Selecting the Best Candidates for Cisplatin-based Adjuvant Chemotherapy After Radical Cystectomy Among Patients with pN+ Bladder Cancer

Afferi, Luca; Lonati, Chiara; Montorsi, Francesco; Briganti, Alberto; Necchi, Andrea; Mari, Andrea; Minervini, Andrea; Tellini, Riccardo; Campi, Riccardo; Schulz, Gerald Bastian; Black, Peter C.; Trapani, Ettore Di; Cobelli, O. De; Karnes, R. Jeffrey; Ahmed, Mohamed E.; Mir, Maria Carmen; Algarra, Maria Asuncion; Rink, Michael; Zamboni, Stefania; Mondini, Francesca; Simeone, Claudio; Antonelli, Alessandro; Tafuri, Alessandro; Krajewski, Wojciech; Małkiewicz, Bartosz; Xylinas, Évanguelos; Soria, Francesco; Salas, Rafael; Arora, Amandeep; Cathelineau, Xavier; Hendricksen, Kees; Ammiwala, Maida; Borghesi, M.; Chierigo, Francesco; Teoh, Jeremy Yuen‐Chun; Mattei, Agostino; Albisinni, Simone; Roghmann, Florian; Roumiguié, M.; Bajeot, A.; Maier, Elisabeth; Aziz, Atiqullah; Hurle, Rodolfo; Contieri, Roberto; Pradere, Benjamin; Carando, Roberto; Poyet, Cédric; Álvarez‐Maestro, Mario; D’Andrea, David; Shariat, Shahrokh F.; Moschini, Marco

doi:10.1016/j.euo.2022.04.001

Cited by 8 publications

(12 citation statements)

References 9 publications

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“…A retrospective study showed that approximately 25-30% of nmUBC patients undergoing RC presented with lymph node positive after pathologic examination (13). In a European large cohort of 1,381 patients with muscle invasive bladder cancer with 1 or 2 positive nodes, 5-year OS was 74% and 38% for pT stage ≤2 and pT stage ≥3 (14). Patients with at least 3 positive nodes show a dismal prognosis of 13% regardless of the pT stage, underlining the importance of node number for patient survival (14).…”

Section: Discussionmentioning

confidence: 99%

“…In a European large cohort of 1,381 patients with muscle invasive bladder cancer with 1 or 2 positive nodes, 5-year OS was 74% and 38% for pT stage ≤2 and pT stage ≥3 (14). Patients with at least 3 positive nodes show a dismal prognosis of 13% regardless of the pT stage, underlining the importance of node number for patient survival (14). A trend towards a larger benefit from adjuvant or neoadjuvant chemotherapy in node-positive bladder cancer has been observed in randomized controlled trials; however, which patients benefit from this approach remains unknown.…”

Section: Discussionmentioning

confidence: 99%

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Tissue Distribution of Cisplatin by Intra-arterial Infusion Route in Comparison to Systemic Route: Implication to Therapy for Node-positive Bladder Cancer

Ichihashi

Inamoto

Uchimoto

et al. 2023

In Vivo

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Background/Aim: In clinical practice, platinumbased systemic chemotherapy works to shrink pelvic lymph nodes. Intra-arterial (IA) bolus infusion may result in more favorable results than systemic chemotherapy. In the present study, we investigated the distribution of cisplatin administrated by IA infusion in varying organs, specifically focusing on the node tissue, in comparison with the intravenous (IV) route. Materials and Methods: Under anesthesia, cisplatin 0.42 mg/body was administrated by IA or IV infusion in rats to mimic a balloon-occluded arterial infusion model used in clinical practice. The kidney, bladder, lymphatic tissue, and peripheral blood were extracted to analyze the amount of cisplatin by inductively coupled plasma-mass spectrometry. Results: Concertation of cisplatin by IA infusion was higher than that by the IV route in the peripheral blood and kidney. IA infusion led to a significantly high concentration of cisplatin in the bladder compared to IV infusion (1.3±0.452 vs. 0.2 ppb/mg ± 0.055, p=0.050). Furthermore, the IA method led to an extremely high concentration of cisplatin in the lymphatic tissue compared to the IV method (0.1±0.036 vs. 13.3±5.36, p=0.048). Conclusion: High cisplatin accumulation in the lymphatic tissue and bladder by IA administration may have a potential role for treating patients with node-positive bladder cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Tissue Distribution of Cisplatin by Intra-arterial Infusion Route in Comparison to Systemic Route: Implication to Therapy for Node-positive Bladder Cancer

Ichihashi

Inamoto

Uchimoto

et al. 2023

In Vivo

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“…Mining of potentially robust clinical and/or biological features will aid in the diagnosis and risk stratification of BLCA patients to facilitate personalized treatment. A recent series of studies has explored the impact of immunohistochemical assays [ 30 ], conventional serum and histological biomarkers [ 31 , 32 , 33 , 34 , 35 ], and adjuvant therapy [ 36 , 37 ] on longitudinal monitoring and prognosis definition in BLCA patients. In this study, we utilized DL to develop a diagnostic model, BlcaMIL, and a prognostic model, MibcMLP, using WSIs for accurate diagnosis of BLCA and prognosis prediction of MIBC patients.…”

Section: Discussionmentioning

confidence: 99%

Accurate Diagnosis and Survival Prediction of Bladder Cancer Using Deep Learning on Histological Slides

Zheng

Yang

et al. 2022

Cancers

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(1) Background: Early diagnosis and treatment are essential to reduce the mortality rate of bladder cancer (BLCA). We aimed to develop deep learning (DL)-based weakly supervised models for the diagnosis of BLCA and prediction of overall survival (OS) in muscle-invasive bladder cancer (MIBC) patients using whole slide digitized histological images (WSIs). (2) Methods: Diagnostic and prognostic models were developed using 926 WSIs of 412 BLCA patients from The Cancer Genome Atlas cohort. We collected 250 WSIs of 150 BLCA patients from the Renmin Hospital of Wuhan University cohort for external validation of the models. Two DL models were developed: a BLCA diagnostic model (named BlcaMIL) and an MIBC prognostic model (named MibcMLP). (3) Results: The BlcaMIL model identified BLCA with accuracy 0.987 in the external validation set, comparable to that of expert uropathologists and outperforming a junior pathologist. The C-index values for the MibcMLP model on the internal and external validation sets were 0.631 and 0.622, respectively. The risk score predicted by MibcMLP was a strong predictor independent of existing clinical or histopathologic indicators, as demonstrated by univariate Cox (HR = 2.390, p < 0.0001) and multivariate Cox (HR = 2.414, p < 0.0001) analyses. The interpretability of DL models can help in the analysis of critical regions associated with tumors to enrich the information obtained from WSIs. Furthermore, the expression of six genes (ANAPC7, MAPKAPK5, COX19, LINC01106, AL161431.1 and MYO16-AS1) was significantly associated with MibcMLP-predicted risk scores, revealing possible potential biological correlations. (4) Conclusions: Our study developed DL models for accurately diagnosing BLCA and predicting OS in MIBC patients, which will help promote the precise pathological diagnosis of BLCA and risk stratification of MIBC to improve clinical treatment decisions.

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“…Moreover, several studies reported that AC administration was associated with survival benefit in a group of N+ patients [187][188][189][190][191][192]. A recent report by Afferi et al indicated that patients with more than 3 metastatic nodes are the group that will benefit from cisplatin-based AC after RC [193].…”

Section: Sternberg Et Al In the Randomized Clinical Trial Evaluated I...mentioning

confidence: 99%

Management of Bladder Cancer Patients with Clinical Evidence of Lymph Node Invasion (cN+)

Małkiewicz¹,

Gurwin²,

Karwacki³

et al. 2022

Preprint

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The purpose of this review is to present the current knowledge about the diagnostic and treatment options in bladder cancer (BCa) patients with clinically positive lymph nodes (cN+). In this review compaction of CT and MRI performance in preoperative prediction of lymph node invasion (LNI) in BCa patients was presented, along with other diagnostic methods. Most scientific societies do not distinguish cN+ patients in their guidelines, recommendations concern muscle-invasive bladder cancer (MIBC) and differ between associations. Currently, the standard treatment of patients with MIBC is radical cystectomy (RC) with bilateral pelvic lymph node dis-section (PLND). The template of PLND and its therapeutic value remain debatable. Moreover, most guidelines recommend neoadjuvant chemotherapy (NAC). However, there is still lack of definitive evidence of the superiority of neoadjuvant chemotherapy over adjuvant chemotherapy. Nevertheless, the curative treatment that provides the best long-term survival in cN+ patients is a multimodal approach with a combination of chemotherapy and RC. Recent studies demonstrate the growing importance of immunotherapy. Special attention should be paid to cN+ BCa patients as the oncological outcomes are significantly worse for this group.

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Selecting the Best Candidates for Cisplatin-based Adjuvant Chemotherapy After Radical Cystectomy Among Patients with pN+ Bladder Cancer

Cited by 8 publications

References 9 publications

Tissue Distribution of Cisplatin by Intra-arterial Infusion Route in Comparison to Systemic Route: Implication to Therapy for Node-positive Bladder Cancer

Tissue Distribution of Cisplatin by Intra-arterial Infusion Route in Comparison to Systemic Route: Implication to Therapy for Node-positive Bladder Cancer

Accurate Diagnosis and Survival Prediction of Bladder Cancer Using Deep Learning on Histological Slides

Management of Bladder Cancer Patients with Clinical Evidence of Lymph Node Invasion (cN+)

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