Non-muscle Invasive Urothelial Carcinoma Of Bladder Research Articles

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.

HER2/neu expression status of post BCG recurrent non-muscle-invasive bladder urothelial carcinomas in relation to their primary ones.

Transurethral resection (TUR) followed by adjuvant therapy is still the treatment of choice of Non-Muscle-Invasive Bladder Urothelial Carcinoma (NMIBUC). However, recurrence is one of the most troublesome features of these lesions. Early second resection and adjuvant BCG therapy has been shown to improve the outcome. To evaluate the prognostic value of C-erbB-2 (HER2/neu) expression status in Non-Muscle-Invasive Bladder Urothelial Carcinoma cases, before and after intravesical Bacillus Calmette Guerin (BCG immunotherapy). HER2/neu expression was studied in 120 (Ta-T1) Non-Muscle-Invasive Urothelial Carcinoma cases. The expression was evaluated and compared to the expression after Bacillus Calmette Guerin (BCG) immunotherapy. HER2/neu expression in low and high grade of the Non- Muscle-Invasive Urothelial Carcinoma was (38%) and (83%) respectively. The difference of the expression rates by tumor grade was statistically significant. In recurring lesions post BCG therapy, C-erbB-2 expression was markedly decreased (31.6%) when compared to its expression before therapy (65%). The HER2/neu expression increased as the tumor grade rose. The reduction in expression following BCG treatment in Non-Invasive transitional cell carcinoma cases could reflect a reduction of the potential malignancy of the tumor.

A Nomogram Model to Predict Recurrence of Non-Muscle Invasive Bladder Urothelial Carcinoma After Resection Based on Clinical Parameters and Immunohistochemical Markers

Objective This study aims to establish a nomogram model by combining traditional clinical parameters with immunohistochemical markers to predict the recurrence of non-muscle invasive bladder urothelial carcinoma (NMIBUC) after resection. Methods In total, 504 patients were included in this study. Of these patients, 353 underwent transurethral resection of bladder tumor (TURBT) in the Yongchuan Hospital of Chongqing Medical University and were identified as a training cohort. Univariate and multivariate Cox regression analyses were used to determine the risk factors associated with recurrence in the training cohort and to establish a nomogram model. A total of 151 patients who were hospitalized in the Second Affiliated Hospital of Chongqing Medical University (validation cohort) were used for further validation. The calibration curve was generated for internal and external model validation. The clinical practicability of this model was further verified by comparing the consistency index (C-index) among various models. Results The mean follow-up time of the training cohort was 45.6 months (range 4–90). In total, 146 patients relapsed in training cohort. After univariate analysis, multivariate analysis further confirmed tumor grade (p=.034), immediate postoperative instillation therapy (p=.025), Ki67 (p=.047), P53 (p=.038) and CK20 (p=.049) as independent risk factors for recurrence, and these factors were included in the nomogram model. The model more accurately predicted recurrence compared with other models based on the highest C-index of 0.82 (95% CI, 0.78–0.86) in the training cohort and 0.80 (95% CI, 0.77–0.83) in the validation cohort. Conclusions This proposed nomogram model based on traditional clinical parameters and immunohistochemical markers can more accurately predict postoperative recurrence in patients with NMIBUC.

SLC14A1 (UT-B) gene rearrangement in urothelial carcinoma of the bladder: a case report

BackgroundBladder cancer (BC) is a common and deadly disease. Over the past decade, a number of genetic alterations have been reported in BC. Bladder urothelium expresses abundant urea transporter UT-B encoded by Slc14a1 gene at 18q12.3 locus, which plays an important role in preventing high concentrated urea-caused cell injury. Early genome-wide association studies (GWAS) showed that UT-B gene mutations are genetically linked to the urothelial bladder carcinoma (UBC). In this study, we examined whether Slc14a1 gene has been changed in UBC, which has never been reported.Case presentationA 59-year-old male was admitted to a hospital with the complaint of gross hematuria for 6 days. Ultrasonography revealed a size of 2.8 × 1.7 cm mass lesion located on the rear wall and dome of the bladder. In cystoscopic examination, papillary tumoral lesions 3.0-cm in total diameter were seen on the left wall of the bladder and 2 cm to the left ureteric orifice. Transurethral resection of bladder tumor (TURBT) was performed. Histology showed high-grade non-muscle invasive UBC. Immunostaining was negative for Syn, CK7, CK20, Villin, and positive for HER2, BRCA1, GATA3. Using a fluorescence in situ hybridization (FISH), Slc14a1 gene rearrangement was identified by a pair of break-apart DNA probes.ConclusionsWe for the first time report a patient diagnosed with urothelial carcinoma accompanied with split Slc14a1 gene abnormality, a crucial gene in bladder.

Effect of continuous saline bladder irrigation with concomitant single instillation of chemotherapy after transurethral resection on intravesical recurrence in patients with non-muscle-invasive bladder cancer.

A single immediate instillation of chemotherapy following transurethral resection of bladder tumor (TURBT) is effective in preventing intravesical recurrence (IVR) in patients with non-muscle-invasive urothelial bladder carcinoma (NMIBC). However, continuous saline bladder irrigation (CSBI) is also performed with a single instillation of chemotherapy (SIC), but its inhibitory effect on IVR remains unclear. In the present study, the effect of CSBI with concomitant SIC following TUR on IVR was evaluated in patients with NMIBC. A retrospective review of 253 patients who underwent TURBT and were clinically and histologically diagnosed with NMIBC at National Defense Medical College Hospital was performed. Doxorubicin (DXR) was administered to all patients. Methods of DXR administration included a single instillation of DXR (60 mg in 30-40 ml saline) in 34 patients (group A), continuous irrigation of the bladder with saline including DXR (80 mg in 1 liter saline) in 40 patients (group B) and overnight CSBI after a single instillation of DXR in 179 patients (group C). The difference in IVR-free survival rates was compared after adjusting for significant differences in several covariates between the groups by nearest-neighbor propensity score matching. Prior to propensity score matching, it was identified that time to IVR was significantly longer in group A than in groups B and C; however, it was observed that several factors significantly differed among the three groups. By using nearest neighbor matching, 18 pairs were matched between groups A and B and 33 pairs between the groups A and C. No significant difference was identified in any covariates between these two matched group pairsTime to IVR was significantly longer in the matched group A than in the matched groups B and C (P=0.0255 and P=0.0023, respectively). In conclusion, SIC alone could provide a higher IVR-free survival rate than CSBI with DXR or CSBI with SIC.

MP72-04 T1 SUBSTAGE IN NON-MUSCLE INVASIVE BLADDER UROTHELIAL CARCINOMA CAN PREDICT PROGRESSION FREE SURVIVAL

You have accessJournal of UrologyBladder Cancer: Non-invasive III (MP72)1 Apr 2020MP72-04 T1 SUBSTAGE IN NON-MUSCLE INVASIVE BLADDER UROTHELIAL CARCINOMA CAN PREDICT PROGRESSION FREE SURVIVAL Yu-kuang Chen*, Tzu-Ping Lin, Yen-Hwa Chang, Junne-Yih Kuo, Hsiao-Jen Chung, Howard Hung-Hao Wu, Eric Yi-Hsiu Huang, Chih-Chieh Lin, Yu-Hua Fan, I-shen Huang, Shih-Yen Lu, Alex T.L. Lin, and William J. Huang Yu-kuang Chen*Yu-kuang Chen* More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , Yen-Hwa ChangYen-Hwa Chang More articles by this author , Junne-Yih KuoJunne-Yih Kuo More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , Howard Hung-Hao WuHoward Hung-Hao Wu More articles by this author , Eric Yi-Hsiu HuangEric Yi-Hsiu Huang More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , Yu-Hua FanYu-Hua Fan More articles by this author , I-shen HuangI-shen Huang More articles by this author , Shih-Yen LuShih-Yen Lu More articles by this author , Alex T.L. LinAlex T.L. Lin More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000952.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For urothelial bladder cancer, the depth of tumor invasion and tumor grade affect prognosis significantly. Among non-muscle invasive bladder urothelial carcinomas (UC) of the urinary bladder, T1 stage have much variable clinical presentation and course. 2016 World Health Organization (WHO) classification recommended the use of substaging, but there is no consensus in optimal system. We analyzed the outcomes of focal and extensive T1 substaging according to the depth of lamina propria invasion (1.0 mm as cut off value) in our institute. METHODS: From 2007 to 2015, patients with pathology report of focal (≤ 1.0 mm) and extensive (>1.0 mm) T1 high grade bladder urothelial carcinoma (UC) were enrolled retrospectively. Patients with history of (pure) CIS, muscle invasive or upper tract UC were excluded. The pathological grading and staging were reported by two pathologists with consensus. The definition of recurrence was reappearance of UC in the bladder, and progression was advancing in stage, metastasis or death caused by UC. Outcomes including recurrence free survival (RFS), progression free survival (PFS), cancer specific (CSS) and overall survival (OS) were analyzed with Kaplan-Meier method. RESULTS: A total of 363 patients were in the cohort, with 55-month follow-up in average. The mean age was 74 (±12.0) years old. One hundred and thirty-eight (38%) patient were classified as T1 focal substage, and 225 patients were T1 extensive. There were no significant differences in the demographic variables including sex, age, smoking or medical comorbidity between the two groups. With Kaplan-Meier survival analysis, PFS was significant shorter (p=0.024, log-rank test, figure) in T1 extensive group, but we were unable to demonstrate a difference in RFS (p=0.168), CSS (p=0.102) or OS (p=0.515) between two groups. After multivariate adjustment with concurrent CIS, tumor size, focality and recurrent status, extensive T1 also showed a poor PFS (HR=1.95, p=0.007), but still no significant difference in RFS (HR=1.35, p=0.061), CSS (HR=1.49, p=0.242) or OS (HR=0.74, p=0.12). CONCLUSIONS: In our single institute cohort, using 1.0 mm as a cut-off value of lamina propria invasion, extensive T1 predicted shorter progression free survival as compared with focal T1. Source of Funding: n/a © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1074-e1075 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yu-kuang Chen* More articles by this author Tzu-Ping Lin More articles by this author Yen-Hwa Chang More articles by this author Junne-Yih Kuo More articles by this author Hsiao-Jen Chung More articles by this author Howard Hung-Hao Wu More articles by this author Eric Yi-Hsiu Huang More articles by this author Chih-Chieh Lin More articles by this author Yu-Hua Fan More articles by this author I-shen Huang More articles by this author Shih-Yen Lu More articles by this author Alex T.L. Lin More articles by this author William J. Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

Evaluation of β-Catenin in Bladder Transitional Cell Carcinoma

Abstract Background Bladder cancer is the fourth most common cancer occurring in United States, second most prevalent cancer in men and tenth most prevalent cancer in women, with age adjusted incidence rate of 24.5 per 100.000 population and mortality rate of 4.2 per 100.000 population per year Because of its high recurrence rate, the actual prevalence of active bladder cancer is estimated to be about 10 times the number of new cases. Aim of the Work This study aims at investigating β-catenin protein expression in bladder transitional cell carcinoma and its possible relation to the clinic-pathological data. Patients and Methods The study was carried out on 80 patients; 60 patients with urothelial Bladder Carcinoma (UBC) and 20 patients with non-malignant lesions (control group); between May 2015 and May 2017. The 60 UBC cases were further divided, according to histopathological criteria, into non-muscle invasive UBC (30 patients) and muscle invasive UBC (30 patients). Results There was a highly a significant difference between β-catenin expression and tumor grade (P = 0.03) ,lymphnode metastasis (P = 0.005), tumor necrosis (P = 0.001) vascular invasion(P = 0.004), and perineural invasion (P = 0.001) No statistical significant relation was found between β-catenin expression either bilharziasis (P = 0.08) ,muscl invasion (p = 0.54) ,or stage (p = 0.7). Conclusion 1-β-Catenin has a role in carcinogenises of UB due to absence of nucleocytoplasmic pattern of β-catenin expression in non- neoplastic cases with its expression in a considerable number of invasive malignant cases and dysplastic urothelium adjacent to carcinoma could refer to the oncogenic role of this expression pattern. Recommendations Further studies on large number of cases of urothelial carcinoma on a longer period of follow up using more accurate diagnostic tools is recommended to elicit the predictive value of these markers on patients’ survival; also further studies on new therapies that target β-catenin or other component of Wnt pathway to detect its efficacy in preventing tumor recurrence or progression especially in non-muscle invasive bladder carcinoma.

IL‑23 concentration‑dependently regulates T24 cell proliferation, migration and invasion and is associated with prognosis in patients with bladder cancer.

Interleukin‑23 (IL‑23, also known as IL23A), is an important proinflammatory cytokine whose role in the development and progression of tumors remains controversial. The present study on IL‑23 focused on its impact on the tumor microenvironment. Existing studies on its direct role on tumor cells are limited. Previously, we reported that the expression level of IL‑23 in human bladder urothelial carcinoma was significantly higher than that in adjacent tissues as determined by immunohistochemistry. In this study, we further validated the results of immunohistochemistry using the Oncomine database and we found that IL23A expression in non‑muscle invasive bladder urothelial carcinoma (NMIBC) was significantly higher than that in muscle invasive bladder urothelial carcinoma (MIBC). Expression of IL23A was negatively correlated with the clinical stage of bladder urothelial carcinoma and had a positive correlation with prognosis. Invitro experiments revealed that different concentrations of IL‑23 had different effects on T24 cells. A low concentration of 20ng/ml IL‑23 promoted T24 cell proliferation, migration, invasion and EMT transformation, while a high concentration of 40ng/ml IL‑23 inhibited these functions. These results indicated that IL‑23 plays a dual role in the progression of bladder cancer. Low concentrations of IL‑23 promote bladder tumor progression, while high concentrations of IL‑23 have the opposite effect.

Impact of squamous and/or glandular differentiation on recurrence and progression following transurethral resection for non-muscle invasive urothelial carcinoma of bladder.

The aim of the present study was to investigate the impact of squamous and/or glandular differentiation on the recurrence and progression in patients with nonmuscle invasive urothelial carcinoma of bladder (NMIUCB) following transurethral resection (TURBT). A total of 869 patients with NMIUCB who had been treated with TURBT at The Second Hospital of Tianjin Medical University (Tianjin, China) between January 2006 and January 2011 were retrospectively selected for the present analysis. Associations among squamous and/or glandular differentiation with other clinical and pathological features were assessed by the χ2 test. Recurrence-free survival (RFS) and progression-free survival (PFS) curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed through a Cox's proportional hazards regression model. Among the 869 patients, 232 (26.7%) patients had squamous and/or glandular differentiation. High grade tumors were more common in patients with squamous and/or glandular differentiation compared with those with pure urothelial carcinoma of bladder (P<0.001). Associations between age (P=0.115), sex (P=0.184), tumor size (P=0.223), tumor multiplicity (P=0.108), pathological tumor stage (P=0.909) and squamous and/or glandular differentiation were not observed to be statistically significant. There was a significant tendency towards higher recurrence rate and shorter RFS time in patients with squamous and/or glandular differentiation. However, no statistically significant differences were observed in progression rate and PFS between the two groups. The multivariate Cox regression analysis, identified squamous and/or glandular differentiation as an independent prognostic predictor of recurrence (hazard ratio =1.46, 95% confidence interval=1.10–1.92, P=0.008). In the present study, the presence of squamous and/or glandular differentiation was associated with a higher recurrence rate and shorter RFS time in patients with NMIUCB. Squamous and/or glandular differentiation is therefore an independent prognostic predictor of recurrence.

AB176. Impact of squamous and/or glandular differentiation on recurrence and progression after transurethral resection for non-muscle invasive urothelial carcinoma of bladder

ObjectiveTo investigate the impact of squamous and/or glandular differentiation on recurrence and progression in patients with non-muscle-invasive urothelial carcinoma of bladder (NMIUCB) following transurethral resection (TURBT).MethodsA total of 869 patients with NMIUCB treated with TURBT at our institution from January 2006 to January 2011 were selected retrospectively for the analysis. Correlations among squamous and/or glandular differentiation with other clinical and pathological features were assessed by chi-square. Recurrence-free survival (RFS) and progression-free survival (PFS) curves were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed through a Cox proportional hazards regression model.ResultsAmong 869 consecutive patients, 232 (26.7%) patients had squamous and/or glandular differentiation. High grade tumors were more common in patients with squamous and/or glandular differentiation than those with pure UCB (P<0.001). Correlations between age (P=0.115), gender (P=0.184), tumor size (P=0.223), tumor multiplicity (P=0.108), pathological tumor stage (P=0.909) and squamous and/or glandular differentiation were not statistically significant. There was a statistically prominent tendency towards higher recurrence rate and shorter RFS time in patients with squamous and/or glandular differentiation. However, no statistically significant differences were observed in progression rate and PFS between the two groups. On multivariate Cox regression analysis, squamous and/or glandular differentiation was identified as an independent prognostic predictor of recurrence (HR 1.46, 95% CI, 1.10–1.92, P=0.008).ConclusionsThe presence of squamous and/or glandular differentiation could be associated with higher recurrence rate and shorter RFS time in patients with NMUCB. It is an independent prognostic predictor of recurrence.

Impact of ABO Blood Type on Outcomes in Patients with Primary Nonmuscle Invasive Bladder Cancer

ABO blood type is an established prognostic factor for several malignancies but its role in bladder urothelial carcinoma is largely unknown. We determined whether ABO blood type is associated with the outcome of transurethral resection of nonmuscle invasive bladder urothelial carcinoma. We retrospectively studied ABO blood types in 931 patients with primary nonmuscle invasive bladder urothelial carcinoma treated with transurethral bladder resection with or without intravesical instillation therapy. Disease recurrence and progression were analyzed with univariable and multivariable competing risks regression models. Median followup was 67 months. Discrimination was evaluated by the concordance index. The ABO blood type was O, A, B and AB in 414 (44.5%), 360 (38.7%), 103 (11.1%) and 54 patients (5.8%), respectively. ABO blood type was significantly associated with outcome on univariable and multivariable analysis. Overall, patients with blood type O had worse recurrence and progression rates than those with A (p = 0.015 and 0.031) or B (p = 0.004 and 0.075, respectively). The concordance index of multivariable base models increased after including ABO blood type. In patients with nonmuscle invasive bladder urothelial carcinoma the ABO blood type may predict the outcome. Those with blood type O showed the highest recurrence and progression rates. Including ABO blood type in multivariable models increases the accuracy of standard prognostic factors. Since the ABO blood type is available for most patients, it may represent an ideal adjunctive marker to predict recurrence and progression. The biological explanation and prognostic value of this finding must be further elucidated.

Bacillus Calmette-Guérin Failure in Patients with Non–Muscle-invasive Urothelial Carcinoma of the Bladder May Be Due to the Urologist's Failure to Detect Urothelial Carcinoma of the Upper Urinary Tract and Urethra

BackgroundVarious reasons exist for so-called bacillus Calmette-Guérin (BCG) failure in patients with non–muscle-invasive urothelial bladder carcinoma (NMIBC). ObjectiveTo explore whether urothelial carcinoma of the upper urinary tract (UUT) and/or prostatic urethra may be a cause for BCG failure. Design, setting, and participantsRetrospective analysis of 110 patients with high-risk NMIBC repeatedly treated with intravesical BCG, diagnosed with disease recurrence, and followed for a median time of 9.1 yr. InterventionTwo or more intravesical BCG induction courses without maintenance. Outcome measurements and statistical analysisPrimary outcome was pattern of disease recurrence (BCG failure) within the urinary tract categorised into UUT and/or urethral carcinoma (with or without intravesical recurrence), and intravesical recurrence alone. Secondary outcome was survival. Predictors of UUT and/or urethral carcinoma and the effect of pattern of disease recurrence on cancer-specific survival were assessed with multivariable Cox regression analysis adjusting for multiple clinical and tumour characteristics. Results and limitationsOf the 110 patients, 57 (52%) had UUT and/or urethral carcinoma (with or without intravesical recurrence), and 53 (48%) had intravesical recurrence alone. In patients with UUT and/or urethral carcinoma, bladder carcinoma in situ (Tis) before the first and second BCG course was present in 42 of 57 (74%) and 47 of 57 (82%) patients, respectively. On multivariable analysis, bladder Tis before the first and/or second BCG course was the only independent predictor of UUT and/or urethral carcinoma. Of the 110 patients, 69 (63%) were alive at last follow-up visit, 18 (16%) had died due to metastatic urothelial carcinoma, and 23 (21%) had died of other causes. Pattern of disease recurrence within the urinary tract was not an independent predictor of cancer-specific survival. Main study limitations were retrospective design and limited power for survival analysis. ConclusionsIn our patients with high-risk NMIBC failing after two or more courses of intravesical BCG, UUT and/or urethral carcinoma was detected in >50% of the cases during follow-up. The vast majority of these patients had bladder Tis before the first and/or second BCG course. In patients experiencing the so-called BCG failure, a diagnostic work-up of UUT and prostatic urethra should always be performed to exclude urothelial carcinoma before additional intravesical therapy or even a radical cystectomy is considered.

Association of Oncofetal Protein Expression with Clinical Outcomes in Patients with Urothelial Carcinoma of the Bladder

Oncofetal proteins are expressed in the developing embryo. Oncofetal protein expression correlates with the clinical outcome of nonmuscle invasive bladder urothelial carcinoma. IMP3, MAGE-A, glypican-3 and TPBG are oncofetal proteins that have not been well characterized in urothelial carcinoma of the bladder. We investigated the expression of these 4 proteins and their association with clinical outcomes using tissue microarrays from 384 consecutive patients treated with radical cystectomy between 1988 and 2003 at 1 academic center. We stained for IMP3, MAGE-A, glypican-3 and TPBG. Univariable and multivariable Cox regression analyses were done to evaluate the association of oncofetal protein expression with disease recurrence and cancer specific mortality. IMP3, MAGE-A, glypican-3 and TPBG were expressed in 39.5%, 45%, 6% and 85% of urothelial bladder carcinomas, respectively. Expression was tumor specific and did not correlate with pathological features except for TPBG. At a median followup of 128 months 176 patients (46%) experienced disease recurrence, 175 (45.5%) had died of the disease and 96 (27.5%) had died of another cause. On univariable analysis IMP3 and MAGE-A expression was associated with an increased risk of disease recurrence (p <0.001 and 0.03) and cancer specific mortality (p = 0.004 and 0.03, respectively). On multivariable Cox regression analysis adjusted for the effects of standard clinicopathological features IMP3 and MAGE-A expression was independently associated with disease recurrence (p = 0.004, HR 1.55, 95% CI 1.15-2.11 and p = 0.02, HR 1.44, 95% CI 1.05-1.99, respectively) but not with cancer specific mortality. Oncofetal proteins are commonly and differentially expressed in urothelial carcinoma of the bladder compared to normal urothelium. IMP3 and MAGE-A expression was associated with disease recurrence and cancer specific mortality but glypican-3 and TPBG expression was not.

Development of a disease recurrence risk predicting model in non-muscle invasive bladder urothelial carcinoma

Objective To develop a nomogram which can accurately predict the disease recurrence risk after the transurethral resection of bladder tumor (TURBT) in patients with non-muscle invasive bladder urothelial carcinoma.Methods There were 317 patients in total with newly diagnosed non-muscle invasive bladder urothelial carcinoma from 1998 to 2007 enrolled in this study.The patient's gender,age,smoking history,drinking history,comorbidity of renal failure,time from diagnosis to operation,tumor size,tumor number,tumor grade,and intravesical therapy served as the predictors of the disease recurrence.Every prognosis factor were analyzed and screened through univariate and multivariate Cox proportional hazard regression statistical analysis,and the nomograms that could be used to predict the 3-year and 5-year recurrence probability after the surgery were developed.And the prediction accuracy of the nomogram had been internal validated and calibrated as well.Results Of the 317 patients,the three-year and five-year disease recurrence rates were 36.9％ (117/317) and 43.5％ (138/317),respectively.The patient's gender (RR=0.617,P=0.011),age (RR=1.369,P=0.088),tumor size (RR=1.474,P=0.030),tumor number (RR =1.663,P =0.002),tumor grade (RR =1.880,P =0.000),and comorbidity of renal failure (RR =3.646,P =0.000) had been proved to be the prognosis factors with significantly statistical difference.The predictive accuracy of the nomograms predicting the 3-year and 5-year disease recurrence after the surgery was 75.2％ and 68.3％,respectively.Conclusion The nomograms can provide individualized accurate risk estimations for patients,and therefore it can provide assured proof to formulate the individualizing treatment and follow-up protocol in clinic. Key words: Bladder neoplasms; Carcinoma; Prognosis; Nomogram

Overexpression of Eg5 predicts unfavorable prognosis in non‐muscle invasive bladder urothelial carcinoma

To investigate the relationship between Eg5 expression and prognosis of patients with non-muscle invasive bladder urothelial carcinoma. Eg5 expression was examined by immunohistochemistry in non-muscle invasive urothelial carcinoma specimens (grade: G1, 32 cases; G2, 92 cases; and G3, 39 cases. Stage: pTa, 49 cases and pT1, 114 cases). The correlation between clinicopathological characteristics and Eg5 expression was evaluated. The prognostic significance of Eg5 immunoreactivity was analyzed through survival analysis in 163 non-muscle invasive cases that were treated with transurethral resection and adjuvant intravesical instillations. The expression of Eg5 was significantly associated with tumor grade (P = 0.006), with a trend towards significant association with stage (P = 0.057). The 163 patients with non-muscle invasive tumors were regularly followed with the mean of 32.52 (from 6 to 72) months. Univariate analysis showed Eg5 overexpression exhibited a significant unfavorable influence on intravesical recurrence (P = 0.012) while having only a marginal correlation with disease progression (P = 0.070). Subsequent Cox hazard multivariate analysis showed that both grade (P = 0.045) and Eg5 expression (P = 0.029) were independent predictors for early intravesical recurrence. Overexpression of Eg5 correlates with poor differentiation of bladder cancer, and it represents an independent prognostic factor in predicting early intravesical recurrence in non-muscle invasive bladder carcinoma patients.