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Cancers
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Advances in Management of Urothelial Cancer
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Advances in Management of Urothelial Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 25 May 2025 | Viewed by 8170

Special Issue Editor

Prof. Dr. Shomik Sengupta

E-Mail Website
Guest Editor
Eastern Health Clinical School, Monash University, 5 Arnold Street, Box Hill, VIC 3128, Australia
Interests: bladder cancer; uro-oncology; clinical trial

Special Issue Information

Dear Colleagues,

Urothelial cancers, particularly arising from the bladder, represent a large healthcare burden. On the one hand, low-risk bladder cancers are common and can recur frequently, thus requiring long-term repetitive follow-up that is invasive and expensive. On the other hand, invasive bladder cancer and upper tract urothelial cancer (UTUC) are rarer but potentially lethal, hence require aggressive and morbid treatment in patients who are elderly or frail. New developments in diagnostic modalities of endoscopy, imaging, biomarkers and genomics have come about in recent years, achieving earlier diagnoses and precise classification and prognostication. In parallel, there is an increased availability of therapeutic options in terms of improved surgical tools and approaches as well as novel and targeted agents delivered systemically or endoluminally. This Special Issue will highlight many of these developments. We welcome reviews of the current status of this field, as well as original research related to the management of urothelial cancer.

Prof. Dr. Shomik Sengupta
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • urothelial cancer
  • bladder cancer
  • upper tract urothelial cancer
  • diagnosis
  • treatment
  • surgery
  • chemotherapy
  • immunotherapy
  • imaging

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Published Papers (6 papers)

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Research

Jump to: Review

11 pages, 1490 KiB  
Article
Pre-Op Hydronephrosis Predicts Outcomes in Patients Receiving Robot-Assisted Radical Cystectomy
by Chris Ho-Ming Wong, Ivan Ching-Ho Ko, David Ka-Wai Leung, Seok Ho Kang, Kousuke Kitamura, Shigeo Horie, Satoru Muto, Chikara Ohyama, Shingo Hatakeyama, Manish Patel, Cheung-Kuang Yang, Kittinut Kijvikai, Ji Youl Lee, Hai-Ge Chen, Rui-Yun Zhang, Tian-Xin Lin, Lui Shiong Lee, Jeremy Yuen-Chun Teoh and Eddie Chan
Cancers 2024, 16(16), 2826; https://doi.org/10.3390/cancers16162826 - 12 Aug 2024
Viewed by 767
Abstract
Introduction: Robot-assisted radical cystectomy (RARC) has gained momentum in the management of muscle invasive bladder cancer (MIBC). Predictors of RARC outcomes are not thoroughly studied. We aim to investigate the implications of preoperative hydronephrosis on oncological outcomes. Patients and Methods: This study analysed [...] Read more.
Introduction: Robot-assisted radical cystectomy (RARC) has gained momentum in the management of muscle invasive bladder cancer (MIBC). Predictors of RARC outcomes are not thoroughly studied. We aim to investigate the implications of preoperative hydronephrosis on oncological outcomes. Patients and Methods: This study analysed data from the Asian RARC consortium, a multicentre registry involving nine Asian centres. Cases were divided into two groups according to the presence or absence of pre-operative hydronephrosis. Background characteristics, operative details, perioperative outcomes, and oncological results were reviewed. Outcomes were (1) survival outcomes, including 10-year disease-free survival (DFS) and overall survival (OS), and (2) perioperative and pathological results. Multivariate regression analyses were performed on survival outcomes. Results: From 2007 to 2020, 536 non-metastatic MIBC patients receiving RARC were analysed. 429 had no hydronephrosis (80.0%), and 107 (20.0%) had hydronephrosis. Hydronephrosis was found to be predictive of inferior DFS (HR = 1.701, p = 0.003, 95% CI = 1.196–2.418) and OS (HR = 1.834, p = 0.008, 95% CI = 1.173–2.866). Subgroup analysis demonstrated differences in the T2-or-above subgroup (HR = 1.65; p = 0.004 in DFS and HR = 1.888; p = 0.008 in OS) and the T3-or-above subgroup (HR = 1.757; p = 0.017 in DFS and HR = 1.807; p = 0.034 in OS). Conclusions: The presence of preoperative hydronephrosis among MIBC patients carries additional prognostic implications on top of tumour staging. Its importance in case selection needs to be highlighted. Full article
(This article belongs to the Special Issue Advances in Management of Urothelial Cancer)
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9 pages, 651 KiB  
Article
Impact of Pre-Operative Ureteroscopy on Bladder Recurrence Following Nephroureterectomy for UTUC
by Chris Ho-Ming Wong, Ivan Ching-Ho Ko, David Ka-Wai Leung, Kang Liu, Hongda Zhao, Mario Alvarez-Maestro, Maria del Pilar Laguna Pes, Jean de la Rosette and Jeremy Yuen-Chun Teoh
Cancers 2024, 16(15), 2683; https://doi.org/10.3390/cancers16152683 - 28 Jul 2024
Viewed by 862
Abstract
(1) Introduction: Diagnostic ureteroscopy (URS) is an important component in the workup of upper tract urothelial carcinoma (UTUC). Whether URS was associated with increased recurrence in the bladder was not fully concluded. The current study aimed to evaluate the implication of URS on [...] Read more.
(1) Introduction: Diagnostic ureteroscopy (URS) is an important component in the workup of upper tract urothelial carcinoma (UTUC). Whether URS was associated with increased recurrence in the bladder was not fully concluded. The current study aimed to evaluate the implication of URS on the incidences of intravesical recurrence following radical nephroureterectomy (RNU) in non-metastatic UTUC patients without prior history of bladder cancer via multi-institutional data. (2) Patients and Methods: Data were obtained from the Clinical Research Office of the Endourology Society Urothelial Carcinomas of the Upper Tract (CROES-UTUC) registry, a prospective, multicentre database. Patients with non-metastatic UTUC treated with RNU were divided into two groups: those undergoing upfront RNU and those having diagnostic URS prior to RNU. Intravesical recurrence-free survival (IVRS) was the primary endpoint, evaluated through Kaplan–Meier analysis and multivariate Cox regression. Cases with adequate follow-up data were included. (3) Results: The analysis included 269 patients. Of these, 137 (50.9%) received upfront RNU and 132 (49.1%) received pre-RNU URS. The URS group exhibited an inferior 24-month IVRS compared to the upfront RNU group (HR = 1.705, 95% CI = 1.082–2.688; p = 0.020). Multivariate analysis confirmed URS as the only significant predictor of IVR (p = 0.019). Ureteric access sheath usage, flexible ureteroscopy, ureteric biopsy, retrograde contrast studies, and the duration of URS did not significantly affect IVRS. (4) Conclusions: Diagnostic URS prior to RNU was found to be associated with an increased risk of IVR in patients with UTUC. The risk was not significantly influenced by auxiliary procedures during URS. Physicians were advised to meticulously evaluate the necessity of diagnostic URS. Full article
(This article belongs to the Special Issue Advances in Management of Urothelial Cancer)
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13 pages, 1966 KiB  
Article
Oncologic Outcomes of Patients with Immune Checkpoint Inhibitor Resistant Urothelial Carcinoma Treated with Enfortumab Vedotin and the Impact of Neutrophil-to-Lymphocyte Ratio and Dysgeusia on Overall Survival: A Retrospective Multicenter Cohort Study in Japan
by Keita Nakane, Kazuki Taniguchi, Minori Nezasa, Torai Enomoto, Toyohiro Yamada, Risa Tomioka-Inagawa, Kojiro Niwa, Masayuki Tomioka, Takashi Ishida, Shingo Nagai, Shigeaki Yokoi, Tomoki Taniguchi, Makoto Kawase, Kota Kawase, Koji Iinuma, Yuki Tobisawa and Takuya Koie
Cancers 2024, 16(15), 2648; https://doi.org/10.3390/cancers16152648 - 25 Jul 2024
Viewed by 886
Abstract
Randomized phase III trial results have demonstrated enfortumab vedotin (EV), an antibody–drug conjugate (ADC) consisting of an anti-Nectin-4 human IgG1 monoclonal antibody and monomethyl auristatin E, is a useful treatment for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) that progressed after [...] Read more.
Randomized phase III trial results have demonstrated enfortumab vedotin (EV), an antibody–drug conjugate (ADC) consisting of an anti-Nectin-4 human IgG1 monoclonal antibody and monomethyl auristatin E, is a useful treatment for patients with locally advanced or metastatic urothelial carcinoma (la/mUC) that progressed after immune checkpoint inhibitor (ICI) therapies. This multicenter retrospective cohort study aimed to identify predictive factors for the efficacy of EV therapy and prolonged overall survival (OS) of patients in clinical practice. This study included patients with la/mUC who received ICI treatment. Patients who subsequently received EV treatment, those who received non-EV chemotherapy, and those who received no treatment were defined as EV, non-EV, and best supportive care (BSC) groups, respectively. The median OS was 20, 15, and 7 months in the EV, non-EV, and BSC groups, respectively (p < 0.001). Patients with la/mUC who had a complete or partial response after EV treatment had a significantly prolonged OS compared with those with stable or progressive disease. Univariate analysis showed age, neutrophil-to-lymphocyte ratio (NLR), dysgeusia, and rash as independent predictors of OS improvement. NLR and dysgeusia were independent predictors of OS after EV in multivariate analysis. Patients without these factors had a significantly prolonged OS compared to those with both factors. In real-world practice, EV therapy is an effective treatment for patients with la/mUC after ICI treatment. Full article
(This article belongs to the Special Issue Advances in Management of Urothelial Cancer)
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10 pages, 373 KiB  
Article
Hyperthermic Intravesical Chemotherapy (HIVEC) Using Epirubicin in an Optimized Setting in Patients with NMIBC Recurrence after Failed BCG Therapy
by Julien Blanc, Jonathan Ruggiero, Ilaria Lucca, Nicolas Arnold, Bernhard Kiss and Beat Roth
Cancers 2024, 16(7), 1398; https://doi.org/10.3390/cancers16071398 - 2 Apr 2024
Viewed by 1208
Abstract
To evaluate hyperthermic intravesical chemotherapy (HIVEC) using conductive heating and epirubicin in an optimized setting as an alternative to radical cystectomy in patients with recurrent non-muscle invasive bladder cancer (NMIBC) who have failed bacillus Calmette-Guérin (BCG) therapy. We retrospectively analyzed our prospectively recorded [...] Read more.
To evaluate hyperthermic intravesical chemotherapy (HIVEC) using conductive heating and epirubicin in an optimized setting as an alternative to radical cystectomy in patients with recurrent non-muscle invasive bladder cancer (NMIBC) who have failed bacillus Calmette-Guérin (BCG) therapy. We retrospectively analyzed our prospectively recorded database of patients who underwent HIVEC between 11/2017 and 11/2022 at two Swiss University Centers. Cox regression analysis was used for univariate/multivariate analysis, and the Kaplan–Meier method for survival analysis. Of the 39 patients with NMIBC recurrence after failed BCG therapy, 25 (64%) did not recur within the bladder after a median follow-up of 28 months. The 12- and 24-month intravesical RFS were 94.8% and 80%, respectively. Extravesical recurrence developed in 14/39 (36%) of patients. Only 7/39 (18%) patients had to undergo radical cystectomy. Seven patients (18%) progressed to metastatic disease, with five of these (71%) having previously developed extravesical disease. No adverse events > grade 2 occurred during HIVEC. Device-assisted HIVEC using epirubicin in an optimized setting achieved excellent RFS rates in this recurrent NMIBC population at highest risk for recurrence after previously failed intravesical BCG therapy. Extravesical disease during or after HIVEC, however, was frequent and associated with metastatic disease and consecutively poor outcomes. Full article
(This article belongs to the Special Issue Advances in Management of Urothelial Cancer)
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Review

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10 pages, 236 KiB  
Review
The Utility of Intraluminal Therapies in Upper Tract Urothelial Carcinoma: A Narrative Review
by Jack Tyrrell, William Chui, Joshua Kealey and Shomik Sengupta
Cancers 2024, 16(10), 1931; https://doi.org/10.3390/cancers16101931 - 18 May 2024
Viewed by 1305
Abstract
Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be [...] Read more.
Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be difficult, given the limitations of diagnostic modalities. Recurrence rates for UTUC can be as high as 36 to 54% after NSS. Intraluminal adjuvant therapy can be attempted following NSS to reduce recurrence, but delivery to the upper tract is more challenging than into the bladder. Bacillus Calmette-Guerin (BCG) and chemotherapy such as Mitomycin (MMC) have been administered via nephrostomy or ureteric catheter, which requires invasive/repeated instrumentation of the upper urinary tract. Drug delivery by reflux from bladder instillation along indwelling stents has also been tried but can potentially be unreliable. Recently, a gel formulation of mitomycin has been developed for the controlled exposure of the upper urinary tract to treatment over a number of hours. Drug-eluting stents to deliver chemotherapy to the upper urinary tract have been developed but have not yet entered clinical practice. Endoluminal phototherapy utilising an intravenous photosensitising agent is another novel approach that has recently been described. Intraluminal therapies may be beneficial in decreasing recurrence rates in UTUC, but currently have some limitations in their usage. Full article
(This article belongs to the Special Issue Advances in Management of Urothelial Cancer)
19 pages, 8570 KiB  
Review
Melanoma Antigen Family A (MAGE A) as Promising Biomarkers and Therapeutic Targets in Bladder Cancer
by Shiv Verma, Diya Swain, Prem Prakash Kushwaha, Smit Brahmbhatt, Karishma Gupta, Debasish Sundi and Sanjay Gupta
Cancers 2024, 16(2), 246; https://doi.org/10.3390/cancers16020246 - 5 Jan 2024
Cited by 2 | Viewed by 2340
Abstract
The Melanoma Antigen Gene (MAGE) is a large family of highly conserved proteins that share a common MAGE homology domain. Interestingly, many MAGE family members exhibit restricted expression in reproductive tissues but are abnormally expressed in various human malignancies, including bladder cancer, which [...] Read more.
The Melanoma Antigen Gene (MAGE) is a large family of highly conserved proteins that share a common MAGE homology domain. Interestingly, many MAGE family members exhibit restricted expression in reproductive tissues but are abnormally expressed in various human malignancies, including bladder cancer, which is a common urinary malignancy associated with high morbidity and mortality rates. The recent literature suggests a more prominent role for MAGEA family members in driving bladder tumorigenesis. This review highlights the role of MAGEA proteins, the potential for them to serve as diagnostic or prognostic biomarker(s), and as therapeutic targets for bladder cancer. Full article
(This article belongs to the Special Issue Advances in Management of Urothelial Cancer)
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