The majority of bladder cancers(BCs)are non-muscle invasive BCs(NMIBCs)and show the morphology of a conventional urothelial carcinoma(UC).Aberrant morphology is rare but can be observed.The classification and characte...The majority of bladder cancers(BCs)are non-muscle invasive BCs(NMIBCs)and show the morphology of a conventional urothelial carcinoma(UC).Aberrant morphology is rare but can be observed.The classification and characterization of histologic subtypes(HS)in UC in BC have mainly been described in muscle in-vasive bladder cancer(MIBC).However,the currently used classification is ap-plied for invasive urothelial neoplasm and therefore,also valid for a subset of NMIBC.The standard transurethral diagnostic work-up misses the presence of HS in NMIBC in a considerable percentage of patients and the real prevalence is not known.HS in NMIBC are associated with an aggressive phenotype.Conse-quently,clinical guidelines categorize HS of NMIBC as“(very)high-risk”tumors and recommend offering radical cystectomy to these patients.Alternative strategies for bladder preservation can only be offered to highly selected patients and ideally within clinical trials.Novel treatment strategies and biomarkers have been established MIBC and NMIBC but have not been comprehensively invest-igated in the context of HS in NMIBC.Further evaluation prior to implementation into clinical practice is needed.展开更多
Objective:Neoadjuvant chemotherapy followed by radical cystectomy is considered the standard of care for patients with muscle invasive bladder cancer.In the last decade,interest in neoadjuvant chemotherapy has slowly ...Objective:Neoadjuvant chemotherapy followed by radical cystectomy is considered the standard of care for patients with muscle invasive bladder cancer.In the last decade,interest in neoadjuvant chemotherapy has slowly shifted from methotrexate,vinblastine,doxorubicin and cisplatin regime to gemcitabine and cisplatin regime.There are many publications on gemcitabine and cisplatin regime in literature which cover different aspects of treatment.This review aims to summarise the findings published so far on gemcitabine and cisplatin regime and present it in a concise manner.Methods:A systematic literature review was conducted searching the PubMeddatabase in December 2016 using the medical subject heading(MeSH)with the terms gemcitabine,cisplatin,chemotherapy,muscle invasive bladder cancer,and neoadjuvant.All relevant studies were included and results were analysed.Results:A total of 13 studies were included which published between 2007 and 2015.These 13 studies comprised of 754 subjects suffering from muscle invasive bladder cancer.The proportion of male patients ranged from 60%to 86.4%and the median age ranged from 54.2 to 77.3 years in various studies.Complete pathological response(pT0)was seen in 30.0%of patients and pathological downstaging(<pT2)was seen in 48.67%of patients.Conclusion:As per latest guidelines,neoadjuvant chemotherapy is recommended for patients with muscle invasive bladder cancer.There is substantial pathological downstaging with low toxicity in patients of muscle invasive bladder cancer who receive neoadjuvant gemcitabine and cisplatin regime.展开更多
Objectives: Muscle-invasive bladder cancer (MIBC) has a poor prognosis with a 5-year overall survival rate of 50%. Current guidelines recommend the use of neoadjuvant chemotherapy (NAC) followed by radical cystectomy ...Objectives: Muscle-invasive bladder cancer (MIBC) has a poor prognosis with a 5-year overall survival rate of 50%. Current guidelines recommend the use of neoadjuvant chemotherapy (NAC) followed by radical cystectomy in these patients. However, its application remains limited and underutilized in clinical practice. This study aims to delineate, in real-life practice, the clinical characteristics and outcomes of patients with muscle-invasive bladder cancer (MIBC) who received NAC and were subsequently candidates for cystectomy. Methods: This study is a retrospective observational analysis of patients with muscle-invasive bladder cancer (stages T2-T4aN0M0 and T1-T4aN1M0) who received neoadjuvant chemotherapy prior to total cystectomy. The data, collected over a six-year period from 2018 to 2024, originates from Hotel Dieu de France University Hospital in Beirut. Various factors were analyzed, including age, sex, history of smoking, stage of disease at diagnosis, presence of carcinoma in situ (CIS), and any prior history of Bacillus Calmette-Guérin (BCG) treatment or T1 or Ta disease. Additionally, the study evaluates renal function prior to neoadjuvant chemotherapy (NAC), specifies the type and number of chemotherapy cycles administered, the pathological complete response (pCR) following cystectomy and calculate both overall survival and disease-free survival rates. Results: A total of 36 patients were analyzed, with a median age of 71.6 years. 77.7% were male, 22.2% were female, and 77.8% were smokers. 55.6% of the patients presented with de novo muscle-invasive bladder cancer (MIBC), 44.4% had a history of Ta or T1 stage tumors and 100% had urothelial histology and lower tract location. Among these 36 patients, 27.8% had received intravesical Bacillus Calmette-Guérin (BCG) treatment, while 72.2% did not. 86.1% of patients had a creatinine clearance greater than 60, whereas 13.9% had a clearance below 60 but still above 50. At the time of diagnosis, 61.1% were at stage II, 13.9% were at stage IIIa, and 25.0% were at stage IIIb. All the patients received the combination of gemcitabine and cisplatin with a median number of 3.9 cycles per patient. Out of the 36 patients, 5 experienced disease progression and did not undergo radical cystectomy, while another 5 opted for trimodal therapy (TMT) after evaluation by cystoscopy showing no residual lesion. The remaining 26 patients proceeded with radical cystectomy. Among these 26 cystectomized, 30.8% demonstrated a complete pathological response. During the follow-up period, 75% of these 36 patients did not experience disease progression, with a median disease-free survival of 9.5 months and a mean disease-free survival of 19.72 months. No deaths were recorded in this study, and overall survival data could not be determined. Conclusion: In our real-world experience, approximately one-third of patients who received gemcitabine and cisplatin NAC followed by radical cystectomy achieved a pathological complete response. Extended follow-up is necessary to assess long-term outcomes, including median overall survival. Future research should focus on investigating and comparing between triple modality therapy and cystectomy, both after neoadjuvant chemotherapy.展开更多
We are reporting a case of urothelial bladder cancer in a 36 year old male patient with no history or exposure to any risk factors.The incidence of urothelial bladder cancer is very low in young individuals i.e.below ...We are reporting a case of urothelial bladder cancer in a 36 year old male patient with no history or exposure to any risk factors.The incidence of urothelial bladder cancer is very low in young individuals i.e.below 40 years of age with reported rate of incidence around 0.1-0.4%.Most of the times,these young individuals present with non-muscle invasive bladder cancer with low grade and low stage.As the age increases,the incidence of high grade bladder cancer increases along with it.The index case presented with high grade muscle invasive bladder cancer at the time of diagnosis without any known risk factors.The 5-year survival of urothelial bladder cancer is better in young patients(93.8%)as compared to older people(85.1%).Cigarette smoking is responsible for development of bladder cancer in majority of patients followed by exposure to occupational carcinogens.Role of genetic alterations in development of bladder cancer is still under research and process of urothelial bladder carcinogenesis is unanswered in young individuals.展开更多
BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non�Hodgkin lymphoma,and patients with DLBCL typically present rapidly growing masses.Lymphoma involving muscle is rare and accounts for onl...BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non�Hodgkin lymphoma,and patients with DLBCL typically present rapidly growing masses.Lymphoma involving muscle is rare and accounts for only 5%;furthermore,multiple muscles and soft tissue involvement of DLBCL is unusual.Due to unusual clinical manifestation,accurate diagnosis could be delayed.CASE SUMMARY A 61-year-old man complained of swelling,pain and erythematous changes in the lower abdomen.Initially,soft tissue infection was suspected,however,skin lesion did not respond to antibiotics.18Fluoro-2-deoxy-D-glucose(18F-FDG)positron emission tomography-computed tomography demonstrated FDG uptake not only in the skin and subcutaneous tissue of the abdomen but also in the abdominal wall muscles,peritoneum,perineum,penis and testis.DLBCL was confirmed by biopsy of the abdominal wall muscle and subcutaneous tissue.After intensive treatment including chemotherapy with rituximab,cyclophosphamide,doxorubicin,vincristine and prednisolone,central nervous system prophylaxis(intrathecal injection of methotrexate,cytarabine and hydrocortisone)and orchiectomy,he underwent peripheral blood stem cell mobilization for an autologous hematopoietic stem cell transplantation.Despite intensive treatment,the disease progressed rapidly and the patient showed poor outcome(overall survival,9 mo;disease free survival,3 mo).CONCLUSION The first clinical manifestation of soft tissue DLBCL involving multiple muscles was similar to the infection of the soft tissue.展开更多
Dear Editor,Radical cystectomy(RC)remains the standard treatment for muscle-invasive bladder cancer[1].However,urinary diversion after RC can lead to a range of postoperative complications,including parastomal hernia,...Dear Editor,Radical cystectomy(RC)remains the standard treatment for muscle-invasive bladder cancer[1].However,urinary diversion after RC can lead to a range of postoperative complications,including parastomal hernia,incontinence,urinary retention,recurrent urinary tract infections,and metabolic disorders,significantly impacting patients'quality of life[2].Partial cystectomy(PC)is a bladdersparing alternative for patients who cannot accept RC and has been utilized in managing muscle-invasive bladder cancer since the last century.However,the application of PC has always been a subject of controversy in clinical practice due to the high recurrence rate.In a matched case-control analysis conducted by Knoedler et al.[3],38%of the patients experienced intravesical tumor recurrence,and 19%of the patients ultimately underwent RC.Another study in the Memorial Sloan-Kettering Cancer Center showed that 22 of 58 patients who received PC experienced superficial or advanced recurrence[4].展开更多
Objective This study aimed to assess the local staging of bladder tumors in patients utilizing preoperative multiparametric MRI(mpMRI)and to demonstrate the clinical efficacy of this method through a comparative analy...Objective This study aimed to assess the local staging of bladder tumors in patients utilizing preoperative multiparametric MRI(mpMRI)and to demonstrate the clinical efficacy of this method through a comparative analysis with corresponding histopathological findings.Methods Between November 2020 and April 2022,63 patients with a planned cystoscopy and a preliminary or previous diagnosis of bladder tumor were included.All participants underwent mpMRI,and Vesical Imaging Reporting and Data System(VI-RADS)criteria were applied to assess the recorded images.Subsequently,obtained biopsies were histopathologically examined and compared with radiological findings.Results Of the 63 participants,60 were male,and three were female.Categorizing tumors with a VI-RADS score of>3 as muscle invasive,84%were radiologically classified as having an invasive bladder tumor.However,histopathological results indicated invasive bladder tumors in 52%of cases.Sensitivity of the VI-RADS score was 100%;specificity was 23%;the negative predictive value was 100%;and the positive predictive value was 62%.Conclusion The scoring system obtained through mpMRI,VI-RADS,proves to be a successful method,particularly in determining the absence of muscle invasion in bladder cancer.Its efficacy in detecting muscle invasion in bladder tumors could be further enhanced with additional studies,suggesting potential for increased diagnostic efficiency through ongoing research.The VI-RADS could enhance the selection of patients eligible for accurate diagnosis and treatment.展开更多
Fifty years after the introduction of Bacillus Calmette-Guérin(BCG),a live attenuated strain of Mycobacterium bovis[1],it is still the most effective and successful adjuvant immunotherapy of non-muscle invasive b...Fifty years after the introduction of Bacillus Calmette-Guérin(BCG),a live attenuated strain of Mycobacterium bovis[1],it is still the most effective and successful adjuvant immunotherapy of non-muscle invasive bladder cancer(NMIBC)[2].The guidelines of the European Association of Urology(EAU)suggest a 6-weekly induction phase followed by a maintenance schedule of BCG once weekly for 3 weeks and at 3,6,12,18,24,30,and 36 months for 1 to 3 years[2].展开更多
文摘The majority of bladder cancers(BCs)are non-muscle invasive BCs(NMIBCs)and show the morphology of a conventional urothelial carcinoma(UC).Aberrant morphology is rare but can be observed.The classification and characterization of histologic subtypes(HS)in UC in BC have mainly been described in muscle in-vasive bladder cancer(MIBC).However,the currently used classification is ap-plied for invasive urothelial neoplasm and therefore,also valid for a subset of NMIBC.The standard transurethral diagnostic work-up misses the presence of HS in NMIBC in a considerable percentage of patients and the real prevalence is not known.HS in NMIBC are associated with an aggressive phenotype.Conse-quently,clinical guidelines categorize HS of NMIBC as“(very)high-risk”tumors and recommend offering radical cystectomy to these patients.Alternative strategies for bladder preservation can only be offered to highly selected patients and ideally within clinical trials.Novel treatment strategies and biomarkers have been established MIBC and NMIBC but have not been comprehensively invest-igated in the context of HS in NMIBC.Further evaluation prior to implementation into clinical practice is needed.
文摘Objective:Neoadjuvant chemotherapy followed by radical cystectomy is considered the standard of care for patients with muscle invasive bladder cancer.In the last decade,interest in neoadjuvant chemotherapy has slowly shifted from methotrexate,vinblastine,doxorubicin and cisplatin regime to gemcitabine and cisplatin regime.There are many publications on gemcitabine and cisplatin regime in literature which cover different aspects of treatment.This review aims to summarise the findings published so far on gemcitabine and cisplatin regime and present it in a concise manner.Methods:A systematic literature review was conducted searching the PubMeddatabase in December 2016 using the medical subject heading(MeSH)with the terms gemcitabine,cisplatin,chemotherapy,muscle invasive bladder cancer,and neoadjuvant.All relevant studies were included and results were analysed.Results:A total of 13 studies were included which published between 2007 and 2015.These 13 studies comprised of 754 subjects suffering from muscle invasive bladder cancer.The proportion of male patients ranged from 60%to 86.4%and the median age ranged from 54.2 to 77.3 years in various studies.Complete pathological response(pT0)was seen in 30.0%of patients and pathological downstaging(<pT2)was seen in 48.67%of patients.Conclusion:As per latest guidelines,neoadjuvant chemotherapy is recommended for patients with muscle invasive bladder cancer.There is substantial pathological downstaging with low toxicity in patients of muscle invasive bladder cancer who receive neoadjuvant gemcitabine and cisplatin regime.
文摘Objectives: Muscle-invasive bladder cancer (MIBC) has a poor prognosis with a 5-year overall survival rate of 50%. Current guidelines recommend the use of neoadjuvant chemotherapy (NAC) followed by radical cystectomy in these patients. However, its application remains limited and underutilized in clinical practice. This study aims to delineate, in real-life practice, the clinical characteristics and outcomes of patients with muscle-invasive bladder cancer (MIBC) who received NAC and were subsequently candidates for cystectomy. Methods: This study is a retrospective observational analysis of patients with muscle-invasive bladder cancer (stages T2-T4aN0M0 and T1-T4aN1M0) who received neoadjuvant chemotherapy prior to total cystectomy. The data, collected over a six-year period from 2018 to 2024, originates from Hotel Dieu de France University Hospital in Beirut. Various factors were analyzed, including age, sex, history of smoking, stage of disease at diagnosis, presence of carcinoma in situ (CIS), and any prior history of Bacillus Calmette-Guérin (BCG) treatment or T1 or Ta disease. Additionally, the study evaluates renal function prior to neoadjuvant chemotherapy (NAC), specifies the type and number of chemotherapy cycles administered, the pathological complete response (pCR) following cystectomy and calculate both overall survival and disease-free survival rates. Results: A total of 36 patients were analyzed, with a median age of 71.6 years. 77.7% were male, 22.2% were female, and 77.8% were smokers. 55.6% of the patients presented with de novo muscle-invasive bladder cancer (MIBC), 44.4% had a history of Ta or T1 stage tumors and 100% had urothelial histology and lower tract location. Among these 36 patients, 27.8% had received intravesical Bacillus Calmette-Guérin (BCG) treatment, while 72.2% did not. 86.1% of patients had a creatinine clearance greater than 60, whereas 13.9% had a clearance below 60 but still above 50. At the time of diagnosis, 61.1% were at stage II, 13.9% were at stage IIIa, and 25.0% were at stage IIIb. All the patients received the combination of gemcitabine and cisplatin with a median number of 3.9 cycles per patient. Out of the 36 patients, 5 experienced disease progression and did not undergo radical cystectomy, while another 5 opted for trimodal therapy (TMT) after evaluation by cystoscopy showing no residual lesion. The remaining 26 patients proceeded with radical cystectomy. Among these 26 cystectomized, 30.8% demonstrated a complete pathological response. During the follow-up period, 75% of these 36 patients did not experience disease progression, with a median disease-free survival of 9.5 months and a mean disease-free survival of 19.72 months. No deaths were recorded in this study, and overall survival data could not be determined. Conclusion: In our real-world experience, approximately one-third of patients who received gemcitabine and cisplatin NAC followed by radical cystectomy achieved a pathological complete response. Extended follow-up is necessary to assess long-term outcomes, including median overall survival. Future research should focus on investigating and comparing between triple modality therapy and cystectomy, both after neoadjuvant chemotherapy.
文摘We are reporting a case of urothelial bladder cancer in a 36 year old male patient with no history or exposure to any risk factors.The incidence of urothelial bladder cancer is very low in young individuals i.e.below 40 years of age with reported rate of incidence around 0.1-0.4%.Most of the times,these young individuals present with non-muscle invasive bladder cancer with low grade and low stage.As the age increases,the incidence of high grade bladder cancer increases along with it.The index case presented with high grade muscle invasive bladder cancer at the time of diagnosis without any known risk factors.The 5-year survival of urothelial bladder cancer is better in young patients(93.8%)as compared to older people(85.1%).Cigarette smoking is responsible for development of bladder cancer in majority of patients followed by exposure to occupational carcinogens.Role of genetic alterations in development of bladder cancer is still under research and process of urothelial bladder carcinogenesis is unanswered in young individuals.
文摘BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non�Hodgkin lymphoma,and patients with DLBCL typically present rapidly growing masses.Lymphoma involving muscle is rare and accounts for only 5%;furthermore,multiple muscles and soft tissue involvement of DLBCL is unusual.Due to unusual clinical manifestation,accurate diagnosis could be delayed.CASE SUMMARY A 61-year-old man complained of swelling,pain and erythematous changes in the lower abdomen.Initially,soft tissue infection was suspected,however,skin lesion did not respond to antibiotics.18Fluoro-2-deoxy-D-glucose(18F-FDG)positron emission tomography-computed tomography demonstrated FDG uptake not only in the skin and subcutaneous tissue of the abdomen but also in the abdominal wall muscles,peritoneum,perineum,penis and testis.DLBCL was confirmed by biopsy of the abdominal wall muscle and subcutaneous tissue.After intensive treatment including chemotherapy with rituximab,cyclophosphamide,doxorubicin,vincristine and prednisolone,central nervous system prophylaxis(intrathecal injection of methotrexate,cytarabine and hydrocortisone)and orchiectomy,he underwent peripheral blood stem cell mobilization for an autologous hematopoietic stem cell transplantation.Despite intensive treatment,the disease progressed rapidly and the patient showed poor outcome(overall survival,9 mo;disease free survival,3 mo).CONCLUSION The first clinical manifestation of soft tissue DLBCL involving multiple muscles was similar to the infection of the soft tissue.
基金supported by Natural Science Foundation of Hubei Province(ZRMS2020002466 to Liu Z).
文摘Dear Editor,Radical cystectomy(RC)remains the standard treatment for muscle-invasive bladder cancer[1].However,urinary diversion after RC can lead to a range of postoperative complications,including parastomal hernia,incontinence,urinary retention,recurrent urinary tract infections,and metabolic disorders,significantly impacting patients'quality of life[2].Partial cystectomy(PC)is a bladdersparing alternative for patients who cannot accept RC and has been utilized in managing muscle-invasive bladder cancer since the last century.However,the application of PC has always been a subject of controversy in clinical practice due to the high recurrence rate.In a matched case-control analysis conducted by Knoedler et al.[3],38%of the patients experienced intravesical tumor recurrence,and 19%of the patients ultimately underwent RC.Another study in the Memorial Sloan-Kettering Cancer Center showed that 22 of 58 patients who received PC experienced superficial or advanced recurrence[4].
文摘Objective This study aimed to assess the local staging of bladder tumors in patients utilizing preoperative multiparametric MRI(mpMRI)and to demonstrate the clinical efficacy of this method through a comparative analysis with corresponding histopathological findings.Methods Between November 2020 and April 2022,63 patients with a planned cystoscopy and a preliminary or previous diagnosis of bladder tumor were included.All participants underwent mpMRI,and Vesical Imaging Reporting and Data System(VI-RADS)criteria were applied to assess the recorded images.Subsequently,obtained biopsies were histopathologically examined and compared with radiological findings.Results Of the 63 participants,60 were male,and three were female.Categorizing tumors with a VI-RADS score of>3 as muscle invasive,84%were radiologically classified as having an invasive bladder tumor.However,histopathological results indicated invasive bladder tumors in 52%of cases.Sensitivity of the VI-RADS score was 100%;specificity was 23%;the negative predictive value was 100%;and the positive predictive value was 62%.Conclusion The scoring system obtained through mpMRI,VI-RADS,proves to be a successful method,particularly in determining the absence of muscle invasion in bladder cancer.Its efficacy in detecting muscle invasion in bladder tumors could be further enhanced with additional studies,suggesting potential for increased diagnostic efficiency through ongoing research.The VI-RADS could enhance the selection of patients eligible for accurate diagnosis and treatment.
文摘Fifty years after the introduction of Bacillus Calmette-Guérin(BCG),a live attenuated strain of Mycobacterium bovis[1],it is still the most effective and successful adjuvant immunotherapy of non-muscle invasive bladder cancer(NMIBC)[2].The guidelines of the European Association of Urology(EAU)suggest a 6-weekly induction phase followed by a maintenance schedule of BCG once weekly for 3 weeks and at 3,6,12,18,24,30,and 36 months for 1 to 3 years[2].
