SARS-CoV-2 Infection and High-Risk Non-Muscle-Invasive Bladder Cancer: Are There Any Common Features?

Abstract

Background: The new severe acute respiratory syndrome virus (SARS-CoV-2) outbreak is a huge health, social and economic issue and has been declared a pandemic by the World Health Organization. Bladder cancer, on the contrary, is a well-known disease burdened by a high rate of affected patients and risk of recurrence, progression and death. Summary: The coronavirus disease (COVID-19 or 2019-nCoV) often involves mild clinical symptoms but in some cases, it can lead to pneumonia with acute respiratory distress syndrome and multiorgan dysfunction. Factors associated with developing a more severe disease are increased age, obesity, smoking and chronic underlying comorbidities (including diabetes mellitus). High-risk non-muscle-invasive bladder cancer (NMIBC) progression and worse prognosis are also characterized by a higher incidence in patients with risk factors similar to COVID-19. Immune system response and inflammation have been found as a common hallmark of both diseases. Most severe cases of COVID-19 and highrisk NMIBC patients at higher recurrence and progression risk are characterized by innate and adaptive immune activation followed by inflammation and cytokine/chemokine storm (interleukin [IL]-2, IL-6, IL-8). Alterations in neutrophils, lymphocytes and platelets accompany the systemic inflammatory response to cancer and infections. Neutrophil-tolymphocyte ratio and platelet-to-lymphocyte ratio for example have been recognized as factors related to poor progno

Increased Use of Blood Transfusions to Manage Urological Conditions during the COVID-19 Pandemic

“…If this speculation is true, these may be even more relevant for patients with malignancies; indeed, blood transfusions could lead to worse oncological outcomes due to the effect of transfusion-related immunomodulation, although convincing evidence is still lacking [8]. Indeed, alteration of the regulation of the immune system is a recognized risk factor for a poor prognosis in BCa [9]. In this context, perioperative blood transfusions have been associated with worse survival rates after surgery for BCa [10].…”

The Impact of COVID-19 Disease on Urology Practice

“…Immune system response and inflammation have been found as a common hallmark of both diseases. 37 A hemostatic radiotherapy is an option for actively bleeding MIBC when radical cystectomy is deferred due to limited resources. 38 Radical orchiectomy should be performed as soon as possible because it is an outpatient procedure and will guide further treatment.…”

Protocol of the Italian Radical Cystectomy Registry (RIC): a non-randomized, 24-month, multicenter study comparing robotic-assisted, laparoscopic, and open surgery for radical cystectomy in bladder cancer

“…Bladder cancer increases with age and, although it is higher in men than women [ 1 ], incidence in both sexes is expected to increase in European countries [ 3 ]. Cigarette smoking has been identified as one of the main risk factors for bladder cancer [ 3 , 4 ], and incidence rates are higher in more developed countries [ 5 ].…”