Recurrent Bladder Carcinoma Research Articles

Early and Post-Treatment Imaging Findings in Perineural Spread: A Pathway to Diffuse Muscle Metastasis in Recurrent Bladder Carcinoma.

Perineural spread (PNS) from pelvic carcinoma has been regarded as a pathway to muscle and bone metastasis. However, few cases have been reported, especially in patients with bladder carcinoma. In the present report, we discuss a case of diffuse cancer involvement in the muscle 5 years after radical cystectomy for advanced bladder carcinoma. Careful observation of temporal changes on medical images confirmed PNS as the pathway to muscle metastasis (i.e., primary PNS). Our report presents early and post-treatment CT, MRI and FDG-PET/CT findings of PNS from the bladder carcinoma.

The UF-5000 Atyp.C parameter is an independent risk factor for bladder cancer

Bladder carcinoma (BC) accounts for > 90% of all urothelial cancers. Pathological diagnosis through cytoscopic biopsy is the gold standard, whereas non-invasive diagnostic tools remain lacking. The “Atyp.C” parameter of the Sysmex UF-5000 urine particle analyzer represents the ratio of nucleus to cytoplasm and can be employed to detect urinary atypical cells. The present study examined the association between urinary Atyp.C values and BC risk. This two-center, retrospective case–control study identified clinical primary or newly recurrent BC (study period, 2022–2023; n = 473) cases together with controls with urinary tract infection randomly matched by age and sex (1:1). Urinary sediment differences were compared using non-parametric tests. The correlations between urinary Atyp.C levels and BC grade or infiltration were analyzed using Spearman’s rank correlation. The BC risk factor odds ratio of Atyp.C was calculated using conditional logistic regression, and potential confounder effects were adjusted using stepwise logistic regression (LR). Primary risk factors were identified by stratified analysis according to pathological histological diagnosis. The mean value of urinary Atyp.C in BC cases (1.30 ± 3.12) was 8.7 times higher than that in the controls (0.15 ± 0.68; P < 0.001). Urinary Atyp.C values were positively correlated with BC pathological grade and invasion (r = 0.360, P < 0.001; r = 0.367, P < 0.001). Urinary Atyp.C was an independent risk factor for BC and closely related with BC pathological grade and invasion. Elevated urinary Atyp.C values was an independent risk factor for BC. Our findings support the use of Atyp.C as a marker that will potentially aid in the early diagnosis and long-term surveillance of new and recurrent BC cases.

Repair of Vaginal Cuff Dehiscence after Laparoscopic Radical Cystectomy with Gracilis Myocutaneous Flap

Vaginal cuff dehiscence after total hysterectomy or total cystectomy had been increasing since laparoscopic or robotic surgery became a common surgery among gynecologists and urologists. A 52-yearold woman underwent laparoscopic radical total cystectomy for muscle invasive bladder carcinoma at Rakuwakai Otowa Hospital. She was emergently admitted with a fist-sized lump protruding from her vagina four months after surgery. Physical examination and her past history on admission disclosed vaginal cuff dehiscence after cystectomy. Computed tomographic scan and magnetic resonance imaging showed no bowel evisceration in the lump. We confirmed that the content of lump was peritoneal tissue and removed it by laparoscopic surgery. Simultaneously, we repaired the vaginal cuff dehiscence with a gracilis myocutaneous flap. There was no subsequent recurrence of vaginal dehiscence or bladder carcinoma in one-year follow-up.

Recurrence of non-muscle invasive bladder carcinoma after transurethral resection with hexaminolevulinate photodynamic diagnosis or regular cystoscopy.

To compare the recurrence of non-muscle invasive bladder carcinoma (NMIBC) after transurethral resection employing cystoscopy with hexaminolevulinate-based photodynamic diagnosis (PDD) or with standard white light. We included patients with newly suspected NMIBC in this retrospective cohort study and compared those undergoing transurethral resection by white light cystoscopy (WLC) (2008-2010) and PDD (2010-2012). All patients were treated following established criteria for good quality resection. The primary outcome was the difference in the recurrence rate after 60 months' follow-up, but we also stratified recurrence by risk groups, as set by the European Organization for Research and Treatment of Cancer. The mean recurrence-free survival was compared between the cohorts. Odds ratios or hazard ratios are reported with their 95% confidence intervals. The WLC and PDD cohorts comprised 124 and 91 subjects, respectively. There were no significant differences in recurrence rates between the cohorts at 6 months (recurrence rate 9/123; 7.3%), 12 months (17/118; 14.4%) or 60 months (39/102; 38.2%), with odds ratios of 1.23 (CI 0.48-3.25), 1.32 (CI 0.67-2.62) and 1.12 (CI 0.70-1.79), in favour of WLC, respectively. Further analysis showed no significant effect of PDD on either recurrence by risk group or on mean recurrence-free survival (hazard ratio, 1.12 [CI 0.70-1.79]). We found no relevant differences in the recurrence of NMIBC after the introduction of PDD with hexaminolevulinate compared to standard WLC when used for transurethral resection in our single institution.

Cancer-Associated Fibroblast-Induced Remodeling of Tumor Microenvironment in Recurrent Bladder Cancer.

Bladder carcinoma (BC) recurrence is a major clinical challenge, and targeting the tumor microenvironment (TME) is a promising therapy. However, the relationship between individual TME components, particularly cancer-associated fibroblasts (CAFs), and tumor recurrence is unclear. Here, TME heterogeneity in primary and recurrent BC is investigated using single-cell RNA sequence profiling of 62460 cells. Two cancer stem cell (CSC) subtypes are identified in recurrent BC. An inflammatory CAF subtype, ICAM1+ iCAFs, specifically associated with BC recurrence is also identified. iCAFs are found to secrete FGF2, which acts on the CD44 receptor of rCSC-M, thereby maintaining tumor stemness and epithelial-mesenchymal transition. Additionally, THBS1+ monocytes, a group of myeloid-derived suppressor cells (MDSCs), are enriched in recurrent BC and interacted with CAFs. ICAM1+ iCAFs are found to secrete CCL2, which binds to CCR2 in MDSCs. Moreover, elevated STAT3, NFKB2, VEGFA, and CTGF levels in iCAFs reshape the TME in recurrent tumors. CCL2 inhibition in an in situ BC mouse model suppressed tumor growth, decreased MDSCs and Tregs, and fostered tumor immune suppression. The study results highlight the role of iCAFs in TME cell-cell crosstalk during recurrent BC. The identification of pivotal signaling factors driving BC relapse is promising for the development of novel therapies.

Prevention of non-muscle-invasive bladder carcinoma recurrence with immediate preoperative instillation of chemoterapy – precave cueto 1802 trial

Prevention of non-muscle-invasive bladder carcinoma recurrence with immediate preoperative instillation of chemoterapy – precave cueto 1802 trial

The Role of NMP22 and CSTB Levels in Predicting Postoperative Recurrence of Bladder Cancer

Objective To investigate the value of preoperative urinary nuclear matrix protein 22 (NMP22) and Cystatin B (CSTB) expressions in evaluating the postoperative recurrence of bladder cancer. Methods The clinical case data of 102 patients with bladder cancer who underwent surgical treatment from January 2017 to January 2022 were collected, and the patients were divided into a recurrence group (n = 54) and nonrecurrence group (n = 48) according to whether the patients recurred after surgery, and the preoperative NMP22 and CSTB expression levels between the two groups were compared. Receiver operating curve (ROC) was used to analyze the evaluation value of preoperative NMP22 and CSTB expression in patients with bladder cancer postoperative recurrence. Logistic multivariate regression method was used to analyze the correlation between preoperative NMP22 and CSTB expression and postoperative bladder cancer recurrence. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of NMP22 and CSTB single detection and combined detection were evaluated for postoperative recurrence of bladder cancer. Results The preoperative expression levels of NMP22 and CSTB in the recurrence group were significantly higher than those in the nonrecurrence group (P < 0.05). The results of ROC curve analysis showed that the AUC of preoperative NMP22 and CSTB expression levels to assess postoperative recurrence of bladder cancer was 0.696 and 0.659, respectively (P < 0.05). Logistic multivariate regression analysis showed that preoperative NMP22 and CSTB overexpression was an independent risk factor for postoperative recurrence of bladder cancer (OR = 1.042, 2.307, P < 0.05). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of preoperative NMP22 combined with CSTB in evaluating bladder cancer recurrence after surgery were higher than those of preoperative NMP22 and CSTB alone, and the differences were statistically significant (P < 0.05). Conclusion Preoperative NMP22 and CSTB conveying is hardly interrelated to postoperative recurrence of bladder carcinoma and has certain appraisal worth for postoperative recurrence of bladder carcinoma, and the combined testing of the two has a taller appraisal worth. NMP22 combined with CSTB detection will help to detect postoperative recurrence of bladder cancer and formulate effective treatment measures in time.

Relationship between post-void residual urine volume, preoperative pyuria and intravesical recurrence after transurethral resection of bladder carcinoma.

To evaluate the relationship between residual urine volume, pyuria and bladder carcinoma recurrence. The clinical data of 305 patients who had post-void residual urine volume measured and preoperative pyuria were retrospectively collected. The patients were classified into three risk groups based on the presence of residual urine and pyuria: good (negative residual urine and pyuria), intermediate (positive residual urine or pyuria) and poor (positive residual urine and pyuria). Predictive factors for intravesical recurrence-free survival were statistically analyzed using Cox proportional hazard models and Kaplan-Meier methods. The propensity score matching method was used to adjust the patients' backgrounds. The median follow-up period for all patients was 44months. The presence of residual urine (P=0.0164) and pyuria (P=0.0233) were two independent prognostic factors for recurrence. After patients were classified into risk groups, the poor-risk group showed significantly shorter recurrence-free survival compared with that of the good- (P=0.0002) and intermediate-risk groups (P=0.0090). Even after matching, the presence of residual urine was related to short recurrence-free survival in male patients (P=0.0012). When stratified by European Organization for Research and Treatment of Cancer risk groups, the presence of pyuria was related to short recurrence-free survival, especially for intermediate-risk patients without bacillus Calmette-Guérin treatment. Post-void residual urine and preoperative pyuria are two risks for recurrence-free survival in non-muscle-invasive bladder cancer.

Association of arsenic with recurrence of urinary bladder cancer.

Arsenic is known to be an important aetiological factor for the development of urinary bladder cancer. It is known to be found excessively in ground water in certain geographical areas, including West Bengal. We have studied patients with recurrent bladder cancer from different areas of this Indian state and correlated arsenic as a causative aetiological factor for development and aggressiveness of the biological behaviour of urinary cancer. We included 31 patients from various parts of West Bengal state with recurrent bladder cancer who were operated in our institute. Their clinical and residential data and their arsenic content of tumour tissue were measured. Statistical analysis was performed to test the association of tissue arsenic with clinicopathological features of recurrent disease. We found very high levels of arsenic in tumour tissue in all residents of the districts with high prevalence of arsenic in the drinking water. We also observed more aggressive clinicopathological progression and early recurrence in patients with high arsenic content. We conclude that arsenic is a causal factor in the clinicopathological progression of recurrent urinary bladder cancer. Measures to decrease the level of arsenic in drinking water should be taken as this may both improve clinicopathological outcomes in the recurrence of urinary bladder carcinoma, as well as reducing its overall incidence.

A new method for purifying Brazilin from lignum sappan – Cytotoxic and anti-proliferative effects in cell lines and improved survival in mice bearing urinary bladder carcinoma

Background: Urinary bladder carcinoma is characterized by high post-operative recurrence rates. Sufu'ning lotion, prepared with Lignum Sappan, can reduce the recurrence of urinary bladder carcinoma. Objectives: The present study describes a methodology for extracting and obtaining high purity brazilin from Lignum sappan and evaluates its effects on urinary bladder carcinoma, in vitro and in vivo . Materials and Methods: The brazilin was extracted from Lignum sappan, purified and identified. The purified brazilin was assessed in vitro for its effects on tumor cell viability and growth using human (T24) and mouse urinary bladder (BTT) cancer cell lines. The role of brazilin in the inhibition of the cell cycle was determined by flow cytometry. The in vivo activity of brazilin was assessed based on the survival of tumor-bearing mice. Results: Brazilin was purified of 99.10% purity and was bioactive as it significantly (P

Intravesical irrigation to prevent early bladder recurrence in patients undergoing laparoscopic radical nephroureterectomy for upper urinary tract cancer.

454 Background: The bladder carcinoma recurrence rate after nephroureterectomy is known to be high. Here we studied the clinical benefit of Intravesical irrigation during laparoscopic radical nephroureterectomy in upper urinary tract cancer (UUTUC) patients. Methods: This study enrolled 197 UUTUC patients who receive laparoscopic radical nephroureterectomy at Chiba University Hospital and Yokohama Rosai Hospital between 2001 and 2019. Association between the various clinical factors and postoperative recurrence rates within two years were statistically analyzed. Intravesical irrigation was carried out only during surgery and by using distilled water or saline. Results: Bladder recurrence was confirmed for 79 of the 197 patients. Irrigation was carried out in 75 cases (distilled water, 49 cases; saline, 26 cases). Tumor grade (G1-2 vs G3; p=0.0029) and irrigation (with vs. without; p&lt;0.0001) were related to bladder recurrence on univariate analysis. Even on multivariate analysis, both tumor grade (p=0.0094) and irrigation ( p&lt;0.0001) remained as independent factors. Comparison between the irrigation and non-irrigation groups showed that bladder recurrence rates were significantly lower in the irrigation groups (irrigation group vs non-irrigation group: 29.3% vs 46.7%, p=0.015). There was no prognostic difference between the type of irrigation (distilled water vs saline, p=0.177). Conclusions: Intravesical irrigation prevented early bladder recurrence in patients undergoing radical nephroureterectomy for UUTUC. [Table: see text]

Long-term results of treatment for recurrent supercifial bladder carcinoma with “Imuron” BCG vaccine

Long-term results of treatment for recurrent supercifial bladder carcinoma with “Imuron” BCG vaccine

Precave: Immediate neoadjuvant instillation of chemotherapy for the prevention of non-muscle invasive bladder carcinoma recurrence: A prospective randomized clinical trial protocol

Introduction and objectivesRecurrence rates for patients presenting with non-muscle invasive bladder carcinoma (NMIBC) can be as high as 60% during the first year after a transurethral resection of bladder tumor (TURBT). Currently, an immediate postoperative instillation of chemotherapy (IPOIC) is recommended for the prevention of recurrences in patients with low to intermediate risk disease. Although in real clinical practice this specific instillation of chemotherapy has many difficulties to be standardized, including its contraindications (suspected or confirmed bladder perforation, wide or extensive resection and, continuous bladder irrigation requirement), which will only make it feasible for around 30% of patients.We propose in this controlled study, to administer an immediate neoadjuvant instillation of chemotherapy (INAIC), which can be applied technically to all patients, no matter the surgical outcomes and compare it with a control group. We expect to find a reduction in the recurrence rate in the experimental group of at least 15%. MethodsWe designed a phase IV, randomized, controlled, open label clinical trial. Main inclusion criteria are: patients with a clinical diagnosis of localized, papillary-type bladder cancer (suspected low to intermediate risk) with a disease-free interval of at least 6 months. Eligible patients will be allocated into group A (INAIC plus TURBT) or group B (TURBT) using a computer-generated block randomization sequence/ratio 1:1. Time to recurrence of both groups will be analyzed and compared using Kaplan-Meier estimates, log-rank tests and, Cox-regression. Univariate and multivariate analyzes will be performed to determine factors which influence recurrence. The study has received the approval of the Ethics Committee for Drug Research (CEIm) of La Paz University Hospital and the Spanish Agency for Medicines and Health Products.

The relationship between ABO blood group type and tumor grade, stage, recurrence and progression in transitional cell carcinoma of the bladder: A preliminary report

Objectives: ABO blood grouping is a well-proven prognostic factor in many malignancies. This study aims to study the association and impact of ABO blood group on disease recurrence and progression in bladder carcinoma. Material and methods: Patients with bladder carcinoma undergoing transurethral resection of bladder tumor (TURBT) were studied prospectively for at least 1-year follow-up for recurrence and progression of the disease. Demographic profile along with blood group was noted. Results: Two hundred patients were included in the study and 194 patients were included in the final analysis. Muscle-invasive bladder cancer was present in 39 (20.1%) patients and the high-grade tumor was present in 88 (45.3%) patients. There was no statistical significance between the association of blood grouping and grade ( p=0.29) and stage of the disease ( p=0.20). During the follow-up period, there were 100 (64.5%) recurrences and 15 (9.7%) patients with non-muscle-invasive bladder carcinoma had progression. The association of blood group with recurrence ( p=0.66) and progression ( p=0.11) of disease was not statistically significant. Conclusion: There is no association between bladder cancer and ABO blood group in terms of grade and stage of the disease. The recurrence and progression of the disease did not differ significantly in different blood groups. Level of Evidence: 2b

Comparison of Nuclear Matrix Protein-22 and Urine Cytology in Diagnosing Bladder Cancer

Background: Urine cytology (UC) is a classic marker used to detect bladder malignancy through urine examination microscopically at the presence of malignant transitional cells that are released. UC is also used to evaluate recurrence after past treatment. A new method that is simpler, faster and easier is by measuring protein in urine produced by malignant cells, namely nuclear matrix protein-22 (NMP-22). The aim of this study was to compare the diagnostic value of NMP-22 and UC to histopathological biopsy in diagnosing bladder carcinoma and to evaluate whether the NMP-22 test could be used for bladder carcinoma screening and recurrence monitoring.Methods: Diagnostic tests on 24 suspected bladder malignancies were performed by taking urine samples for NMP22 examination and UC. Sensitivity, specificity, positive predictive value and negative NMP-22 and UC on histopathological biopsy were analyzed.Results: Positive results were obtained in 21 (87.5%) and negative in 3 (12.5%) NMP22 examinations. The sensitivity, specificity, positive and negative predictive values of NMP-22 on histopathological biopsy were 95%; 67%, 95%, 67%. Sensitivity, specificity,positive predictive value and negative UC on histopathological biopsy were 38.1%; 100%, 100%, 18.8%.Conclusions: NMP-22 sensitivity is higher than UC in diagnosing bladder carcinoma. NMP-22 can be used for bladder carcinoma screening and for recurrence monitoring

Recurrent oligometastatic transitional cell bladder carcinoma: is there room for radiotherapy?

This paper presents a retrospective report on radiotherapy (RT) in the oligometastastic recurrence of bladder cancer. Thirteen patients treated for low-volume metastatic transitional cell urinary bladder carcinoma (TCC) were reviewed, with the primary endpoint to evaluate the safety and efficacy of RT, proposed as an alternative to systemic treatment and/or to defer commencement of systemic therapy. The inclusion criteria were: patients who received RT without other local/systemic therapy for oligometastatic TCC with lymph node, bone and lung lesions or local recurrence. Previous systemic therapy and surgery on the primary tumor were allowed in this tumor response, and toxicity evaluation and progression free-survival was also assessed. Thirteen patients with 21 lesions were treated with stereotactic body radiotherapy (SBRT) or conformal 3D radiotherapy (3D-CRT) between 2012 and 2017. All participants were discussed by a multidisciplinary urological board. The median age at RT was 68 years (range 50-80), the median Karnofsky performance status (KPS) was 90 (range 80-90) and the median interval between TCC diagnosis and commencement of RT on oligometastasis was 23 months (range 8-105). The median treatment dose was 25 Gy (range 20-36 Gy) given over a median of 5 fractions (range 3-10 fractions) with a median follow-up of 25 months (range 3-43 months). Imaging assessment was available for 20 lesions. The radiological progression of disease was registered in 9 patients at the median of 4.2 months from radiotherapy (range 1.9-18.8 months). This identified in-field and out-field progression in 6 patients and only out-field progression in the remaining 3. At last contact, 3 patients were alive with no evidence of disease, 3 had evidence of disease, 6 died of cancer-related disease and one died from another cause. No severe acute and late toxicity was observed. The literature contains no consistent data on TCC oligometastatic setting, but radiotherapy on lymph node, bone and/or lung oligo-recurrence from TCC offers durable disease control in a small number of patients with a very low toxicity profile. Further studies are required to establish the radiotherapy role in oligometastatic recurrent bladder cancer.

The link between FOXJ1 expression level in bladder carcinoma and tumor recurrence.

[This retracts the article DOI: 10.3892/ol.2017.7504.].

The Role of Vitamin D Receptor Polymorphisms in Predicting the Response to Therapy for Nonmuscle Invasive Bladder Carcinoma

Clinical and pathological predictors of bladder carcinoma recurrence and progression are relatively well defined. However, there is a paucity of genetic data specifically on the association of single nucleotide polymorphisms in specific genes for predicting recurrence and progression following immunotherapy. The VDR gene was found to regulate the immunomodulatory effects of vitamin D and it enhances the innate immunity system. We evaluated 3 VDR single nucleotide polymorphisms and their predictive role on the response to immunotherapy. Patients with bladder cancer at intermediate-high risk who underwent post-transurethral resection intravesical bacillus Calmette-Guérin in Singapore and Hong Kong from 1995 to 2014 were recruited for analysis. We evaluated 3 VDR single nucleotide polymorphisms using polymerase chain reaction. Kaplan-Meier survival curves and relationships with outcomes were analyzed by multivariable Cox regression. A total of 338 predominantly Chinese patients were included in study. Individuals carrying the VDR genotype Bsm A/G were significantly associated with lower time to recurrence after bacillus Calmette-Guérin therapy (p <0.001). On multivariable analysis the HR of recurrence in patients with the Bsm A allele was 3.95 times that in patients without the allele (p = 0.037). Patients with the VDR GATC subhaplotype were 3.05 times more likely than patients with other subhaplotypes to experience recurrences (p = 0.003). Study limitations include the small sample size and the lack of information on previous bacillus Calmette-Guérin vaccine exposure and on vitamin D levels. Our findings in this study suggest that various VDR singlenucleotide polymorphisms are associated with recurrences after bacillus Calmette-Guérin immunotherapy. Further functional studies should be performed to elucidate the significance of the VDR gene in the management of bladder cancer and the potential therapy implications.

Reduced immunohistochemical PTEN staining is associated with higher progression rate and recurrence episodes in non-invasive low-grade papillary urothelial carcinoma of the bladder.

Non-invasive low-grade papillary urothelial carcinoma (NILGPUC) of the bladder is regarded as a relatively indolent disease. However, its propensity for frequent recurrences constitutes a major clinical problem. Additionally, there is a progression risk of 10-15% to either a higher grade and/or a higher stage disease in these tumors. The molecular factors that will predict recurrence and progression in low-grade pTa bladder carcinoma have not yet been elucidated. Herein, we investigated the association of phosphatase and tensin homolog deleted on chromosome 10 (PTEN) alterations with recurrence and progression in NILGPUC using immunohistochemistry. Eighty-one cases of bladder cancer initially diagnosed as NILGPUC in a single institution with follow-up were encountered after searching medical records. Tissue microarrays (TMA) that contained both tumor and non-neoplastic mucosa from each case were constructed using paraffin blocks of transurethral resections. Sections from TMA blocks were stained immunohistochemically for PTEN protein and were evaluable in 76 cases. Any absence of staining was recorded and correlated with clinical findings. Ten patients (13.2%) showed progression and 41 (53.9%) showed recurrence. Reduced PTEN expression was observed in 29 cases (38.1%). Cases with reduced PTEN had higher progression rate compared to cases with intact PTEN (p = 0.026). Tumor relapse was more frequent in cases with reduced PTEN (65.5 vs 46.8%), but this difference was not statistically significant (p = 0.112). On the other hand, decreased PTEN expression was associated with higher number of recurrence episodes (p = 0.002). PTEN seems to have a link with the disease course in NILGPUC of the bladder.

The link between FOXJ1 expression level in bladder carcinoma and tumor recurrence.

We studied the expression level of FOXJ1 in bladder epithelial carcinoma and its relation to clinical features and tumor recurrence. From January 2014 to June 2015, 66 patients with bladder epithelial carcinoma were enrolled in this study and their tumor and para-carcinoma tissue samples were collected. FOXJ1 positive expression rate was evaluated using immunohistochemical staining, and FOXJ1 mRNA expression level was measured by RT-PCR. RT-PCR and immunohistochemistry results showed that FOXJ1 expression level in tumor samples was significantly lower than that in para-carcinoma tissue samples. The median survival time in patients with positive expression of FOXJ1 was significantly longer than that of patients with negative expression of FOXJ1. We also showed that FOXJ1 expression level was negatively correlated with neoplasm staging and tumor recurrence rate. We concluded that FOXJ1 was expressed in low quantities in bladder epithelial carcinoma, which was closely correlated with the biological characteristics of the tumor. FOXJ1 expression presents a promising application prospect for further exploration of the specific biological mechanism of FOXJ1 in regulating the occurrence and development of bladder epithelial carcinoma. FOXJ1 may be used as a new marker for early diagnosis and prediction of recurrence.