Presence Of Cis Research Articles

The impact of double-J ureteral stenting before radical cystectomy on the development of upper tract urothelial carcinoma.

It is controversial whether the use of a double-J stent (DJ) in patients with bladder cancer before radical cystectomy (RC) increases the risk of tumour seeding in the upper tract and thus the risk of metachronous upper tract urothelial carcinoma (UTUC). The aim of our study is to investigate the risk of upper tract recurrence after RC in patients previously managed with a DJ stent. A total of 699 patients who had undergone RC between January 2003 and March 2022 with complete perioperative data and pathological outcome were included in our study. Patients treated preoperatively with a DJ stent were identified and compared for development of metachronous UTUC with those who did not receive prior internal stenting. Multivariable Cox regression analysis was used to determine predictors of UTUC occurrence among the possible pathological features; risk factors for mortality after RC were also examined. Of 699 patients, 117 (16.7%) were managed preoperatively with a DJ stent. The overall probability of metachronous UTUC was 1%, 4% and 6% at 1, 3 and 5 years, respectively. The groups with and without DJ stenting were comparable regarding their clinicopathologic features, except for the higher incidence of hydronephrosis in the DJ group. At similar follow-up periods (median follow-up 32 months), metachronous UTUC was detected in four (3.4%) patients in the DJ group and in 13 (2.2%) in the non-stented group (P=0.44). The median interval (IQR) from cystectomy to UTUC was 40.5 (20-49) months in the DJ group and 37 (24-82) in the non-stented group (P=0.7). In the multivariable analysis, only presence of CIS (HR 3.83, 95% CI 1.19-12.29, P=0.024) and positive ureteral margin (HR=5.2, 95% CI 1.38-19.57, P=0.015) were predictors of metachronous UTUC. The study is limited by the retrospective nature and relatively short follow-up. Ureteral stenting for management of hydronephrosis in patients with bladder cancer undergoing RC is a viable option, without higher risk for UTUC or mortality. Patients with positive ureteral margin and CIS are considered high-risk groups for upper tract recurrence and should receive long-term, rigorous follow-up.

Recursive Partitioning Analysis to Define Prognostic Groups Using a Large Single Institution Experience of Multimodality Radiation Therapy for Bladder Cancer

<h3>Purpose/Objective(s)</h3> We analyzed a cohort of patients who received definitive trimodality therapy (TMT) for bladder cancer at a single high-volume institution. We hypothesized that a recursive partitioning analysis (RPA) including patient and tumor characteristics would allow stratification of patients into clinically meaningful prognostic groups for local recurrence. <h3>Materials/Methods</h3> A retrospective cohort analysis was performed for bladder cancer patients treated with definitive radiation or chemoradiation therapy from 2006 to 2021 at our institution. We assessed overall and disease-free survival for the cohort and as a function of clinical and pathologic features. We performed an RPA for multivariate decision tree analysis to associate outcomes with individual clinical and pathologic variables. <h3>Results</h3> 175 patients were identified who were treated with definitive radiation (28%) or chemoradiation (72%) and had adequate follow-up data for analysis. Median follow up time was 23 months (Median age=78 [IQR 71-84], 77% male). While Grade 1-2 toxicities were common, Grade ≥3 toxicities were rare and there were no treatment related deaths. Cumulative 2yr and 5yr CSS were 79% and 61%, respectively. Radical cystectomy (RCx) eligible patients (35%) had a significantly longer OS after bladder sparing therapy compared to RCx ineligible patients (5y OS 54% vs 29%, Log-Rank p=0.003), however no difference in cancer specific survival was seen between groups (5y CSS 61% vs 58%, Log-Rank p = 0.851). Tumor size greater than 5cm did not correlate with risk of recurrence (Log-Rank p=0.194). The most common site of recurrence in the cohort was distant (35%), followed by locoregional (19%) and bladder only (6%). Nine patients (5%) underwent salvage cystectomy (7 for invasive local recurrence) after initial definitive radiation therapy. Using RPA and decision tree analysis, the presence of CIS and older age at treatment were the strongest predictors of local recurrence. The RPA results confirmed no significant association between tumor size and risk of local recurrence. <h3>Conclusion</h3> Multimodality bladder preservation had CSS comparable to modern surgical series and high rates of functional organ preservation. Cystectomy candidacy was a strong predictor of overall survival but not cancer specific survival, suggesting group level mismatches in competing risks of death. Extensive CIS was associated with increased risk of local failure, but tumor size may not be a reliable predictor of treatment response. RPA prognostic groups were generated which may be used to guide clinical decision making and improve patient selection for bladder preservation.

Efficacy of hyperthermic-intra-vesical chemotherapy in patients with BCG-refractory nonmuscle-invasive bladder cancer.

4592 Background: In Bacillus Calmette-Guérin (BCG) refractory non-muscle-invasive bladder cancer (NMIBC), radical cystectomy is the standard of care. For patients unwilling or unable to undergo cystectomy, alternative intravesical therapies are currently being investigated to minimize the risk of recurrence and progression. Chemohyperthermia by HIVEC (Hyperthermic-Intra-Vesical Chemotherapy) is a therapeutic option in BCG-refractory patients. The objective of our study was to evaluate the 2-year oncological results of HIVEC in BCG-refractory patients. Methods: Between June 2016 and September 2021, patients treated with HIVEC (6 weekly instillations) for BCG-refractory NMIBC were prospectively included in our study. These patients had a theoretical indication for cystectomy but were ineligible for surgery or refused it. The primary endpoint was 1-year recurrence-free survival (RFS) rate. Secondary endpoints were 6-month complete response rate for Cis, 1-year overall and cancer-specific survival rates and bladder preservation rate. Results: Seventy patients, mean age 70 [42-89] years, were treated consecutively. After a mean follow-up of 20.9 months, 32 patients recurred (mean time of 10.6 months) and 7 patients finally had a cystectomy. The recurrence-free survival rate was 53.1% at 1 year and 20.5% at 2 years. Six patients progressed to a muscle-invasive disease, after a mean delay of 6.7 months. Four of them experienced metastatic progression and died from bladder cancer. Cancer-specific and overall survival rates were 95.1% and 92.9% at 1 year, and 87.5% and 77.8% at 2 years. The bladder preservation rate was 90%. For patients with Cis (34% of the entire series), the 6-month complete response rate was 75%. The presence of Cis was not a predictive factor of response to HIVEC. Tolerance was excellent with 38.2% grade 1-2 adverse events and no grade 3-4 adverse events. Conclusions: Chemohyperthermia using the HIVEC device achieved a RFS rate of 53.1% at 1 year and enabled a bladder preservation rate of 90%. While cystectomy remains the standard of care, HIVEC may be discussed cautiously for patients who are not eligible for surgery and well informed of the risk of progression to muscle-invasive disease.

Effects of Bismuth Oxide Nanoparticles, Cisplatin and Baicalein-rich Fraction on ROS Generation in Proton Beam irradiated Human Colon Carcinoma Cells

Abstract Introduction: Proton beam radiotherapy is an advanced cancer treatment technique, which would reduce the effects of radiation on the surrounding healthy cells. The usage of radiosensitizers in this technique might further elevate the radiation dose towards the cancer cells. Material and methods: The present study investigated the production of intracellular reactive oxygen species (ROS) due to the presence of individual radiosensitizers, such as bismuth oxide nanoparticles (BiONPs), cisplatin (Cis) or baicalein-rich fraction (BRF) from Oroxylum indicum plant, as well as their combinations, such as BiONPs-Cis (BC), BiONPs-BRF (BB), or BiONPs-Cis-BRF (BCB), on HCT-116 colon cancer cells under proton beam radiotherapy. Results: It was found that the ROS in the presence of Cis at 3 Gy of radiation dose was the highest, followed by BC, BiONPs, BB, BRF, and BCB treatments. The properties of bismuth as a radical scavenger, as well as the BRF as a natural compound, might contribute to the lower intracellular ROS induction. The ROS in the presence of Cis and BC combination were also time-dependent and radiation dose-dependent. Conclusions: As the prospective alternatives to the Cis, the BC combination and individual BiONPs showed the capacities to be developed as radiosensitizers for proton beam therapy.

No Added Benefit of Systematic Bladder Biopsies after BCG Induction in High-Risk Non-Muscle-Invasive Bladder Cancer Optimally Managed

Objectives: To evaluate the added detection benefit of routine transurethral biopsies after an induction course of intravesical Bacillus Calmette-Guérin (BCG) for high-grade NMIBC. Methods: We retrospectively included all patients who underwent white and blue light TURB, subsequent adjuvant induction scheme of BCG, followed by post-instillation biopsies. We excluded patients in whom a prior BCG induction course failed those with synchronous upper tract urothelial carcinoma, and those who did not receive the full 6-week course. A total of 62 patients met inclusion criteria and their records were analyzed. Cystoscopy findings, urine cytology and pathological results of transurethral biopsy were evaluated. Sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios and diagnostic accuracy were calculated for cystoscopy and cytology separately and in combination. Results: After BCG, a total of 342 bladder biopsy were taken with a median of 5 (IQR 2) per case. The biopsy was positive in 13 patients (21%). The median number of positive biopsies was 2 (IQR 1) and the total number of positive biopsies was 27 (8%). The biopsy was positive at the initial tumor site in 8 patients (61.5%). No complications of Clavien III to V were reported. Out of 62 patients who underwent systematic transurethral biopsy, only 3 (5%) presented complications from grade I to II. We found a significant association of positive biopsy with positive urinary cytology (p &lt;0.001) and the presence of erythematous lesions (p &lt;0.02) or visible tumors (p &lt;0.001) at cystoscopy. The pre-BCG stage T (p = 0.32), the presence of CIS (p = 0.71), the multifocal tumor (p = 0.41) and the size (p = 0.52) were not associated with a positive biopsy occurrence. For normal bladder mucosa the predictive value of negative biopsy in cases with negative vs positive cytology was 98% vs 79% (p 0.001). Conclusion: Routine transurethral bladder biopsies after a BCG induction course are not mandatory in the modern era of NMIBC management.

MP16-10 RECURRENCE AT FIRST EVALUATION (THREE-MONTH CYSTOSCOPY) AFTER BACILLUS CALMETTE-GUERIN INDUCTION THERAPY: NOMOGRAMS OF RECURRENCE CHARACTERISTICS CAN PREDICT ONCOLOGICAL OUTCOMES

You have accessJournal of UrologyBladder Cancer: Non-invasive II (MP16)1 Sep 2021MP16-10 RECURRENCE AT FIRST EVALUATION (THREE-MONTH CYSTOSCOPY) AFTER BACILLUS CALMETTE-GUERIN INDUCTION THERAPY: NOMOGRAMS OF RECURRENCE CHARACTERISTICS CAN PREDICT ONCOLOGICAL OUTCOMES Islam R. Mansour, Amr A. Elsawy, Ahmed Elghareeb, and Ahmed Harraz Islam R. MansourIslam R. Mansour More articles by this author , Amr A. ElsawyAmr A. Elsawy More articles by this author , Ahmed ElghareebAhmed Elghareeb More articles by this author , and Ahmed HarrazAhmed Harraz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002001.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrence at 3-month cystoscopy after BCG-induction therapy is a poor prognostic indicator in high-risk NMIBC. We lack tools to predict oncological outcomes in individual patients with different patterns of first evaluation recurrence. We aim to assess the prognostic implications of different recurrence patterns at 3-month after BCG-induction and to provide nomograms that allow prediction of further tumor recurrence and progression. METHODS: We retrospectively analyzed database for NMIBC. Between 2000 and 2018, 231 patients high-risk NMIBC developed recurrence at 3-month after BCG-induction. The data were randomly split into training (75%) and validating (25%) datasets based on the outcome variable (recurrence/progression). Kaplan Meier curve was utilized to estimate the recurrence-free survival (RFS) and progression-free survival (PFS). COX regression analysis was performed to identify independent predictors. The COX multivariate model was used to develop two nomograms for factors predicting the RFS and PFS at 1-yr and 2-yr. Calibration plots and decision curve analysis (DCA) in the validating datasets were established for both nomograms. RESULTS: Data were split into training (174 patients) and validating (57 patients) datasets with no significant difference in-between. Using the training dataset, only the presence of CIS was shown to independently predict RFS. Nomogram depicting the probabilities of RFS at 1- and 2-yr was constructed with accuracy 83% (95% CI: 0.74-0.92) and 82% (95% CI: 0.74-0.92), respectively. On the other hand, CIS, trigonal tumors and non-papillary lesions independently predict PFS. Nomogram depicting the probabilities of PFS at 1- and 2-yr was constructed with accuracy 72% (95% CI: 63%-95%) and 72% (95% CI: 54%-90%). CONCLUSIONS: Findings at 3-month cystoscopy significantly predicted the RFS and PFS. CIS was an independent predictor for RFS while CIS, trigonal tumors and non-papillary tumors were independent predictors of PFS. We developed and internally validated two nomograms that might help joint decision making between the physician and patient. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e300-e300 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Islam R. Mansour More articles by this author Amr A. Elsawy More articles by this author Ahmed Elghareeb More articles by this author Ahmed Harraz More articles by this author Expand All Advertisement Loading ...

A Retrospective Analysis of Clinical and Pathologic Characteristics of Recurrent Bladder Tumor in a Tertiary Hospital in Addis Ababa, Ethiopia.

Previous recurrences, tumor category (Ta, T1), the presence of CIS with superficial bladder tumors, the number of tumors, tumor size and multiplicity are predictors of bladder tumor recurrence. Recurrence is better predicted by multiplicity, size and previous recurrence. This is retrospective descriptive study. All patients with urinary bladder tumor admitted to TASH from January 1st, 2018 to December 31st, 2019 is the study population. Information was retrieved using structured questionnaire. Most of the recurrent tumors 55 (76.4%) had huge size and were multiple 62 (86.1%) in the primary presentation. Most recurrent tumors 47 (65.3%) are low grade bladder tumors. About 17 (23.6%) were high grade tumor in their primary presentation. European studies showed size and multiplicity increase risk of recurrence. However, our patients have late presentations which probably made the proportion of recurrence higher. Most of the recurrent bladder tumors have huge size and multiple in number at their initial presentation. All histological variants of Urothelial carcinomas recur.

Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients

Introduction and objectivesThe goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging.Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival.We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. Material and methodsIn our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS.In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. ResultsThe following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. ConclusionsThe most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.

Factores de riesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes con enfermedad T1G3

Introduction and objectivesThe goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging.Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival.We present here the patient and tumor factors that may influence the presence of residual disease at re-TUR. Material and methodsIn our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS.In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. ResultsThe following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001. The presence of muscle in the specimen was no longer significant, while the presence of CIS only remained significant in the model with tumor size, p < 0.001. ConclusionsThe most significant factors for a higher risk of residual disease at re-TUR in T1G3 patients are multifocal tumors and tumors more than 3 cm. Patients with concomitant CIS and those without muscle in the specimen also have a higher risk of residual disease.

The impact of carcinoma in situ in ureteral margins during radical cystectomy: A case-controlled study

Background and objectiveThe presence of carcinoma in situ (Cis) in association with bladder cancer is associated with a poor prognosis. However, the prognosis associated with the presence of Cis in ureteral margins (CUM) during radical cystectomy has been poorly defined.To assess the prognosis associated with the presence of Cis in ureteral margins in patients with pM0 bladder cancer who have not undergone neoadjuvant chemotherapy. Materials and MethodsA retrospective case-control study was conducted between 2001 and 2016 using data from one academic center in France.From 1,450 radical cystectomies, 122 patients (case) who had CUM were matched according to age, sex, pTNM stage and urinary diversion method with a population sample of 122 patients (controls) who did not have Cis in ureteral margins during radical cystectomy.The survival analysis was performed by Kaplan-Meier using a (95%) CI. Multivariate Cox regression analysis was used to test the effect of CUM on cancer-specific survival. Recurrence-free survival was defined as a recurrence of urothelial carcinoma in the upper urinary tract. Results and limitationsThe mean follow-up period was 55.43 ± 39.6 months. The rate of Cis in the bladder in the CUM cases group was evaluated at 11.47%. The median overall and specific survival was inferior in the CUM cases group estimated at 43.3 [35.33-56.93] months, 52.43 [42.16-68.93] months respectively compared to the control group with a significant difference (P= 0.001, P= 0.0039). The cumulative probability of urothelial recurrence-free survival was decreased in the case group compared with the control group (63.9% vs. 92.6%, P = 0.0001).Multivariate analysis shown that urothelial recurrence was associated with CUM [(P <0.001), (HR adjusted =11.31), (95% CI): (3.38-37.77)] and the macroscopic appearance of the ureter (thickened, dilated) [(P= 0.003), (HR adjusted =4.62), (95% CI): (3.31-8.84)]. ConclusionCUM is a poor prognostic factor that impacts cancer-specific survival and Recurrence-free survival. The presence of CUM has been independently associated with a significant increase in the risk of urothelial recurrence, and a decrease in both overall and specific survival. This supports the use of frozen section analysis to complete radical cystectomy without CUM.

Gemcitabine based trimodality treatment in patients with muscle invasive bladder cancer: May neutrophil lymphocyte and platelet lymphocyte ratios predict outcomes?

PurposeCisplatin based chemoradiation has been commonly used as a definitive treatment for muscle-invasive bladder cancer (MIBC). The aim of the current study is to evaluate oncologic results and toxicity profile of bladder-sparing treatment with external beam radiotherapy (EBRT) and gemcitabine chemotherapy (ChT) in patients with MIBC. Materials and MethodsBetween April 2005 and November 2018 44 patients with nonmetastatic and N0 MIBC were treated with transurethral resection of bladder (TURB), EBRT and concurrent gemcitabine. All patients were staged using thorax-abdomen-pelvic CT and pelvic MRI. EBRT was delivered using 3D conformal technique or intensity modulated radiotherapy. Patients received 50 Gy in 25 to 28 fractions to full bladder followed by a boost dose of 10 Gy in 5 fractions to empty bladder with weekly concurrent gemcitabine of 50 mg/m2. All patients were evaluated for age, gender, smoking status, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) at diagnosis, presence of hydroureteronephrosis (HUN), preoperative tumor size, tumor multifocality, presence of CIS, clinical tumor stage. Acute/late genitourinary (GUS) and gastrointestinal (GIS) toxicity, recurrence status, cancer specific survival (CSS) and overall survival (OS) were evaluated. Statistical analysis was performed using SPSS v21.0. Kaplan-Meier survival estimates were calculated to describe CSS and OS. The effect of different parameters on survival was investigated using the log rank test. ResultsMedian age of the patients was 72 years (interquartile [IQR]; 66–80). The median tumor size was 30 mm (IQR, 15–59 mm). Thirty-two (77%) patients had T2, 6 (14%) patients had T3, and 4 (9%) patients had T4a disease. Median NLR was 2.6 (IQR, 1.7–3.8) and median PLR was 126.47 (IQR, 77.4–184.8). Median follow-up time was 21 months (range, 6–153 months). At the first TURB performed 6 weeks after CRT, complete response, partial response, stable disease, and progression was detected in 37 (84%), 3 (7%), 1 (2%), and 3 (7%) patients, respectively. One- and 2-year OS, CSS, LRFS, and DMFS rates were 86% and 64%; 88% and 66%; 65% and 44%; 68% and 48%, respectively. In univariate analysis; prognostic factors were age and presence of HUN for OS and DMFS; age, HUN, presence of CIS, NLR, and PLR for DSS; HUN, NLR, and PLR for LRFS, respectively. In multivariate analysis, the independent predictor was the presence of HUN for OS, LRFS, and DMFS; NLR for DSS; PLR for LRFS and age for DMSF. For a subgroup of 17 patients with complete TURB and no CIS and HUN symptoms, 2-year OS, DSS, LRFS, and DMFS rates were 88%, 88%, 72%, and 79%, respectively. The treatment was well-tolerated and all patients completed the planned EBRT and ChT. No acute or late ≥ grade 3 toxicity was observed. Grade II acute GIS toxicity was detected in 3 (7%) patients and grade II acute GUS toxicity was detected in 9 (21%) patients, respectively. Grade II late GUS toxicity was observed in 2 (5%) patients. ConclusionGemcitabine based trimodality treatment is well-tolerated with similar oncologic outcomes reported in the literature. Older age, presence of CIS and high NLR and PLR values seem to deteriorate DSS.

An Insight into the Solid-State Miscibility of Triacylglycerol Crystals.

The crystallization properties of triacylglycerols (TAGs) strongly determine the functional properties of natural lipids. The polymorphic and mixing phase behavior of TAG molecules have long been, and still are, a hot topic of research with special relevance for the cosmetic, pharmaceutical, and food industry. To avoid the difficulties arising from the study of whole real fats, studies at the molecular level on mixtures of a limited number of TAGs has become an indispensable tool to identify the underlying causes of the physical properties in lipid systems. In particular, phase diagrams of binary mixtures of TAGs exhibiting a different degree of heterogeneity (monoacid or mixed fatty acids; molecular symmetry; the presence of cis or trans double bonds) have resulted in a significant breakthrough in our knowledge about structure–interaction–function relationships. The present work aims to provide an overview of the main reports regarding binary and ternary TAG systems, from the early studies to the most recent developments.

PD60-04 SURVIVAL ANALYSIS AND PREDICTORS OF NON-MUSCLE INVASIVE BLADDER CANCER RECURRENCE IN CLINICAL COMPLETE-RESPONDERS AFTER NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive VI (PD60)1 Apr 2020PD60-04 SURVIVAL ANALYSIS AND PREDICTORS OF NON-MUSCLE INVASIVE BLADDER CANCER RECURRENCE IN CLINICAL COMPLETE-RESPONDERS AFTER NEOADJUVANT CHEMOTHERAPY FOR MUSCLE-INVASIVE BLADDER CANCER Helena Vila-Reyes*, Kevin Lee, G.Joel Decastro, Gen Li, Christopher R. Haas, Jamie S. Pak, Izak Faiena, Christopher B. Anderson, and James M. McKiernan Helena Vila-Reyes*Helena Vila-Reyes* More articles by this author , Kevin LeeKevin Lee More articles by this author , G.Joel DecastroG.Joel Decastro More articles by this author , Gen LiGen Li More articles by this author , Christopher R. HaasChristopher R. Haas More articles by this author , Jamie S. PakJamie S. Pak More articles by this author , Izak FaienaIzak Faiena More articles by this author , Christopher B. AndersonChristopher B. Anderson More articles by this author , and James M. McKiernanJames M. McKiernan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000977.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) with neoadjuvant chemotherapy (NAC) is the gold standard treatment for muscle-invasive bladder cancer (MIBC), but 30-40% of the patients achieve a clinical complete response (cCR) after NAC. In cT0 patients who elect bladder preservation, non-muscle invasive (NMIBC) and MIBC relapses may appear during the follow-up. The outcomes of MIBC relapse have been extensively assessed, while NMIBC have been less studied. We report the outcomes and predictive factors related to NMIBC recurrence in patients with cCR following NAC for MIBC who elected surveillance. METHODS: We retrospectively reviewed our cohort of cCR after NAC for MIBC, and selected patients who chose subsequent bladder preservation. Clinical T0 status was assessed with negative re-TURBT, cytology and imaging after NAC. Patients with immediate partial or RC post-NAC and those with positive lymph nodes or metastases pre-NAC, were excluded. Uni- and multivariate models were used to identify predictive factors of NMIBC recurrence and response rate to BCG-treatment. Kaplan Meier estimator and log-rank test were used for survival analysis. RESULTS: We identified 60 patients with cCR from 2001-2019, with a median follow-up of 51.4 mo (IQR 26.3-79.5). Median age at diagnosis was 70 years (IQR 63-75) and 50 (83%) were men. Nine (15%) patients experienced MIBC relapse and were excluded from the study. 51 patients were finally analyzed. Thirteen (25%) patients had previous NMIBC history and 85% of them had received BCG at some point before NAC. Twenty-five (49%) experienced NMIBC recurrences. Only the presence of CIS before NAC was a predictive factor for NMIBC recurrence (OR 4.28 (95% CI [1.07-17.14], p=0.04). Fifteen (60%) patients received BCG, with stages: cTa - 5 (33%), cT1 - 1 (7%) and cTis - 9 (60%). 7 of them (47%) had complete durable responses (median follow-up of 67.4 months). Patients who had CIS at TURBT pre-NAC had a non-significant trend to lower response to BCG (OR 0.13 (95% CI [0.01-1.33], p=0.086). When comparing the NMIBC group with those who did not recur, no differences were observed in terms of metastases-FS, CSS and OS (p=0.26, 0.70 and 0.50, respectively). CONCLUSIONS: Patients with previous MIBC and cCR to NAC who had NMIBC recurrence don’t seem to have a worse MFS, CSS or OS, when compared to those who did not recur. Only CIS pre-NAC was identified as a factor for NMIBC recurrence. Larger series are necessary to identify if there is any predictive factor for BCG-response in NMIBC recurrences following cCR. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1274-e1274 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Helena Vila-Reyes* More articles by this author Kevin Lee More articles by this author G.Joel Decastro More articles by this author Gen Li More articles by this author Christopher R. Haas More articles by this author Jamie S. Pak More articles by this author Izak Faiena More articles by this author Christopher B. Anderson More articles by this author James M. McKiernan More articles by this author Expand All Advertisement PDF downloadLoading ...

Changes of carotenoids contents and analysis of astaxanthin geometrical isomerization in Haematococcus pluvialis under outdoor high light conditions

In this study, carotenoid contents of Haematococcus pluvialis during outdoor high light cultivation were measured, moreover, changes of astaxanthin geometrical isomers and biotic factors which may affect isomerization were investigated. During the incubation, contents of both astaxanthin and its precursors (zeaxanthin and canthaxanthin) increased over time, whereas the relative content of lutein decreased. Contents of all astaxanthin isomers increased, while the proportion of different astaxanthin geometrical isomers fluctuated during the incubation. All-trans-astaxanthin of total astaxanthin (T/A) was higher during the astaxanthin accumulation phase than that in the cell transformation phase, which was in contrast to results of 13-cis-astaxanthin of total astaxanthin (13C/A) and 9-cis-astaxanthin of total astaxanthin (9C/A). Farnesyl diphosphate synthase (trans (2E,6E)-FPPS, EC2.5.1.10) and geranylgeranyl diphosphate synthase (GGPS, EC2.5.1.29), the key proteins involved in geometrical isomerization, decreased during the astaxanthin accumulation phase. Moreover, the presence of cis (2Z,6E)-FPPS was firstly confirmed in H. pluvialis by HPLC-MS/MS shotgun method. The results indicated the biotic factor (trans-FPPS, cis-FPPS and GGPS) may play an important role in astaxanthin geometrical isomerization of H. pluvialis, but not a crucial role. This study would help in optimizing the regulation of astaxanthin geometrical isomers in H. pluvialis, with great significance in theory and production.

Correlation of epidermal growth factor receptor score with prognostic variables in transitional cell carcinoma of urinary bladder among north-eastern Indian population

Background: Epidermal growth factor receptor (EGFR) has demonstrated over expression in bladder tumours and correlation with stage and grade of tumours. The aim of present study was to find the relation between score of the EGFR in Transitional Cell Carcinoma (TCC) of bladder and its various prognostic variables.Methods: This is a retrospective study conducted in Dept of Urology, Gauhati Medical College Hospital between Dec 2016 and July 2017. Forty cases of TCC bladder that were operated either by TURBT or radical cystectomy have been taken. However, patients with CKD, pre-existing systemic disease and UTI were excluded from the study. Presence of EGFR and its score were analysed. The rating was done as 0 (non-immunoreactive), 1+ (weak), 2+ (moderate) and 3+ (strong). The correlation between EGFR score and the various factors like age, sex, stage, size of tumour, presence of CIS, tumour grade, muscle invasion, number of tumours and type of stalk were evaluated statistically using chi square tests.Results: Average age is 59.825 years and male to female ratio is 5.6:1. EGFR score is not significantly related with age, sex, stage of disease, muscle invasiveness or number of tumours whereas size of tumour, presence of CIS changes, grade of TCC and type of tumour stalk bears statistically significant relation with EGFR score.Conclusions: Studies have shown EGFR positivity to be associated with high tumour stage, tumour progression, and poor clinical outcome. Authors have found size &gt;3cm, CIS changes, high grade tumours and broad-based stalks to be significantly associated with higher EGFR scores among patients with TCC of bladder.

Predictive factors of failure of BCG therapy in high-level superficial bladder tumors

Introduction High-grade bladder tumors are superficial, poorly differentiated, they are characterized by there architectural disorganization and marked cytologic abnormalities. The treatment of superficial tumors of the bladder has a twofold objective: the first one is to reduce the frequency of local recurrences and, on the second one is to prevent progression towards muscular infiltration. Hence, the indication of the adjuvant treatment to the transurethral resection of the bladder. The purpose of our work is to study the predictive factors for the failure of intravesical BCG instillations in the management of these tumors. Failure was defined by the progression or recurrence of superficial high-grade bladder tumors. Material and method We undertook in this work a retrospective descriptive study, including 80 patients who were treated in the urology department “A” at the RABAT CHU for high-grade urothelial carcinoma PTa and PT1 between January 2010 and June 2013. Rates of recurrence, progression after BCG therapy were studied. The prognostic factors associated with this type of tumor were then sought after by Cox regression. The overall average decline in the study was 50 months or about 4.5 years. Results The patients were 71 men and 9 women. The average age of our patients was 60 years old with extremes ranging from 38 to 71 years old. At 50 months, 60% of patients treated with BCG therapy are free from recurrence. This rate is 69% for PTa tumors and 53% for pT1 tumors ( P = 0.03); 22 (27%) patients had a recurrence under the same histological grade in the first 24 months, 11 (13%) patients had tumor progression, 4 of which were infiltrating cystectomy treated. In univariate analysis, the significantly identified risk factors for recurrence were: multifocal lesions ( P = 0.001), presence of associated in situ carcinoma, vascular invasion ( P P = 0.001), and the lack of maintenance therapy with BCG therapy. The risk factors for progression were: the presence of CIS, the crossing of the lamina propria especially in PT1G3 tumors, and the size greater than 5 cm. In multi-varied analysis, the presence of CIS, crossing the lamina propria and the tumor size in case of tumor PT1G3 are the significant factors of the failure of BCG therapy ( P = 0.001). The primary or secondary character of the high histological grade of tumor, patient age and multifocality ( P = 0.4) were not significant. This multi-varied study also showed a strong correlation between tumor size and invasion of the lamina propria. Conclusion The results of this retrospective study suggest that high-grade tumors must be compulsorily controlled by BCG therapy with a maintenance protocol. This study also made it possible to select patients with very high-risk of recurrence and progression after BCG therapy who should receive close monitoring and cystectomy if BCG therapy fails.

MP83-13 CLINICAL T1 UROTHELIAL CARCINOMA: OUTCOMES FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Non-invasive II1 Apr 2018MP83-13 CLINICAL T1 UROTHELIAL CARCINOMA: OUTCOMES FOLLOWING RADICAL CYSTECTOMY Daniel Zainfeld, Saum Ghodoussipour, Shane Pearce, Ankeet Shah, Gus Miranda, Jie Cai, Anne Schuckman, Hooman Djaladat, and Siamak Daneshmand Daniel ZainfeldDaniel Zainfeld More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Shane PearceShane Pearce More articles by this author , Ankeet ShahAnkeet Shah More articles by this author , Gus MirandaGus Miranda More articles by this author , Jie CaiJie Cai More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2761AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In the absence of predictive biomarkers, management of bladder cancer is determined by clinical findings and pathologic staging from endoscopic tumor resections. Conservative management of non-muscle invasive disease may delay or prevent definitive treatment in many patients yet the morbidity of radical cystectomy is significant. We sought to determine predictors of pathologic outcomes among patients with clinical T1 urothelial carcinoma and to better characterize this patient cohort. METHODS Retrospective review of our IRB approved prospectively maintained bladder cancer database was completed. All patients with worst clinical stage T1 urothelial carcinoma who underwent radical cystectomy and pelvic lymph node dissection were identified. Patients with any prior detrusor involvement or with variant histology patterns were excluded from analysis. Patient demographics as well as clinical and pathologic characteristics were assessed. Oncologic outcomes in the form of recurrence free survival and overall survival were evaluated. RESULTS 603 patients underwent radical cystectomy between 1983 and 2016 for clinical stage T1 urothelial carcinoma. 379 (62.85%) did not receive intravesical chemotherapy and proceeded directly to radical cystectomy. However, 287 (47.6%) underwent at least two TURBTs prior to cystectomy without evidence of cT2 disease. Final pathology revealed 242 (40.13%) with more extensive disease than that suggested by clinical stage including 75 (12.44%) with lymph node metastasis. Among 211 patients in whom presence of detrusor was confirmed at resection, 64 (30.34%) were upstaged at cystectomy including 14 (6.64%) with lymph node metastasis. Recurrence free survival and overall survival were both significantly impacted by pathologic stage as determined by log-rank test (p<0.0001). Lymphovascular invasion on TURBT was significantly associated with incidence of lymph node metastasis (p<0.0001) as was presence of CIS (p=0.0465). CONCLUSIONS Urothelial carcinoma represents an aggressive malignancy with significant mortality though curable in the localized setting. Clinical staging by TURBT cannot adequately identify risk factors for progressive or metastatic disease. Optimal management of non-muscle invasive urothelial carcinoma demands a nuanced approach to risk stratification. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1121 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Daniel Zainfeld More articles by this author Saum Ghodoussipour More articles by this author Shane Pearce More articles by this author Ankeet Shah More articles by this author Gus Miranda More articles by this author Jie Cai More articles by this author Anne Schuckman More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A multicenter clinical trial of intravesical BCG in combination with ALT-803 in patients with BCG-unresponsive non-muscle invasive bladder cancer.

TPS544 Background: BCG unresponsive NMIBC includes patients with persistent high-grade disease or recurrence within 6 months of receiving at least two courses of BCG; or T1 high-grade disease at the first evaluation following BCG induction alone. The recommendation after failing BCG in patients suitable for surgery is cystectomy or for unwilling/unfit patients, salvage chemotherapy or immunotherapy (administered with limited success). This highlights a critical need for novel preservation therapies to facilitate a better quality of life and reduce health-care costs for patients who are unresponsive to BCG (Correa 2015, Dalbagni 2006, Dinney 2013, Kamat 2017). Altor BioScience has initiated a phase II clinical study in BCG unresponsive patients to expand on promising data collected from a compassionate use patient who remains disease free more than 2.5 years after ALT-803 plus BCG treatment for refractory NMIBC (Huang 2017). Methods: This is a Phase II, open-label, single-arm, multicenter study of intravesical BCG plus ALT-803 in patients with BCG unresponsive high grade NMIBC. Group A will enroll patients who have histologically confirmed presence of CIS [with or without Ta or T1 disease]. Group B will enroll patients who have histologically confirmed high-grade Ta or T1 disease (in the absence of CIS). All patients will receive BCG plus ALT-803 weekly for 6 consecutive weeks. A cystoscopy will be performed at Week 12. Patients with no disease or low-grade Ta will receive a maintenance course of therapy (3 weekly instillations of BCG plus ALT-803). Patients with residual CIS and/or high-grade Ta will receive a re-induction course of therapy. Presence of Ta will require a TURBT. Patients with greater than or equal to T1 disease or new CIS will be deemed treatment failures. Patients with a Complete Response (CR) or low-risk disease at Months 6, 9 and 12 are eligible for continued BCG plus ALT-803 maintenance. Patients will be followed for recurrence, progression, and survival. The primary endpoint is to assess complete response (CR; absence of lesions on cystoscopy or negative, for cause, biopsies along with negative urine cytology) of CIS at six months. Enrollment is underway. Clinical trial information: NCT03022825.

De Novo Bladder Urothelial Neoplasm in Renal Transplant Recipients: A Retrospective, Multicentered Study

Background and Objectives: Renal transplant recipients (RTRs) have a 2- to 7-fold risk of developing a neoplasm compared to general population. Bladder urothelial neoplasms in this cohort has an incidence of 0.4–2%. Many reports describe a more aggressive behavior. The objective of this study is to describe oncologic characteristics of bladder urothelial neoplasms in RTRs and to evaluate its recurrence, progression, and survival rates. Methods: A retrospective multicentered study was performed evaluating all de novo bladder urothelial neoplasms cases in RTRs from 1988 to 2014. Descriptive statistical analysis and evaluation of recurrence, progression, and survival rates were performed. Results: A total of 28 de novo bladder transitional cell carcinomas (TCCs) were identified (incidence rate 0.64%). Cancer-specific survival rates were 100, 75, and 70% after 1, 5, and 10 years, respectively. Age at diagnosis superior to 60 years was found to be a statistically significant variable for recurrence risk. Progression rate was 14%. Presence of CIS was significantly associated with progression. All cancer-specific deaths were in the high-risk group and all were progressions from non-muscle invasive to muscle invasive bladder cancer. Conclusions: Bladder urothelial neoplasms following renal transplant is associated with a trend toward worst prognosis. Early aggressive treatments, such as early radical cystectomy, might be advisable to reduce cancer-specific deaths.

Muscle invasive bladder cancer: Prognostic factors, follow-up and treatment of relapses

ContextBladder cancer is the cause of more than 150,000 deaths per year. The overall rate of survival is approximately 45%, with a 10-year recurrence-free rate of 50–59%, with no changes in the last decade. ObjectiveDue to a lack of agreement on the follow-up of cystectomy or on a uniform treatment when faced with the various types of recurrence, we have analyzed the most recent literature in an attempt to unify the criteria for the diagnosis and treatment of bladder cancer. Acquisition of evidenceReview of Spanish and English publications in the medical literature in the last 10 years, highlighting the most significant series in terms of the number of patients, follow-up time, as well as the existing meta-analyses. Synthesis of the evidenceRecurrence after cystectomy can occur in the urinary apparatus (upper urinary tract or distal urethra) and local (cystectomy bed) and/or distant metastases. Despite strict control, more than 60% of the relapses are discovered based on symptoms and not by the routine follow-up test. Locoregional and distant relapses are more common the more advanced the stage at the time of cystectomy, going from 11–21% in pT2N0 to 52–72% when there is lymphocytic N+ involvement.Recurrence in the urethra and/or upper urinary track has other prognostic factors such as multiplicity, the presence of Cis and involvement of prostatic stroma. There are various treatments for tumor relapses. Increasingly, the patient's comorbidity is considered when deciding on the therapeutic strategy. Treatments are typically multimodal and include surgery, radiotherapy and chemotherapy. ConclusionThe follow-up of patients who undergo cystectomy should be individualized, taking into account the prognostic factors of recurrence and the patient's comorbidity, assuming that in some cases, multimodal treatment is indicated.