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Systematic review and meta-analysis of radiation therapy for high-risk non-muscle invasive bladder cancer.

Urol Oncol 2021 Apr 10. Epub 2021 Apr 10.

University of Colorado, Division of Urology, Aurora, CO; Yale University, Cancer Outcomes and Public Policy Effectiveness Research, (COPPER) Center, New Haven, CT. Electronic address:

Introduction: Radiation therapy (XRT) has been investigated as a possible treatment for high-risk non-muscle invasive bladder cancer (NMIBC) with the goal of bladder preservation, especially with the ongoing Bacillus Calmette-Guerin (BCG) shortage. Yet, little is known about the clinical efficacy and the quality of evidence supporting XRT for NMIBC. Herein, we performed a systematic review and meta-analysis to evaluate XRT in the treatment of patients with high-risk NMIBC. Read More

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Apparent Diffusion Coefficient Value can Predict Poor Bacillus Calmette-Guérin Responders in T1HG/NMIBC: Prospective Cohort Study.

Clin Genitourin Cancer 2021 Mar 17. Epub 2021 Mar 17.

Urology Department, Zagazig University, Zagazig, Egypt. Electronic address:

Background: Prediction of recurrence and progression and the choice of type of management are largely based on stage and grade; however, these prognostic features are limited in the prediction of clinical outcomes. The objective was to investigate the relation between the apparent diffusion coefficient (ADC) value and recurrence and progression of T1G3 of urothelial carcinoma after transurethral resection of the bladder tumor (TURBT) and Bacillus Calmette-Guérin instillation.

Materials And Methods: This prospective study included 65 patients with single bladder mass T1G3 less than 3 cm without carcinoma in situ or lymphovascular invasion. Read More

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Active surveillance for non-muscle invasive bladder cancer: A systematic review and pooled-analysis.

Cancer Treat Res Commun 2021 Apr 3;27:100369. Epub 2021 Apr 3.

IRCCS Humanitas Research Hospital - Rozzano, Milan, Italy.

Introduction: One of the Non-Muscle Invasive Bladder Cancer (NMIBC) treatment options recently recommended by International Guidelines is represented by Active Surveillance (AS),. Herein we carried out a systematic review and pooled-analysis of currently available evidences in order to provide recommendations for daily urological practice.

Material And Methods: The PubMed, EMBASE, and Coch rane Library databases were searched with the terms "Non-Muscle Invasive" or "pTa/pT1" and "Bladder Cancer" or "Bladder Tumor". Read More

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Assessing treatment response after intravesical bacillus Calmette-Guerin induction cycle: are routine bladder biopsies necessary?

World J Urol 2021 Apr 8. Epub 2021 Apr 8.

Department of Urology and Renal Transplantation, University of Foggia-Ospedali Riuniti of Foggia, Foggia, Italy.

Purpose: To determine the need for routine bladder biopsies (BBs) in assessing response to the induction cycle of intravesical bacillus Calmette-Guérin (BCG) for high-risk non-muscle-invasive bladder cancer (NMIBC).

Methods: Our prospectively maintained NMIBC database was queried to identify patients with high-risk disease (carcinoma in situ, high-grade Ta/T1) who underwent BBs after BCG induction cycle. Urine cytology, cystoscopy, and BBs findings were evaluated. Read More

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[A Randomized Controlled Study of Intravesical Instillation Therapy of Bacillus Calmette-Guérin vs. Epirubicinin Treating Non-muscular Invasive Bladder Cancer].

Sichuan Da Xue Xue Bao Yi Xue Ban 2021 Mar;52(2):326-333

Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China.

Objective: To explore the best treatment plan of intravesical instillation for patients with non-muscular invasive bladder cancer (NMIBC), to explore recurrence-related clinicopathological factors after intravesical instillation, and to evaluate the value of the prognosis and prediction models currently used for NMIBC patients.

Methods: Starting from 2016, patients who underwent transurethral resection of bladder tumor (TURBT) in our hospital and who received post-surgery diagnosis of having intermediate or high risks for NMIBC were enrolled in the study. They were randomly assigned to different group sat a ratio of 2∶2∶1 for receiving intravesical instillation therapy of Bacillus Calmette-Guérin (BCG) for 19 times, BCG for 15 times, and epirubicin (EPI) for 18 times. Read More

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Diagnostic performance of Oncuria™, a urinalysis test for bladder cancer.

J Transl Med 2021 Apr 6;19(1):141. Epub 2021 Apr 6.

Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, USA.

Background: Due to insufficient accuracy, urine-based assays currently have a limited role in the management of patients with bladder cancer. The identification of multiplex molecular signatures associated with disease has the potential to address this deficiency and to assist with accurate, non-invasive diagnosis and monitoring.

Methods: To evaluate the performance of Oncuria™, a multiplex immunoassay for bladder detection in voided urine samples. Read More

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Detection of Urothelial Bladder Cancer Based on Urine and Tissue Telomerase Activity Measured by Novel RT-TRAP-2PCR Method.

J Clin Med 2021 Mar 4;10(5). Epub 2021 Mar 4.

Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia.

Purpose: To assess the diagnostic performance of urine telomerase activity (TA) in detecting bladder cancer (BCa) using the modified Telomeric Repeat Amplification Protocol (TRAP) and the Real Time Telomeric Repeat Amplification Protocol with double Polymerase Chain Reaction (RT-TRAP-2PCR).

Methods: In this case-control study, matching urine (in the pre- and post-surgical period) and tissue samples from 68 patients with BCa were assessed for TA. As a control, 45 urine samples were examined from non-BCa patients. Read More

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Longitudinal Follow-up and Performance Validation of a mRNA-based Urine Test (Xpert® Bladder Cancer Monitor) for surveillance in Non-Muscle Invasive Bladder Cancer Patients.

BJU Int 2021 Apr 1. Epub 2021 Apr 1.

UT Southwestern, 5323 Harry Hines Blvd. J8.112, Dallas, TX, 75390-9110, USA.

Purpose: Frequent recurrences and the potential for progression of non-muscle-invasive bladder cancer (NMIBC) demand close surveillance. This prospective study evaluated the performance of Xpert Bladder Cancer Monitor (Xpert) test as a predictor of tumor recurrence.

Patients And Methods: Patients (n=429) undergoing surveillance for NMIBC underwent Xpert, cytology, and UroVysion testing. Read More

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Clinical Significance of Horizontal and Vertical Margin of En Bloc Resection for Non-Muscle Invasive Bladder Cancer.

J Urol 2021 Mar 29:101097JU0000000000001735. Epub 2021 Mar 29.

Department of Urology, The Jikei University School of Medicine, Kashiwa, Chiba, Japan.

Purpose: The primary advantage of en bloc resection of bladder tumors (ERBT) is to provide better diagnostic accuracy. However, the clinical significance of horizontal and vertical margin has not been demonstrated. We evaluated the clinical importance of surgical margins in patients who underwent ERBT. Read More

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Overnight Continuous Saline Bladder Irrigation After Resection of Bladder Tumor Does Not Improve Oncological Outcomes in Patients Who Have Received Intravesical Chemotherapy.

Front Oncol 2021 10;11:638065. Epub 2021 Mar 10.

First Clinical Medical College, Shanxi Medical University, Taiyuan, China.

Objective: To evaluate the safety and efficacy of overnight continuous saline bladder irrigation (CSBI) for patients who have received thulium laser resection of bladder tumor (TmLRBT) combined with immediate intravesical chemotherapy previously.

Methods: From October 2014 to June 2018, 235 patients with newly diagnosed non-muscle invasive bladder cancer (NMIBC) were included in this retrospective study. All patients received intravesical instillation of pirarubicin immediately after TmLRBT. Read More

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BCG-unresponsive high-grade non-muscle invasive bladder cancer: what does the practicing urologist need to know?

World J Urol 2021 Mar 27. Epub 2021 Mar 27.

University Hospital of Bicêtre-Paris Sud-Saclay University, Le Kremlin Bicêtre, Paris, France.

Purpose: Bacille Calmette-Guérin (BCG) is a well-established treatment for preventing or delaying tumour recurrence following high-grade nonmuscle invasive bladder cancer (NMIBC) resection. However, many patients will experience recurrence or progression during or following BCG. This scenario has been one of the most challenging in urologic oncology for several decades since BCG implementation. Read More

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International Society of Urological Pathology Expert Opinion on Grading of Urothelial Carcinoma.

Eur Urol Focus 2021 Mar 23. Epub 2021 Mar 23.

Indiana University School of Medicine, Indianapolis, IN, USA.

Context: Grading is the mainstay for treatment decisions for patients with non-muscle-invasive bladder cancer (NMIBC).

Objective: To determine the requirements for an optimal grading system for NMIBC via expert opinion.

Evidence Acquisition: A multidisciplinary working group established by the International Society of Urological Pathology reviewed available clinical, histopathological, and molecular evidence for an optimal grading system for bladder cancer. Read More

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Assessment of Xpert Bladder Cancer Monitor test performance for the detection of recurrence during non-muscle invasive bladder cancer follow-up.

World J Urol 2021 Mar 26. Epub 2021 Mar 26.

Sorbonne Université, GRC n°5, Predictive Onco-Urology, AP-HP, Hôpital Tenon, Service d'Urologie-Batiment Gabriel, 4 rue de la Chine, 75020, Paris, France.

Purpose: To assess the performance of the Xpert Bladder Cancer (BC) Monitor during the follow-up of patients with non-muscle invasive bladder cancer (NMIBC).

Methods: Patients with previously diagnosed NMIBC and followed up in clinical practice settings in two French urology departments between September 2017 and July 2019 were consecutively enrolled in this prospective observational study. Patients with a positive cystoscopy or computed tomography urogram underwent subsequent transurethral resection of the bladder, and/or biopsy, and the specimens were pathologically assessed. Read More

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Expression of VISTA on tumor-infiltrating immune cells correlated with short intravesical recurrence in non-muscle-invasive bladder cancer.

Cancer Immunol Immunother 2021 Mar 26. Epub 2021 Mar 26.

Department of Microbiology and Immunology, Innovative Therapeutics Research Institute, Inje University College of Medicine, Busan, Korea.

V-domain immunoglobulin suppressor of T cell activation (VISTA) is an immune checkpoint molecule expressed in hematopoietic cells, granulocytes, macrophages, and monocytes. However, few studies to date have investigated VISTA expression, especially its clinical utility, in bladder cancer. The present retrospective study aimed to examine VISTA, programmed death ligand-1 (PD-L1), and CD45 expression by immunohistochemical and immunofluorescence staining of archived pathological tissue samples from 159 patients with primary bladder cancer. Read More

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Impact of systemic inflammatory markers on the response to Hyperthermic IntraVEsical Chemotherapy (HIVEC) in patients with non-muscle-invasive bladder cancer after bacillus Calmette-Guérin failure.

Arab J Urol 2021 Jan 13;19(1):86-91. Epub 2021 Jan 13.

Department of Urology, Azienda Ospedaliera di Rilievo Nazionale (A.O.R.N.) Antonio Cardarelli, Naples, Italy.

: To evaluate the impact of pre- and post-treatment systemic inflammatory markers on the response to Hyperthermic IntraVEsical Chemotherapy (HIVEC) treatment in a cohort of patients with high-grade non-muscle-invasive bladder cancer with bacillus Calmette-Guérin (BCG) failure or intolerance who were unsuitable or unwilling to undergo early radical cystectomy. As a secondary endpoint, we assessed the influence of some demographic, clinical and pathological factors on the response to chemo-hyperthermia. : Between March 2017 and December 2019, 72 consecutive patients were retrospectively analysed. Read More

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January 2021

Assessment of the oncological outcomes of three different bacillus Calmette-Guérin strains in patients with high-grade T1 non-muscle-invasive bladder cancer.

Arab J Urol 2021 Jan 13;19(1):78-85. Epub 2021 Jan 13.

Department of Urology and Oncologic Urology, Wroclaw Medical Univeristy, Wroclaw, Poland.

Objective: : To determine whether there are significant differences in oncological outcomes between three different bacillus Calmette-Guérin (BCG) strains used for adjuvant intravesical immunotherapy in patients with high-grade T1 (T1HG) non-muscle-invasive bladder cancer (NMIBC).

Patients And Methods: : Data of 590 patients with a diagnosis of primary T1HG NMIBC were retrospectively reviewed. The study included 138 (23. Read More

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January 2021

Electro-mediated drug administration of mitomycin C in preventing non-muscle-invasive bladder cancer recurrence and progression after transurethral resection of the bladder tumour in intermediate- and high-risk patients.

Arab J Urol 2020 Aug 31;19(1):71-77. Epub 2020 Aug 31.

Department of Urology, Ospedale F. Miulli, Acquaviva delle Fonti, Bari, Italy.

Objective: To evaluate the effectiveness of electro-mediated drug administration of mitomycin C (EMDA/MMC) after transurethral resection of the bladder tumour (TURBT) in preventing non-muscle-invasive bladder cancer (NMIBC) recurrence and progression and to explore clinical and demographic factors associated with treatment response.

Patients And Methods: Between April 2016 and August 2019, 112 patients diagnosed with intermediate- or high-risk NMIBC underwent a TURBT followed by an EMDA/MMC treatment. The percentage of treatment responders and progression-free survivors at 3 and 6 months were evaluated. Read More

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Diagnostic value of Xpert Bladder Cancer Monitor in the follow-up of patients affected by non-muscle invasive bladder cancer: an update.

Ther Adv Urol 2021 Jan-Dec;13:1756287221997183. Epub 2021 Mar 5.

Department of Urology, Bolzano General Hospital, Lorenz Böhler St 5, Bolzano, 39100, Italy.

Aims: Xpert Bladder Cancer Monitor is a urinary marker based on the evaluation of five target mRNAs overexpressed in patients with bladder cancer (BC). The aim of our study is to update our results regarding the diagnostic accuracy of the Xpert Bladder Cancer Monitor test in the follow-up of patients with non-muscle invasive bladder cancer (NMIBC).

Methods: We conducted a prospective study on 1015 samples of 416 patients (mean age 72. Read More

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Systemic combining inflammatory score (SCIS): a new score for prediction of oncologic outcomes in patients with high-risk non-muscle-invasive urothelial bladder cancer.

Transl Androl Urol 2021 Feb;10(2):626-635

Urology Section, Department of Surgery, University of Catania, Catania, Italy.

Background: An accurate and early diagnosis of bladder cancer (BC) is essential to offer patients the most appropriate treatment and the highest cure rate. For this reason, patients need to be best stratified by class and risk factors. We aimed to develop a score able to better predict cancer outcomes, using serum variables of inflammation. Read More

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February 2021

Fibronectin urothelial gene expression as a new reliable biomarker for early detection of local toxicity secondary to adjuvant intravesical therapy for non-muscle invasive bladder cancer.

Ther Adv Urol 2021 Jan-Dec;13:1756287221995683. Epub 2021 Feb 27.

Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Sicilia, Italy.

Background: A marker of urothelial damage could be helpful for early detection and monitoring of local toxicity due to intravesical therapy for non-muscle invasive bladder cancer (NMIBC). The aim of the study was to investigate the correlation between fibronectin (FN) gene expression in bladder washings and local toxicity secondary to adjuvant intravesical therapy.

Materials And Methods: Patients undergoing adjuvant intravesical therapy for NMIBC and age-matched healthy patients were enrolled. Read More

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February 2021

STAG2 as a prognostic biomarker in low-grade non-muscle invasive bladder cancer.

Urol Oncol 2021 Mar 9. Epub 2021 Mar 9.

Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC. Electronic address:

Objective: Improvements to bladder cancer risk stratification guidelines are needed to better tailor post-operative surveillance and adjuvant therapy to individual patients. We previously identified STAG2 as a commonly mutated tumor suppressor gene in bladder cancer and an independent predictor of progression in NMIBC. Here we test the value of combining STAG2 immunostaining with other risk stratification biomarkers in NMIBC, and as an individual biomarker in MIBC. Read More

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Rapamycin enhances BCG-specific γδ T cells during intravesical BCG therapy for non-muscle invasive bladder cancer: a randomized, double-blind study.

J Immunother Cancer 2021 Mar;9(3)

Experimental Developmental Therapeutics (EDT) Program, Mays Cancer Center at UT Health MD Anderson, San Antonio, Texas, USA

Background: Although intravesical BCG is the standard treatment of high-grade non-muscle invasive bladder cancer (NMIBC), response rates remain unsatisfactory. In preclinical models, rapamycin enhances BCG vaccine efficacy against tuberculosis and the killing capacity of γδ T cells, which are critical for BCG's antitumor effects. Here, we monitored immunity, safety, and tolerability of rapamycin combined with BCG in patients with NMIBC. Read More

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The prognostic value of cytokeratin and extracellular collagen expression in urinary bladder cancer.

Curr Mol Med 2021 Feb 24. Epub 2021 Feb 24.

Institute of Pathology, Faculty of Medicine, University of Duisburg-Essen, 45147 Essen. Germany.

Background: Expression levels of collagens have been implicated in the progression of various cancers and interact with cytokeratins, but are not well studied in bladder cancer (BC). Therefore, we analyzed the gene and protein expression levels of collagen 1A1 (Col1a1/COL1A1), collagen 3A1 (col3a1/COL3A1), collagen 5A2 (col5a2/COL5A2), cytokeratin 14 (krt14/CK14), and cytokeratin 17 (krt17/CK17) in urothelial BC samples of different stages.

Methods: In total, 102 fresh frozen and 190 formalin fixed and paraffin embedded (FFPE) samples were tested using immunohistochemistry and RT-qPCR. Read More

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February 2021

Primary Complete Transurethral Resection of Bladder Tumor Using Photodynamic Diagnosis for High-Risk Nonmuscle Invasive Bladder Cancer: Is a Restaging Photodynamic Transurethral Resection Really Necessary?

J Endourol 2021 Mar 26. Epub 2021 Mar 26.

Department of Urology and Kidney Transplantation, Conception Academic Hospital, Aix-Marseille University, APHM, Marseille, France.

To evaluate the risk of residual tumor and tumor upstaging during a second resection after primary complete transurethral resection of bladder tumor (TURBT) using photodynamic diagnosis (PDD) for high-risk nonmuscle invasive bladder cancer (NMIBC). From January 2014 to March 2020, a single-institutional study was conducted including consecutive patients with high-risk NMIBC (T1 and/or and/or high grade) who underwent a restaging transurethral resection (reTUR) within 12 weeks after a primary complete resection. Each TURBT was performed using blue light after intravesical instillation of hexaminolevulinate. Read More

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Monopolar versus bipolar transurethral resection of lateral wall-located bladder cancer under obturator nerve block: a single center prospective randomized study.

Int Braz J Urol 2021 May-Jun;47(3):584-593

University of Health Sciences, Bozyaka Training and Research Hospital, Izmir, Turkey.

Introduction: The aim of the present prospective-randomized study was to compare perioperative outcomes and complications of bipolar and monopolar TURBT for lateral wall-located non-muscle invasive bladder cancers (NMIBC) under obturator nerve block (ONB).

Patients And Methods: 80 patients who underwent TURBT for lateral wall-located primary bladder tumors under ONB from March, 2016 to November, 2019 were included in the present study. The patients were randomized equally into two groups; monopolar TUR (M-TURBT) and bipolar TUR (B-TURBT). Read More

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Promoter hypomethylation as potential confounder of Ras gene overexpression and their clinical significance in subsets of urothelial carcinoma of bladder.

Mol Biol Rep 2021 Feb 23. Epub 2021 Feb 23.

Department of Biochemistry, University of Lucknow, Lucknow, 226007, India.

Overexpression of normal Ras and its aberrant CpG island methylation in the promoter regions have been shown to direct cells for uncontrolled abnormal growth and bladder tumor formation and therefore, fetched recent attention as a marker of diagnosis and prognosis to predict the biological behavior of urothelial carcinoma of bladder (UCB). Methylation pattern at CpG islands of the promoter regions of rat sarcoma (Ras) gene homologues namely Kristen-Ras (K-Ras), Harvey (H-Ras), and Neuroblastoma (N-Ras) were examined by methylation specific polymerase chain reaction (MSP). Real time-quantitative polymerase chain reaction (RT-qPCR) was done to determine transcriptomic expressions of these Ras isoforms in the prospective series of 42 NMIBC (non-muscle invasive bladder cancer) and 45 MIBC (muscle invasive bladder cancer) biopsies. Read More

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February 2021

A Systematic Review of the Efficacy and Safety of Outpatient Bladder Tumour Ablation.

Eur Urol Focus 2021 Feb 15. Epub 2021 Feb 15.

Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

Context: Management of non-muscle-invasive bladder cancer (NMIBC) is costly and associated with negative health-related quality-of-life effects, in part because of the frequent need for repeated transurethral resections under general/regional anaesthesia. Outpatient-based diathermy or laser ablation is another option, but evidence for its efficacy is mixed and its use is controversial.

Objective: To systematically review evidence regarding the efficacy and safety of outpatient diathermy and laser ablation for the treatment of recurrent NMIBC. Read More

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February 2021

The Impact of Progression on Healthcare Resource Utilization and Costs Among Patients with High-Grade Non-Muscle Invasive Bladder Cancer After Bacillus Calmette-Guérin Therapy: A Retrospective SEER-Medicare Analysis.

Adv Ther 2021 03 11;38(3):1584-1600. Epub 2021 Jan 11.

Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.

Introduction: We evaluated the real-world healthcare resource utilization (HRU) and costs among patients with high-grade non-muscle invasive bladder cancer (HG-NMIBC) following Bacillus Calmette-Guérin (BCG) therapy.

Methods: Patients aged ≥ 65 years diagnosed with HG-NMIBC between 2008 and 2015 who received adequate BCG induction and were identified in the SEER-Medicare database. Those who received intravesical chemotherapy or radical cystectomy within 12 months of the last BCG induction dose, and had ≥ 6 months of data availability after treatment (index date), were included. Read More

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Clinical Value of Postoperative Neutrophil-to-Lymphocyte Ratio Change as a Detection Marker of Bladder Cancer Recurrence.

Cancer Manag Res 2021 29;13:849-860. Epub 2021 Jan 29.

Institute of Urology and Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region 530021, People's Republic of China.

Purpose: This study investigated the clinical significance of postoperative neutrophil-to-lymphocyte ratio (NLR) changes in bladder cancer recurrence.

Patients And Methods: For evaluating the predictive value of postoperative dynamic change of NLR, a retrospective cohort study was performed to analyze 213 patients with bladder cancer who underwent surgical treatment from January 2013 to December 2019 at the Affiliated Tumor Hospital of Guangxi Medical University. Baseline characteristics and recurrence-free survival (RFS) were statistically compared, and a multivariate analysis was used to identify prognostic factors. Read More

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January 2021

Further Understanding of Urokinase Plasminogen Activator Overexpression in Urothelial Bladder Cancer Progression, Clinical Outcomes and Potential Therapeutic Targets.

Onco Targets Ther 2021 13;14:315-324. Epub 2021 Jan 13.

Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.

Purpose: The Plasminogen Activation System (PAS) plays a role in tumor growth, invasion and metastasis and has been associated with oncological outcomes in urinary bladder carcinoma (UBC). The use of the different components of this system as molecular markers could improve our understanding of the heterogeneous behavior of UBC and might enable earlier disease detection, individual risk stratification, more accurate outcome prediction and be a rationale for new targeted therapies.

Methods: A comprehensive literature search including relevant articles up to October 2020 was performed using the MEDLINE/PubMed database. Read More

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January 2021