Bladder cancer is the most common malignant tumor in the urinary system. The standard treatment of muscle-invasive bladder cancer (MIBC) is the radical cystectomy combined with pelvic lymphadenectomy. In recent years, radiotherapy has played an important role in the MIBC bladder-preserving treatment model. This article will review the advances in the application of radiotherapy for bladder preservation in MIBC, and introduce the application progress of radiotherapy in trimodality therapy of adjuvant radiotherapy and chemotherapy after transurethral resection of bladder tumors, radical radiotherapy, preoperative radiotherapy, radiotherapy combined with immunotherapy, the development and challenges of radiotherapy technology, and radiotherapy-related adverse reactions. The aim of this article is to provide a reference for further exploration of a more scientific and effective comprehensive treatment mode for bladder preservation.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
ObjectiveTo investigate the effect of combined or non-combined liver resection for T2a gallbladder cancer. MethodsAccording to the established inclusion and exclusion criteria, the patients with T2a gallbladder cancer admitted to Peking Union Medical College Hospital from January 2016 to December 2021 were retrospectively collected, then were assigned into combined with liver resection group and non-combined with liver resection group. The general characteristics, perioperative information, and prognosis of the two groups were compared. ResultsA total of 58 patients were enrolled in this study, including 23 males and 35 females; aged (64.8±11.1) years. There were 43 cases in the combined with liver resection group and 15 cases in the non-combined with liver resection group. There were no statistic differences in the demographic data, lifestyle, onset symptoms, preoperative combined diseases, and preoperative tumor markers between the two groups (P>0.05). Compared with the combined with liver resection group, the proportion of patients received bile duct resection was higher (P=0.013) and the operation time was shorter (P=0.045) in the non-combined with liver resection group. There were no statistic differences in the other perioperative informations between the two groups (P>0.05). A total of 12 patients had postoperative complications, including 3 cases of grade Ⅰ, 8 cases of grade Ⅱ, and 1 case of grade Ⅲa by Clavien-Dindo classification. All patients improved after treatment and were discharged smoothly. No patient was readmitted within 30 d after discharge. All 58 patients were followed up with a median follow up time of 29 months. During the follow-up period, there were 47 cases (81.0%) of tumor-free survival, 2 cases (3.4%) of survival with tumor, and 9 cases (15.5%) of death. There were no statistic differences in the overall survival and disease-free survival between the two groups by log-rank test (χ2=3.418, P=0.064; χ2=1.543, P=0.214). ConclusionFromthe results of this study, for T2a gallbladder cancer, liver resection would not result in increased complications or longer hospital stay, but don’t obviously improve prognosis.
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.
ObjectiveTo summarize the research progress of long non-coding RNA (lncRNA) in the regulation of malignant biological behavior of gallbladder cancer so as to provide references for its related research.MethodThe relevant literatures about studies of lncRNA in gallbladder cancer in recent years were reviewed.ResultsThe recent studies had shown that 19 lncRNAs associated with gallbladder cancer had played the important roles in regulating tumor cell proliferation, migration, invasion, apoptosis, “sponge” miRNAs, chemoresistance, and tumor metastasis. Among them, most lncRNAs tended to have carcinogenic properties, only a few had anticarcinogenic effect. Although the research suggested the mechanism and role of lncRNA to promote or inhibit the occurrence and development of gallbladder cancer, the current research on its mechanism was still limited. In addition, some lncRNAs were found to be specifically expressed in the serum of patients with gallbladder cancer, so which were expected to become biomarkers for tumor diagnosis and prognosis.ConclusionslncRNAs associated with gallbladder cancer have carcinogenic or anticarcinogenic effect, or chemoresistance. They play potential roles in diagnosis, prognosis, and (or) treatment of tumors, but molecular mechanisms of their effects are still limited.
Objective To investigate the relationship between microvessel density(MVD) and lymph node metastasis and prognosis in gallbladder carcinoma. MethodsThe MVD in 42 gallbladder carcinoma by immunohistochemical SP method using a polyclonal antibody to FⅧ and the relationship between MVD and histologic types, depth of invasion, lymph node metastasis, distant metastasis and prognosis was studied. Results The value of MVD was correlated with the depth of invasion (P＜0.05), lymph node metastasis (P＜0.01) and distant metastasis (P＜0.05). It was not significantly related to the pathologic pattern and tumor differentiation. The significantly negtive correlation was found between MVD and 5-year survival in patients with gallbladder carcinoma. Conclusion MVD is bly related to the metastasis of gallbladder carcinoma. It may serve as a prognotic factor.
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 analyze the epidemiological characteristics and trends of gallbladder cancer incidence and mortality in Zhejiang cancer registration areas from 2000 to 2021, providing a basis for formulating prevention and control strategies for gallbladder cancer. MethodsData on incidence and mortality were collected from 22 cancer registry areas in Zhejiang Province from 2000 to 2021, calculating the crude incidence (mortality), age-standardized incidence / mortality rate by Chinese standard population(ASR China), age-standardized incidence /mortality rate by World standard population (ASR World) and cumulative rate (0–74 years old). The average annual percentage change (AAPC) was calculated by using Joinpoint software. ResultsIn 2021, the crude incidence of gallbladder cancer in Zhejiang cancer registration areas was 6.79 per 100 000. The ASR China and ASR World were 2.99 and 2.96 per 100 000, respectively, ranking 18th of all new cancer cases. The incidence ASR China in female (3.13 per 100 000) was higher than that in male (2.85 per 100 000). The incidence ASR China in rural areas (3.01 per 100 000) was slightly higher than that in urban areas (2.97 per 100 000). The crude mortality of gallbladder cancer was 5.14 per 100 000, with the mortality ASR China and ASR World of 2.09 and 2.10 per 100 000, respectively, ranking 10th of all new cancer deaths. The mortality ASR China in female (2.19 per 100 000) was higher than that in male (1.98 per 100 000). The mortality ASR China in urban areas (2.11 per 100 000) was slightly higher than that in rural areas (2.07 per 100 000). Both the crude incidence and mortality of gallbladder cancer increased with age. The crude incidence and mortality showed an upward trend over time, with AAPC of 2.59% and 3.75%, respectively (P<0.001). The incidence ASR China did not show significant changes over time (AAPC=0.05%, P=0.856). The incidence ASR China in male and rural areas showed increasing trends over time, with AAPCs of 0.89% (P=0.016) and 1.14% (P=0.001), respectively. The incidence ASR China in female and urban areas showed no significant trends over time, with AAPCs of –0.26% (P=0.503) and –0.02% (P=0.967), respectively. The mortality showed a slower upward trend after adjusting the age structure (AAPC=1.01%, P=0.020). ConclusionsThe elderly population in rural areas, especially elderly women, are the primary targets for the prevention and control of gallbladder cancer. Aging is the main factor contributing to the increase in the incidence and mortality of gallbladder cancer. After adjusting for demographic factors, the overall upward trend of the incidence in the male population and rural areas, as well as mortality, cannot be ignored.
ObjectiveTo study the effects of the expressions of endostatin, basic fibroblast growth factor (bFGF) and CD34 on oncogenesis and progression of gallbladder cancer, and to explore some valuable criterias for its biotherapy. Methods The expressions of endostatin, bFGF and CD34 were studied by means of immunohistochemistry (SP) in 61 cases of gallbladder cancer and 10 cases of normal cholecystic tissue, and microvessel density (MVD) was calculated by the expression of CD34. Their relationships with clinical pathological features were also investigated. Results The expression rates of endostatin in normal cholecystic tissue and in gallbladder cancer tissue were 40.00% (4/10) and 77.05% (47/61) respectively, which had statistical difference (P＜0.05). The expression of endostatin in 61 cases of caner was relational to clinical stage and metastasis of lymph nodes (P＜0.05), while no significant correlation was detected with sex and age of patient, location of tumor, size of tumor and histologic grade (P＞0.05). The expression rates of bFGF in normal cholecystic tissue and in gallbladder cancer tissue were 20.00%（2/10） and 67.21% （41/61） respectively, which had statistical difference (P＜0.05). The expression of bFGF in 61 cases of caner was relational to clinical stage and metastasis of lymph nodes (P＜0.05), while no significant correlation was detected with sex and age of patient, location of tumor, size of tumor and histologic grade (P＞0.05). MVD in gallbladder cancer tissue and in normal cholecystic tissue was （76.66±20.15） piece/HP and (29.53±5.03) piece/HP respectively, showing significant difference (P＜0.01). In 61 cases of cancer, MVD in clinical stage Ⅲ～Ⅴ 〔(80.53±17.98) piece/HP〕 was much higher than that in stage Ⅰ+Ⅱ 〔(46.79±5.38) piece/HP〕, P＜0.01; MVD was higher in those with lymph nodes metastasis 〔(94.60±7.28) piece/HP〕 than those without metastasis 〔(58.12±9.24) piece/HP〕, P＜0.01; and MVD was (60.59±14.71) piece/HP in histologic grade G1， (83.08±15.30) piece/HP in G2， and (96.53±6.92) piece/HP in G3, the difference was significant among them （P＜0.01）. There was no significant correlation between MVD and sex and age of patient, location of tumor and size of tumor (P＞0.05). There were statistically significant correlations between expressions of endostatin and MVD （P＜0.01）, expressions of bFGF and MVD （P＜0.01）. Conclusions The result suggests that endostatin, bFGF and CD34 play roles in oncogenesis and progression of gallbladder cancer. Detection of these proteins has positive effects on diagnosis, malignant degree determination and treatment of gallbladder cancer.
ObjectiveTo summarize the progress and challenges in the research of gallbladder cancer organoid, and explore the possible solution strategies. MethodThe literature relevant to the researches of gallbladder cancer organoid at home and abroad in recent years was reviewed. ResultsThe research of gallbladder cancer organoid was in its infancy. The gallbladder cancer organoid was mainly constructed from surgically resected gallbladder cancer tissues. Now the research of gallbladder cancer organoid had made some progress, such as on the pathogenesis and drug screening of gallbladder cancer. ConclusionsThe study on gallbladder cancer organoid can further understand the gallbladder cancer and help to speed up the update of diagnosis and treatment plan. However, the model of gallbladder cancer organoid is facing the challenges such as low construction success rate. The experience gained from organoids research in other diseases is worthy of reference.