Safe Provision of Systemic Anti-Cancer Treatment for Urological Cancer Patients During COVID-19: A Tertiary Centre Experience in the First Wave of COVID-19

Background Safe provision of systemic anti-cancer treatment (SACT) during the COVID-19 pandemic remains an ongoing concern amongst clinicians. Methods Retrospective analysis on uro-oncology patients who continued or started SACT between 1st March and 31st May 2020 during the pandemic (with 2019 as a comparator). Results 441 patients received SACT in 2020 (292 prostate, 101 renal, 38 urothelial, 10 testicular) compared to 518 patients in 2019 (340 prostate, 121 renal, 42 urothelial, 15 testicular). In 2020, there were 75.00% fewer patients with stage 3 cancers receiving SACT (p<0.0001) and 94.44% fewer patients receiving radical treatment (p=0.0019). The number of patients started on a new line of SACT was similar between both years (118 in 2019 vs 102 in 2020; p=N.S) but with 53.45% fewer patients started on chemotherapy in 2020 (p=0.00067). Overall, 5 patients tested positive for COVID-19 (one asymptomatic, two moderate pneumonitis, one severe pneumonitis). Compared to 2019, 30-day mortality was similar (1.69% in 2019 vs 0.98% in 2020; p=N.S) whereas the 6-month mortality was lower (9.32% in 2019 vs 1.96% in 2020; p=0.023) in 2020. Conclusion This single-centre study demonstrated that uro-oncology patients can safely receive SACT during COVID-19 pandemic with a low incidence of infection and mortality.

Prognostic Value of Long Non-coding RNAs in Urological Malignancies: A Systematic Review, and Meta-Analysis

Background: Many studies have explored the potential roles of long non-coding RNAs (lncRNAs) in urological cancer (UC) progression. The clinical outcome and prognosis of UCs remain weak. Therefore, finding clinical prognostic markers is needed to improve therapeutic potential. The aim of this study was to consider the possible association between the lncRNAs expression with the survival time and clinical outcomes in patients with UC. Methods: A literature search was performed in several related databases to find eligible English papers published before 9 February 2021. Hazard ratios (HRs) with 95% CI were calculated to investigate the association between lncRNAs expression and overall survival in patients with UC. Results: A total of 46 studies, including 39 lncRNAs were identified. Results indicated that lncRNAs expression was significantly correlated with poor overall survival (OS) outcome in patients with UCs (HR: 1.923, 95% CI: 1.448-2.554, P<0.001). Also, we divided included studies into up-regulated and down-regulated subgroups according to lncRNAs expression. The results indicated a significant association with poor OS outcomes in both up-regulated (HR=2.546, 95% CI: 1.896-3.41, P<0.001) and down-regulated (HR=0.33, 95% CI: 0.22-0.49, P<0.001). Moreover, expression of lncRNAs was significantly associated with lymph node metastasis (LNM) (OR=0.25, 95% CI: 0.13-0.47, P<0.001) Conclusion: Abnormal expression of various lncRNAs is a potential novel marker for predicting the clinical outcomes of urological tumors.

Organ-Specific Uptake of Extracellular Vesicles Secreted by Urological Cancer Cells

Extracellular vesicles (EVs) secreted by cancer cells have been shown to take a pivotal part in the process of local and systemic tumor progression by promoting the formation of a supportive local tumor microenvironment and preparing premetastatic niches in distant organ systems. In this study, we analyzed the organ-specific uptake of EVs secreted by urological cancer cells using an innovative in-vivo approach. EVs from benign and malignant prostate, kidney, and bladder cells were isolated using ultracentrifugation, fluorescence-labeled and injected intravenously in immunodeficient mice. After 12 or 24 h, the animals were sacrificed, their organs were harvested and analyzed for the presence of EVs by high-resolution fluorescence microscopy. Across all entities, EVs were taken up fast (12 h > 24 h), and EVs from malignant cells were taken up more efficiently than EVs from benign cells. Though not entirely organ-specific, EVs were incorporated in different amounts, depending on the entity (prostate: lung > liver > brain; kidney: brain > lung > liver; bladder: lung > liver > brain). EV uptake in other organs than lung, liver, brain, and spleen was not observed. Our results suggest a role of EVs in the formation of premetastatic niches and an organotropism in EV uptake, which have to be examined in more detail in further studies.

High Expression of SLC16A1 as a Biomarker to Predict Poor Prognosis of Urological Cancers

ObjectiveTumor metabolism has always been the focus of cancer research. SLC16A1, as a key factor in catalysis of monocarboxylate transport across the plasma membrane, has been found to be associated with the occurrence and metastasis of a variety of cancers, but its prognostic significance and mechanism in different tumors are still unclear.MethodsBased on the gene expression matrix and clinical information of human cancer tissues acquired from TCGA and GTEX databases, the differential expression of SLC16A1 in different tumors and normal tissues was analyzed. To confirm the association between its expression, the mutation of MMRS gene, and the expression level of DNMTs. Univariate Cox regression was applied to analyze the association between SLC16A1 expression and patient prognosis. The effect of SLC16A1 expression on patient survival was examined by Kaplan Meier analysis. GSEA was used to identify related signaling pathways.ResultsThe expression of SLC16A1 was differentially expressed in most tumors, especially in the urinary tract where it is commonly highly expressed, and differential expression of SLC16A1 in different clinical stages. SLC16A1 expression was significantly positively correlated with MMRS gene mutation and DNMTS expression. Moreover, high SLC16A1 expression was associated with poorer overall survival (OS) and progression-free survival (PFS) in urological cancers. In particular, the results of the enrichment analysis showed that SLC16A1 was associated with processes such as cell adhesion and many signaling pathways affecting cell cycle were significantly enriched in the group with high-expressed SLC16A1.ConclusionSLC16A1 expression was upregulated in urological cancer. SLC16A1 may promote tumor development by regulating the epigenetic process of urological cancer and demonstrated a great potential as a prognostic biomarker of urological cancer patients.

218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic

Aim Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff. Method From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases. Results 87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening. Conclusions Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.

Urological Cancer Treatment by a Multidisciplinary Team throughout the Covid-19 Pandemic: What Have We Learned?

Introduction It is known that cancer care is best approached by a multidisciplinary team (MDT). This became specifically true in the Covid-19 pandemic in which choices for urological cancer treatment are influenced by many factors. In some cases, delayed treatment may have consequences regarding the patient's oncological outcomes. The aim of the present article is to report our experience throughout the Covid-19 pandemic treating patients with urological neoplasms at a high-volume center. Methods We used a convenience sampling method. Cases were evaluated and discussed on an individual basis at the MDT meetings, and, after a consensus regarding delaying or scheduling treatment, patients were scheduled according to the risk of postponing the procedures. The Medically Necessary, Time-Sensitive (MeNTS) scoring system was measured in each patient; all patients answered the Centers for Disease Control and Prevention (CDC) Covid-19 self-screening questionnaire prior to surgery. The Covid-19-free survival rate was estimated. Results A total of 194 patients were assessed by the multidisciplinary team and finally treated, with median follow-up of 4 (interquartile range [IQR]: 2.75 to 6) months. Only two patients had Covid-19 confirmed by real-time polymerase chain reaction (RT-PCR). In total, 54 patients underwent oncological surgery, 129 were treated with radiotherapy, and 11 were treated with intravenous chemotherapy. The median age was 66 years (IQR: 59 to 94 years), and the median MeNTS score in the surgically-treated cohort was 35 points (IQR: 31 to 47 points). Conclusions The evaluation and treatment of urological cancer should be conducted by an MDT; this is of utmost importance, especially during the Covid-19 pandemic. The data collected in our institution showed that most patients could be safely treated by taking all necessary precautions and discussing each case individually in the MDT meetings and performing a close follow-up.