Resection Of Bladder Cancer Research Articles

Deciding When to Omit Repeat Transurethral Resection of Superficial Bladder Cancer: Do Photodynamic Diagnostics help?

BACKGROUND: Repeat transurethral resection of bladder tumor is recommended when certain risk constellations are present on initial resection. Current evidence is conflicting, leading to dissenting recommendations in multinational guidelines around the world. Photodynamic diagnostics (PDD) is a tool which has been shown to increase diagnostic accuracy, but evidence is still lacking if this may permit omission of repeat resections in certain cases. OBJECTIVE: To evaluate whether the use of photodynamic diagnostics has an impact on resection quality and residual tumor rate, and to explore which parameters may have an impact on the necessity of repeat transurethral resections. METHODS: We retrospectively evaluated 373 patients in the timeframe of ten years, in whom a repeat transurethral resection of bladder tumor has been performed following initial resection at our department. About half of those resections were performed using photodynamic diagnostics. RESULTS: When PDD was used, more tumor mass was revealed and resected, but the shown trend toward a lower residual tumor rate was non-significant. Muscularis was shown more often on PDD resections. While being a rare occurrence, upstaging on repeat resection happened significantly less often after initial PDD use. Furthermore, tumor size and multifocality significantly influenced residual tumor rate in Ta high-grade stage. CONCLUSIONS: PDD use may lead to a more accurate initial staging but this may not have an impact on short-term residual tumor rate. Tumor size and multifocality should be granted more weight in the decision-making process as when to perform a repeat resection.

Safety, feasibility, and quality of holmium laser en-bloc resection of nonmuscle invasive bladder tumors - A single-center experience.

Introduction:Conventional transurethral resection of bladder tumor (cTURBT), despite its piecemeal resection and associated limitations, remains the most widely practiced technique of TURBT. Resecting the tumor in a single piece would avoid most of the drawbacks of cTURBT. Our objective was to assess the feasibility, safety, and quality of Holmium (Ho) laser en-bloc resection (ERBT) for nonmuscle-invasive bladder cancer (NMIBC).Materials and Methods:We retrospectively studied 67 patients who underwent Ho laser EBRT for primary NMIBC. Data were collected regarding tumor size, number and location, intraoperative complications, and postoperative course. Patients were grouped as first 20, next 20 (21–40), and last 27 cases to assess how the quality of resection improved with increasing experience.Results:The mean tumor size was 28.7 ± 7.9 mm, with 34.3% of the patients having a tumor larger than 3 cm. While 43 patients (64.17%) had a single tumor, the rest had multiple tumors, ranging from 2 to 9 in number. The mean total duration of resection was 38.7 ± 11.6 min. No case required conversion to cTURBT. No patient experienced obturator reflex or bladder perforation. Detrusor muscle was present in 85.07% of the resections. With increasing experience, requirement for bladder irrigation and the incidence of postoperative clot evacuation decreased (P < 0.0001 and P = 0.31, respectively), and the detrusor-positive rate in the specimen increased (P = 0.24). The mean duration of catheterization was 1.76 ± 0.54 days.Conclusion:Ho laser ERBT is safe and feasible for complete resection of NMIBCs with no risk of obturator-nerve reflex and a high rate of detrusor-positive specimens.

The changing role of lasers in urologic surgery.

To summarize recent publications on the topic of laser in urology and explore new developments which may impact the future role of lasers in surgery. Ho: Yttrium-aluminium garnet (YAG) laser with Moses technology allows less retropulsion during a lithotripsy, yet its efficacy needs to be tested in clinical trials. Data on the efficacy of this device for benign prostatic obstruction treatment is also pending. A new promising generation of laser systems - thulium-fiber (Tm-fiber) lasers - has been introduced. Tm-fiber has already been shown to be effective and well tolerated in endoscopic enucleation of the prostate and has demonstrated favorable outcome compared with Ho:YAG in preclinical lithotripsy studies. However, more studies are needed to better understand the use of this novel technology and elucidate its role within the armamentarium of available technologies. Lasers remain an integral part of benign prostatic hyperplasia surgery and stone treatment and gain popularity in en-bloc resection of bladder cancer. Current efficacy of laser systems in prostate cancer ablation and their place in laparoscopy remain unclear, despite promising initial reports.

Expression and Clinical Significance of MMP-28 in Bladder Cancer.

Aims:The aim of this study to determine the expression of MMP-28 in bladder urothelial carcinoma and to analyze the correlation between MMP-28 and the clinicopathological characteristics of human bladder carcinoma, and its relationship with patient prognosis.Methods:A total of 491 surgically resected bladder cancer samples and 80 normal tissue adjacent to the tumor were stained by immunohistochemistry. The expression of MMP-28 in these samples was quantitated, and the value of MMP-28 as a marker of bladder cancer and prognosis was assessed.Results:The expression of MMP-28 in urinary bladder carcinoma was higher than in normal bladder mucosa. The high level of MMP-28 was significantly correlated with tumor histology grade, lymphatic metastasis, lymph node infiltration, and distant metastasis (P < 0.05). The upregulation of MMP-28 was also closely related to the risk of cancer progression and the survival of patients. Further analysis documented that high expression of MMP-28 was associated with decreased overall survival in bladder cancer patients.Conclusions:The abnormal expression of MMP-28 may be related to the initiation and development of urothelial carcinoma. The upregulation of MMP-28 can be used as one of the effective indicators to diagnose bladder cancer and predict tumor progression.

Diagnostic Performance and Predictive Capacity of Immediate Urine Cytology After Transurethral Resection of Non-Muscle Invasive Bladder Cancer; A Prospective Study

Diagnostic Performance and Predictive Capacity of Immediate Urine Cytology After Transurethral Resection of Non-Muscle Invasive Bladder Cancer; A Prospective Study

Second Transurethral Resection (TUR) for Bladder Cancer Diagnosed with High Grade pT1 by Initial TUR Under Narrow Band Imaging

We evaluated 52 consecutive cases of patients undergoing second transurethral resections (TUR) for non-muscle invasive bladder cancer (NMIBC) in which the patients were diagnosed with high grade pT1 by the initial TUR under narrow band imaging (NBI). The initial TUR under NBI (NBI-TUR) was performed : Systematic intravesical observation under white light imaging (WLI) and NBI was followed by a multiple site biopsy (MSB), after which lesions detected in positive findings were resected completely under NBI. The tumor detection rates under WLI and NBI were calculated separately and compared with endoscopic findings and MSB samples. The second TUR was performed as a resection that included the surrounding mucosa and muscle layer of the initial NBI-TUR scar under WLI observation, 4-8 weeks after the initial NBI-TUR. The patients were divided into two groups : The residual cancer lesion-positive group (NBIR positive), and the residual cancer lesion-negative group (NBIR negative). The tumor detection rate under NBI was more sensitive compared with that under WLI in the initial NBI-TUR (89.4% vs 59.1% p< 0.0001), and the residual cancer detection rate in the 2nd TUR reached 34.6% (18/52). There was no significant difference in the background factors between the NBIR positive and NBIR negative. While the number of cancer lesions detected under NBI was significantly higher than that under WLI in the NMIBCdiagnosed high grade pT1, the rate of cancer lesions that were difficult to identify in the initial NBI-TUR was still high. These findings demonstrate the limitations of the mono-therapeutic effect of NBI-TUR.

Diagnostic performance of image technique based transurethral resection for non-muscle invasive bladder cancer: systematic review and diagnostic meta-analysis

ObjectiveTo explore the diagnostic performance of image technique based transurethral resection for bladder cancer, with white light-guided cystoscopy (WLC) as the reference standard.DesignSystematic review and meta-analysis.Data sourcesPubMed/MEDLINE, Web of Science,...

SC70 - The feasibility and prognostic value of sequential evaluation of EGFR cell expression in bladder washings after transurethral resection of Non-Muscle Invasive Bladder Cancer: A new potential tool to identify patients at higher risk of disease progression

SC70 - The feasibility and prognostic value of sequential evaluation of EGFR cell expression in bladder washings after transurethral resection of Non-Muscle Invasive Bladder Cancer: A new potential tool to identify patients at higher risk of disease progression

The Resected Tumour Volume of the Specimen as a Marker of the Quality of the Transurethral Resection in T1 Urinary Bladder Cancer

This prospectively performed population-based study included all patients in the Southeast Healthcare Region in Sweden with T1 UBC registered in the period 1992-2001, inclusive. RV, RTV and important clinic-pathological variables were studied. All patients had T1 tumours including detrusor muscle at the histopathological examination. Median values for RV and RTV were cut-off points for dichotomisation and 3 cm was the cut-off point for tumour size measured at TUR. Recurrence and progression were analysed using Kaplan-Meier curves with Log-rank test and Cox Proportional Hazards analysis.

Augmented Bladder Tumor Detection Using Deep Learning

Adequate tumor detection is critical in complete transurethral resection of bladder tumor (TURBT) to reduce cancer recurrence, but up to 20% of bladder tumors are missed by standard white light cystoscopy. Deep learning augmented cystoscopy may improve tumor localization, intraoperative navigation, and surgical resection of bladder cancer. We aimed to develop a deep learning algorithm for augmented cystoscopic detection of bladder cancer. Patients undergoing cystoscopy/TURBT were recruited and white light videos were recorded. Video frames containing histologically confirmed papillary urothelial carcinoma were selected and manually annotated. We constructed CystoNet, an image analysis platform based on convolutional neural networks, for automated bladder tumor detection using a development dataset of 95 patients for algorithm training and five patients for testing. Diagnostic performance of CystoNet was validated prospectively in an additional 54 patients. In the validation dataset, per-frame sensitivity and specificity were 90.9% (95% confidence interval [CI], 90.3–91.6%) and 98.6% (95% CI, 98.5–98.8%), respectively. Per-tumor sensitivity was 90.9% (95% CI, 90.3–91.6%). CystoNet detected 39 of 41 papillary and three of three flat bladder cancers. With high sensitivity and specificity, CystoNet may improve the diagnostic yield of cystoscopy and efficacy of TURBT. Patient summaryConventional cystoscopy has recognized shortcomings in bladder cancer detection, with implications for recurrence. Cystoscopy augmented with artificial intelligence may improve cancer detection and resection.

Practice pattern of non-muscle invasive bladder cancer in Japan, Korea and Taiwan: A Web-based survey.

To investigate the treatment pattern of non-muscle invasive bladder cancer patients among urologists in Japan, Korea and Taiwan, with emphasis on compliance with important treatment guidelines. A Web-based questionnaire survey was conceived by representative members of each country's urological oncology society and was open from June 2016 to February 2017 to each society's members. Descriptive statistics and multinomial logistic regression analysis were used. A total of 2334 urologists were invited and 701 responded to the survey with a response rate of 30.0%. Instruments used during transurethral resection of bladder cancer varied significantly between countries and depended on their availability. The re-transurethral resection rate for pT1 or high-grade disease >50% of the time was significantly higher in Japan than in the other two countries, but the collective rate was just 49%. The frequency of intravesical therapy in intermediate- to high-risk disease was generally consistent across countries. However, the choice of agent between chemotherapy and bacillus Calmette-Guérin was significantly different between countries. Maintenance bacillus Calmette-Guérin was used <10% of the time by 45% of respondents, the most important reasons being fear of side-effects, followed by a lack of efficacy and shortage of drug supply. There are significant differences between Japan, Korea and Taiwan in the management of intermediate- to high-risk non-muscle invasive bladder cancer. The results of this survey can serve as the basis for joint efforts to develop common clinical guidelines.

Expression level of ZNF217 in bladder cancer and its clinical significance

Objective To determine the expression of ZNF217 protein in bladder cancer tissues and to analyze its clinicopathological characteristics, so as to clarify its clinical significance. Methods The clinicopathological data of 123 patients with bladder cancer who underwent bladder cancer resection were retrospectively analyzed. The expression of ZNF217 protein in bladder cancer tissues and corresponding adjacent tissues was detected by immunohistochemistry, and its correlation with clinical characteristics of patients was analyzed. Results ZNF217 protein was highly expressed in tumor tissues, and the ratio of high expression of tumor tissues was 67.4%, but it was lowly expressed in adjacent tissues. By comparing with clinicopathological features, the expression level of ZNF217 was significantly correlated with tumor T stage and tumor recurrence (all P 0.05). The survival analysis showed that patients with high expression of ZNF217 in bladder cancer had significantly shorter overall survival and progression-free survival than those with low ZNF217 expression (all P<0.05). Conclusions ZNF217 is highly expressed in bladder cancer tissues, and its expression level is associated with tumor stage, tumor recurrence and poor prognosis, suggesting that it can be used as a potential therapeutic target for bladder cancer. Key words: Bladder cancer; Immunohistochemistry; ZNF217; Tumor stage; Recurrence

Delayed 18F FDG PET/CT Imaging in the Assessment of Residual Tumors after Transurethral Resection of Bladder Cancer.

Background Delayed fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT is used to diagnose bladder cancer. However, it remains difficult to determine whether a lesion with abnormal 18F FDG uptake is tumor residue or recurrence or if it is an inflammatory reaction in patients with bladder cancer after oncologic treatment. Purpose To determine the diagnostic performance of delayed 18F FDG PET/CT in the differentiation of residual tumors from postoperative inflammatory reactions in patients with bladder cancer after initial transurethral resection of bladder tumor (TURBT). Materials and Methods A retrospective clinical study between January 2015 and April 2018 was performed in 79 patients with bladder cancer who had undergone 18F FDG PET/CT within 1 month after initial TURBT. After PET/CT, all patients underwent a second surgery within 2 weeks to confirm the histologic nature of the suspicious lesion and to remove residual tumors. Uni- and multivariable analysis were used to identify predictive factors for residual bladder tumors. Results A total of 79 patients (61 men, 18 women; mean age, 63 years ± 11 [standard deviation]) were enrolled in this study. A total of 98 lesions was studied, 64 (65.3%) of which were residual tumors after initial TURBT. When compared with inflammatory reactions, residual tumors had higher mean standardized uptake value (SUVmean) (mean, 5.8 ± 2.0 vs 9.3 ± 5.4; P < .001), higher maximum standardized uptake value (SUVmax) (mean, 15.5 ± 9.8 vs 22.2 ± 13.6, P = .01), and greater lesion thickness (mean, 9.6 mm ± 4.1 vs 17.9 mm ± 11.1, P < .001) at 18F FDG PET/CT. SUVmean (odds ratio [OR], 1.2; 95% confidence interval [CI]: 1.0, 1.5; P = .049) and lesion thickness (OR, 1.2; 95% CI: 1.0, 1.3; P = .006 or OR, 1.2; 95% CI: 1.1, 1.3; P = .001) were identified as independent predictors for residual tumors with multivariable logistic regression analysis. On the basis of the threshold values of SUVmean and lesion thickness, we revealed a prediction rate of 37.5% (17 of 47), 85.4% (26 of 29), and 98.3% (21 of 22) for residual tumors in low-, moderate-, and high-risk subgroups, respectively. Conclusion Use of fluorine 18 fluorodeoxyglucose PET/CT to differentiate lesions after transurethral resection of bladder tumor indicates that higher mean standardized uptake values and greater lesion thickness are predictive factors for residual tumors in patients with bladder cancer after oncologic treatment. Published under a CC BY 4.0 license.

Preoperative neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predict clinical outcome in patients with muscle-invasive bladder cancer

Objective To investigate whether the ratio of neutrophil-lymphocyte ratio (NLR) to platelet-lymphocyte ratio (PLR) can be used as a prognostic indicator for radical cystectomy (RC) for patients with muscle-invasive bladder cancer (MIBC). Methods The 132 patients with MIBC who underwent radical bladder cancer resection were divided into high NLR group (NLR 2.03, 65 cases), low NLR group (NLR<2.03, 59 cases), high PLR group (PLR 125.30, 37 cases) and low PLR group (PLR<125.30, 87 cases) according to the preoperative peripheral blood NLR and PLR. Kaplan-meier method was used to analyze the influence of each clinicopathological feature on the survival and death of patients. Log-rank test was used to compare the survival curves of NLR and PLR groups respectively. Cox regression model was used to analyze the factors affecting the prognosis of MIBC patients. Results High levels of NLR and PLR are closely related to the clinical staging of bladder cancer (χ2=4.422, P<0.05; χ2=3.115, P<0.05). In addition, univariate regression model analysis showed that both high level NLR [hazard ratio (HR)=3.503, P<0.01] and high level PLR (HR=2.688, P<0.01) could affect the 3-year survival time of bladder cancer patients, and the difference was statistically significant. Multivariate regression model analysis showed that only a high level of NLR (HR=3.678, P<0.05) was an independent risk factor for 3-year survival. Conclusion NLR is an independent risk factor for MIBC, and its predictive value is significantly better than PLR. Key words: Neutrophil lymphocyte ratio; Platelet lymphocyte ratio; Invasive bladder cancer; Progression

A pilot study to assess the safety and usefulness of combined transurethral endoscopic mucosal resection and en-bloc resection for non-muscle invasive bladder cancer

BackgroundTransurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC). Although most solid tumors are principally removed via single block resection without incising the mass, disruption of the lesion is unavoidable in traditional TUR. Furthermore, pathological diagnosis is often difficult due to heat-related denaturation of tissues in TUR. Although transurethral en-bloc resection is useful for judging tumor invasion, it is associated with a prolonged operative duration. We attempted to show the safety and usefulness of combined endoscopic mucosal resection (EMR) and en-bloc resection in NMIBC patients.MethodsWe investigated 39 patients with clinical NMIBC who were treated using our original EMR + en-bloc resection technique, which involved removal of the tumor mass that protruded from the mucosa, using a polypectomy snare similar to that used for EMR. The residual lesion was removed using en-bloc resection. The operative period, duration of hospitalization, and recurrence rates were compared with those of conventional TUR (n = 31).ResultsThe mean (standard deviation, range) time interval for EMR and total operative duration were 1.6 (1.1, 1–5) min and 18.3 (10.5, 3–48) min, respectively. The total operative duration was comparable to that of TUR (17.3 min, p = 0.691). The mean duration of catheterization in the EMR + en-bloc resection group (4.2 days) was also similar to that in the TUR group (3.7 days; p = 0.285). No severe complications were observed with EMR + en-bloc resection. The pathologists were able to determine tumor invasiveness with considerable certainty in all specimens obtained via the EMR + en-bloc procedure than via TUR, and the difference in the ease of diagnosis was statistically significant (p = 0.016). Recurrence rates were comparable (p = 0.662) between the EMR + en-bloc (15.4%) and TUR groups (19.4%).ConclusionsOur results demonstrated that the EMR + en-bloc resection technique is feasible, safe, and useful for treating patients with NMIBC. Furthermore, this technique helps provide a more accurate pathological diagnosis.

Effects of intraoperative PEEP on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer: study protocol for a randomized controlled trial

BackgroundThere are increasing studies showing that the use of a lung-protective ventilation strategy has a lung protection effect in patients undergoing abdominal surgery; however, the appropriate positive end-expiratory pressure (PEEP) has not yet defined. Adopting a suitable PEEP may prevent postoperative pulmonary complications. Robot-assisted laparoscopic surgery is the newest and most minimally invasive treatment for bladder cancer or prostate cancer. It is also necessary to consider the effects of Trendelenburg position with pneumoperitoneum on airway pressure and pulmonary function. The role of PEEP during the intraoperative period in preventing postoperative pulmonary complications for robot-assisted laparoscopic surgery is not clearly defined.Methods/designA total of 208 patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer will be enrolled and then randomly assigned to a standard PEEP (6–8 cm H2O) group and a low PEEP (≤2 cm H2O) group. Both groups will receive an inspired oxygen fraction of 0.50 and a tidal volume of 8 mL/kg ideal body weight. Standard perioperative fluid management standardization and analgesic treatments will be applied in both groups. The primary endpoint is postoperative pulmonary complications within 7 days after surgery. Secondary endpoints are the modified clinical pulmonary infection score, postoperative extrapulmonary complications, postoperative surgical complications, intensive care unit length of stay, hospital length of stay, and 30-day mortality.DiscussionThis trial aimed to assess the effects of low tidal volumes combined with intraoperative PEEP ventilation strategy on postoperative pulmonary complications in patients undergoing robot-assisted laparoscopic radical resection for bladder cancer or prostate cancer.Trial registrationID: ChiCTR1800019867. Registered on December 2, 2018.

En-bloc resection of non-muscle invasive bladder cancer: what must be answered in the future?

En-bloc resection of non-muscle invasive bladder cancer: what must be answered in the future?

En bloc resection improves the identification of muscularis mucosae in non-muscle invasive bladder cancer.

The T1 substage, according to the relationship between muscularis mucosae (MM) and tumors, is a promising prognostic factor for T1 bladder cancer. However, the identification rate of MM is low in specimens, and it is, therefore, not widely used in clinical practice. In this study, we investigated whether en bloc resection of non-muscle invasive bladder cancer (NMIBC) could improve the identification of muscularis mucosae (MM), which may further accurate identification of the T1 substage. Specimens from 158 patients with primary NMIBC were retrospectively reviewed by two independent pathologists to assess the presence of MM and stratify the T1 substage. Of 158 specimens, 70 specimens were obtained via TURBt with a plasma kinetic loop and 88 were obtained via front-firing potassium-titanyl-phosphate (KTP) green-light laser en bloc resection. Univariable and multivariable logistic regression models were used to analyze the relationship between the clinical characteristics and the presence of MM. The mean age was 58.22years (range 18-85years). Multivariable logistic regression analysis showed that the KTP laser resection method was associated with the presence of MM in specimens (P = 0.008). In addition, tumors with smaller sizes, which could also be en bloc resected with TURBt (e.g., ≤1cm), had a higher presence of MM (P = 0.047). En bloc resection improves the identification rate of MM, which may enhance the accurate identification of the T1 substage.

Evaluation of prognostic effects of MSI, PD-L1 and TIL in resected bladder cancer.

465 Background: The aim of the study was evaluating prognostic significance of tumor infiltrating lymphocytes (TIL), microsatellite instability (MSI) and programmed cell death ligand-1 (PD-L1) expression which are used as predictive biomarkers in immunotherapy. Methods: Clinic and pathologic features of bladder cancer patients who were underwent radical cystectomy were retrospectively analyzed from patients’ records in this single-center study. PD-L1, PD-L1 in TIL, PMS2, MSH2, MSH6 and MLH1 immunohistochemistry staining were carried out to archived resected tumor specimens of the eligible patients. MSI was evaluated according to existing of PMS2, MSH2, MSH6 and MLH1. Results: Fifty-six males (91.8%) and 5 females (8.2%) of total 61 patients were eligible for the study. Median age was 61.72 (35-81). PD-L1 expression in tumor cells and PD-L1 expression in TIL were positive in 14,8% (n = 9) and 16.4% (n = 10) of total 74 patients, respectively. MSI was high in 15 patients (24.6%). Intratumoral TIL rate was &lt; 10% in 49 patients (80.3%) while &gt; 10% in 12 patients. (19.7%) In Chi-square test, there was no statistically significant relationship between PD-L1, PD-L1 in TIL, MSI and TIL rate and patients’ characteristics including sex, stage, pathologic grade and lymph node status. Three-years overall survival (OS) rate was calculated as 43%. Univariate analysis did not reveal any significant difference in 3-years OS in PD-L1 expression in tumor, PD-L1 expression in TIL and TIL rate &gt; 10% . (p = 0.822, p = 0.638, p = 0.318; respectively ). There was a positive trend with MSI high patients and OS (p = 0.089). At also; age and stage showed statistically significant difference in multivariate analysis. (p = 0.023, p = 0.011, respectively). Conclusions: This study revealed that there is no prognostic significance of PD-L1 and TIL. However, there are positive trend between OS and MSI, which is proven as predictive biomarker of immunotherapy, in patients who were followed with same treatment and follow-up approach in single center. These results must be corroborated with large and prospective investigations in order to better understanding biology and behavior of bladder cancer.

574 - Bipolar en bloc tumor resection versus standard monopolar TURBT in non-muscle invasive bladder cancer – a medium-term, prospective, randomized-controlled comparison

574 - Bipolar en bloc tumor resection versus standard monopolar TURBT in non-muscle invasive bladder cancer – a medium-term, prospective, randomized-controlled comparison