Dynamics of Cancer-Related Proteins in Patients with Bladder Cancer

Bladder cancer (BC) is the second most common malignancy in the urologic field. Preoperative predictive biomarkers of cancer progression and prognosis are imperative for optimizing appropriate treatment for patients with BC. The prediction of patient outcomes before initial treatment would enable physicians to choose better modalities and avoid unnecessary aggressive treatments. In addition, preoperative molecular markers are expected to be a minimally invasive tool for predicting precise prognosis and progression in patients with BC. The proteins secreted from the tumor cells reflect various states of tumors in real time and at given conditions, and those expression patterns are different from normal cell components. Approximately 20–25% of cellular proteins are in extracellular spaces, and these proteins have important roles in invasion, angiogenesis, regulation of cell-to-cell interactions, and metastasis. It has been suggested that tumor-secreting proteins are a promising source for tumor diagnostic biomarkers. Proteomic analysis was utilized to identify the secreted proteins in sera from patients with BC. Several biomarkers associated with BC are reviewed here

Nestin is an independent predictor of cancer-specific survival after radical cystectomy in patients with urothelial carcinoma of the bladder.

OBJECTIVES: To investigate the association between the expression of nestin, a class VI intermediate filament protein, and pathologic features or survival in patients with urothelial carcinoma of the bladder (UCB). METHODS: Nestin expression in tumor cells was immunohistochemically studied in 93 patients with UCB who underwent radical cystectomy with pelvic lymphadenectomy. The associations with clinicopathologic parameters were evaluated. Kaplan-Meier survival analysis and Cox proportional hazards models were used to estimate the effect of nestin expression on survival. RESULTS: Nestin expression in cystectomy specimens was observed in 13 of 93 patients (14.0%). Nestin expression was associated with pathologic tumor stage (p = 0.006). Nestin-negative patients had better overall survival compared with nestin-positive patients (log-rank p = 0.0148). Univariable analysis indicated that nestin expression, lymphovascular invasion, and lymph node status were significantly associated with cancer-specific survival (hazard ratios, 2.78, 2.15, and 2.80, respectively). On multivariable analysis, nestin expression and lymph node status were independent prognostic factors in cancer-specific survival (hazard ratios, 2.45 and 2.65, respectively). CONCLUSIONS: The results suggest that nestin expression is a novel independent prognostic indicator for patients with UCB and a potentially useful marker to select patients who may be candidates for adjuvant chemotherapy

Boerhaave syndrome presenting black pleural effusion: A case report

A 55-year-old man experienced nausea and vomiting after brushing his teeth. He experienced back pain after this episode and visited our emergency department. Chest computed tomography (CT) images revealed moderate pleural fluid accumulation and mild left pneumothorax. Thoracentesis showed black pleural effusion. Thoracic drainage included food debris with black pleural effusion, and gastroscopy revealed food debris and perforation of the lower esophagus. Esophageal perforation was surgically repaired using omental implantation and pleuroclysis. Given the high mortality rate associated with black pleural effusion, prompt diagnostic procedures and corresponding management are essential

Cumulative survival of UCB patients according to nestin expression estimated sby the Kaplan–Meier method.

<p>(A) Progression-free survival; (B) cancer-specific survival; and (C) overall survival.</p

Immunohistochemical analysis of nestin expression in UCB.

<p>The photographs are representative tumor cells that were negative (A) and positive (B) for nestin. Nestin expression was also observed in the cytoplasm of vascular endothelial cells and fibroblasts in tumor stroma in each case (Figure 1A, B).</p

Association of nestin expression with clinical and pathologic characteristics of patients who underwent radical cystectomy for UCB.

<p>UCB =  urothelial carcinoma of the bladder; pT =  pathologic tumor.</p><p>*Fisher exact test (two-sided).</p><p>**Five patients had unknown pathologic status of the lymph nodes.</p><p>***Nine patients had no lymphovascular status.</p