Validation of the risk stratification newly defined in the Japanese Urological Association guidelines 2019 for non-muscle invasive bladder cancer: A multi-institutional collaborative study.

OBJECTIVES: To validate the risk stratification newly defined in the Japanese Urological Association guidelines 2019 for non-muscle invasive bladder cancer and provide a more accurate stratification model for a heterogeneous intermediate-risk group. METHODS: A total of 1610 patients, who underwent transurethral resection, diagnosed with non-muscle invasive bladder cancer in nine collaborating hospitals were retrospectively reviewed. They were classified into low-risk, intermediate-risk, high-risk, and highest-risk groups, and recurrence-free survival, progression-free survival, cancer-specific survival, and overall survival were compared among the groups. The intermediate-risk group was subdivided into two groups based on the multivariable Cox regression model of recurrence and progression risk factors, and a revised risk model was created. RESULTS: The progression-free survival, cancer-specific survival, and overall survival were well stratified, while the recurrence-free survival of the intermediate-risk group was the shortest among the four groups (p < 0.001). The independent risk factors for recurrence and progression-free survival in the intermediate-risk group were as follows: age ≥ 70 years, sex, multiple tumors, tumor size ≥3 cm, and recurrent cases. The intermediate-risk group was subdivided into two groups: favorable intermediate-risk group and unfavorable intermediate-risk group. The revised risk model showed significant differences. CONCLUSION: We validated the Japanese Urological Association guidelines 2019 stratification model. The revised risk model provided a more accurate treatment selection for this disease subset.

External validation of a genitourinary cancer-specific prognostic scoring system to predict survival for patients with bone metastasis (modified B-FOM scoring model): Comparison with other scoring models in terms of accuracy.

OBJECTIVE: We previously developed genitourinary (GU) cancer-specific scoring system for prediction of survival in patients with bone metastasis (the Bone-Fujimoto-Owari-Miyake [B-FOM] scoring model) based on five prognostic factors: the type of primary tumor (prostate cancer (PCa) vs renal cell carcinoma (RCC) and PCa vs urothelial carcinoma (UC)), poor performance status (PS), visceral metastasis, high Glasgow-prognostic score (GPS), elevated neutrophil-to-lymphocyte ratio (NLR). The aim of this study was to externally validate and further improve the performance of the B-FOM score. METHODS: The external validation cohort comprised 309 patients with GU cancer with bone metastasis from multiple institutions. Clinical factors were analyzed using Kaplan-Meier method and COX regression hazard model. Performance of a modified B-FOM score was compared to that of other scoring models by the Kaplan-Meier method and the area under the curve (AUC) of receiver operating characteristic curves. RESULTS: The median follow-up period of development and validation cohort were 25 and 17 months, respectively. Kaplan-Meier curve demonstrated that the type of primary tumor (RCC and UC vs PCa), poor PS, presence of visceral metastasis, high GPS, elevated NLR were significantly associated with shorter cancer-specific survival. Risk groups were successfully stratified by the modified B-FOM score classification. Moreover, the AUC of the modified B-FOM scoring model for predicting mortality at 6, 12, and 24 months were 0.895, 0.856, and 0.815, respectively, which were the highest among evaluated models. CONCLUSIONS: The B-FOM scoring model is a simple and accurate prediction tool. By using this scoring model at the time of the diagnosis of bone metastasis in patients with GU cancers, an individualized optimal treatment strategy can be selected.

[The efficacy of the use of acetic acid test in a case of local recurrence of penile carcinoma].

A 62-old-year male presented to our hospital with induration of the prepuce and bleeding from the glans penis that occurred during sexual intercourse. Scrape cytology was performed, which showed class V, suspected squamous cell carcinoma. Computed tomography showed no metastases, and magnetic resonance imaging revealed no invasion of the corpus spongiosum. Circumcision and resection of the glanstumor were performed. Histopathological examination revealed squamous cell carcinoma in situ. We diagnosed the case as penile carcinoma in situ (pTisN0M0, UICC stage 0, and Jackson stage I). At 6 months postoperatively, local recurrence of penile carcinoma was detected by visual inspection after 5% acetic acid staining, and tumor resection was performed. At 9 months postoperatively (after the 2nd resection), the patient has remained disease-free, with no evidence of recurrence.

[Renal pelvic tumor with difficult radiological diagnosis : a report of two cases].

Case 1 : A 60-year-old man presented with right flank pain. A computed tomography (CT) scan revealed a large right renal tumor, multiple lung metastases, multiple liver metastases, and tumor thrombus of the right renal vein. These findings were strongly suggestive of renal cell carcinoma. The patient suddenly complained of dyspnea at night due to bilateral pulmonary embolism, and the patient died 11 days after onset. Needle necropsy showed that the tumors were squamous cell carcinomas of the renal pelvis. Case 2 : A 66-year-old man presented with macrohematuria. An abdominal CT scan revealed a right renal mass and liver metastasis. The differential diagnosis was between renal cell carcinoma and urothelial carcinoma. A renal biopsy revealed urothelial carcinoma of the renal pelvis. The patient died of the disease 3 months after initiation of chemotherapy with gemcitabine and cisplatin. We report these 2 cases to emphasize the importance of renal biopsy and thorough histological analysis for the determination of treatment strategies against unresectable renal tumors.

[Fibrosarcoma of the spermatic cord detected with an inguinal tumor : a case report].

We report a case of fibrosarcoma of the spermatic cord detected with an inguinal tumor. A 45-year old man was admitted to our hospital for further examination of a right inguinal tumor. Computed tomography (CT) and magnetic resonance imaging revealed a right spermatic cord tumor,45 mm in size, and a retroperitoneal tumor in proximity to the right external iliac artery,55 mm in size. He was clinically suspected as having malignant lymphoma. As the differential diagnosis, liposarcoma and leiomyosarcoma were considered. High orchidectomy was performed for the purpose of diagnosis. The histopathological examination suggested fibrosarcoma, with a positive surgical margin. Six days after high orchidectomy, retroperitoneal tumor extirpation was performed. Total resection was difficult because the adhesion with the external iliac vein was strong. The tumor was extirpated as much as possible. The result of the histopathological examination showed fibrosarcoma. Adjuvant radiotherapy (54 Gy) was performed. After radiotherapy, local recurrence was detected by CT. He underwent systemic chemotherapy with adriamycin (60 mg/m2). After 3 courses, there was a slight reduction in tumor size. However, his general condition rapidly deteriorated with marked cachexy and he died six months from the first medical examination.