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1.
Medicine (Baltimore) ; 99(38): e22191, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957347

RESUMO

To investigate the role of previous cancer on overall survival in patients with bladder cancer (BCa) and to establish an effective prognostic tool for individualized overall survival prediction.A total of 78,660 patients diagnosed with BCa between 2000 and 2013 were selected from the Surveillance, Epidemiology, and End Results (SEER) database, among which 8915 patients had a history of other cancers. We compared the overall survival between patients with and without previous cancer after propensity score matching and we further established a nomogram for overall survival prediction.Univariate and multivariate Cox analyses were used to determine independent prognostic factors. The calibration curve and concordance index (C-index) were used to assess the accuracy of the nomogram. Cox proportional hazards models and Kaplan-Meier analysis were used to compare survival outcomes.BCa patients with previous cancer had worse overall survival compared with those without previous cancer (HR = 1.37; 95%CI = 1.32-1.42, P < .001). Cancers in lung prior to BCa had the most adverse impact on overall survival (HR = 2.35; 95%CI = 2.10-2.63; P < .001), and the minimal impact was located in prostate (HR = 1.16; 95%CI = 1.10-1.22; P < .001) for male and in gynecological (HR = 1.15; 95%CI = 1.02-1.30; P = .027) for female. The shorter interval time between 2 cancers and the higher stage of the previous cancer development, the higher risk of death. Age, race, sex, marital status, surgery, radiation, grade, stage, type of previous cancer as the independent prognostic factors were selected into the nomogram. The favorable calibration curve and C-index value (0.784, 95%CI = 0.782-0.786) indicated the nomogram could accurately predict the 1-, 3-, and 5-year overall survival rate of BCa patients.Previous cancer has a negative impact on the overall survival of BCa patients and requires more effective clinical management. The nomogram provides accurate survival prediction for BCa patients and might be helpful for clinical treatment selection and follow-up strategy adjustment.


Assuntos
Carcinoma de Células de Transição/mortalidade , Segunda Neoplasia Primária/mortalidade , Neoplasias da Bexiga Urinária/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nomogramas , Programa de SEER
2.
Medicine (Baltimore) ; 99(30): e20920, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791672

RESUMO

BACKGROUND: Accumulating emerging studies have demonstrated that systemic inflammation can obviously affect tumor occurrence and progression. Nevertheless, the prognostic value of hematological inflammation biomarkers in bladder cancer is controversial. Thus, we conducted a meta-analysis to evaluate the key hematological biomarkers with various clinical outcomes in bladder cancer. METHODS: We used online databases PUBMED and EMBASE to search relevant studies published prior to August 2019. After collecting the basic characteristics and prognostic data from the studies included, overall survival (OS), cancer-specific survival (CSS) and progression-free survival (PFS) were used as primary results. Subgroup analyses were performed according to ethnicity, the number of samples, survival outcomes, the value of cut-off, follow-up time and metastasis stage. RESULTS: Thirty-three independent studies with 17,087 bladder cancer patients were added in the present analysis. The collected results showed that the increased neutrophil-to-lymphocyte ratio was associated with a poor OS (hazard ratio [HR] = 1.48, 95% confidence interval [CI]: 1.32-1.67, P < .00001), CSS (HR = 1.71, 95%CI: 1.35-2.18, P < .0001) and PFS (HR = 1.59, 95%CI: 1.38-1.83, P < .00001). Additionally, the elevated platelet-to-lymphocyte ratio was related to a poor OS (HR = 1.29, 95% CI: 1.07-1.54, P = .007), CSS (HR = 1.14, 95%CI = 0.98-1.34, P = .02) and PFS (HR = 1.2, 95%CI: 1.08-1.34, P = .0008). Moreover, a decreased lymphocyte-to-monocyte ratio was associated with a poor OS (HR = 0.77, 95% CI: 0.70-0.84, P = .001), CSS (HR = 0.76, 95%CI: 0.70-0.84). An elevated modified Glasgow prognostic score was also associated with a poor OS (HR = 2.71, 95%CI: 1.08-2.82, P = .003), CSS (HR = 1.50, 95%CI: 0.56-4.05) and PFS (HR = 1.52, 95%CI: 1.23-1.88, P = .001). CONCLUSIONS: Our study indicated that the pretreatment hematological biomarkers (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, and modified Glasgow prognostic score) were predicative biomarkers of prognosis in bladder cancer patients. Further research is needed to conduct further prospective and multicenter studies to confirm our findings.


Assuntos
Carcinoma/sangue , Neoplasias da Bexiga Urinária/sangue , Biomarcadores/sangue , Carcinoma/mortalidade , Humanos , Contagem de Linfócitos , Contagem de Plaquetas , Neoplasias da Bexiga Urinária/mortalidade
3.
Medicine (Baltimore) ; 99(28): e21059, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664121

RESUMO

LncRNA plasmacytoma variant translocation 1 (PVT1) has been recognized as an oncogenic lncRNA, which participates in the migration and invasion of many kinds of cancer cells and the development of cancers. In the present study, we explored its clinical significance and prognostic value in muscle invasive bladder cancer (MIBC).A total of 98 MIBC patients' samples were collected, who had undergone radical cystectomy from the March 2013 to December 2018. The associations between PVT1 expression and clinical data were calculated using the Chi-test. Overall survival curves were determined by the Kaplan-Meier technique and contrasted via log-rank test. We utilized univariate and multivariate Cox proportional hazard models to examine the HR and 95% CI.The expression levels of PVT1 were significantly higher in MIBC tissues than that in normal bladder tissues (P < .001). PVT1 expression was significantly correlated with tumor grade (P = .009), margin (P = .002), T stage (P = .02), and lymph node metastasis (P < .001). MIBC patients with high PVT1 expression level had shorter overall survival than those with low PVT1 expression level (log-rank test, P = .004). Multivariate Cox regression analysis showed that PVT1 expression level (HR = 2.381, 95% CI: 1.821-7.012, P = .014) was an independent factor in predicting the overall survival of MIBC patients.In summary, increased PVT1 expression in MIBC patients is correlated with a higher MIBC stage and is significantly associated with poor prognosis for MIBC patients, which may provide new insights into new therapeutic strategy and postoperative intervention against bladder cancer.


Assuntos
RNA Longo não Codificante/biossíntese , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/mortalidade , Idoso , Biomarcadores Tumorais , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Regulação para Cima
4.
PLoS One ; 15(6): e0233676, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32484812

RESUMO

In urothelial cell type non-muscle invasive urinary bladder carcinoma, TNM stage and WHO grade are widely used to classify patients into low and high­risk groups for prognostic and therapeutic decision-making. However, stage and grade reproducibility and prediction accuracy are wanting. This may lead to suboptimal treatment. We evaluated whether proliferation features, nuclear area of the epithelial cancer cells and the composition of stromal and tumor infiltrating lymphocytes have independent prognostic value. In 183 primary non-muscle invasive bladder cancer patients with long follow-up (median for stage progression cohort: 119 months, range 5-173; median for tumor recurrence cohort: 82, range 3-165) proliferation features Ki67, PPH3 and Mitotic Activity Index (MAI), Mean Nuclear Area (MNA), lymphocyte subsets (CD8+, CD4+, CD25+) and plasma cells (CD138+) were assessed on consecutive sections. Post-resection instillation treatments (none, mitomycin, BCG) were strictly standardized during the intake period. Risk of recurrence was associated with expression of Ki67 (≤ 39 vs. > 39) and Multifocality (p = 0.01). Patients with low Ki67 had a higher recurrence rate than those with high Ki67. Lymphocyte composition did not predict recurrence. Stage progression was strongly associated with high values for MAI (>15) and CD25+ (>0.2%). In a multivariate analysis the combination of MAI and CD25+ was the single most prognostic feature (p<0.001). Validation of these results in additional, independent studies is warranted.


Assuntos
Carcinoma de Células de Transição/patologia , Linfócitos do Interstício Tumoral/imunologia , Índice Mitótico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/genética , Carcinoma de Células de Transição/imunologia , Progressão da Doença , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Estimativa de Kaplan-Meier , Antígeno Ki-67/metabolismo , Linfócitos do Interstício Tumoral/metabolismo , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/genética , Recidiva Local de Neoplasia/imunologia , Estadiamento de Neoplasias , Prognóstico , Reprodutibilidade dos Testes , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/mortalidade
5.
Anticancer Res ; 40(5): 2905-2909, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32366441

RESUMO

BACKGROUND: The Japanese bladder cancer treatment guidelines recommend concurrent chemoradiotherapy, including wide pelvic irradiation. Many elderly patients, however, cannot tolerate standard treatment because of low performance status. Therefore, to reduce complications, elderly patients sometimes receive radiation therapy without elective nodal irradiation or chemotherapy. PATIENTS AND METHODS: Outcomes were retrospectively analyzed in 19 elderly patients with N0 muscle-invasive bladder cancer treated with whole-bladder irradiation without chemotherapy. RESULTS: The 3- and 5-year overall survival rates were 30.7% and 12.2%, respectively. No patient experienced severe late complications (grade 3 or higher). Recurrence was observed in 11 patients (57.9%). The initial location of recurrence was within the bladder. CONCLUSION: Whole-bladder irradiation alone did not increase lymph node metastases or severe complications in elderly patients. Whole-bladder radiation therapy without chemotherapy or wide pelvic irradiation may be a promising treatment method for patients who are not candidates for standardized treatment.


Assuntos
Neoplasias da Bexiga Urinária/radioterapia , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
6.
Cancer Sci ; 111(7): 2349-2360, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32449280

RESUMO

Solute carrier family 12 member 5 (SLC12A5) has an oncogenic role in bladder urothelial carcinoma. The present study aimed to characterize the molecular mechanisms of SLC12A5 in bladder urothelial carcinoma pathogenesis. Functional assays identified that in bladder urothelial carcinoma SLC12A5 interacts with and stabilizes SOX18, and then upregulates matrix metalloproteinase 7 (MMP7). In vivo and in vitro assays were performed to confirm the effect of SLC12A5's interaction with SOX18 on MMP7-mediated bladder urothelial carcinoma progression. SLC12A5 was upregulated in human bladder tumors, and correlated with the poor survival of patients with bladder urothelial carcinoma tumor invasion and metastasis, promoted by SLC12A5 overexpression. We demonstrated that SLC12A5 interacted with SOX18, and then upregulated MMP7, thus enhancing tumor progression. Importantly, SLC12A5 expression correlated positively with SOX18 and MMP7 expression in bladder urothelial carcinoma. Furthermore, SLC12A5 expression was suppressed by miR-133a-3p. Ectopic expression of SLC12A5 partly abolished miR-133a-3p-mediated suppression of cell migration. SLC12A5-SOX18 complex-mediated upregulation on MMP7 was important in bladder urothelial carcinoma progression. The miR-133a-3p/SLC12A5/SOX18/MMP7 signaling axis was critical for progression, and provided an effective therapeutic approach against bladder urothelial carcinoma.


Assuntos
Regulação Neoplásica da Expressão Gênica , Metaloproteinase 7 da Matriz/genética , Fatores de Transcrição SOXF/metabolismo , Simportadores/metabolismo , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/metabolismo , Adulto , Idoso , Linhagem Celular Tumoral , Movimento Celular , Proliferação de Células , Progressão da Doença , Feminino , Humanos , Imuno-Histoquímica , Masculino , Metaloproteinase 7 da Matriz/metabolismo , Pessoa de Meia-Idade , Prognóstico , Ligação Proteica , Transdução de Sinais , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
7.
PLoS One ; 15(5): e0233397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442187

RESUMO

INTRODUCTION: Geographical variations in cancer mortality can be explained, in part, by their association with social inequalities. The objective of our study was to analyse the spatial pattern of mortality in relation to the most common causes of cancer in the Spanish autonomous community of Andalusia and its possible association with social inequalities. MATERIALS AND METHODS: A small area cross-sectional study in Andalusia, with census tracts as units of spatial analysis, for the period 2002-2013. Cases and person-years, sex and age group came from the Longitudinal Population Database of Andalusia. Standardized mortality rates and smoothed risk ratios were calculated using the Besag, York and Mollié model for lung, colorectal, breast, prostate, bladder and stomach cancer. In order to evaluate the association with social inequalities we included the deprivation index of the census tract as a covariate. RESULTS: The results show an East-West mortality pattern with higher risk in the west for lung and bladder cancer among men, and breast cancer among women. For all of Andalusia, the association between deprivation index of the census tract and mortality relative risks is positive and significant for lung, stomach and bladder cancers in men, while in women we observed a negative association for lung cancer and a positive for stomach cancer. CONCLUSIONS: Knowledge regarding the spatial distribution of cancer mortality and the socioeconomic inequalities related should contribute to the design of specific health and social policies-aimed at tackling cancer mortality and social inequalities in areas of high mortality and/or levels of deprivation.


Assuntos
Neoplasias/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Criança , Pré-Escolar , Neoplasias Colorretais/mortalidade , Feminino , Geografia , Disparidades nos Níveis de Saúde , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/mortalidade , Fatores de Risco , Análise de Pequenas Áreas , Fatores Socioeconômicos , Espanha/epidemiologia , Análise Espacial , Neoplasias Gástricas/mortalidade , Neoplasias da Bexiga Urinária/mortalidade , Adulto Jovem
8.
Int J Clin Oncol ; 25(8): 1459-1474, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32451768

RESUMO

This systematic review and meta-analysis aimed to assess the prognostic value of preoperative hematologic biomarkers in patients with urothelial carcinoma of the bladder treated with radical cystectomy. PUBMED, Web of Science, Cochrane Library, and Scopus databases were searched in September 2019 according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. Studies were deemed eligible if they compared cancer-specific survival in patients with urothelial carcinoma of the bladder with and without pretreatment laboratoryabnormalities. Formal meta-analyses were performed for this outcome. The systematic review identified 36 studies with 23,632 patients, of these, 32 studies with 22,224 patients were eligible for the meta-analysis. Several preoperative hematologic biomarkers were significantly associated with cancer-specific survival as follows: neutrophil - lymphocyte ratio (pooled hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.11-1.29), hemoglobin (pooled HR: 0.87, 95% CI 0.82-0.94), C-reactive protein (pooled HR: 1.44, 95% CI 1.26-1.66), De Ritis ratio (pooled HR: 2.18, 95% CI 1.37-3.48), white blood cell count (pooled HR: 1.05, 95% CI 1.02-1.07), and albumin-globulin ratio (pooled HR: 0.26, 95% CI 0.14-0.48). Several pretreatment laboratory abnormalities in patients with urothelial carcinoma of the bladder were associated with cancer-specific mortality. Therefore, it might be useful to incorporate such hematologic biomarkers into prognostic tools for urothelial carcinoma of the bladder. However, given the study limitations including heterogeneity and retrospective nature of the primary data, the conclusions should be interpreted with caution.


Assuntos
Biomarcadores/sangue , Cistectomia/métodos , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Proteína C-Reativa/análise , Feminino , Humanos , Contagem de Leucócitos , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Neutrófilos/patologia , Contagem de Plaquetas , Período Pré-Operatório , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/sangue
9.
Jpn J Clin Oncol ; 50(9): 1068-1075, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32469066

RESUMO

OBJECTIVES: To identify the prognosis of pure non-urothelial carcinoma (non-UC) of bladder and to compare them with those of pure urothelial carcinoma (UC). METHODS: We used Japan's nationwide hospital-based cancer registry data to extract histologically confirmed pure non-UC and UC cases of bladder diagnosed in 2008-2009. We estimated the 5-year overall survival (OS) by a Kaplan-Meier analysis. RESULTS: A total of 8094 patients with confirmed histological subtypes of bladder cancer were identified. The most common pure non-UC was squamous cell carcinoma (SQ, n = 192, 2.4%) followed by adenocarcinoma (AC, n = 138, 1.7%) and small cell neuroendocrine carcinoma (SmC, n = 54, 0.7%). The proportion of female patients (48%) was significantly higher in the SQ group compared with the pure UC group (P < 0.001). The 5-year OS rate of the non-UC patients was significantly worse than that of the UC patients (40 vs. 61%, P < 0.001). According to stages, the 5-year OS rates of the stage I and III non-UC patients were significantly worse than those of the UC patients (P = 0.001). Considering histologic subtypes and stages, the 5-year OS rates of the stage I SQ patients were worse than those of the AC and SmC patients (46, 68 and 64%, respectively). CONCLUSION: The prognosis of pure non-UC was worse than that of pure UC, especially in the stage I and III non-UC patients. To improve these patients' oncologic outcomes, a more aggressive surgical approach may be necessary in stage I patients with non-UC, especially in pure SQ.


Assuntos
Neoplasias da Bexiga Urinária/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/patologia , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Taxa de Sobrevida , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Adulto Jovem
10.
J Surg Oncol ; 121(8): 1329-1336, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32246846

RESUMO

BACKGROUND AND OBJECTIVES: To investigate other-cause mortality (OCM) rates over time according to several baseline characteristics in bladder cancer (BCa) patients treated with radical cystectomy (RC). METHODS: Within the Surveillance, Epidemiology, and End Results database (1988-2011), we identified 7702 T1-2 N0 M0 urothelial BCa patients treated with RC. Temporal trends and multivariable Cox regression (MCR) analyses assessed 5-year OCM. Data were stratified according to the year of diagnosis (1988-1995 vs 1996-2000 vs 2001-2004 vs 2005-2008 vs 2009-2011), age group (<60 vs 60-75 vs >75 years), sex, race, marital status, and socioeconomic status. RESULTS: Overall, OCM rates decreased from 13.9% in 1988-1995 to 8.6% in 2009-2011. The greatest decrease was recorded in elderly (>75) patients (32%-16%, slope: -0.55% per year; P = .01), followed by patients aged 60 to 75 (21%-5%, slope: -0.35% per year; P = .01), unmarried patients (16%-10%, slope: -0.26% per year; P < .001), male patients (14%-8.9%, slope: -0.23% per year), and African Americans (16%-11%, slope: -0.27% per year; P < .001). MCR models corroborated these results. CONCLUSIONS: Most important decrease in OCM after RC over the last decades was recorded in the elderly, unmarried, and male patients. Nonetheless, these three patient groups still represent ideal targets for efforts aimed at minimizing the morbidity and mortality after RC, as their risk of OCM is higher than in others.


Assuntos
Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Cistectomia/métodos , Cistectomia/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Programa de SEER , Estados Unidos/epidemiologia
11.
Int J Clin Oncol ; 25(7): 1364-1376, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32232691

RESUMO

BACKGROUND: The aim of this study is to establish new risk tables for the current clinical setting, enabling short- and long-term risk stratification for recurrence, progression, and cancer-specific death after transurethral resection in non-muscle invasive bladder cancer (NMIBC). Currently available risk tables lack input from the 2004 World Health Organization grading system and risk prediction for cancer-specific death. METHODS: This was a multi-institutional database study of 1490 patients diagnosed with NMIBC (the development cohort). A multivariate Fine and Gray subdistribution hazard model was used to assess the prognostic impact of various factors. Patients were classified into low-, intermediate-, and high-risk groups according to a sum of the weight of selected factors, and predicted cumulative rates were calculated. Internal validation was conducted using 200 bootstrap resamples to assess the optimism for the c-index and estimate a bias-corrected c-index. External validation of the developed risk table was performed on an independent dataset of 91 patients. RESULTS: The Japanese NIshinihon uro-onCology Extensive collaboration group (J-NICE) risk stratification table was derived from six, five, and two factors for recurrence, progression, and cancer-specific death, respectively. The internal validation bias-corrected c-index values were 0.619, 0.621, and 0.705, respectively. The application of the J-NICE table to an external dataset resulted in c-indices for recurrence, progression, and cancer-specific death of 0.527, 0.691, and 0.603, respectively. CONCLUSIONS: We propose a novel risk stratification model that predicts outcomes of treated NMIBC and may overcome the shortcomings of existing risk models. Further external validation is required to strengthen its clinical impact.


Assuntos
Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Prognóstico , Modelos de Riscos Proporcionais , Reprodutibilidade dos Testes , Fatores de Risco , Neoplasias da Bexiga Urinária/cirurgia , Adulto Jovem
12.
Int J Clin Oncol ; 25(7): 1377-1384, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32318904

RESUMO

BACKGROUND: Radical cystectomy (RC) is the primary treatment strategy for muscle invasive bladder cancer (MIBC). However, it carries a high risk of urethral recurrence (UR) in male patients. The risk factors and oncological outcomes of UR remain unclear. We aimed to identify the risk factors and oncological outcomes of UR in male patients with MIBC after RC combined with urinary diversion. METHODS: After propensity score matching, we evaluated 137 male patients with MIBC who underwent RC combined with urinary diversion at our center between January 1, 2007 and December 31, 2015. Patient demographics, comorbidity, and perioperative data were recorded. Univariate and multivariate Cox proportional hazards regression were used to estimate the hazard ratio and 95% confidence intervals. Cancer-specific survival (CSS) and overall survival (OS) were measured using the Kaplan-Meier curve with log-rank test. P < 0.05 was considered statistically significant. RESULTS: Of the 310 patients, 30 (9.7%) patients underwent UR. In the matched group, the independent risk factors of UR were history of TURB (HR = 3.069, P = 0.018), tumor stage (T3 vs. T2, HR = 3.997, P = 0.014; T4 vs. T2, HR = 2.962, P = 0.015), and tumor multifocality (HR = 2.854, P = 0.011). The CSS and OS of patients with UR were equivalent to the patients without UR (P = 0.295, P = 0.616). CONCLUSION: This propensity score-matched case-control study showed that UR is not rare in male patients with MIBC after RC combined with urinary diversion. We identified three independent risk factors of UR: history of TURB, tumor stage, and tumor mutifocality. The oncological outcomes were equivalent between patients with and without UR. These findings could help improve treatment strategies and follow-up schedules.


Assuntos
Cistectomia/métodos , Neoplasias Uretrais/patologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Idoso , Estudos de Casos e Controles , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores de Risco , Resultado do Tratamento , Neoplasias Uretrais/mortalidade , Neoplasias Uretrais/secundário , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
13.
Medicine (Baltimore) ; 99(13): e19597, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32221080

RESUMO

Nucleobindin 2 (NUCB2) has been reported to play an important role in both tumorigenesis and cancer progression. This study aimed to examine the clinical significance of NUCB2 expression urothelial carcinoma of the bladder (UCB).The expression level of NUCB2 and its correlation with clinicopathological parameters was analyzed in 225 UCB tissues by immunohistochemistry. Kaplan-Meier analysis and Cox proportional hazards regression models were used to investigate the correlation between NUCB2 expression and the prognosis of UCB patients. High NUCB2 expression of UCB patients significantly correlated with aggressive clinicopathological features. Patients with high NUCB2 had shorter overall survival and recurrence-free survival in Kaplan-Meier survival curve (P = .018 and P = .001, respectively).Our results show that high expression of NUCB2 associated with aggressive clinicopathological feature and predicted unfavorable prognosis in patients with UCB might serve as feasible biomarker for clinical outcome of UCB patients after surgery and potential therapeutic target in the future.


Assuntos
Nucleobindinas/biossíntese , Neoplasias da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Neoplasias da Bexiga Urinária/mortalidade
14.
Int J Clin Oncol ; 25(6): 1163-1169, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32125546

RESUMO

BACKGROUND: A previous comparative study in Japan has demonstrated that the two consecutive UroVysion tests are useful tools to detect the presence of bladder cancer during follow-up after transurethral resection, but they also presented their high rates of false-positive results. Here, we aimed to evaluate the relationship between the UroVysion tests and subsequent intravesical recurrence. METHODS: In the previous study, patients without bladder cancer during the first analysis showed the same examination set repeated 3 months later as the second analysis. In this follow-up study, 326 patients showed negative findings confirmed on cystoscopy during the second UroVysion test. Recurrence-free survival was assessed using a median follow-up of 27 months. RESULTS: In the two consecutive UroVysion tests, 214 patients (65.6%) showed negative UroVysion results in both tests, whereas 91 presented a positive result on either tests and 21 patients presented positive results in both tests. During the follow-up, 40 patients (12.3%) had an intravesical recurrence with non-muscle-invasive bladder cancer. The recurrence rates in patients with negative results in both tests, those with one positive result in either tests, and those with positive results in both tests were 8.4%, 16.5%, and 33.3%, respectively. The multivariate analysis indicated that the history of bladder cancer and the consecutive UroVysion test pattern were independent risk factors for recurrence. CONCLUSIONS: Our data confirmed the effectiveness of two consecutive UroVysion tests in predicting intravesical recurrence after TURBT. Further prospective studies would help determine an appropriate interval for cystoscopy follow-up.


Assuntos
Hibridização in Situ Fluorescente/métodos , Recidiva Local de Neoplasia/diagnóstico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistectomia , Cistoscopia , Feminino , Seguimentos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estudos Prospectivos , Neoplasias da Bexiga Urinária/mortalidade
15.
Actas urol. esp ; 44(2): 94-102, mar. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192842

RESUMO

INTRODUCCIÓN: El papel de la quimioterapia adyuvante (QTAdy) en el tumor vesical músculo-invasivo sigue siendo controvertido actualmente. OBJETIVO: Evaluar el efecto de la QTAdy en la supervivencia cáncer específica del tumor vesical músculo-invasivo tras cistectomía radical (CR). MATERIAL Y MÉTODOS: Análisis retrospectivo de 292 pacientes diagnosticados de tumor vesical urotelial tratados con CR entre 1986-2009 con estadio pT3-4pN0/+cM0, divididas en dos cohortes:185(63,4%) pacientes tratados con QTAdy y otra con 107(36,6%) sin QTAdy. Mediana de seguimiento de 40,5 meses (IQR 55-80,5). Análisis comparativo con test Chi cuadrado y t Student/ANOVA. Cálculo de supervivencia con el método de Kaplan-Meier y test de long-rank. Análisis multivariante (regresión de Cox) para identificar variables predictoras independientes de mortalidad cáncer específica (MCE). RESULTADOS: El 42,8% de la serie presentó afectación ganglionar tras CR. Al finalizar el seguimiento, 22,9% estaban libres de tumor vesical y 54,8% habían fallecido por esa causa. La mediana de supervivencia cáncer específica fue de 30 meses. No se observaron diferencias significativas en supervivencia cáncer específica en función del tratamiento con QTAdy en pacientes pT3pN0 (p = 0,25) ni pT4pN0 (p = 0,29), pero sí en pT3-4pN+ (p = 0,001). En el análisis multivariante se identificaron el estadio patológico (p = 0,0001) y el tratamiento con QTAdy (p = 0,007) como factores pronósticos independientes de MCE. La QTAdy redujo el riesgo de MCE (HR:0,59, IC95% 0,40-0,87, p = 0,007). CONCLUSIONES: El estadio pT y pN se identificaron como variables predictoras independientes de MCE tras CR. La administración de QTAdy en nuestra serie se comportó como factor protector reduciendo el riesgo de MCE, aunque en el análisis por estadios, únicamente los pacientes pN+ se vieron beneficiados


INTRODUCTION: Currently, the role of adjuvant chemotherapy (ADJ) in muscle invasive bladder tumor remains controversial. OBJECTIVE:To evaluate the effect of ADJ on cancer specific survival of muscle invasive bladder tumor after radical cystectomy (RC). MATERIAL AND METHODS: Retrospective analysis of 292 patients diagnosed with urothelial bladder tumor pT3-4pN0 / + cM0 stage, treated with RC between 1986-2009. Total cohort was divided in two groups: 185 (63.4%) patients treated with ADJ and 107 (36.6%) without ADJ. Median follow-up was 40.5 months (IQR 55-80.5).comparative analysis was performed with Chi-square test and Student's t test /ANOVA. Survival analysis was carried out with the Kaplan-Meier method and log-rank test. Multivariate analysis (Cox regression) was made to identify independent predictors of cancer-specific mortality (CSM). RESULTS: 42.8% of the series presented lymph node involvement after RC. At the end of follow-up, 22.9% were BC-free and 54.8% had died due to this cause. The median cancer specific survival was 30 months. No significant differences were observed in cancer specific survival regarding the treatment with ADJ in pT3pN0 (p = .25) or pT4pN0 (p = .29) patients, but it was significant in pT3-4pN+ (p = .001). Multivariate analysis showed pathological stage (p = .0001) and treatment with ADJ (p = .007) as independent prognostic factors for CSM. ADJ reduced the risk of CSM (HR:0.59,95% CI 0.40-0.87, p = .007). CONCLUSIONS: pT and pN stages were identified as independent predictors of CSM after RC. The administration of ADJ in our series behaved as a protective factor reducing the risk of CSM, although only pN+ patients were benefited in the stage análisis


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Carcinoma de Células de Transição/tratamento farmacológico , Carcinoma de Células de Transição/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/cirurgia , Carcinoma de Células de Transição/mortalidade , Neoplasias da Bexiga Urinária/mortalidade , Estudos Retrospectivos , Estadiamento de Neoplasias , Estimativa de Kaplan-Meier , Quimioterapia Adjuvante , Cistectomia , Prognóstico
16.
Int Braz J Urol ; 46(2): 224-233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022511

RESUMO

INTRODUCTION: Considering the lack of data on BC trends in Brazilian population, mainly as a result of the difficulty on gathering data, the present manuscript provides an overview of bladder cancer incidence, hospitalization, mortality patterns and trends using the Brazilian Data Center for The Public Health System (DATASUS). MATERIALS AND METHODS: All hospital admissions associated with BC diagnosis (ICD-10 C67) between 2008 and 2017 were analyzed. Distributions according to year, gender, age group, ethnicity, death, length of hospital stay, and costs were evaluated. Demographic data was obtained from the last Brazilian national census. RESULTS: From 2008 to 2017 there were 119,058 public hospital admissions related to BC. Patients were mostly white males aged 60 to 79 years-old. Mortality rates for patients who have undergone surgery was 6.75% on average, being 7.38% for women and 6.49% for men. Mortality rates were higher when open surgeries were performed compared to endoscopic procedures (4.98% vs 1.18%). Considering only endoscopic procedures, mortality rates were three times higher after urgent surgeries compared to elective ones (2.6% vs 0.6%). Over the years the cystectomy/transurethral bladder resection (C/T) ratio significantly decreased in all Brazilian Regions. In 2008, the C/T ratio was 0.19, while in 2017 it reduced to 0.08. CONCLUSIONS: Despite BC relatively low incidence, it still represents a significant social economic burden in Brazil, as it presents with recurrent episodes that might require multiple hospitalizations and surgical treatment. The set of data collected might suggest that population access to health care has improved between 2008-2017.


Assuntos
Neoplasias da Bexiga Urinária/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Setor Público/estatística & dados numéricos , Fatores Socioeconômicos
17.
J Robot Surg ; 14(5): 703-708, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32002803

RESUMO

The objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient's demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1-2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, ≥ pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery.


Assuntos
Cistectomia/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Brasil , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
18.
J Urol ; 204(2): 215-223, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32003614

RESUMO

PURPOSE: The clinicopathological features and treatment outcomes of plasmacytoid variant-urothelial carcinoma of the bladder have not been fully understood. We evaluated the clinicopathological characteristics and survival outcomes of plasmacytoid variant-urothelial carcinoma of the bladder compared to conventional urothelial carcinoma of the bladder. MATERIALS AND METHODS: A systematic review was performed following the PRISMA guideline. PubMed®/MEDLINE®, Embase® and Cochrane Library were searched up to June 2019. The differences in the clinicopathological features (stage pT3 or greater, lymph node metastasis, ureteral margin positive and perivesical soft tissue margin positive status) and survival outcomes (overall mortality and cancer specific mortality) between plasmacytoid variant-urothelial carcinoma of the bladder and conventional urothelial carcinoma of the bladder were compared. The GRADE approach was used for rating the certainty of evidence. RESULTS: Eight studies were included. Patients with plasmacytoid variant-urothelial carcinoma of the bladder had a higher frequency of stage pT3 or greater (OR 3.84, 95% CI 1.63-9.03, p=0.002) and risk of lymph node metastasis (OR 2.58, 95% CI 1.15-5.76, p=0.02), ureteral margin positive (OR 12.18, 95% CI 4.62-32.13, p <0.00001) and perivesical soft tissue margin positive (OR 12.31, 95% CI 5.15-29.41, p <0.00001) status after radical cystectomy than those with conventional urothelial carcinoma of the bladder. Although there was no difference in cancer specific mortality (HR 1.40, 95% CI 0.82-2.40, p=0.22) between plasmacytoid variant-urothelial carcinoma of the bladder and conventional urothelial carcinoma of the bladder, plasmacytoid variant-urothelial carcinoma of the bladder had worse survival outcomes (overall mortality) than conventional urothelial carcinoma of the bladder approaching the borderline of significance (HR 1.62, 95% CI 0.98-2.68, p=0.06) when adjusted for other clinicopathological characteristics. CONCLUSIONS: Plasmacytoid variant-urothelial carcinoma of the bladder was strongly associated with adverse clinicopathological features and worse overall mortality compared to conventional urothelial carcinoma of the bladder after adjusting for other clinicopathological parameters, and plasmacytoid variant histology of urothelial carcinoma of the bladder is an independent prognostic factor for overall survival.


Assuntos
Carcinoma de Células de Transição/mortalidade , Carcinoma de Células de Transição/patologia , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia , Humanos , Taxa de Sobrevida
19.
Oncology ; 98(3): 161-167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31962315

RESUMO

BACKGROUND: The effect of anesthetic techniques on cancer recurrence has been the subject of intensive research in the past years, as it affects a large proportion of the population. The use of opioids and halogenated agents in cancer patients during the perioperative period may be related to higher rates of cancer recurrence and reduced disease-free survival. METHODS: This was a prospective study. The sample was composed of 100 patients who underwent a radical cystectomy for infiltrating bladder cancer in a reference center. We compared disease-free survival associated with combined anesthesia versus opiate-based analgesia. The relationship between the administered hypnotic and disease-free survival was also investigated. RESULTS: The median disease-free survival of the patients who received combined anesthesia was 585 (240-1,005) days versus 210 (90-645) days in the other group. A significant difference was observed between the two groups (p = 0.01). Combined analysis of all groups revealed significant differences in disease-free survival between patients who received combined anesthesia with propofol (510 [315-1,545] disease-free days) and those who received sevoflurane and opioids (150 [90-450] disease-free days) (p = 0.02). CONCLUSIONS: Anesthesia may play a crucial role in tumor relapse, as it is administered at the moment of the greatest risk of dissemination: surgical handling of the tumor. Opioids and volatile agents have been related to an increased risk for cancer recurrence. We compared the use of propofol + local anesthesia versus sevoflurane + opioids and also found that disease-free survival was longer among patients who received propofol + local anesthesia. Disease-free survival increases with the use of propofol in combination with epidural anesthesia in patients who undergo surgery for infiltrating bladder cancer.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia por Inalação , Anestesia Intravenosa , Anestésicos Intravenosos/administração & dosagem , Cistectomia , Propofol/administração & dosagem , Neoplasias da Bexiga Urinária/cirurgia , Analgésicos Opioides/efeitos adversos , Anestesia por Inalação/efeitos adversos , Anestesia por Inalação/mortalidade , Anestesia Intravenosa/efeitos adversos , Anestesia Intravenosa/mortalidade , Anestésicos Intravenosos/efeitos adversos , Cistectomia/efeitos adversos , Cistectomia/mortalidade , Intervalo Livre de Doença , Humanos , Metástase Neoplásica , Recidiva Local de Neoplasia , Propofol/efeitos adversos , Estudos Prospectivos , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de Tempo , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/patologia
20.
PLoS One ; 15(1): e0227568, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929567

RESUMO

BACKGROUND: Increasing evidence has suggested that multiple long non-coding RNAs (lncRNAs) act key regulatory functions in the pathogenesis of bladder cancer. This study aimed to determine the expression and clinical significance of lncRNA ROR1 antisense RNA 1 (ROR1-AS1) from patients with bladder cancer, and to explore the potential role and mechanism underlying ROR1-AS1-related cancer progression. METHODS: Real time quantitative PCR (RT-qPCR) was conducted to detected the expression levels of ROR1-AS1 and miR-504 in bladder cancer samples and cell lines. Chi-square test was used for correlation analysis. 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide (MTT) and wound scratch assays were applied to assesses the effects of ROR1-AS1 overexpression and knockdown on bladder cancer cell growth and migration in vitro, respectively. The prognosis of bladder cancer patients was evaluated by survival curves with Kaplan-Meier method. The regulatory mechanism of ROR1-AS1 on miR-504 was confirmed by bioinformatics analysis and luciferase reporter gene assay. RESULTS: ROR1-AS1 levels were obviously upregulated in bladder cancer tissues than matched normal bladder tissues. High expression of ROR1-AS1 was remarkably correlated with higher histological grade, advanced tumor stage, and positive lymph node metastasis. High ROR1-AS1 expression was markedly correlated with shorter overall survival of bladder cancer patients. Moreover, knockdown of ROR1-AS1 notably repressed T24 and 5637 cell growth and migration. ROR1-AS1 directly bound with miR-504 and act as a molecular sponge to decrease miR-504 expression. Silencing of miR-504 partly abrogated ROR1-AS1 knockdown-induced inhibitory effects on bladder cancer cell growth and migration. CONCLUSIONS: Our data demonstrated that increased ROR1-AS1 promotes cell growth and migration of bladder cancer via regulation of miR-504, indicating ROR1-AS1 may be used as a prognostic biomarker and therapeutic target for bladder cancer.


Assuntos
MicroRNAs/metabolismo , RNA Longo não Codificante/metabolismo , Neoplasias da Bexiga Urinária/patologia , Antagomirs/metabolismo , Sequência de Bases , Linhagem Celular Tumoral , Movimento Celular , Proliferação de Células , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , MicroRNAs/antagonistas & inibidores , MicroRNAs/genética , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Interferência de RNA , RNA Longo não Codificante/antagonistas & inibidores , RNA Longo não Codificante/genética , RNA Interferente Pequeno/metabolismo , Alinhamento de Sequência , Regulação para Cima , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/mortalidade
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