Low‐risk non‐muscle‐invasive bladder cancer: Further prognostic stratification into the “very‐low‐risk” group based on tumor size

Background: Trans-urethral resection of bladder tumor is an essential diagnostic tool as well as effective treatment modality for non-muscle invasive bladder cancer. We aimed to evaluate the recurrence and progression of the non-muscle invasive bladder cancer in Nepalese patients. Methods: This was a retrospective study of 43 patients with non-muscle invasive bladder cancer, who underwent trans-urethral resection of bladder tumour followed by adjuvant intravesical instillation of chemo or immunotherapy between January, 2013 to December, 2018. Patients were divided into low, intermediate and high-risk groups according to the clinical and pathological factors used by the European Organization for Research and Treatment of Cancer scoring system. Outcomes were calculated in terms of recurrence and progression in each group. Results: Out of 43 patients, 11 (25.58%) patients had low risk, 18 (41.86%) patients had intermediate risk and 14 (32.56%) patients had high risk of recurrence categories. No recurrence and progression of the disease noted in low risk group. In the intermediate risk group, out of 18 patients, 4 (22.2%) patients developed recurrence and 2 (11.1%) patients had progression of disease. In high risk group, out of 14 patients, 4 (26.8%) patients developed recurrence and 2 (14%) patients developed progression of the disease. Conclusions: Even in a low volume centre of bladder cancer, effective treatment for non-muscle invasive bladder cancer with trans-urethral resection of bladder tumour followed by adjuvant intravesical chemo or immunotherapy can be given safely to reduce recurrence and progression of the disease.

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Intratumoral heterogeneity of surrogate molecular subtypes in urothelial carcinoma in situ of the urinary bladder: implications for prognostic stratification of high-risk non-muscle-invasive bladder cancer

Virchows Archiv ◽

10.1007/s00428-021-03054-0 ◽

2021 ◽

Author(s):

Stefan Garczyk ◽

Felix Bischoff ◽

Ursula Schneider ◽

Reinhard Golz ◽

Friedrich-Carl von Rundstedt ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Carcinoma In Situ ◽

Molecular Subtypes ◽

Smoking Status ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Prognostic Stratification ◽

Muscle Invasive

AbstractReliable factors predicting the disease course of non-muscle-invasive bladder cancer (NMIBC) with carcinoma in situ (CIS) are unavailable. Molecular subtypes have potential for prognostic stratification of muscle-invasive bladder cancer, while their value for CIS patients is unknown. Here, the prognostic impact of both clinico-pathological parameters, including CIS focality, and immunohistochemistry-based surrogate subtypes was analyzed in a cohort of high-risk NMIBC patients with CIS. In 128 high-risk NMIBC patients with CIS, luminal (KRT20, GATA3, ERBB2) and basal (KRT5/6, KRT14) surrogate markers as well as p53 were analyzed in 213–231 biopsies. To study inter-lesional heterogeneity of CIS, marker expression in independent CIS biopsies from different bladder localizations was analyzed. Clinico-pathological parameters and surrogate subtypes were correlated with recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall survival (OS). Forty-six and 30% of CIS patients exhibited a luminal-like (KRT20-positive, KRT5/6-negative) and a null phenotype (KRT20-negative, KRT5/6-negative), respectively. A basal-like subtype (KRT20-negative, KRT5/6-positive) was not observed. A significant degree of inter-lesional CIS heterogeneity was noted, reflected by 23% of patients showing a mixed subtype. Neither CIS surrogate subtype nor CIS focality was associated with patient outcome. Patient age and smoking status were the only potentially independent prognostic factors predicting RFS, PFS, OS, and PFS, respectively. In conclusion, further clarification of heterogeneity of surrogate subtypes in HR NMIBC and their prognostic value is of importance with regard to potential implementation of molecular subtyping into clinical routine. The potential prognostic usefulness of patient age and smoking status for high-risk NMIBC patients with CIS needs further validation.

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PD41-07 EXAMINING THE MD ANDERSON RISK CRITERIA FOR PATIENTS WITH MUSCLE-INVASIVE BLADDER CANCER: ARE LOW RISK PATIENTS HARMED WITH UPFRONT CYSTECTOMY?

The Journal of Urology ◽

10.1016/j.juro.2018.02.1946 ◽

2018 ◽

Vol 199 (4S) ◽

Author(s):

Timothy Lyon ◽

Igor Frank ◽

Paras Shah ◽

Vidit Sharma ◽

Matthew Tollefson ◽

...

Keyword(s):

Bladder Cancer ◽

Low Risk ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Risk Criteria ◽

Risk Patients ◽

Muscle Invasive ◽

Md Anderson

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Reduced recurrence of low‐risk non‐muscle‐invasive bladder cancer is associated with low urine‐specific gravity

International Journal of Urology ◽

10.1111/iju.14351 ◽

2020 ◽

Vol 27 (11) ◽

pp. 1019-1023

Author(s):

Tomohiro Iwasawa ◽

Naoya Niwa ◽

Kazuhiro Matsumoto ◽

Akari Komatsuda ◽

Hiroki ide ◽

...

Keyword(s):

Bladder Cancer ◽

Specific Gravity ◽

Low Risk ◽

Invasive Bladder Cancer ◽

Urine Specific Gravity ◽

Muscle Invasive Bladder Cancer ◽

Muscle Invasive

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Systematic analysis of gene expression profiles reveals prognostic stratification and underlying mechanisms for muscle-invasive bladder cancer

Cancer Cell International ◽

10.1186/s12935-019-1056-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ping-Bao Zhang ◽

Zi-Li Huang ◽

Yong-Hua Xu ◽

Jin Huang ◽

Xin-Yu Huang ◽

...

Keyword(s):

Bladder Cancer ◽

High Risk ◽

Risk Prediction ◽

Risk Group ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Gene Signatures ◽

Muscle Invasive ◽

Multiple Drugs ◽

Worse Prognosis

Abstract Background Muscle-invasive bladder cancer (MIBC) is originated in the muscle wall of the bladder, and is the ninth most common malignancy worldwide. However, there are no reliable, accurate and robust gene signatures for MIBC prognosis prediction, which is of the importance in assisting oncologists to make a more accurate evaluation in clinical practice. Methods This study used univariable and multivariable Cox regression models to select gene signatures and build risk prediction model, respectively. The t-test and fold change methods were used to perform the differential expression analysis. The hypergeometric test was used to test the enrichment of the differentially expressed genes in GO terms or KEGG pathways. Results In the present study, we identified three prognostic genes, KLK6, TNS1, and TRIM56, as the best subset of genes for muscle-invasive bladder cancer (MIBC) risk prediction. The validation of this stratification method on two datasets demonstrated that the stratified patients exhibited significant difference in overall survival, and our stratification was superior to three other stratifications. Consistently, the high-risk group exhibited worse prognosis than low-risk group in samples with and without lymph node metastasis, distant metastasis, and radiation treatment. Moreover, the upregulated genes in high-risk MIBC were significantly enriched in several cancer-related pathways. Notably, PDGFRB, a receptor for platelet-derived growth factor of PI3K-Akt signaling pathway, and TUBA1A were identified as two targets of multiple drugs. In addition, the angiogenesis-related genes, as well as two marker genes of M2 macrophage, CD163 and MRC1, were highly upregulated in high-risk MIBC. Conclusions In summary, this study investigated the underlying molecular mechanism and potential therapeutic targets associated with worse prognosis of high-risk MIBC, which could improve our understanding of progression of MIBC and provide new therapeutic strategies for the MIBC patients.

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