Transurethral Resection Of Bladder Cancer Research Articles

Cross-sectional and longitudinal analyses of urinary extracellular vesicle mRNA markers in urothelial bladder cancer patients

We designed this multi-center prospective study with the following objectives: (1) the cross-sectional validation of extracellular vesicles (EV) mRNA markers to detect urothelial bladder cancer (UBC) before transurethral resection of bladder cancer (TURBT), and (2) the longitudinal validation of EV mRNA markers to monitor non-muscle invasive bladder cancer (NMIBC) recurrence after TURBT. EV mRNA markers evaluated in this study were KRT17, GPRC5A, and SLC2A1 in addition to two additional markers from literatures, MDK and CXCR2, and measured by quantitative RT-PCR with normalization by a reference gene (ALDOB). Diagnostic performances of EV mRNA markers were compared to conventional markers. Regarding the first objective, we confirmed that EV mRNA biomarkers in urine were higher in UBC patients, particularly those with higher stage/grade tumors, than in those without UBC (n = 278 in total) and the diagnostic performance of EV mRNA MDK and KRT17 outperformed conventional biomarkers with AUC 0.760 and 0.730, respectively. Concerning the second objective, we prospectively analyzed the time courses of EV mRNA markers while NMIBC patients (n = 189) (median follow-up 19 months). The expression of EV mRNA KRT17 was significantly high in patients with recurrence, while it gradually decreased over time in those without recurrence (p < 0.01).

Clinical features and oncological outcomes of bladder cancer microsatellite instability.

Excellent anticancer effect for solid tumors with microsatellite instability (MSI)-high by anti-PD-1 antibody has been reported. In this study, we investigated the clinical impact of MSI status in bladder cancer. This study included 205 Japanese patients who underwent transurethral resection for bladder cancer between 2005 and 2021. The prevalence rates of microsatellite stable (MSS), MSI-low (MSI-L), and MSI-high (MSI-H) were determined using molecular testing. We examined the association of MSI status (MSS versus MSI-L/H) with clinicopathological characteristics and oncological outcomes. MSI-L/H tumors were associated with higher T-category in non-muscle invasive bladder cancer (NMIBC). Additionally, MSI-L/H tumors were associated with a higher risk of intravesical recurrence in NMIBC patients treated with intravesical bacillus Calmette-Guérin (BCG) but not with non-BCG therapy. This study suggested that the MSI status might serve as a predictive marker for intravesical recurrence after BCG intravesical therapy in NMIBC and highlighted an unmet need for an alternative treatment in patients with MSI-L/H tumors.

Surgeon experience in second-look transurethral resection of bladder cancer – a prospective study

Introduction and objectivesTransurethral resection of bladder tumor (TURBT) is crucial in the treatment of bladder tumors and when incorrectly performed can cause staging mistakes. To avoid these errors, a second resection is recommended in selected cases. The aim of this study is to evaluate the surgeon's ability to predict histologically complete primary resection of newly diagnosed bladder tumors avoiding the need for a second TURBT. MethodsThis is a prospective, observational study involving 47 consecutive patients with newly diagnosed bladder tumors who had previously undergone primary TURBT, and met EAU criteria for second-look TURBT. Second-look TURBT specimens were analyzed for routine histological assessment and compared with the surgeon's impression of the tumor at initial resection. ResultsOf 91 patients submitted to primary TURBT, 47 met the criteria for second-look TURBT. Second-look specimens revealed residual disease in 20.9% of patients and 3 (6.4%) of patients showed upstaging disease. The sensitivity of a senior to detect disease on second-look TURBT in relation to muscle invasion was 75%, and the specificity was 85%. ConclusionsSecond-look TURBT is crucial in the treatment of bladder cancer and cannot be replaced by a surgeon's opinion, so international recommendations should be followed. Supervision of less experienced surgeons is a cornerstone.

P201 - Expertise Matters: Unveiling the Impact of Surgeon Experience on Second-Look Transurethral Resection of Bladder Cancer – a prospective Study

P201 - Expertise Matters: Unveiling the Impact of Surgeon Experience on Second-Look Transurethral Resection of Bladder Cancer – a prospective Study

Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39months, and renal dysfunction did not progress following partial cystectomy.

Promoting post discharge telephone follow-up of patients with transurethral resection for bladder cancer: a best practice implementation project.

Telephone follow-up (TFU) is a method that can be recommended for patients with chronic disease, including patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder (TURB). This project aimed to improve postdischarge TFU of patients with TURB in a tertiary care system and referral system in Tabriz, Iran. This evidence implementation project used the JBI evidence implementation framework. Two audit criteria were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. The aggregated data collated from the urology ward demonstrated that all criteria had achieved 0% compliance in the baseline audit round. Strategies such as patient education about TFU, educational pamphlets developed according to the latest validated guidelines, and a mobile app for education material about bladder cancer, diagnosis, management, and follow-up were implemented. The Phase 3 follow-up showed an 88% increase in compliance with staff education about the postdischarge TFU as a component of comprehensive discharge planning and a 22% achievement of timely patient follow-up by telephone. A clinical audit is an effective approach to promoting postdischarge TFU in bladder cancer cases following TURB. TFU for bladder cancer patients who underwent TURB is an optimal goal that is easily achieved through patient, nursing staff, and residents' education using the latest guidelines.

AI-based pathologic biomarker for pathologic downstaging in patients with muscle-invasive bladder cancer undergoing cystectomy after neoadjuvant nivolumab, gemcitabine, and cisplatin: BLAAST-1 Trial.

e16566 Background: The BLASST-1 study is a multi-center phase II trial evaluating the combination of neoadjuvant nivolumab with gemcitabine-cisplatin (N+GC) for muscle-invasive bladder cancer (MIBC) patients undergoing radical cystectomy (RC). The primary endpoint was pathologic down staging (PaR; ≤pT1N0). We previously reported a PaR rate of 65.8% (Gupta S et al. ASCO GU 2020). Given the lack of validated and optimal biomarkers to predict PaR, we studied the association of an AI-based pathologic biomarker measuring pre-treatment morphological features with PaR. Methods: Forty-one patients with MIBC (cT2-T4a, N≤1, M0) and candidates for RC were enrolled between Feb 2018 and June 2019 (cT2N0 90%, cT3N0 7%, cT4N1 3%). Thirty-six patients had transurethral resection of bladder cancer (TURBT) with pre-treatment diagnostic specimens available for analysis. Patients received four cycles of N+GC followed by RC within 8 weeks. A board-certified pathologist selected diagnostic regions from TURBT-derived representative H&amp;E diagnostic slides for each patient. To compute the pathological biomarker, a proprietary deep-learning algorithm (Valar Labs, Palo Alto, CA) first segmented nuclei from digital whole-slide images of the H&amp;E specimens to extract quantitative histological features. The Valar pathologic biomarker was then computed from features associated with immune infiltration and morphological characteristics of neoplastic cells. The Valar biomarker was split based on unsupervised clustering into two groups: Valar-High was associated with PaR and Valar-Low with no PaR. PD-L1 cutoff of 1% was used for dichotomization. To compare the Valar biomarker with PD-L1, a subcohort of 33 patients with available PD-L1 scores were analyzed. T-tests and diagnostic performance metrics were used to distinguish between PaR response rates in each cluster group across tests. Results: Patients designated Valar-High (n=23) had higher PaR compared to no PaR in the Valar-Low (n=13) group (PAR 78.3% vs 38.4%, respectively, p&lt;0.008). Compared to PD-L1, the Valar biomarker had higher sensitivity (85.7 vs 57.1%), specificity (66.6 vs 66%), positive predictive value (81.8 vs 75.0%), negative predictive value (72.7 vs 47.0%), and accuracy (78.8 vs 60.6%) across both cohorts. The Valar biomarker was not correlated to PD-L1 (r^2=0.029) or sex (22 male, 14 female). The combined Valar-High or PD-L1 High test had a high sensitivity for PaR (95.2%). Conclusions: In this hypothesis-generating study, pre-treatment morphological features measured by the AI-based Valar pathologic biomarker identified responders to neoadjuvant N+GC in MIBC. Further prospective studies are needed to study the prognostic vs. predictive utility of this biomarker.

Blue light transurethral resection and biopsy of bladder cancer with hexaminolevulinate: Histopathological characteristics and recurrence rates in a single UK centre study.

Blue light cystoscopy with hexaminolevulinate (HAL) during transurethral resection of bladder cancer (TURBT) has been shown to improve detection, thereby reducing bladder cancer recurrence compared with white light cystoscopy. Single-centred UK (United Kingdom) study on 101 patients who underwent blue light cystoscopy between July 2017 and November 2020, performed by a single surgeon. Our study was divided into two arms; the primary arm had no prior diagnosis of bladder malignancy (N= 41), whereas secondary re-resection arm had (N= 57). Three patients with non-urothelial bladder cancer were excluded. Patients were followed up for 24 months. Data were collected on biopsy quality, histopathological characteristics and recurrence. The end points of the study were recurrence rate at 24 months in both arms and detection of CIS in patients who undergo TURBT or biopsy after initial white light study in the secondary, re-resection arm. This was analysed with Fisher's exact test. Of 98 patients, 39 had malignancy in their first blue light TURBT/biopsy: primary arm (10/41, 24.4%) and secondary arm (29/57, 50.9%), with detrusor present in 80.5% and 80.7%, respectively. In the secondary arm, blue light re-resection TURBT detected significantly more CIS (20.7% vs 51.7%, p= 0.0277) compared with white light with 3.4% upstaged to muscle invasive bladder cancer (G3pT2). Median time to re-resection was 3.06 months. Recurrence rate was 33.3% in the primary arm and 37.5% in the secondary arm after 24 months of follow-up. Our data confirm that blue light TURBT with HAL provides superior detection and diagnosis of CIS in patients with previous white light cystoscopy.

MP63-19 ADEQUATE VS INADEQUATE BCG INTRAVESICAL THERAPY IN INTERMEDIATE AND HIGH RISK NMIBC: TOTAL NUMBER OF INSTILLATIONS IS WHAT REALLY MATTERS

You have accessJournal of UrologyCME1 Apr 2023MP63-19 ADEQUATE VS INADEQUATE BCG INTRAVESICAL THERAPY IN INTERMEDIATE AND HIGH RISK NMIBC: TOTAL NUMBER OF INSTILLATIONS IS WHAT REALLY MATTERS Mario DE Angelis, Francesco Pellegrino, Mattia Longoni, Pietro Scilipoti, Chiara Re, Alessandro Bertini, Umberto Capitanio, Andrea Salonia, Giorgio Gandaglia, Riccardo Leni, Francesco Montorsi, Alberto Briganti, and Marco Moschini Mario DE AngelisMario DE Angelis More articles by this author , Francesco PellegrinoFrancesco Pellegrino More articles by this author , Mattia LongoniMattia Longoni More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Chiara ReChiara Re More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Umberto CapitanioUmberto Capitanio More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , and Marco MoschiniMarco Moschini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical immunotherapy with Bacillus Calmette-Guérin (BCG) is currently recommended by EAU guidelines for proper treatment of patients with intermediate (IR) and high risk (HR) non-muscle invasive bladder cancer (NMIBC). We aimed to verify if complete adherence to BCG therapy relates to better oncological outcomes in terms of risk of recurrence and progression METHODS: We retrospectively identified 250 patients who underwent transurethral resection of bladder cancer between 2012 and 2022 at a tertiary referral centre. All these patients were diagnosed with IR or HR NMIBC and treated with BCG according to EAU guidelines. We evaluated if intravesical treatment was adequate, defined as at least 1 year of maintenance in IR patients and 3 years in HR patients. Multivariable analyses (MVA) tested the impact of number of instillations and therapy adequateness on recurrence and progression. Recurrence and progression were compared with the Kaplan-Meier (KM) analysis according to intravesical therapy adequateness RESULTS: 45 patients (18%) received adequate intravesical therapy according to their class of risk. Patients with adequate treatment received about triple the amount of instillations compared with inadequately treated ones (21 vs 9). Median FU was 42 months. In this period, 75 patients showed disease recurrence, 62 of which were treated inadequately (83%). Similarly, 93% of progressions concerned patients treated inadequately. At MVA, both total number of instillations and proper treatment were related with disease progression (HR 0.92, p=0.015 vs HR 0.22, p=0.041). Conversely, recurrence was only associated with total number of instillation (HR 0.95, p=0.019). KM analysis shows how at 2 years follow-up, progression free survival was higher in patients who received adequate treatment compared with those treat inadequately (96%vs 83%) CONCLUSIONS: A more intense BCG instillation regime is associated with lower risk of recurrence and progression of bladder cancer. In particular, a higher amount of instillations seems to be more related with tumor recurrence and progression. These results confirm the hypothesis that too often real life differ from guidelines, resulting in an actual undertreatment of these patients and the consequent worsening of the disease. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e879 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mario DE Angelis More articles by this author Francesco Pellegrino More articles by this author Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Chiara Re More articles by this author Alessandro Bertini More articles by this author Umberto Capitanio More articles by this author Andrea Salonia More articles by this author Giorgio Gandaglia More articles by this author Riccardo Leni More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Marco Moschini More articles by this author Expand All Advertisement PDF downloadLoading ...

Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral Resection for Bladder Cancer

Effect of Ultrasound-guided Obturator Nerve Block on Complications in Transurethral Resection for Bladder Cancer

Outcomes of supervised resident compared to attendings in transurethral resection of bladder cancer: The importance of mentoring

Outcomes of supervised resident compared to attendings in transurethral resection of bladder cancer: The importance of mentoring

Combination of hyperthermia and intravesical chemotherapy for the treatment of pT1 stage bladder cancer: A retrospectively clinical study.

To evaluate the efficiency and safety of combined local bladder hyperthermia and intravesical chemotherapy (IVC) for the treatment of patients with pT1 stage bladder cancer. A total of 189 patients with pT1 who underwent transurethral resection of bladder cancer (TURBT) were retrospectively reviewed. After TURBT, the patients with low-grade urothelial carcinoma (UC) were treated with either an IVC with pirarubicin (THP) protocol or chemo-thermotherapy (CHT) with THP protocol, whereas patients with high-grade UC were treated with either an intravesical immunotherapy (IVI) with bacillus Calmette-Guerin (BCG) protocol or CHT protocol, patients' characteristics, tumor biological features, and follow-up data were analyzed and compared between CHT and IVC group in low-grade UC, CHT, and IVI group in high-grade UC, respectively. The median follow-up time was 24 months. In patients with low-grade UC, the median recurrence free survival (RFS) interval and costs of treatment in CHT group were significantly higher than those in IVC group (p=.01, p<.001, respectively), CHT was associated with higher RFS compared with IVC by Kaplan-Meier analysis, and three patients in IVC group upgraded to high grade when tumor recurred, whereas no cases were found upgraded in CHT group, p=.38. In patients with high-grade UC, tumor recurrence rates at 12 (p=.004) and 24 months (p=.004) after TURBT, rate of complications (p=.04)-especially for hematuresis (p=.03) and irritation symptoms (p=.04)-the median costs of treatment (p<.001) in CHT group were significantly lower than those in IVI group, RFS interval, health-related quality of life) at 12 and 24 months after TURBT in CHT group was significantly higher than those in IVI group (p<.001, p=.002, and p<.001, respectively), and CHT was associated with higher RFS compared with IVI by Kaplan-Meier analysis. The rate of patients upstaged to pT2 in CHT group seemed lower than that in IVI group, but there was no significantly statistical difference (14.3% vs. 24%, p=.58). CHT has a beneficial prophylactic effect in patients with pT1 bladder cancer, especially in patients with high-grade UC, which is much more effective and safer than BCG, meanwhile it costs less compared with BCG.

Preoperative White Blood Cell-Related Indicators Can Predict the Prognosis of Patients with Transurethral Resection of Bladder Cancer.

IntroductionNumerous studies, including bladder cancer (BLCA), have confirmed the relationship between conventional systemic inflammatory biomarkers and the prognosis of tumors. Leukocytes, as the most common factor in inflammatory indicators, have been reported to predict prognosis in other tumors. However, we have not seen this research in BLCA. Therefore, we aim to find new blood markers to predict the prognosis of patients with transurethral resection of bladder tumor (TURBT).MethodsTwo cohorts from the two different hospitals were used for the specific study. The best cutoff values of leukocytes-related indicators were determined according to the ROC curve. Univariate and multivariate Cox regression analysis were used to explore the impact of indicators and clinical features on prognosis for patients with TURBT. The KM curve was used to show the impact of indicators on the prognosis. According to the consequence of multivariate method, a risk model was established to evaluate the prognosis of patients with bladder cancer.ResultsThe white blood cell-to-lymphocyte ratio (WLR), the white blood cell-to-hemoglobin ratio (WHR), the white blood cell-to-neutrophil ratio (WNR), the white blood cell-to-monocyte ratio (WMR) and the white blood cell-to-erythrocyte ratio (WRR) are related to the prognosis of BLCA. The new risk model consisted of WHR, WMR and platelet-to-lymphocyte ratio (PLR), and patients with TURBT in the high-risk group had a worse prognosis.ConclusionsLeukocyte-related preoperative indicators could predict the prognosis of the patients with TURBT and provided some guidance for clinical workers.

Endoscopic balloon cryoablation against single instillation after transurethral resection of bladder cancer: A multicenter, randomized, controlled noninferiority trial.

e16561 Background: Cryotherapy is a prevalent percutaneous ablative therapy for solid tumors. However, studies on the clinical practice of endoscopic cryotherapy for intraluminal malignancies are lacking. We aim to explore the feasibility of endoscopic cryotherapy for bladder cancer. Methods: In this multicenter, randomized, parallel controlled, non-inferiority trial, we compared endoscopic balloon cryoablation (EBCA) with a single instillation (SI) of pirarubicin after transurethral resection (TUR).Men or women aged 18-85 years with a clinical diagnosis of bladder cancer (tumor number no more than 3 and maximal tumor size no more than 3 cm) were included. The exclusion criteria were as follows: locally advanced urinary bladder cancer (clinical stage T3 or T4), lymph node involvement (N1) or distant metastasis (M1), severe organ dysfunction, severe coagulation disorder, sepsis, concomitant neoplastic malignancy and other conditions unsuitable for surgery or intravesical chemotherapy. Women in pregnancy or lactation were also excluded. Eligible participants were randomly assigned (1:1) to the TUR-EBCA or TUR-SI group. The primary endpoint was the residual-free rate at repeated TUR. A non-inferiority test was used to compare the primary endpoint with a chosen margin of 10%. The secondary endpoints included the recurrence-free survival (RFS), progression-free survival (PFS) and adverse events. Results: We recruited 227 participants between November, 2017, and September, 2020. In total, 205 patients received EBCA or SI after TUR, of whom 163 completed all the required interventions and follow-up. In the per-protocol analyses, 75 (91.5%) of 82 patients had no residual tumor in the TUR-EBCA group compared with 61 (76.5%) of 81 in the TUR-SI group (risk difference 14.9%; 95% confidence interval [CI] 0.03 to 0.27, P &lt; 0.001), meeting the criteria for non-inferiority. Similar results were found in the after intention-to-treat analysis. After a median follow-up of 21 months, the TUR-EBCA group had better RFS(HR = 0.49; 95% confidence interval [CI] 0.24 to 0.99; Log-rank P = 0.046) and PFS (HR = 0.25; 95% confidence interval [CI] 0.08 to 0.77; Log-rank P = 0.0092). There were no significant differences in the SAEs rate (3.0% vs. 3.9%, p = 0.52). Conclusions: EBCA is a safe and effective adjuvant alternative to TUR for bladder cancer with the potential advantage of “energetically resecting” the tumor base. Clinical trial information: NCT02760953.

Conspicuity and muscle-invasiveness assessment for bladder cancer using VI-RADS: a multi-reader, contrast-free MRI study to determine optimal b-values for diffusion-weighted imaging

ObjectiveTo (1) compare bladder cancer (BC) muscle invasiveness among three b-values using a contrast-free approach based on Vesical Imaging-Reporting and Data System (VI-RADS), to (2) determine if muscle-invasiveness assessment is affected by the reader experience, and to (3) compare BC conspicuity among three b-values, qualitatively and quantitatively.MethodsThirty-eight patients who underwent a bladder MRI on a 3.0-T scanner were enrolled. The gold standard was histopathology report following transurethral resection of BC. Three sets of images, including T2w and different b-values for DWI, set 1 (b = 1000 s/mm2), set 2 (b = 1500 s/mm2), and set 3 (b = 2000 s/mm2), were reviewed by three differently experienced readers. Descriptive statistics and Intraclass Correlation Coefficient (ICC) were calculated. Comparisons among readers and DWI sets were performed with the Wilcoxon test. Receiver operating characteristic (ROC) analysis was performed. Areas under the curves (AUCs) and pairwise comparison were calculated.ResultsAUCs of muscle-invasiveness assessment ranged from 0.896 to 0.984 (reader 1), 0.952–0.968 (reader 2), and 0.952–0.984 (reader 3) without significant differences among different sets and readers (p > 0.05). The mean conspicuity qualitative scores were higher in Set 1 (2.21–2.33), followed by Set 2 (2–2.16) and Set 3 (1.82–2.14). The quantitative conspicuity assessment showed that mean normalized intensity of tumor was significantly higher in Set 2 (4.217–4.737) than in Set 1 (3.923–4.492) and Set 3 (3.833–3.992) (p < 0.05).ConclusionMuscle invasiveness can be assessed with high accuracy using a contrast-free protocol with T2W and DWI, regardless of reader’s experience. b = 1500 s/mm2 showed the best tumor delineation, while b = 1000 s/mm2 allowed for better tumor–wall interface assessment.

Radiomics of Contrast-Enhanced Computed Tomography: A Potential Biomarker for Pretreatment Prediction of the Response to Bacillus Calmette-Guerin Immunotherapy in Non-Muscle-Invasive Bladder Cancer.

Background: Bacillus Calmette-Guerin (BCG) instillation is recommended postoperatively after transurethral resection of bladder cancer (TURBT) in patients with high-risk non-muscle-invasive bladder cancer (NMIBC). An accurate prediction model for the BCG response can help identify patients with NMIBC who may benefit from alternative therapy. Objective: To investigate the value of computed tomography (CT) radiomics features in predicting the response to BCG instillation among patients with primary high-risk NMIBC. Methods: Patients with pathologically confirmed high-risk NMIBC were retrospectively reviewed. Patients who underwent contrast-enhanced CT examination within one to 2 weeks before TURBT and received ≥5 BCG instillation treatments in two independent hospitals were enrolled. Patients with a routine follow-up of at least 1 year at the outpatient department were included in the final cohort. Radiomics features based on CT images were extracted from the tumor and its periphery in the training cohort, and a radiomics signature was built with recursive feature elimination. Selected features further underwent an unsupervised radiomics analysis using the newly introduced method, non-negative matrix factorization (NMF), to compute factor factorization decompositions of the radiomics matrix. Finally, a robust component, which was most associated with BCG failure in 1 year, was selected. The performance of the selected component was assessed and tested in an external validation cohort. Results: Overall, 128 patients (training cohort, n = 104; external validation cohort, n = 24) were included, including 12 BCG failures in the training cohort and 11 failures in the validation cohort each. NMF revealed five components, of which component 3 was selected for the best discrimination of BCG failure; it had an area under the curve (AUC) of .79, sensitivity of .79, and specificity of .65 in the training set. In the external validation cohort, it achieved an AUC of .68, sensitivity of .73, and specificity of .69. Survival analysis showed that patients with higher component scores had poor recurrence-free survival (RFS) in both cohorts (C-index: training cohort, .69; validation cohort, .68). Conclusion: The study suggested that radiomics components based on NMF might be a potential biomarker to predict BCG response and RFS after BCG treatment in patients with high-risk NMIBC.

Genetic contributions of MHC class I antigen processing and presentation pathway to bladder cancer risk and recurrence.

Human leukocyte antigen class I (HLA class I) antigen processing and presentation pathway (APP) defines anti-tumor immune response. ERAP, TAP, tapasin (TAPBP), and IFNγ modulate APP: control HLA class I expression in the tumor and the repertoire of presented tumor antigens. At the same time, vascular endothelial growth factor (VEGF) acts as an immunomodulator in the tumor microenvironment. The objective of the current study was to examine the association of single nucleotide polymorphisms (SNPs) in the ERAP1, ERAP2, TAP1, TAP2, TAPBP, IFNG genes with the corresponding mRNA expression in bladder cancer (BC) risk and recurrence after transurethral resection of BC. Moreover, we assessed the relationship between HLA class I and VEGF plasma levels and BC recurrence. We analyzed 9 SNPs in 124 BC patients using TaqMan genotyping and compared them with the data from 503 healthy individuals from the 1000 Genomes Project. In addition, we quantified the effects of SNPs on the corresponding mRNA expression in tumor and non-tumor adjacent tissue in 60 BC patients with primary and 30 with recurrent tumor by quantitative real-time PCR. Furthermore, the plasma HLA class I and VEGF levels were analyzed in BC patients and healthy controls by ELISA. IFNG (rs1861493) was associated with BC risk, TAPBP (rs3106189, rs2071888) with recurrence-free survival (RFS). Moreover, TAPBP mRNA expression was lower in tumors than in the adjacent tissue. The SNPs ERAP2 (rs251339) and TAP2 (rs241447, rs241448) variants affected mRNA expression in BC tissue. In tumor tissue, the high mRNA expression of ERAP1 was more common in BC patients with single tumors, ERAP2 in non-smokers, and TAP2 mRNA in recurrence. The lower HLA and higher VEGF plasma levels were observed in BC patients compared with healthy controls. We conclude that the genetic elements responsible for MHC class I APP may influence the BC risk, risk of recurrence, and RFS.

Blue versus white light for transurethral resection of non-muscle invasive bladder cancer.

Disease recurrence andprogression remain major challenges in the treatment of non-muscle invasive bladder cancer (NMIBC).Blue light-enhanced transurethral resection of bladder cancer (TURBT)is anapproach to improve stagingand achieve a complete resection of NMIBC. To assess the effects of blue light-enhancedTURBTcompared to white light-based TURBT in the treatment of NMIBC. We searched severalmedical literaturedatabases, including the Cochrane Library, MEDLINE, and Embase, as well as trial registers, includingClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform. We performed a comprehensive search with no restrictions on language of publication or publication status until March 2021. We included randomized controlled trials using blue light versus white lightTURBT. Included participants hada high level of suspicion based on imaging or'visible diagnosis'forprimary urothelial carcinoma of the bladder or recurrenturothelial carcinoma of the bladder upon cytoscopy.We excluded studies in which blue lightwas used in a surveillance setting. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and risk of bias assessment. Our primary outcomes were time to disease recurrence, time to disease progression, and serious surgical complications. Secondary outcomes were time to death from bladder cancer, any adverse events, and non-serious complications. We rated the certainty of evidence using the GRADE approach. We included 16 randomized controlled trials involving a total of 4325 participants in the review. The studies compared blue light versus white light TURBT for treatment of NMIBC. Primary outcomes Blue light TURBT may reduce the risk of disease recurrence over time (hazard ratio (HR)0.66, 95% confidence interval (CI) 0.54 to 0.81; low-certainty evidence) depending on baseline risk.For participants with low-, intermediate-, and high-risk NMIBC, this corresponded to 48 (66 fewer to 27 fewer), 109 (152 fewer to 59 fewer),and 147 (211 fewer to 76 fewer)fewer recurrencesper 1000 participants when compared towhite light TURBT, respectively. Blue light TURBT may also reduce therisk of disease progressionover time(HR 0.65, 95% CI 0.50to 0.84;low-certainty evidence) depending on baseline risk.For participants with low-, intermediate-, and high-risk NMIBC, this corresponded to 1 (1 fewer to 0 fewer), 17 (25 fewer to 8 fewer),and 56(81fewer to 25fewer)fewer progressionsper 1000 participants when compared to white light TURBT, respectively. Blue light TURBT may have little orno effect onserious surgical complications(risk ratio (RR) 0.54, 95% CI 0.14 to 2.14; low-certainty evidence). This corresponded to10 fewer (19 fewer to 25 more) surgical complications per 1000 participants with blue light TURBT. Secondary outcomes Blue light TURBT may have little orno effect on the risk of death from bladder cancer over time (HR 0.55, 95% CI 0.19 to 1.61;low-certainty evidence). This corresponded to 22 deathsper 1000 participants with white light TURBT and10 fewer (17 fewer to 13more) deathsper 1000 participants with blue light TURBT. Wearevery uncertainhow blue light TURBTaffects the outcome adverse events of any grade (RR 1.09, 95% CI 0.88to 1.33; low-certainty evidence). No analysis was possible for the outcome non-serious surgical complications,as it was not reported by any of the included studies. Blue light-enhancedTURBT forthe treatment of non-muscle invasive bladder cancercompared to white light-based TURBT may reduce the risk of disease recurrence and disease progressionover time depending on baseline risk. There may be little orno effect onserious surgical complications. The certainty of evidence for our findings was low, meaning that future studies are likely change to the reported estimates of effect. Frequent issues that led to downgrading of the certainty of the evidence were study limitations, inconsistency, and imprecision.

TP7.2.3 The effect of immediate versus early instillation of mitomycin C after transurethral resection of bladder cancer: Is timing everything?

Abstract Introduction and Aims Almost three quarters of patients diagnosed with bladder cancer have non-muscle invasive disease. The European Association of Urology (EAU) guidelines recommend the use of intravesical instillation of Mitomycin C (MMC) to reduce the rate of recurrence. Methods A retrospective cohort analysis was carried out of all patients who underwent a TURBT between January 2016 and January 2019 in our Trust. A comparison of recurrence outcomes was investigated between patients who had immediate instillation of MMC (within 1 hours post-TURBT) versus early instillation (within 24 hours post-TURBT). Recurrence was assessed at 3 months cystoscopy and at 1 year follow-up. Results 201 patients were included. 100 underwent immediate MMC instillation (75% male, 25% female); 101 early instillation (72% male, 28% female). There was 11% recurrence (immediate) versus 13% (early) in instillation groups at 3 months. At first year, recurrence was seen in 12% (immediate) versus 14% (early) groups. Of these recurrences, there was an upstaging of tumour in 27% (immediate) versus 31% (early) at the 3 monthly follow-up and 25% (immediate) versus 28% (early) at the 1st year. The mean period of post-operative stay following initial TURBT was 0.8 days in the immediate versus 1.1 days in the early instillation groups. Conclusion Although no statistical differences were seen in this study, the results appear to favour immediate instillation of MMC after TURBT with respect to reduction in recurrence and upstaging rates. Post-operative length of stay in hospital was also shorter in patients who had an immediate MMC instillation.

Recent Advances in the Management of Patients with Non-Muscle-Invasive Bladder Cancer Using a Multidisciplinary Approach: Practical Recommendations from the Spanish Oncology Genitourinary (SOGUG) Working Group.

Simple SummaryThis report presents clinically relevant advances in the management of non-muscle-invasive bladder cancer, which have been the focus of discussion of expert members of the Spanish Oncology Genitourinary (SOGUG) Multidisciplinary Working Group in the framework of the Genitourinary Alliance project (12GU), designed as a space for the integration of novel information in the care of bladder cancer patients. The present study is focused on different aspects regarding the evaluation of hematuria, assessment of second (or repeated) transurethral resection of bladder cancer, histopathological diagnosis and problems with tumor grading, importance of histological variants, shortage of drug supply, and the current role and influence of immunotherapy and biological markers on the oncological outcome of patients. All proposals and recommendations have a multidisciplinary practical approach and are intended to help clinicians in shared decision making for patients with non-muscle-invasive urothelial cancer.On the basis of the discussion of the current state of research on relevant topics of non-muscle-invasive bladder cancer (NMIBC) among a group of experts of the Spanish Oncology Genitourinary (SOGUG) Working Group, recommendations were proposed to overcome the challenges posed by the management of NMIBC in clinical practice. A unified definition of the term ‘microhematuria’ and the profile of the patient at risk are needed. Establishing a ‘hematuria clinic’ would contribute to a centralized and more efficient evaluation of patients with this clinical sign. Second or repeated transurethral resection (re-TUR) needs to be defined, including the time window after the first procedure within which re-TUR should be performed. Complete tumor resection is mandatory when feasible, with specification of the presence or absence of muscle. Budding should be used as a classification system, and stratification of T1 tumors especially in extensive and deep tumors, is advisable. The percentage of the high-grade component should always be reported, and, in multiple tumors, grades should be reported separately. Luminal and basal subtypes can be identified because of possibly different clinical outcomes. Molecular subtypes and immunotherapy are incorporated in the management of muscle-invasive bladder cancer but data on NMIBC are still preliminary.