Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with transurethral resection of bladder tumor (TURBT) for muscle-invasive bladder cancer (MIBC). Methods China National Knowledge Infrastructure, Chongqing VIP, Wanfang, SinoMed, PubMed, Web of Science, and Cochrane Library were searched from the establishment of databases until December 2023. All randomized controlled trials of TACE combined with TURBT for MIBC were collected and subjected to meta-analysis using RevMan 5.4 software. Results A total of 7 studies were included, involving 490 patients, with 246 in the TACE+TURBT group and 244 in the TURBT group. The meta-analysis results showed that compared with TURBT, TACE+TURBT had certain advantages in reducing recurrence rate [relative risk (RR)=0.49, 95% confidence interval (CI) (0.35, 0.68)], improving survival rate [RR=1.16, 95%CI (1.07, 1.27)], shortening surgical time [standardized mean difference (SMD)=−4.97, 95%CI (−7.54, −2.40)], reducing intraoperative bleeding [SMD=−4.19, 95%CI (−5.78, −2.60)], and improving quality of life [SMD=4.51, 95%CI (2.15, 6.86)]. The adverse reactions of the two groups were similar. Conclusions Existing evidence suggests that TACE may reduce intraoperative bleeding and shorten surgical time to help achieve maximum TURBT. TACE combined with TURBT may be superior to simple TURBT in terms of tumor recurrence rate and survival rate. TACE combined with TURBT can benefit MIBC patients in bladder-preserving treatment plans.
目的:探讨ΔNp63和Ki67在膀胱移行上皮癌(transitional cell carcinoma of bladder,TCCB)中的免疫组化表达及与膀胱癌病理分级、临床病理分期和预后的相关性。方法:随机选择2006～2007年间56例TCCB和12例正常膀胱黏膜病理切片用SP免疫组化行ΔNp63和Ki67检测,将结果与病理分级、分期和预后进行分析。结果:ΔNp63和Ki67在膀胱移行细胞癌中的阳性表达率明显高于正常膀胱黏膜(Plt;005)。ΔNp63和Ki67在低分化、浸润性癌组织中的阳性表达率明显高于高分化、浅表性癌组织,在膀胱癌的病理分级和临床分期之间表达差异有统计学意义(Plt;005)。ΔNp63和Ki67在复发病例中的阳性表达率显著高于初发病例(Plt;005)。采用Spearman等级相关性分析对ΔNp63和Ki67在TCCB中的表达进行比较,ΔNp63与Ki67呈正相关,rs′为0316,且Plt;005。结论:ΔNp63和Ki67与膀胱癌的临床病理分级和分期及预后密切相关,随膀胱癌分化程度的降低和浸润程度的增加而增强。ΔNp63和Ki67在TCCB的进展中可能有相互协同作用,ΔNp63可能通过促进细胞增殖发挥促癌作用,联合检测ΔNp63和Ki67可以作为判断TCCB的预后的肿瘤标记物。
Bladder cancer is a common malignant tumor of the urinary system. The incidence and mortality of bladder cancer in China have been at a high level. In the past, people generally believed that the bladder was a sterile environment, but it has been found that there are symbiotic microorganisms in the bladder. In addition, microorganisms and their metabolites in urine may be involved in the occurrence and development of various urinary system diseases such as bladder cancer. At the same time, microorganisms and their component products such as Bacillus Calmette-Guerin vaccine play an important role in the treatment of bladder cancer. This article reviews the research progress of urinary tract microorganisms and the occurrence, development and treatment of bladder cancer, and aims to provide new ideas for the early diagnosis and treatment, prevention and prognosis evaluation of bladder cancer.
Objective To assess the clinical efficacy and treatment-induced side effects of intravesically administered bacillus calmette-guerin (BCG) plus chemotherapy following TURB-t in patients with superficial bladder cancer compared with BCG alone.Methods Randomized controlled trials (RCTs) were identified from PubMed (1950 to December 2006), Ovid (1966 to December 2006), EMbase (1984 to December 2006), The Cochrane Library (Issue 4, 2006), CBM (1978 to 2006) and VIP (1989 to 2006). We also handsearched relevant published and unpublished reports as well as their references.The quality of included trials was evaluated by two reviewers. We used The Cochrane Collaboration’ s RevMan 4.2.9 software for statistical analysis. Results Four studies involving 681 patients were included. Meta-analyses showed that, in patients with Ta and T1 bladder cancer, there was a significant difference in the recurrence rate between intravesically administered BCG plus chemotherapy and BCG alone (RR 0.69, 95%CI 0.53 to 0.90). In patients with Tis bladder cancer, no significant difference was found in the recurrence rate between the two groups (RR 1.22, 95%CI 0.97 to 1.54). In patients with Ta, T1 and Tis bladder cancer, no statistically significant difference was found in the incidence of side effects (RR 0.85, 95%CI 0.70 to 1.03). Conclusion Compared with BCG alone, intravesically administered BCG plus chemotherapy in patients with Ta and T1 superficial bladder cancer can reduce the incidence of tumor recurrence more effectively. For patients with Tis bladder cancer, the two therapeutic regimens do not differ in the incidence of tumor recurrence. The two regimens have similar side effects. There is a moderate possibil ity of selection bias, performance bias and publ ication bias in the small number of included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality double-blind randomized controlled trials is needed.
ObjectiveTo investigate the expression and clinical significance of HIST1H1B gene in bladder cancer.MethodsInformation on HIST1H1B in the dataset GSE13507 was downloaded from the GEO database. Discrepancy in expression of HIST1H1B in normal tissues and bladder cancer tissues was analyzed by t-test. Survival analysis was performed by using Log-rank algorithm. The association between HIST1H1B gene expression and clinicpathological features was analyzed using Chi-square test. Gene enrichment analysis (GSEA) was performed to explore possible pathways of HIST1H1B involved in bladder cancer.ResultsHIST1H1B was down-regulated in normal tissues and highly expressed in bladder cancer tissues (P=0.002 5). The expression of HIST1H1B was associated with age, gender, T stage, M stage, N stage, disease stage, but not associated with invasiveness and progression. Whether in overall survival (HR=1.732, 95%CI 1.070 to 2.803) or tumor-specific survival (HR=2.000, 95%CI 0.996 to 4.017), patients with high expression of HIST1H1B were significantly lower than that in patients with low expression (P<0.05). GSEA results showed that HIST1H1B may influence the occurrence and development of bladder cancer by regulating MYC signaling pathway V2, G2M checkpoint, E2F signaling pathway, spermatogenesis, mitotic spindle, etc.ConclusionsHIST1H1B may be a biomarker for determining the prognosis of bladder cancer and a target for treatment of bladder cancer.
ObjectiveTo systematically evaluate the efficacy and safety of simultaneous transurethral resection of bladder cancer and prostate (TURBT+TURP) in the treatment of bladder cancer with benign prostatic hyperplasia (BPH). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data and VIP from inception to January 2015, to collect randomized controlled trials (RCTs) and cohort studies investigating the efficacy and safety of TURBT with TURP in the treatment of bladder cancer with BPH. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies, and then meta-analysis was performed using RevMan 5.3 software. Results3 A total of 3 RCTs (n=137) and 10 retrospective cohort studies (n=998) were included. The results of meta-analysis showed that there were no significant differences between the simultaneous resection group and the control group in the overall recurrence rate (RCT:OR=0.55, 95% CI:0.24 to 1.24, P=0.15; retrospective cohort study:OR=0.78, 95% CI:0.60 to 1.01, P=0.06), postoperative recurrence rate in the prostatic fossa/urethra (RCT:OR=1.40, 95% CI:0.28 to 7.60, P=0.68; retrospective cohort study:OR=1.36, 95% CI:0.49 to 3.74, P=0.55), progression rate (OR=0.93, 95% CI:0.53 to 1.61, P=0.79) and overall perioperative complication rate (RCT:OR=0.35, 95% CI:0.08 to 1.55, P=0.17; retrospective cohort study:OR=0.1.75, 95% CI:0.44 to 6.98, P=0.43). ConclusionCompared with only TURBT or sequential TURBT and TURP, simultaneous TURBT and TURP do not increase the overall recurrence rate, postoperative recurrence rate in the prostatic fossa/urethra, progression rate and overall postoperative complication rate. However, due to the limited quality and quantity of included studies, larger sample size and higher quality RCTs are needed to verify the above conclusion.
Objective To determine whether intravesically administered Adriamycin can prevent superficial bladder tumor to recur through assessing the efficacy of with intravesical Adriamycin and without intravesical Adriamycin after TURB-t. Method The search strategy was made according to the demand of Cochrane Collaboration. Medline, Embase，CBMdisc and the Cochrane Library were searched for RCTs. Data were extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Thirty three relevant trials were searched, of which eighteen trials were included and fifteen trials were excluded. Meta-analysis showed intravesically administered Pirarnbicin (THP), Epirubicin (EPI) and Adriamycin (ADM) can reduce the recurrence rate of superficial bladder cancer after operation during one or two years. Conclusions Intravesically administered THP, EPI and ADM can reduce the recurrence rate of superficial bladder cancer after TUPB-t’s operation during one or two years. In addition, the factors affecting the prognosis should be performed, such as the dosage of irrigation of bladder, reserving time and the course.
With the rapid development of artificial intelligence technology, researchers have applied it to the diagnosis of various tumors in the urinary system in recent years, and have obtained many valuable research results. The article sorted the research status of artificial intelligence technology in the fields of renal tumors, bladder tumors and prostate tumors from three aspects: the number of papers, image data, and clinical tasks. The purpose is to summarize and analyze the research status and find new valuable research ideas in the future. The results show that the artificial intelligence model based on medical data such as digital imaging and pathological images is effective in completing basic diagnosis of urinary system tumors, image segmentation of tumor infiltration areas or specific organs, gene mutation prediction and prognostic effect prediction, but most of the models for the requirement of clinical application still need to be improved. On the one hand, it is necessary to further improve the detection, classification, segmentation and other performance of the core algorithm. On the other hand, it is necessary to integrate more standardized medical databases to effectively improve the diagnostic accuracy of artificial intelligence models and make it play greater clinical value.
ObjectivesTo analyze the trend of incidence and mortality of bladder cancer from 1990 to 2017 and the effects of age, time period and birth cohort on bladder cancer incidence and mortality.MethodsData on age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) of bladder cancer from 1990 to 2017 were extracted from the Global Burden of Disease 2017 (GBD 2017) database. Joinpoint regression model was used to analyze the average annual percentage change of ASIR and ASDR of bladder cancer. The age-period-cohort model was established to analyze the age, period and birth cohort effects on ASIR and ASDR of bladder cancer.ResultsFrom 1990 to 2017, both ASIR and ASDR of bladder cancer decreased slightly. ASIR decreased from 6.42 per 100 000 in 1990 to 6.04 per 100 000 in 2017, with an average annual percentage change of −0.9% (−1.0% to −0.8%), and ASDR decreased from 3.15 per 100 000 in 1990 to 2017 2.57/100 000, with an average annual percentage change of −0.4% (−0.4% to −0.3%). The age-period-cohort model results showed that as age increased, the risk of bladder cancer incidence and mortality increased; as the birth cohort progressed, the risk of bladder cancer morbidity and mortality decreased. The time period had little effect on the incidence and mortality of bladder cancer.ConclusionsThe incidence and mortality of bladder cancer are declining globally. On the other hand, the increase of the aging global population could reverse the incidence and mortality trend, active measures should be taken to address the adverse effects of aging.