Development and Validation of a Novel Recurrence Risk Stratification for Initial Non-Muscle Invasive Bladder Cancer in the Han Chinese Population

Comprehensive analysis and prognostic assessment of senescence-associated genes in bladder cancer

BACKGROUND

The prevalence and mortality of bladder cancer (BLCA) present a significant medical challenge. While the function of senescence-related genes in tumor development is recognized, their prognostic significance in BLCA has not been thoroughly explored.

METHODS

BLCA transcriptome datasets were sourced from the TCGA and GEO repositories. Gene groupings were determined through differential gene expression and non-negative matrix factorization (NMF) methodologies. Key senescence-linked genes were isolated using singular and multivariate Cox regression analyses, combined with lasso regression. Validation was undertaken with GEO database information. Predictive models, or nomograms, were developed by merging risk metrics with clinical records, and their efficacy was gauged using ROC curve methodologies. The immune response's dependency on the risk metric was assessed through the immune phenomenon score (IPS). Additionally, we estimated IC50 metrics for potential chemotherapeutic agents.

RESULTS

Reviewing 406 neoplastic and 19 standard tissue specimens from the TCGA repository facilitated the bifurcation of subjects into two unique clusters (C1 and C2) according to senescence-related gene expression. After a stringent statistical evaluation, a set of ten pivotal genes was discerned and applied for risk stratification. Validity tests for the devised nomograms in forecasting 1, 3, and 5-year survival probabilities for BLCA patients were executed via ROC and calibration plots. IC50 estimations highlighted a heightened responsiveness in the low-risk category to agents like cisplatin, cyclopamine, and sorafenib.

CONCLUSIONS

In summation, our research emphasizes the prospective utility of risk assessments rooted in senescence-related gene signatures for enhancing BLCA clinical oversight.

Development of a dynamic risk system for predicting the risk of recurrence and progression in patients with non-muscle-invasive bladder cancer after thulium laser resection of bladder tumor or transurethral resection of bladder tumor followed by intravesical BCG instillation

Background

The high recurrence rate of non-muscle-invasive bladder cancer (NMIBC) after tumor resection brings huge physical and financial burdens for patients. Several predictive models that predict the recurrence of patients with NMIBC have drawbacks in clinical practice. With the rapid development of therapeutic methods, more factors should be taken into consideration when constructing predictive model.

Methods

We retrospectively enrolled 90 patients who were diagnosed as intermediate- or high-risk NMIBC and received a Thulium laser resection of bladder tumor (TmLRBT) or transurethral resection of bladder tumor (TURBT) followed by BCG instillation. Univariate Cox regression analysis and multivariate Cox regression analysis were performed to screen out the independent prognostic factors of recurrence free survival (RFS). A nomogram and risk index were constructed using these prognostic factors.

Results

In this study, 22 patients suffered recurrence; 37 patients (41%) received TmLRBT, and over 90% patients completed intravesical BCG instillation for one year. The univariate Cox regression showed that surgery (TURBT vs TmLRBT), previous bladder tumor, tumor number, pathological stage, post-operative catheterization and number of BCG therapy were associated with RFS. The multivariate Cox regression revealed that surgery (TURBT vs TmLRBT) (HR = 3.16, 95%CI [1.02 - 9.83]); previous bladder tumor (HR = 4.03, 95%CI [1.41 - 11.54]); number of BCG therapy (HR = 0.89, 95%CI [0.84 - 0.95]) were independent prognostic factors. A nomogram was constructed and exhibited excellent capability in predicting the RFS with an AUC of 0.789, 0.848, 0.806 at 6-, 12- and 24-months respectively and a c-index of 0.822. Also, the calibration curve and decision curve analysis were performed to verify the predictive efficacy. The risk index was derived from the nomogram and also exhibited favorable capability in predicting the progression free survival (PFS) of patients.

Conclusions

Patients who received TmLRBT, without previous bladder tumor history and had more intravesical BCG instillations are likely to have better RFS. The nomogram and the risk index which were constructed to predict the RFS and PFS of patients may help urologists to make clinical decisions and aid in precision medicine.

The impact of smoking on recurrence and progression of non-muscle invasive bladder cancer: a systematic review and meta-analysis

OBJECTIVES

Although smoking is a well-recognized causative factor of urothelial bladder cancer and accounts for 50% of cases, less is known about the prognostic significance of smoking on non-muscle invasive bladder cancer (NMIBC) prognosis. This systematic review and meta-analysis aimed to evaluate the effect of smoking on the risk of NMIBC recurrence and progression.

MATERIALS AND METHODS

We systematically searched Medline, Web of Science and Scopus databases for original articles published before October 2021 regarding the effect of smoking on NMIBC recurrence and progression. Information about smoking status and the number of events or odds ratio or hazard ratio for event-free survival must have been reported to include the study in the analysis. Quality In Prognosis Studies tool was utilized for the risk of bias assessment.

RESULTS

We selected 64 eligible studies, including 28 617 patients with NMIBC with available data on smoking status. In a meta-analysis of 28 studies with 7885 patients, we found that smokers (current/former) were at higher risk for recurrence (OR = 1.68; 95% CI 1.34-2.09; P < 0.0001) compared to never smokers. Subgroup analysis of 2967 patients revealed that current smokers were at a 1.24 higher risk of recurrence (OR = 1.24; 95% CI 1.02-1.50; P = 0.03) compared to former smokers. A meta-analysis of the hazard ratio revealed that smokers are at higher risk of recurrence (HR = 1.31; 95%CI 1.15-1.48; P < 0.0001) and progression (HR = 1.18; 95%CI 1.08-1.29; P < 0.001) compared to never smokers. Detrimental prognostic effect of smoking on progression, but not for recurrence risk was also noted in the subgroup analysis of high-risk patients (HR = 1.30; 95%CI 1.09-1.55; P = 0.004) and BCG-treated ones (HR = 1.15; 95%CI 1.06-1.25; P < 0.001).

CONCLUSION

In conclusion, patients with non-muscle invasive bladder cancer and a history of smoking have a worse prognosis regarding recurrence-free and progression-free survival compared to non-smokers.

Preoperative CT features to predict risk stratification of non-muscle invasive bladder cancer

PURPOSE

To investigate whether preoperative CT features can be used to predict risk stratification of non-muscle invasive bladder cancer (NMIBC).

METHODS

The 168 patients with pathologically confirmed NMIBC who underwent preoperative CT urography were retrospectively analyzed and were divided into training (n = 117) and testing (n = 51) sets. According to the European Association of Urology Guidelines, patients were classified into low-risk (n = 50), medium-risk (n = 23), and high-risk (n = 95) groups. A random over-sample was performed to handle the offset caused by the unbalanced groups. We measured some CT features that may help stratify which for modeling were determined using an F-test-based feature selection with a tenfold cross-validation procedure, and the Gaussian Naive Bayes model was trained on the entire training set. In the testing set, the performance of the model was evaluated.

RESULTS

The selected CT features were the maximum and the minimum diameter of the largest tumor, whether the largest tumor is located at the trigone, and tumor number. In the testing set, the model reached a macro- and micro- AUC of 0.783 and 0.745 with an accuracy of 0.529. As for the one-vs-rest problem, the model was most effective in identifying low-risk individuals, with an AUC, accuracy, sensitivity, and specificity of 0.870, 0.647, 1.000, and 0.438, respectively; the medium-risk group reached 0.814, 0.882, 0.250, and 0.936, respectively; the identification of the high-risk group was harder, going 0.665, 0.529, 0.250, and 0.870, respectively.

CONCLUSION

It is feasible to predict the risk stratification of NMIBC using preoperative CT features.

Current Researches on Nanodrug Delivery Systems in Bladder Cancer Intravesical Chemotherapy

Bladder cancer is one of the most common malignant tumors in urinary system. Intravesical chemotherapy is a common adjuvant therapy after transurethral resection of bladder tumors. However, it has several disadvantages such as low drug penetration rate, short residence time, unsustainable action and inability to release slowly, thus new drug delivery and new modalities in delivery carriers need to be continuously explored. Nano-drug delivery system is a novel way in treatment for bladder cancer that can increase the absorption rate and prolong the duration of drug, as well as sustain the action by controlling drug release. Currently, nano-drug delivery carriers mainly included liposomes, polymers, and inorganic materials. In this paper, we reveal current researches in nano-drug delivery system in bladder cancer intravesical chemotherapy by describing the applications and defects of liposomes, polymers and inorganic material nanocarriers, and provide a basis for the improvement of intravesical chemotherapy drugs in bladder cancer.

Profiles of tumor-infiltrating immune cells and prognostic genes associated with the microenvironment of bladder cancer

The immune microenvironment in bladder cancer (BC) and its significance still remain poorly understood. The present work aims to investigate tumor-infiltrating immune cells (TIICs) and prognostic genes associated with the tumor microenvironment (TME) of BC. The immune and stromal scores of BC samples from The Cancer Genome Atlas database were downloaded from the ESTIMATE website. Based on these scores, BC samples were assigned to the high and low score groups and 429 intersecting differentially expressed genes were identified. Functional enrichment analysis further revealed that these genes dramatically participated in the immune-related biological processes and signaling pathways. Two TME-related genes, angiotensin II receptor type 2 (AGTR2) and sclerostin domain containing 1 (SOSTDC1), were identified to establish an immune-related risk model using Cox regression analyses. Intriguingly, patients with high-risk scores had poor outcomes (p < 0.001). The areas under the curve for the risk model in predicting 3- and 5-year survival rates were 0.692 and 0.707, respectively. Kaplan-Meier survival analysis showed that the expression of AGTR2 and SOSTDC1 significantly correlated with the overall survival of BC patients. Additionally, 22 TIICs in the BC microenvironment were analyzed with the CIBERSORT algorithm. This study indicated that the effective components of TME affected the clinical outcomes of BC patients and might provide a basis for the development of new immunotherapies for BC patients.