Intensity-modulated radiation therapy (IMRT) has become the mainstay of treatment for localized prostate cancer. In IMRT, minimizing differences between the conditions used during planning CT and daily treatment is im...Intensity-modulated radiation therapy (IMRT) has become the mainstay of treatment for localized prostate cancer. In IMRT, minimizing differences between the conditions used during planning CT and daily treatment is important to prevent adverse events in normal tissues. In the present study, we evaluated the impact of variation in bladder volume on the doses to various organs. A total of 35 patients underwent definitive radiotherapy at Saitama Medical Center. A Light Speed RT16 (GE Healthcare) was used for planning and to obtain examination CT images. Such images were acquired after 4 - 6 days of planning CT image acquisition. The IMRT plans were optimized using the planning CT data to satisfy the dose constraints set by our in-house protocols for the PTV and the OARs. The dose distributions were then re-calculated using the same IMRT beams, and checked on examination CT images. It was clear that bladder volume affected the doses to certain organs. We focused on the prostate, bladder, rectum, small bowel, and large bowel. Regression coefficients were calculated for variables that correlated strongly with bladder volume (p < 0.05). We found that variation in bladder volume [cm<sup>3</sup>] predicted deviations in the bladder V<sub>70Gy</sub>, V<sub>50Gy</sub>, and V<sub>30Gy</sub> [%];the maximum dose to the small bowel [cGy];and the maximum dose to the large bowel [cGy]. The regression coefficients were -0.065, -0.125, -0.180, -10.22, and -9.831, respectively. We evaluated the impacts of such variation on organ doses. These may be helpful when checking a patient’s bladder volume before daily IMRT for localized prostate cancer.展开更多
Objective: to explore the effect of simple bladder volume-pressure measurement technology and its effect on the quality of life.Methods: choose computer random method from June 2020 to June 2022, 68 cases of hospital ...Objective: to explore the effect of simple bladder volume-pressure measurement technology and its effect on the quality of life.Methods: choose computer random method from June 2020 to June 2022, 68 cases of hospital stroke neurogenic bladder patients are divided into two groups, a control group, a total of 34 patients, the implementation of intermittent catheterization, the other is observation group, there are 34 cases, on the basis of control group treatment, increase the simple bladder capacity-pressure measurement technique.Compare the various clinical indicators.Results: the data of the observed group were better than the control group showed in Table 1-Table 4, with P < 0.05. Conclusion: the application of simple bladder volume-pressure measurement technology in neurogenic bladder combined with intermittent catheterization can help restore autonomous urination, reduce the incidence of symptomatic urinary tract infection, help increase bladder capacity, reduce residual urine volume, and higher quality of life for patients, which is worthy of practice in various medical institutions.展开更多
Clinical bladder evaluation is a cost-effective,non-invasive method for diagnosing and managing urinary dysfunction,particularly in patients with neurogenic bladder or other impairments.This process aims to assess bla...Clinical bladder evaluation is a cost-effective,non-invasive method for diagnosing and managing urinary dysfunction,particularly in patients with neurogenic bladder or other impairments.This process aims to assess bladder capacity,storage,and voiding functions through simple,realistic,and resource-friendly approaches.It involves a structured series of steps,from history-taking and physical examination to bladder-emptying procedures,monitoring urine leaks,assessing reflex voiding,measuring post-void residual(PVR),and calculating total bladder capacity.These evaluations help differentiate between upper motor neuron and lower motor neuron bladder dysfunction,providing critical insights for tailored management.The interpretation of findings focuses on identifying bladder type,assessing leak timing and volume,evaluating reflex voiding,and measuring PVR and total bladder capacity.The results guide interventions such as timing selfclean intermittent catheterization,adjusting fluid intake,and using bladder diaries to monitor patterns.Clinical bladder evaluation is particularly advantageous in low-resource settings,as it avoids the risks and costs associated with urodynamic studies while reflecting real-life patient conditions more effectively.Despite its benefits,no validation studies currently exist for clinical bladder assessment,and its parameters,like maximum voided volume,remain underexplored compared to urodynamic measures.Given the accessibility,affordability,and practicality of this approach,it holds promise for widespread application,especially in primary care settings and among economically disadvantaged populations.This editorial describes the process step-by-step and highlights its role in improving patient outcomes while minimizing complications.展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
The published article titled“Puerarin inhibits proliferation and induces apoptosis by upregulation of miR-16 in bladder cancer cell line T24”has been retracted from Oncology Research,Vol.26,No.8,2018,pp.1227–1234.
Background:The COVID-19 pandemic disrupted healthcare systems globally,raising concerns about delayed cancer diagnosis and treatment.In France,transurethral resection of bladder tumors(TURBT)was prioritized in nationa...Background:The COVID-19 pandemic disrupted healthcare systems globally,raising concerns about delayed cancer diagnosis and treatment.In France,transurethral resection of bladder tumors(TURBT)was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma.This study aimed to assess the impact of care reorganization on tumor staging,recurrence,palliative care,and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods.Methods:We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019(pre-pandemic),2020(early pandemic),2021(mid-pandemic),and 2022(late pandemic)in two French institutions.TURBT indications were categorized as diagnostic,palliative,or staging.Clinical and pathological data were compared across the four periods.Statistical analyses included Chi-square tests,Estimated Annual Percentage Change(EAPC),and multivariable logistic regression adjusted for age,sex,ASA score,and center.Results:A total of 790 TURBT procedures were analyzed.The proportion of muscle-invasive bladder cancer(pT≥2)declined over time(18.7%in 2019 to 13.2%in 2022;p=0.63),while superficial tumors(pTa)increased(57.2%to 65.5%).All-cause mortality significantly decreased from 38.0%in 2019 to 22.0%in 2020,20.5%in 2021,and 19.5%in 2022(p=0.006).EAPC showed a significant annual decline in mortality(–24.3%,p=0.004).In multivariable analysis,2020,2021,and 2022 were each associated with significantly lower odds of mortality compared to 2019.Recurrence rates remained stable across all periods(p=0.93).Interhospital variation persisted in mortality and recurrence.Conclusions:Despite the pandemic,urothelial bladder cancer outcomes did not worsen through 2022.On the contrary,timely reorganization,prioritization of TURBT,and triage strategies were associated with reduced mortality and palliative care needs,highlighting the resilience of cancer care when guided by adaptive health policies.展开更多
Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the ...Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the potential mechanisms of action of XP.The rats underwent bladder outlet obstruction surgery and were administered the corresponding drug concentrations by gavage for 4 weeks.The study observed the body weight,water intake,bladder and kidney indices(to evaluate their general status),urination behavior pattern(to observe frequency and urgency),and urodynamics(to measure bladder parameters).Hematoxylin and eosin and Masson's trichome staining were used to observe changes in the bladder structure.Enzyme-linked immunosorbent assay was used to measure the levels of nerve growth factor,brain-derived neurotrophic factor,and acetylcholine in the urine.The key targets involved in these mechanisms were validated using reverse transcription-quantitative polymerase chain reaction,immunohistochemistry,and western blot in vivo/vitro experiments.Result:Network pharmacological analysis predicted that XP may alleviate OAB by affecting the cholinergic synapse and calcium signaling pathways.XP treatment significantly reduced the bladder index,improved urine behavior and urodynamic parameters,decreased the neurotransmitters in urine,and reduced the thickness of the bladder wall and collagen ratio.These results indicate that XP can alleviate OAB symptoms and improve the bladder structure.In vivo/vitro experiments further demonstrated that XP can inhibit targets,such as muscarinic acetylcholine receptor 2,and participate in cholinergic synapses to further regulate the parasympathetic nervous system.It can also reduce the overexpression of Ca^(2+) caused by agonists,inhibit targets such as transient receptor potential vanilloid type 1,and participate in calcium signaling pathways to maintain Ca^(2+) homeostasis.Conclusion:These results suggest that XP inhibited bladder overactivity by maintaining Ca^(2+) homeostasis and regulating the parasympathetic nervous system.展开更多
BACKGROUNDΒ-elemene is widely used to treat a variety of cancers,including bladder cancer(BLCA).However,the anti-cancer target,effective constituents and mechanism was unclear.AIM To investigate the therapeutic effec...BACKGROUNDΒ-elemene is widely used to treat a variety of cancers,including bladder cancer(BLCA).However,the anti-cancer target,effective constituents and mechanism was unclear.AIM To investigate the therapeutic effect and underlying mechanism ofβ-elemene in BLCA.METHODS We first mined the GEPIA2 database to explore the association between the GM3(ST3 Beta-Galactoside Alpha-2,3-Sialyltransferase 5,GM3,ST3GAL5)gene and BLCA.Second,we performed in vitro experiments using BLCA cells to verify the inhibitory effect and targets therapy ofβ-elemene on BLCA.RESULTS Our results revealed a significantly reduced expression of GM3 in BLCA tissues.Notably,BLCA patients with higher GM3 expression exhibited prolonged overall survival and disease-free survival.In vitro studies demonstrated thatβ-elemene significantly affected BLCA cell viability,leading to a marked upregulation of GM3 expression,increased apoptotic cell populations,and a notable reduction in cell migration and invasion.WB analysis showed thatβ-elemene enhanced GM3 protein expression while simultaneously decreasing phosphorylated epidermal growth factor receptor(p-EGFR)levels.Additionally,overexpression or RNAi of GM3 in BLCA cells resulted in corresponding changes in epidermal growth factor receptor and p-EGFR expression levels.CONCLUSION This study provides preliminary evidence for further investigation into the molecular mechanisms ofβ-elemene in the treatment of BLCA.展开更多
Background:Studies have reported the special value of PANoptosis in cancer,but there is no study on the prognostic and therapeutic effects of PANoptosis in bladder cancer(BLCA).This study aimed to explore the role of ...Background:Studies have reported the special value of PANoptosis in cancer,but there is no study on the prognostic and therapeutic effects of PANoptosis in bladder cancer(BLCA).This study aimed to explore the role of PANoptosis in BLCA heterogeneity and its impact on clinical outcomes and immunotherapy response while establishing a robust prognostic model based on PANoptosis-related features.Methods:Gene expression profiles and clinical data were collected from public databases.Spatial heterogeneity of cell death pathways in BLCA was evaluated.Consensus clustering was performed based on identified PANoptosis genes.Cell death pathway scores,molecular,and pathway activation differences between different groups were compared.Protein-protein interaction(PPI)network construction was constructed,and immune-related gene sets,tumor immune dysfunction and exclusion(TIDE)scores,and SubMap analysis were used to evaluate immunomodulator expression and immunotherapy efficacy.Ten machine learning algorithms were utilized to develop the most accurate predictive risk model,and a nomogram was created for clinical application.Results:BLCA demonstrated a spatially heterogeneous distribution of pyroptosis,apoptosis,and necroptosis.Notably,T effector cells significantly colocalized with total apoptosis.Two PANoptosis modes were identified:high PANoptosis(high.PANO)and low PANoptosis(low.PANO).High.PANO was associated with worse clinical outcomes and advanced tumor stage,and increased activation of immune-related and cell death pathways.It also showed increased infiltration of immune cells,elevated expression of immunomodulatory factors,and enhanced responsiveness to the immunotherapy.The PANoptosis-related machine learning prognostic signature(PMLS)exhibited strong predictive power for outcomes in BLCA.CSPG4 was identified as a key gene underlying prognostic and therapeutic differences.Conclusion:PANoptosis shapes distinct prognostic and immunological phenotypes in BLCA.PMLS offers a reliable prognostic tool.CSPG4 may represent a potential therapeutic target in PANoptosis-driven BLCA.展开更多
BACKGROUND An ileal neobladder is a standardized form of urinary diversion that provides acceptable outcomes in terms of long-term quality of life.Urothelial carcinomas(UCs)arising in the ileal neobladder are extremel...BACKGROUND An ileal neobladder is a standardized form of urinary diversion that provides acceptable outcomes in terms of long-term quality of life.Urothelial carcinomas(UCs)arising in the ileal neobladder are extremely rare,and few reports on this have been published in the English language.CASE SUMMARY We report a case of UC that developed in the ileal neobladder of a 63-year-old man.The patient was diagnosed with UC in situ and underwent radical cystoprostatectomy and ileal neobladder creation.Ten years after the surgery and neoadjuvant chemotherapy,an UC developed in the ileal neobladder.CONCLUSION Ileal neobladder urothelial carcinoma can originate from the implanted urothelium and the intestinal mucosa can migrate intraluminally.展开更多
Bladder cancer(BLCA)is a highly invasive malignancy with limited targeted therapies.Lu et al reveal the oncogenic role of HOXC6 in BLCA by showing its elevated mRNA and protein levels in cancerous tissues.Silencing HO...Bladder cancer(BLCA)is a highly invasive malignancy with limited targeted therapies.Lu et al reveal the oncogenic role of HOXC6 in BLCA by showing its elevated mRNA and protein levels in cancerous tissues.Silencing HOXC6 sig-nificantly inhibits BLCA cell proliferation,migration and invasion,induces apo-ptosis and arrests the cell cycle at G0/G1.In addition,HOXC6 also regulates pa-thways related to chemical carcinogenesis and reactive oxygen species,with a strong association with the target gene TIMELESS,supported by binding signals in its promoter region.Here,we discuss the role of HOXC6 as a potential bio-marker and therapeutic target,contributing to a deeper understanding of the HOXC6-TIMELESS axis and its implications for advancing BLCA research and therapy.展开更多
While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasibl...While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.展开更多
Objective:Bladder cancer(BCa)is a prevalent malignant tumor in the urinary system.Molecular subtyping,utilizing molecular characteristics,represents a novel classification system that has demonstrated its efficacy in ...Objective:Bladder cancer(BCa)is a prevalent malignant tumor in the urinary system.Molecular subtyping,utilizing molecular characteristics,represents a novel classification system that has demonstrated its efficacy in tumor diagnosis and treatment.Given the critical role of molecular subtyping in the BCa treatment,acquiring a comprehensive understanding is imperative for guiding treatment decisions,optimizing risk assessment systems,and ultimately improving patient prognosis.Methods:In this review,we provide a comprehensive overview of the research progress in molecular subtyping of BCa,with a primary focus on discussing its utility in guiding various treatment modalities including neoadjuvant chemotherapy,neoadjuvant immunotherapy,and targeted therapy.In addition,this review also covers the trimodality treatment,antibody-drug conjugates,and the treatment of small cell BCa.Results:We present a comprehensive overview of the responsiveness or resistance of different molecular subtypes of BCa to various therapeutic modalities.The basal subtype demonstrates favorable sensitivity to neoadjuvant chemotherapy across multiple classification systems,whereas the luminal infiltrated subtype exhibits potential susceptibility to immunotherapy.In terms of targeted therapy,the basal-like and the basal/squamous subtypes in some classifications have shown notable responsiveness to epidermal growth factor receptor-targeted therapy.Moreover,the luminal subtype in the University of Texas M.D.Anderson Cancer Center classification,the luminal papillary subtypes according to the Cancer Genome Atlas Research Network classification in 2017,and the luminal unstable type in the 2019 Molecular Subtyping classification show potential for the fibroblast growth factor receptor 3-targeted treatment.Conclusion:The significance and impact of BCa molecular subtyping in guiding treatment,evaluating progression,and predicting prognosis are increasingly acknowledged.Accurate subtyping and broad application can bring good benefits to clinical decision-making,risk assessment,and prognostic evaluation.展开更多
Background:Bladder cancer prognosis remains suboptimal despite advancements in research.Current molecular subtyping methods are resource-intensive,highlighting the need for efficient,cost-effective approaches to predi...Background:Bladder cancer prognosis remains suboptimal despite advancements in research.Current molecular subtyping methods are resource-intensive,highlighting the need for efficient,cost-effective approaches to predict BCa molecular subtypes.Method:We developed a predictive model for BCa molecular subtypes using machine learning(ML)and pathomics derived from Hematoxylin-Eosin stained pathological slides.A cohort of 353 patients from TCGA was employed,and image features were extracted for analysis.Pathomic signatures were constructed using the LASSO Cox regression algorithm,and a pathomic-clinical nomogram was developed and validated in training and testing cohorts.Results:Seventy distinct image features were identified from 150 pathomic signatures.The model demonstrated robust predictive ability,with AUCs of 0.833 and 0.822 in the training and validation cohorts,respectively.The addition of pathomic score,N stage,and M stage improved the model’s discrimination,achieving AUCs of 0.877 and 0.794 in the training and validation cohorts.Limitations include the lack of an external validation cohort.Conclusion:Our ML-based pathomics model shows promise in predicting BCa molecular subtypes and has the potential to enhance prognosis prediction and inform treatment strategies,marking a significant step towards precision medicine for BCa.展开更多
Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the e...Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.展开更多
BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the im...BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC.METHODS Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed.Patient medical records were assessed.Predictors for overall survival(OS)were determined using multivariable Cox regression.RESULTS Of the 346 included patients with iGBC,138(39.9%)had bile spillage,which was associated with higher American Society of Anesthesiologists classification(P=0.020),cholecystitis(P<0.001),higher tumor stage(P=0.005),and non-radical resection(P<0.001).Bile spillage was associated with poor OS[hazard ratio=1.97,95%confidence interval(CI):1.48-2.63,P<0.001]with a median OS of 12 months(95%CI:7-18 months)vs 34 months(95%CI:14-55 months,P<0.001).In multivariable analysis,spillage was not an independent prognostic factor for survival(hazard ratio=1.21,95%CI:0.84-1.74,P=0.313).CONCLUSION Although bile spillage correlates with prognostic factors,it lacks independent prognostic significance for survival.Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center,irrespective of whether bile spillage has occurred.展开更多
Gall bladder cancer(GBC)remains a highly aggressive disease,with an overall 5-year dismal survival rate of 15%-20%.Its asymptomatic nature in very early stages and non-specific clinical presentations pose significant ...Gall bladder cancer(GBC)remains a highly aggressive disease,with an overall 5-year dismal survival rate of 15%-20%.Its asymptomatic nature in very early stages and non-specific clinical presentations pose significant challenges to timely detection.Consequently,GBC often presents late,making it one of the most challenging cancers to manage.Surgery offers the best chance for long-term survival;however,only 10%of GBC patients are candidates for upfront resection,with the majority presenting in locally advanced or metastatic stages.Further-more,GBC is generally resistant to chemotherapy and radiotherapy,limiting the effectiveness of systemic therapy.Therefore,early diagnosis is crucial to offer the best treatment through surgical resection and to improve the outcome.Recent advancements in imaging technologies,biomarker discovery,and molecular diagnostics offer promising avenues for enhancing detection rates.Though non-invasive,most of them lack specificity,and the majority fail as an early diagnostic tool.This review examines the current status of early detection strategies for GBC,addresses the limitations of existing approaches,and explores the newer emer-ging diagnostic tools and techniques and how they can be exploited in future for its early detection.展开更多
Objective:To systematically review the most recent scientific literature regarding modern strategies for organ preservation in the treatment of non-metastatic muscle-invasive bladder cancer.Methods:Literature search w...Objective:To systematically review the most recent scientific literature regarding modern strategies for organ preservation in the treatment of non-metastatic muscle-invasive bladder cancer.Methods:Literature search was made using PubMed,Google Scholar,EMBASE,Wiley Library,and ClinicalTrials.gov following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement.The primary outcome was 5-year overall survival rate,which was addressed by a systematic review and meta-analysis.The risk of bias and quality of evidence were assessed according to the Cochrane Collaboration and the Grading of Recommendations,Assessment,Development and Evaluation system.Results:The evidence is consistent in showing that 5-year survival of trimodality therapy is similar to radical cystectomy in selected patients,ranging between 29%and 73%.Patients undergoing bladder-sparing therapy were found to have better outcomes in terms of quality of life and sociability than those undergoing radical cystectomy.Immunotherapy is establishing itself as a strategy for organ-preservation treatment,showing complete response rates between 42%and 100%.However,most of these results have been obtained from ongoing clinical trials.Furthermore,there are still no studies comparing the efficacy among the different available therapies.Conclusion:Although radical cystectomy remains the gold standard treatment for muscle-invasive bladder cancer,its significant morbidity has prompted the exploration of alternative therapies.In this context,bladder preservation therapies,though supported by limited literature,emerge as a potential alternative that could offer comparable oncological outcomes in selected patients.展开更多
Bladder cancer remains a significant global health challenge,requiring repeated treatments and surveillance and potentially morbid therapies,particularly in advanced and recurrent stages.Exosomes,small extracellular v...Bladder cancer remains a significant global health challenge,requiring repeated treatments and surveillance and potentially morbid therapies,particularly in advanced and recurrent stages.Exosomes,small extracellular vesicles central to intercellular communication,have emerged as innovative tools in cancer diagnostics,prognosis,and therapy.Their role in modulating the immune response and the tumor microenvironment makes them particularly attractive for cancer immunotherapy.This review provides a comprehensive overview of exosome biology,with a focus on their role in immune modulation and potential therapeutic applications.We explore the progress and challenges of exosome-based immunotherapy in cancer,followed by a discussion on the current state of bladder cancer immunotherapy.Additionally,we highlight the roles of exosomes in bladder cancer,emphasizing their diagnostic and prognostic applications.Despite promising preclinical studies and a growing number of clinical trials in other cancers,exosome-based therapies remain underexplored in bladder cancer.We discuss the current clinical trials related to exosomes in bladder cancer and propose their potential future role in immunotherapy.Finally,we address the challenges and opportunities in translating exosome-based therapies from bench to bedside,emphasizing the need for further preclinical and clinical investigations.This review emphasized the potential of exosome-based immunotherapy as a transformative approach for bladder cancer diagnosis and treatment.展开更多
Objective:This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder(SCCUB).Methods:Clinicopathological data and prognosis of 24 patients with primary...Objective:This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder(SCCUB).Methods:Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University(from January 2016 to December 2021)were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma(HG-UC)during the same period.The study endpoints were disease-free survival(DFS)and overall survival(OS).Results:Of the 24 patients with SCCUB,19 were male and five were female.Eight(33%)cases were pure SCCUB(pSCCUB).Sixteen(67%)cases were mixed SCCUB(mSCCUB),all of which were mixed with urothelial carcinoma.All patients underwent surgery and 13(76%,13/17;seven patients were lost to follow-up)patients received postoperative adjuvant chemotherapy.We found no significant difference in clinicopathological features between pSCCUB and mSCCUB.However,compared to HG-UC,SCCUB had higher lymph node metastasis(p=0.014),more lymphovascular invasion(p=0.024),higher Ki-67 expression(p<0.001),and more disease progression events(p=0.001).Median DFS and OS for SCCUB were 22 months and 38 months,respectively.The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB.However,SCCUB patients had worse DFS and OS than HG-UC patients(both p<0.05).The multivariate Cox analysis showed that the tumor size(hazard ratio 1.44,95%CI 1.96–2.15,p=0.048)was an independent factor affecting DFS of SCCUB patients.Conclusion:Compared with the common HG-UC,SCCUB is rare with specific clinicopathological features and a worse prognosis.展开更多
文摘Intensity-modulated radiation therapy (IMRT) has become the mainstay of treatment for localized prostate cancer. In IMRT, minimizing differences between the conditions used during planning CT and daily treatment is important to prevent adverse events in normal tissues. In the present study, we evaluated the impact of variation in bladder volume on the doses to various organs. A total of 35 patients underwent definitive radiotherapy at Saitama Medical Center. A Light Speed RT16 (GE Healthcare) was used for planning and to obtain examination CT images. Such images were acquired after 4 - 6 days of planning CT image acquisition. The IMRT plans were optimized using the planning CT data to satisfy the dose constraints set by our in-house protocols for the PTV and the OARs. The dose distributions were then re-calculated using the same IMRT beams, and checked on examination CT images. It was clear that bladder volume affected the doses to certain organs. We focused on the prostate, bladder, rectum, small bowel, and large bowel. Regression coefficients were calculated for variables that correlated strongly with bladder volume (p < 0.05). We found that variation in bladder volume [cm<sup>3</sup>] predicted deviations in the bladder V<sub>70Gy</sub>, V<sub>50Gy</sub>, and V<sub>30Gy</sub> [%];the maximum dose to the small bowel [cGy];and the maximum dose to the large bowel [cGy]. The regression coefficients were -0.065, -0.125, -0.180, -10.22, and -9.831, respectively. We evaluated the impacts of such variation on organ doses. These may be helpful when checking a patient’s bladder volume before daily IMRT for localized prostate cancer.
文摘Objective: to explore the effect of simple bladder volume-pressure measurement technology and its effect on the quality of life.Methods: choose computer random method from June 2020 to June 2022, 68 cases of hospital stroke neurogenic bladder patients are divided into two groups, a control group, a total of 34 patients, the implementation of intermittent catheterization, the other is observation group, there are 34 cases, on the basis of control group treatment, increase the simple bladder capacity-pressure measurement technique.Compare the various clinical indicators.Results: the data of the observed group were better than the control group showed in Table 1-Table 4, with P < 0.05. Conclusion: the application of simple bladder volume-pressure measurement technology in neurogenic bladder combined with intermittent catheterization can help restore autonomous urination, reduce the incidence of symptomatic urinary tract infection, help increase bladder capacity, reduce residual urine volume, and higher quality of life for patients, which is worthy of practice in various medical institutions.
文摘Clinical bladder evaluation is a cost-effective,non-invasive method for diagnosing and managing urinary dysfunction,particularly in patients with neurogenic bladder or other impairments.This process aims to assess bladder capacity,storage,and voiding functions through simple,realistic,and resource-friendly approaches.It involves a structured series of steps,from history-taking and physical examination to bladder-emptying procedures,monitoring urine leaks,assessing reflex voiding,measuring post-void residual(PVR),and calculating total bladder capacity.These evaluations help differentiate between upper motor neuron and lower motor neuron bladder dysfunction,providing critical insights for tailored management.The interpretation of findings focuses on identifying bladder type,assessing leak timing and volume,evaluating reflex voiding,and measuring PVR and total bladder capacity.The results guide interventions such as timing selfclean intermittent catheterization,adjusting fluid intake,and using bladder diaries to monitor patterns.Clinical bladder evaluation is particularly advantageous in low-resource settings,as it avoids the risks and costs associated with urodynamic studies while reflecting real-life patient conditions more effectively.Despite its benefits,no validation studies currently exist for clinical bladder assessment,and its parameters,like maximum voided volume,remain underexplored compared to urodynamic measures.Given the accessibility,affordability,and practicality of this approach,it holds promise for widespread application,especially in primary care settings and among economically disadvantaged populations.This editorial describes the process step-by-step and highlights its role in improving patient outcomes while minimizing complications.
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
文摘The published article titled“Puerarin inhibits proliferation and induces apoptosis by upregulation of miR-16 in bladder cancer cell line T24”has been retracted from Oncology Research,Vol.26,No.8,2018,pp.1227–1234.
文摘Background:The COVID-19 pandemic disrupted healthcare systems globally,raising concerns about delayed cancer diagnosis and treatment.In France,transurethral resection of bladder tumors(TURBT)was prioritized in national urology guidelines to ensure the timely management of urothelial carcinoma.This study aimed to assess the impact of care reorganization on tumor staging,recurrence,palliative care,and mortality in bladder cancer patients from the pre-pandemic through late-pandemic periods.Methods:We conducted a retrospective multicenter study including all patients who underwent TURBT with histologically confirmed urothelial carcinoma between April and December of 2019(pre-pandemic),2020(early pandemic),2021(mid-pandemic),and 2022(late pandemic)in two French institutions.TURBT indications were categorized as diagnostic,palliative,or staging.Clinical and pathological data were compared across the four periods.Statistical analyses included Chi-square tests,Estimated Annual Percentage Change(EAPC),and multivariable logistic regression adjusted for age,sex,ASA score,and center.Results:A total of 790 TURBT procedures were analyzed.The proportion of muscle-invasive bladder cancer(pT≥2)declined over time(18.7%in 2019 to 13.2%in 2022;p=0.63),while superficial tumors(pTa)increased(57.2%to 65.5%).All-cause mortality significantly decreased from 38.0%in 2019 to 22.0%in 2020,20.5%in 2021,and 19.5%in 2022(p=0.006).EAPC showed a significant annual decline in mortality(–24.3%,p=0.004).In multivariable analysis,2020,2021,and 2022 were each associated with significantly lower odds of mortality compared to 2019.Recurrence rates remained stable across all periods(p=0.93).Interhospital variation persisted in mortality and recurrence.Conclusions:Despite the pandemic,urothelial bladder cancer outcomes did not worsen through 2022.On the contrary,timely reorganization,prioritization of TURBT,and triage strategies were associated with reduced mortality and palliative care needs,highlighting the resilience of cancer care when guided by adaptive health policies.
基金supported by the Natural Science Foundation in Xinjiang Uygur Autonomous Region(Urumqi,China,2023D01F38).
文摘Objective:To observe the effect of Xipayimaizibizi oral liquid(XP)in an overactive bladder(OAB)experimental rat model and to explore its pharmacological mechanisms.Methods:Network pharmacology was used to explore the potential mechanisms of action of XP.The rats underwent bladder outlet obstruction surgery and were administered the corresponding drug concentrations by gavage for 4 weeks.The study observed the body weight,water intake,bladder and kidney indices(to evaluate their general status),urination behavior pattern(to observe frequency and urgency),and urodynamics(to measure bladder parameters).Hematoxylin and eosin and Masson's trichome staining were used to observe changes in the bladder structure.Enzyme-linked immunosorbent assay was used to measure the levels of nerve growth factor,brain-derived neurotrophic factor,and acetylcholine in the urine.The key targets involved in these mechanisms were validated using reverse transcription-quantitative polymerase chain reaction,immunohistochemistry,and western blot in vivo/vitro experiments.Result:Network pharmacological analysis predicted that XP may alleviate OAB by affecting the cholinergic synapse and calcium signaling pathways.XP treatment significantly reduced the bladder index,improved urine behavior and urodynamic parameters,decreased the neurotransmitters in urine,and reduced the thickness of the bladder wall and collagen ratio.These results indicate that XP can alleviate OAB symptoms and improve the bladder structure.In vivo/vitro experiments further demonstrated that XP can inhibit targets,such as muscarinic acetylcholine receptor 2,and participate in cholinergic synapses to further regulate the parasympathetic nervous system.It can also reduce the overexpression of Ca^(2+) caused by agonists,inhibit targets such as transient receptor potential vanilloid type 1,and participate in calcium signaling pathways to maintain Ca^(2+) homeostasis.Conclusion:These results suggest that XP inhibited bladder overactivity by maintaining Ca^(2+) homeostasis and regulating the parasympathetic nervous system.
基金Supported by the Zhejiang Provincial Traditional Chinese Medicine Foundation,No.2021ZA021 and No.2022ZZ005.
文摘BACKGROUNDΒ-elemene is widely used to treat a variety of cancers,including bladder cancer(BLCA).However,the anti-cancer target,effective constituents and mechanism was unclear.AIM To investigate the therapeutic effect and underlying mechanism ofβ-elemene in BLCA.METHODS We first mined the GEPIA2 database to explore the association between the GM3(ST3 Beta-Galactoside Alpha-2,3-Sialyltransferase 5,GM3,ST3GAL5)gene and BLCA.Second,we performed in vitro experiments using BLCA cells to verify the inhibitory effect and targets therapy ofβ-elemene on BLCA.RESULTS Our results revealed a significantly reduced expression of GM3 in BLCA tissues.Notably,BLCA patients with higher GM3 expression exhibited prolonged overall survival and disease-free survival.In vitro studies demonstrated thatβ-elemene significantly affected BLCA cell viability,leading to a marked upregulation of GM3 expression,increased apoptotic cell populations,and a notable reduction in cell migration and invasion.WB analysis showed thatβ-elemene enhanced GM3 protein expression while simultaneously decreasing phosphorylated epidermal growth factor receptor(p-EGFR)levels.Additionally,overexpression or RNAi of GM3 in BLCA cells resulted in corresponding changes in epidermal growth factor receptor and p-EGFR expression levels.CONCLUSION This study provides preliminary evidence for further investigation into the molecular mechanisms ofβ-elemene in the treatment of BLCA.
基金supported by grants from the National Natural Science Foundation of China(No.82172741)Shanghai Municipal Health Bureau(No.2020CXJQ03).
文摘Background:Studies have reported the special value of PANoptosis in cancer,but there is no study on the prognostic and therapeutic effects of PANoptosis in bladder cancer(BLCA).This study aimed to explore the role of PANoptosis in BLCA heterogeneity and its impact on clinical outcomes and immunotherapy response while establishing a robust prognostic model based on PANoptosis-related features.Methods:Gene expression profiles and clinical data were collected from public databases.Spatial heterogeneity of cell death pathways in BLCA was evaluated.Consensus clustering was performed based on identified PANoptosis genes.Cell death pathway scores,molecular,and pathway activation differences between different groups were compared.Protein-protein interaction(PPI)network construction was constructed,and immune-related gene sets,tumor immune dysfunction and exclusion(TIDE)scores,and SubMap analysis were used to evaluate immunomodulator expression and immunotherapy efficacy.Ten machine learning algorithms were utilized to develop the most accurate predictive risk model,and a nomogram was created for clinical application.Results:BLCA demonstrated a spatially heterogeneous distribution of pyroptosis,apoptosis,and necroptosis.Notably,T effector cells significantly colocalized with total apoptosis.Two PANoptosis modes were identified:high PANoptosis(high.PANO)and low PANoptosis(low.PANO).High.PANO was associated with worse clinical outcomes and advanced tumor stage,and increased activation of immune-related and cell death pathways.It also showed increased infiltration of immune cells,elevated expression of immunomodulatory factors,and enhanced responsiveness to the immunotherapy.The PANoptosis-related machine learning prognostic signature(PMLS)exhibited strong predictive power for outcomes in BLCA.CSPG4 was identified as a key gene underlying prognostic and therapeutic differences.Conclusion:PANoptosis shapes distinct prognostic and immunological phenotypes in BLCA.PMLS offers a reliable prognostic tool.CSPG4 may represent a potential therapeutic target in PANoptosis-driven BLCA.
文摘BACKGROUND An ileal neobladder is a standardized form of urinary diversion that provides acceptable outcomes in terms of long-term quality of life.Urothelial carcinomas(UCs)arising in the ileal neobladder are extremely rare,and few reports on this have been published in the English language.CASE SUMMARY We report a case of UC that developed in the ileal neobladder of a 63-year-old man.The patient was diagnosed with UC in situ and underwent radical cystoprostatectomy and ileal neobladder creation.Ten years after the surgery and neoadjuvant chemotherapy,an UC developed in the ileal neobladder.CONCLUSION Ileal neobladder urothelial carcinoma can originate from the implanted urothelium and the intestinal mucosa can migrate intraluminally.
基金Supported by National Key R&D Program of China,No.2023YFC2507904Hubei Strategic Science and Technology Talent Plan,No.2024DJA037+1 种基金National Natural Science Foundation of China,No.32270768,No.82273970 and No.82370715Innovation Group Project of Hubei Province No.2023AFA026.
文摘Bladder cancer(BLCA)is a highly invasive malignancy with limited targeted therapies.Lu et al reveal the oncogenic role of HOXC6 in BLCA by showing its elevated mRNA and protein levels in cancerous tissues.Silencing HOXC6 sig-nificantly inhibits BLCA cell proliferation,migration and invasion,induces apo-ptosis and arrests the cell cycle at G0/G1.In addition,HOXC6 also regulates pa-thways related to chemical carcinogenesis and reactive oxygen species,with a strong association with the target gene TIMELESS,supported by binding signals in its promoter region.Here,we discuss the role of HOXC6 as a potential bio-marker and therapeutic target,contributing to a deeper understanding of the HOXC6-TIMELESS axis and its implications for advancing BLCA research and therapy.
文摘While cystolitholapaxy for bladder stones is commonly performed using a transurethral approach,large or complex stone burdens in patients with complex lower urinary tract anatomy may make this inefficient or infeasible.Percutaneous cystolitholapaxy is a safe,effective,minimally invasive alternative for diverse indications,including patients with benign prostatic hyperplasia,urethral stricture disease,closed bladder neck,continent catheterized channel,or other urinary diversion.In this article,we review the indications for and advantages of percutaneous cystolitholapaxy and describe our step-by-step technique for this procedure,including representative imaging and favored equipment.We also discuss preoperative and postoperative considerations,management of potential complications,strategies to optimize clinical outcomes and patient safety,and comparisons with transurethral approaches.Finally,we report outcomes from our institutional series of percutaneous cystolitholapaxy cases to highlight the safety and efficacy of the procedure.
基金supported by the grants from the National Natural Science Foundation of China(82273132 to Liu B).
文摘Objective:Bladder cancer(BCa)is a prevalent malignant tumor in the urinary system.Molecular subtyping,utilizing molecular characteristics,represents a novel classification system that has demonstrated its efficacy in tumor diagnosis and treatment.Given the critical role of molecular subtyping in the BCa treatment,acquiring a comprehensive understanding is imperative for guiding treatment decisions,optimizing risk assessment systems,and ultimately improving patient prognosis.Methods:In this review,we provide a comprehensive overview of the research progress in molecular subtyping of BCa,with a primary focus on discussing its utility in guiding various treatment modalities including neoadjuvant chemotherapy,neoadjuvant immunotherapy,and targeted therapy.In addition,this review also covers the trimodality treatment,antibody-drug conjugates,and the treatment of small cell BCa.Results:We present a comprehensive overview of the responsiveness or resistance of different molecular subtypes of BCa to various therapeutic modalities.The basal subtype demonstrates favorable sensitivity to neoadjuvant chemotherapy across multiple classification systems,whereas the luminal infiltrated subtype exhibits potential susceptibility to immunotherapy.In terms of targeted therapy,the basal-like and the basal/squamous subtypes in some classifications have shown notable responsiveness to epidermal growth factor receptor-targeted therapy.Moreover,the luminal subtype in the University of Texas M.D.Anderson Cancer Center classification,the luminal papillary subtypes according to the Cancer Genome Atlas Research Network classification in 2017,and the luminal unstable type in the 2019 Molecular Subtyping classification show potential for the fibroblast growth factor receptor 3-targeted treatment.Conclusion:The significance and impact of BCa molecular subtyping in guiding treatment,evaluating progression,and predicting prognosis are increasingly acknowledged.Accurate subtyping and broad application can bring good benefits to clinical decision-making,risk assessment,and prognostic evaluation.
基金supported by the Guangzhou Municipal Basic Research Program Jointly Funded by City,University,and Enterprise Special Project(2024A03J0907)the Natural Science Foundation of Guangdong Province(2024A1515013201)+1 种基金the National Natural Science Foundation of China(82203720,82203188,82002682,81972731,81773026,81972383)the Science and Technology Project of Zhongshan Municipality(No.2024B1032).
文摘Background:Bladder cancer prognosis remains suboptimal despite advancements in research.Current molecular subtyping methods are resource-intensive,highlighting the need for efficient,cost-effective approaches to predict BCa molecular subtypes.Method:We developed a predictive model for BCa molecular subtypes using machine learning(ML)and pathomics derived from Hematoxylin-Eosin stained pathological slides.A cohort of 353 patients from TCGA was employed,and image features were extracted for analysis.Pathomic signatures were constructed using the LASSO Cox regression algorithm,and a pathomic-clinical nomogram was developed and validated in training and testing cohorts.Results:Seventy distinct image features were identified from 150 pathomic signatures.The model demonstrated robust predictive ability,with AUCs of 0.833 and 0.822 in the training and validation cohorts,respectively.The addition of pathomic score,N stage,and M stage improved the model’s discrimination,achieving AUCs of 0.877 and 0.794 in the training and validation cohorts.Limitations include the lack of an external validation cohort.Conclusion:Our ML-based pathomics model shows promise in predicting BCa molecular subtypes and has the potential to enhance prognosis prediction and inform treatment strategies,marking a significant step towards precision medicine for BCa.
文摘Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.
文摘BACKGROUND Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma(iGBC)and may be associated with poor survival due to presumed high risk of peritoneal seeding.AIM To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC.METHODS Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed.Patient medical records were assessed.Predictors for overall survival(OS)were determined using multivariable Cox regression.RESULTS Of the 346 included patients with iGBC,138(39.9%)had bile spillage,which was associated with higher American Society of Anesthesiologists classification(P=0.020),cholecystitis(P<0.001),higher tumor stage(P=0.005),and non-radical resection(P<0.001).Bile spillage was associated with poor OS[hazard ratio=1.97,95%confidence interval(CI):1.48-2.63,P<0.001]with a median OS of 12 months(95%CI:7-18 months)vs 34 months(95%CI:14-55 months,P<0.001).In multivariable analysis,spillage was not an independent prognostic factor for survival(hazard ratio=1.21,95%CI:0.84-1.74,P=0.313).CONCLUSION Although bile spillage correlates with prognostic factors,it lacks independent prognostic significance for survival.Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center,irrespective of whether bile spillage has occurred.
文摘Gall bladder cancer(GBC)remains a highly aggressive disease,with an overall 5-year dismal survival rate of 15%-20%.Its asymptomatic nature in very early stages and non-specific clinical presentations pose significant challenges to timely detection.Consequently,GBC often presents late,making it one of the most challenging cancers to manage.Surgery offers the best chance for long-term survival;however,only 10%of GBC patients are candidates for upfront resection,with the majority presenting in locally advanced or metastatic stages.Further-more,GBC is generally resistant to chemotherapy and radiotherapy,limiting the effectiveness of systemic therapy.Therefore,early diagnosis is crucial to offer the best treatment through surgical resection and to improve the outcome.Recent advancements in imaging technologies,biomarker discovery,and molecular diagnostics offer promising avenues for enhancing detection rates.Though non-invasive,most of them lack specificity,and the majority fail as an early diagnostic tool.This review examines the current status of early detection strategies for GBC,addresses the limitations of existing approaches,and explores the newer emer-ging diagnostic tools and techniques and how they can be exploited in future for its early detection.
文摘Objective:To systematically review the most recent scientific literature regarding modern strategies for organ preservation in the treatment of non-metastatic muscle-invasive bladder cancer.Methods:Literature search was made using PubMed,Google Scholar,EMBASE,Wiley Library,and ClinicalTrials.gov following the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement.The primary outcome was 5-year overall survival rate,which was addressed by a systematic review and meta-analysis.The risk of bias and quality of evidence were assessed according to the Cochrane Collaboration and the Grading of Recommendations,Assessment,Development and Evaluation system.Results:The evidence is consistent in showing that 5-year survival of trimodality therapy is similar to radical cystectomy in selected patients,ranging between 29%and 73%.Patients undergoing bladder-sparing therapy were found to have better outcomes in terms of quality of life and sociability than those undergoing radical cystectomy.Immunotherapy is establishing itself as a strategy for organ-preservation treatment,showing complete response rates between 42%and 100%.However,most of these results have been obtained from ongoing clinical trials.Furthermore,there are still no studies comparing the efficacy among the different available therapies.Conclusion:Although radical cystectomy remains the gold standard treatment for muscle-invasive bladder cancer,its significant morbidity has prompted the exploration of alternative therapies.In this context,bladder preservation therapies,though supported by limited literature,emerge as a potential alternative that could offer comparable oncological outcomes in selected patients.
基金funded by start-up funds from the University of Chicago.
文摘Bladder cancer remains a significant global health challenge,requiring repeated treatments and surveillance and potentially morbid therapies,particularly in advanced and recurrent stages.Exosomes,small extracellular vesicles central to intercellular communication,have emerged as innovative tools in cancer diagnostics,prognosis,and therapy.Their role in modulating the immune response and the tumor microenvironment makes them particularly attractive for cancer immunotherapy.This review provides a comprehensive overview of exosome biology,with a focus on their role in immune modulation and potential therapeutic applications.We explore the progress and challenges of exosome-based immunotherapy in cancer,followed by a discussion on the current state of bladder cancer immunotherapy.Additionally,we highlight the roles of exosomes in bladder cancer,emphasizing their diagnostic and prognostic applications.Despite promising preclinical studies and a growing number of clinical trials in other cancers,exosome-based therapies remain underexplored in bladder cancer.We discuss the current clinical trials related to exosomes in bladder cancer and propose their potential future role in immunotherapy.Finally,we address the challenges and opportunities in translating exosome-based therapies from bench to bedside,emphasizing the need for further preclinical and clinical investigations.This review emphasized the potential of exosome-based immunotherapy as a transformative approach for bladder cancer diagnosis and treatment.
基金financially supported by the National Natural Science Foundation of China(82071750 and 81772713 to Niu H)Taishan Scholar Program of Shandong Province(tstp20221165 to Niu H).
文摘Objective:This study aimed to investigate the clinicopathological features and prognosis of small cell carcinoma of the urinary bladder(SCCUB).Methods:Clinicopathological data and prognosis of 24 patients with primary SCCUB treated at the Affiliated Hospital of Qingdao University(from January 2016 to December 2021)were retrospectively collected and compared with 335 patients with primary high-grade urothelial carcinoma(HG-UC)during the same period.The study endpoints were disease-free survival(DFS)and overall survival(OS).Results:Of the 24 patients with SCCUB,19 were male and five were female.Eight(33%)cases were pure SCCUB(pSCCUB).Sixteen(67%)cases were mixed SCCUB(mSCCUB),all of which were mixed with urothelial carcinoma.All patients underwent surgery and 13(76%,13/17;seven patients were lost to follow-up)patients received postoperative adjuvant chemotherapy.We found no significant difference in clinicopathological features between pSCCUB and mSCCUB.However,compared to HG-UC,SCCUB had higher lymph node metastasis(p=0.014),more lymphovascular invasion(p=0.024),higher Ki-67 expression(p<0.001),and more disease progression events(p=0.001).Median DFS and OS for SCCUB were 22 months and 38 months,respectively.The Kaplan-Meier survival curve showed that the pathological type or surgical type did not affect DFS or OS of SCCUB.However,SCCUB patients had worse DFS and OS than HG-UC patients(both p<0.05).The multivariate Cox analysis showed that the tumor size(hazard ratio 1.44,95%CI 1.96–2.15,p=0.048)was an independent factor affecting DFS of SCCUB patients.Conclusion:Compared with the common HG-UC,SCCUB is rare with specific clinicopathological features and a worse prognosis.
