288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
Background Although routine surveillance imaging to examine upper urinary tract urothelial cancer recurrence during follow-up of nonmuscle invasive bladder cancer is recommended, its necessity remains invalidated. A single-institute long-term follow-up cohort study to evaluate the clinical impact of routine surveillance imaging and identify risk factors for upper urinary tract urothelial cancer recurrence after nonmuscle invasive bladder cancer treatment was conducted. Methods and Materials A retrospective chart review of 864 patients with primary nonmuscle invasive bladder cancer who underwent initial transurethral resection of bladder tumor between 1980 and 2020 was conducted. The opportunities to diagnose its recurrence were examined. Moreover, oncological outcomes included upper urinary tract urothelial cancer recurrence-free survival and overall survival. Results Of 864 patients, 19 (2.2%) experienced upper urinary tract urothelial cancer recurrence. Among 19 patients, recurrence was detected through routine imaging in 12 (63.2%), cystoscopy in 2 (10.5%), urine cytology in 2 (10.5%), and presence of gross hematuria in 1 (5.3%). All patients had high- or highest-risk NMIBC at diagnosis of primary nonmuscle invasive bladder cancer. On multivariate Fine-Gray proportional regression analyses, a tumor size of ≥30 mm and carcinoma in situ were independently associated with short upper urinary tract urothelial cancer recurrence-free survival (P=0.040 and 0.0089, respectively). Conclusion Most patients experiencing upper urinary tract urothelial cancer recurrence were diagnosed by routine surveillance imaging, suggesting its clinical importance, especially for patients with nonmuscle invasive bladder cancer accompanied by a tumor size of ≥30 mm and carcinoma in situ.
Collapse
Affiliation(s)
- Nobutaka Nishimura
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tatsuki Miyamoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Takuto Shimizu
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
- Department of Prostate Brachytherapy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| |
Collapse
|
3
|
Zaza MMA, Salem TAEM, El-Sadat AM, Hassan Ali M. Comparative study between mitomycin C versus Bacillus Calmette-Guérin (BCG) in high-risk non-muscle-invasive bladder cancer. Urologia 2024; 91:61-68. [PMID: 37905506 DOI: 10.1177/03915603231206603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES We aimed to compare the efficacy and adverse events of Bacillus Calmette-Guérin (BCG) versus Mitomycin C (MMC) in high-risk Non-Muscle-Invasive Bladder Cancer (NMIBC) patients. METHODS This randomized controlled study was conducted over 24 months in four hospitals in Egypt. A sample of 90 patients was randomly assigned to either treatment group, with procedures including baseline examinations, a single postoperative instillation of chemotherapy, a 6-week induction cycle of the assigned drug, and regular follow-up cystoscopies and upper urinary tract imaging. Treatment results and side effects were monitored, with data analyzed via Statistical Package for Social Sciences (SPSS). RESULTS No significant differences were observed in mean age or tumor characteristics (p > 0.05). However, adverse reactions were significantly higher in the BCG group, including cystitis (40% vs. 17.78%, p = 0.020), hematuria (24.44% vs. 4.44%, p = 0.007), overall local reactions (75.56% vs. 26.67%, p < 0.001), fever (13.33% vs. 2.22%, p = 0.049), and fatigue (17.78% vs. 2.22%, p = 0.014). The MMC group had a slightly higher recurrence rate (28.89% vs. 17.78%, hazard ratio 1.89, 95% CI: 0.78-4.55, p = 0.15) with a shorter median time to recurrence (six vs. 12 months). Progression rates were similar (8.89% MMC vs. 4.44% BCG, p = 0.398). CONCLUSION Although BCG and MMC have comparable efficacy in managing high-risk NMIBC, BCG demonstrated a higher rate of adverse reactions. Decision-making should consider this balance, patient preferences, and health status. Further research is needed for the validation and exploration of these findings.
Collapse
|
4
|
Bourlotos G, Baigent W, Hong M, Plagakis S, Grundy L. BCG induced lower urinary tract symptoms during treatment for NMIBC-Mechanisms and management strategies. Front Neurosci 2024; 17:1327053. [PMID: 38260019 PMCID: PMC10800852 DOI: 10.3389/fnins.2023.1327053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Non-muscle invasive bladder cancer (NMIBC) accounts for ~70-75% of total bladder cancer tumors and requires effective early intervention to avert progression. The cornerstone of high-risk NMIBC treatment involves trans-urethral resection of the tumor followed by intravesical Bacillus Calmette-Guerin (BCG) immunotherapy. However, BCG therapy is commonly accompanied by significant lower urinary tract symptoms (LUTS) including urinary urgency, urinary frequency, dysuria, and pelvic pain which can undermine treatment adherence and clinical outcomes. Despite this burden, the mechanisms underlying the development of BCG-induced LUTS have yet to be characterized. This review provides a unique perspective on the mechanisms thought to be responsible for the development of BCG-induced LUTS by focussing on the sensory nerves responsible for bladder sensory transduction. This review focuses on how the physiological response to BCG, including inflammation, urothelial permeability, and direct interactions between BCG and sensory nerves could drive bladder afferent sensitization leading to the development of LUTS. Additionally, this review provides an up-to-date summary of the latest clinical data exploring interventions to relieve BCG-induced LUTS, including therapeutic targeting of bladder contractions, inflammation, increased bladder permeability, and direct inhibition of bladder sensory signaling. Addressing the clinical burden of BCG-induced LUTS holds significant potential to enhance patient quality of life, treatment compliance, and overall outcomes in NMIBC management. However, the lack of knowledge on the pathophysiological mechanisms that drive BCG-induced LUTS has limited the development of novel and efficacious therapeutic options. Further research is urgently required to unravel the mechanisms that drive BCG-induced LUTS.
Collapse
Affiliation(s)
- Georgia Bourlotos
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - William Baigent
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| | - Matthew Hong
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Sophie Plagakis
- Urology Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Luke Grundy
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA, Australia
| |
Collapse
|
5
|
Lin JH, Hung CH, Huang YC, Chen CS, Ho DR. The p38-MITOGEN-ACTIVATED PROTEIN KINASE Signaling Pathway Is Involved in Leonurus artemisia Extract-Induced Inhibition of the Proliferation of Human Bladder Cancer BFTC-905 Cells via G1/G0 Arrest and Causes Apoptosis In Vitro. Pharmaceuticals (Basel) 2023; 16:1338. [PMID: 37895809 PMCID: PMC10609973 DOI: 10.3390/ph16101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/29/2023] Open
Abstract
Bladder cancer is a urothelial malignancy. Bladder cancer starts in the urothelial cells lining the inside of the bladder. The 5-year recurrence rate for bladder cancer ranges from 31% to 78%, and the progression rate is approximately 45%. To treat bladder cancer, intravesical drug therapy is often used. Leonurus artemisia extract (LaE) was obtained from medicinal samples of Chinese motherwort Scientific Chinese Medicine; L. artemisia has various biological effects. This study investigated the impact of LaE on human bladder cancer cells (the BFTC-905 cell line) and the molecular mechanism underlying apoptosis resulting from the activation of cell signal transduction pathways in bladder cancer cells. A cell counting kit-8 (CCK-8) assay was used to determine the effect of LaE on cell growth. The effect of LaE on migration ability was observed using a wound healing assay. The effects of LaE on the cell cycle, reactive oxygen species production, and apoptosis were investigated. Western blot analysis detected apoptosis-related and mitogen-activated protein kinase signaling pathway-related protein concentrations. At non-toxic concentrations, LaE inhibited the proliferation of BFTC-905 cells in a concentration-dependent manner, and the half-maximal inhibitory concentration (IC50) was 24.08172 µg/µL. LaE impaired the migration ability of BFTC-905 cells. LaE arrested the cell cycle in the G1 and G0 phases, increased reactive oxygen species production, and induced apoptosis. LaE increased Bax and p-ERK concentrations and decreased Bcl-2, cleaved caspase-3, and p-p38 concentrations. No differences in PARP, C-PARP, vimentin, e-cadherin, p-JNK, or TNF-alpha concentrations were observed. These results suggest that LaE inhibits the proliferation of human bladder cancer cells. Moreover, the mitogen-activated protein kinase signaling pathway is involved in the inhibition of the proliferation of BFTC-905 cells.
Collapse
Affiliation(s)
- Jian-Hui Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (J.-H.L.); (Y.-C.H.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chein-Hui Hung
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (J.-H.L.); (Y.-C.H.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chih-Shou Chen
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (J.-H.L.); (Y.-C.H.)
| | - Dong-Ru Ho
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi 613, Taiwan; (J.-H.L.); (Y.-C.H.)
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- School of Medicine, National Tsing Hua University, Hsinchu 300044, Taiwan
| |
Collapse
|
6
|
Shibutani K, Ishikawa K, Mori N. Uncommon but Clinically Significant: Bacillus Calmette-Guerin (BCG) Infection of the Urinary Tract and its Impact on Quality of Life. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e940375. [PMID: 37537854 PMCID: PMC10405347 DOI: 10.12659/ajcr.940375] [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: 03/16/2023] [Revised: 06/30/2023] [Accepted: 06/08/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The intravesical administration of bacillus Calmette-Guerin (BCG), an attenuated live strain of Mycobacterium bovis, is an immunotherapy given for superficial bladder cancer and is generally well tolerated and widely used. However, BCG sometimes causes local infections, such as cystitis and prostatitis or systemic infection. Because BCG infection is a rare complication of intravesical BCG instillation, the combination of an anti-tuberculous regimen and its duration of are unknown. CASE REPORT We describe 2 cases of BCG infection localized to the urinary tract. Case 1 was a 77-year-old man with BCG infection of the bladder and prostate. Combination therapy of anti-tuberculous agents with isoniazid, rifampicin, and ethambutol did not improve his symptoms, and his quality of life was significantly impaired from the symptoms of BCG infection; therefore, he underwent total resection of the bladder and prostate. Case 2 was an 84-year-old man with BCG infection of the bilateral ureter and bladder. It took 15 months for his symptoms to improve, but combination therapy with isoniazid, rifabutin, and ethambutol improved his condition completely. CONCLUSIONS Although BCG infection of the urinary tract is a rare complication, it is clinically important because it directly affects the quality of life of patients and requires a longer duration of treatment, depending on the symptoms. Tissue cultures are also difficult to culture, making a definitive diagnosis challenging. If the symptoms of BCG infection are not controlled, surgery can be necessary even if it is not a complication of a vital organ.
Collapse
|
7
|
Chen C, Fa Y, Kuo Y, Liu Y, Lin C, Wang X, Lu Y, Chiang Y, Yang C, Wu L, Ho JA. Thiolated Mesoporous Silica Nanoparticles as an Immunoadjuvant to Enhance Efficacy of Intravesical Chemotherapy for Bladder Cancer. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2204643. [PMID: 36638276 PMCID: PMC9982584 DOI: 10.1002/advs.202204643] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/16/2022] [Indexed: 06/17/2023]
Abstract
The characteristics of global prevalence and high recurrence of bladder cancer has led numerous efforts to develop new treatments. The spontaneous voiding and degradation of the chemodrug hamper the efficacy and effectiveness of intravesical chemotherapy following tumor resection. Herein, the externally thiolated hollow mesoporous silica nanoparticles (MSN-SH(E)) is fabricated to serve as a platform for improved bladder intravesical therapy. Enhanced mucoadhesive effect of the thiolated nanovector is confirmed with porcine bladder. The permeation-enhancing effect is also verified, and a fragmented distribution pattern of a tight junction protein, claudin-4, indicates the opening of tight junction. Moreover, MSN-SH(E)-associated reprogramming of M2 macrophages to M1-like phenotype is observed in vitro. The antitumor activity of the mitomycin C (MMC)-loaded nanovector (MMC@MSN-SH(E)) is more effective than that of MMC alone in both in vitro and in vivo. In addition, IHC staining is used to analyze IFN-γ, TGF-β1, and TNF-α. These observations substantiated the significance of MMC@MSN-SH(E) in promoting anticancer activity, holding the great potential for being used in intravesical therapy for non-muscle invasive bladder cancer (NMIBC) due to its mucoadhesivity, enhanced permeation, immunomodulation, and prolonged and very efficient drug exposure.
Collapse
Affiliation(s)
- Cheng‐Che Chen
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
- Department of UrologyTaichung Veterans General Hospital40705TaichungTaiwan
| | - Yu‐Chen Fa
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
| | - Yen‐Yu Kuo
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
| | - Yi‐Chun Liu
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
| | - Chih‐Yu Lin
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
| | - Xin‐Hui Wang
- Instrumentation CenterNational Taiwan University10617TaipeiTaiwan
| | - Yu‐Huan Lu
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
| | - Yu‐Han Chiang
- Department of ChemistryNational Taiwan University10617TaipeiTaiwan
| | - Chia‐Min Yang
- Department of ChemistryNational Tsing Hua University300044HsinchuTaiwan
- Frontier Research Center on Fundamental and Applied Sciences of MattersNational Tsing Hua University300044HsinchuTaiwan
| | - Li‐Chen Wu
- Department of Applied ChemistryNational Chi Nan UniversityPuliNantou54561Taiwan
| | - Ja‐an Annie Ho
- BioAnalytical Chemistry and Nanobiomedicine LaboratoryDepartment of Biochemical Science and TechnologyNational Taiwan University10617TaipeiTaiwan
- Department of ChemistryNational Taiwan University10617TaipeiTaiwan
- Center for Emerging Materials and Advance DevicesNational Taiwan University10617TaipeiTaiwan
- Center for BiotechnologyNational Taiwan University10617TaipeiTaiwan
| |
Collapse
|
8
|
Lin L, Guo X, Ma Y, Zhu J, Li X. Does repeat transurethral resection of bladder tumor influence the diagnosis and prognosis of T1 bladder cancer? A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:29-38. [PMID: 35752497 DOI: 10.1016/j.ejso.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND To reduce recurrence or progression of tumor, NCCN guidelines recommend repeat transurethral resection of bladder tumors (reTURB) for non-muscle-invasive bladder cancer (NMIBC). The study aims to compare the impact of initial TURB and reTURB on the rate of residual or upstaging tumors and short-term and long-term survival outcomes of T1 bladder cancer (BC). MATERIALS AND METHODS We searched through several public database, including PubMed, Embase, Ovid Medline and Ovid EBM Reviews - Cochrane Central Register of Controlled Trials. The latest search time was October 2021. RESULTS In general, 68 articles were involved. Short-term RFS (1-year and 3-year) of reTURB group was better compared with TURB group in T1 patients. The pooled RR were 1.10 (95%CI: 1.01-1.19) and 1.15 (95%CI: 1.03-1.28), respectively. While reTURB did not improve long-term RFS (5-year, 10-year, 15-year) in T1 patients. The pooled RR were 1.12 (95%CI: 0.97-1.30), 1.11 (95%CI: 0.82-1.50) and 1.37 (95%CI: 0.50-3.74), respectively. Analysis of PFS, OS and CSS demonstrated similar outcomes with RFS. We found that about two-thirds of samples contained detrusor. The residual tumor rate in stage T1 was 0.48 (95%CI: 0.42-0.53). While the rate of upstaging in stage T1 was 0.10 (95%CI: 0.07-0.13). CONCLUSIONS In conclusion, reTURB might provide short-term survival benefits for T1 BC, but it was not the same for long-term outcomes. The residual and upstaging rates of T1 BC in reTURB were around 50% and 10%, respectively. Our study might be conducive to clinically informed consents when patients expressed their concerns about the necessity of reTURB and its impact on diagnosis, treatment and prognosis.
Collapse
Affiliation(s)
- Lede Lin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaotong Guo
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Zhu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xiang Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
9
|
Li K, Raveendran A, Xie G, Zhang Y, Wu H, Huang Z, Jia Z, Yang J. Prediction for recurrent non-muscle invasive bladder cancer. Cancer Biomark 2023; 38:275-285. [PMID: 37661872 DOI: 10.3233/cbm-220373] [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: 09/05/2023]
Abstract
Non-muscle invasive bladder cancer (NMIBC) has a high recurrence rate, which places a significant burden on both patients and the healthcare system. Hence, it holds significant importance to predict the recurrence risk following treatment for individuals diagnosed with non-muscle invasive bladder cancer (NMIBC). As new generation technologies continue to emerge, an increasing number of recurrence risk prediction tools are being developed and discovered. This article provides an overview of the primary recurrence risk prediction tools currently available, including the liquid biopsy, tissue biopsy, and risk prediction tables. Each of these tools is described in detail and illustrated with relevant examples. Furthermore, we conduct an analysis of the advantages and disadvantages of these tools. This article aims to enhance the reader's understanding of the current progress in recurrence prediction tools and encourage their practical utilization in the fields of precision medicine and public health.
Collapse
Affiliation(s)
- Keqiang Li
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Aravind Raveendran
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Guoqing Xie
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Yu Zhang
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
- Academy of Medical Sciences, Zhengzhou University, Henan, China
| | - Haofan Wu
- Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Zhenlin Huang
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Zhankui Jia
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jinjian Yang
- Laboratory Urology, Department of Urology, The First Affiliated Hospital of Zhengzhou University, Henan, China
| |
Collapse
|
10
|
Mullapudi SS, Rahmat JN, Mahendran R, Lim YK, Ong LT, Wong KY, Chiong E, Kang ET, Neoh KG. Tumor-targeting albumin nanoparticles as an efficacious drug delivery system and potential diagnostic tool in non-muscle-invasive bladder cancer therapy. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2022; 46:102600. [PMID: 36064034 DOI: 10.1016/j.nano.2022.102600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Current intravesical chemotherapy for non-muscle invasive bladder cancer (NMIBC) has limited efficacy due to loss of the instilled agent from urine voiding and the agent's lack of specificity for the tumors. We developed a nanocarrier (txCD47-HNP, ∼100 nm) based on human serum albumin conjugated with a peptide that targets the cluster of differentiation 47 receptor overexpressed on bladder cancer (BC) cells. The IC50 of gemcitabine elaidate (GEM) loaded in the txCD47-HNP was almost an order of magnitude lower than that of free GEM. In a mouse orthotopic BC model, GEM loaded in txCD47-HNP effectively reduced the tumor burden. Tumor cells in BC patients' urine can also be targeted by fluorescence-labeled txCD47-HNP resulting in >83 % of the cells exhibiting fluorescence. Thus, txCD47-HNP can potentially be a theranostic agent in NMIBC management by serving as a targeted drug delivery vehicle as well as an alternative to urine cytology.
Collapse
Affiliation(s)
- Sneha Sree Mullapudi
- Department of Biomedical Engineering, National University of Singapore, Kent Ridge 117583, Singapore
| | - Juwita Norasmara Rahmat
- Department of Biomedical Engineering, National University of Singapore, Kent Ridge 117583, Singapore
| | - Ratha Mahendran
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Yew Koon Lim
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Lee Ting Ong
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Kah Ying Wong
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore
| | - Edmund Chiong
- Department of Surgery, National University of Singapore, Kent Ridge 119228, Singapore; Department of Urology, National University Hospital, Kent Ridge 119074, Singapore
| | - En-Tang Kang
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Kent Ridge 117585, Singapore
| | - Koon Gee Neoh
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Kent Ridge 117585, Singapore.
| |
Collapse
|
11
|
Li Y, Youssef SF, Buanz ABM. Intravesical combination therapies for non-muscle invasive bladder cancer: Recent advances and future directions. Eur J Pharmacol 2022; 926:175024. [DOI: 10.1016/j.ejphar.2022.175024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/30/2022] [Accepted: 05/09/2022] [Indexed: 11/03/2022]
|
12
|
Wettstein MS, Baxter NN, Sutradhar R, Mamdani M, Song P, Qadri SR, Li K, Liu N, van der Kwast T, Hermanns T, Kulkarni GS. Uptake of re-resection in T1 bladder cancer: An interrupted population-based time series analysis among different groups of surgeons. Urol Oncol 2022; 40:165.e1-165.e8. [DOI: 10.1016/j.urolonc.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/16/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
|
13
|
Bhindi B, Kool R, Kulkarni GS, Siemens DR, Aprikian AG, Breau RH, Brimo F, Fairey A, French C, Hanna N, Izawa JI, Lacombe L, McPherson V, Rendon RA, Shayegan B, So AI, Zlotta AR, Black PC, Kassouf W. Canadian Urological Association guideline on the management of non-muscle-invasive bladder cancer - Abridged version. Can Urol Assoc J 2022; 15:230-239. [PMID: 35099374 DOI: 10.5489/cuaj.7487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Bimal Bhindi
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ronald Kool
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | - Armen G Aprikian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Rodney H Breau
- Division of Urology, University of Ottawa, Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Fadi Brimo
- Department of Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Adrian Fairey
- Division of Urology, University of Alberta, Edmonton, AB, Canada
| | - Christopher French
- Division of Urology, Department of Surgery, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nawar Hanna
- Department of Urology, Université de Montréal, Montreal, QC, Canada
| | - Jonathan I Izawa
- Department of Surgery, Division of Urology, Western University, London, ON, Canada
| | - Louis Lacombe
- Department of Surgery, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Victor McPherson
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Sinai Health System and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
14
|
Wettstein MS, Baxter NN, Sutradhar R, Mamdani M, Song P, Qadri SR, Li K, Liu N, van der Kwast T, Hermanns T, Kulkarni GS. Oncological benefit of re-resection for T1 bladder cancer: a comparative effectiveness study. BJU Int 2022; 129:258-268. [PMID: 34674366 DOI: 10.1111/bju.15622] [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: 01/03/2023]
Abstract
OBJECTIVES To quantify the real-world survival benefit of re-resection vs no re-resection in patients diagnosed with T1 bladder cancer (BC) at the population level. PATIENTS AND METHODS Retrospective population-wide observational cohort study based on pathology reports linked to health administrative data. We identified patients who were diagnosed with T1 BC in the province of Ontario (01/2001-12/2015) and used billing claims to ascertain whether they received re-resection within 2-10 weeks. The time-dependent effect of re-resection on survival outcomes was modelled by Cox proportional hazards regression (unadjusted and adjusted for numerous assumed patient- and surgeon-level confounding variables). Effect measures were presented as hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We identified 7666 patients of which 2162 (28.7%) underwent re-resection after a median (interquartile range) time of 45 (35-56) days. Patients who received re-resection were less likely to die from any causes (HR 0.68, 95% CI 0.63-0.74, P < 0.001) and from BC (HR 0.66, 95% CI 0.57-0.76, P < 0.001) during any time of follow-up. After adjusting for all assumed confounding variables, re-resection was still significantly associated with a lower overall mortality (HR 0.88, 95% CI 0.81-0.95, P < 0.001), while the association with cancer-specific survival marginally lost its statistical significance (HR 0.87, 95% CI 0.75-1.02, P = 0.08). CONCLUSIONS A second transurethral resection within 2-6 weeks after the initial resection (i.e. re-resection) is recommended for patients diagnosed with primary T1 BC as prior studies suggest therapeutic, diagnostic, and prognostic benefits. However, results on survival endpoints are sparse, conflicting, and often affected by various biases. To the best of our knowledge, the present population-wide study represents the largest cohort of patients diagnosed with T1 BC and provides real-world evidence supporting the utilisation of re-resection in this group of patients.
Collapse
Affiliation(s)
- Marian S Wettstein
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Nancy N Baxter
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Rinku Sutradhar
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | | | - Syed R Qadri
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathy Li
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Theodorus van der Kwast
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thomas Hermanns
- Department of Urology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| |
Collapse
|
15
|
Downes MR, Lajkosz K, Kuk C, Gao B, Kulkarni GS, van der Kwast TH. The impact of grading scheme on non-muscle invasive bladder cancer progression: potential utility of hybrid grading schemes. Pathology 2022; 54:425-433. [PMID: 35074179 DOI: 10.1016/j.pathol.2021.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/04/2021] [Accepted: 10/11/2021] [Indexed: 12/31/2022]
Abstract
Non-muscle invasive bladder cancer (NMIBC) grade is a major determinant of progression risk. The most widely utilised grading systems are the World Health Organization (WHO) 1973 and 2004 schemes. Recent publications suggest the utility of combining both into a four-tier or a hybrid three-tier system, subdividing WHO 2004 high grade into two separate categories while maintaining low grade as a single group. We identified two retrospective cohorts of bladder resections/biopsies of papillary urothelial NMIBC with long term clinical follow-up. The sentinel specimen was assessed for WHO 2004 and 1973 grade, along with pathological stage and carcinoma in situ. Each case was additionally stratified into a hybrid three-tier system (low grade; high grade, grades 2 and 3) and a four-tier system (low grade, grades 1 and 2; high grade, grades 2 and 3). Uni- and multivariable analysis for progression and event free survival (PFS/EFS) were calculated along with the time dependent area under the curve (AUC) for each grading scheme. There were 609 cases (Cohort A, n=343; Cohort B, n=266), including 449 (74%) pTa, 156 pT1 (26%) and four pTx with 338 (56%) low grade (177, grade 1; 161, grade 2) and 271 (44%) high grade (137, grade 2; 134, grade 3). A total of 108 patients progressed (17.7%): 97 high grade, (grade 3, n=59; grade 2, n=38). Multivariable analyses of PFS with the hybrid 3- and 4-tier systems showed higher Harrell's concordance indices (0.851 and 0.853, respectively) than WHO 1973 (0.844) and WHO 2004 (0.846). In both cohorts AUC values were higher (0.77-0.85) for the two hybrid grading systems compared to WHO 1973 or WHO 2004 (0.72-0.82). Similar results were seen on analysis of EFS. The data support the use of a hybrid three-tier or four-tier grading system to improve stratification of NMIBC patients.
Collapse
Affiliation(s)
- Michelle R Downes
- Division of Anatomic Pathology, Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Katherine Lajkosz
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - Theodorus H van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| |
Collapse
|
16
|
Arthuso FZ, Fairey AS, Boulé NG, Courneya KS. Bladder cancer and exeRcise trAining during intraVesical thErapy-the BRAVE trial: a study protocol for a prospective, single-centre, phase II randomised controlled trial. BMJ Open 2021; 11:e055782. [PMID: 34561265 PMCID: PMC8475156 DOI: 10.1136/bmjopen-2021-055782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Non-muscle invasive bladder cancer (NMIBC) accounts for about 75% of newly diagnosed bladder cancers. The treatment for NMIBC involves surgical removal of the tumour followed by 6 weekly instillations of immunotherapy or chemotherapy directly into the bladder (ie, intravesical therapy). NMIBC has a high rate of recurrence (31%-78%) and progression (15%). Moreover, bladder cancer and its treatment may affect patient functioning and quality of life. Exercise is a safe and effective intervention for many patient with cancer groups, however, no studies have examined exercise during intravesical therapy for NMIBC. The primary objective of the Bladder cancer and exeRcise trAining during intraVesical thErapy (BRAVE) trial is to examine the safety and feasibility of an exercise intervention in patients with bladder cancer undergoing intravesical therapy. The secondary objectives are to investigate the preliminary efficacy of exercise on health-related fitness and patient-reported outcomes; examine the social cognitive predictors of exercise adherence; and explore the potential effects of exercise on tumour recurrence and progression. METHODS AND ANALYSIS BRAVE is a phase II randomised controlled trial that aims to include 66 patients with NMIBC scheduled to receive intravesical therapy. Participants will be randomly assigned to the exercise intervention or usual care. The intervention consists of three supervised, high-intensity interval training sessions per week for 12 weeks. Feasibility will be evaluated by eligibility, recruitment, adherence and attrition rates. Preliminary efficacy will focus on changes in cardiorespiratory fitness and patient-reported outcomes from baseline (prior to intravesical therapy) to pre-cystoscopy (3 months). Cancer outcomes will be tracked at 3 months, and 1-year follow-up by cystoscopy. Analysis of covariance will compare between-group differences at post-intervention (pre-cystoscopy) for all health-related fitness and patient-reported outcomes. ETHICS AND DISSEMINATION The study was approved by the Health Research Ethics Board of Alberta-Cancer Committee (#20-0184). Dissemination will include publication and presentations at scientific conferences and public channels. TRIAL REGISTRATION NUMBER NCT04593862; Pre-results.
Collapse
Affiliation(s)
- Fernanda Z Arthuso
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian S Fairey
- Division of Urology, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
17
|
Rubio-Briones J, Algaba F, Gallardo E, Marcos-Rodríguez JA, Climent MÁ. Recent Advances in the Management of Patients with Non-Muscle-Invasive Bladder Cancer Using a Multidisciplinary Approach: Practical Recommendations from the Spanish Oncology Genitourinary (SOGUG) Working Group. Cancers (Basel) 2021; 13:cancers13194762. [PMID: 34638247 PMCID: PMC8507539 DOI: 10.3390/cancers13194762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/15/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This report presents clinically relevant advances in the management of non-muscle-invasive bladder cancer, which have been the focus of discussion of expert members of the Spanish Oncology Genitourinary (SOGUG) Multidisciplinary Working Group in the framework of the Genitourinary Alliance project (12GU), designed as a space for the integration of novel information in the care of bladder cancer patients. The present study is focused on different aspects regarding the evaluation of hematuria, assessment of second (or repeated) transurethral resection of bladder cancer, histopathological diagnosis and problems with tumor grading, importance of histological variants, shortage of drug supply, and the current role and influence of immunotherapy and biological markers on the oncological outcome of patients. All proposals and recommendations have a multidisciplinary practical approach and are intended to help clinicians in shared decision making for patients with non-muscle-invasive urothelial cancer. Abstract On the basis of the discussion of the current state of research on relevant topics of non-muscle-invasive bladder cancer (NMIBC) among a group of experts of the Spanish Oncology Genitourinary (SOGUG) Working Group, recommendations were proposed to overcome the challenges posed by the management of NMIBC in clinical practice. A unified definition of the term ‘microhematuria’ and the profile of the patient at risk are needed. Establishing a ‘hematuria clinic’ would contribute to a centralized and more efficient evaluation of patients with this clinical sign. Second or repeated transurethral resection (re-TUR) needs to be defined, including the time window after the first procedure within which re-TUR should be performed. Complete tumor resection is mandatory when feasible, with specification of the presence or absence of muscle. Budding should be used as a classification system, and stratification of T1 tumors especially in extensive and deep tumors, is advisable. The percentage of the high-grade component should always be reported, and, in multiple tumors, grades should be reported separately. Luminal and basal subtypes can be identified because of possibly different clinical outcomes. Molecular subtypes and immunotherapy are incorporated in the management of muscle-invasive bladder cancer but data on NMIBC are still preliminary.
Collapse
Affiliation(s)
- José Rubio-Briones
- Urology Department, Instituto Valenciano de Oncología & Hospital VITHAS 9 de Octubre, 06009 Valencia, Spain
- Correspondence:
| | - Ferran Algaba
- Pathology Section Fundació Puigvert, Universitat Autònoma de Barcelona, 08025 Barcelona, Spain;
| | - Enrique Gallardo
- Oncology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, 08208 Sabadell, Spain;
| | | | - Miguel Ángel Climent
- Medical Oncology Service, Fundación Instituto Valenciano de Oncología, 46009 Valencia, Spain;
| | | |
Collapse
|
18
|
Enhanced Visualization Methods for First Transurethral Resection of Bladder Tumour in Suspected Non-muscle-invasive Bladder Cancer: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2021; 21:1-123. [PMID: 34484486 PMCID: PMC8382283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Bladder cancer begins in the innermost lining of the bladder wall and, on histological examination, is classified as one of two types: non-muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer. Transurethral resection of bladder tumour (TURBT) is the standard treatment for people with NMIBC, but the high rate of cancer recurrence after first TURBT is a challenge that physicians and patients face. Tumours seen during follow-up may have been missed or incompletely resected during first TURBT. TURBT is conventionally performed using white light to see the tumours. However, small papillary or flat tumours may be missed with the use of white light alone. With the emergence of new technologies to improve visualization during TURBT, better diagnostic and patient outcomes may be expected. We conducted a health technology assessment of two enhanced visualization methods, both as an adjunct to white light to guide first TURBT for people with suspected NMIBC-hexaminolevulinate hydrochloride (HAL), a solution that is instilled into the bladder to make tumours fluoresce under blue-violet light, and narrow band imaging (NBI), a technology that filters light into wavelengths that can be absorbed by hemoglobin in the tumours, making them appear darker. Our assessment included an evaluation of effectiveness, safety, cost-effectiveness, and the budget impact of publicly funding these new technologies to improve patient outcomes following first TURBT. The use of NBI in diagnostic cystoscopy was out of scope for this health technology assessment. METHODS We performed a systematic literature search of the clinical evidence from inception to April 15, 2020. We searched for randomized controlled trials (RCTs) that compared the outcomes of first TURBT with the use of HAL or NBI, both as an adjunct to white light, with the outcomes of first TURBT using white light alone, or studies that made such comparison between HAL and NBI. We conducted pairwise meta-analyses using a fixed effects model where head-to-head comparisons were available. In the absence of any published RCT for comparison between HAL and NBI, we indirectly compared the two technologies through indirect treatment comparison (ITC) analysis. We assessed the risk of bias of each included study using the Cochrane risk-of-bias tool. We assessed the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic economic literature search and conducted a cost-utility analysis with a 15-year time horizon from a public payer perspective. We also analyzed the budget impact of publicly funding HAL and NBI as an adjunct to white light in people undergoing their first TURBT for suspected non-muscle-invasive bladder cancer in Ontario. RESULTS In the clinical evidence review, we identified 8 RCTs that used HAL or NBI as an adjunct to white light during first TURBT. Pairwise meta-analysis of HAL studies showed that HAL-guided TURBT as an adjunct to white light significantly reduces recurrence rate at 12 months compared with TURBT using white light alone (risk ratio 0.70, 95% confidence interval [CI] 0.51-0.95) (GRADE: Moderate). Five-year recurrence-free survival was significantly higher when HAL was used as an adjunct to white light than when white light was used alone (GRADE: Moderate). There was little to no difference in the tumour progression rate (GRADE: Moderate).Meta-analysis of NBI studies did not show a significant difference between NBI-guided TURBT as an adjunct to white light and TURBT using white light alone in reducing the rate of recurrence at 12 months (risk ratio 0.94, 95% CI 0.75-1.19) (GRADE: Moderate). No evidence on the effect on recurrence-free survival or tumour progression rate was identified for NBI-guided TURBT. The indirect estimate from the network analysis showed a trend toward a lower rate of recurrence after HAL-guided TURBT than after NBI-guided TURBT but the difference was not statistically significant (risk ratio 0.76, 95% CI 0.51-1.11) (GRADE: Low). Studies showed that use of HAL or NBI during TURBT was generally safe.The incremental cost-effectiveness ratio of HAL-guided TURBT compared with NBI-guided TURBT, both as an adjunct to white light, is $12,618 per quality-adjusted life-year (QALY) gained. Compared with TURBT using white light alone and using adjunct NBI, the probability of HAL-guided TURBT being cost-effective is 69.1% at a willingness-to-pay value of $50,000 per QALY gained and 74.6% at a willingness-to-pay of $100,000 per QALY gained. The annual budget impact of publicly funding HAL-guided TURBT in Ontario over the next 5 years ranges from an additional $0.6 million in year 1 to $2.5 million in year 5. CONCLUSIONS First TURBT guided by HAL as an adjunct to white light likely reduces the rate of recurrence at 12 months and increases 5-year recurrence-free survival when compared with first TURBT using white light alone. There is likely little to no difference in the tumour progression rate. First TURBT guided by NBI as an adjunct to white light likely results in little to no difference in the rate of recurrence at 12 months when compared with first TURBT using white light alone. Based on an indirect comparison, there may be little to no difference in cancer recurrence rate between HAL-guided and NBI-guided first TURBT. Use of HAL or NBI during first TURBT is generally safe. For people undergoing their first TURBT for suspected non-muscle-invasive bladder cancer, using HAL as an adjunct to white light is likely to be cost-effective compared with using white light alone or with using NBI as an adjunct to white light. We estimate that publicly funding HAL as an adjunct to white light to guide first TURBT for people in Ontario with suspected NMIBC would result in additional costs of between $0.6 million and $2.5 million per year over the next 5 years.
Collapse
|
19
|
Beyene A. A Retrospective Analysis of Clinical and Pathologic Characteristics of Recurrent Bladder Tumor in a Tertiary Hospital in Addis Ababa, Ethiopia. Ethiop J Health Sci 2021; 31:779-784. [PMID: 34703177 PMCID: PMC8512944 DOI: 10.4314/ejhs.v31i4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous recurrences, tumor category (Ta, T1), the presence of CIS with superficial bladder tumors, the number of tumors, tumor size and multiplicity are predictors of bladder tumor recurrence. Recurrence is better predicted by multiplicity, size and previous recurrence. METHODS This is retrospective descriptive study. All patients with urinary bladder tumor admitted to TASH from January 1st, 2018 to December 31st, 2019 is the study population. Information was retrieved using structured questionnaire. RESULTS Most of the recurrent tumors 55 (76.4%) had huge size and were multiple 62 (86.1%) in the primary presentation. Most recurrent tumors 47 (65.3%) are low grade bladder tumors. About 17 (23.6%) were high grade tumor in their primary presentation. European studies showed size and multiplicity increase risk of recurrence. However, our patients have late presentations which probably made the proportion of recurrence higher. CONCLUSION Most of the recurrent bladder tumors have huge size and multiple in number at their initial presentation. All histological variants of Urothelial carcinomas recur.
Collapse
Affiliation(s)
- Andualem Beyene
- Dept. Surgery, School of Medicine, College of Health Sciences, Addis Ababa University
| |
Collapse
|
20
|
CUAJ E. Poster Exhibit 2: Non-prostate Genitourinary Cancers. Can Urol Assoc J 2021; 15:S84-S98. [PMID: 34162473 DOI: 10.5489/cuaj.7401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
21
|
Serum malondialdehyde (MDA) level as a potential biomarker of cancer progression for patients with bladder cancer. ACTA ACUST UNITED AC 2021; 58:146-152. [PMID: 32364521 DOI: 10.2478/rjim-2020-0008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bladder cancer is the most common malignancy involving the urinary system. Recent research tends to emphasize the role of oxidative stress products in the carcinogenesis of bladder cancer. The level of oxidative stress can be measured by assessing the MDA levels. This study aimed to evaluate serum MDA levels in patients with bladder cancer, as well as to determine its potential role as a biomarker in the diagnosis of the disease and progression risk considerations. METHODS The study was designed as a cross-sectional study and included 90 patients, divided into three groups with 30 patients each: Ta, T1and T2-T4 group, based on histopathological findings after transurethral resection of the tumor. The control group included 30 healthy volunteers. MDA level was determined using the spectrophotometric method. RESULTS Serum MDA level in patients with bladder cancer [0.86 (0.78-1.05) μmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69-0.72) μmol/L] (p < 0.001). Serum MDA level in Ta group [0.73 (0.70-1.05) μmol/L], T1 group [0.85 (0.80-1.12) μmol/L] and in T2-T4 group [0.91 (0.84-1.04) μmol/L] was significantly higher than the serum MDA level in control group [0.70 (0.69-0.72) μmol/L] (p < 0.01). MDA level in T1 and T2-T4 group was significantly higher than the MDA level in Ta group (p < 0.01). No significant difference was observed in MDA level between T1 and T2-T4 group (p = NS). A statistically significant positive correlation was found between tumor size and serum MDA level in patients with bladder cancer (rho = 0.254 p < 0.01). CONCLUSIONS The results of the present study suggest that MDA serum level might play a significant role as a biomarker in the diagnosis of bladder cancer, as well as in the monitoring of its progression.
Collapse
|
22
|
Yang Z, Shen Z, Jin D, Zhang N, Wang Y, Lei W, Zhang Z, Chen H, Naz F, Xu L, Wang L, Wang S, Su X, Yu C, Li C. Mutations of METTL3 predict response to neoadjuvant chemotherapy in muscle-invasive bladder cancer. J Clin Transl Res 2021; 7:386-413. [PMID: 34239995 PMCID: PMC8259609] [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: 11/12/2020] [Revised: 01/27/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND AIM Neoadjuvant chemotherapy (NAC) followed by radical cystectomy is the current gold standard treatment for muscle-invasive urothelial bladder cancer (MIBC). Nonetheless, some MIBC patients showed limited pathological response after NAC. Herein, we used whole-exome sequencing (WES) to identify genetic mutations in MIBC that can predict NAC response. METHODS Forty MIBC patients were enrolled in this study, in which 33 were successfully examined by WES and Sanger sequencing in the discovery cohort (n=13) and the validation cohort (n=20), respectively. ANNOVAR software was used to identify the potential mutations based on the data of WES. In addition, tumor-specific somatic mutations including single nucleotide variants and indels were called with the muTECT and Strelka software. The mutational analysis of specific genes was carried out based on the data from cBioPortal for Cancer Genomics. RESULTS In the discovery cohort, the mutation frequencies of TP53, MED16, DRC7, CEND1, ATAD5, SETD8, and PIK3CA were significantly higher in 13 MIBC patients. Specifically, the presence of somatic mutations of APC, ATM, CDH9, CTNNB1, METTL3, NBEAL1, PTPRH, RNASEL, and FBXW7 in NAC responder signifies that these mutations were potential predictors of pathological response to NAC. Furthermore, somatic mutations of CCDC141, PIK3CA, CHD5, GPR149, MUC20, TSC1, and USP54 were exclusively identified in NAC nonresponders, suggesting that these mutations may participate in the process of NAC resistance. In the validation cohort, the somatic mutations of CDH9, METTL3, and PTPRH were significantly enriched in NAC responders while the somatic mutation of CCDC141 was significantly enriched in NAC nonresponders. Furthermore, survival analysis revealed that the patients expressing mutated METTL3 have a longer overall survival and disease- or progression-free survival than the patients acquiring wild-type METTL3. CONCLUSION The somatic mutation of METTL3 can be a potential predictive biomarker of NAC response in MIBC patients. RELEVANCE FOR PATIENTS MIBC patients bearing mutated METTL3 display a pathological response to NAC and have a significantly longer overall survival or disease/progression-free survival as compared to the patients bearing wild-type METTL3. Thus, the somatic mutation of METTL3 is a potential biomarker for predicting response to NAC in MIBC patients, assisting doctors in making the clinical decision.
Collapse
Affiliation(s)
- Zhao Yang
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China,2College of Life Science, Key Laboratory of Protection and Utilization of Biological Resources in Tarim Basin of Xinjiang Production and Construction Corps, Tarim University, Alar 843300, Xinjiang, China,Corresponding authors: Zhao Yang College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China. E-mail:
| | - Zongyi Shen
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Di Jin
- 3Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Nan Zhang
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Yue Wang
- 4Department of Cancer Research, Novogene Bioinformatics Institute, Beijing 100016, China
| | - Wanjun Lei
- 4Department of Cancer Research, Novogene Bioinformatics Institute, Beijing 100016, China
| | - Zhiming Zhang
- 4Department of Cancer Research, Novogene Bioinformatics Institute, Beijing 100016, China
| | - Haige Chen
- 3Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Faiza Naz
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Lida Xu
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Lei Wang
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Shihui Wang
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Xin Su
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China
| | - Changyuan Yu
- 1College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China,
Changyuan Yu College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China. E-mail:
| | - Chong Li
- 5Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China,6Zhongke Jianlan Medical Research Institute, Beijing 101400, China,
Chong Li Core Facility for Protein Research, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China. E-mail:
| |
Collapse
|
23
|
Akan S, Ediz C, Sahin A, Tavukcu HH, Urkmez A, Horasan A, Yilmaz O, Verit A. Can the systemic immune inflammation index be a predictor of BCG response in patients with high-risk non-muscle invasive bladder cancer? Int J Clin Pract 2021; 75:e13813. [PMID: 33152142 DOI: 10.1111/ijcp.13813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/02/2020] [Indexed: 12/25/2022] Open
Abstract
AIM We aimed to investigate the predictor role of the systemic immune-inflammation index (SII) on Bacille Calmette-Guerin (BCG) response in patients with high-risk non-muscle invasive bladder cancer (NMIBC). METHODS A total of 96 patients with high-risk NMIBC, who received intravesical BCG, were enrolled in the study. BCG responsive group (group 1) and BCG failure group (group 2) were compared in terms of demographic and pathological data, peripheral lymphocyte, neutrophil and platelet counts, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), SII, recurrence-free survival (RFS) and progression-free survival (PFS). The SII was calculated as in the formula: SII = neutrophil × platelet/lymphocyte. The prognostic ability of the SII for progression was analysed with multivariate backward stepwise regression models. RESULTS The mean follow-up time 34.635 ± 14.7 months. Group 2 had significantly higher SII, peripheral lymphocyte, neutrophil and platelet counts than group 1. An ROC curve was plotted for the SII to predict the BCG failure and the cut-off point was calculated as 672.75. Effect of the SII to the model was statistically significant (P = .003) and a higher SII increased the progression onefold. A tumour greater than 30 mm in size and a high SII together increased the progression 3.6 folds. CONCLUSIONS The SII might be a successful, non-invasive and low-cost parameter for prediction of BCG failure in patients with high-risk NMIBC. The cut-off value for SII is 672.75 and above this level BCG failure and progression to MIBC might be anticipated. However, these results should be validated in prospective randomised controlled studies with large patient groups.
Collapse
Affiliation(s)
- Serkan Akan
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Caner Ediz
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Aytac Sahin
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Hasan Huseyin Tavukcu
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Urkmez
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alper Horasan
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Omer Yilmaz
- Department of Urology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ayhan Verit
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
24
|
Marcq G, Foerster B, Abufaraj M, Matin SF, Azizi M, Gupta M, Li WM, Seisen T, Clinton T, Xylinas E, Mir MC, Schweitzer D, Mari A, Kimura S, Bandini M, Mathieu R, Ku JH, Guruli G, Grabbert M, Czech AK, Muilwijk T, Pycha A, D'Andrea D, Petros FG, Spiess PE, Bivalacqua T, Wu WJ, Rouprêt M, Krabbe LM, Hendricksen K, Egawa S, Briganti A, Moschini M, Graffeille V, Autorino R, John P, Heidenreich A, Chlosta P, Joniau S, Soria F, Pierorazio PM, Shariat SF, Kassouf W. Novel Classification for Upper Tract Urothelial Carcinoma to Better Risk-stratify Patients Eligible for Kidney-sparing Strategies: An International Collaborative Study. Eur Urol Focus 2021; 8:491-497. [PMID: 33773965 DOI: 10.1016/j.euf.2021.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/23/2021] [Accepted: 03/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The European Association of Urology risk stratification dichotomizes patients with upper tract urothelial carcinoma (UTUC) into two risk categories. OBJECTIVE To evaluate the predictive value of a new classification to better risk stratify patients eligible for kidney-sparing surgery (KSS). DESIGN, SETTING, AND PARTICIPANTS This was a retrospective study including 1214 patients from 21 centers who underwent ureterorenoscopy (URS) with biopsy followed by radical nephroureterectomy (RNU) for nonmetastatic UTUC between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A multivariate logistic regression analysis identified predictors of muscle invasion (≥pT2) at RNU. The Youden index was used to identify cutoff points. RESULTS AND LIMITATIONS A total of 811 patients (67%) were male and the median age was 71 yr (interquartile range 63-77). The presence of non-organ-confined disease on preoperative imaging (p < 0.0001), sessile tumor (p < 0.0001), hydronephrosis (p = 0.0003), high-grade cytology (p = 0.0043), or biopsy (p = 0.0174) and higher age at diagnosis (p = 0.029) were independently associated with ≥pT2 at RNU. Tumor size was significantly associated with ≥pT2 disease only in univariate analysis with a cutoff of 2 cm. Tumor size and all significant categorical variables defined the high-risk category. Tumor multifocality and a history of radical cystectomy help to dichotomize between low-risk and intermediate-risk categories. The odds ratio for muscle invasion were 5.5 (95% confidence interval [CI] 1.3-24.0; p = 0.023) for intermediate risk versus low risk, and 12.7 (95% CI 3.0-54.5; p = 0.0006) for high risk versus low risk. Limitations include the retrospective design and selection bias (all patients underwent RNU). CONCLUSIONS Patients with low-risk UTUC represent ideal candidates for KSS, while some patients with intermediate-risk UTUC may also be considered. This classification needs further prospective validation and may help stratification in clinical trial design. PATIENT SUMMARY We investigated factors predicting stage 2 or greater cancer of the upper urinary tract at the time of surgery for ureter and kidney removal and designed a new risk stratification. Patients with low or intermediate risk may be eligible for kidney-sparing surgery with close follow-up. Our classification scheme needs further validation based on cancer outcomes.
Collapse
Affiliation(s)
- Gautier Marcq
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada; Urology Department, Claude Huriez Hospital, CHU Lille, Lille, France
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Surena F Matin
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Mounsif Azizi
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, Division of Urology, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, Canada
| | - Mohit Gupta
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wei-Ming Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Thomas Seisen
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Timothy Clinton
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Paris Descartes University, Paris, France
| | - M Carmen Mir
- Instituto Valenciano de Oncologia Foundation, Valencia, Spain
| | - Donald Schweitzer
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Marco Bandini
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Ja H Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Georgi Guruli
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Markus Grabbert
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Anna K Czech
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Armin Pycha
- Department of Urology, Provincial Hospital of Bozen, Bozen, Italy; Medical School, Sigmund Freud University, Vienna, Austria
| | - David D'Andrea
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Firas G Petros
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA; Department of Urology and Kidney Transplant, The University of Toledo Medical Center and Eleanor N. Dana Cancer Center, Toledo, OH, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Trinity Bivalacqua
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Urology, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Morgan Rouprêt
- Urology, GRC 5, Predictive ONCO-URO, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Laura-Maria Krabbe
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University Hospital Muenster, Muenster, Germany
| | - Kees Hendricksen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Marco Moschini
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Patricia John
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology, University Hospital Cologne, Cologne, Germany
| | - Piotr Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Torino School of Medicine, Turin, Italy
| | - Phillip M Pierorazio
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Wassim Kassouf
- Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Canada.
| |
Collapse
|
25
|
Yang Y, Liu C, Yan X, Li J, Yang X. En Bloc Tumor Resection, Optical Molecular Imaging, and the Potential Synergy of the Combination of the Two Techniques in Bladder Cancer. Front Oncol 2021; 11:638083. [PMID: 33796465 PMCID: PMC8008058 DOI: 10.3389/fonc.2021.638083] [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: 12/05/2020] [Accepted: 02/04/2021] [Indexed: 12/14/2022] Open
Abstract
Although transurethral resection of bladder tumor is the golden standard for the treatment of non-muscle invasive bladder cancer, this surgical procedure still has some serious drawbacks. For example, piecemeal resection of tumor tissue results in exfoliated tumor cells dissemination and implantation, and fragmented tumor specimens make it difficult for pathologists to accurately assess the pathological stage and histologic grade. En bloc tumor resection follows the basic principle of oncological surgery and provides an intact tumor specimen containing detrusor muscle for pathologists to make accurate histopathological assessment. However, there is no robust clinical evidence that en bloc tumor resection is superior to conventional resection in terms of oncological outcomes. Considering the high recurrence rate, small or occult tumor lesions may be overlooked and incomplete tumor resection may occur during white light cystoscopy-assisted transurethral resection. Molecular fluorescent tracers have the ability to bind tumor cells with high sensitivity and specificity. Optical molecular imaging mediated by it can detect small or occult malignant lesions while minimizing the occurrence of false-positive results. Meanwhile, optical molecular imaging can provide dynamic and real-time image guidance in the surgical procedure, which helps urologists to accurately determine the boundary and depth of tumor invasion, so as to perform complete and high-quality transurethral tumor resection. Integrating the advantages of these two technologies, optical molecular imaging-assisted en bloc tumor resection shows the potential to improve the positive detection rate of small or occult tumor lesions and the quality of transurethral resection, resulting in high recurrence-free and progression-free survival rates.
Collapse
Affiliation(s)
- Yongjun Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Chao Liu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaoting Yan
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jiawei Li
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaofeng Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
26
|
Yang Y, Liu C, Yan X, Li J, Yang X. Overnight Continuous Saline Bladder Irrigation After En Bloc Resection of Bladder Tumor Does Not Improve Oncological Outcomes in Patients Who Have Received Intravesical Chemotherapy. Front Oncol 2021; 11:638065. [PMID: 33777796 PMCID: PMC7988089 DOI: 10.3389/fonc.2021.638065] [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: 12/05/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To evaluate the safety and efficacy of overnight continuous saline bladder irrigation (CSBI) for patients who have received thulium laser en bloc resection of bladder tumor (TmLRBT) combined with immediate intravesical chemotherapy previously. Methods From October 2014 to June 2018, 235 patients with newly diagnosed non-muscle invasive bladder cancer (NMIBC) were included in this retrospective study. All patients received intravesical instillation of pirarubicin immediately after TmLRBT. The patients were divided into two groups according to the duration of postoperative bladder irrigation with normal saline. After immediate intravesical chemotherapy, patients in group 1 received overnight CSBI, while patients in group 2 did not receive overnight CSBI. Data on the time of initial tumor recurrence, recurrence-free survival (RFS) and progression-free survival (PFS) rates, and perioperative complications were collected and analyzed. Results Of 235 included patients (129 in group 1 and 106 in group 2), the median follow-up periods were 42 and 38 months, respectively. There were no significant differences in patients' baseline characteristics between the two groups. The RFS rates of patients in group 1 were 90.7, 82.7, and 76.8% at the end of the first, third, and fifth years, while the corresponding RFS rates of patients in group 2 were 87.7, 78.9, and 73.3%, respectively. Four patients in group 1 and five patients in group 2 experienced tumor progression. No significant differences between the two groups were observed in the time of initial tumor recurrence, RFS, and PFS rates. Only Grade I complications occurred in the two groups, and no significant difference was reached between the two groups. Conclusions For patients with NMIBC who have previously received TmLRBT combined with immediate intravesical chemotherapy, overnight CSBI may not improve oncological outcomes and reduce perioperative complications.
Collapse
Affiliation(s)
- Yongjun Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Chao Liu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaoting Yan
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jiawei Li
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaofeng Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China.,Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
27
|
Tripathi K, Goel A, Singhai A, Garg M. Promoter hypomethylation as potential confounder of Ras gene overexpression and their clinical significance in subsets of urothelial carcinoma of bladder. Mol Biol Rep 2021; 48:2183-2199. [PMID: 33620658 DOI: 10.1007/s11033-021-06227-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/10/2021] [Indexed: 12/31/2022]
Abstract
Overexpression of normal Ras and its aberrant CpG island methylation in the promoter regions have been shown to direct cells for uncontrolled abnormal growth and bladder tumor formation and therefore, fetched recent attention as a marker of diagnosis and prognosis to predict the biological behavior of urothelial carcinoma of bladder (UCB). Methylation pattern at CpG islands of the promoter regions of rat sarcoma (Ras) gene homologues namely Kristen-Ras (K-Ras), Harvey (H-Ras), and Neuroblastoma (N-Ras) were examined by methylation specific polymerase chain reaction (MSP). Real time-quantitative polymerase chain reaction (RT-qPCR) was done to determine transcriptomic expressions of these Ras isoforms in the prospective series of 42 NMIBC (non-muscle invasive bladder cancer) and 45 MIBC (muscle invasive bladder cancer) biopsies. CpG loci in H-Ras and K-Ras were observed to be more hypomethylated in MIBC, whereas more hypomethylation in N-Ras was noted in NMIBC. Strong association of hypomethylation index with tumor stage, grade, type and size validate them it as marker of diagnosis in UCB patients. Differential overexpression of H-Ras, N-Ras and K-Ras genes in NMIBC and MIBC and their association with patients' demographics identify them as important diagnostic markers in pathogenesis of UCB. Given the reported ability of promoter hypomethylation to activate Ras expression, correlation studies examined positive significant association between hypomethylation index and expression. Study concludes that promoter hypomethylation of N-Ras and K-Ras could be a potential confounder of their increased expression in NMIBC. Biological significance of simultaneous presence of higher expression and promoter hypomethylation of Ras gene isoforms in MIBC is difficult to resolve in a given cohort of patients.
Collapse
Affiliation(s)
- Kiran Tripathi
- Department of Biochemistry, University of Lucknow, Lucknow, 226007, India
| | - Apul Goel
- Department of Urology, King George Medical University, Lucknow, 226003, India
| | - Atin Singhai
- Department of Pathology, King George Medical University, Lucknow, 226003, India
| | - Minal Garg
- Department of Biochemistry, University of Lucknow, Lucknow, 226007, India.
| |
Collapse
|
28
|
Rey-Cárdenas M, Guerrero-Ramos F, Gómez de Liaño Lista A, Carretero-González A, Bote H, Herrera-Juárez M, Carril-Ajuria L, Martín-Soberón M, Sepulveda JM, Billalabeitia EG, Castellano D, de Velasco G. Recent advances in neoadjuvant immunotherapy for urothelial bladder cancer: What to expect in the near future. Cancer Treat Rev 2021; 93:102142. [PMID: 33453566 DOI: 10.1016/j.ctrv.2020.102142] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 12/13/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Urothelial bladder cancer (UC) is the most common malignancy involving the urinary system and represents a significant health problem. Immunotherapy has been used for decades for UC with intravesical bacillus Calmette-Guérin (BCG) set as the standard of care for non-muscle-invasive bladder cancer (NMIBC). The advent of immune checkpoint inhibitors (ICIs) has completely transformed the treatment landscape of bladder cancer enabling to expand the treatment strategies. Novel ICIs have successfully shown improved outcomes on metastatic disease to such an extent that the standard of care paradigm has changed leading to the development of different trials with the aim of determining whether ICIs may have a role in early disease. The localized muscle-invasive bladder cancer (MIBC) scenario remains challenging since the recurrence rate continues to be high despite all therapeutic efforts. This article will review the current experience of ICIs in the neoadjuvant setting of UC, the clinical trials landscape and finally, an insight of what to expect in the immediate and mid-term future.
Collapse
Affiliation(s)
- M Rey-Cárdenas
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - F Guerrero-Ramos
- Urology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - A Gómez de Liaño Lista
- Medical Oncology Department, Complejo Hospitalario Universitario Insular-Materno Infantil, Canary Islands, Avda. Marítima del Sur, s/n, 35016 Las Palmas de Gran Canaria, Spain.
| | - A Carretero-González
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - H Bote
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - M Herrera-Juárez
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - L Carril-Ajuria
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - M Martín-Soberón
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - J M Sepulveda
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - E G Billalabeitia
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - D Castellano
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| | - G de Velasco
- Medical Oncology Department, University Hospital 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain.
| |
Collapse
|
29
|
Marcq G, Kassouf W. Adjuvant Intravesical Therapy: Bacillus Calmette-Guerin. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
30
|
Sailer E, Krause FS, Tauber V, Schimetta W, Alfred Graf S. Deciding When to Omit Repeat Transurethral Resection of Superficial Bladder Cancer: Do Photodynamic Diagnostics help? Bladder Cancer 2020. [DOI: 10.3233/blc-200325] [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: Repeat transurethral resection of bladder tumor is recommended when certain risk constellations are present on initial resection. Current evidence is conflicting, leading to dissenting recommendations in multinational guidelines around the world. Photodynamic diagnostics (PDD) is a tool which has been shown to increase diagnostic accuracy, but evidence is still lacking if this may permit omission of repeat resections in certain cases. OBJECTIVE: To evaluate whether the use of photodynamic diagnostics has an impact on resection quality and residual tumor rate, and to explore which parameters may have an impact on the necessity of repeat transurethral resections. METHODS: We retrospectively evaluated 373 patients in the timeframe of ten years, in whom a repeat transurethral resection of bladder tumor has been performed following initial resection at our department. About half of those resections were performed using photodynamic diagnostics. RESULTS: When PDD was used, more tumor mass was revealed and resected, but the shown trend toward a lower residual tumor rate was non-significant. Muscularis was shown more often on PDD resections. While being a rare occurrence, upstaging on repeat resection happened significantly less often after initial PDD use. Furthermore, tumor size and multifocality significantly influenced residual tumor rate in Ta high-grade stage. CONCLUSIONS: PDD use may lead to a more accurate initial staging but this may not have an impact on short-term residual tumor rate. Tumor size and multifocality should be granted more weight in the decision-making process as when to perform a repeat resection.
Collapse
Affiliation(s)
- Eva Sailer
- Department of Urology and Andrology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Frens-Steffen Krause
- Department of Urology and Andrology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Volkmar Tauber
- Department of Urology and Andrology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Wolfgang Schimetta
- Department of Applied Systems Research and Statistics, Johannes Kepler University Linz, Linz, Austria
| | - Sebastian Alfred Graf
- Department of Urology and Andrology, Kepler University Hospital, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| |
Collapse
|
31
|
Stability Analysis of Delayed Tumor-Antigen-ActivatedImmune Response in Combined BCG and IL-2Immunotherapy of Bladder Cancer. Processes (Basel) 2020. [DOI: 10.3390/pr8121564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We use a system biology approach to translate the interaction of Bacillus Calmette-Gurin (BCG) + interleukin 2 (IL-2) for the treatment of bladder cancer into a mathematical model. The main goal of this research is to predict the outcome of BCG + IL-2 treatment combinations. We examined whether the delay effect caused by the proliferation of tumor antigen-specific effector cells after the immune system destroys BCG-infected urothelium cells after BCG and IL-2 immunotherapy influences success in bladder cancer treatment. To do this, we introduce a system of differential equations where the variables are the main participants in the immune response after BCG installations to fight cancer: the number of tumor cells, BCG cells, immune cells, and cytokines involved in the tumor-immune response. The relevant parameters describing the dynamics of the system are taken from a variety of biological, clinical literature and estimated using the mathematical models. We examine the local stability analysis of non-negative equilibrium states of the model. In theory, treatment could improve system stability, and we analyze the stability of all equilibria using the method of Lyapunov functionals construction and the method of linear matrix inequalities (LMIs). Our results prove that the period for the proliferation of tumor antigen-specific effector cells does not influence to the success of the non-responsive patients after an intensified combined BCG + IL-2 treatment.
Collapse
|
32
|
Carando R, Soldini E, Cotrufo S, Zazzara M, Ludovico GM. Electro-mediated drug administration of mitomycin C in preventing non-muscle-invasive bladder cancer recurrence and progression after transurethral resection of the bladder tumour in intermediate- and high-risk patients. Arab J Urol 2020; 19:71-77. [PMID: 33763251 PMCID: PMC7954506 DOI: 10.1080/2090598x.2020.1816150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To evaluate the effectiveness of electro-mediated drug administration of mitomycin C (EMDA/MMC) after transurethral resection of the bladder tumour (TURBT) in preventing non-muscle-invasive bladder cancer (NMIBC) recurrence and progression and to explore clinical and demographic factors associated with treatment response. Patients and methods Between April 2016 and August 2019, 112 patients diagnosed with intermediate- or high-risk NMIBC underwent a TURBT followed by an EMDA/MMC treatment. The percentage of treatment responders and progression-free survivors at 3 and 6 months were evaluated. Results Follow-up data were available for 101 patients (90%) at 3 months and 92 (82%) at 6 months. Response rates to EMDA/MMC treatment were 85% at 3 months and 75% at 6 months, and progression-free rates were 94% and 90%, respectively. No statistically significant differences were seen between intermediate- and high-risk patients. A higher risk of tumour recurrence and progression was associated with previous Bacillus Calmette–Guérin (BCG) failure. According to the Clavien–Dindo classification, only low-grade complications were observed. Conclusions EMDA/MMC after TURBT was associated with high response and progression-free rates at 3 and 6 months, with only low-grade adverse events. These results confirm the efficacy and safety of EMDA/MMC as a therapeutic option for both intermediate- and high-risk patients. However, patients with BCG failure responded poorly to EMDA/MMC. Abbreviations: ACCI: age-adjusted Charlson Comorbidity Index; CHT: chemohyperthermia; CIS: carcinoma in situ; EMDA: electro-mediated drug administration; EORTC: European Organisation for Research and Treatment of Cancer; IQR: interquartile range; (N)MIBC: (non-)muscle-invasive bladder cancer; MMC: mitomycin C; OR, odds ratio; TURBT: transurethral resection of the bladder tumour
Collapse
Affiliation(s)
- Roberto Carando
- Klinik für Urologie, Luzerner Kantonsspital, Luzern, Switzerland.,Clinica Luganese Moncucco, Lugano, Switzerland.,Clinica S. Anna, Sorengo, Switzerland.,Clinica S. Chiara, Locarno, Switzerland
| | - Emiliano Soldini
- Department of Business Economics, Health and Social Care, Research Methodology Competence Centre, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Simone Cotrufo
- Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Michele Zazzara
- Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| | - Giuseppe M Ludovico
- Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy
| |
Collapse
|
33
|
Maisch P, Retz M, Gschwend JE, Koll F, Schmid SC. Clinical Practice Guidelines for Bladder Cancer: A Systematic Review and Meta-Analysis Using the AGREE II Instrument. Urol Int 2020; 105:31-40. [PMID: 32829338 DOI: 10.1159/000509431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 06/07/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Numerous health care organizations have established guidelines on diagnosis and treatment of bladder cancer. However, the lack of a standardized guideline development approach results in considerable differences of the guidelines' methodological quality. OBJECTIVE To assess the methodological quality of all relevant clinical practice guidelines (CPGs) for urinary bladder cancer and provide a reference for clinicians in choosing guidelines of high methodological quality. EVIDENCE ACQUISITION A systematic literature search was conducted in Medline via PubMed, 4 CPG databases, and 7 databases of interdisciplinary organizations. CPGs for non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) with the topics screening, pathology, diagnosis, treatment, and aftercare published in English language between 2012 and 2018 were included. The CPG quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. EVIDENCE SYNTHESIS A total of 16 CPGs were included for the quality appraisal. Because of predefined criteria, 5 CPGs were "strongly recommended" (American Urological Association NMIBC, European Association of Urology [EAU] NMIBC, EAU MIBC, National Institute for Health and Care Excellence, and National Comprehensive Cancer Network), 4 CPGs were "weakly recommended" and 7 CPGs were "not recommended." CONCLUSIONS The methodological quality of bladder cancer guidelines is diverse. Considering the rapid development of new therapies (e.g., immune checkpoint inhibitors), "living guidelines" of high methodological quality, such as the EAU NMIBC or MIBC guideline, will become more relevant in the future guideline's landscape.
Collapse
Affiliation(s)
- Philipp Maisch
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany,
| | - Margitta Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Florestan Koll
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | - Sebastian C Schmid
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| |
Collapse
|
34
|
Systematic Review: Safety of Intravesical Therapy for Bladder Cancer in the Era of COVID-19. ACTA ACUST UNITED AC 2020; 2:1444-1448. [PMID: 32838196 PMCID: PMC7433676 DOI: 10.1007/s42399-020-00461-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2020] [Indexed: 01/08/2023]
Abstract
A novel coronavirus has emerged in late 2019 capable of causing a severe respiratory disease known as COVID-19. Its pathogenesis appears to be the initiation of an immune response and resulting cytokine storm that damages the healthy lung tissue of the host. Some epidemiological studies found bacillus Calmette-Guérin (BCG) vaccine can help to decrease morbidity and mortality of the viral infection. We aim to review and summarize what is known about COVID-19 and the current implications of intravesical BCG with regard to the disease.
Collapse
|
35
|
Current and innovative approaches in the treatment of non-muscle invasive bladder cancer: the role of transurethral resection of bladder tumor and organoids. Radiol Oncol 2020; 54:135-143. [PMID: 32374292 PMCID: PMC7276645 DOI: 10.2478/raon-2020-0025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background Bladder cancer is the 7th most common cancer in men. About 75% of all bladder cancer are non-muscle invasive (NMIBC). The golden standard for definite diagnosis and first-line treatment of NMIBC is transurethral resection of bladder tumour (TURB). Historically, the monopolar current was used first, today bipolar current is preferred by most urologists. Following TURB, depending on the tumour grade, additional intravesical chemo- or/and immunotherapy is indicated, in order to prevent recurrence and need for surgical resection. Development of new technologies, molecular and cell biology, enabled scientists to develop organoids - systems of human cells that are cultivated in the laboratory and have characteristics of the tissue from which they were harvested. In the field of urologic cancers, the organoids are used mainly for studying the course of different diseases, however, in the field of bladder cancer the data are scarce. Conclusions Different currents - monopolar and bipolar, have different effect on urothelium, that is important for oncological results and pathohistological interpretation. Specimens of bladder cancer can be used for preparation of organoids that are further used for studying carcinogenesis. Bladder organoids are step towards personalised medicine, especially for testing effectiveness of chemo-/immunotherapeutics.
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW Molecular characterization of cancer allows us to understand oncogenesis and clinical prognosis as well as facilitates development of biomarkers and treatment. Our aim was to review the current literature on genomic characterization of bladder cancer, and how far we are in implementing genomics into clinical practice. RECENT FINDINGS Bladder cancers are molecularly diverse tumors with a high mutational rate. On molecular level, bladder cancer can be categorized into at least six subtypes called luminal-papillary, luminal-unstable, luminal non-specified, basal-squamous, neuroendocrine-like, and stroma-rich. These subtypes have characteristic genomic and transcriptomic profiles and appear to have different prognoses. Several molecular subtypes have been identified in bladder cancer. Prospective trials are underway to validate the applicability of genomic subtypes for clinical decision making. Further integrative analyses of genomic alterations, gene expression, epigenetics, and proteomics need to be performed before genomic subtyping can be attained in clinical practice.
Collapse
Affiliation(s)
- Tuomas Jalanko
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.,Department of Urology, Helsinki University, Helsinki, Finland
| | - Joep J de Jong
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Roland Seiler
- Department of Urology, University of Bern, Bern, Switzerland
| | - Peter C Black
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
| |
Collapse
|
37
|
Matulay JT, Soloway M, Witjes JA, Buckley R, Persad R, Lamm DL, Boehle A, Palou J, Colombel M, Brausi M, Kamat AM. Risk‐adapted management of low‐grade bladder tumours: recommendations from the International Bladder Cancer Group (IBCG). BJU Int 2020; 125:497-505. [DOI: 10.1111/bju.14995] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/29/2019] [Accepted: 01/08/2020] [Indexed: 01/05/2023]
Affiliation(s)
| | - Mark Soloway
- Memorial Cancer Institute Memorial Hospital Hollywood FL USA
| | - J. Alfred Witjes
- Radboud University Nijmegen Medical Centre Nijmegen the Netherlands
| | | | - Raj Persad
- Bristol Royal Infirmary and Bristol Urological Institute Bristol UK
| | | | | | - Joan Palou
- Fundació Puigvert Universitat Autònoma de Barcelona Barcelona Spain
| | - Marc Colombel
- Claude Bernard University Hôpital Edouard Herriot Lyon France
| | | | - Ashish M. Kamat
- University of Texas MD Anderson Cancer Center Houston TX USA
| |
Collapse
|
38
|
Chehroudi AC, Black PC. Emerging intravesical therapies for the management of bacillus Calmette-Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer: Charting a path forward. Can Urol Assoc J 2020; 14:204-213. [PMID: 31977307 DOI: 10.5489/cuaj.6101] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Management of patients with bacillus Calmette-Guérin (BCG)-unresponsive, high-risk, non-muscle-invasive bladder cancer (NMIBC) presents a formidable clinical challenge that requires urologists to weigh the competing risks of progression during further intravesical therapy vs. the morbidity of radical cystectomy. The prognosis of high-risk NMIBC recurring after BCG depends on the adequacy of prior BCG, timing of recurrence, and tumor histology. The standard of care is currently radical cystectomy, as effective salvage intravesical therapy has not been established. The development of bladder-sparing treatments has been hampered to date by inconsistent definitions of BCG failure and difficulties in identifying appropriate control treatments in clinical trials. Despite these limitations, the spectrum of salvage therapy is expanding to include enhanced intravesical chemo-, gene, and immuno-therapies. In this review, we provide an overview of these emerging agents in the context of our current understanding of BCG failure and the unique considerations for clinical trial design in this disease state.
Collapse
Affiliation(s)
- Ali Cyrus Chehroudi
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
39
|
Au S, Keyes M, Black P, Villamil CF, Tavassoli P. Clinical and pathological characteristics of bladder cancer in post brachytherapy patients. Pathol Res Pract 2020; 216:152822. [PMID: 31982182 DOI: 10.1016/j.prp.2020.152822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/16/2019] [Accepted: 01/09/2020] [Indexed: 11/25/2022]
Abstract
The long-term risk of secondary malignancy is a potential late effect of brachytherapy. However, the time interval, anatomic site and histopathology are not well studied. We sought to characterize the bladder cancers that developed following treatment of prostate cancer with brachytherapy. Between 1998 and 2014, 4570 patients were treated with brachytherapy at the BC Cancer Agency. Out of those, 69 patients subsequently developed bladder cancer, some of which could have been radiation induced. Histology slides were reviewed for all cases, and site and pathologic features were recorded. Cases were classified as luminal and basal subtypes based on GATA3 and CK5/6 immunohistochemistry. Bladder neck and trigone were among the common sites of involvement. Pathologic review of cases showed that 68 % were high-grade, 25 % were muscle-invasive, and 20 % showed variant histology, including small cell carcinoma, sarcomatoid carcinoma, squamous cell carcinoma, and adenocarcinoma. A subgroup of cases more likely to be radiation-induced, based on site and time interval, was associated with increased pathologic stage (pT1 or higher) compared to the other cases (70 % vs 34 %, p = 0.01). In conclusion, the majority of bladder cancers following brachytherapy in this cohort were of high grade and low stage at diagnosis, most of them demonstrating luminal immunophenotype. A significant number of variant histologies are seen, each demonstrating a specific immunophenotype.
Collapse
Affiliation(s)
- Sammy Au
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Mira Keyes
- Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC, Canada
| | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Carlos F Villamil
- Department of Pathology and Laboratory Medicine, BC Cancer Agency, Vancouver, BC, Canada
| | - Peyman Tavassoli
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
40
|
Zhang J, Wang Y, Weng H, Wang D, Han F, Huang Q, Deng T, Wang X, Jin Y. Management of non-muscle-invasive bladder cancer: quality of clinical practice guidelines and variations in recommendations. BMC Cancer 2019; 19:1054. [PMID: 31694589 PMCID: PMC6836507 DOI: 10.1186/s12885-019-6304-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
Background Bladder cancer (BC) has become a major worldwide public health issue, especially non-muscle-invasive bladder cancer (NMIBC). A flood of related clinical practice guidelines (CPGs) have emerged; however, the quality and recommendations of the guidelines are controversial. We aimed to appraise the quality of the CPGs for NMIBC within the past 5 years and compare the similarities and differences between recommendations for therapies. Methods A systematic search to identify CPGs for NMIBC was performed using electronic databases (including PubMed, Embase, Web of Science), guideline development organizations, and professional societies from January 12, 2014 to January 12, 2019. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was performed to assess the overall agreement among reviewers. Results Nine CPGs were included. The overall agreement among reviewers was excellent. The interquartile range (IQR) of scores for each domain were as follows: scope and purpose 69.44% (35.42, 85.42%); stakeholder involvement 41.67% (30.56, 75.00%); rigour of development 48.96% (27.08, 65.63%); clarity and presentation 80.56% (75.00, 86.11%); applicability 34.38% (22.92, 40.63%) and editorial independence 70.83% (35.42, 85.42%). The NICE, AUA, EAU and CRHA/CPAM clinical practice guidelines consistently scored well in most domains. It was generally accepted that the transurethral resection of bladder tumour (TURBT) and intravesical chemotherapy should be performed in the management of bladder cancer. The application of chemotherapy was highly controversial in high risk NMIBC. The courses of BCG maintenance were similar and included 3 years of therapy at full maintenance doses. Conclusions The quality of NMIBC guidelines within the past 5 years varied, especially regarding stakeholders, rigour and applicability. Despite many similarities, the recommendations had some inconsistencies in the details.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Urology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China.,The First Clinical College of Wuhan University, Wuhan University, No. 99, Zhangzhidong Road, Wuchang District, Wuhan, 430072, China
| | - Yunyun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Hong Weng
- Department of Urology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Danqi Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China.,School of Basic Medical Sciences, Wuhan University, No. 115, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Fei Han
- Emergency Department, Xuan Wu Traditional Chinese Medicine Hospital, No.8, Wanming Road, Xicheng District, Beijing, 10000, Beijing, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Tong Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China
| | - Yinghui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China.
| |
Collapse
|
41
|
Rohailla S, Kitchlu A, Wheatcroft M, Razak F. Mycotic aneurysm formation after bacillus Calmette-Guérin instillation for recurrent bladder cancer. CMAJ 2019; 190:E467-E471. [PMID: 29661816 DOI: 10.1503/cmaj.171214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sagar Rohailla
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Abhijat Kitchlu
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Mark Wheatcroft
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - Fahad Razak
- Postgraduate Medical Education, Department of Medicine (Rohailla), University of Toronto; Division of Nephrology, Department of Medicine (Kitchlu); Division of Vacsular Surgery, Department of Surgery (Wheatcroft); and Division of General Internal Medicine, Department of Medicine (Razak), St. Michael's Hospital, University of Toronto, Toronto, Ont.
| |
Collapse
|
42
|
Tan GH, Kuk C, Zlotta AR. Are there differences among bacillus Calmette-Guérin (BCG) strains regarding their clinical efficacy in the treatment of non-muscleinvasive bladder cancer? The jury is still out but the answer is likely no. Can Urol Assoc J 2019; 14:E54-E56. [PMID: 31348742 DOI: 10.5489/cuaj.5923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Guan Hee Tan
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Urology, Department of Surgery, Sinai Health System, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, Canada.,Division of Urology, Department of Surgery, Sinai Health System, Toronto, ON, Canada
| |
Collapse
|
43
|
Cassell A, Yunusa B, Jalloh M, Mbodji MM, Diallo A, Ndoye M, Diallo Y, Labou I, Niang L, Gueye SM. Non-Muscle Invasive Bladder Cancer: A Review of the Current Trend in Africa. World J Oncol 2019; 10:123-131. [PMID: 31312279 PMCID: PMC6615913 DOI: 10.14740/wjon1210] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/21/2019] [Indexed: 01/02/2023] Open
Abstract
Bladder cancer is the fourth most common cancer in men and the 11th most common cancer in woman accounting for 6.6% of all cancer cases. Approximately 70-75% bladder cancers are non-muscle invasive bladder cancer (NMIBC). A few African studies have provided considerable rates of NMIBC as compared to western settings 70% to 85%. Critical step in the management of NMIBC is to prevent tumor recurrence which include transurethral resection of the bladder tumor (TURBT) for staging and histological diagnosis. A second TURBT for high grade tumor, T1 tumors and intravesical adjuvant chemotherapy and immunotherapy are essential to reduce recurrence rate. Nevertheless, variant histology, multiple, progressive and recurrent high-grade tumors are best treated with early radical cystectomy. The African literature is scanty on the management of NMIBC. Most of the histological types are squamous cell bladder cancer and may not conform to transurethral resection only but rather radical cystectomy. Most of these patients are not suitable for any form of treatment as they present with advanced disease. However, there is an increasing incidence of urothelial cancer in Africa over the years due to urbanization. It is best that major investment is made in uro-oncological care to address the growing challenge of these subtypes.
Collapse
Affiliation(s)
- Ayun Cassell
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Bashir Yunusa
- Department of Surgery, Liberia College of Physicians and Surgeons, Monrovia, Liberia
| | - Mohamed Jalloh
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Mouhamadou M Mbodji
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Abdourahmane Diallo
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Madina Ndoye
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | | | - Issa Labou
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Lamine Niang
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| | - Serigne M Gueye
- Department of Urology and Andrology, Hopital General de Grand Yoff, Dakar, Senegal
| |
Collapse
|
44
|
Huang D, Jin YH, Weng H, Huang Q, Zeng XT, Wang XH. Combination of Intravesical Bacille Calmette-Guérin and Chemotherapy vs. Bacille Calmette-Guérin Alone in Non-muscle Invasive Bladder Cancer: A Meta-Analysis. Front Oncol 2019; 9:121. [PMID: 30881921 PMCID: PMC6405446 DOI: 10.3389/fonc.2019.00121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Background: About 75% of newly diagnosed bladder cancer cases suffer from non-muscle invasive bladder cancer (NMIBC), which used to recur and progress despite transurethral resection of bladder tumor (TURBT). This meta-analysis was conducted to examine if combined application of intravesical bacille Calmette-Guérin (BCG) with chemotherapy is associated with better prognosis. Methods: Systematic searches of randomized controlled trials (RCTs) concerning NMIBC were performed in PubMed, EMbase, CENTRAL, CNKI, WanFang, VIP, CBM databases, and some specialized websites. Two researchers independently implemented study selection, quality assessment and data extraction. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for treatment effects on recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) were directly extracted, if available, or estimated using relevant data from included studies. Side effects, such as fever, gastrointestinal reaction, cystitis, irritative bladder symptoms and hematuria, were also extracted as outcome measurements, and associated relative risks (RRs) were calculated to assess treatment safety. RevMan 5.3 software was used to perform statistical analyses. Results: Thirteen RCTs containing 1,754 patients with NMIBC were included in this meta-analysis. Compared with BCG alone, the combination therapy significantly improved RFS (HR = 0.53, 95% CI: 0.43-0.66, P < 0.01), OS (HR = 0.66, 95%CI: 0.50-0.86, P = 0.002), and DSS (HR = 0.48, 95%CI: 0.29-0.80, P = 0.005). While PFS showed no obvious difference between combination therapy and BCG alone (HR = 0.65, 95%CI: 0.25-1.68, P = 0.38). The rate of fever (RR = 0.50, 95%CI: 0.27-0.91, P = 0.02), irritative bladder symptoms (RR = 0.69, 95%CI: 0.52-0.90, P = 0.007) and hematuria (RR = 0.50, 95%CI: 0.28-0.89, P = 0.02) were significantly decreased in patients treated with combination therapy compared to those with BCG alone. There were no statistically significant differences between combination therapy and BCG alone in toxicity (RR = 0.69, 95%CI: 0.34-1.40, P = 0.30), gastrointestinal reaction (RR = 2.54, 95%CI: 0.61-10.60, P = 0.20) or cystitis (RR = 0.67, 95%CI: 0.29-1.54, P = 0.34). Conclusions: Combined application of intravesical BCG and chemotherapy appears to be an effective treatment for patients with intermediate- to high-risk NMIBC, but not for those with tumor in situ alone or recurrent bladder cancer.
Collapse
Affiliation(s)
- Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
45
|
Moschini M, Zamboni S, Mattei A, Amparore D, Fiori C, De Dominicis C, Esperto F. Bacillus Calmette-Guérin unresponsiveness in non-muscle-invasive bladder cancer patients: what the urologists should know. MINERVA UROL NEFROL 2019; 71:17-30. [DOI: 10.23736/s0393-2249.18.03309-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
46
|
Zamboni S, Baumeister P, Mattei A, Mordasini L, Antonelli A, Simeone C, Moschini M. Single postoperative instillation for non-muscle invasive bladder cancer: are there still any indication? Transl Androl Urol 2019; 8:76-84. [PMID: 30976571 PMCID: PMC6414349 DOI: 10.21037/tau.2018.08.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/09/2018] [Indexed: 11/22/2022] Open
Abstract
Intravesical chemotherapeutical agents after transurethral resection have shown to be effective in reducing the risk of recurrence and progression during the follow up. Specifically, an early single chemotherapeutical instillation (SI) might play an important role but the efficacy of this treatment has been questioned. For these reasons, we sought to review and summarize the current evidence with a non-systematic Medline/PubMed literature search. Level 1a evidence strongly supports the utility of SI in reducing recurrence in low-intermediate risk non-muscle invasive bladder cancer (NMIBC) patients, with about 35% of relative reduction rates in patients with single, <3 cm and low-intermediate stage and grade tumors. The efficacy of this procedure is particularly evident when epirubicin or mitomycin C is administered. However, no randomized controlled trials compared the effect of the different types of drugs for SI. Only few trials have analyzed the effect of timing in SI, therefore, the optimal delivery timeframe is not yet completely clear with some series suggesting that a delivery within the first 2 hours after surgery might have an impact on recurrence rates and others that show no differences with those treated within 24 hours. None of the patients included in the randomized controlled trials analyzed in this review suffered from systemic toxicity. On the other hand, other side effects were recorded, including: chemical cystitis and skin reaction. Although it is a safe procedure, rare severe complications have been reported in the literature, mostly due to extravasation of drugs in patients who underwent extended resection or bladder perforation. To avoid potential deadly complications, SI should not be administered in these patients.
Collapse
Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Philipp Baumeister
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Livio Mordasini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| | - Alessandro Antonelli
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Claudio Simeone
- Department of Urology, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Spitalstrasse 2, Lucerne, Switzerland
| |
Collapse
|
47
|
van der Pol CB, Chung A, Lim C, Gandhi N, Tu W, McInnes MD, Schieda N. Update on multiparametric MRI of urinary bladder cancer. J Magn Reson Imaging 2018; 48:882-896. [DOI: 10.1002/jmri.26294] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Christian B. van der Pol
- Department of Radiology, Juravinski Hospital and Cancer Centre, HHS; McMaster University; Hamilton ON Canada
| | - Andrew Chung
- Department of Radiology, Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts USA
| | - Christopher Lim
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts USA
| | - Niket Gandhi
- Department of Radiology, The Ottawa Hospital; University of Ottawa; Ottawa ON Canada
| | - Wendy Tu
- Department of Radiology, The Ottawa Hospital; University of Ottawa; Ottawa ON Canada
| | - Matthew D.F. McInnes
- Department of Radiology, The Ottawa Hospital; University of Ottawa; Ottawa ON Canada
| | - Nicola Schieda
- Department of Radiology, The Ottawa Hospital; University of Ottawa; Ottawa ON Canada
| |
Collapse
|
48
|
Schroeck FR, Lynch KE, Chang JW, MacKenzie TA, Seigne JD, Robertson DJ, Goodney PP, Sirovich B. Extent of Risk-Aligned Surveillance for Cancer Recurrence Among Patients With Early-Stage Bladder Cancer. JAMA Netw Open 2018; 1:e183442. [PMID: 30465041 PMCID: PMC6241521 DOI: 10.1001/jamanetworkopen.2018.3442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/12/2018] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Cancer care guidelines recommend aligning surveillance frequency with underlying cancer risk, ie, more frequent surveillance for patients at high vs low risk of cancer recurrence. OBJECTIVE To assess the extent to which such risk-aligned surveillance is practiced within US Department of Veterans Affairs facilities by classifying surveillance patterns for low- vs high-risk patients with early-stage bladder cancer. DESIGN SETTING AND PARTICIPANTS US national retrospective cohort study of a population-based sample of patients diagnosed with low-risk or high-risk early-stage bladder between January 1, 2005, and December 31, 2011, with follow-up through December 31, 2014. Analyses were performed March 2017 to April 2018. The study included all Veterans Affairs facilities (n = 85) where both low-and high-risk patients were treated. EXPOSURES Low-risk vs high-risk cancer status, based on definitions from the European Association of Urology risk stratification guidelines and on data extracted from diagnostic pathology reports via validated natural language processing algorithms. MAIN OUTCOMES AND MEASURES Adjusted cystoscopy frequency for low-risk and high-risk patients for each facility, estimated using multilevel modeling. RESULTS The study included 1278 low-risk and 2115 high-risk patients (median [interquartile range] age, 77 [71-82] years; 99% [3368 of 3393] male). Across facilities, the adjusted frequency of surveillance cystoscopy ranged from 3.7 to 6.2 (mean, 4.8) procedures over 2 years per patient for low-risk patients and from 4.6 to 6.0 (mean, 5.4) procedures over 2 years per patient for high-risk patients. In 70 of 85 facilities, surveillance was performed at a comparable frequency for low- and high-risk patients, differing by less than 1 cystoscopy over 2 years. Surveillance frequency among high-risk patients statistically significantly exceeded surveillance among low-risk patients at only 4 facilities. Across all facilities, surveillance frequencies for low- vs high-risk patients were moderately strongly correlated (r = 0.52; P < .001). CONCLUSIONS AND RELEVANCE Patients with early-stage bladder cancer undergo cystoscopic surveillance at comparable frequencies regardless of risk. This finding highlights the need to understand barriers to risk-aligned surveillance with the goal of making it easier for clinicians to deliver it in routine practice.
Collapse
Affiliation(s)
- Florian R. Schroeck
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- White River Junction VA Medical Center, White River Junction, Vermont
| | - Kristine E. Lynch
- VA Salt Lake City Health Care System, Salt Lake City, Utah
- University of Utah, Salt Lake City
| | - Ji won Chang
- VA Salt Lake City Health Care System, Salt Lake City, Utah
- University of Utah, Salt Lake City
| | - Todd A. MacKenzie
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | - John D. Seigne
- Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Douglas J. Robertson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
- White River Junction VA Medical Center, White River Junction, Vermont
| | - Philip P. Goodney
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
- White River Junction VA Medical Center, White River Junction, Vermont
| | - Brenda Sirovich
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
- White River Junction VA Medical Center, White River Junction, Vermont
| |
Collapse
|
49
|
Pandey R, Jackson JK, Liggins R, Mugabe C, Burt HM. Enhanced taxane uptake into bladder tissues following co-administration with either mitomycin C, doxorubicin or gemcitabine: association to exfoliation processes. BJU Int 2018; 122:898-908. [PMID: 29862643 DOI: 10.1111/bju.14423] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the effect of three anticancer drugs (mitomycin c (MMC), doxorubicin or gemcitabine) on bladder wall morphology and the uptake of paclitaxel or docetaxel following coadministration. The primary objective of this study was to measure the uptake of MMC, doxorubicin or gemcitabine with or without exposure of the tissue to amine terminated cationic nanoparticles (CNPs) and to investigate any possible exfoliation effects of the three drugs on intact bladder tissue. The secondary objective was to investigate the uptake of taxane drugs (docetaxel, DTX) and paclitaxel, (PTX) from surfactant micelle formulations in the presence of MMC, doxorubicin or gemcitabine. MATERIALS AND METHODS Sections of fresh pig bladder tissue were incubated in Franz diffusion cells with the urothelial side exposed to solutions of doxorubicin, MMC and gemcitabine containing radioactive drug for 90 min. Some tissue samples were simultaneously exposed to each of the three drugs in combination with the surfactant micelle formulations of PTX (Taxol) or DTX (Taxotere). Tissue sections were then cryostat sectioned for drug quantitation by liquid scintillation counting or fixed for scanning electron microscopy and haematoxylin and eosin staining. RESULTS All three drugs caused exfoliation of the urothelial layer of bladder tissues. Drug uptake studies showed that all three drugs effectively penetrated the lamina propria through to the muscular layer over a 2-h incubation and these levels were unaffected by pre-treatment with CNPs. The uptake levels of the taxane drugs PTX and DTX were significantly enhanced following simultaneous treatment of bladders with MMC, doxorubicin or gemcitabine. CONCLUSION The exfoliation effects of MMC, doxorubicin and gemcitabine allow for good tissue penetration of these drugs with no additional effect from CNP treatment of bladders. The observed exfoliation effect of these amine-containing drugs probably arises from a cationic interaction with the mucus and urothelium cell layer in a manner similar to that previously reported for CNPs. These studies suggest that the lack of long-term clinical efficacy of these drugs may not arise from poor intravesical drug penetration but may result from a rapid diffusion of the drugs into the deeper vascularised muscular region with rapid drug clearance. The enhanced uptake of PTX or DTX following co-administration with MMC, doxorubicin or gemcitabine probably arises from the removal of the urothelial barrier by exfoliation allowing for improved taxane partitioning into superficial layers. These effects may allow for dual drug intravesical strategies offering greatly improved taxane uptake and potential additive drug effects for improved efficacy.
Collapse
Affiliation(s)
- Rakhi Pandey
- Pharmaceutical Science, The University of British Columbia, Vancouver, BC, Canada
| | - John K Jackson
- Pharmaceutical Science, The University of British Columbia, Vancouver, BC, Canada
| | - Richard Liggins
- Centre for Drug Research and Development, The University of British Columbia, Vancouver, BC, Canada
| | - Clement Mugabe
- Centre for Drug Research and Development, The University of British Columbia, Vancouver, BC, Canada
| | - Helen M Burt
- Pharmaceutical Science, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
50
|
Bladder cancer presenting with acrometastases: a different cause of foot pain. Skeletal Radiol 2018; 47:1003-1009. [PMID: 29388038 DOI: 10.1007/s00256-018-2888-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 02/02/2023]
Abstract
Acrometastasis means tumor seeding distally to the elbow or the knee and is an uncommon event. Foot acrometastases occur in 0.58% of patients with skeletal metastases overall, and only about 10% of these are caused by bladder cancer. We present a case of bladder cancer manifesting with insidious foot pain, caused by multiple lytic lesions located solely at the left foot. It was suspected after whole-body CT and later confirmed by biopsy result. We enumerate the differential diagnosis of distal extremity lytic lesions for educational purposes and review the literature listing similar published cases.
Collapse
|