Objective To compare single-dose and multiple instilthe patients treated with epirubicin than in the control group (24, 25 and 52%, respectively; P<0.001). In lations of epirubicin in the chemoprophylaxis of superficial bladder tumours.those receiving epirubicin, the rates of recurrence were statistically comparable (P=0.9). Patients who had a Patients and methods In a prospective randomized and controlled study, 168 evaluable patients were large tumour burden showed slightly lower recurrence rates with single-dose epirubicin than with delayed assigned to three groups after transurethral resection of bladder tumour (TURBT) and histological confirmaintenance therapy but the diÂerence was statistically insignificant. Patients with a history of bladder mation of its superficial nature (pTa and pT1). The groups were comparable for tumour stage, grade and tumours before treatment had lower recurrence rates with maintenance treatment than with a single dose other tumour characteristics. In group 1, patients received a single dose of 50 mg epirubicin in 50 mL (34.6 and 22.6% in groups 1 and 2, respectively); again this diÂerence was statistically insignificant. normal saline immediately after TURBT; group 2 received 50 mg epirubicin in 50 mL normal saline Patients with grade 3 tumours showed a marginal diÂerence in favour of maintenance therapy. The rates 1-2 weeks after TURBT and the instillations were repeated for 8 weeks and thereafter monthly to of progression amongst the three groups were 5.5, 3.4 and 9.3%, respectively, with no significant diÂer-complete one year of treatment; group 3 (control group) received no adjuvant therapy after TURBT.ences. The overall toxicity rates were comparable in the two treated groups (22 and 25%). The patients were assessed by cysto-urethroscopy, urine cytology and DNA flow cytometry 8 weeks Conclusion With the possible exception of grade 3 tumours, single-dose immediate epirubicin is as eÂec-after resection and then every 3 months during the first 2 years and 6 monthly thereafter during the tive as delayed maintenance therapy, with the advantage of being more cost-eÂective. next 2 years. Intravenous urography was performed annually and when otherwise indicated.

Bacteria is recognized as opportunistic tumor inhabitant, giving rise to an environmental stress that may alter tumor microenvironment, which directs cancer behavior. In vitro infection of the T24 cell line with E. coli was performed to study the bacterial impact on bladder cancer cells. EMT markers were assessed using immunohistochemistry, western blot and RT-PCR. Stemness characteristics were monitored using RT-PCR. Furthermore, the metabolic reprograming was investigated by detection of ROS and metabolic markers. A significant (p ≤ 0.001) upregulation of vimentin as well as downregulation of CK19 transcription and protein levels was reported. A significant increase (p ≤ 0.001) in the expression level of stemness markers (CD44, NANOG, SOX2 and OCT4) was reported. ROS level was elevated, that led to a significant increase (p ≤ 0.001) in UCP2. This enhanced a significant increase (p ≤ 0.001) in PDK1 to significantly downregulate PDH (p ≤ 0.001) in order to block oxidative phosphorylation in favor of glycolysis. This resulted in a significant decrease (p ≤ 0.001) of AMPK, and a significant elevation (p ≤ 0.001) of MCT1 to export the produced lactate to extracellular matrix. Thus, bacteria may induce alteration to the heterogonous tumor cell population through EMT, CSCs and metabolic reprogramming, which may improve cancer cell ability to migrate and self-renew.

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Background: To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC). Patients and methods: A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48). Results: Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005). Conclusion: In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.

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