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1.
Arch Esp Urol ; 73(2): 132-139, 2020 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32124844

RESUMO

OBJECTIVES:  The aim of this study was to evaluate relationship between preoperative Prognostic Nutritional Index (PNI) values and tumor stage and to identify predictive value of PNI in patients with primary bladder cancer (BC). METHODS:  A total of 164 patients with primary bladder cancer were retrospectively analyzed using institutional bladder cancer database between January 2008 and January 2018. The PNI was calculated using preoperative blood sample results. According to pathological results, the patients were divided into groups as pTa (n=94), pT1 (n=54), and pT2 (n=16) and further into subgroups as Group 1 (pTa patients, n=94) and Group2 (pT1 + pT2 patients, n=70). Subgroups were compared statistically in terms of PNI values and independent risk factors were evaluated using Backward Step wise multivariate logistic regression analysis. RESULTS:  Of patients, 145 (88.4%) were males and 19 (11.6%) were females with a mean age of 66.46±10.57 (range, 36 to 93) years. Mean total peripheral lymphocyte count was 2.11±0.71 (×109/L), mean serum albumin was 4.11±0.53 (gr/dL), and mean PNI score was 51.66±6.36. There was a statistically significant difference in serum albumin levels and PNI scores according to tumor stages (p=0.008 and p=0.003, respectively). There was a statistically significant difference in mean serum total protein, albumin, and PNI scores (p<0.01, for all). Tumor size, tumor grade, PNI, carcinoma in situ,and atypical variant status were independent risk factors for predicting tumor stage. CONCLUSIONS:  Our study results demonstrate that PNI is a potential preoperative predictor of tumor stage and is an independent risk factor for predicting tumor stage in patients with primary bladder cancer. Lower PNI levels are associated with high stage disease.


Assuntos
Avaliação Nutricional , Estado Nutricional , Neoplasias da Bexiga Urinária , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/terapia
2.
Urology ; 137: 173-177, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31945380

RESUMO

Rhabdomyosarcoma is the most common sarcoma diagnosed in childhood and adolescence, arising from the bladder/prostate in only 5%-10% of cases. Treatment-induced cytodifferention of tumor cells into mature rhabdomyoblasts has been reported following chemoradiation and is thought to suggest a more favorable outcome. We report a case of embryonal rhabdomyosarcoma of the bladder/prostate that exhibited extensive cytodifferentiation with downregulation of myogenin and MyoD1 gene expression in rhabdomyoblasts following treatment with chemoradiation therapy. The downregulation of myogenin and MyoD1 expression in rhabdomyoblasts following chemoradiation treatment has not previously been described in the literature and its significant remains uncertain.


Assuntos
Diferenciação Celular , Quimiorradioterapia , Proteína MyoD/genética , Miogenina/genética , Neoplasias da Próstata , Rabdomiossarcoma Embrionário , Neoplasias da Bexiga Urinária , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Biópsia/métodos , Diferenciação Celular/efeitos dos fármacos , Diferenciação Celular/efeitos da radiação , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/métodos , Diagnóstico Diferencial , Regulação para Baixo , Expressão Gênica , Humanos , Imuno-Histoquímica , Lactente , Masculino , Proteína MyoD/análise , Miogenina/análise , Seleção de Pacientes , Prognóstico , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Rabdomiossarcoma Embrionário/diagnóstico por imagem , Rabdomiossarcoma Embrionário/genética , Rabdomiossarcoma Embrionário/patologia , Rabdomiossarcoma Embrionário/terapia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia
3.
Nat Rev Urol ; 17(2): 77-106, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31953517

RESUMO

Bladder cancer - the tenth most frequent cancer worldwide - has a heterogeneous natural history and clinical behaviour. The predominant histological subtype, urothelial bladder carcinoma, is characterized by high recurrence rates, progression and both primary and acquired resistance to platinum-based therapy, which impose a considerable economic burden on health-care systems and have substantial effects on the quality of life and the overall outcomes of patients with bladder cancer. The incidence of urothelial tumours is increasing owing to population growth and ageing, so novel therapeutic options are vital. Based on work by The Cancer Genome Atlas project, which has identified targetable vulnerabilities in bladder cancer, immune checkpoint inhibitors (ICIs) have arisen as an effective alternative for managing advanced disease. However, although ICIs have shown durable responses in a subset of patients with bladder cancer, the overall response rate is only ~15-25%, which increases the demand for biomarkers of response and therapeutic strategies that can overcome resistance to ICIs. In ICI non-responders, cancer cells use effective mechanisms to evade immune cell antitumour activity; the overlapping Warburg effect machinery of cancer and immune cells is a putative determinant of the immunosuppressive phenotype in bladder cancer. This energetic interplay between tumour and immune cells leads to metabolic competition in the tumour ecosystem, limiting nutrient availability and leading to microenvironmental acidosis, which hinders immune cell function. Thus, molecular hallmarks of cancer cell metabolism are potential therapeutic targets, not only to eliminate malignant cells but also to boost the efficacy of immunotherapy. In this sense, integrating the targeting of tumour metabolism into immunotherapy design seems a rational approach to improve the therapeutic efficacy of ICIs.


Assuntos
Carcinoma de Células de Transição/metabolismo , Carcinoma de Células de Transição/terapia , Glucose/metabolismo , Imunoterapia/métodos , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/terapia , Pontos de Checagem do Ciclo Celular , Humanos , Linfócitos T/metabolismo , Neoplasias da Bexiga Urinária/imunologia
4.
Urology ; 136: 9-18, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31770548

RESUMO

For prostate cancer, we review racial differences in incidence, androgen pathways, growth factors, tumor location, rate of definitive treatment, and outcomes. We review the effect of race on risk-stratification and discuss studies of active surveillance in the African American population. For bladder cancer, race- and gender- associated differences in incidence, sex hormone pathways. For renal cell carcinoma, disparities in incidence, genetic factors, tumor pathology, time to presentation, and disease specific survival have been observed. We evaluate the impact of race and ethnicity on tumor pathology and discuss gaps in our current understanding of renal cell carcinoma pathogenesis.


Assuntos
Carcinoma de Células Renais/terapia , Disparidades em Assistência à Saúde , Neoplasias Renais/terapia , Neoplasias da Próstata/terapia , Neoplasias da Bexiga Urinária/terapia , Feminino , Humanos , Masculino
6.
Int J Cancer ; 146(2): 542-552, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31584197

RESUMO

Our previous researches have identified immunoevasive subtype muscle-invasive bladder cancer (MIBC) characterized with immune cells infiltration patterns. Our study explored the clinical significance, immunoregulatory role and therapeutic value of intratumoral IL22-producing cells in MIBC. Two hundred and fifty-nine formalin-fixed paraffin-embedded MIBC samples and 83 freshly resected MIBC tissues and 391 TCGA MIBC samples were retrospectively evaluated. Immunohistochemistry and flow cytometry were applied to identify immune cell infiltration and functional status. In vitro intervention studies were to test the therapeutic and predictive potential of IL22+ cells. Our data revealed patients with high IL22+ cells infiltration suffered poor overall survival and recurrence-free survival in both training and validation cohorts. Only pT2 patients of combined cohort with low IL22+ cells infiltration gained survival benefits from adjuvant chemotherapy (ACT) significantly. Besides, immune contexture featured with increased pro-tumor cells and immunosuppressive cytokines was identified in patients with high IL22+ cells density. The expression pattern of exhausted and effector markers in CD8+ T cells from high IL22+ cells subgroup indicated their dysfunctional status. Importantly, nivolumab showed tumor-killing efficacy in tumors with high IL22+ cells infiltration, and immunosuppressive contexture with CD8+ T cells exhaustion was abrogated in tumors treated with anti-IL22 antibody. In summary, IL22+ cells infiltration determined immunosuppressive contexture with CD8+ T cell dysfunction. Tumor-infiltrating IL22+ cells could be used as an independent marker to predict prognosis and ACT responses. IL22+ cells infiltration possessed the potential to be a favorable predictor for nivolumab application and IL22 blockade could be a novel therapeutic strategy in MIBC.


Assuntos
Antineoplásicos Imunológicos/farmacologia , Interleucinas/metabolismo , Nivolumabe/farmacologia , Evasão Tumoral/efeitos dos fármacos , Neoplasias da Bexiga Urinária/terapia , Idoso , Antineoplásicos Imunológicos/uso terapêutico , Linfócitos T CD8-Positivos/imunologia , Quimioterapia Adjuvante/métodos , Cistectomia , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Interleucinas/imunologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/imunologia , Invasividade Neoplásica/patologia , Nivolumabe/uso terapêutico , Prognóstico , Estudos Retrospectivos , Evasão Tumoral/imunologia , Bexiga Urinária/citologia , Bexiga Urinária/imunologia , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologia
7.
Urol Clin North Am ; 47(1): 93-101, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757304

RESUMO

Non-muscle-invasive bladder cancer is a challenging disease to treat, with few effective salvage intravesical options available for patients who develop bacillus Calmette-Guerin-unresponsive disease. Although radical cystectomy with pelvic lymphadenectomy remains the gold standard treatment for these patients, there remains an unmet need for other options for those who are unable or unwilling to undergo surgery. To this end, intravesical gene therapy is emerging as a potential alternative with promising early data and ongoing efforts to better understand the mechanisms of action to optimize therapy.


Assuntos
Terapia Genética/métodos , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Humanos
8.
Urol Clin North Am ; 47(1): 103-110, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757293

RESUMO

This article provides a comprehensive review of the available data for immunotherapy being used as a salvage treatment in non-muscle-invasive bladder cancer. The literature demonstrates that the immune system has an important role in bladder cancer progression. Initial results from studies using checkpoint inhibitors, recombinant interferon-α2b protein, and oncolytic adenoviruses have shown promising responses with acceptable toxicities. However, the majority of the current data arises from small trials with limited follow-up. There are currently several ongoing studies in this setting, which we await completion, to increase our understanding of immunotherapy as a salvage treatment in non-muscle-invasive bladder cancer.


Assuntos
Imunidade Inata , Fatores Imunológicos/administração & dosagem , Imunoterapia/métodos , Terapia de Salvação/métodos , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Progressão da Doença , Humanos , Invasividade Neoplásica , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologia
9.
Urol Clin North Am ; 47(1): 111-118, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757294

RESUMO

Due to significant risks of cancer recurrence and progression, and limited options after intravesical Bacillus Calmette Guerin (BCG) therapy, there is a critical unmet need to identify novel treatments for those patients with BCG-unresponsive bladder cancer. There is active investigation of immunotherapies which provide both biologic and clinical rationales for indoleamine-2,3- dioxygenase inhibitors in salvage therapy for non-muscle invasive bladder cancer.


Assuntos
Acetamidas/administração & dosagem , Indolamina-Pirrol 2,3,-Dioxigenase/antagonistas & inibidores , Oximas/administração & dosagem , Quinolinas/administração & dosagem , Terapia de Salvação/métodos , Sulfonamidas/administração & dosagem , Triptofano/análogos & derivados , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Inibidores Enzimáticos/administração & dosagem , Humanos , Invasividade Neoplásica , Resultado do Tratamento , Triptofano/administração & dosagem , Triptofano Oxigenase , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologia
10.
Urol Clin North Am ; 47(1): 15-21, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757296

RESUMO

Disease progression and recurrence are common among patients on Bacillus Calmette-Guérin (BCG) therapy, and options for bladder-preserving subsequent therapy remain limited. Ongoing efforts to develop better second-line bladder-sparing therapies rely on clinical trials of patients deemed to have failed management with BCG. This article describes historical definitions of BCG failure, as well as recent efforts to better delineate and refine the clinical criteria for identifying individual patients who will not benefit from further intravesical BCG therapy. It also reviews guidance from the most recent expert consensus panels and professional association guidelines regarding which patients should not receive additional BCG therapy.


Assuntos
Vacina BCG/administração & dosagem , Seleção de Pacientes , Terapia de Salvação/métodos , Neoplasias da Bexiga Urinária/terapia , Adjuvantes Imunológicos/administração & dosagem , Administração Intravesical , Progressão da Doença , Humanos , Invasividade Neoplásica , Falha de Tratamento , Neoplasias da Bexiga Urinária/patologia
11.
Urol Clin North Am ; 47(1): 5-13, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757300

RESUMO

The best predictors of response to intravesical immunotherapy are tumor grade and stage, tumor recurrence pattern, nomograms, panels of urinary cytokines, and fluorescent in situ hybridization patterns of urine cytology examinations. Future investigations on predictors of Bacillus Calmette-Guérin efficacy are needed to better select those patients who will really benefit from a conservative treatment. Hardly any of the proposed nomograms were designed to precisely predict the outcome of Bacillus Calmette-Guérin immunotherapy. A new nomogram for NMIBC recurrence and progression based on all non-muscle-invasive bladder cancer subgroups would include factors already proven in cancer prognosis and prediction.


Assuntos
Vacina BCG/administração & dosagem , Imunoterapia/métodos , Terapia de Salvação/métodos , Neoplasias da Bexiga Urinária/terapia , Adjuvantes Imunológicos/administração & dosagem , Administração Intravesical , Progressão da Doença , Humanos , Invasividade Neoplásica , Nomogramas , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
12.
Urol Clin North Am ; 47(1): 55-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757301

RESUMO

Non-muscle-invasive bladder cancer can be a challenging disease to manage. In recent years, hyperthermia therapy in conjunction with intravesical therapy has been gaining traction as a treatment option for bladder cancer, especially if Bacillus Calmette-Guerin might not be available. Trials of intravesical chemotherapy with heat are few and there has been considerable heterogeneity between studies. However, multiple new trials have accrued and high-quality data are forthcoming. In this review, we discuss the role of combined intravesical hyperthermia and chemotherapy as a novel approach for the treatment of bladder cancer.


Assuntos
Hipertermia Induzida/métodos , Mitomicina/administração & dosagem , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Antibióticos Antineoplásicos/administração & dosagem , Humanos , Resultado do Tratamento
13.
Hinyokika Kiyo ; 65(9): 377-380, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31697880

RESUMO

Pleomorphic giant cell carcinoma of the bladder is a highly malignant subtype and its prognosis is very poor. Among 22 previously reported cases, 14 cases were diagnosed as muscle-invasive tumors and the 10 patients died within 1.5 years after the initial diagnosis. We herein report a long-surviving patient with cT3bN2M0 pleomorphic giant cell carcinoma of the bladder without recurrence. A 73-year-old man presented with macroscopic hematuria and cystoscopy revealed a papillary nodular tumor 45 millimeters in diameter at the right bladder wall. Bilateral external iliac lymph node metastases were found on computed tomography (CT) and magnetic resonance imaging (MRI). The histopathological diagnosis of the transurethral resection specimen was pleomorphic giant cell urothelial carcinoma, high-grade, G3, pT2 or higher. The pleomorphic giant cells were composed of large epithelioid cells with single or multiple bizarre nuclei. The patient underwent 2 cycles of neoadjuvant chemotherapy using gemcitabine and cisplatin. Follow-up CT and MRI revealed disappearance of iliac lymph node matastases. Laparoscopic radical cystectomy and lymphadenectomy were performed. The histopathological diagnosis was pleomorphic giant cell urothelial carcinoma, ypT3aN0M0, RM0. Giant cells were found in 70% of the tumor. No recurrence has been found for 4 years after surgery. If neoadjuvant chemotherapy is effective, long-term survival without recurrence may be possible after radical cystectomy even in cases of muscle-invasive or N2 pleomorphic giant cell carcinoma of the bladder.


Assuntos
Carcinoma de Células Gigantes , Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Idoso , Carcinoma de Células Gigantes/terapia , Cistectomia , Humanos , Masculino , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária/terapia
14.
Medicine (Baltimore) ; 98(44): e17437, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689748

RESUMO

This study aimed to investigate the effect of a patient education and rehabilitation program (PERP) on anxiety, depression, and quality of life in muscle invasive bladder cancer (MIBC) patients underwent adjuvant chemotherapy.One hundred and thirty MIBC patients about to receive adjuvant chemotherapy with 4-cycle gemcitabine and cisplatin (GC) regimen (16 weeks) were consecutively enrolled and randomly allocated into PERP group and control group as 1:1 ratio. Hospital Anxiety and Depression Scale (HADS) anxiety and depression scores and Quality of Life Questionnaire (QLQ-C30) scores were assessed before treatment (W0) and after treatment (W16).After 16-week treatment, PERP group exhibited decreased HADS anxiety score (P = .036), ΔHADS anxiety score (W16-W0) (P < .001) and percentage of anxiety patients (P = .019) compared to control group. And PERP group presented with numerically reduced HADS depression score but without statistical significance (P = .076) compared to control group, while lower ΔHADS depression score (W16-W0) (P = .014) and percentage of depression patients (P = .015) compared to control group. As to quality of life, QLQ-C30 global health status score (P = .032), Δglobal health status score (W16-W0) (P = .003) and Δfunctional score (W16-W0) (P = .005) were higher in PERP group compared to control group. However, no difference of QLQ-C30 functional score (P = .103), QLQ-C30 symptom score (P = .808) or Δsymptom score (W16-W0) (P = .680) was observed between two groups.PERP relieves anxiety, depression and improves quality of life in MIBC patients underwent adjuvant chemotherapy.


Assuntos
Ansiedade/terapia , Depressão/terapia , Educação de Pacientes como Assunto/métodos , Qualidade de Vida , Neoplasias da Bexiga Urinária/psicologia , Neoplasias da Bexiga Urinária/terapia , Adulto , Fatores Etários , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Índice de Massa Corporal , Quimioterapia Adjuvante/métodos , Quimioterapia Adjuvante/psicologia , China , Comorbidade , Feminino , Comportamentos Relacionados com a Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Fatores Socioeconômicos
15.
Cancer Immunol Immunother ; 68(12): 2067-2080, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31720813

RESUMO

PURPOSE: Tumor-associated macrophages (TAMs) exist as heterogeneous subsets and have dichotomous roles in cancer-immune evasion. This study aims to assess the clinical effects of Galectin-9+ tumor-associated macrophages (Gal-9+TAMs) in muscle-invasive bladder cancer (MIBC). EXPERIMENTAL DESIGN: We identified Gal-9+TAMs by immunohistochemistry (IHC) analysis of a tumor microarray (TMA) (n = 141) from the Zhongshan Hospital and by flow cytometric analysis of tumor specimens (n = 20) from the Shanghai Cancer Center. The survival benefit of platinum-based chemotherapy in this subpopulation was evaluated. The effect of the tumor-immune microenvironment with different percentages of Gal-9+TAMs was explored. RESULTS: The frequency of Gal-9+TAMs increased with tumor stage and grade. Gal-9+TAMs predicted poor overall survival (OS) and recurrence-free survival (RFS) and were better than Gal-9-TAMs and TAMs to discriminate prognostic groups. In univariate and multivariate Cox regression analyses, patients with high percentages of Gal-9+TAMs showed the prominent survival benefit after receiving adjuvant chemotherapy (ACT). High Gal-9+TAM infiltration correlated with increasing numbers of regulatory T cells (Tregs) and mast cells and decreasing numbers of CD8+T and dendritic cells (DCs). Dense infiltration of Gal-9+TAMs was related to reduced cytotoxic molecules, enhanced immune checkpoints or immunosuppressive cytokines expressed by immune cells, as well as active proliferation of tumor cells. Additionally, the subpopulation accumulated was strongly associated with PD-1+TIM-3+CD8+T cells. CONCLUSIONS: Gal-9+TAMs predicted OS and RFS and response to ACT in MIBC patients. High Gal-9+TAMs were associated with a pro-tumor immune contexture concomitant with T cell exhaustion.


Assuntos
Galectinas/metabolismo , Macrófagos/imunologia , Músculos/patologia , Linfócitos T Reguladores/imunologia , Neoplasias da Bexiga Urinária/terapia , Adulto , Biomarcadores Farmacológicos , Movimento Celular , Quimioterapia Adjuvante , Feminino , Humanos , Masculino , Análise em Microsséries , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Análise de Sobrevida , Evasão Tumoral , Microambiente Tumoral , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/mortalidade
16.
Curr Urol Rep ; 20(12): 82, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31781871

RESUMO

PURPOSE OF REVIEW: Local tumor staging is paramount in the evaluation and management of bladder cancer. While neoadjuvant chemotherapy (NAC) followed by radical cystectomy and urinary diversion remains the gold standard for management of muscle-invasive bladder cancer, bladder-sparing regimens involving systemic chemotherapy and pelvic radiotherapy remain a viable option for select patients. Moreover, pre-cystectomy identification of patients with a complete response to NAC may obviate the need for radical cystectomy, but accurate post-therapy staging can be difficult to achieve. Contemporary imaging techniques may provide additional benefit in local tumor staging beyond standard imaging and cystoscopic biopsy. Our purpose is to summarize the ability of different imaging modalities to accurately stage bladder cancer patients in the treatment-naïve and post-chemotherapy settings. RECENT FINDINGS: Contemporary investigations have been studying multiparametric magnetic resonance imaging (mp-MRI) in the evaluation of bladder cancer. Its recent incorporation into bladder cancer staging is mainly being assessed in treatment-naïve patients; however, different sequences are being studied to assess their accuracy after the introduction of chemotherapy and possibly radiation. Multiple recent studies incorporating cystoscopy and biopsy are proving to be less accurate than originally predicted. Imaging has generally had a very limited role in guiding therapy in localized bladder cancer, but with the incorporation of newer sequences and techniques, imaging is poised to become vital in decision-making strategies of this cancer. Reliable local tumor staging through improved imaging may help better select patients for bladder-sparing treatments while maintaining optimized oncologic outcomes and allow this paradigm to become more acceptable in the urologic oncology community.


Assuntos
Neoplasias da Bexiga Urinária/diagnóstico por imagem , Cistoscopia , Humanos , Imagem por Ressonância Magnética , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X/métodos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/terapia
17.
Curr Urol Rep ; 20(12): 84, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31781942

RESUMO

PURPOSE OF REVIEW: BCG is the gold standard agent used in high-risk non-muscle-invasive bladder cancer (NMIBC) that is amenable to bladder sparing management. However, recent BCG shortages appear to be a chronic problem. There are limited effective intravesical options in lieu of BCG or in patients in whom BCG is not effective. This review aims to highlight emerging bladder sparing therapies and trials for NMIBC. RECENT FINDINGS: Patients with high-risk NMIBC who do not respond to BCG are at increased risk for progression and death from bladder cancer. There are a variety of clinical trials exploring different therapeutic approaches including checkpoint inhibition, novel chemotherapy and drug delivery, viral and gene therapy, vaccines, and targeted therapy. In the era of limited supply of BCG, there is a need for both effective first-line alternatives as and options for patients who do not respond to BCG. Fortunately, there are a variety of active trials and mechanisms exploring these areas aggressively.


Assuntos
Vacina BCG/provisão & distribução , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Vacina BCG/administração & dosagem , Vacinas Anticâncer/uso terapêutico , Pontos de Checagem do Ciclo Celular/efeitos dos fármacos , Ensaios Clínicos como Assunto , Progressão da Doença , Terapia Genética , Humanos , Imunoterapia/métodos , Terapia Viral Oncolítica , Neoplasias da Bexiga Urinária/patologia
18.
Curr Urol Rep ; 20(12): 79, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31781979

RESUMO

PURPOSE OF REVIEW: Bladder cancer is a deadly and common malignancy, with 24% of new cases presenting as T1 disease. High-grade T1 in particular represents a difficult entity to treat due to its clinical variability and known risks of recurrence, progression, and cancer-specific mortality. The differences in guidelines from major urologic organizations underscore this variability, and the past year has seen another BCG shortage, further complicating management. Advances have been made in the molecular and genomic characterization of high-grade T1, and new clinical trials are available to investigate alternative therapies. In this review, we summarize the variations in guidelines, alternatives to BCG, emerging molecular and genomic discoveries, and recent clinical trials. RECENT FINDINGS: Adherence to guidelines for non-muscle-invasive bladder cancer in the community among practicing urologists remains low, in part due to the variations in available guidelines. In the era of a BCG shortage, decreased dosing schedules and alternative intravesical options are increasingly being used. New biomarkers are being discovered to better risk-stratify patients, with future therapies aimed at targeting aggressive disease. HGT1 urothelial carcinoma remains a highly variable and aggressive disease, but we are making significant progress in better characterizing the clinical and molecular factors that influence recurrence and progression, to better guide management.


Assuntos
Vacina BCG/administração & dosagem , Carcinoma de Células de Transição/terapia , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Vacina BCG/provisão & distribução , Biomarcadores/metabolismo , Carcinoma de Células de Transição/genética , Carcinoma de Células de Transição/metabolismo , Carcinoma de Células de Transição/patologia , Ensaios Clínicos como Assunto , Fidelidade a Diretrizes , Humanos , Guias de Prática Clínica como Assunto , Neoplasias da Bexiga Urinária/genética , Neoplasias da Bexiga Urinária/metabolismo , Neoplasias da Bexiga Urinária/patologia
20.
Medicine (Baltimore) ; 98(43): e17572, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651858

RESUMO

RATIONALE: Rhabdomyosarcoma (RMS) is a common soft tissue sarcoma in children with high malignancy. The prognosis of refractory recurrent RMS is extremely poor, and the 5-year survival rate is less than 20%. PATIENT CONCERNS: We reported a 2-year-old male patient with RMS who underwent 3 operations and 2 recurrences while being treated with regular multidisciplinary therapy. DIAGNOSES: A diagnosis of embryonal rhabdomyosarcoma with primary bladder (IIIa, TNM stage 2, and medium risk group) was made. INTERVENTIONS: After repeated recurrence, the patient was treated with chimeric antigen receptor T (CAR-T) cells, which had a safety mechanism and specifically bound the CD56 antigen in the fourth generation. OUTCOMES: The process of CAR-T cell transfusion was smooth, and there were no significant cytokine release syndrome manifestations after reinfusion. The patient was in complete remission at last follow-up visit after 3.5 years. CONCLUSION: CD56-CAR-T cell therapy is a safe and effective approach and may be an option for children with solid tumors who are nonresponsive to conventional radiotherapy and chemotherapy, or are unsuitable for hematopoietic stem cell transplantation.


Assuntos
Antígeno CD56/imunologia , Imunoterapia Adotiva/métodos , Recidiva Local de Neoplasia/terapia , Receptores de Antígenos Quiméricos/uso terapêutico , Rabdomiossarcoma/terapia , Neoplasias da Bexiga Urinária/terapia , Pré-Escolar , Seguimentos , Humanos , Masculino , Indução de Remissão , Rabdomiossarcoma/patologia , Neoplasias da Bexiga Urinária/patologia
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