No abstract

2Word count: 1,384 words. 3 ABSTRACTPurpose: To determine prognostic factors associated with prolonged survival after metastasectomy for urothelial carcinoma (UC). Materials and Methods:Forty-two patients who underwent resection of metastases of UC with curative intent at 4 different Japanese university hospitals were included.Most of the patients (41/42) underwent systemic chemotherapy before and/or after metastasectomy. Overall survival was analyzed using the Kaplan-Meier method, and the relationship between the clinical characteristics and survival was analyzed using the log-rank test.Results: Details of metastasectomy were as follows: lymph node dissection (n=20), pulmonary resection (n=12), pelvic exenteration (n=3), resection of local recurrence (n=2), resection of subcutaneous metastasis (n=2), liver resection (n=1), and others

histopathological variables were analyzed to evaluate predictive values for survival. RESULTSThe median survival time in patients with high and low hENT1 expression was 17.3 and 11.6 months, respectively (log-rank test, P = 0.003). This contrasted with the median survival in patients with high and low ERCC1 expressions, which did not differ significantly (high ERCC1, 13.6 months; low ERCC1, 17.1 months; P = 0.178). In univariate Cox regression analyses for pretreatment clinicopathological variables, performance status ( P = 0.02) and hENT1 expression ( P = 0.004), but not ERCC1 expression ( P = 0.182), were associated with overall survival. Multivariate analysis using a Cox proportional hazards model showed that hENT1 expression was an independent prognostic factor ( P = 0.008). CONCLUSIONThe data obtained in the present study show that high expression of hENT1 in tumour cells is associated with prolonged survival in patients with metastatic bladder cancer treated with gemcitabine-cisplatin-based combination chemotherapy. KEYWORDShuman equilibrative nucleoside transporter 1, excision repair cross complementing 1, bladder cancer, chemotherapy, gemcitabine and cisplatin, immunohistochemical analysis What's known on the subject? and What does the study add? The expression of hENT1 was significantly associated with prolonged survival in advanced bladder cancer treated with gemcitabine-cisplatin-based combination chemotherapy.The mechanism-based approach to the chemotherapeutic agents may be helpful to personalize medicine for the individual advanced bladder cancer patient.

These results indicate that metabolic syndrome causes the changes in urinary constituents, leading to increased risk of both uric acid and calcium stone formation. Improvement in insulin resistance, a central cause of metabolic syndrome, might prevent uric acid stone formation by raising urinary pH.

Evidence of the prognostic value of pretreatment systemic immune-inflammation index (SII) after radical cystectomy (RC) for bladder cancer is limited. This study aims to assess the association between preoperative SII and prognosis after RC for bladder cancer. In this multicenter retrospective study, we calculated preoperative SII as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in 237 patients who underwent RC for bladder cancer between March 2009 and March 2018. Patients were classified into high SII and low SII groups by using the optimal cutoff value (438 × 109/L) based on receiver operating characteristic curve analysis for cancer-specific death. We compared cancer-specific survival (CSS) and overall survival (OS) between the two groups. To evaluate the prognostic impact of preoperative SII, we also performed Cox proportional regression analyses for CSS and OS. Of 237 patients, 127 patients were classified into the high SII group and 110 patients into the low SII group. During the follow-up period, 70 patients died of bladder cancer (30%) and 21 patients died from other causes (9%). Patients with high SII had significantly lower rates of CSS and OS than those with low SII (p < 0.01 and p < 0.01, respectively). Multivariable Cox proportional hazard analysis showed that high SII was independently associated with poor CSS (p = 0.01) and poor OS (p < 0.01). In conclusion, high SII could be an independent significant predictor of poor prognosis after RC in patients with bladder cancer.