Is it safe to replace retur in T1 high grade non-muscle invasive bladder cancer patients with urine cytology and in-office cystoscopy? Preliminary results from the ongoing prospective multicenter trial “hunire”

Abstract Purpose: We wished to investigate the clinical characteristics, treatments for tumor, pathology and outcomes of bladder cancer patients with HIV-infected.Patients and methods: We identified 10 cases of bladder cancer with HIV-infected from 2015 to 2020.We retrospectively investigated the clinical characteristics of the cases including demographic information, clinical presentation, TNM stage and so on. We investigated treatments for tumor, pathology, outcomes and HIV-relevant parameters during patients’ hospitalization course as well. Results: In our study, it was astonished to find that bladder cancer patients with HIV-infected were males at the median age of 51 years old, and no females were diagnosed on the contrary. Nine (90%)patients presented with painless gross hematuria, while one patient with incidental findings on ultrasonic examination. Six(60%) patients co-infected with another kind of infectious disease, four with syphilis, and two with HBV respectively. The median CD4+ T-lymphocyte cell count was 493/ul withthin 2 weeks prior to the diagnosis bladder cancer. Cystoscope examination manifested that the lesions were located in the trigonum of the bladder in four(40%)patients. All patients underwent surgeries successfully, six underwent transurethral resection of bladder tumor(TURBT),two of whom relapsed once, and one underwent TURBT twice due to recurrence and then RC and urethrectomy because of urethral invasion. All non muscle-invasive bladder cancer(NMIBC)patients received intravesical chemotherapy with pirarubicin 30mg for at least half year conventionally, and only one patient occurred mild adverse reaction of irritative symptoms of bladder. Pathologic analysis documented that all patients(100%) had transitional cell carcinoma(TCC). Tumor grade classification showed that three cases were identified with low grade TCC, and six cases with high grade or invasive TCC, two of whom occurred recurrence for once or twice respectively. One patient was identified with low grade TCC of primary tumor and high grade TCC of recurrent focal(Figure 2).Five cases(50%) were ascertained as (NMIBC) with pT1N0M0, while the rest five patients(50%) were muscle-invasive bladder cancer(MIBC) with at least pT2N0M0. During the median follow-up of 56 months (range from 5 months to 68 months) six cases(five were MIBC patients )died due to distant metastases. No patients acceptted adjuvent immunotherapy mainly due to the role of PD-1+ T cells in HIV transcription in treated aviremic individuals, concerns of unknown adverse effects and economic factors.Conclusions: It seemed like that bladder caner patients had higher tumor stage and more aggressive pathology. we did not find any evidence on the relationship between immunodeficiency and cancer progression because of relatively stable HIV status of this crew in our study. MIBC patients with HIV-infected really have worse outcomes, and more attention is warranted to pay to this special population in this situation when they present with hematuria extraordinarily.

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Intracytoplasmic Lumen in Urine Cytology Predicts Worse Prognosis in Non-Muscle-Invasive Bladder Cancers

Acta Cytologica ◽

10.1159/000505955 ◽

2020 ◽

Vol 64 (4) ◽

pp. 360-367

Author(s):

Toshie Terauchi ◽

Satoko Nakada ◽

Michiho Takenaka ◽

Seiya Mizuguchi ◽

Yoshiiku Okanemasa ◽

...

Keyword(s):

Bladder Cancer ◽

Distant Metastasis ◽

Urine Cytology ◽

Invasive Bladder Cancer ◽

High Grade ◽

Muscle Invasive Bladder Cancer ◽

Node Metastasis ◽

Muscle Invasive ◽

Muscle Invasion ◽

Worse Prognosis

Background: Intracytoplasmic lumina (ICL) are observed in several cancers, including urothelial carcinoma (UC). We have reported that ICL in urine cytology (cICL) is more frequent in high-grade UCs than in low-grade UCs; however, the correlation between the presence of ICL and prognosis is unclear. Objectives: The aim of this work was to determine the association between cICL and prognosis in bladder cancer. Method: We retrospectively investigated 87 patients with bladder cancer who received a histological diagnosis within 3 months of urine cytology at Kanazawa Medical University between 2003 and 2007. The cytological diagnosis and the number of cICL, histological diagnosis, tumor grade or variant, pT stage, ICL in histological specimens, and immunohistochemistry for mucins were evaluated. Data on the treatment type, recurrence, survival, cause of death, and length of follow-up were collected from electronic medical records. Results: Muscle invasion, high-grade UC, lymph node metastasis, distant metastasis, adjuvant therapy, and disease-related mortality were more frequent in patients with cICL-positive bladder cancer than in those without cICL-positive bladder cancer. Immunohistochemistry revealed the expression of Muc-1 and Muc-4 in patients with cICL-positive bladder cancer. Univariate analysis revealed that cytological diagnosis by the Paris system and the 2015 version of the Japanese reporting system, muscle invasion, high-grade UC, lymph node metastasis, distant metastasis, and adjuvant chemotherapy and/or radiotherapy were significant factors associated with prognosis. Furthermore, survival was shorter in patients with cICL-positive non-muscle-invasive bladder cancer than in those with cICL-negative non-muscle-invasive bladder cancer. In the multivariate analysis, only distant metastasis was significantly associated with survival. Conclusions: cICL predicted shorter survival in patients with non-muscle-invasive bladder cancer, suggesting that ICL is one of the important diagnostic features of high-grade UC with a worse prognosis in urine cytology.

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1700 PROGNOSTIC SIGNIFICANCE OF POSITIVE URINE CYTOLOGY IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS

The Journal of Urology ◽

10.1016/j.juro.2013.02.3010 ◽

2013 ◽

Vol 189 (4S) ◽

Author(s):

Fumitaka Koga ◽

Shuichiro Kobayashi ◽

Yasuhisa Fujii ◽

Minato Yokoyama ◽

Yasukazu Nakanishi ◽

...

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Prognostic Significance ◽

Urine Cytology ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Positive Urine ◽

Muscle Invasive

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The clinical impact of routine bladder biopsy after BCG treatment of high grade non muscle invasive bladder cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.2_suppl.438 ◽

2016 ◽

Vol 34 (2_suppl) ◽

pp. 438-438

Author(s):

Igle J. De Jong ◽

Leonie Theresa Jonker ◽

Maud Anne Sien Weerink ◽

Erik Bastiaan Cornel ◽

Daphne Luijendijk ◽

...

Keyword(s):

Bladder Cancer ◽

Multicenter Trial ◽

Clinical Impact ◽

Invasive Bladder Cancer ◽

High Grade ◽

Muscle Invasive Bladder Cancer ◽

Bcg Therapy ◽

Muscle Invasive ◽

The Impact

438 Background: The need for invasive and costly routine bladder biopsies after an induction course of intravesical Bacillus Calmette-Guérin (BCG) in patients with high-grade non-muscle invasive bladder cancer is being questioned. Previous studies focused on differences in tumor detection between cystoscopic, cytologic and histologic results, whereas the clinical impact was disregarded. The aim of this study is to determine the impact of routine bladder biopsies on treatment. Methods: This retrospective multicenter trial included 348 patients from four hospitals in the Netherlands, who had had their BCG therapy evaluated by routine bladder biopsies between 2005 and 2014. The results of urethrocystoscopy (UCS) and/or cytology were compared to pathology outcomes. The influence of malignancies missed by UCS and/or cytology on further treatment was analyzed in 348 patients and in subgroups of patients with and without carcinoma in situ (CIS). A number needed to test was calculated. Secondary outcomes were costs and complications. Results: In patients with a normal UCS, malignancies were detected in 27/228 (11,8%), 19/136 (14%) and 8/92 (8,7%) in respectively all patients, patients with CIS and patients without CIS. This resulted in a radical cystectomy in only six (2,6%) patients, of which five (3,7%) with and one (1,1%) without CIS. Thirty-eight patients with a normal UCS have to undergo routine biopsies to effect therapeutic treatment in one (Number needed to test, NNT = 38). Estimated costs of one change of treatment are $81.300 USD(€72.818). Twenty-three of 348 (6,6%) transurethral biopsies were complicated. Conclusions: Considering the small clinical impact and high costs, routine bladder biopsies to evaluate BCG-induction are not recommended. The decision to perform bladder biopsies should be based on cystoscopic and cytologic results.

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High Apelin Level Indicates a Poor Prognostic Factor in Muscle-Invasive Bladder Cancer

Disease Markers ◽

10.1155/2019/4586405 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Long Yang ◽

Yan-Lei Li ◽

Xiao-Qing Li ◽

Zheng Zhang

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Vascular Invasion ◽

Tumor Stage ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Kaplan Meier ◽

Tumor Tissues ◽

High Tumor Stage ◽

Muscle Invasive

Purpose. To compare the expression level of apelin in muscle-invasive bladder cancer and matched paracarcinoma tissues and investigate the relationship between apelin and clinical prognosis in the patients. Methods. To assess apelin expression by using immunohistochemical method compared with bladder tumors and matched paracarcinoma tissues. Subsequently, the correlation of apelin expression with the clinicopathological features of bladder cancer patients was analyzed. Kaplan-Meier survival curves method was used to analyze apelin prognostic significance for muscle-invasive bladder cancer patients (including 404 muscle-invasive bladder cancer patients and 28 normal bladder tissues, in TCGA dataset). Results. Apelin protein level was overexpressed in bladder tumor tissues compared with paracarcinoma tissues. Furthermore, high apelin expression was associated with high tumor stage (P<0.05), distant metastasis (P<0.05), and vascular invasion (P<0.05). Kaplan-Meier curve analyses showed that the overexpression of apelin was a potential predictor of overall survival and disease-free survival. Conclusion. Apelin was upregulated in bladder tumor tissues compared with matched adjacent noncancer tissues, especially in the high tumor stage, distant metastasis, and vascular invasion. What is more, high expression of apelin in muscle-invasive bladder cancer indicates the poor prognosis. These data suggested that apelin might be a therapeutic potential biomarker in muscle-invasive bladder cancer patients.

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A qualitative evaluation of a nurse-led pre-operative stoma education program for bladder cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-021-06093-0 ◽

2021 ◽

Author(s):

Elizabeth Marie Wulff-Burchfield ◽

Maryellen Potts ◽

Katherine Glavin ◽

Moben Mirza

Keyword(s):

Bladder Cancer ◽

Cancer Patients ◽

Education Program ◽

Management Practices ◽

Self Management ◽

Invasive Bladder Cancer ◽

Educational Approach ◽

Muscle Invasive Bladder Cancer ◽

Patient Advocate ◽

Muscle Invasive

Abstract Introduction Radical cystectomy remains the standard of care for muscle-invasive bladder cancer and high-risk non-muscle-invasive bladder cancer. Postoperative ostomy education is common, but patients struggle to maintain self-management practices. A preoperative ostomy education program was developed to meet this need, and we conducted a qualitative study with participating patient-caregiver dyads to evaluate the educational and psychosocial impacts of the program and examine alignment with program objectives. Materials and methods A qualitative descriptive study was conducted utilizing a thematic analysis approach. Sixteen patients, eighteen caregivers, and three program educators completed semi-structured interviews from 3 to 18 months post the program. Interviews were audio-recorded and transcribed. Thirteen end-of-course surveys from the initial educational program cohort were transcribed, coded, analyzed; this data was triangulated with patient, caregiver, and educator interviews. Results Analysis uncovered three themes: (1) Patient and caregiver motivation to attend the program, (2) attitudes toward this life-changing event, and (3) education. For theme 1, patients and caregivers cited lack of knowledge, fear, and concern about ostomy surgery and care as motivation. For theme 2, there were a variety of attitudes toward the ostomy, ranging from avoidance to acceptance, and a similar breadth of attitudes toward caregiving, with some patients and caregivers describing ongoing dependence and other patients seeking complete independence. For theme 3, the interactive curriculum was determined to be effective, and the patient advocate was cited as the most memorable program component. Conclusions A formal preoperative ostomy education program employing an interactive educational approach and featuring a patient advocate can prepare bladder cancer patients and caregivers for ostomy self-management and post-ostomy life.

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