RÉSUMÉ
BACKGROUND: As the incidence of urological malignancies after renal transplantation (RT) is observed to be greater than in the general population, a better understanding of them is important. We present our experience with urological tumors in RT recipients at our transplant center, and analyze their incidence, management and outcomes. MATERIALS AND METHODS: A retrospective analysis of 2177 RT recipients on follow-up at our center between 1990 and 2022 was conducted for de novo genitourinary malignancy. Patients diagnosed with malignancy before transplantation were excluded. Clinicopathological data at diagnosis and follow-up were collected and analyzed. Kaplan-Meier estimates were used to evaluate overall survival (OS) and cancer-specific survival (CSS). Statistical analysis was performed using IBM SPSS v.24 (IBM Corp., Armonk, NY, USA). RESULTS: The overall incidence of Urological malignancies was 3.9%, with 89 cancers diagnosed in 85 patients. Renal cell carcinoma was most common (n = 61, 68.5%), followed by prostate cancer (n = 10, 11.2%), urothelial carcinoma (n = 10, 11.2%), squamous cell carcinoma of the penis/scrotum (n = 7, 7.9%), and testicular cancer (n = 1, 1.1%). Mean duration between transplantation and diagnosis of malignancy was 9.9 (0.4-20.7) years. At a median follow-up of 4.6 (018.2) years, 27 deaths were seen; 7(25.9%) were due to urological malignancy. CSS rates were 86% and 78% at five and ten years, respectively, after diagnosis. CONCLUSION: We present one of the largest series of de novo urological malignancies observed over an extended 30-year follow-up of RT recipients, demonstrating an elevated risk in line with other studies. Regular surveillance for malignancies is advised, in order to ensure early diagnosis and management.
Sujet(s)
Transplantation rénale , Complications postopératoires , Tumeurs urologiques , Humains , Transplantation rénale/effets indésirables , Mâle , Femelle , Études rétrospectives , Adulte d'âge moyen , Études de suivi , Tumeurs urologiques/étiologie , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/anatomopathologie , Incidence , Pronostic , Adulte , Taux de survie , Complications postopératoires/épidémiologie , Facteurs de risque , Défaillance rénale chronique/chirurgie , Sujet âgé , Jeune adulteRÉSUMÉ
Exposure to ambient air pollution has significant adverse health effects; however, whether air pollution is associated with urological cancer is largely unknown. We conduct a systematic review and meta-analysis with epidemiological studies, showing that a 5 µg/m3 increase in PM2.5 exposure is associated with a 6%, 7%, and 9%, increased risk of overall urological, bladder, and kidney cancer, respectively; and a 10 µg/m3 increase in NO2 is linked to a 3%, 4%, and 4% higher risk of overall urological, bladder, and prostate cancer, respectively. Were these associations to reflect causal relationships, lowering PM2.5 levels to 5.8 µg/m3 could reduce the age-standardized rate of urological cancer by 1.5 ~ 27/100,000 across the 15 countries with the highest PM2.5 level from the top 30 countries with the highest urological cancer burden. Implementing global health policies that can improve air quality could potentially reduce the risk of urologic cancer and alleviate its burden.
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Pollution de l'air , Matière particulaire , Tumeurs urologiques , Humains , Pollution de l'air/effets indésirables , Pollution de l'air/analyse , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/étiologie , Matière particulaire/effets indésirables , Matière particulaire/analyse , Mâle , Polluants atmosphériques/effets indésirables , Polluants atmosphériques/analyse , Exposition environnementale/effets indésirables , Facteurs de risque , Tumeurs de la vessie urinaire/épidémiologie , Tumeurs de la vessie urinaire/étiologie , Tumeurs du rein/épidémiologie , Tumeurs du rein/étiologie , Tumeurs de la prostate/épidémiologie , Tumeurs de la prostate/étiologie , FemelleRÉSUMÉ
Although cancer diagnosis and treatment have rapidly advanced in recent decades, urological malignancies, which have high morbidity and mortality rates, are among the most difficult diseases to treat. The Hippo signaling is an evolutionarily conserved pathway in organ size control and tissue homeostasis maintenance. Its downstream effectors, Yes-associated protein (YAP) and transcriptional coactivator with PDZ-binding motif (TAZ), are key modulators of numerous physiological and pathological processes. Recent work clearly indicates that Hippo signaling is frequently altered in human urological malignancies. In this review, we discuss the disparate viewpoints on the upstream regulators of YAP/TAZ and their downstream targets and systematically summarize the biological implications. More importantly, we highlight the molecular mechanisms involved in Hippo-YAP signaling to improve our understanding of its role in every stage of prostate cancer, bladder cancer and kidney cancer progression. A better understanding of the biological outcomes of YAP/TAZ modulation will contribute to the establishment of future therapeutic approaches.
Sujet(s)
Voie de signalisation Hippo , Protein-Serine-Threonine Kinases , Transduction du signal , Facteurs de transcription , Humains , Protein-Serine-Threonine Kinases/métabolisme , Facteurs de transcription/métabolisme , Tumeurs urologiques/métabolisme , Tumeurs urologiques/étiologie , Tumeurs urologiques/anatomopathologie , Protéines de signalisation YAP/métabolisme , Animaux , Transcriptional coactivator with PDZ-binding motif proteins/métabolisme , Protéines adaptatrices de la transduction du signal/métabolisme , Régulation de l'expression des gènes tumoraux , Tumeurs de la vessie urinaire/métabolisme , Tumeurs de la vessie urinaire/anatomopathologie , Tumeurs de la vessie urinaire/génétique , MâleSujet(s)
Tumeurs urologiques , Humains , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/étiologie , Aliments de restauration rapide/effets indésirables , Régime alimentaire/effets indésirables , Régime alimentaire/statistiques et données numériques , Facteurs de risque , Mâle , Manipulation des aliments , Aliments transformésRÉSUMÉ
Most genitourinary tract cancers have a negative impact on male fertility. Although testicular cancers have the worst impact, other tumors such as prostate, bladder, and penis are diagnosed early and treated in relatively younger patients in which couple fertility can be an important concern. The purpose of this review is to highlight both the pathogenetic mechanisms of damage to male fertility in the context of the main urological cancers and the methods of preserving male fertility in an oncological setting, in light of the most recent scientific evidence. A systematic review of available literature was carried out on the main scientific search engines, such as PubMed, Clinicaltrials.Gov, and Google scholar. Three hundred twenty-five relevant articles on this subject were identified, 98 of which were selected being the most relevant to the purpose of this review. There is a strong evidence in literature that all of the genitourinary oncological therapies have a deep negative impact on male fertility: orchiectomy, partial orchiectomy, retroperitoneal lymphadenectomy (RPLND), radical cystectomy, prostatectomy, penectomy, as well as radiotherapy, chemotherapy, and hormonal androgen suppression. Preservation of fertility is possible and includes cryopreservation, hormonal manipulation with GnRH analogs before chemotherapy, androgen replacement. Germ cell auto transplantation is an intriguing strategy with future perspectives. Careful evaluation of male fertility must be a key point before treating genitourinary tumors, taking into account patients' age and couples' perspectives. Informed consent should provide adequate information to the patient about the current state of his fertility and about the balance between risks and benefits in oncological terms. Standard approaches to genitourinary tumors should include a multidisciplinary team with urologists, oncologists, radiotherapists, psycho-sexologists, andrologists, gynecologists, and reproductive endocrinologists.
Sujet(s)
Préservation de la fertilité , Infertilité masculine , Tumeurs du testicule , Tumeurs urologiques , Humains , Mâle , Préservation de la fertilité/effets indésirables , Préservation de la fertilité/méthodes , Androgènes , Infertilité masculine/étiologie , Infertilité masculine/thérapie , Tumeurs du testicule/complications , Tumeurs urologiques/étiologie , Tumeurs urologiques/thérapieRÉSUMÉ
BACKGROUND: The incidence of malignancies after successful kidney transplantation has historically been higher than in the general population, with adverse impact on clinical outcomes. However, uncertainty remains as to which cancers occur at what time points after kidney transplantation. METHODS: We conducted a longitudinal cohort study to investigate the temporal trends and topographic patterns of de novo malignancies to optimize surveillance protocols and improve transplant outcome in renal transplant recipients. Measurement of death and cancer events was performed to calculate the cumulative risk of events of interest. RESULTS: Between 2000 and 2013, 3169 renal transplant recipients were retrospectively screened; 3035 (96%) of them met eligibility criteria and were evaluated with a follow-up of 27612 person-years. There was suboptimal overall survival and malignancy-free survival in renal transplant recipients compared to reference groups (HR: 1.65; 95% CI: 1.50-1.82; p < .001; HR: 2.33; 95% CI: 2.04-2.66; p < .001, respectively). Among renal transplant recipients, urological malignancies were predominant (57.5%), followed by digestive tract malignancies (21.4%). The cancer risks of the urinary bladder and upper urinary tract were lower in male subjects (HR: .48; 95% CI: .33-.72; p < .001; HR: .34; 95% CI: .20-.59; p < .001, respectively). The temporal trends of urological malignancies among renal transplant recipients were expressed in a bimodal pattern, with M-shaped peaks at 3 and 9 years, with gender disparity. CONCLUSIONS: In renal transplant recipients, cancer occurrences are shown as M-shaped twin peaks. Our study highlights that specific customized 'targeted' strategies for cancer surveillance programs are required to optimize posttransplant care.
Sujet(s)
Transplantation rénale , Tumeurs , Tumeurs urologiques , Humains , Mâle , Transplantation rénale/effets indésirables , Études longitudinales , Études rétrospectives , Tumeurs/épidémiologie , Tumeurs/étiologie , Études de cohortes , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/étiologie , Incidence , Receveurs de transplantation , Facteurs de risqueRÉSUMÉ
BACKGROUND: Chronic kidney disease (CKD) is believed to be associated with an increased risk for cancer, especially urinary tract cancer. However, previous studies predominantly focused on the association of decreased estimated glomerular filtration rate (eGFR) with cancer. In this study, we investigated the association of albuminuria with cancer incidence, adjusted for eGFR. METHODS: We included 8490 subjects in the Prevention of Renal and Vascular End-stage Disease (PREVEND) observational study. Urinary albumin excretion (UAE) was measured in two 24-hour urine specimens at baseline. Primary outcomes were the incidence of overall and urinary tract cancer. Secondary outcomes were the incidence of other site-specific cancers, and mortality due to overall, urinary tract, and other site-specific cancers. RESULTS: Median baseline UAE was 9.4 (IQR, 6.3-17.8) mg/24 h. During a median follow-up of 17.7 years, 1341 subjects developed cancer (of which 177 were urinary tract cancers). After multivariable adjustment including eGFR, every doubling of UAE was associated with a 6% (hazard ratios (HR), 1.06, 95% confidence intervals (CI), 1.02-1.10), and 14% (HR, 1.14, 95% CI, 1.04-1.24) higher risk of overall and urinary tract cancer incidence, respectively. Except for lung and hematological cancer, no associations were found between UAE and the incidence of other site-specific cancer. Doubling of UAE was also associated with a higher risk of mortality due to overall and lung cancer. CONCLUSIONS: Higher albuminuria is associated with a higher incidence of overall, urinary tract, lung, and hematological cancer, and with a higher risk of mortality due to overall and lung cancers, independent of baseline eGFR.
Sujet(s)
Tumeurs hématologiques , Insuffisance rénale chronique , Tumeurs urologiques , Humains , Études de cohortes , Albuminurie/complications , Insuffisance rénale chronique/complications , Débit de filtration glomérulaire , Albumines , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/étiologie , Facteurs de risqueRÉSUMÉ
PURPOSE: The purpose of this paper is to present evidence regarding the associations between smoking and the following urologic cancers: prostate, bladder, renal, and upper tract urothelial cancer (UTUC). METHODS: This is a narrative review. PubMed was queried for evidence-based analyses and trials regarding the associations between smoking and prostate, bladder, renal, and UTUC tumors from inception to September 1, 2022. Emphasis was placed on articles referenced in national guidelines and protocols. RESULTS: Prostate-multiple studies associate smoking with higher Gleason score, higher tumor stage, and extracapsular invasion. Though smoking has not yet been linked to tumorigenesis, there is evidence that it plays a role in biochemical recurrence and cancer-specific mortality. Bladder-smoking is strongly associated with bladder cancer, likely due to DNA damage from the release of carcinogenic compounds. Additionally, smoking has been linked to increased cancer-specific mortality and higher risk of tumor recurrence. Renal-smoking tobacco has been associated with tumorigenesis, higher tumor grade and stage, poorer mortality rates, and a greater risk of tumor recurrence. UTUC-tumorigenesis has been associated with smoking tobacco. Additionally, more advanced disease, higher stage, lymph node metastases, poorer survival outcomes, and tumor recurrence have been linked to smoking. CONCLUSION: Smoking has been shown to significantly affect most urologic cancers and has been associated with more aggressive disease, poorer outcomes, and tumor recurrence. The role of smoking cessation is still unclear, but appears to provide some protective effect. Urologists have an opportunity to engage in primary prevention by encouraging cessation practices.
Sujet(s)
Carcinome transitionnel , Tumeurs de la vessie urinaire , Tumeurs urologiques , Mâle , Humains , Récidive tumorale locale/épidémiologie , Récidive tumorale locale/anatomopathologie , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/étiologie , Tumeurs de la vessie urinaire/épidémiologie , Tumeurs de la vessie urinaire/étiologie , Carcinome transitionnel/anatomopathologie , Fumer/effets indésirables , Fumer/épidémiologie , Carcinogenèse , Études rétrospectives , PronosticRÉSUMÉ
Several studies have investigated the role of inflammation in promoting tumorigenesis and cancer progression. Neoplastic as well as surrounding stromal and inflammatory cells engage in well-orchestrated reciprocal interactions to establish an inflammatory tumor microenvironment. The tumor-associated inflammatory tissue is highly plastic, capable of continuously modifying its phenotypic and functional characteristics. Accumulating evidence suggests that chronic inflammation plays a critical role in the development of urological cancers. Here, we review the origins of inflammation in urothelial, prostatic, renal, testicular, and penile cancers, focusing on the mechanisms that drive tumor initiation, growth, progression, and metastasis. We also discuss how tumor-associated inflammatory tissue may be a diagnostic marker of clinically significant tumor progression risk and the target for future anti-cancer therapies.
Sujet(s)
Tumeurs du pénis , Tumeurs urologiques , Mâle , Humains , Tumeurs urologiques/étiologie , Inflammation/complications , Inflammation/anatomopathologie , Carcinogenèse , Transformation cellulaire néoplasique , Microenvironnement tumoralRÉSUMÉ
BACKGROUND/AIM: We investigated whether coronavirus disease 2019 (COVID-19) vaccination and its adverse events would cause cancer treatment of patients with urological cancer to be postponed or changed. PATIENTS AND METHODS: We collected COVID-19 vaccination information including adverse events from the medical records of 214 patients with urological cancer receiving cancer drug therapy. RESULTS: The cancer types were renal cancer in 40 cases (18.7%), upper urinary tract cancer in 10 cases (4.7%), bladder cancer in 21 cases (9.8%), prostate cancer in 140 cases (65.4%), and others in 3 cases (1.4%). Of the 214 patients, 178 (83.2%) had received the second dose of the vaccine. Out of 180 vaccinated patients, some adverse events were observed in 69 (38.3%). Vaccination rates for males and females were 85.4% (169/198) and 68.8% (11/16), respectively, and were not significantly different (p=0.081). The incidence of adverse events was significantly higher in females [72.7% (8/11)] than in males [36.1% (61/169)]; p=0.015. Treatment was modified in 11 vaccinated patients; postponed or changed at the discretion of the attending physician in 8 cases, skipped at the discretion of the patient in 1 case, and postponed due to side effects of the immune checkpoint inhibitor in 1 case. Treatment for one patient with upper urinary tract cancer on pembrolizumab was postponed for three weeks due to adverse events of the vaccine. CONCLUSION: Only 0.6% of the adverse events of the vaccine required postponement of treatment, suggesting that vaccination is safe even during cancer drug therapy.
Sujet(s)
COVID-19 , Effets secondaires indésirables des médicaments , Tumeurs urologiques , COVID-19/épidémiologie , COVID-19/prévention et contrôle , Vaccins contre la COVID-19/effets indésirables , Effets secondaires indésirables des médicaments/étiologie , Femelle , Humains , Mâle , Tumeurs urologiques/traitement médicamenteux , Tumeurs urologiques/étiologie , Vaccination/effets indésirablesRÉSUMÉ
Tobacco use is the cause of several urologic cancers. Persistent use after diagnosis is associated with worse cancer-specific, quality of life, and overall mortality outcomes. Cigarette smoking remains the most common form of tobacco use despite significant population-level decline over the past few decades. The burden of smoking-related urologic disease is under appreciated by urologists and patients which has resulted in gaps in clinical care and limitations to research progress. We sought to summarize evidence-based practices and guideline recommendations for assessing and reporting tobacco use in the clinical and research settings. With a focus on smoking, our two primary goals are: 1) to promote the adoption of standardized and validated measures of tobacco use and 2) to highlight evidence-based strategies for urologists to use in clinical practice.
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Recherche biomédicale/normes , Prestations des soins de santé/normes , Oncologie médicale/normes , Guides de bonnes pratiques cliniques comme sujet/normes , Arrêter de fumer/méthodes , Usage de tabac/effets indésirables , Tumeurs urologiques/prévention et contrôle , Adhésion aux directives , Humains , Tumeurs urologiques/étiologieRÉSUMÉ
Over-immunosuppressed kidney transplant recipients are susceptible to malignancies and BK polyomavirus (BKPyV)-associated nephropathy (BKPyVAN). This study aimed to verify the association between BKPyV infection and urinary tract cancers (UTC). A total of 244 kidney transplant recipients were enrolled at Chang Gung Memorial Hospital from June 2000 to February 2020. Biopsy-proven BKPyVAN patients (n = 17) had worse kidney function (eGFR: 26 ± 13.7 vs. 47.8 ± 31.0 mL/min/1.73 m2). The 5-year allograft survival rates for patients with and without BKPyVAN were 67% and 93%, respectively (p = 0.0002), while the 10-year patient survival was not different between the two groups. BKPyVAN patients had a significantly higher incidence of UTC compared to the non-BKPyVAN group (29.4% vs. 6.6%). Kaplan-Meier analysis showed that the UTC-free survival rate was significantly lower in BKPyVAN patients, and the onset of UTC was significantly shorter in BKPyVAN patients (53.4 vs. 108.9 months). The multivariate logistic regression analysis demonstrated that age (RR = 1.062) and BKVAN (RR = 6.459) were the most significant risk factors for the development of UTC. Our study demonstrates that BKPyVAN patients have greater allograft losses, higher incidence, a lower cancer-free survival rate, and an earlier onset with a higher relative risk of developing UTC compared to non-BKPyVAN patients.
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Virus BK/pathogénicité , Maladies du rein/complications , Maladies du rein/virologie , Infections à polyomavirus/complications , Infections à virus oncogènes/complications , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/étiologie , Adulte , Sujet âgé , Chine/épidémiologie , Femelle , Humains , Immunosuppression thérapeutique/effets indésirables , Immunosuppresseurs/effets indésirables , Incidence , Maladies du rein/épidémiologie , Transplantation rénale/effets indésirables , Mâle , Adulte d'âge moyen , Études rétrospectives , Facteurs de risque , Receveurs de transplantation/statistiques et données numériques , Transplantation homologue/effets indésirables , Tumeurs urologiques/virologie , VirémieRÉSUMÉ
PURPOSE: To investigate the prognostic role of the preoperative systemic immune-inflammation index (SII) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). MATERIALS AND METHODS: We retrospectively analyzed our multi-institutional database to identify 2492 patients. SII was calculated as platelet count × neutrophil/lymphocyte count and evaluated at a cutoff of 485. Logistic regression analyses were performed to investigate the association of SII with muscle-invasive and non-organ-confined (NOC) disease. Cox regression analyses were performed to investigate the association of SII with recurrence-free, cancer-specific, and overall survival (RFS/CSS/OS). RESULTS: Overall, 986 (41.6%) patients had an SII > 485. On univariable logistic regression analyses, SII > 485 was associated with a higher risk of muscle-invasive (P = 0.004) and NOC (P = 0.03) disease at RNU. On multivariable logistic regression, SII remained independently associated with muscle-invasive disease (P = 0.01). On univariable Cox regression analyses, SII > 485 was associated with shorter RFS (P = 0.002), CSS (P = 0.002) and OS (P = 0.004). On multivariable Cox regression analyses SII remained independently associated with survival outcomes (all P < 0.05). Addition of SII to the multivariable models improved their discrimination of the models for predicting muscle-invasive disease (P = 0.02). However, all area under the curve and C-indexes increased by < 0.02 and it did not improve net benefit on decision curve analysis. CONCLUSIONS: Preoperative altered SII is significantly associated with higher pathologic stages and worse survival outcomes in patients treated with RNU for UTUC. However, the SII appears to have relatively limited incremental additive value in clinical use. Further study of SII in prognosticating UTUC is warranted before routine use in clinical algorithms.
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Marqueurs biologiques , Immunité , Inflammation/métabolisme , Tumeurs urologiques/étiologie , Tumeurs urologiques/mortalité , Humains , Inflammation/étiologie , Numération des leucocytes , Numération des lymphocytes , Mâle , Odds ratio , Numération des plaquettes , Pronostic , Récidive , Tumeurs urologiques/diagnostic , Tumeurs urologiques/thérapieRÉSUMÉ
Urothelial carcinoma represents one of the most prevalent types of cancer worldwide, and its incidence is expected to grow. Although the treatment of the advanced disease was based on chemotherapy for decades, the developments of different therapies, such as immune checkpoint inhibitors, antibody drug conjugates and tyrosine kinase inhibitors, are revolutionizing the therapeutic landscape of this tumor. This development coincides with the increasing knowledge of the pathogenesis and genetic alterations in urothelial carcinoma, from the non-muscle invasive setting to the metastatic one. The purpose of this article is to provide a comprehensive review of the different tyrosine kinase targets and their roles in the therapeutic scene of urothelial carcinoma.
Sujet(s)
Marqueurs biologiques tumoraux , Thérapie moléculaire ciblée , Inhibiteurs de protéines kinases/pharmacologie , Inhibiteurs de protéines kinases/usage thérapeutique , Protein-tyrosine kinases/métabolisme , Tumeurs urologiques/traitement médicamenteux , Tumeurs urologiques/étiologie , Inhibiteurs de l'angiogenèse/pharmacologie , Inhibiteurs de l'angiogenèse/usage thérapeutique , Essais cliniques comme sujet , Récepteurs ErbB/antagonistes et inhibiteurs , Récepteurs ErbB/métabolisme , Humains , Invasion tumorale , Stadification tumorale , Phosphatidylinositol 3-kinases/métabolisme , Protein-tyrosine kinases/antagonistes et inhibiteurs , Protéines proto-oncogènes c-akt/métabolisme , Transduction du signal/effets des médicaments et des substances chimiques , Sérine-thréonine kinases TOR/métabolisme , Résultat thérapeutique , Tumeurs de la vessie urinaire/diagnostic , Tumeurs de la vessie urinaire/traitement médicamenteux , Tumeurs de la vessie urinaire/étiologie , Tumeurs urologiques/diagnosticRÉSUMÉ
BACKGROUND: Horseshoe kidney (HSK) is a congenital disorder that is usually asymptomatic, but that increases the risks of kidney stones and infectious disease. However, renal outcomes such as end-stage renal disease (ESRD) in patients with HSK remain unclear. METHODS: In total, 146 patients with HSK (age of ≥20 years) from two tertiary hospitals were included in this study. Control individuals who underwent medical check-ups were selected by matching for age, sex, serum creatinine level, hypertension and diabetes. The hazard ratios (HRs) for the risks of ESRD and all-cause mortality were calculated after adjustment for multiple variables. RESULTS: The proportions of HSK-related complications for obstruction, kidney stones, urinary tract infection and urogenital cancer were 26, 25, 19 and 4%, respectively. During the median follow-up period of 9 years (maximum 32 years), the incidence of ESRD was 2.6/10 000 person-years. The risk of ESRD in patients with HSK was higher than in control individuals [adjusted HR = 7.6; 95% confidence interval (CI) 1.14-50.47]. All-cause mortality did not differ between the two groups (adjusted HR = 0.6; 95% CI 0.08-4.29). CONCLUSIONS: Patients with HSK are at risk of ESRD, which may be attributable to the high prevalence of complications. Accordingly, these patients should be regarded as having chronic kidney disease and require regular monitoring of both kidney function and potential complications.
Sujet(s)
Reins fusionnés/complications , Calculs rénaux/étiologie , Obstruction urétérale/étiologie , Infections urinaires/étiologie , Tumeurs urologiques/étiologie , Adulte , Femelle , Humains , Incidence , Calculs rénaux/épidémiologie , Calculs rénaux/anatomopathologie , Mâle , Pronostic , République de Corée/épidémiologie , Taux de survie , Obstruction urétérale/épidémiologie , Obstruction urétérale/anatomopathologie , Infections urinaires/épidémiologie , Infections urinaires/anatomopathologie , Tumeurs urologiques/épidémiologie , Tumeurs urologiques/anatomopathologieRÉSUMÉ
The choice of first-line therapy for patients with metastatic urothelial cancer (mUC) is based on cisplatin-eligibility and programmed death-ligand 1 (PD-L1) status. For patients with mUC who are ineligible for cisplatin and with low PD-L1 expression, chemotherapy-based regimens are the only approved first-line option. In a Phase I/II trial of the chemotherapy-free regimen, bempegaldesleukin (BEMPEG; NKTR-214) plus nivolumab, patients with locally advanced or mUC experienced tumor responses regardless of baseline PD-L1 expression (objective response rates: 50 and 45% in patients with PD-L1-positive and -negative tumors, respectively). The Phase II PIVOT-10 study (NCT03785925), evaluates efficacy and safety of first-line BEMPEG plus nivolumab in cisplatin-ineligible patients with locally advanced or mUC. Most patients will have low PD-L1 expression. Primary end point: objective response rates (including complete response).
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Protocoles de polychimiothérapie antinéoplasique/usage thérapeutique , Plan de recherche , Tumeurs urologiques/traitement médicamenteux , Protocoles de polychimiothérapie antinéoplasique/effets indésirables , Marqueurs biologiques tumoraux , Cisplatine/administration et posologie , Humains , Interleukine-2/administration et posologie , Interleukine-2/analogues et dérivés , Thérapie moléculaire ciblée , Grading des tumeurs , Métastase tumorale , Stadification tumorale , Nivolumab/administration et posologie , Polyéthylène glycols/administration et posologie , Pronostic , Tumeurs urologiques/diagnostic , Tumeurs urologiques/étiologie , Tumeurs urologiques/mortalitéRÉSUMÉ
As part of the recent series of articles to create a comprehensive description of the radiation risks of solid cancer incidence after ionizing radiation exposure, based on the atomic bomb survivors' Life Span Study (LSS), this work focuses on the risks of urinary tract cancer (UTC) and kidney cancer. Analyses covered a 52-year period of follow-up, through 2009, among 105,444 eligible survivors who were alive and cancer free in 1958. This represents an additional 11 years of follow-up since the last comprehensive report, with a total of 3,079,502 person-years. We observed 790 UTC and 218 kidney cancer cases. Adjusted for smoking, there was a strong linear radiation dose response for UTC. The sex-averaged excess relative risk per 1 Gy (ERR/Gy) was 1.4 (95% confidence interval, CI: 0.82 to 2.1). Both males and females showed significantly increased ERRs/Gy with female point estimates at a factor of 3.4 (95% CI: 1.4 to 8.6) greater than male estimates. UTC radiation risks were largely unmodified by age at exposure or attained age. The attributable fraction of UTC to radiation exposure was approximately 18% while that attributed to smoking was 48%. Kidney cancer showed an increased ERR due to smoking (0.56 per 50 pack-years; 95% CI -0.007 to 1.6; P = 0.054), but we did not observe any strong associations of kidney cancer with radiation exposure, although sex-specific dose responses were found to be statistically different.
Sujet(s)
Tumeurs du rein/épidémiologie , Tumeurs radio-induites/épidémiologie , Tumeurs de la vessie urinaire/épidémiologie , Tumeurs urologiques/épidémiologie , Adolescent , Adulte , Sujet âgé , Sujet âgé de 80 ans ou plus , Survivants de bombardements atomiques , Enfant , Enfant d'âge préscolaire , Femelle , Humains , Nourrisson , Nouveau-né , Japon/épidémiologie , Tumeurs du rein/étiologie , Tumeurs du rein/anatomopathologie , Mâle , Adulte d'âge moyen , Tumeurs radio-induites/anatomopathologie , Armes nucléaires , Exposition aux rayonnements/effets indésirables , Rayonnement ionisant , Facteurs de risque , Tumeurs de la vessie urinaire/étiologie , Tumeurs de la vessie urinaire/anatomopathologie , Tumeurs urologiques/étiologie , Tumeurs urologiques/anatomopathologie , Jeune adulteRÉSUMÉ
BK polyomavirus (BKPyV) has been associated with some high-grade and special urothelial cell carcinoma (UCC) subtypes in immunosuppressed patients. Here, we evaluated the relationship of BKPyV-positive urine cytology specimens (UCS) with UCC. A large single-institution database was retrospectively searched for UCS positive for decoy cells, suggesting BKPyV infection. These were tested for the presence of BKPyV by PCR and immunohistochemistry (IHC) in urine sediments and formalin-fixed paraffin-embedded (FFPE) tissue samples of UCC. Decoy cells were reported in 30 patients out of the database with 22.867 UCS. Of these 30 patients, 16 (53.3%) had no history of UCC. Six patients out of these 16 had a history of transplantation, 4 had a history of severe chronic medical conditions, and 6 had no chronic disease. The other fourteen patients were diagnosed with either in situ or invasive UCC of the urinary bladder (14/30; 46.6%) prior to the detection of decoy cells in the urine. Nine of these UCC patients received intravesical treatment (BCG or mitomycin) after the first presentation with UCC. However, the clinical data on the treatment of the other five UCC patients was lacking. IHC identified BKPyV-positivity in the urine samples of non-UCC and UCC patients, while no BKPyV positivity was found in FFPE tissues of primary UCCs and metastases. In addition, BKPyV-PCR results revealed the presence of BKPyV DNA in the urine of the UCC cases, yet none in the UCC tissues itself. These data strongly indicate that BKPyV reactivation is not restricted to immunosuppression. It can be found in UCS of the immunocompetent patients and may be related to the intravesical BCG or mitomycin treatment of the UCC patients.