Epidemiologic and socioeconomic status of bladder cancer in Mazandaran Province, northern Iran

Prevalence and associated factors for asymptomatic microscopic hematuria in adults in the PERSIAN Guilan cohort study (PGCS)

Although hematuria is not life-threatening, some could be the result of a more severe condition. Our objectives are to report on the prevalence and risk factors of asymptomatic microscopic hematuria (AMH) in the prospective epidemiological research studies of the Iranian adults (PERSIAN) Guilan cohort study (PGCS) population. This cross-sectional study was conducted from 2014 to 2017 and consisted of 10,520 individuals aged 35-70. Data collection was conducted using a questionnaire during a face-to-face interview. The urine analyses (UA) were done up to 2 h after sample collection. Based on a urine microscopy evaluation, AMH is defined as 3 or more red blood cells per high power field (HPF). Simple and multiple logistic regression analysis was conducted to explore factors associated with AMH. The prevalence of AMH in this study was 34.1% and was more prevalent in participants of older ages and female gender as well as those with low educational level, underweight-body mass index (BMI), high physical activity, smoking, alcohol consumption, and kidney stone disease. On the other hand, obesity, opium, and diabetes decreased the likelihood of AMH. The results of the present study shed light on the prevalence and risk factors of AMH and suggested that a significant portion of the study population is affected by AMH. Considering the lack of consensus on a definite clinical guideline for AMH in our country, the results of the present study could be used to design a unit algorithm for screening and therapy of AMH.

Adherence to Mediterranean-Style Dietary Pattern and Risk of Bladder Cancer: A Case-Control Study in Iran

Few dietary patterns are related to reduce the Bladder Cancer (BC) risk. One of the well-known dietary patterns is the Mediterranean diet (MD). This case-control study investigated the association between MD and the odds of BC among Iranian population. The present case-control study was performed on 103 eligible cases and 200 controls age 45 to 92 years. Diet of participants was assessed by a validated 168-item food frequency questionnaire (FFQ). Adherence to MD was measured by Mediterranean-Style Dietary Pattern Score (MSDPS). Multivariate logistic regression was used to estimate the relationship between MSDPS and risk of BC. After controlling for potential confounders, a negative association was observed between MSDPS and risk of BC (OR = 0.22; 95%CI = 0.09-0.52; p trend = 0.001). Furthermore, significant negative associations were observed for dairy, fish and other seafood, whole-grain, bread intake and risk of BC (p for trend < 0.05). In contrast, the risk of BC increased for high intake of poultry (OR = 1.09; 95%CI = 1.03-1.15; p trend = 0.003), sweets (OR = 1.24; 95%CI = 1.03-1.48; p trend = 0.018) and egg (p for trend = 0.01). Our results suggested that dietary habit in concordance with the principles of the Mediterranean dietary pattern may protect against BC.

Evaluation of secondary cancers, synchronous and metachronous with bladder cancer

The number of bladder cancer survivors worldwide is increasing due to the advancement of diagnostic methods and bladder cancer treatment. Besides, bladder cancer is the sixth most common cancer in Iran. Nowadays, many secondary cancers have been proven with bladder cancer. This study focused on synchronous and metachronous cancers with bladder cancer. This study was performed retrospectively. A total of 276 patients with a definitive diagnosis of bladder cancer were included in the study. Tumors were diagnosed using ultrasound and cystoscopy. Out of 276 patients with bladder tumor, 240 underwent resection, 25 underwent radical cystectomy, and 31 underwent chemotherapy in addition to resection. The mean age of patients was 65±3.9 years. Among the patients, 184 were male (67%), and 92 were female (33%). Smoking was the most common known risk factor. There were 165 smokers, 135 of whom were male and 30 female. Sixty-nine patients had no known risk factor (P <0.05). Gastric cancer was the most common secondary cancer with bladder cancer in all individuals (5.7%). Prostate cancer (20%) in men and cervical cancer (11.9%) in women was the most common secondary cancer simultaneous with bladder cancer. Given the importance of SPC as a cause of cancer death, early detection and screening of primary cancer survivors will increase patients' life expectancy and quality of life.

Genetic and molecular biology of bladder cancer among Iranian patients

Background

Bladder cancer (BC) is the sixth common cancer among Iranians. Various risk factors such as smoking, body mass index, chronic infection, age, and genetic factors are associated with BC progression.

Methods

It has been shown that a significant ratio of patients have tumors with muscle bladder layer invasion and poor prognosis at the time of diagnosis. Therefore, the early detection of tumors is required to reduce the mortality rate of BC cases. Since there is a wide geographical incidence variation in BC in Iran, it seems that the ethnic and genetic factors can be the main risk factors among Iranian BC patients.

Results

For the first time, in present review we have summarized all of the reported genes among Iranian BC patients until now which were significantly associated with tumorigenesis. Moreover, we categorized all of the reported genes based on their cell and molecular functions to clarify the genetic and molecular biology of BC among Iranian population.

Conclusion

This review paves the way of determination of a population‐based genetic panel markers for the early detection of BC in this population.

Bladder Cancer in Iran: An Epidemiological Review

PURPOSE

Bladder cancer is the sixth most common cancer in Iran. Information about the epidemiological situation of the disease and its risk factors is necessary for conducting a planning program to reduce the disease. This study is conducted with the aim of evaluating the epidemiological features of bladder cancer in Iran.

METHODS

This is a systematic review of the published articles in both Persian and English in international and national journals during the years 2000-2019 with key words of Iran and bladder cancer. Articles were selected from the national information database (SID, Magiran) and international databases (PubMed, Scopus, and Web of Science). Articles related to the epidemiological aspects of the disease, including incidence, prevalence, mortality, and risk factors, were evaluated.

RESULTS

The incidence rate of bladder cancer was about 1.6-115; cumulative survival rate was 0.95, mortality rate was 0.5-0.84 and its prevalence in the Iranian population was between 4.10% and 12.8%. The risk of developing malignancy in major risk factor groups, including smoking and opium, was 6.2 (2.04-18.7), increases in protein and animal fat consumption were about 5- and 19-times higher than in the general population, respectively. In terms of occupational exposure, bus and heavy truck drivers were 11.3 (1.3-92.05) more at risk than others.

CONCLUSION

Regarding the increasing trend of this disease, changes in lifestyle to reduce risk factors can be effective in decreasing the incidence and mortality rate of this malignancy.

Bladder cancer survival nomogram: Development and validation of a prediction tool, using the SEER and TCGA databases

Bladder cancer (BC) is a common malignancy associated with high morbidity and mortality, however, accurate and convenient risk assessment tools applicable to BC patients are currently lacking. Previous studies using nomograms to evaluate bladder cancer (BC) survival have been based on small samples. Using a large dataset, this study aimed to construct more precise clinical nomograms to effectively predict bladder cancer survival.Data on patients with pathologically-confirmed bladder cancer were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Additional BC patient data for an external validation cohort were extracted from the Cancer Genome Atlas (TCGA) database. Clinical parameters that constituted potential risk factors were reviewed and analyzed using univariate and multivariate Cox proportional hazards regression. A nomogram was constructed with parameters that significantly correlated with the overall survival (OS). Prognostic performance of a nomogram was assessed using the concordance index (c-index), area under the receiver operating characteristic curve (AUC), and a calibration curve. The model was then tested with data from an internal and external validation cohort. Patients' survival was analyzed and compared with the Kaplan-Meier (KM) method.Multivariate Cox regression showed that age, sex, race, stage_T1, stage_T2a, stage_T2b, stage_T3a, stage_Ta, stage_Tis, stage_N, stage_M were independent predictors of BC survival. A nomogram was constructed based on these factors. The c-index of the nomogram was 0.7916 (95% confidence interval CI, 0.79-0.80). The calibration curve showed excellent agreement between the predicted and observed values. The c-index for the internal validation cohort was 0.7917 (95% CI 0.79-0.80), which was higher than for the training cohort, suggesting robustness of the model. For the training cohort, the AUC for the 3- and the 5-year survival was 0.82 and 0.813, respectively. The c-index for the TNM-based model was superior to that for the AJCC-TNM classification.The models presented in this study might be suitable for clinical use, supporting clinicians in their individualized assessment of expected survival in BC patients. They might also be used as a layered tool for clinical research.

A review of bladder cancer in Sub-Saharan Africa: A different disease, with a distinct presentation, assessment, and treatment

Background

Cancer of the bladder is the ninth leading cause of cancer in developed countries. It is the second most common urological malignancy. Transitional cell carcinoma (TCC) is the most common histological subtype in developed countries. In most of Africa, the most common type is squamous cell carcinoma (SCC). Cancer of bladder guidelines produced by the European Urological Association and the American Urological Association, including the tumor, node, and metastasis staging is focused on TCC of the bladder.

Objectives

The purpose of the study is to review the pathogenesis, pathology, presentation, and management of cancer of the bladder in Africa and to use this information to propose a practical staging system for SCC.

Methods

The study used the meta-analysis guideline provided by PRISMA using bladder cancer in Africa as the key search word. The study collected articles available on PubMed as of July 2017, Africa Online and Africa Index Medicus. PRISMA guidelines were used to screen for full-length hospital-based articles on cancer of the bladder in Africa. These articles were analyzed under four subcategories which were pathogenesis, pathology, clinical presentation, and management. The information extracted was pooled and used to propose a practical staging system for use in African settings.

Results

The result of evaluation of 821 articles yielded 23 full-length papers on hospital-based studies of cancer of the bladder in Africa. Cancer of the bladder in most of Africa is still predominantly SCC (53%-69%). There has been a notable increase in TCC in Africa (9%-41%). The pathogenesis is mostly schistosoma-related SCC presents late with painful hematuria and necroturia (20%). SCC responds poorly to chemotherapy or radiotherapy. The main management of SCC is open surgery. This review allowed for a practical organ-based stage of SCC of the bladder that can be used in Africa.

Conclusion

Bladder cancer in Africa presents differently from that in developed countries. Guidelines on cancer of the bladder may need to take account of this to improve bladder cancer management in Africa.

A review of incidence and mortality of colorectal, lung, liver, thyroid, and bladder cancers in Iran and compared to other countries

In Iran, a developing country in southwest Asia, an epidemiologic transition is underway from communicable to noncommunicable diseases. In Iran, cancer is the second largest group of chronic non-communicable diseases (NCDs) and the third most common cause of death following heart disease, accidents and other natural phenomena. There are some studies reporting an increasing trend in the incidence and mortality rate of a variety of cancers in Iran. Therefore, controlling and preventive interventions pertaining to cancers must be a main priority for health policy and it is recommended that the high-risk population receive earlier screening. In this review, incidence and mortality of colorectal, lung, liver, thyroid, and bladder cancers in Iran are reported.

Opium and bladder cancer: A systematic review and meta-analysis of the odds ratios for opium use and the risk of bladder cancer

Objective

The association between opium use and bladder cancer has been investigated in many studies, with varying reporting results reported. This study aims to estimate the total odds ratio for the association between bladder cancer and opium consumption using meta-analysis.

Methods

The study was designed according to PRISMA guidelines. Two independent researchers searched for the relevant studies using PubMed, Web of Science, Scopus, OVID, Embase, and Google Scholar. After systematic screening of the studies identified during the first step, Cochrane risk of bias tool was determined for the selected studies. The case-control and the cohort studies were investigated to assess risk of bladder cancer due to opium use. In addition, the cross-sectional studies were analysed separately to assess frequency of opium consumption. These estimates were combined using the inverse variance method. Fixed or random effect models were applied to combine the point odds ratios. The heterogeneity between the primary results was assessed using the Cochran test and I-square index. The suspected factors for heterogeneity were investigated using meta-regression models. An Egger test was conducted to identify any probable publication bias. Forest plots illustrated the point and pooled estimates. All analyses were performed using Stata version 14 software and RevMan version 5.3.

Results

We included 17 primary studies (11 case-control, one cohort and five cross-sectional) in the final meta-analysis. The total odds ratios (95% confidence intervals) for developing bladder cancer by opium use alone, and concurrent use of opium and cigarettes were estimated as 3.85 (3.05–4.87) and 5.7 (1.9–16.3) respectively. The odds ratio (95% confidence interval) for opium use with or without cigarette smoking was estimated as 5.3 (3.6–7.7).

Conclusion

This meta-analysis showed that opium use similar to cigarette smoking and maybe with similar mechanisms can be a risk factor for bladder cancer. It is therefore expected to be a risk factor for other cancers.

Characteristics of Patients With Transitional Cell Carcinoma of the Urinary Bladder in Kermanshah Province, Iran

BACKGROUND

In Iran, bladder cancer is one of the most common malignancy sites among men, ranking as the fifth with age-specific incidence rate of about 11.2 per 100,000 males. It causes 8% of all malignancies in men and 3% of all malignancies in women.

OBJECTIVES

The aim of this study was to report the epidemiological, clinical, and pathological features of bladder cancer in Western Iran compared to other studies.

PATIENTS AND METHODS

This is a retrospective study between 2003 and 2014 when forty-four patients with bladder cancer referred to Hematology Clinic of Kermanshah, Kermanshah, Iran. Transitional cell carcinoma (TCC) was in 39 patients.

RESULTS

In the patients with TCC, the mean age in diagnosis for them was 65.43 years (± 11.64), range of age 42 to 88 years , thirty-three patients (84.6%) were male, and six patients (15.4%) were female. Of 39 patients with TCC, 16 patients (41%) had metastasis. 21 patients (53.8%) were smoker and 16 patients (41%) had muscle invasive. 35 patients (89.7%) were histological high grade and the rest of patients were low grade. In the TCC patients with increasing age, metastasis and muscle invasive increased.

CONCLUSIONS

The age presentation of TCC in West Iran was similar to other studies. Percentage of patients with high grade is more than other studies, and also the number of patients with bladder cancer has increased during last 4 years. For better results, studies must be conducted with more patients in this area, and other areas of Iran with checking of genetics, race and environmental factors.

Demographic survey of four thousand patients with 10 common cancers in North Eastern Iran over the past three decades

BACKGROUND

Cancer is a major cause of mortality in developing countries and correct and valid information about the epidemiology of this disease is the first step in the planning of health care in each region. The aim of this study was to determine the relative frequency, mean age and sex ratio of the most 10 common non-skin cancers in the world and Iran, among patients referred to an oncology clinic.

MATERIALS AND METHODS

This descriptive study was conducted in Mashhad, north east of Iran. The data obtained from the records of patients referred to the private oncology center between the years of 1985-2012." According to the latest report of GLOBOCAN study commonest malignancies included were lung, breast, colorectal, prostate, stomach, liver, cervix, esophageal, bladder cancers and Non-Hodgkin lymphoma.

RESULTS

A total of 4,606 cases were analyzed. The mean age was 55.5±13.8years (male: 59.5±13.9, female: 52.6±12.9). Overall, breast cancer (1,264 cases, relative frequency of 27.4%) was the most prevalent cancer; however the mean ages of diagnosis were not significantly different between 5-year time period divisions (p=0.290). The most common cancer in men was esophageal cancer (26.3%).The lowest mean age was related to women diagnosed with breast cancer (48.5±11.8) and men with non-Hodgkins lymphoma (48.4±17.8). There were statistically significant differences between the mean age of men and women with gastric (p=0.003) and esophageal cancers (p<0.001). Male to female sex ratios in our study for bladder, lung and stomach cancers were 6.57, 2.60 and 2.50 respectively.

CONCLUSIONS

The results showed that breast cancer tends to be found in younger female patients and bladder cancer appears more often in men. Screening in target population in addition to early diagnosis may reduce death and disability.

Incidence Trend and Epidemiology of Common Cancers in the Center of Iran

Introduction:

Cancer is a major public health problem in Iran and many other parts of the world. The cancer incidence is different in various countries and in country provinces. Geographical differences in the cancer incidence lead to be important to conduct an epidemiological study of the disease. This study aimed to investigate cancer epidemiology and trend in the province of Qom, located in center of Iran.

Method:

This is an analytical cross-sectional study carried out based on re-analysis cancer registry report and the disease management center of health ministry from 2004 to 2008 in the province of Qom. To describe incidence time trends, we carried out join point regression analysis using the software Join point Regression Program, Version 4.1.1.1.

Results:

There were 3,029 registered cases of cancer during 5 years studied. Sex ratio was 1.32 (male to female). Considering the frequency and mean standardized incidence, the most common cancer in women were breast, skin, colorectal, stomach, and esophagus, respectively while in men the most common cancers included skin, stomach, colorectal, bladder, and prostate, respectively. There was an increasing and significant trend, according to the annual percentage change (APC) equal to 8.08% (CI: 5.1-11.1) for all site cancer in women.

Conclusion:

The incidence trend of all cancers was increasing in this area. Hence, planning for identifying risk factors and performing programs for dealing with the disease are essential.

Are bladder neoplasms more aggresive in patients with a smoking-related second malignancy?

BACKGROUND

Relationships between smoking and bladder neoplasms, one of the common malignancies, are well-known. Different smoking-related malignancies may occur together. In this study, we evaluated the stage and grade of bladder neoplasms in patients also featuring lung or larynx cancer.

MATERIALS AND METHODS

From January 2006 to February 2012, patients who underwent surgery for bladder neoplasms in our clinic were screened retrospectively. In the evaluation, 5 patients had larynx cancer and 20 patients have lung cancer in addition, all having been smoking for a long time. The bladder tumor stage and grade were investigated in these 25 cases.

RESULTS

Mean age of patients was 66.8 (49-78). In the evaulation, all of 5 patients who had larnyx cancer also had high grade urothelial cancer. One had T2 urothelial, and 3 T1 urothelial cancer. In the same way, all of the 20 patients with lung cancer also have high grade urothelial cancer, three T2, and 13 T1. Bladder cancer stage and grade were determined to be significantly increased in patients with concomitant bladder and lung or larynx cancer.

CONCLUSIONS

In the patients who have smoking releated second malignancy, bladder cancer prognosis appears more aggressive. We now need a larger series and multi-center studies for understanding relevant pathophysiology.

Age at diagnosis in bladder cancer: does opium addiction play a role?

BACKGROUND

Bladder cancer is a major health problem, especially among men. Opium addiction can be an important risk factor. One important question is whether it can affect the age of onset of bladder cancer .We performed this study to evaluate this question.

MATERIALS AND METHODS

In a cross-section study, records of patients diagnosed with bladder carcinoma in Shahid Labbafinejad Medical Center, within 1999-2008 were included. Data were extracted from records regarding age at onset, gender, smoking status, and opioid addiction and analyzed with SPSS 13.

RESULTS

Within 10 years, 920 cases were diagnosed with bladder cancer of which 97 percent were transitional cell carcinoma. In 698 cases, opium addiction status was recorded in 21.3% (n=149). Age at diagnosis was 59.7±11.51 (median: 60) among opioid addicts which was significantly lower than non- addicts (63.1±13.65, Median: 65) (P<0.001).

CONCLUSIONS

Opium addiction can decrease the age of onset of bladder cancer.

Mortality of urinary tract cancer in Inner Mongolia 2008- 2012

The aim of this study was to determine the mortality rate and burden of urinary tract cancers among residents of Inner Mongolia. We analyzed mortality data reported by the Death Registry System from 2008 to 2012. The rate of mortality due to urinary tract cancer was 2.04 per 100,000 person-years for the total population, 2.91 for men, and 1.11 for women. Therefore, the mortality rate for men was 2.62-fold the mortality rate for women, constituting a statistically significant difference (p<0.001). Over the period 2008 through 2012, the total potential years of life lost was 1388.1 person-years for men and 777.1 person-years for women, and the average years of life lost were 7.71 years per male decedent and 12.0 years per female decedent. Mortality due to urinary tract cancers is substantially greater among the elderly population. Further, the mortality rate associated with urinary tract cancers is greater for elderly men than it is for elderly women. Therefore, in Inner Mongolia, urinary tract cancers appear to pose a greater mortality risk for men than they do for women.