Stage Ta Research Articles

Abstract PO3-22-03: Effect of Radiation Therapy on Survival Outcomes in Elderly ER/PR Positive AJCC Stage T1 Breast Cancer Patients

Abstract Background: The CALGB 9343 study in 2004 reported that women >70 years of age with pT1NO hormone receptor positive breast cancer received no meaningful benefit from breast irradiation following lumpectomy. The effectiveness of adjuvant radiation therapy in node negative, T1 tumor patients has been limited to institutional experiences with relatively lack of information in population-based studies. In this hospital-based study using National Cancer Data Base (NCDB) from 2004 to 2020, we report on adjuvant radiation therapy (XRT) usage and the survival outcomes in stage IA, IB, IC breast cancer patients who received XRT versus those who did not. Materials and Methods: Patients in the National Cancer Database (NCDB) who were registered between 2004 and 2019 and followed up to the end of 2020 were used in this research. We evaluated a cohort of 126,156 female breast cancer patients of age >= 70 years with the American Joint Committee on Cancer (AJCC) stage TIA, TIB, and TIC. All patients were ER/PR positive, received hormonal therapy, all patients were either white or black, were either privately or Medicare insured, received hormonal therapy, and patients were receipt of adjuvant chemotherapy or not. Radiation statuses were grouped as no radiation, radiation only and/or radiation with boost. Other adjusted variables included: age, race, Charlson comorbidity index, payer status, income, education, distance traveled, diagnosing/treating facility, location of treatment and treatment delay. SAS for Windows 9.4 was used for all data management and statistical analysis. Multivariate Cox regression was used to assess the effect of the XRT on overall survival while adjusting for other factors. All p-values < 0.05 or 95% Confidence Limits of Hazards Ratio (HR) does not include 1 were considered statistically significant. Results: Among 126,156 female breast cancer patients, the age distribution was 47.87%, 31.72%, and 20.4% for age group of 70-74, 75-79, 80 or older, respectively. Ninety-three percent of patients were white. 89% of patients were Medicare and 11% were privately insured at diagnosis. 21% of patient were with the Charlson Comorbidity index score 1 or above. 10.77%, 34.42% and 54.81% of patients were AJCC Stage T1A, T1B, and T1C respectively. 11.7% of patients received chemotherapy and 57.9% of patients received radiation therapy. 54.38%, 59.59%, and 57.59% of T1a, T1b, and T1c patients received the XRT, respectively. In univariate analysis, the XRT demonstrated a statistically significant increase of 10-year survival by 9.75%, 9.8%, and 12.6% in T1a, T1b, and T1c (all p < 0.0001) patients respectfully. In multivariate cox regression analysis, age was a predictor of survival outcome with a HR at 1.65, 3.02 for 75-79, and 80 or older as compared to 70-74 years old, respectively. In addition, compared to patients who traveled less than 20 miles, the HR were 0.90 for patients travelled more than 20 miles. AJCC stage was also associated the survival, a HR of 1.05 (95% CI: 1.01-1.186) for T1b, 1.16 (95% CI: 1.11 – 1.21) for T1c as compared for T1a. Adjusting for other factors, the usage of radiation reduced the risk of dying by 25% (HR=0.75, 95% CI: 0.73-0.77) when compared to no radiation therapy. Conclusion: The current study has demonstrated that more than 54% of these patients received radiation therapy. In univariate analysis, the benefit of adjuvant radiation therapy is more than 9.7% for T1a, T1b, and T1c on 10-year overall survival which is statistically significant. Adjusting for other factors, patients receiving radiation therapy in these elderly population have a 25% less chance of dying as compared to no radiation therapy regardless of AJCC Stage. A further propensity score matching method would help assess the effectiveness of radiation therapy on these patients’ population. A randomized prospective clinical trial would be better to define the precise benefit of adjuvant radiation therapy in this elderly population. Table 1 Patients Demographic, Social Economic and Clinical Characteristics XX- XX Table 3 Hazard Ratios estimate from Multivariate Cox Regression XX- XX Radiation Effect on Overall Survival of Elderly Breast Cancer Patients by Stage T1A, T1B, T1C XX- XX Citation Format: Runhua Shi, Gary Burton. Effect of Radiation Therapy on Survival Outcomes in Elderly ER/PR Positive AJCC Stage T1 Breast Cancer Patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-22-03.

Identification of an Objective Cut-Off Point to Define the Clinical Stage T4a in Colon Cancer

Introduction: The current state of pathology practice and the variability in diagnosing pT4a colon cancer have been underexplored in existing studies. Our objective was to establish a specific cutoff point to distinguish between the pathological stages of pT3 and pT4a in colon cancer. Methods: We conducted a cross-sectional study involving pT3 and pT4 (pN0-2, cM0) colon cancers, measuring the distance to the serosa. Patients were categorized and analyzed based on this distance and the peritoneal reaction, with the aim being to ascertain their prognostic implications. Results: A total of 384 patients were analyzed. Patients with a distance between the invading front of cancer and the serosa ≥ 1 mm without a peritoneal reaction exhibited a median survival of 118 months, contrasting the amount of 70 months for those with <1 mm plus peritoneal reaction. Only lengths <1 mm with peritoneal reaction showed a significant correlation with mortality (p < 0.001). Conclusion: Our study revealed that patients in whom neoplastic cells were less than 1 mm from the serosal surface, accompanied by a peritoneal reaction (hemorrhage, inflammation, neovascularization, fibrin), had significantly lower survival rates compared to those with more than 1 mm distance and without peritoneal response (70 vs. 118 months, p < 0.001). Hence, such cases should be considered within the pT4a stage.

Clinical performance and utility of a noninvasive urine-based methylation biomarker: TWIST1/Vimentin to detect urothelial carcinoma of the bladder.

Traditional clinical modalities for diagnosing bladder urothelial carcinoma (BUC) remain limited due to their invasive nature, significant costs, discomfort associated with cystoscopy, and low sensitivity to urine cytology. Therefore, there is an urgent need to identify highly sensitive, specific, and noninvasive biomarkers for the early detection of this neoplasm. Hypermethylated TWIST1/Vimentin promoter may be a noninvasive biomarker using urine sample. We assessed the TWIST1/Vimentin promoter methylation status in urine samples using the Methylated Human TWIST1 and Vimentin Gene Detection Kit (Jiangsu MicroDiag Biomedicine Co., Ltd., China). The samples were collected from five groups: group 1 consisted of patients with BUC, group 2 contained other patients with urologic tumors, group 3 consisted of patients with benign diseases (e.g., urinary tract infections, lithiasis, and benign prostatic hyperplasia), Group 4 included UTUC (upper tract urothelial carcinoma) patients and group5 comprised healthy individuals. The study encompassed 77 BUC patients, and we evaluated the degree of methylation of the TWIST1/Vimentin gene in their urine samples. Notably, TWIST1/Vimentin positivity was significantly elevated in comparison to groups 2, 3 and 5 (all p < 0.001) at a rate of 77.9%, but no significant difference was observed when compared to group 4. In the relationship between TWIST1/Vimentin methylation and clinicopathological features of BC patients from our center, we found there was no significant association between TWIST1/Vimentin status and proteinuria and/or hematuria, and hypermethylation of TWIST1 / VIM genes was found in both high and low tumor grade and in both non-muscle invasive bladder cancer (stages Tis, Ta, or T1) and muscle-invasive bladder cancer (stage T2 or above). In the multivariable analysis for cancer detection, a positive TWIST1/Vimentin methylation were significantly linked to a heightened risk of BC. Moreover, TWIST1/Vimentin promoter methylation demonstrated an ability to detect BUC in urine samples with a sensitivity of 78% and a specificity of 83%. Our findings reveal that hypermethylation of the TWIST1/Vimentin promoter occurs in bladder urothelial carcinoma, and its high sensitivity and specificity suggest its potential as a screening and therapeutic biomarker for urothelial carcinoma of the bladder.

The impact of modified T3 sub-staging on the prognosis of gallbladder cancer patients

Objective: To explore the value of a new modified T3 sub-staging for the prognosis evaluation in gallbladder cancer patients. Methods: This is a retrospective case-series study. The clinical data of patients with pathologically confirmed stage T3 gallbladder cancer who were admitted to the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2021 were retrospectively analyzed. A total of 190 patients were enrolled in this study, 67 males and 123 females, with an age (M(IQR)) of 63(14) years (range:17 to 88 years). The stage T3 was divided into four sub-stages according to the site of tumor invasion: (1) T3a:tumor perforates the serosa,but not invading the liver and one other adjacent structure; (2) T3b:tumor perforates the serosa and invades one other adjacent structure,but not the liver; (3) T3c:tumor perforates the serosa and invades the liver,but not one other adjacent structure; (4) T3d:tumor perforates the serosa,invades the liver and one other adjacent structure. To evaluate the application value of this modified sub-staging,the Kaplan-Meier method was used to draw the survival curve,univariate analysis and multivariate analysis were done using the Log-rank test and Cox proportional hazard model respectively. Results: According to the modified T3 sub-staging method,34 patients (17.9%) were in stage T3a,24 cases(12.6%) were in stage T3b, 97 cases (51.1%) were in stage T3c, and 35 cases (18.4%) were in stage T3d. The median survival time of patients in stages T3a,T3b,T3c and T3d after radical resection was 72.0 months, 32.0 months, 12.0 months and 10.0 months, respectively. The 1-, 3-, and 5-year survival rates of patients in stage T3a, T3b, T3c and T3d were 79.4%, 53.3%, and 53.3%; 79.2%, 44.6%, and 26.0%;49.5%,27.5%,and 18.1%;42.9%,15.9%, and 15.9% (χ2=18.349,P<0.01),respectively. Univariate analysis showed that gallbladder stones,pathological differentiation,perineural invasion, N stage,postoperative adjuvant therapy and modified T3 substage were factors affecting patient prognosis(all P<0.05). Cox multivariate analysis showed that modified sub-stages with T3c (HR=2.043, 95%CI:1.176 to 3.549) and T3d(HR=2.419, 95%CI:1.284 to 4.555), accompanied by gallbladder stones (HR=1.661,95%CI:1.150 to 2.398),pathological differentiation with poorly differentiated(HR=1.709,95%CI:1.198 to 2.438), and the N stage with N1 and N2(HR=1.602, 95%CI:1.090 to 2.355, 2.714, 95%CI: 1.621 to 4.544) were independent prognostic risk factors for patients in stage T3,while postoperative adjuvant chemotherapy(HR=0.351) was a protective factor for prognosis. There was no statistically significant difference in survival between patients with stage T3a and T3b who underwent hepatic wedge resection and liver segment or major resection (P=0.402). For patients with stage T3c and T3d with liver invasion,the survival difference after hepatic wedge resection and segmental or major resection was statistically significant (P=0.008). Conclusion: The modified T3 sub-staging system based on the depth and direction of tumor invasion maybe helpful to further stratify the prognosis of patients with gallbladder cancer.

Efficacy and Safety of Postoperative Adjuvant Radiation Therapy in Resected Nasal Cavity and Paranasal Sinus Mucosal Melanoma: A Combined Analysis

BackgroundMucosal melanoma of the nasal cavity and paranasal sinuses (NPMM) is a highly aggressive disease. The role of postoperative adjuvant radiotherapy is controversial. MethodsA total of 300 patients with NPMM treated between March 2009 and January 2020 were divided into SA (surgery alone, 158 patients) and SR (surgery plus radiotherapy, 142 patients) groups. Postoperative radiotherapy was recommended, with a total dose of 65–70 Gy/30–35 fx to the GTV (gross tumor volume) and 60 Gy/30 fractions to the CTV (clinical target volume). The primary endpoint was relapse-free survival (RFS). Secondary endpoints included local-recurrence-free survival, distant metastasis-free survival (DMFS), and overall survival (OS). ResultsAt a median follow-up of 50.0 months, RFS in the SA and SR groups was 9.8 and 15.2 months (HR: 0.714, 95% CI: 0.546–0.933, P = 0.014). DMFS in SA and SR groups was 23.8 and 21.3 months (HR: 0.896, 95% CI: 15.7–31.9 vs. 13.3–29.3, P = 0.457). OS in SA and SR groups was 31.0 and 35.1 months (HR: 0.816, 95% CI: 25.7–36.3 vs. 27.1–43.2, P = 0.178). For patients with stage IVA NPMM, radiotherapy reduced the incidence of relapse by 0.43-fold. ConclusionsPostoperative radiotherapy played a crucial role in the local control of resected NPMM, especially in patients with stage T4a or IVA disease.

Other-cause mortality in incidental prostate cancer.

In incidental prostate cancer (IPCa), elevated other-cause mortality (OCM) may obviate the need for active treatment. We tested OCM rates in IPCa according to treatment type and cancer grade and we hypothesized that OCM is significantly higher in not-actively-treated patients. Within the Surveillance, Epidemiology, and End Results database (2004-2015), IPCa patients were identified. Smoothed cumulative incidence plots as well as multivariable competing risks regression models were fitted to address OCM after adjustment for cancer-specific mortality (CSM). Of 5121 IPCa patients, 3655 (71%) were not-actively-treated while 1466 (29%) were actively-treated. Incidental PCa not-actively-treated patients were older and exhibited higher proportion of Gleason sum (GS) 6 and clinical T1a stage. In smoothed cumulative incidence plots, 5-year OCM was 20% for not-actively-treated versus 8% for actively-treated patients. Conversely, 5-year CSM was 5% for not-actively-treated versus 4% for actively-treated patients. No active treatment was associated with 1.4-fold higher OCM, even after adjustment for age, cancer characteristics, and CSM. According to GS, OCM reached 16%, 27%, and 35% in GS 6, 7, and 8-10 not-actively-treated IPCa patients, respectively and exceeded CSM recorded for the same three groups (2%, 6%, and 28%, respectively). Our results quantified OCM rates, confirming that in not-actively-treated IPCa patients OCM is indeed significantly higher than in their actively-treated counterparts (HR: 1.4). These observations validate the use of no active treatment in IPCa patients, in whom OCM greatly surpasses CSM (20% vs. 5%).

Risk factors of postoperative complications and their effect on survival after laparoscopic gastrectomy for gastric cancer.

The association between postoperative complications and long-term survival after laparoscopic gastrectomy (LG) for gastric cancer (GC) remains uncertain. This study aimed to determine the incidence and risk factors of postoperative complications and evaluate their impact on survival outcomes in patients undergoing LG. A retrospective study was conducted on 621 patients who underwent LG for gastric adenocarcinoma between March 2015 and December 2021. Postoperative complications were classified according to the Clavien-Dindo classification, with major complications defined as Grade III or higher. Logistic regression models with stepwise backward procedure were used to identify risk factors for complications. To assess the impact of postoperative complications on survival, uni- and multi-variable Cox proportional hazard models were used for overall survival (OS) and disease-free survival (DFS). Overall rate of postoperative complications was 17.6% (109 patients); 33 patients (5.3%) had major complications. Independent risk factors for major complications were Charlson comorbidities index (OR [95% CI], 1.87 [1.09-3.12], p-value = 0.018 for each one score increase), and type of anastomosis (OR [95% CI], 0.28 [0.09-0.91], p-value = 0.029 when comparing Billroth II with Billroth I). Multivariable analysis identified major complications as an independent prognostic factor to reduce OS (HR [95% CI], 2.32 [1.02-5.30], p-value = 0.045) and DFS (HR [95% CI], 2.63 [1.37-5.06], p-value = 0.004). Other prognostic factors for decreased survival outcomes were tumor size, presence of invasive lymph nodes, and T4a stage. Major complications rate of LG for GC was approximately 5.3%. Charlson comorbidities index and type of anastomosis were identified as risk factors for major postoperative complications. Major complications were demonstrated to pose adverse impact on survival outcomes.

A Comprehensive Retrospective Institutional Study for Decoding Oral Squamous Cell Carcinoma.

Background Oral cancer is found to be the thirteenth most common cancer as stated by the WHO (World Health Organization 2023). Oral squamous cell carcinoma (OSCC) is associated with deleterious oral habits such as smoking, chewing tobacco and betel quid, alcohol consumption, low socioeconomic status, sharp teeth, and various causative factors. Materials and methods A three-year retrospective analysis (March 2020-September 2023) was carried out with the available patient records in the Dental Information Archival Software (DIAS) used in a private dental college in Chennai. The demographic data such as age, gender, and habit duration and clinicopathological data such as the anatomical site; tumor, node, and metastasis (TNM) staging; perineural invasion (PNI); lymphovascular invasion (LVI); and oral health-related quality of life were retrieved. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results Males (78.35%) more commonly reported OSCC than females (21.62%), and the majority of them were in the age category of fifth to seventh decades of life. The most affected region was the buccal mucosa with 33.3%, followed by the lower alveolus with 30.63%. The duration of harmful habits varied from one year to more than 40 years, and the majority of the patients had T4a staging (40.54%), followed by T2 staging (29.73%) with a habit duration of morethan five years. Approximately 22.52% and 0.9% had PNI and LVI,respectively. The correlation between the two variables was evaluated using the Pearson correlation test and was found to be statistically significant (p < 0.05), i.e., habit to gender and staging with gender were p = 0.027 and p = 0.028, respectively. Conclusion The majority of cases reported were found to be at T4a tumor staging with a habitual duration of more than five years, and more than half of the study population had severe compromise in their quality of life. The presence ofperineural invasion and lymphovascular invasion has an impact on nodal metastasis, treatment choices, recurrence, and oral health-related quality of life. To address this challenge, oral health programs can implement comprehensive antitobacco counseling strategies, oral cancer public awareness programs to tackle the rising incidence of OSCC, and earlyoral precancer screening measures to enhance the prevention and overall quality of life of individuals with oral cancer.

PIVOT-006: A phase 3, randomized study of cretostimogene grenadenorepvec versus observation for the treatment of intermediate risk non-muscle invasive bladder cancer (IR-NMIBC) following transurethral resection of bladder tumor (TURBT).

TPS715 Background: Guidelines for Intermediate Risk Non-Muscle Invasive Bladder Cancer (IR-NMIBC) recommend adjuvant intravesical (IVE) therapy or surveillance. Despite this, 30–60% of patients still recur, and these Guideline recommendations are lacking level-1 evidence. Thus, there is a considerable gap in knowledge and an unmet medical need for improved therapies in the adjuvant setting. Cretostimogene Grenadenorepvec is an oncolytic adenovirus designed to preferentially replicate in and kill cancer cells. The vector is transcriptionally regulated by the E2F promoter that is up-regulated in retinoblastoma (Rb) pathway-defective tumor cells, common in most IR-NMIBC bladder tumors. Additionally, the virus is engineered to selectively express GM-CSF, in order to induce a robust systemic anti-tumor immune response. PIVOT-006 is an open-label, multi-center, randomized Phase 3 study designed to assess the efficacy and safety of intravesical Cretostimogene after TURBT versus TURBT alone. Methods: Eligibility criteria: age ≥18 years, Eastern Cooperative Oncology Group performance status of 0-2, histologically confirmed IR-NMIBC with absence of nodal or metastatic disease at screening. IR-NMIBC, as defined by American Urologic Association-Society of Urologic Oncology Guidelines on NMIBC, is either a Low Grade (LG) stage Ta tumor that recurs within 12 months of prior LG or High Grade (HG) bladder cancer, a solitary LGTa tumor &gt;3cm in size, multifocal LGTa tumors, primary HGTa lesion &lt; 3cm in size, or a LGT1 tumor. Participants will be stratified by receipt of perioperative chemotherapy and tumor grade. Pts (N~450) will be randomized 1:1 to receive intravesical Cretostimogene (Cohort 1) adjuvant to TURBT or TURBT alone (Cohort 2). Single dose perioperative intravesical chemotherapy at the time of TURBT is permitted. If intravesical NMIBC recurrence is noted in Cohort 2, participants will be eligible to receive intravesical Cretostimogene. In Cohort 1, intravesical Cretostimogene will be instilled in combination with n-dodecyl-B-D-maltoside (DDM, an inactive detergent) for 6 weekly doses during the induction phase, followed by 3 weekly maintenance cycles at months 3 and 6, and culminating in single intravesical doses at months 9 and 12. Primary disease assessments include serial cystoscopy, urine cytology, axial imaging, and centralized review of pathologic samples. The primary outcome measure is recurrence free survival. Secondary outcome measures include safety, tolerability, progression free survival, and time to next intervention. Exploratory outcome measures include patient-reported quality of life, biomarker analyses, coxsackie adenovirus receptor and E2F promoter expression, neutralizing antibodies, and markers of immunogenicity. Clinical trial information: Pending.

Short-term and Long-term Outcomes After Laparoscopic Surgery for Pathological Stage T4a and T4b Colon Cancer.

Short-term and Long-term Outcomes After Laparoscopic Surgery for Pathological Stage T4a and T4b Colon Cancer.

The High Resolution MASS spectrometry in Personalised Medicine: Retinol-Binding Protein 4 as a Candidate Biomarker Predictor of Progression in Bladder Urothelial Carcinoma

Introduction: Bladder cancer (BC) is the seventh most commonly diagnosed cancer in males. A large proportion of T1 cases and some Ta cases are under-staged and the significant risk of residual tumour after initial TURB of TaT1 lesions has been demonstrated. A second TURB is recommended in T1 tumours because it can increase recurrence-free survival (RFS) providing prognostic information. Non-invasive methods differentiating bladder cancer stages would be essential for diagnosis of under staged cases. Previously we demonstrated that a panel of urinary proteins measured by high resolution mass spectrometry could predict bladder cancer stages namely Ta, T1 and T2 cases. Our aim is to increase the accuracy of the biomarker panel for BC stage differentiation using a more patients, also intending to identify proteins that could be a signature to bladder cancer progression. Methods: Forty-eight urine samples were collected from volun- teers of these groups: 20 patients with bladder cancer stage Ta; 19 patients with BC stage T1 and 9 patients with BC stage T2+ (T2, T3 and T4). Urinary proteome was cleaned and digested using the Filter-Aided Sample Preparation methodology and analysed by liquid chromatography-mass spectrometry. For protein identification and label-free quantification we used MaxQuant, the data was further interrogated with the bioinformatics platform Perseus. Results: A biomarker panel was developed which consists of 87 proteins which were down-regulated between three different urothelial bladder carcinoma stages evaluated. Retinol-binding protein 4 (RBP4) consistently increases from Ta to T1, to T2+ (p &lt;0.001) and in high grade tumours (p = 0.006). Conclusion: Our results showed a proteomic biomarker panel capable to differentiate bladder cancer stages. Besides, retinolbinding protein 4 can be a candidate signature of progression.

Scientific Status Quo of Small Renal Lesions: Diagnostic Assessment and Radiomics.

Background: Small renal masses (SRMs) are defined as contrast-enhanced renal lesions less than or equal to 4 cm in maximal diameter, which can be compatible with stage T1a renal cell carcinomas (RCCs). Currently, 50-61% of all renal tumors are found incidentally. Methods: The characteristics of the lesion influence the choice of the type of management, which include several methods SRM of management, including nephrectomy, partial nephrectomy, ablation, observation, and also stereotactic body radiotherapy. Typical imaging methods available for differentiating benign from malignant renal lesions include ultrasound (US), contrast-enhanced ultrasound (CEUS), computed tomography (CT), and magnetic resonance imaging (MRI). Results: Although ultrasound is the first imaging technique used to detect small renal lesions, it has several limitations. CT is the main and most widely used imaging technique for SRM characterization. The main advantages of MRI compared to CT are the better contrast resolution and tissue characterization, the use of functional imaging sequences, the possibility of performing the examination in patients allergic to iodine-containing contrast medium, and the absence of exposure to ionizing radiation. For a correct evaluation during imaging follow-up, it is necessary to use a reliable method for the assessment of renal lesions, represented by the Bosniak classification system. This classification was initially developed based on contrast-enhanced CT imaging findings, and the 2019 revision proposed the inclusion of MRI features; however, the latest classification has not yet received widespread validation. Conclusions: The use of radiomics in the evaluation of renal masses is an emerging and increasingly central field with several applications such as characterizing renal masses, distinguishing RCC subtypes, monitoring response to targeted therapeutic agents, and prognosis in a metastatic context.

Near-infrared spectroscopy as a novel method of exvivo bladder cancer tissue characterisation.

To evaluate near-infrared (NIR) spectroscopy in differentiating between benign and malignant bladder pathologies ex vivo immediately after resection, including the grade and stage of malignancy. A total of 355 spectra were measured on 71 bladder specimens from patients undergoing transurethral resection of bladder tumour (TURBT) between April and August 2022. Scan time was 5 s, undertaken using a portable NIR spectrometer within 10 min from excision. Specimens were then sent for routine histopathological correlation. Machine learning models were applied to the spectral dataset to construct diagnostic algorithms; these were then tested for their ability to predict the histological diagnosis of each sample using its NIR spectrum. A two-group algorithm comparing low- vs high-grade urothelial cancer demonstrated 97% sensitivity, 99% specificity, and the area under the receiver operating characteristic curve (AUC) was 0.997. A three-group algorithm predicting stages Ta vs T1 vs T2 achieved 97% sensitivity, 92% specificity, and the AUC was 0.996. This first study evaluating the diagnostic potential of NIR spectroscopy in urothelial cancer shows that it can be accurately used to assess tissue in an ex vivo setting immediately after TURBT. This offers point-of-care assessment of bladder pathology, with potential to influence the extent of resection, reducing both the need for re-resection where invasive disease may be suspected, and also the potential for complications where extent of diagnostic resection can be limited. Further studies utilising fibre-optic probes offer the potential for in vivo assessment.

The Value of Radiological Imaging in Assessing Extrarenal Fat and Renal Vein Invasion in Renal Cell Carcinoma.

Renal cell carcinoma with extrarenal fat (perinephric or renal sinus fat) and renal vein invasion is the main evidence for the T3a stage according to the American Joint Committee on Cancer tumor-node-metastasis (TNM) staging system. Extrarenal fat invasion of renal cell carcinoma is defined as the presence of perinephric fat invasion or renal sinus fat invasion. Renal vein invasion is defined as the presence of main or segmental (branch) renal vein invasion. Accurate assessment of extrarenal fat and renal vein invasion is crucial for urologists to adopt the optimal therapeutic schedule, including radical nephrectomy or nephron-sparing treatments. Currently, imaging is still the most widely used means of examination for diagnosis and staging of renal cell carcinoma, especially multidetector computed tomography (MDCT). Therefore, we have, herein, summarized the latest progress and the future direction regarding imaging for assessing perinephric or renal sinus fat and renal vein invasion of renal cell carcinoma to assist clinical treatment selection and patient risk stratification.

T1a renal cancer cryoablation - first experiences in Poland.

Cryoablation is one of the methods of treating patients with renal cancer with curative intent. This procedure is not widely available in Poland due to the lack of reimbursement until April 2023. The purpose of this study is to present the results of the first experiences in cryoablation of renal cell carcinoma in Poland. Patients with renal cell carcinoma in T1a stage (up to 4 cm in diameter) were treated with percutaneous cryoablation between December 2020 and December 2023. All patients were disqualified from surgical treatment due to age, comorbidities, or history of nephrectomy. Diagnosis was confirmed by computed tomography (CT)-guided core needle biopsy that was performed 2-4 weeks before cryoablation. Twenty-five patients underwent CT-guided cryoablation of T1a renal cancer. The mean age of the patients was 77 years (43-91 years). The mean diameter of lesions was 27 mm (15-40 mm). None of the patients presented with local or distant recurrence within the mean 12-months of follow-up period (100% progression-free survival). Urine leak treated with a stent was detected in one patient. Four patients died within the follow-up period, but none of the deaths was directly related to the procedure. Cryoablation is an effective and safe procedure and should be available to more patients in Poland.

Clinical use of nadofaragene firadenovec-vncg.

Non-muscle-invasive bladder cancer (NMIBC), which is restricted to the mucosa (stage Ta, carcinoma in situ (CIS)) or submucosa (stage T1), comprises 75% of bladder cancer diagnoses. Intravesical bacillus Calmette-Guérin (BCG) therapy is the standard-of-care initial treatment for high-risk NMIBC; however, a significant proportion of patients have BCG-unresponsive disease. While radical cystectomy is a definitive treatment in this setting, not all patients are willing or able to undergo this complex procedure associated with morbidity, mortality, and decreased quality of life. Bladder-preserving options for patients with BCG-unresponsive NMIBC represent an unmet need in this patient population. Nadofaragene firadenovec-vncg (Adstiladrin) is a nonreplicating adenoviral vector-based gene therapy indicated for the treatment of adult patients with high-risk BCG-unresponsive NMIBC with CIS with or without papillary tumors. The antitumor efficacy of nadofaragene firadenovec is driven by its local delivery of copies of the gene encoding for interferon alpha-2b (IFNα-2b) to urothelial cells. In the phase III CS-003 study, over half of participants with CIS exhibited a complete response by month 3 after instillation, with minimal serious adverse events. The favorable efficacy and safety profile, clinical utility, novel mechanism of action, and every 3-month dosing schedule give nadofaragene firadenovec a unique role in the treatment of high-risk BCG-unresponsive NMIBC. This review provides a practical approach to the effective clinical use of nadofaragene firadenovec regarding pre-instillation visit arrangements, storage, handling, instillation procedures, and post-instillation procedures. Implementation of these recommendations will ensure efficient real-world use of nadofaragene firadenovec and the development of useful training materials and relevant standard operating procedures to help support a clinic's treatment for patients with BCG-unresponsive NMIBC with CIS. Video Abstract https://vimeo.com/user17898099/review/953723559/e18af7ec43.

Urinary Bladder Cancer Induced by N-Butyl-N-(4-Hydroxybutyl)-Nitrosamine.

Urinary bladder cancer is the tenth most common cancer worldwide with high morbidity and mortality. The majority of bladder cancers are urothelial carcinomas. More than half are papillomas or the papillary urothelial carcinomas (stages Ta and T1), which have a relatively good prognosis. Squamous cell carcinomas have a variable survival rate, while carcinomas in situ (Tis) can progress to muscle-invasive urothelial carcinomas (T2) with a poor prognosis. The most challenging feature of bladder cancer is its high recurrence rate, ranging from 50% to 90% of cases. The N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) model is an invaluable experimental tool for bladder cancer research, as BBN-induced bladder cancer in rodents resembles human bladder cancer in its morphological, biological, and molecular features. We present here a detailed protocol for the treatment of mice and the main expected results.

Artificial Intelligence Model for a Distinction between Early-Stage Gastric Cancer Invasive Depth T1a and T1b.

Background: Endoscopic submucosal dissection (ESD) is a widely accepted treatment for patients with mucosa (T1a) disease without lymph node metastasis. However, the inconsistency of inspection quality of tumor staging under the standard tool combining endoscopic ultrasound (EUS) with computed tomography (CT) scanning makes it restrictive. Methods: We conducted a study using data augmentation and artificial intelligence (AI) to address the early gastric cancer (EGC) staging problem. The proposed AI model simplifies early cancer treatment by eliminating the need for ultrasound or other staging methods. We developed an AI model utilizing data augmentation and the You-Only-Look-Once (YOLO) approach. We collected a white-light image dataset of 351 stage T1a and 542 T1b images to build, test, and validate the model. An external white-light images dataset that consists of 47 T1a and 9 T1b images was then collected to validate our AI model. The result of the external dataset validation indicated that our model also applies to other peer health institutes. Results: The results of k-fold cross-validation using the original dataset demonstrated that the proposed model had a sensitivity of 85.08% and an average specificity of 87.17%. Additionally, the k-fold cross-validation model had an average accuracy rate of 86.18%; the external data set demonstrated similar validation results with a sensitivity of 82.98%, a specificity of 77.78%, and an overall accuracy of 82.14%. Conclusions: Our findings suggest that the AI model can effectively replace EUS and CT in early GC staging, with an average validation accuracy rate of 86.18% for the original dataset from Linkou Cheng Gun Memorial Hospital and 82.14% for the external validation dataset from Kaohsiung Cheng Gun Memorial Hospital. Moreover, our AI model's accuracy rate outperformed the average EUS and CT rates in previous literature (around 70%).

The importance of preoperative T3 stage substaging by 3D endorectal ultrasonography for the prognosis of middle and low rectal cancer.

The study aimed to validate the role of 3D-endorectal ultrasonography in prognosis and recurrence for patients with T3-stage rectal cancer by evaluating the preoperative extramural depth of tumor invasion. In this study, we investigated the medical records of rectal cancer patients who were admitted to Changhai Hospital's Colorectal Surgery Division. The sample group was categorized into three subgroups (T3a, T3b, and T3c) based on the extent of tumor progression (<5 mm, 5-10 mm, and >10 mm) to assess the endorectal ultrasonography diagnostic performance. The 5-year disease-free survival and overall survival were assessed using the Kaplan-Meier method and a log rank test. Cox regression analysis verified the tumor invasion depth's significance as a prognostic predictor, and it was also utilized to evaluate other independent risk variables for recurrence after surgery. The study included 72 individuals with low and middle rectal cancer from January 2014 to November 2019. Twenty-two individuals had stage T3a, 22 had stage T3b, and 28 had stage T3c based on preoperative endorectal ultrasonography. Endorectal ultrasonography had 88.0%, 86.8%, and 76.2% overall accuracy for stratifying subgroups, respectively. According to the Kaplan-Meier curve, 5-year OS was 100%, 83.5%, and 92.9% for T3a, T3b, and T3c (p = 0.172), and 5-year disease-free survival was 100%, 80.8%, and 72.9% for T3a, T3b, and T3c, respectively (p = 0.014). A distinct risk factor for 5-year disease-free survival was the degree of tumor infiltration (p = 0.039). Preoperative T3 stage subdivision allows for categorization of prognosis and survival. Endorectal ultrasonography reports should make explicit declarations of T3a, T3b, and T3c scales.

LONG TERM OUTCOME OF LAPAROSCOPIC RADICAL NEPHRECTOMY FOR PATHOLOGICAL T1, T2 RENAL CELL CANCER AT VIET DUC HOSPITAL

Background: To evaluation of the long term outcome of laparoscopic radical nephrectomy for pathological T1, T2 renal cell cancer at Viet Duc Hospital. Methods: We retrospectively identified 73 patients who underwent RN between 2015 and 2022. We divided patients into three groups based on tumour size: &lt;4 cm, 4– 7 cm, &gt;7 cm. Clinical and paraclinical characteristics include age, gender, back pain, tumor size, tumor location, disease stage on computed tomography scans, histopathological results, postoperative outcomes and complications, postoperative survival time, and accumulated survival time. Results: the average age was 53.52 ± 12.17 years. CT scans classified renal cell carcinoma stages preoperatively according to IUAC 2009: 53.4% were stage T1a, 42.4% were stage T1b, 2.8% were stage T2a, and 1.4% were stage T2b, 2 patients experienced infection at the trocar site used for kidney extraction, 4 patients developed postoperative fever, and 1 patient had postoperative bleeding requiring a blood transfusion. One patient underwent emergency open surgery immediately after discharge due to bleeding through the drainage. The postoperative complication rate according to the Clavien-Dindo classification was 11% (8 patients). The results show that 63 patients are still alive, 5 patients have passed away due to the disease, and 5 patients have died from other causes such as traffic accidents, cardiovascular diseases, and cerebral vascular accidents. The average follow-up time is 46.7±26.5 months. The cumulative survival rates at 3, 4, 5, 6, and 7 years after radical nephrectomy for the treatment of renal cell carcinoma were 100%, 97.6%, 94.8%, 90.9%, and 83.3%, respectively. The average additional survival time after surgery was 84.11 ± 1.80 months. Conclusions: Laparoscopic radical nephrectomy for early-stage renal cell carcinoma (T1 and T2) demonstrates high surgical safety and absolute efficacy in oncology.