Cancer and Thrombosis: New Treatments, New Challenges

The direct-acting oral anticoagulant (DOAC) has become an alternative to low-molecular-weight heparin (LMWH) for treatment and prophylaxis of venous thromboembolism (VTE) in cancer patients. The clinicians are, however, faced with difficult decisions regarding DOAC treatment: Which patients cannot use DOACs? Should incidental VTE be treated similar to symptomatic VTE? Is it safe to give DOACs to patients with gastrointestinal or urogenital cancers? How about drug–drug interactions? Should all cancer patients receive thromboprophylaxis? Is arterial thrombosis a problem? The current article reviews the available literature regarding these questions and aims to provide practical solutions based on data from the clinical trials and new guidelines.

Current Status of Single Port Laparoscopic/Robotic Surgeries for Urogenital Cancers

Single port laparoscopic or robotic surgery is emerging and progressing but is still very challenging for many surgeons due to less degree of motion and limited space leading to instrument crash. With the aid of new technology and instrumentation, limitations are constantly broken in robot-assisted laparoscopic surgery. A lot of initiations have been done over the past a few years. A wide range of single port laparoscopic or robot-assisted laparoscopic pelvic and retroperitoneal urological procedures can be done with different approaches for treating urogenital cancers. Randomized trials with larger sample size and longer postoperative follow up are suggested for further evaluation of the outcomes and added value.

The Origin of Tumor DNA in Urine of Urogenital Cancer Patients: Local Shedding and Transrenal Excretion

In urogenital cancers, urine as a liquid biopsy for non-invasive cancer detection holds great promise for future clinical application. Their anatomical position allows for the local shedding of tumor DNA, but recent data indicate that tumor DNA in urine might also result from transrenal excretion. This study aims to assess the origin of tumor-associated DNA in the urine of 5 bladder and 25 cervical cancer patients. Besides natural voided urine, paired urine samples were collected in which contact with the local tumor was circumvented to bypass local shedding. The latter concerned nephrostomy urine in bladder cancer patients, and catheter urine in cervical cancer patients. Methylation levels of GHSR, SST, and ZIC1 were determined using paired bladder tumor tissues and cervical scrapes as a reference. Urinary methylation levels were compared to natural voided urine of matched controls. To support methylation results, mutation analysis was performed in urine and tissue samples of bladder cancer patients. Increased methylation levels were not only found in natural voided urine from bladder and cervical cancer patients, but also in the corresponding nephrostomy and catheter urine. DNA mutations detected in bladder tumor tissues were also detectable in all paired natural voided urine as well as in a subset of nephrostomy urine. These results provide the first evidence that the suitability of urine as a liquid biopsy for urogenital cancers relies both on the local shedding of tumor cells and cell fragments, as well as the transrenal excretion of tumor DNA into the urine.

Transcriptomics analysis for the identification of potential age-related genes and cells associated with three major urogenital cancers

Age is one of the most important risk factors of the occurrence for tumor patients. The majority of patients with urogenital cancers are the elderly, whose clinical characteristics are greatly affected by age and ageing. Our study aimed to explore age-related genes, cells, and biological changes in three common urogenital cancers via integrative bioinformatics analysis. First, mRNA (count format) and clinical data for bladder cancer, prostate cancer and renal cell carcinoma were downloaded from the Cancer Genome Atlas (TCGA). Through the comparison of clinicopathological characteristics, genes expression and cells infiltration between the old group and the young group, it was found that the clinical characteristics, genes and cells in the tumor microenvironment of different ages were quite different. And 4 key cells, 14 hub genes and some potential pathways were identified and considered as important factors. More importantly, we analyzed the differential landscape of the genes and cells from different perspectives, and confirmed its importance. In conclusion, we identified genes and cell types associated with age-related changes in the tumour microenvironment in urogenital cancer patients. These genes and cell types may play a critical role in the age-associated differences in clinicopathological characteristics among urogenital cancers, thus providing a link between ageing and cancer occurrence. The findings of this study may pave the way for the development of age-tailored approaches to treat cancer and other age-related diseases.

Pulmonary Metastases in Urogenital Cancers; Surgical Treatment and Outcomes

Background Metastasis is remaining one of the major problems in cancer treatment. Like many other malignancies, urogenital tumors originating from kidney, prostate, testes, and bladder tend to metastasize to the lungs.The aim of this retrospective study is to evaluate the results of pulmonary metastasectomy in patients with primary urogenital tumors.Methods This study was approved by the local ethical committee. This study retrospectively analyses the patients who underwent lung resections for metastases in our department between 2002 and 2018. 22 out of 126 patients referred for pulmonary metastasectomy to our department had metastases from urogenital tumors.Demographic data and clinicopathological features were extracted from the medical records. Disease-free interval (DFI) was defined as the time between the first curative surgery and the detection of pulmonary metastasis. Results Among 22 patients who underwent lung metastasectomy consisted of 17 males and five females. Their metastasis originated from renal cell carcinoma (RCC; n = 9), bladder tumor (n = 7), testis tumors (n = 4), and prostate cancer (n = 2). There was no intraoperative complication. Postoperative complications were seen in 2 patients. Conclusions Although pulmonary metastases and its surgical management in various types of tumors is well known and documented, the data is limited to the role of the surgery for metastases of urogenital cancers on literature. Despite the limitations of this study, we aim to document our promising results of pulmonary metastasectomy in patients with primary urogenital tumors.Trial registration This study was approved by the local ethical committee (Registration number: 49109414-604.02 ; Date: 11/06/2019).