Invasive Bladder Tumors Research Articles

Strategies to Improve Clinical Outcomes and Patient Experience Undergoing Transurethral Resection of Bladder Tumor.

To describe patient experiences of transurethral resection of bladder tumor (TURBT) and review recent advances in enhancing clinical outcomes. High rates of recurrence and progression of non-muscle invasive bladder tumors expose patients to multiple TURBT procedures throughout their disease process. Understanding the impact of TURBT on quality of life and patient experiences is crucial for shared decision-making, thus enhanced recovery protocol trials are being explored to improve patient outcomes. The variability in TURBT practices worldwide contributes to differing bladder tumor recurrence rates, prompting efforts to standardize practices by evaluating the impact of patient, hospital, and surgeon factors. For select cases, less intensive surveillance regimens have reduced toxicities and costs without compromising oncologic outcomes. New innovative approaches such as en bloc- and stratified resection techniques may reduce perioperative complications and improve clinical outcomes. Finally, neoadjuvant and ablative treatments have shown to be promising alternatives to TURBT, necessitating further investigation in this setting. TURBT is essential for diagnosing and treating bladder cancer. Reducing associated morbidities and improving surgical outcomes involve multifaceted approaches, including standardizing surgical practices, exploring innovative techniques, and optimizing surveillance regimens, all while promoting patient quality of life. Neoadjuvant therapies as alternative treatments are on the horizon and may ultimately change the landscape of bladder cancer care.

The influence of anesthesia type on recurrence of the non-muscle invasive bladder tumor according to risk groups: 3 year follow up

Purpose: Many risk factors affecting bladder cancer recurrence, such as genetic and environmental factors, have been previously identified. It has been stated that risk factors that cause immunosuppression play a role in the spread of cancer cells. Anesthetic agent, which is a perioperative factor, may affect the risk of cancer recurrence by disrupting the immune system. The aim of this study was to compare the effect of regional anesthesia (RA) and general anesthesia (GA) on non-muscle invasive bladder cancers (NMIBC) recurrence. Materials and methods: A total of one hundred seventy-eight patients who underwent transurethral bladder tumor resection (TURBT) for NMIBC and underwent surgery under GA or RA between 2011 and 2016 in the urology departments of Pamukkale University and Uludağ University were included in the study. In the first group, 80 patients had RA. In the second group, 98 patients underwent GA during TURBT for NMIBC. Results: The recurrence time was shorter in the GA group (5.5 months) than in the RA group (11 months) (p=0.015). First-year relapse was higher in the GA group than in the RA group (p=0.048), but there was no difference in third-year relapse between groups (p=0.810). The mean recurrence time was 11 months (95% CI; 9.058 - 12.942) in the RA group and 5 months (95% CI; 2.090 - 7.910) in the GA group (p=0.031). Conclusion: During transurethral resection of the bladder tumor, an increase in the recurrence time was observed in patients with intermediate-risk NMIBC who received RA compared to patients who received GA. RA provided a 7-month benefit in relapse delay.

Evaluating the concordance between Vesical imaging Reporting and Data System scores and bladder tumor histopathology

ObjectiveThis study aims to assess the local staging of bladder cancer tumors in patients utilizing preoperative multiparametric MRI (mpMRI) and to demonstrate the clinical efficacy of this method through a comparative analysis with corresponding histopathological findings. MethodsBetween November 2020 and April 2022, 63 patients with a planned cystoscopy and a preliminary or previous diagnosis of bladder cancer were included. All participants underwent mpMRI, and Vesical Imaging Reporting and Data System (VI-RADS) criteria were applied to assess the recorded images. Subsequently, obtained biopsies were histopathologically examined and compared with radiological findings. ResultsOf the 63 participants, 60 (95.2%) were male, and 3 (4.8%) were female. Categorizing tumors with a VI-RADS score of >3 as muscle invasive, 84% were radiologically classified as having an invasive bladder tumor. However, histopathological results indicated invasive bladder tumors in 52.4% of cases. Sensitivity of the VI-RADS scoring system was 100%; specificity was 33%; negative predictive value was 100%; and positive predictive value was 62.3%. ConclusionThe scoring system obtained through MpMRI, VI-RADS, proves to be a successful method, particularly in determining the absence of muscle invasion in bladder cancer. Its efficacy in detecting muscle invasion in bladder tumors could be further enhanced with additional studies, suggesting potential for increased diagnostic efficiency through ongoing research. VI-RADS could enhance the selection of patients eligible for accurate diagnosis and treatment.

Clamp for Safety: Improving Intravesical Chemotherapy Practices.

Processes for intravesical chemotherapy after transurethral resection of nonmuscle invasive bladder tumors may lack standardization. In 2019, at a large health care system in Los Angeles, California, five incident reports involving chemotherapeutic agent spills from urinary catheters after bladder tumor procedures necessitated a quality improvement project. The project lead determined that a cost-effective alternative device for securing the chemotherapeutic agent in the bladder was needed at four surgical locations of the health care system. In addition, a review of the literature and an observational assessment revealed lack of adherence to standard and recommended processes for using personal protective equipment (PPE) when handling hazardous medications. After revising existing processes, acquiring a cost-effective clamp and recommended chemotherapy PPE, instructing personnel on the clamping process and use of PPE, and implementing use of the clamp, there have been no spills associated with intravesical chemotherapy across the four surgical locations.

Documento multidisciplinar de consenso sobre el tratamiento actual del tumor vesical no-músculo invasor que no responde al tratamiento con bacilo Calmette-Guérin

Radical cystectomy is the current treatment of choice for patients with BCG-unresponsive non-muscle invasive bladder cancer (NMIBC). However, the high comorbidity of this surgery and its effects on the quality of life of patients require the investigation and implementation of bladder-sparing treatment options. These must be evaluated individually by the uro-oncology committee based on the characteristics of the BCG failure, type of tumor, patient preferences and treatment options available in each center. Based on FDA-required oncologic outcomes (6-month complete response rate for CIS: 50%; duration of response in responders for CIS and papillary: 30% at 12 months and 25% at 18 months), there is not currently a strong preference for one treatment over another, although the intravesical route seems to offer less toxicity. This work summarizes the evidence on the management of BCG-unresponsive NMIBC based on current scientific evidence and provides consensus recommendations on the most appropriate treatment.

Multidisciplinary treatment for small cell carcinoma of the bladder: a case report.

Small cell carcinoma (SCC) of the urinary bladder is a rare and highly aggressive subtype of bladder cancer. Most cases are diagnosed at advanced stages, and its therapeutic strategy remains unestablished. Here, we report a case of bladder SCC in which multidisciplinary treatment has resulted in relatively long-term survival. A 68-year-old man presented with gross hematuria. A cystoscopy revealed an invasive bladder tumor. A transurethral resection of bladder tumor (TURBT) was performed, and the pathological diagnosis was SCC. After systemic chemotherapy using etoposide and carboplatin and subsequent TURBT, a radical cystectomy and ileal conduit were performed. Three months postoperatively, the patient had a recurrence in the para-aortic lymph node. Systemic combination chemotherapy with carboplatin plus irinotecan (CBDCA + CPT-11) was administered, followed by amrubicin and an immune checkpoint inhibitor. In addition to this treatment, radiation therapy for the metastatic region led to the reduction of pain and shrinkage of the metastatic lesion. The patient survived for 2years after the initial diagnosis. Our report indicates that multidisciplinary treatment can be effective for SCC of the bladder, and a therapeutic strategy including the identification of novel biomarkers should be established.

Bladder tumor ablation with 980-nm and 980-/1470-nm diode lasers: a retrospective study

Abstract Purpose This study evaluated the safety and feasibility of ablation of both non-muscle invasive and muscle invasive bladder tumors using single- and dual-wavelength diode lasers (980 nm and 980/1470 nm). Methods We retrospectively examined 151 patients with bladder tumors of any type from 2009 to 2021 who underwent V-LABT (visual laser ablation of bladder tumor) with both single- and dual-wavelength diode lasers at Shalamar Hospital Lahore, Pakistan. All procedures were performed by the same surgeon. Shalamar Medical and Dental College review board approved this retrospective cohort study (IRB No. -623-2023). The collected clinical data were consolidated into a single group, encompassing various variables such as the patients’ age, tumor size, number of tumors, tumor location, tumor grade, ablation duration, postoperative catheterization time, bladder discomfort, obturator nerve reflex, intraoperative and postoperative complications, and recurrence of tumors at the ablation sites. The patients were monitored for a minimum of 12 months to observe recurrence at the ablation sites through cystoscopy performed postoperatively every three months. The data were analyzed using Chi-square test, and p value < 0.05 was considered significant. Results The average age of the 151 patients was found to be 64.72 ± 13.85 years. The size of the tumors was 4.88 ± 2.16 cm, with 48/151 (31.7%) patients having tumors larger than 3 cm. Among the cases studied, 117/151 (77.4%) patients had a single tumor, while the remaining patients had multiple tumors ranging in size from 5 to 7 cm in aggregate. Ablation took 1.57 ± 0.73 h to complete on average. None of the patients required a conversion to TURBT in 151 patients. No obturator reflexes or bladder perforations were observed in any case. Postoperatively, histopathology results showed 53/151 (35%) and 92/151 (60.9%) high- and low-grade tumors. The average catheterization duration was 6.58 ± 1.47 days. Tumors located on difficult sites, such as the anterior wall, lateral wall, and bladder neck, were ablated with ease. There was no recurrence seen on previously tumor ablated sites till 12-month follow-up. Conclusion Ablation of bladder tumors of any type using single- or dual-wavelength diode laser (980 nm and 980/1470 nm) is safe and feasible. These lasers possess the capability to effectively ablate/coagulate bladder tumors in challenging anatomical locations including diverticular tumors with minimal difficulty.

Management of T1G3 Transitional Cell Carcinoma of Urinary Bladder with Intravesical Bacillus Calmette-Guerin (BCG): Our Experience

Aim: To determine efficacy of BCG in T1G3 urinary bladder tumors at department of urology Chandka Medical College Larkana. Patients and Methods: This is retrospective study, patient were selected from hospital record from July 2016 to June 2022. Around 80 included in our study group who were treated in our department for management of high grade non-muscle invasive bladder tumor. After following inclusion and exclusion criteria TURBT were performed and BCG was installed intravesically for induction and maintenance purpose. Patients were followed for 5 years and data was collected on study specific proforma. Results: 80 patients were included in our study with mean age 35year +5.5 SD. Transurethral resection of urinary bladder tumor was performed in all patients with bladder growth. Induction and maintenance instillation of bacillus Calmette-Guerin (BCG) therapy was given to all. The recurrence was noted in 5 patients (6.25%) and the progression was also seen in these 5 patients (6.25%). Disease-specific survival is 93.75% at the follow-up of 5 years. As prevalence of ca bladder is increasing day by day and bladder is sole organ for storing urine so nowadays strategies of treatment is bladder saving surgery. So patient will feel comfortable with natural bladder and on other hand it will minimize complication related to artificially generated urinary bladder. Conclusion: Maintenance BCG therapy for T1G3 bladder tumors is an effective treatment, with satisfactory results and bladder preservation. Keywords: Ca bladder, intravesival chemotherapy, BCG, T1G3 and management.

Pilot study on quantifying the epithelial/mesenchymal hybrid state in the non-muscle invasive and muscle invasive bladder tumors: A promising marker of diagnosis and prognosis

BackgroundManifestation of epithelial-to-mesenchymal transition (EMT) program in tumor cells is associated with the occurrence of multiple intermediate phenotypic states namely epithelial (E), mesenchymal (M) and hybrid E/M across the epithelial-mesenchymal spectrum and these states exhibit different invasive properties. Understanding the cellular and molecular mechanisms defining the E/M hybrid state of the cells during bladder tumor development may significantly aid in the identification of novel diagnostic and prognostic markers. Materials and methodsThe present study is taken up to identify hybrid E/M score based on the immunohistochemical localization and surface expressions of epithelial proteins [E-cadherin and Beta-catenin] and mesenchymal marker proteins [N-cadherin and Vimentin] on formalin fixed paraffin embedded tumor sections of the prospective series of 99 non-muscle invasive bladder cancer (NMIBC) and 87 muscle invasive bladder cancer (MIBC) patients. E/M score was then statistically examined with patients’ demographics to assess its potential in the diagnosis and prognosis of UCB patients. ResultsAmong the E (E-cadherinhigh, β-cateninhigh), hybrid E/M (E-cadherinlow, β-cateninlow, N- cadherinhigh and Vimentinhigh) and M (N-cadherinhigh and Vimentinhigh) phenotypes, E/M phenotype was observed to be more prevalent in MIBC compared to E phenotype in NMIBC subtype. The current study reports the statistical association of tumor stage and tumor grade with the hybrid E/M state of urothelial tumor cells across both the subtypes. Hybrid E/M phenotype in MIBC patients was significantly shown to lower the overall survival time period compared to NMIBC patients. This supports the contribution of hybrid E/M state of tumor cells to the.aggressiveness of the disease. ConclusionsCharacterizing the hybrid E/M state instead of all or none phenotype becomes an imperative to understand the dynamics of EMT and MET in the tumor pathophysiology of NMIBC and MIBC subtypes, and could contribute to better patient stratification and therapeutic strategies.

Outcome of radical cystectomy in remote area of Pakistan: Recep Tayyip Erdogan Hospital, Muzaffargarh (IHHN)

Background: Radical cystectomy with bilateral pelvic lymphadenectomy is the standard treatment for high grade/ muscle invasive urinary bladder tumor. Continent or incontinent urinary diversion is the part of this major operation. High volume centers perform routinely but low volume centers do less frequent. It might be because of availability of equipment and trained surgeon in remote area of Pakistan. Objectives: to assess the results of radical cystectomy at a low-volume center for high-grade muscle-invasive bladder tumours. For patients aged 50 to 75, this involves evaluating surgical complications, overall survival, and the absence of tumour recurrence throughout a one-year follow-up period. Study design: A Retrospective StudyDuration and place of study: Recep Tayyip Erdogan hospital, Muzaffargarh from October 2018 to August 2022 Methods: total Cases from both genders and 50 to 75 years old with High grade/ Muscle invasive urinary bladder carcinoma, incomplete resection during TURBT due to high volume of mass (irresistible) included. Performa designed for collection of information. All the patients underwent same procedure by same urologist. Patients were followed for one year after surgery. Results: All participants were followed for one year. 33.3% patients had paralytic ileus (CDC I), 13.3% had wound infection (CDC I) and 6.7% had urinary leakage (CDC IIIb). There was 86.6% overall survival rate. 6.7% lost to follow up. Mean operative time was 308 ±95 minutes. There was no recurrence noted throughout the study period. Conclusion: Good operative results can also achieve at low volume centers. High level of surveillance and expertise help to achieve better outcomes in remote. Keywords: cystectomy, radical cystectomy, bladder tumor, ileal conduit

Role of En Bloc Resection in Staging of Non-Muscle Invasive Bladder Urothelial Carcinoma

Background Among cancers affecting both sexes, bladder cancer ranks as the fourth most prevalent cancer globally, and in the top 5 in prevalence in individual countries of all income levels and all regions enbloc resection approach of bladder tumors has a great effect in staging bladder tumors that help in early management of bladder tumors. Objective to review systematically studies whether en bloc resection of non-muscle invasive bladder cancer (NMIBC) could improve the identification of muscularis mucosa (MM) and muscle properia. Patients and Methods We searched PubMed, Google scholar search engine, Cochrane database of systematic reviews, EMBASE and science Direct, using the following Keywords “bladder tumors, enbloc resection, transurethral resection,”. The mentioned databases were searched for studies published during the last five years Results Total number of patients in included studies was 1940 of which 955 (49.2%) underwent en bloc resection and 985(50.8%) underwent conventional TURBT. after analyzing available data, en bloc resection has superiority in less recurrence rate and less hospital stay and higher in staging rate. Data Sources Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal) and all materials available in the Internet till 2022. Data Extraction If the studies did not fulfill the inclusion criteria, they were excluded. Study quality assessment included whether ethical approval was gained, eligibility criteria specified, appropriate controls, and adequate information and defined assessment measures. Conclusion In our review, ERBT show that it is an effective approach with some advantages over cTURBT regarding the treatment of NMIBC. This review revealed that hospitalization time and staging rate are superior in patients treated with ERBT than cTURBT, and complication rate and 24-month recurrence rate were also lower using ERBT. Accumulating evidence indicates that ERBT improves the quality of the surgical specimens and decreases the ReTUR frequency. Based on the previous evidence we recommend that, ERBT should be adapted by more surgeons in the treatment of non muscle invasive bladder tumors.

Effectiveness of BCG in recurrent non-muscle invasive bladder tumor: A 10 year retrospective study from a tertiary care centre

Abstract Introduction: Cancer-a term a word used to be so rare five decades back that people didn’t even know about this but now it has become so common and rampant and interestingly can be compared to a devil whose size seems to be increasing progressively. Even after so much advancement in medical science we have not been able to catch its tail. Urinary Bladder one of the very common cancer in our urological domain with its subtype non-muscle invasive bladder cancer (NMIBC) having high recurrence and progression rates has become very interesting subject for research. Such features led investigators to study the use of drugs to prevent this, out of which Bacillus Calmette–Guerin (BCG) has been successfully used as an intra vesical therapy to prevent recurrence and progression in NMIBC for more than four decades. Materials and Methods: In our study we have analyzed 111 patients retrospectively with only recurrent urinary bladder tumor irrespective of treatment received in the past. After completion Trans Urethral resection of bladder tumor (TURBT) and re-staging TURBT to substantiate the stage, induction and maintenance course of intravesical BCG was given according to Lamm protocol & the impact of this therapy was studied in regards to recurrence free, progression free, cystectomy free & overall survival rates. Result: Out of 111 patients, sixty percent of patient remained disease free, 19 patients had stage progression, nine patients underwent radical cystectomy and there was three cancer specific death. Conclusion: Despite BCG being the gold standard treatment for NMIBC, still intense research is required as there is a wide dark area of BCG failure.

A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer.

Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.

Development of a predictive model for optimizing the selection of patients for second transurethral resection bladder

Background: Transurethral resection of bladder (TURB) is considered the gold standard treatment of non-muscle invasive bladder tumor (NMIBT). The urological clinical practice guidelines recommend second-TURB (re-TURB), in certain situations, to achieve a complete resection and appropriately stratify the tumor. Objective: To design a predictive model of residual tumor in re-TURB, to optimize patient selection and avoid unnecessary surgeries. Methods: Retrospective analysis of 413 NMIBT with a macroscopically complete TURB and identification of the muscle layer, with subsequent re-TURB (2-6 weeks), according to EAU Clinical Guidelines criteria, from January 2010 to December 2021. We have identified predictive variables of residual tumor through univariate and multivariate analysis using logistic regression. The evaluation of the exactitude of the predictive model has been made using AUC (area under curve-ROC curve). Results: Median age in the series was 74 (38-91) years old, and 86.7% were male. Tumors that required second-TURB were mostly primary (64.6%), stage T1 (84.5%), high grade (82.6%), multifocal (54.8%) and with a size less than 3 cm (73.1%). Residual tumor was found in 28.1% of re-TURB. The independent predictors factors of residual tumor identified were: recurrence tumor (OR 1.87; IQ 1.14-3.06, p=0.01) and multifocality tumors (OR 2.11; IQ 1.31-3.4; p=0.002). High-grade shows a trend to statistical signification as risk factor (p=0.07) and early administration of mitomycin-C behaved as an independent protector factor (OR 0.40; IQ 0.3-0.81; p=0.006). The predictive model shows an AUC=0.7 (IQ 0.62-0.73; p=0.0001). Conclusion: Our predictive model evaluates the probability of finding residual tumor in second-TURB with a 70% accuracy. This way, we could optimize the selection of patients in low risk of residual tumor, thus avoiding unnecessary surgeries.

Evaluation of Dynamic Thiol/Disulfide Homeostasis in Patients with Non-Muscle Invasive Bladder Tumor

Evaluation of Dynamic Thiol/Disulfide Homeostasis in Patients with Non-Muscle Invasive Bladder Tumor

BCG shortage for intravesical instillation is associated with early tumoral recurrence in patients with high-risk non-muscle invasive bladder tumours

IntroductionDuring 2019 there was a worldwide shortage of BCG strains for intravesical instillation, limiting the availability of full dose schemes for maintenance courses. The main objective was to analyze the impact on tumoral relapse secondary to BCG shortage in our center. Secondary outcomes included recurrence and progression–free survival rates and tumoral relapse specific characteristics. MethodsRetrospective cohort study including 158 subjects (64 treated during 2019 and 94 during 2017) with high-risk non-muscle invasive bladder cancer and treated with a combination of Transurethral bladder resection (TURB) followed by adjuvant intravesical instillation with BCG in a tertiary hospital in Spain.Basal characteristics of both groups were analyzed. Times to event of interest (relapse; including recurrence and/or progression) were estimated with Kaplan–Meier survival analysis. Disease-free survival rates were analyzed using a multivariable Cox regression model of proportional hazards. ResultsMedian follow-up in the 2019 sample was 24 months and 50 months in the 2017 group with a median number of instillations of 8 and 12 respectively. Median time to relapse of 285 days (145–448) during 2019 and 382 days (215–567) in 2017 were observed (logRank p = 0.025). Further multivariable analysis revealed a proportional hazard ratio (HR) for disease-free survival rate of 1.87 (95% CI: 1.04–3.37 p = 0.036). No statistically significant differences in tumoral relapse characteristics were observed. ConclusionBCG shortage and subsequent reduced-dose schemes used for intravesical instillation due to limited availability, increase early tumoral relapse rates. These findings are consistent with available evidence, showing the need for full-dose BCG courses.

Quality of life in patients with non-muscle invasive bladder tumor undergoing adjuvant intravesical treatment

IntroductionThe objective of the study was to establish a possible relationship between mitomycin-C (MMC) and bacillus Calmette-Guérin (BCG) treatments and quality of life impairment. Material and MethodsQuasi-experimental, prospective, and longitudinal study including patients undergoing adjuvant treatment in NMIBC. The Short form-12 (SF-12) and Urogenital Distress Inventory-6 (UDI-6) questionnaires were used to measure quality of life. Questionnaire scores were compared between cases with MMC and BCG before induction (M1), at 4 weeks (M2) and at 2 months (M3). ResultsOf the 90 patients enrolled, 54 were in the BCG group and 36 in the MMC group. It was found that BCG patients had worse perceived physical quality of life compared to MMC patients in M2 (OR:2.59, p=0.046). In addition, significant changes were found in the urinary quality of life of patients on MMC treatment between the different time points (UDI-6 score: 33.33 in M1, 27.78 in M2 and 16.67 in M3, p=0.001). ConclusionsThere are no differences in urinary quality of life between patients treated with MMC and BCG. Patients with MMC show a significant recovery of urinary quality of life from the completion of the induction course, which becomes even more significant after 2 months. In addition, BCG-treated patients have worse physical quality of life after 4 weeks of treatment than those treated with MMC.

Urinary Cotinine: A Promising Marker of Recurrence of Non-muscle Invasive Bladder Tumor

Introduction and objectives: Nicotine is well known to be an addictive compound of tobacco, but it is not primarily carcinogenic. It is metabolized to cotinine, which is considered the best marker of tobacco exposure. Little is known whether recurrence rate of bladder cancer is related to nicotine metabolites eliminated in urine. We aim by this study to evaluate the relation between urinary cotinine level and the recurrence of bladder cancer. Materials and Methods: Between January 2018 and June 2022, a cross sectional study was conducted. Enrolled patients were smokers already diagnosed with non-muscle invasive bladder cancer, treated by resection only, and presenting for a follow up cystoscopy. Included patients had unchanged smoking habits in the day before the procedure, same ethnicity (Caucasians) and no additional professional exposure. Cotinine level was measured on a sample of voided urine before cystoscopy. Tumor recurrence was considered positive independently from the histological type, and was assessed by direct vision cystoscopy. Patients were considered moderate or heavy smokers depending on the level of cotinine in their urine samples (< or > 550 ng/ml respectively). A Fisher Exact Test was used to assess the relationship between variables. Results: A total of 135 patients was included. Mean age was 64 years (range 36 to 78). The mean duration of smoking was 30.3 years. Urinary cotinine level was > 550 ng/ml in 80 patients (59.26%) and < 550 ng/ml in 55 patients (40.74%). Recurrence was identified in 70 patients (51.85%) and was absent in the remaining 65 (48.15%). Recurrence was observed in 68.75% of the heavy smokers and in 27.27 % of moderate smokers. Cotinine level higher than 550 ng/mL was linked to an increased risk of bladder cancer, with a relative risk of 4.16 (p-value < 0,025). Conclusion: High urinary cotinine levels (>550 ng/ml) conveys a 4 folds’ risk for the recurrence of bladder cancer in smokers. Additional prospective studies are needed to better understand the relation between urinary cotinine levels and bladder cancer, and its usefulness in bladder cancer surveillance.

Long-term effect of transurethral partial cystectomy with a 2-micrometer continuous-wave laser for non-muscle-invasive bladder cancer.

We have reported the efficacy and safety of 2-micrometer continuous-wave laser cystectomy of non-muscle invasive bladder tumor (NMIBC) (J Urol. 2009;182:66-9). In this study, we evaluated the long-term outcomes of patients with NMIBC who underwent transurethral partial cystectomy with a 2-micrometer continuous-wave laser, and explored the risk factors for tumor recurrence. This was a retrospective study of patients with NMIBC planned to undergo transurethral partial cystectomy with a 2-micrometer continuous-wave laser at the Fourth Medical Center of the PLA General Hospital between January 2012 and December 2014. The primary outcome was bladder cancer recurrence. A total of 75 patients were enrolled. Sixty-two (82.7%) were male. The patients were 59.8 ± 12.9 years of age. The mean operation time was 38.7 ± 20.4 min. No Clavien grade >2 complications occurred. The duration of catheter indwelling was 3.6 ± 1.8 days. The hospital stay was 6.0 ± 2.3 days. The median follow-up was 80 months. A total of 17 patients had a recurrence during follow-up, and the recurrence-free survival (RFS) rate was 77.3%. In the multivariable analysis, the tumor risk group were independently associated with the recurrence of NMIBC (p = 0.026). After TURBT with a 2-micrometer continuous-wave laser, RFS was 77.3% at the median follow-up of 80 months. All complications were mild. Only tumor risk group was independently associated with the recurrence of NMIBC.

Role of preoperative neutrophil to lymphocyte ratio in prediction of recurrence, progression, and BCG failure in non-muscle invasive bladder cancer: a retrospective study.

neutrophil/lymphocyte ratio (NLR), as a biomarker of the systemic inflammatory response, has been studied for diverse tumors. Our study aims to determine whether the NLR can be reliably used as a tool to predict disease course in patients diagnosed with primary non-muscle invasive bladder tumors (NMIBC). a retrospective study between 2009 to 2014 was conducted on 300 patients newly diagnosed with NMIBC at our institution. The cut-off value of NLR was set at 2.5. Survival curves were compared using the log-rank test. The association between recurrence, progression, and NLR was assessed univariate, and the prognostic significance of high NLR was assessed using multivariate analysis. one hundred and seventy-five patients had an NLR <2.5 and 125 patients had an NLR ≥ 2.5. The survival rate with recurrence at 5 years was higher in the group with an NLR >2.5 (p<0.001, 35 vs 18 months), similarly, the survival rate with progression at 5 years was higher in the group with an NLR > 2.5 (p=0.001, 36 vs. 27 months). The failure rate of immunotherapy using BCG was higher when the NLR was over 2.5. In a multivariate analysis, the factors associated with recurrence were NLR>2.5 (HR=2.03, 95% CI=1.32-3.11, p=0.001), pathologic stage pT1 (HR=2.42, 95% CI=1.52-3.85, p=0.001), high-grade (HR=1.76, 95% CI=1.52-3.92, p=0.01), concomitant CIS lesions (HR=2.31, 95% CI=1.36-3.92, p=0.001), presence of lymphovascular emboli (HR=5.77, 95% CI=1.77-18.78, p=0.004), and BCG immunotherapy failure (HR=5.29, 95% CI=2.88-9.70, p=0.001). With regard to progression, in a multivariate study, the significant factors were NLR>2.5(HR=2.91, 95% CI=1.17-7.23, p=0.01), BCG immunotherapy failure (HR=5.68, 95% CI=3.16-10.22, p=0.001), and the presence of lymphovascular emboli (HR=5.01, 95% CI=1.50-16.05, p=0.001). preoperative NLR value could predict recurrence, progression, and failure of BCG immunotherapy in NMIBC patients.