Nonmuscle Invasive Research Articles

Comprehensive Educational Needs Assessment Plan for Non-Muscle Invasive Bladder Cancer (NMIBC) Patient Care and Treatment among Relevant Healthcare Professionals

Comprehensive Educational Needs Assessment Plan for Non-Muscle Invasive Bladder Cancer (NMIBC) Patient Care and Treatment among Relevant Healthcare Professionals

Oncological and Survival Outcomes of Pelvic Lymph Node Dissection in Patients with Nonmuscle Invasive Bladder Cancer Undergoing Radical Cystectomy Using the National Cancer Database

ObjectiveTo evaluate the role of pelvic lymph node dissection (PLND) in patients diagnosed with high-risk nonmuscle-invasive bladder cancer (NMIBC) undergoing radical cystectomy (RC) using a national cohort of NMIBC patients. MethodsA cohort of patients diagnosed with NMIBC cancer with urothelial carcinoma from the National Cancer Database (NCDB) between 2004 and 2019 was utilized. The cohort consists of patients who have not received BCG and underwent upfront radical cystectomy or pelvic exenteration. Kaplan–Meier analysis was utilized to assess overall survival (OS) outcomes. Cox regression was also utilized to identify independent predictors of OS. ResultsThe cohort of 9399 patients was stratified by clinical T stage and then subdivided by pathological outcome. For patients with cTa, a majority received a lymph node dissection 97.74% (941/1019), amongst the entire cohort, a minority had node positive disease 3.3% (34/1019). For cTis, most patients received a lymph node dissection 94.08% (482/507), and a minority had node positive disease 5.1% (26/507). For cT1, most patients had a lymph node dissection 95.62% (6,060/6,337), and a 13.1% (832/6337) of patients had a positive lymph node. Amongst patients with cT1 disease who underwent PLND, KMA demonstrated better OS compared to patients who did not undergo PLND (P < .001). ConclusionThe data suggests an OS benefit in patients with later stage (cT1) NMIBC. Thus, our findings support the existing clinical guidelines of pelvic lymph node dissection in patients with high-risk nonmuscle invasive bladder cancer.

Impact of diabetes mellitus on oncologic outcomes in patients receiving robot-assisted radical cystectomy for bladder cancer.

Aim of this study is to investigate the association between DM and oncological outcomes among patients with muscle-invasive (MI) or high-risk non-muscle invasive (NMI) bladder cancer (BC) who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC). An IRB approved multi-institutional BC database was queried, including patients underwent RARC between January 2013 and June 2023. Patients were divided into two groups according to DM status. Baseline, clinical, perioperative, pathologic data were compared. Chi-square and Student t tests were performed to compare categorical and continuous variables, respectively. Kaplan-Meier method and Cox regression analyses were performed to assess the association between DM and oncologic outcomes. Out of 547 consecutive patients, 97 (17.7%) had DM. The two cohorts showed similar preoperative features, except for ASA score (p = 0.01) and Hypertension rates (p < 0.001). No differences were detected for perioperative complications, pT stage, pN stages and surgical margins status (all p > 0.12). DM patients displayed significantly lower 5-yr disease-free survival (DFS) (44.6% vs. 63.3%, p = 0.007), 5-yr cancer-specific survival (CSS) (45.1% vs. 70.1%, p = 0.001) and 5-yr Overall survival (OS) (39.9% vs. 63.8%, p = 0.001). At Multivariable Cox-regression analyses DM status was identified as independent predictor of worse cancer-specific survival (CSS) (HR 2.1; p = 0.001) and overall survival (OS) (HR 2.05; p < 0.001). Among BC patients who underwent RARC, DM patients showed worse oncologic outcomes than the non-DM patients, with DM status playing an independent negative predicting role in CSS and OS. Future prospective studies are awaited, stimulating basic and translational research to identify possible mechanisms of interaction between DM and BC.

Epirubicin and Non-Muscle Invasive Bladder Cancer Treatment: A Systematic Review.

(1) Background: Intravesical chemotherapy is the standard of care in intermediate-risk non-muscleinvasive bladder cancer (NMIBC). Different agents are used across the world based on availability, cost, and practice patterns. Epirubicin (EPI), one of these agents, has been used by many centers over many decades. However, its true differential efficacy compared to other agents and its tolerability are still poorly reported. We aimed to assess the differential efficacy and safety of intravesical EPI in NMIBC patients. (2) Methods: This study aimed to systematically review the efficacy and safety profile of Epirubicin (EPI) in the management of non-muscle invasive bladder cancer (NMIBC) compared to other adjuvant therapies. A systematic search of the PUBMED, Web of Science, clinicaltrials.gov, and Google Scholar databases was conducted on 31 December 2023, using relevant terms related to EPI, bladder cancer, and NMIBC. The inclusion criteria targeted studies that evaluated patients treated with EPI following the transurethral resection of bladder tumors (TURBT) for NMIBC and compared oncological outcomes such as recurrence and progression with other adjuvant therapies, including Mitomycin C (MMC), Gemcitabine (GEM), and Bacillus Calmette-Guérin (BCG). Additionally, studies investigating the safety profile of EPI administered intravesically at room temperature and under hyperthermia, as well as oncological outcomes associated with hyperthermic intravesical EPI administration, were included. (3) Results: Eleven studies reported adverse events after adjuvant intravesical instillations with EPI; the most frequently reported adverse events included cystitis (34%), dysuria, pollakiuria, hematuria, bladder irritation/spasms, fever, nausea and vomiting, and generalized skin rash (2.3%). Nine studies compared EPI to BCG in terms of recurrence and progression rates; BCG instillations showed a lower recurrence rate compared to EPI, with limited or non-significant differences in progression rates. Two studies found no significant differences between EPI and MMC regarding progression and recurrence rates. One study showed statistically significant lower recurrence and progression rates with GEM in high-risk NMIBC patients. Another study found no significant differences between EPI and GEM regarding recurrence and progression. (4) Conclusions: EPI exhibits similar oncological performances to Gemcitabine and Mitomycin C currently used for adjuvant therapy in NMIBC. Novel delivery mechanisms such as hyperthermia are interesting newcomers.

The International Bladder Cancer Group Intermediate-Risk Non-muscle Invasive Bladder Cancer Scoring System Predicts the Need for Intervention for Patients on Active Surveillance

The International Bladder Cancer Group Intermediate-Risk Non-muscle Invasive Bladder Cancer Scoring System Predicts the Need for Intervention for Patients on Active Surveillance

Diagnostic Value of Serum and Urine Endocan Levels in Nonmuscle Invasive Bladder Cancer: A Prospective Comparative Study

Objective. This prospective study aimed to explore the potential diagnostic value of endocan levels in bladder cancer by investigating a possible association of serum and urine endocan levels with the stage and grade of bladder tumors in patients with nonmuscle-invasive bladder cancer (NMIBC) in terms of risk stratification. Materials and Methods. Participants included 66 male patients with NMIBC. Patients with full pathology results, NMIBC stage T1, and healthy controls were categorized as groups 1, 2, and 3, respectively. Patients were further classified into high- and low-grade groups following their pathology results. Risk classification according to the European Association of Urology (EAU) was assigned to patients with NMIBC, and associations of risk groups with serum and urine endocan levels were analyzed. An enzyme-linked immunosorbent assay was used to identify serum and urine endocan concentrations. Results. Serum endocan levels according to pathological staging were significantly higher in groups 1 and 2 than in group 3. The urine endocan level was statistically significantly higher in group 2 than in group 3 p&lt;0.001. The predictive power of the urine endocan level was evaluated for its ability to predict T1 disease, revealing an area under the curve of 0.735 and a threshold of 903. The EAU classification was evaluated according to risk groups, and the urine endpoint was statistically significantly higher in the univariate analysis for the high and very high-risk groups p=0.034. Conclusion. Our results indicate that endocan levels hold significant promise in prognostic feature evaluation in NMIBC, particularly in the context of screening patients with hematuria.

Active Surveillance in Non-Muscle Invasive Bladder Cancer, the Potential Role of Biomarkers: A Systematic Review.

Bladder cancer (BC) is the tenth most common cause of cancer worldwide and is the thirteenth leading cause of cancer mortality. The non-muscle invasive (NMI) variant represents 75% of cases and has a mortality rate of less than 1%; however, it has a high recurrence rate. The gold standard of management is transurethral resection in the case of new lesions. However, this is associated with significant morbidity and costs, so the reduction of these procedures would contribute to reducing complications, morbidity, and the burden to the health system associated with therapy. In this clinical scenario, strategies such as active surveillance have emerged that propose to manage low-risk BC with follow-up; however, due to the low evidence available, this is a strategy that is underutilized by clinicians. On the other hand, in the era of biomarkers, it is increasingly known how to use them as a tool in BC. Therefore, the aim of this review is to provide to clinical practitioners the evidence available to date on AS and the potential role of biomarkers in this therapeutic strategy in patients with low-grade/risk NMIBC. This is the first review linking use of biomarkers and active surveillance, including 29 articles.

Alternative Therapy to Intravesical Bacillus Calmette–Guerin in Nonmuscle Invasive Bladder Cancer

Summary Intravesical Bacillus Calmette-Guerin (BCG) is recommended as an adjuvant therapy for intermediate and high-risk bladder cancers following complete resection. However, up to 45% of patients receiving BCG experience treatment failure. High failure rates along with increased toxicity and a global shortage of BCG availability have led to the search for alternative agents which can replace BCG. These agents can be used as second-line therapies after BCG failure before considering patients for radical cystectomy. Intravesical chemotherapeutic agents such as gemcitabine, docetaxel, valrubicin, sequential gemcitabine-docetaxel, and sequential valrubicin-docetaxel have been shown to yield comparable or better outcomes compared to BCG with low toxicity. Newer methods of drug delivery such as chemohyperthermia (CHT), electromotive drug administration (EMDA) and targeted releasing system 200 (TAR-200) have been reported to amplify drug delivery and enhance outcomes. The immune checkpoint inhibitor pembrolizumab has been used for BCG unresponsive disease with satisfactory response rates but with a higher risk of adverse events. A newer immunotherapeutic agent, ALT-803/N-803, which is an interleukin 15 superagonist, has shown promising short-term results. Novel oncolytic viral delivery systems such as nadofaragene-firadenovac, CG0070, CG0070-pembrolizumab have been shown to alter immune response and destroy malignant cells with good short-term outcomes. The number of BCG alternatives has surged in the recent past and newer agents continue to emerge. Expanding the study populations and long-term follow-up will enable affirming these alternatives as BCG equivalents in the future.

The association between p53 and FGFR3 expression with the aggressiveness of bladder invasive urothelial carcinoma cases in Prof. dr. IGNG Ngoerah Hospital, Bali, Indonesia

Background: Bladder urothelial carcinoma (BUC) shows varying histological features, behavior, and prognosis. The two most common genes altered in BUC were TP53 and FGFR3. The FGFR3 alteration related to lesser aggressiveness than TP53 and anti-FGFR3 targeted therapy is being investigated. This study determined p53 and FGFR3 expression in BUC cases treated at Prof. dr. IGNG Ngoerah Hospital. Methods: A cross-sectional observational analytic study was conducted in 2023 in the Anatomical Pathology Laboratory at Prof. dr. IGNG Ngoerah Hospital. The subjects were forty-three BUC patients from 2018-2022 who met the eligibility criteria obtained by consecutive sampling. Tumor aggressiveness, represented by the degree of differentiation and depth of invasion, was assessed from HE slides, resulting in low and high-grade muscle-invasive (MI) and non-muscle-invasive (NMI) cases. The p53 and FGFR3 expression were assessed with immunostaining and categorized as low and high expression with 50% and 70% cut-off of positive cells, respectively. The association between variables was statistically analyzed with the Fisher Exact test. Results: Most patients were male (82.44%), aged &gt;50 years (92.37%), invasive type (62.60%), high grade (80.12%), and MI (52.67%). Immunostaining showed a predominance of high p53 expression (60.5%) and low FGFR3 expression (62.8%). Some cases showed concomitant p53 and FGFR3 expression. Statistical analysis revealed no association between p53 expression and the degree of differentiation and depth of invasion (p=0.625; 0.388, respectively). There was a significant association between FGFR3 expression and the degree of differentiation (p=0.003) but not with the depth of invasion (p=0.110). Conclusion: In conclusion, p53 expression was not associated with BUC aggressiveness, whereas FGFR3 expression was significantly associated with the degree of differentiation but not with the depth of invasion. Concomitant p53 and FGFR3 expression may reflect the complexity of BUC carcinogenesis. Further studies are needed for a better understanding of TP53 and FGFR3's involvement in BUC carcinogenesis and therapy.

No Association Between BCG Instillations and COVID-19 Incidence in a Dutch Non-Muscle Invasive Bladder Cancer Cohort.

No Association Between BCG Instillations and COVID-19 Incidence in a Dutch Non-Muscle Invasive Bladder Cancer Cohort.

Wake-Up Call to Address Sleep Health in Non-Muscle Invasive Bladder Cancer: Underappreciated Contributor to Poor Quality of Life.

Few studies have specifically examined sleep health in patients with non-muscle invasive bladder cancer (NMIBC). Further study is warranted to inform future strategies in patients with NMIBC. We aim to describe sleep health in a cohort of patients with NMIBC, and its relationship with quality of life (QOL). We conducted an observational cross-sectional study in patients undergoing surveillance for NMIBC. The validated Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep health (scores from 0-21) in the overall study population as well as stratified. We assessed QOL among participants with and without poor sleep quality using the SF-12 and QLQ-NMIBC-24. In a cohort of 94 NMIBC patients, median age was 67 years (IQR: 58, 72) and median time since initial diagnosis was 27 months (IQR: 9, 41). The mean PSQI score was 6.3 (SD: 3.8) and 64% percent of participants met or exceeded the PSQI cut-off score of 5, with a score of 5 or more indicating overall poor sleep quality. In those with poor sleep quality, there were statistically significant detriments in multiple QOL domains. In patients undergoing surveillance for NMIBC, there is a substantial burden of sleep disturbances and resulting decrements in QOL. These data support the need for future interventions to support sleep quality and highlight the importance of addressing sleep health as part of NMIBC survivorship care to improve QOL in patients with NMIBC.

Clinicopathologic features and prognostic significance of mixed (Low and high-grade) papillary urothelial carcinoma comparison with low and high-grade papillary urothelial carcinoma.

The World Health Organization/International Society of Urological Pathology (2022 WHO/ISUP) classification categorizes noninvasive carcinomas based on the highest grade observed in a pathology sample. According to this classification, a lesion is classified as mixed-grade (MG) if the highest-grade component comprises less than 5% high-grade (HG) carcinoma [14]. This study included 160 cases of low-grade papillary urothelial carcinoma (LGUC) and 160 cases of HG papillary urothelial carcinoma (HGUC), selected randomly. In addition, 160 consecutive and unselected cases of MG papillary urothelial carcinoma (MGUC) were obtained from all bladder transurethral resection specimens diagnosed with papillary urothelial carcinoma between January 2007 and January 2021. The results of the multivariate analysis showed that histologic grade, invasion of the lamina propria, and the presence of carcinoma in situ at presentation were independent prognostic parameters regarding recurrence-free survival (p = 0.002; hazard ratio (HR) = 1.44, 95% confidence interval (CI) = 1.059-1.956, p = 0.02; and HR = 1.76, 95% CI = 1.159-2.684, p = 0.008, respectively). Histologic grade was the only independent prognostic parameter of disease-specific survival (DSS) (p < 0.001). Comparisons between non-muscle invasive (NMI) MGUC and NMI LGUC, as well as between NMI MGUC and NMI HGUC, revealed statistically significant differences in terms of DSS (HR = 0.07, 95% CI = 0.024-0.252,p< 0.001 and HR = 1.59, 95% CI = 1.023-2.460, p = 0.039, respectively). Our study findings demonstrate statistically significant differences regarding DSS between NMI MGUC and NMI HGUC, as well as between NMI MGUC and NMI LGUC. Therefore, we suggested that considering the presence of less than 5% MGUC as a separate category may be appropriate. However, it is important to validate our results in larger cohorts with longer follow-up periods to establish the clinical significance of MGUC and provide guidance for patient management.

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.

Audit, Feedback, and Education to Improve Quality and Outcomes in Transurethral Resection and Single-Instillation Intravesical Chemotherapy for Nonmuscle Invasive Bladder Cancer Treatment: Protocol for a Multicenter International Observational Study With an Embedded Cluster Randomized Trial.

Nonmuscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancers. It is common and costly. Cost and detriment to patient outcomes and quality of life are driven by high recurrence rates and the need for regular invasive surveillance and repeat treatments. There is evidence that the quality of the initial surgical procedure (transurethral resection of bladder tumor [TURBT]) and administration of postoperative bladder chemotherapy significantly reduce cancer recurrence rates and improve outcomes (cancer progression and mortality). There is surgeon-reported evidence that TURBT practice varies significantly across surgeons and sites. There is limited evidence from clinical trials of intravesical chemotherapy that NMIBC recurrence rate varies significantly between sites and that this cannot be accounted for by differences in patient, tumor, or adjuvant treatment factors, suggesting that how the surgery is performed may be a reason for the variation. This study primarily aims to determine if feedback on and education about surgical quality indicators can improve performance and secondarily if this can reduce cancer recurrence rates. Planned secondary analyses aim to determine what surgeon, operative, perioperative, institutional, and patient factors are associated with better achievement of TURBT quality indicators and NMIBC recurrence rates. This is an observational, international, multicenter study with an embedded cluster randomized trial of audit, feedback, and education. Sites will be included if they perform TURBT for NMIBC. The study has four phases: (1) site registration and usual practice survey; (2) retrospective audit; (3) randomization to audit, feedback, and education intervention or to no intervention; and (4) prospective audit. Local and national ethical and institutional approvals or exemptions will be obtained at each participating site. The study has 4 coprimary outcomes, which are 4 evidence-based TURBT quality indicators: a surgical performance factor (detrusor muscle resection); an adjuvant treatment factor (intravesical chemotherapy administration); and 2 documentation factors (resection completeness and tumor features). A key secondary outcome is the early cancer recurrence rate. The intervention is a web-based surgical performance feedback dashboard with educational and practical resources for TURBT quality improvement. It will include anonymous site and surgeon-level peer comparison, a performance summary, and targets. The coprimary outcomes will be analyzed at the site level while recurrence rate will be analyzed at the patient level. The study was funded in October 2020 and began data collection in April 2021. As of January 2023, there were 220 hospitals participating and over 15,000 patient records. Projected data collection end date is June 30, 2023. This study aims to use a distributed collaborative model to deliver a site-level web-based performance feedback intervention to improve the quality of endoscopic bladder cancer surgery. The study is funded and projects to complete data collection in June 2023. ClinicalTrials.org NCT05154084; https://clinicaltrials.gov/ct2/show/NCT05154084. DERR1-10.2196/42254.

Re: DaBlaCa-13 Study: Oncological Outcome of Short-term, Intensive Chemoresection with Mitomycin in Nonmuscle Invasive Bladder Cancer: Primary Outcome of a Randomized Controlled Trial

Re: DaBlaCa-13 Study: Oncological Outcome of Short-term, Intensive Chemoresection with Mitomycin in Nonmuscle Invasive Bladder Cancer: Primary Outcome of a Randomized Controlled Trial

MP69-05 FEASIBILITY OF DNA METHYLATION MARKERS FOR DIAGNOSIS AND PROGNOSIS OF UPPER TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyCME1 Apr 2023MP69-05 FEASIBILITY OF DNA METHYLATION MARKERS FOR DIAGNOSIS AND PROGNOSIS OF UPPER TRACT UROTHELIAL CARCINOMA Farshad Sheybaee Moghaddam, Alireza Ghoreifi, Hongtao Li, Yohei Sekino, Kian Asanad, Manju Aron, Gangning Liang, and Hooman Djaladat Farshad Sheybaee MoghaddamFarshad Sheybaee Moghaddam More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Hongtao LiHongtao Li More articles by this author , Yohei SekinoYohei Sekino More articles by this author , Kian AsanadKian Asanad More articles by this author , Manju AronManju Aron More articles by this author , Gangning LiangGangning Liang More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003332.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Upper tract urothelial carcinoma (UTUC) is an uncommon, yet biologically heterogeneous disease that accounts for 5-10% of all urothelial tumors. The diagnosis and risk-stratification of UTUC patients is challenging given the limitations of current diagnostic tools. DNA methylation has emerged as a potential prognostic and diagnostic factor in urothelial carcinoma, yet few studies have examined its role in UTUC. In this study, we aim to identify specific tissue DNA methylation markers in muscle invasive (≥pT2) and non-muscle invasive (<pT2) UTUC cases. METHODS: Microdissection and DNA extraction of over 300 slides were performed and the EPIC work was completed on all USC samples-including 8 non-muscle invasive, 10 muscle invasive and lymph node positive samples and 4 normal tissue/WBC as controls. Methylation patterns were analyzed and compared between non-muscle invasive (NMI) and muscle invasive (MI) UTUC samples. Table 1 shows epics from other centers were also included in the study. A training set including epic data of 32 normal samples, 50 non-muscle invasive (NMI), and 48 muscle invasive samples (MI) was used to design the probe, and Epic data of 65 samples including 17 normal tissue, 24 NMI and 24 MI samples were used as testing samples. Principle component analysis (PCA) was used to cluster the UTUC and normal samples. RESULTS: Different patterns of methylation were detected in NMI versus MI-UTUCs. By comparing adjacent normal tissues and white blood cells (WBCs), specific DNA methylation probes were developed for NMI-UTUC and MI-UTUCs (Figure 1). According to PCA, MI-UTUC vs NMI-UTUC 1924 probes is able to cluster the UTUC samples (|deltaMedian|>0.3, p<0.05) (Figure 2). CONCLUSIONS: UTUC has a distinct DNA methylation pattern that is distinguishable from normal urothelial tissue. UTUC-specific DNA methylation probes can be used to differentiate muscle-invasive UTUCs. Source of Funding: University of Southern California Urology research council © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e965 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Farshad Sheybaee Moghaddam More articles by this author Alireza Ghoreifi More articles by this author Hongtao Li More articles by this author Yohei Sekino More articles by this author Kian Asanad More articles by this author Manju Aron More articles by this author Gangning Liang More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...

MP08-15 THE ROLE OF FLEXIBLE BLUE LIGHT CYSTOSCOPY IN SURVEILLANCE OF NON-MUSCLE INVASIVE BLADDER CANCER. RESULTS FROM A NORDIC REGISTRY

You have accessJournal of UrologyCME1 Apr 2023MP08-15 THE ROLE OF FLEXIBLE BLUE LIGHT CYSTOSCOPY IN SURVEILLANCE OF NON-MUSCLE INVASIVE BLADDER CANCER. RESULTS FROM A NORDIC REGISTRY Karsten Egbert Arnold Zieger, Kristine Young-Halvorsen, and Per-Uno Malmström Karsten Egbert Arnold ZiegerKarsten Egbert Arnold Zieger More articles by this author , Kristine Young-HalvorsenKristine Young-Halvorsen More articles by this author , and Per-Uno MalmströmPer-Uno Malmström More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder cancer is one of the most prevalent cancers in the world. Approximately 75% of bladder cancers are non-muscle invasive (NMIBC) with a high tendency of recurrence and progression. Thus, patients undergo regular surveillance cystoscopies, often life-long. Blue light cystoscopy (BLC) improves the diagnosis of papillary and flat lesions, and may play a role in the surveillance setting by reducing the risk of missing significant lesions, refuting suspicious changes, and strengthening confidence in recurrence-free cystoscopies. This study aims to evaluate the impact of BLC in a surveillance setting. METHODS: The Nordic Blue Light Flexible Cystoscopy (BLFC) registry is a prospective, observational, multi-center study including patients undergoing BLFC for suspicion or surveillance of NMIBC in an outpatient setting. The registry is approved by local ethics committees. Data recorded are patient demographics, bladder cancer history, findings under WLC and BLC, patient preference, discomfort and treatment. RESULTS: We performed 436 BLFC in 319 patients in surveillance of NMIBC. The EAU risk group distribution was 172 (54%) high risk, 136 (43%) intermediate risk and 11 (3%) low risk. 147 (34%) cases underwent adjuvant therapy with BCG or chemotherapy prior to BLFC. 318 (73%) cystoscopies revealed suspicious lesions using white light or blue light. We took biopsies from 452 lesions, showing malignancy in 126/409 (31%) lesions positive for blue light, while 7/43 (16%) lesions negative for blue light. In 86 cases (20%), lesions were identified only by blue light. Pathology showed malignancy in 37/104 biopsies (36%), including 18 CIS. Patients with small recurrences underwent office fulguration, 45 patients (10%) were referred to TURBT, and 82 patients subsequently received adjuvant intravesical therapy. 34 patients expressed discomfort during BLFC, due to bladder distension or the associated biopsy and/or fulguration. Physicians reported benefit of BLC in 367/436 (84%) of the cystoscopies, with a stronger confidence in confirming or refuting a suspicious lesion as the main advantage (28%). CONCLUSIONS: Flexible BLC as an adjunct to white light cystoscopy for surveillance of NMIBC improves the detection of malignant lesions. Furthermore, it improves surgeons’ confidence on identifying clinical important lesions. The combination of BLC with immediate fulguration of tumours in an outpatient setting may positively affect the patients’ burden in NMIBC. The impact on patients overall outcome is target of future evaluations. Source of Funding: Photocure ASA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e100 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karsten Egbert Arnold Zieger More articles by this author Kristine Young-Halvorsen More articles by this author Per-Uno Malmström More articles by this author Expand All Advertisement PDF downloadLoading ...

PD29-05 ASSOCIATION OF AGE WITH NON-MUSCLE INVASIVE BLADDER CANCER: A BIOLOGICAL BASIS FOR EPIDEMIOLOGICAL DISPARITIES?

You have accessJournal of UrologyCME1 Apr 2023PD29-05 ASSOCIATION OF AGE WITH NON-MUSCLE INVASIVE BLADDER CANCER: A BIOLOGICAL BASIS FOR EPIDEMIOLOGICAL DISPARITIES? Niyati Lobo, Akshay Sood, Zhigang Duan, Wei Shen Tan, Valentina Grajales, Sia Viborg Lindskrog, Lars Dyrskjøt, Aarhus, Denmark, Hui Zhao, Sharon Giordano, Stephen B. Williams, and Ashish M. Kamat Niyati LoboNiyati Lobo More articles by this author , Akshay SoodAkshay Sood More articles by this author , Zhigang DuanZhigang Duan More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Sia Viborg LindskrogSia Viborg Lindskrog More articles by this author , Lars DyrskjøtLars Dyrskjøt More articles by this author , Aarhus Aarhus More articles by this author , Denmark Denmark More articles by this author , Hui ZhaoHui Zhao More articles by this author , Sharon GiordanoSharon Giordano More articles by this author , Stephen B. WilliamsStephen B. Williams More articles by this author , and Ashish M. KamatAshish M. Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003315.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Age disparity in patients with non-muscle-invasive bladder cancer (NMIBC) exists. Whether this is due to differences in cancer care or tumour biology is unclear. We sought to investigate age disparities in NMIBC using individual patient-level data from two cohorts: the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and the publicly available UROMOL dataset. METHODS: SEER-Medicare linked data was used to identify patients, aged ≥66 years, with clinical stage Ta, Tis and T1 NMIBC between 2005-2019 (n=32 225). Multivariable competing-risks Cox regression analyses were used to examine the association between age and recurrence (defined as receipt of TURBT ≥3 months after index diagnosis of NMIBC or progression), progression (defined as receipt of definitive treatment for bladder cancer) and bladder cancer-specific mortality rates after adjusting for demographic-, cancer- and treatment-related variables. Using the UROMOL cohort (n=834), age disparities across transcriptomic, genomic and spatial proteomic domains were assessed. Differences between groups were testing using Pearson’s Chi-square test or Fisher’s test for categorical variables. RESULTS: Analysis of the SEER-Medicare cohort revealed 10-year recurrence rates of 60.9%, 61.1% and 60.4% in patients aged 66-70 yrs, 71-80 yrs and ≥81 yrs, respectively; 10-year progression rates of 29.3%, 32.2% and 38.2%, respectively; and 10-year bladder-cancer specific mortality rates of 5.5%, 7.9% and 14.3%, respectively. Age ≥ 81 yrs was associated with a higher risk of progression (HR 1.32, 95% CI 1.25-1.40, p<0.001) and bladder cancer-specific mortality (HR 2.58, 95% CI 2.27-2.95, p<0.001). Analysis of UROMOL 2021 transcriptomic classes revealed that Class 2a was more frequently observed in older patients (34% in >75 yrs vs. 22% in ≤65 yrs; p=0.004). Compared to patients <65 yrs, those aged >75 yrs were more likely to have TP53 pathway change (54% vs. 38%; p=0.032). UROMOL genomic class 3 was more frequently observed in patients >75 yrs (42% vs. 24%; p=0.001), who also had higher amounts of altered genome (median: 337.7Mb vs. 168.2Mb; p<0.001). No significant differences were observed in immune cell infiltration scores between age groups. CONCLUSIONS: Among SEER-Medicare patients with NMIBC, advanced age is associated with higher risks of progression and bladder-cancer specific mortality. These results reflect age-related molecular biological differences observed across transcriptomic and genomic domains. Source of Funding: Niyati Lobo was supported by The Urology Foundation-Fulbright Scholar Award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e826 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niyati Lobo More articles by this author Akshay Sood More articles by this author Zhigang Duan More articles by this author Wei Shen Tan More articles by this author Valentina Grajales More articles by this author Sia Viborg Lindskrog More articles by this author Lars Dyrskjøt More articles by this author Aarhus More articles by this author Denmark More articles by this author Hui Zhao More articles by this author Sharon Giordano More articles by this author Stephen B. Williams More articles by this author Ashish M. Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-11 ADVANCED AGE (&gt;70 YEARS) DOES NOT AFFECT ONCOLOGICAL OUTCOMES IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS TREATED WITH ADEQUATE BACILLUS CALMETTE-GUERIN: A COMPETING RISK ANALYSIS FROM a TERTIARY CARE CENTER.

You have accessJournal of UrologyCME1 Apr 2023MP63-11 ADVANCED AGE (>70 YEARS) DOES NOT AFFECT ONCOLOGICAL OUTCOMES IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS TREATED WITH ADEQUATE BACILLUS CALMETTE-GUERIN: A COMPETING RISK ANALYSIS FROM a TERTIARY CARE CENTER. Roberto Contieri, Valentina Grajales, Wei Shen Tan, Kelly Bree, Patrick Hensley, Charles C. Guo, Graciela M. Nogueras-Gonzalez, Neema Navai, Colin P. Dinney, and Ashish M. Kamat Roberto ContieriRoberto Contieri More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Kelly BreeKelly Bree More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Charles C. GuoCharles C. Guo More articles by this author , Graciela M. Nogueras-GonzalezGraciela M. Nogueras-Gonzalez More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin P. DinneyColin P. Dinney More articles by this author , and Ashish M. KamatAshish M. Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the newly released European Association of Urology (EAU) prognostic factor risk groups, age over 70 should be considered an additional clinical risk factor for progression amongst patients with non-muscle invasive bladder cancer (NMIBC). However, this statement is based on an analysis of patients who did not receive intravesical BCG therapy. Herein, we aim to evaluate the impact of age on oncological outcomes in NMIBC patients treated with adequate BCG. METHODS: We performed an IRB approved retrospective study analyzing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Based on EAU guidelines, patients were stratified into two groups according to age ( <70 yrs and>70 yrs). Primary endpoint was cancer-specific mortality (CSM). The cumulative incidence method was used to estimate the risk of CSM, high-grade (HG) recurrence and progression to muscle-invasive BC or metastatic disease after accounting for other causes of death (OCD) as a competing risk event; curves were compared with the Pepe-Mori test. Multivariate competing-risks regression analyses were used to predict HG recurrence and progression according to age after accounting for OCD. RESULTS: A total of 632 patients treated with adequate BCG were identified (355 <70 yrs versus 277>70 yrs). The median follow-up was 64.6 months (Interquartile range: 35.3–99.4) . Older patients were more likely to have a concomitant CIS (29.0% vs. 35.7%, p=0.072), and less likely to undergo second resection (reTUR) (66.2% vs. 56.5%, p=0.013). Despite this, at multivariate competing-risk regression analyses, age>70 did not emerge as an independent predictor of HG recurrence or progression (SHR 1.07, 95% CI: 0.78–1.46; p=0.687 and SHR: 1.60; 95% CI: 0.89–2.89; p=0.118). OS at 5 (94.2% vs. 78.5%) and 10 years (81.1% vs 42.3%) was considerably lower in the>70 yrs group. However, the 5-yr CSM overlap between the age groups (5.1% 95% CI: 2.7-8.7 vs. 2.0% 95% CI: 0.8–4.2). CONCLUSIONS: Age >70 was not associated with significantly worse oncological outcomes in NMIBC patients treated with adequate BCG Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant, NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (p50CA091846), the Cancer Center Support Grant (NCI Grant P30 CA016672). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e875 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Contieri More articles by this author Valentina Grajales More articles by this author Wei Shen Tan More articles by this author Kelly Bree More articles by this author Patrick Hensley More articles by this author Charles C. Guo More articles by this author Graciela M. Nogueras-Gonzalez More articles by this author Neema Navai More articles by this author Colin P. Dinney More articles by this author Ashish M. Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...

MP54-14 MENTAL HEALTH ILLNESS IN PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER. DOES BCG PLAY A ROLE?

You have accessJournal of UrologyCME1 Apr 2023MP54-14 MENTAL HEALTH ILLNESS IN PATIENTS WITH NON-MUSCLE INVASIVE BLADDER CANCER. DOES BCG PLAY A ROLE? Valentina Grajales, Zhigang Duan, Wei Shen Tan, Roberto Contieri, Hui Zhao, Sharon Giordano, Stephen B. Williams, and Ashish M. Kamat Valentina GrajalesValentina Grajales More articles by this author , Zhigang DuanZhigang Duan More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Roberto ContieriRoberto Contieri More articles by this author , Hui ZhaoHui Zhao More articles by this author , Sharon GiordanoSharon Giordano More articles by this author , Stephen B. WilliamsStephen B. Williams More articles by this author , and Ashish M. KamatAshish M. Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to a third of cancer patients experience a mental health condition during their cancer treatment; Bacillus Calmette-Guerin (BCG) has been shown to be neuroprotective. Herein, we assess the incidence of mental health illness (MHI) in non-muscle invasive bladder cancer (NMIBC) patients and the impact of intravesical BCG on the development of non-neurodegenerative MHI. METHODS: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare data set, we identified 30,991 patients diagnosed with NMIBC between 2005-2017. MHI diagnosis and BCG treatment were identified using ICD9/ICD10 diagnosis codes and HCPCS codes from Medicare inpatient, outpatient, and physician claims. We excluded developmental, organic, and neurodegenerative MHI. Descriptive statistics were done using the Pearson’s chi-square test for categorical variables. RESULTS: A total of 27.0% of patients (N=8,367) received at least an induction course of BCG. Pre-existing MHI was present in 15.9% (N=4,928) of patients 1 year prior to bladder cancer diagnosis. These patients had lower rates of induction BCG (23.0% VS 27.8%, p<0.001). Excluding pre-existing MHI, 43.7% (N=11,377) of patients developed MHI after their bladder cancer diagnosis. Both female and older patients had higher rates of developing MHI (p<0.001), Table 1. Patients without pre-existing MHI treated with at least an induction course of BCG (N=7,233) had a lower MHI development rate than those who did not receive BCG (41.5% VS 44.5%, p<0.001). CONCLUSIONS: Patients with NMIBC are at high risk of developing MHI after diagnosis especially elderly and female patients. Patients who received at least induction BCG treatment had lower rates of developing de novo MHI, however, those with pre-existing MHI were less likely to receive BCG. Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e759 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Valentina Grajales More articles by this author Zhigang Duan More articles by this author Wei Shen Tan More articles by this author Roberto Contieri More articles by this author Hui Zhao More articles by this author Sharon Giordano More articles by this author Stephen B. Williams More articles by this author Ashish M. Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...