Purpose
We aimed to identify, verify, and validate a multiplex urinary biomarker-based prediction model for diagnosis and surveillance of urothelial carcinoma of bladder, using high-throughput proteomics methods.
Materials and Methods
Label-free quantification of data-dependent and data-independent acquisition of 12 and 24 individuals was performed in each of the discovery and verification phases using mass spectrometry, simultaneously using urinary exosome and proteins. Based on five scoring system based on proteomics data and statistical methods, we selected eight proteins. Enzyme-linked immunosorbent assay on urine from 120 patients with bladder mass lesions used for validation. Using multivariable logistic regression, we selected final candidate models for predicting bladder cancer.
Results
Comparing the discovery and verification cohorts, 38% (50/132 exosomal differentially expressed proteins [DEPs]) and 44% (109/248 urinary DEPs) are consistent at statistically significance, respectively. The 20 out of 50 exosome proteins and 27 out of 109 urinary proteins were upregulated in cancer patients. From eight selected proteins, we developed two diagnostic models for bladder cancer. The area under the receiver operating characteristic curve (AUROC) of two models were 0.845 and 0.842, which outperformed AUROC of urine cytology.
Conclusion
The results showed that the two diagnostic models developed here were more accurate than urine cytology. We successfully developed and validated a multiplex urinary protein-based prediction, which will have wide applications for the rapid diagnosis of urothelial carcinoma of the bladder. External validation for this biomarker panel in large population is required.
Citations
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Purpose
The purpose of this study was to determine the impact of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), statin, and cyclooxygenase 2 (COX-2) inhibitor on the development of kidney, prostate, and urothelial cancers by analyzing the Korean National Health Insurance Service–National Sample Cohort (NHIS-NSC) database.
Materials and Methods
Among a representative sample cohort of 1,025,340 participants in NHIS-NSC database in 2002, we extracted data of 799,850 individuals who visited the hospital more than once, and finally included 321,122 individuals aged 40 and older. Following a 1-year washout period between 2002 and 2003, we analyzed 143,870 (male), 320,861 and 320,613 individuals for evaluating the risk of prostate cancer, kidney cancer and urothelial cancer developments, respectively, during 10-year follow-up periods between 2004 and 2013. The medication group consisted of patients prescribed these drugs more than 60% of the time in 2003. To adjustfor various parameters of the patients, a multivariate Cox regression model was adopted.
Results
During 10-year follow-up periods between 2004 and 2013, 9,627 (6.7%), 1,107 (0.4%), and 2,121 (0.7%) patients were diagnosed with prostate cancer, kidney cancer, and urothelial cancer, respectively. Notably, multivariate analyses revealed that NSAIDs significantly increased the risk of prostate cancer (hazard ratio [HR], 1.35). Also, it was found that aspirin (HR, 1.28) and statin (HR, 1.55) elevated the risk of kidney cancer. No drugs were associated with the risk of urothelial cancer.
Conclusion
In sum, our study provides the valuable information for the impact of aspirin, NSAID, statin, and COX-2 inhibitor on the risk of prostate, kidney, and urothelial cancer development and its survival outcomes.
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Purpose The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. Materials and Methods A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS.
Results UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. Conclusion Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.
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A study was performed to evaluated the effect of M-VAC(methotrexate, vinblastine, doxorubicin and cisplatin) chematheraty for advanced transitional cell carcinoma of the urinary tract. During July 1987 to June 1993, sixty eight patients with histologically proven advanced transitional cell carcinoma were treated with M-VAC chemotherapy at Seoul National University HospitaL Amang them, 43 patients with index lesions who received more than 2 cycles of chemotherapy, and were adequately followed up were analyzed for M-VAC chematherapy. Thirty nine patients were men and 4 women with the median age of 59 years. They were followed for 9 to 61 months with the median of 27 months after completion of chemotherapy. Of 43 eligible patients, complete remission was found in 9 patients(20.9%) and partial remis- sion in 1 l(25.6%), showing 46.5% of overa11 response rate. The overall median survival of the 43 patients were 14 months. In 9 patients with complete remission, the median duration of remis- sion was more than 20 months and median survival was more than 25 months with the two year survival rate of 100%. In 11 patients with partial remission, the median duration of remission was 11 months and median survival was 19 months with the one year survial rate of 81.8% and two year survival rate of 30%. The median survial of the 23 nonresponders was 10 months, with one and two year survival rate of 39.1% and 4.8%. Of the l4 patients with lymph node metastasis without any distant metastasis, 7 patients(50%) showed complete remission and another 3 patients(21.4%) showed partial remission, with the overall response rate of 72.4%. In con- trary, of the 29 patients with distant metastasis with or without nodal metastasis, the overall response rate was 34.5% including complete remission of only in 2 patients(6.9%). Toxicity was not negligible. Myelosuppression was observed in 58.1% of the patients, sepsis in 11.6/, renal toxicity in 48.8% and mucositis in 39.5%, but chemotherpy related death was not observed. M-VAC chemotherapy is apparently beneficial in patients with advanced transitional cell carcinoma of the urinary tract, especially with nodal metastasis, despite significant toxicity.