Intravesical Therapy for Non-Muscle-Invasive Bladder Cancer: What Is the Real Impact of Squamous Cell Carcinoma Variant on Oncological Outcomes?

Background and Objectives: To evaluate the oncological impact of squamous cell carcinoma (SCC) variant in patients submitted to intravesical therapy for non-muscle-invasive bladder cancer (NMIBC). Materials and Methods: Between January 2015 and January 2020, patients with conventional urothelial NMIBC (TCC) or urothelial NMIBC with SCC variant (TCC + SCC) and submitted to adjuvant intravesical therapies were collected. Kaplan\u2013Meier analyses targeted disease recurrence and progression. Uni-and multivariable Cox regression analyses were used to test the role of SCC on disease recurrence and/or progression. Results: A total of 32 patients out of 353 had SCC at diagnosis. Recurrence was observed in 42% of TCC and 44% of TCC + SCC patients (p = 0.88), while progression was observed in 12% of both TCC and TCC + SCC patients (p = 0.78). At multivariable Cox regression analyses, the presence of SCC variant was not associated with higher rates of neither recurrence (p = 0.663) nor progression (p = 0.582). Conclusions: We presented data from the largest series on patients with TCC and concomitant SCC histological variant managed with intravesical therapy (BCG or MMC). No significant differences were found in term of recurrence and progression between TCC and TCC + SCC. Despite the limited sample size, this study paves the way for a possible implementation of the use of intravesical BCG and MMC in NMIBC with histological variants

The Role of Novel Bladder Cancer Diagnostic and Surveillance Biomarkers-What Should a Urologist Really Know?

The aim of this review is to analyze and describe the current landscape of bladder cancer diagnostic and surveillance biomarkers. We researched the literature from 2016 to November 2021 to find the most promising new molecules and divided them into seven different subgroups based on their function and location in the cell. Although cystoscopy and cytology are still the gold standard for diagnosis and surveillance when it comes to bladder cancer (BCa), their cost is quite a burden for national health systems worldwide. Currently, the research is focused on finding a biomarker that has high negative predictive value (NPV) and can exclude with a certainty the presence of the tumor, considering missing it could be disastrous for the patient. Every subgroup has its own advantages and disadvantages; for example, protein biomarkers cost less than genomic ones, but on the other hand, they seem to be less precise. We tried to simplify this complicated topic as much as possible in order to make it comprehensible to doctors and urologists that are not as familiar with it, as well as encourage them to actively participate in ongoing research

Bladder cancer histological variants: which parameters could predict the concordance between transurethral resection of bladder tumor and radical cystectomy specimens?

Introduction The concordance rate of bladder cancer (BCa) histological variants (HV) between transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) is sub-optimal and is unclear which factors may influence it. The aim of this study was to identify factors that may be correlated to a higher TURBT-RC concordance rate. Material and methods Consecutive patients who had undergone RC between 2000 and 2019 at a single Institution with pathological evidence of HV were included. Patients with diagnosis of HV both at RC and at the previous TURBT were enlisted in the TURBT-RC Concordance Group (CG), whereas patients with only evidence of HV at RC in the TURBT-RC Non-Concordance Group (NCG). Surgical factors evaluated were the source of energy (mono-vs bipolar), surgeon’s experience (10 mm represented an independent predictor of concordance [OR 2.95; CI (1.01–8.61); p = 0.048]. Tumor recurrence, focality and dimension, source of energy, surgeon’s experience, performance of re-TURBT and total number of specimens at TURBT did not significantly predict the concordance. Conclusions Longer specimens at TURBT yield a higher chance to detect HV before RC. In this light, improving the quality of bladder resection means improving the management of BCa

Efficacy of High‐Resolution Preoperative 3D Reconstructions for Lesion Localization in Oncological Colorectal Surgery—First Pilot Study

When planning an operation, surgeons usually rely on traditional 2D imaging. Moreover, colon neoplastic lesions are not always easy to locate macroscopically, even during surgery. A 3D virtual model may allow surgeons to localize lesions with more precision and to better visualize the anatomy. In this study, we primary analyzed and discussed the clinical impact of using such 3D models in colorectal surgery. This is a monocentric prospective observational pilot study that includes 14 consecutive patients who presented colorectal lesions with indication for surgical therapy. A staging computed tomography (CT)/ magnetic resonance imaging (MRI) scan and a colonoscopy were performed on each patient. The information gained from them was provided to obtain a 3D rendering. The 2D images were shown to the surgeon performing the operation, while the 3D reconstructions were shown to a second surgeon. Both of them had to locate the lesion and describe which procedure they would have performed; we then compared their answers with one another and with the intraoperative and histopathological findings. The lesion localizations based on the 3D models were accurate in 100% of cases, in contrast to conventional 2D CT scans, which could not detect the lesion in two patients (in these cases, lesion localization was based on colonoscopy). The 3D model reconstruction allowed an excellent concordance correlation between the estimated and the actual location of the lesion, allowing the surgeon to correctly plan the procedure with excellent results. Larger clinical studies are certainly required

Preliminary results from an independent analysis of the italian cohort of the identify study: Baseline features of italian patients investigated for suspicious urinary tract malignancy at 5 italian tertiary referral centers

Aim of the study: IDENTIFY is an international prospective multicenter study aiming to investigate the management of patients referred for suspicious urinary tract cancers. Our aim was to describe the main features of patients undergoing investigation for suspected urothelial cancer (UC) in Italy. Materials and methods: IDENTIFY project started in December\u201917, recruiting patients that underwent a cystoscopy to exclude urothelial cancer. We included patients until May 2018. A history of previous urological cancer or a previous cystoscopy were criteria for exclusion. Data were prospectively collected online (redcap.org) from 5 urological departments in Italy. Clinical condition, familial and environmental risk factors (smoking, exposure to chemicals, ongoing drugs), characteristics of hematuria and of urine analysis, blood test and imaging were collected, as well as pathologic reports of UC. Results: Over 618 patients were recorded at the time of analysis. Of these, 181 were excluded because of incomplete results and 437 were finally included. Cystoscopies were performed due to macroscopic and microscopic-hematuria in 73,2% and 6,2% whilst in the remnant 20,6% no hematuria was present. Sex ratio (M/F) was 351/86, mean age was 70 (median 72); 80% of the patients were over 60. The overall incidence for malignant UC was 50,1% (219/437 \u2013 85% TCC); 20,4% (89/437) had benign disease, the remnant 29,5% had irrelevant findings. Malignant UC was more frequent in males, n = 189/351 (53,8% p<,001) and in patients older than 60 n = 185/350 (52,9% p<,02). In current or exsmokers n = 149/252 (59,1%) had a UC diagnosis whilst n = 48/131 nonsmokers (36,6%) had UC (p<,001). The incidence of malignant UC was not influenced by BMI, in the subgroups of BMI 6425 and 65 30 the 48,3% and the 44,4% respectively were found positive for malignancy (p>,05). Among the n = 115 with a positive family history for any cancer, n = 68 (59,1%) developed a malignant UC (p<,001). In the case of hematuria, micro or macroscopic, bladder disease was found in n = 248/347 cases (71,5%), of which 66,5% were confirmed to be malignant. For multiples hematuria episodes, the incidence of malignancy was 51,7% versus 41,5% in case of one single bleeding (p<,001). Interestingly, differences in malign UC incidence between macro and microscopic hematuria were lighter: 47,2% versus 51,9% respectively (p>,05). The most frequent benign causes of hematuria were: 42% prostatic, 19% stones and 15% UTI and among the malignant, the most frequent cancers were: bladder 88%, renal pelvis 4,5% and prostate 3,8%. Table 1 shows the features of the cohort and results of Chi^2 test over the different incidence between groups. Discussion: In this preliminary independent analysis of the Italian cohort of the IDENTIFY study hematuria is undeniably associated with UC, even if benign a cause is frequent. An undelayed check-up of all the urinary tract is mandatory especially in subgroups at a higher incidence of UC. The IDENTIFY study definitive analysis is awaited to confirm our findings

Risk factors of bladder cancer in patients undergoing transurethral cystoscopy: A multicentric italian experience from the IDENTIFY study cohort

Aim of the study: Bladder cancer (BC) is the eleventh most commonly diagnosed cancer worldwide. The aim of this work was to evaluate the most significant predictive factors for the likelihood of bladder cancer based on the related risk factors in a contemporary Italian cohort. Materials and methods: Demographic and clinical data were obtained from five Italian centers participating to the IDENTIFY study from December 2017 to May 2018, a large prospective, international, multicentric study of patients undergoing cystoscopy, with or without hematuria, for the investigation of suspected urinary tract cancer. Patients with previous urological cancer were excluded. Age, sex, Body Max Index (BMI), Smoke habit, family history of urological malignancies, professional exposure and hematuria (macroscopic or microscopic) data were collected. All cystoscopic urothelial cancer diagnosis were confirmed by subsequent pathological examination. The predictive value of each variable was measured using univariate analysis and multinomial logistic regression to develop the multivariate analysis. Results: We recorded data of 618 patients from five Italian academic centers, 437 patients presented complete data and follow up and were included in the final analysis. 351 (80.3%) of the patients were male. Patients older than 60 years were the majority (80.1%). The smoke habit was present in 252 subjects (65.8%). Familiar history of urological malignancies was positive in 115 patients (26.3%). Patients presenting macroscopic hematuria were 320 (73.2%) while microscopic hematuria was demonstrated in 27 (6.2%) subjects. Professional exposure to related risk factors was present in 41 patients. Results of the univariate analysis in the prediction of BC are shown in the tables below. Male status (p < 0.001), age older than 60 years old (p = 0.02), smoke habit (p < 0.001), family history (p < 0.001) and multiple hematuria episodes (p < 0.001) were significantly associated with the risk of having diagnostic cystoscopy positive for urothelial cancer whilst BMI and professional exposure were not (p > 0.05). On the multivariate analysis current or previous smoking status (p = 0.007) and hematuria (macro or micro) (p = 0.023) were predictors of a diagnosis of urothelial cancer at cystoscopy. Discussion: In this independent analysis of the Italian cohort of the IDENTIFY study, macro-hematuria and smoke habit better predicted the likelihood of bladder cancer in patients undergoing cystoscopy for urothelial cancer suspicion. Final results of the IDENTIFY study are awaited to confirm our findings