Resection Of Bladder Cancer Research Articles

A New Prognostic Tool for Patients Undergoing Radiotherapy plus Upfront Transurethral Resection for Bladder Cancer.

To create a tool to estimate overall survival (OS) of patients with non-metastatic bladder cancer. Eight parameters were retrospectively evaluated for OS in 42 patients undergoing radiotherapy and upfront transurethral resection for bladder cancer. The prognostic tool included those parameters that were significant on both univariate and multivariate analyses. The tool was based on the 3-year OS rate divided by 10. Patient scores were calculated by adding the points for each significant parameter. On univariate analysis, 3-year OS was associated with gender (p=0.017), pack years (p=0.009) and Karnofsky performance score (KPS) (p<0.001). On Cox regression, pack years (p=0.007) and KPS (p<0.001) remained significant and were incorporated into the tool. Three prognostic groups were designated with 6, 10-11 and 15 points with 3-year OS-rates of 0%, 34% and 83%, respectively (p<0.001). A tool was developed to estimate the OS of patients with bladder cancer to improve individualization of treatment.

Modified technique of ureteral stent placement during transurethral resection of bladder cancer invading the ureteral orifice

Objective To evaluate the efficacy and safety of modified technique of ureteral stent placement during transurethral resection of bladder tumor. Methods Seventeen patients with muscle invasive bladder cancer invading the ureteral orifice from March 2014 to June 2016 in Beijing Friendship Hospital were randomly divided into two groups. In the modified technique group (group A, n= 10), tumor was resected until the ureteral orifice was exposed. Then, a guide wire was placed through the tunnel of Electrode loop and the ureteral stent was placed along the guide wire. In control group (group B, 7 cases), after ureteral orifice exposed, the guide wire and ureteral stent was placed with cystoscopy. The demographic, oncological baseline and operative factors were evaluated between two groups. Results There was no difference in tumor grade and maximum diameter between two groups (P>0.05). The operation time in group A was significantly shorter than that in group B[(39.5±14.8)min vs (59.3±16.2) min, P=0.020], and the intraoperative vision clarity score was better in group A as well[(7.7±1.3) vs (5.9±1.2), P=0.010]. There was no statistical difference between the two groups in the complication. Conclusions The modified technique can improve the efficiency of ureteral stent placement during transurethral resection of bladder tumor without any risk enhancement. Key words: Urinary bladder neoplasms; Ureteral orifice invading; Uretera; Stent; Technique improvement

The clinical efficacy of transurethral plasma needle electrode en bloc resection of bladder cancer

Objective To summarize the clinical experience and analyze the efficacy of transurethral plasma needle electrode en bloc resection for bladder cancer. Methods From February 2015 to August 2016, a total of 26 patients, including 21 males and 5 females, with bladder cancer received transurethral plasma needle electrode en bloc resection of bladder tumor. Their age ranged from 42 to 75 years, mean (56±13)years. The size of tumor ranged from 1 to 4 cm, mean (2.3±1.6)cm. The solitary tumor was found in 19 cases and multiple tumors were found in 7 cases, including 2 tumors in 5 cases, 3 tumors in 2 cases. In 6 cases, the tumor located in the lateral bladder wall. All the pre-operative biopsy showed the urethelial carcinoma in all cases, No bladder extravasion or upper urinary tumor was noticed in the CTU before surgery.By using the electrode needle tip inserted into the bladder mucosa, blunt release or cut the tumor bases until the deep muscularis or the serosal layer, complete removal of the tumor. The specimen was removed from the bladder and sent to the pathological examination.The operation time, the volume of blood loss during operation, surgical complications, pathological diagnosis and the wounds recovery were recorded and analyzed. Results All surgeries were undergone successfully. Totally 35 tumors were resected with diameter of 1.0-4.0 cm, mean (2.3±1.6)cm. The estimated blood loss was less than 10 ml. The operative duration ranged from 20 to 50 min, mean (30±16)min. The duration for removing the single tumor ranged from 5 to 25 min. No obturator nerve reflex were observed during surgery. No blood loss and complications occurred after operation. All patients received 30 mg pirarubicin bladder instillation chemotherapy immediately and no adverse reaction was noticed. Postoperative pathological stages of enrolled cases were distributed as 33 cases of T1G1 staging, 2 cases of T1G3 staging. No positive margin was observed. 3 months after operation, cystoscopy showed that the wound healed well. A total of 26 cases followed up for 3-10 months (mean 6.0±2.3 months). No one developed recurrence. Conclusions Transurethral plasma needle electrode en bloc resection of bladder tumor would reduce the incidence of complications and obturator nerve reflex. It can provide sufficient specimens for histological diagnosis. Key words: Bladder tumor; Transurethral resection of bladder tumor; Plasma needle electrode; The en bloc resection.

Effects of programmed death-ligand 1 expression on OK-432 immunotherapy following transurethral resection in non-muscle invasive bladder cancer.

The present study aimed to investigate the effect of the negative costimulatory molecule programmed death-ligand 1 (PD-L1) on immunotherapy with OK-432, following transurethral resection of bladder tumors in non-muscle invasive bladder cancer (NMIBC), and to elucidate the underlying mechanism. PD-L1 was detected by immunohistochemical staining in tumor specimens from 55 cases of NMIBC following postoperative immunotherapy with OK-432. The PD-L1 mRNA and protein expression levels were measured in the bladder cancer T24 cell line and the human uroepithelial SV-HUC-1 cell line, following treatment with interleukin (IL)-2, interferon (IFN)-α and IFN-γ, by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and western blot analysis, respectively. PD-L1 was widely expressed in the NMIBC tumors, with 56.4% (31/55) of specimens exhibiting positive staining. When compared with PD-L1-negative patients, PD-L1-positive patients exhibited significantly increased recurrence [48.4% (15/31) vs. 16.7% (4/24)] and progression [16.1% (5/31) vs. 4.2% (1/24)] rates (P<0.05). RT-qPCR and western blotting demonstrated that cytokines IL-2, IFN-α and IFN-γ markedly upregulated PD-L1 mRNA expression rates and protein levels in bladder cancer T24 cells (P<0.05), but had no significant effect in non-tumor SV-HUC-1 cells. In conclusion, PD-L1 expression was negatively-associated with the efficacy of OK-432 intravesical immunotherapy in patients with NMIBC. The results indicated that the involved mechanism occurred via upregulation of PD-L1 by immune cytokines, which in turn suppressed the antitumor effectiveness of the immune system, thereby promoting tumor recurrence and progression.

Second-look resection for primary stage T1 bladder cancer: a population-based study

Objective: This study aimed to evaluate the use of second-look resection (SLR) in stage T1 bladder cancer (BC) in a population-based Swedish cohort.Materials and methods: All patients diagnosed with stage T1 BC in 2008–2009 were identified in the Swedish National Registry for Urinary Bladder Cancer. Registry data on TNM stage, grade, primary treatment and pathological reports from the SLR performed within 8 weeks of the primary transurethral resection were validated against patient charts. The endpoint was cancer-specific survival (CSS).Results: In total, 903 patients with a mean age of 74 years (range 28–99 years) were included. SLR was performed in 501 patients (55%), who had the following stages at SLR: 172 (35%) T0, 83 (17%) Ta/Tis, 210 (43%) T1 and 26 (5%) T2–4. The use of SLR varied from 18% to 77% in the six healthcare regions. Multiple adjuvant intravesical instillations were given to 420 patients (47%). SLR was associated with intravesical instillations, age younger than 74 years, discussion at multidisciplinary tumour conference, G3 tumour and treatment at high-volume hospitals. Patients undergoing SLR had a lower risk of dying from BC (hazard ratio 0.62, 95% confidence interval 0.45–0.84, p < .0022). Five-year CSS rates were as follows, in patients with the indicated tumours at SLR (p = .001): 82% in those with T1, 90% in T0, 90% in Ta/Tis and 56% in T2–4.Conclusions: There are large geographical differences in the use of SLR in stage T1 BC in Sweden, which are presumably related to local treatment traditions. Patients treated with SLR have a high rate of residual tumour but lower age, which suggests that a selection bias affects CSS.

Comparison of Monopolar and Bipolar Transurethral Resection of Non-Muscle Invasive Bladder Cancer

Objective: We aimed to compare the safety and efficacy of monopolar and bipolar transurethral resection (TUR) of bladder tumors (TURBTs). Material and Methods: A total of 240 patients who underwent TURBT were prospectively included in the study from May 2011 to May 2014. All patients with suspected bladder tumors were eligible for study inclusion. Those who refused consent and those undergoing routine restaging TURBT were excluded from analysis. Patients were divided on the basis of the monopolar arm and the bipolar arm. Study outcomes included the incidence of bladder perforation and obturator jerk, decrease in hemoglobin and sodium levels, rates of re-coagulation and blood transfusion, TUR syndrome, and operation time. Results: The mean age of the patients was 62 ± 13.7 years. The incidence of obturator jerk and bladder perforation was greater in the bipolar arm. However, with a decrease in the hemoglobin and sodium levels, rates of re-coagulation and blood transfusion were greater in the monopolar arm. Statistical analysis did not show significant differences with regard to study outcomes between the groups. There was no case of TUR syndrome in the 2 arms. The residual tumors' rate was similar between the 2 groups. Conclusions: Our results showed that efficacy and safety of the monopolar and bipolar methods seems to be comparable in patients with bladder tumors.

Histopathological and prognostic significance of the expression of sex hormone receptors in bladder cancer: A meta-analysis of immunohistochemical studies.

ObjectiveEmerging preclinical evidence suggests the involvement of sex hormones and their receptor signals in the development and progression of bladder cancer. Meanwhile, previous studies have demonstrated conflicting results on the relationship between the status of sex hormone receptors in urothelial tumors and histopathological characteristics of the tumors or patient outcomes. We therefore conducted this meta-analysis to assess the clinicopathological impact of the expression of androgen receptor (AR) and estrogen receptors (ERs) in bladder cancer.MethodsA comprehensive literature search in databases (i.e. PubMed, Web of Science, Cochrane) was performed for all immunohistochemical studies stained for AR, ERα, and/or ERβ in surgically resected bladder cancer specimens and analyzed for patient outcomes. We selected eligible studies in accordance with the PRISMA guidelines and analyzed data using R software.ResultsA total of 2,049 patients from 13 retrospective studies were included in this meta-analysis. The difference in ERα expression between non-tumors and tumors was significant [odds ratio (OR) = 0.412; P<0.001], while those of AR (OR = 3.256; P = 0.336) or ERβ (OR = 0.580; P = 0.674) were not statistically significant. AR positivity in tumors was strongly correlated with gender (male vs. female: OR = 0.658; P = 0.027) or tumor grade (low-grade vs. high-grade: OR = 0.575; P<0.001). ERβ positive rates were significantly higher in high-grade (OR = 2.169; P<0.001) and muscle-invasive (OR = 3.104; P<0.001) tumors than in low-grade and non-muscle-invasive tumors, respectively. Survival analysis in patients with non-muscle-invasive bladder cancer revealed associations between AR expression and better recurrence-free survival [hazard ration (HR) = 0.593; P = 0.006) as well as between ERβ expression and worse recurrence-free (HR = 1.573; P = 0.013) or progression-free (HR = 4.148; P = 0.089) survivals.ConclusionsThese data suggest down-regulation of ERα expression in bladder tumors, compared with non-neoplastic urothelial tissues. AR or ERβ expression was down- or up-regulated, respectively, in high-grade and/or muscle-invasive bladder cancers. Moreover, immunohistochemistry of AR/ERβ in surgical specimens may serve as prognosticators in patients with non-muscle-invasive bladder tumor.

657 - Monopolar versus bipolar transurethral resection for primary non-muscle invasive bladder cancer

657 - Monopolar versus bipolar transurethral resection for primary non-muscle invasive bladder cancer

Assessment of the infiltrative character of bladder cancer at the time of transurethral resection: a single center study.

IntroductionDetermining the clinical stage of bladder carcinoma before radical cystectomy is characterized by a high inaccuracy rate. The discrepancy in some reports reaches up to 48%. Therefore intraoperative clinical staging of bladder carcinoma is not recommended before radical treatment as it is for prostate cancer. However, the accuracy of clinical assessment of the muscle invasive character of the tumors at the time of transurethral resection has not been studied. In our study we estimate the accuracy of clinical staging during endoscopic treatment.Material and methods332 patients who had undergone transurethral resection of bladder cancer were studied in this retrospective analysis. Data such as age, gender, presence of hydronephrosis, operator, the results of bimanual bladder examination, TURB report and pathologic report, were collected from each patient. Intraoperative prediction of the muscle invasive nature of the tumor was compared with pathological reports. A logistic regression analysis was used to evaluate the influence of particular variables on upstaging and downstaging.ResultsOverall accuracy between clinical and histopathology staging was 87.8%. Discrepancy was observed only in 36 patients. Patients with pTa stage were the most numerous group among patients with accurate prediction of the muscle invasiveness character of the tumor. Univariable logistic regression indicated that the presence of a palpable mass in the bimanual examination was a predictor of upstaging, with an OR 11.75 CI95% [2.49–55.32].ConclusionsThe study indicated the high accuracy between clinical and pathological reports. Intraoperative evaluation of tumor character should be an indispensable part of treatment, which can be useful for planning in advance the further stages of treatment.

Does the gross prosector impact pT3 subclassification or lymph node counts in bladder cancer?

Gross prosector analysis of perivesicular adipose tumor invasion is the sole differentiator between pT3 substages, and gross evaluation is critical to lymph node identification. Gross prosector impact on pT3 subclassification and lymph node counts in cystectomy specimens resected for bladder cancer has not been previously analyzed. Both pT3 subclassification and total number of lymph nodes removed at radical cystectomy for bladder cancer are considered important components of the pathology report; however, both have controversial prognostic significance. Our objective was to assess the impact of the gross prosector on pT3 substaging and lymph node count. Pathology reports from 560 cystectomy cases performed for primary bladder cancer were reviewed. Educational interventions regarding cystectomy gross prosector documentation were conducted. Gross prosectors did not document the presence or absence of macroscopic perivesicular adipose invasion in 17% of cases. There was a decrease in the frequency of cases lacking documentation after educational intervention (33% to 5%, P<.01). Most pT3 cases lacking documentation were classified as pT3a (75%). The percentage of pT3 cases classified as pT3a decreased after intervention (68% to 35%, P<.01). Overcounting of lymph nodes by gross prosectors was more common than undercounting (22% versus 2%). Pathology residents and prosectors with lower caseloads had more uncounted lymph packets (P<.01). In conclusion, we demonstrated an impact of the gross prosector on pT3 substaging and lymph node counts within bladder cancer resection specimens. This novel variable may confound the relationship of these parameters upon oncologic outcomes and should be incorporated into quality assurance programs.

275P Clinical outcomes of second transurethral resection in non-muscle invasive high grade bladder cancer: a retrospective, multi-institutional, collaborative study

275P Clinical outcomes of second transurethral resection in non-muscle invasive high grade bladder cancer: a retrospective, multi-institutional, collaborative study

MiR-138-5p contributes to cell proliferation and invasion by targeting Survivin in bladder cancer cells.

BackgroundSurvivin (encoded by the gene BIRC5) plays an important role in the carcinogenesis of bladder cancer. Identifying miRNAs that target Survivin in the setting of bladder cancer will help to develop Survivin-based therapies for bladder cancer.MethodsThe expression levels of miR-138-5p and Survivin protein were measured in 12 resected bladder cancer specimens. The correlation between miR-138-5p and Survivin was further examined by evaluating Survivin expression in human bladder cancer cell lines that either overexpressed or knocked down miR-138-5p. A luciferase reporter assay was performed to test the direct binding of miR-138-5p to the target gene BIRC5. We also investigated the biological role of miR-138-5p targeting to Survivin in bladder cancer cell lines both in vivo and in vitro.ResultsIn this study, we found that the Survivin protein was either absent or weakly expressed in normal adjacent tissues and consistently up-regulated in bladder cancer tissues; however, the mRNA levels did not vary as much, suggesting that a post-transcriptional mechanism was involved. Because microRNAs are powerful post-transcriptional regulators of gene expression, we used bioinformatic analyses to search for microRNAs that could potentially target BIRC5 in the setting of bladder cancer. We identified 2 specific targeting sites for miR-138-5p in the 3′ untranslated region (3′-UTR) of BIRC5. We further identified an inverse correlation between miR-138-5p and Survivin protein levels in bladder cancer tissue samples. By overexpressing or knocking down miR-138-5p in bladder cancer cells, we experimentally confirmed that miR-138-5p directly recognizes the 3′-UTR of the BIRC5 transcript and regulates Survivin expression. Furthermore, the biological consequences of the targeting of BIRC5 by miR-138-5p were examined in vitro via cell proliferation and invasion assays and in vivo using a mouse xenograft tumor model. We demonstrated that BIRC5 repression by miR-138-5p suppressed the proliferative and invasive characteristics of bladder cancer cells and that miR-138-5p exerted an anti-tumor effect by negatively regulating BIRC5 in a xenograft mouse model.ConclusionsTaken together, our findings provide the first clues regarding the role of miR-138-5p as a tumor suppressor in bladder cancer by inhibiting BIRC5 translation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12943-016-0569-4) contains supplementary material, which is available to authorized users.

105 - Identification of patients who benefit most from restaging resection of bladder cancer

105 - Identification of patients who benefit most from restaging resection of bladder cancer

Clinical outcomes of second transurethral resection in non-muscle invasive high-grade bladder cancer: a retrospective, multi-institutional, collaborative study.

A retrospective, multi-institutional collaborative study was conducted to evaluate the impact of second transurethral resection (TUR) on the clinical outcome of non-muscle invasive high-grade bladder cancer and to identify predictors of invasion to the lamina propria (pT1) or deeper and residual tumor at the second TUR. The clinical and pathological features of 198 patients with non-muscle invasive high-grade bladder cancer treated in five medical institutions from April 1990 to March 2013 were reviewed retrospectively. All patients underwent a second TUR within a mean of 1.5months after the first resection. Clinicopathological findings of the first and second TURs were compared. Cancer-specific survival and recurrence-free survival were evaluated. Univariate and multivariate analyses for predictors of residual cancer at the second TUR were performed using a logistic regression model. At the second TUR, no tumor was found in 111 (56%) patients, and 87 (44%) had residual cancer. At the first TUR, five pT1 patients (3%) were upstaged to pT2, one pTa patient (1%) was upstaged to pT1, and 12 G2 patients (6%) had their tumor upgraded to G3. Patients the group with less than stage pT1 cancer at the second TUR had significantly better survival than those in the group with stage pT1 or deeper cancer. Tumor multiplicity at the first resection was an independent risk factor for pT1 or deeper tumor at the second TUR. A second TUR is a valuable diagnostic procedure for accurate staging of non-muscle invasive high-grade bladder cancer. Tumor multiplicity at the first TUR was a significant independent predictor of pT1 or deeper tumor at the second TUR.

Mucinous adenocarcinoma of the bladder: A case report and review of the literature

Mucinous adenocarcinoma of the bladder is rare. The most common symptoms are hematuria, suprapubic pain and dysuria. The patient in the present case was a 59-year-old female who presented with a tumor sized ~5.0×3.4 cm, located in the anterior bladder wall, which was pathologically diagnosed as mucinous bladder adenocarcinoma. The stage at presentation was considered to be advanced and inoperable, due to extensive local invasion. For this type of cancer, early diagnosis is crucial. If the cancer is limited to the bladder, the survival rate may exceed 75%. Thus, for patients with confirmed or highly suspicious bladder mucinous adenocarcinoma, radical bladder cancer resection is required. The 5-year survival rate of this type of cancer is 35-55%. In the present case, the cancer of the patient was considered inoperable and 3 months later she succumbed to the disease.

Transurethral electric resection plus arterial catheterization chemotherapy for T2a bladder carcinoma

Clinical data of 23 patients with T2a bladder cancer admitted from March 2008 to August 2013 were retrospectively analyzed. Among 23 patients, 11 cases were treated with transurethral resection (TURBT) plus arterial catheterization chemotherapy (study group) and 12 cases were treated with radical cystectomy (control group). The overall survival time and recurrence free survival time of two groups were compared. Patients in study group were followed up for 20-68 months, recurrence occurred in 5 cases (5/11), including 4 cases of invasive recurrence; patients in control group were followed up for 2~86 months, 1 case had superficial recurrent and underwent TURBT, 2 cases dead due to bladder tumor. During the course of chemotherapy, the main adverse effects were digestive reaction (7/11), fever (4/11), bone marrow suppression (2/11), symptomatic treatment was given, which was tolerated. There were no significant differences in overall survival time and recurrence free survival time between two groups (P>0.05). The quality of life of study group was better than that of control group (P<0.05). It is suggested that the arterial interventional chemotherapy combined with transurethral resection for T2a stage invasive bladder cancer has a certain curative effect with the advantage of preservation of bladder function and higher quality of life. Key words: Urinary bladder neoplasms; Drug therapy, interventional; Prognosis

Expression of Annexin A2 and Its Correlation With Drug Resistance and Recurrence of Bladder Cancer.

To explore the expressions of annexin A2 in bladder cancer cell lines and bladder cancer tissues, we want to find the relationship among annexin A2, drug resistance, and recurrence of bladder cancer. Our laboratory established the PUMC-91 bladder cancer cell line against gradient concentration of Adriamycin (0.3, 0.6, and 1.0 μg/mL), and we also collected 60 cases of surgically resected bladder cancer recurrent tissue samples. The tissues were classified into 2 groups according to the frequency of recurrence (<6 months and >2 years) after initial surgery. The method of immunohistochemistry was used to examine the differences in the expression of annexin A2. There were statistical differences in annexin A2 among normal bladder epithelial cell line SV-HUC-1, PUMC-91, PUMC-91 against 0.3 μg/mL Adriamycin, and PUMC-91 against 1.0 μg/mL Adriamycin (P < .05). The expressions of Annexin A2 were found to be higher than those that recurred at >2 years (P = .002) in the bladder cancer tissues and that recurred at <6 months after initial surgery. It was also associated with invasion depth (stage) of bladder cancer, such as higher expression in T2 (invasive muscular) group than Tis (carcinoma in situ) and T1 (invasive mucosa lamina propria) groups (P = .003 and P = .000, respectively). But, it did not correlate with the differentiation (grade) of cancer cells in bladder cancer tissues (P = .593). Annexin A2 can act as a valuable biomarker for predicting the drug resistance and recurrence of bladder cancer.

The clinical value of PSA increase during intravesical adjuvant therapy for nonmuscle-invasive bladder cancer.

Prostatic Specific Antigen (PSA), Bacillus Calmette-Guerin (BCG) increase after intravesical BCG has been reported. The need of prostate biopsy in these patients is object of debate. The aim of our study was to evaluate the effect of intravesical therapy on PSA after transurethral resection (TUR) of nonmuscle-invasive bladder cancer (NMIBC). Patients undergoing intravesical chemotherapy or immunotherapy for NMIBC were entered. PSA was measured before TUR, before the first and after the sixth instillation, 30 and 90 days after the last instillation. Patients with PSA ≥4 ng/ml or palpable prostate nodule were excluded. Out of 130 patients, 105 were evaluable. PSA increase (mean: 7.15 ng/ml) was detected after TUR and before intravesical therapy in 14 patients (13.3%). Of the remaining 91 patients, 65 (71.4%) received chemotherapy and 26 (28.6%) BCG. Median PSA before and during therapy was 1.80 and 1.97 ng/ml, with a 36% median increase in 66 patients (72.5%) (p = 0.13). No statistically significant difference emerged between chemotherapy and BCG (p = 0.22). PSA higher than 4 ng/ml was detected in six (6.3%) and two (2.1%) patients after chemotherapy and BCG, respectively, and was no more evident at 90 days. PSA increase due to intravesical therapy is rare and usually not clinically significant. PSA rising above 4 ng/ml during intravesical treatment was evident only in 8% of patients. PSA before TUR should be available and considered as the basal value. Elevated PSA detected during therapy should be monitored and biopsy proposed only if persisting more than 3 months after the end.

Mid-Term Follow-Up of “En Bloc” Resection of Nonmuscle Invasive Bladder Cancer: Results from a Prospective Single-Center Study

Abstract Introduction and Purpose: “En bloc” resection of bladder tumors (ERBTs) is an innovative technique, which is shown to improve staging quality and reduce recurrence at early follow-ups. Out...

Distinct Pattern of CC Chemokine 2 and 5 in Post-Transurethral Resection of Bladder Cancer

Distinct Pattern of CC Chemokine 2 and 5 in Post-Transurethral Resection of Bladder Cancer