The effects of transurethral resection and cystoprostatectomy on dissemination of epithelial cells in the circulation of patients with bladder cancer

Abstract

Transurethral resection of exophytic bladder tumours (TURT) is the first step in the management of bladder cancer. The procedure confirms the diagnosis and provides important prognostic information, including grading and staging of the disease. During endoscopy, the tumour and underlying muscle are resected. This procedure, performed under continuous irrigation, can lead to passage of the irrigating fluid, accompanied by benign and/or malignant epithelial cell suspensions, into the peripheral circulation, facilitated by inevitable venous breaches during resection, and by transient elevations of the intravesical pressure during resection (Hahn, 1995). Theoretically, this may contribute to disease progression, invasion and metastases as has been suggested in other malignancies, including breast and prostate cancer during open surgical excision which has been shown to induce passage of normal and malignant epithelial cells into the peripheral circulation (Eschwège et al, 1995;Choy and McCulloch, 1996; Oeflein et al, 1996). To our knowledge, however, haematogenous dissemination of epithelial cells during endoscopic resection of bladder cancer or during cystoprostatectomy has not been studied previously.The aim of our study was to evaluate prospectively the risk of haematogenous dissemination of epithelial cells following transurethral resection and cystoprostatectomy for bladder cancer. PATIENTS, MATERIALS AND METHODS PatientsThirty-three patients were studied. Two were thought to have malignant disease in the bladder, but were found to have non-specific inflammation (n = 1) and schistosomiasis (n = 1) with no evidence of malignancy. Thirty-one consecutive patients had different stages and grades of transitional cell carcinoma of the bladder, 25 of whom required transurethral resection of their bladder tumour. Of those, 20 had superficial disease (pTaG1-G2: n = 19; pT1G2: n = 1), all tumours being single or multifocal with a total fresh weight less than 5 g, and no post-operative haemorrhagic complications; and five had muscle invasive tumours (pT2G3: n = 2; pT3aG3: n = 1; pT4G3: n = 2). Five of the remaining cancer patients underwent radical cystoprostatectomy for muscle invasive cancers (pT2G3: n = 3; pT3bG3: n = 1; pT4G3: n = 1). The final patient who was analysed received a radical cystoprostatectomy 6 months earlier for a pT4G3 tumour, and developed pelvic recurrence and skeletal metastases. He was treated with systemic chemotherapy. Sample collection and preparationVenous blood samples (10 ml) were obtained by venepuncture from the antecubital fossa in every patient before surgery, and between 1 and 2 h after completion of the procedure. In the patient with known metastatic disease, blood samples were obtained prior to administration of chemotherapy. Summary This study was undertaken to evaluate the risk of haematogenous dissemination of epithelial cells induced by endoscopic resection and/or cystoprostatectomy for transitional cell carcinoma of the bladder. Thirty-three patients were studied. Thirty-one had d...

Diagnostic value of circulating tumor cell detection in bladder and urothelial cancer: systematic review and meta-analysis

“…Eight of these studies did not meet the inclusion criteria: 3 studies had enrolled < 20 patients or < 30 patients and controls [ 17 , 46 , 47 ]; 2 were not written in English [ 52 , 53 ], 1 [ 51 ] reported follow-up data from a patient cohort originally assessed in a previous report [ 50 ]; 1 article did not include controls in the study design and all enrolled patients had stage IV urothelial cancer [ 44 ]; and 1 article was a case report of 2 patients with metastatic urothelial cancer [ 42 ]. Therefore 28 articles were included in further meta-analysis calculations: 18 articles [ 16 , 19 - 21 , 23 - 25 , 27 , 37 - 41 , 43 , 45 , 48 - 50 ] were included the meta-analysis of diagnostic accuracy of CTC detection (combined total of 764 patients and 708 controls) and 12 articles [ 16 , 18 - 20 , 22 - 26 , 39 , 41 , 50 ] were included in the meta-analysis of CTC association with disease stage (combined total of 331 patients with stage ≤II cancer and 203 with advanced-stage III-IV cancer).…”

Quality control in transurethral resection of bladder tumours

“…TUR of invasive bladder tumours does not appear to disseminate urothelial tumour cells in the peripheral circulation, nor is there evidence that the procedure upstages (i.e. positive nodes) the disease at cystectomy [26]. In a recent review of 1589 cases of radical cystectomy done after a re‐staging TUR, there was local recurrence in 3.5% (all in patients with advanced extravesical tumours and none among patients with organ‐confined disease) [27].…”

“…The most serious complication, occurring in 1.3–3.5% of cases, is bladder perforation [25,26]. Most are small, extravesical perforations, easily managed by several days of catheter drainage.…”

The current status and clinical value of circulating tumor cells and circulating cell-free tumor DNA in bladder cancer

“…The CTC detection rate in this study was higher than those described in studies using the CellSearch system ( Table 1 ) ( 66 ). Lower detection rates were observed when applying anti-KRT antibodies in ICC on PBMCs enriched by density gradient centrifugation ( 67 ). Moreover, application of assays based on the activity of the enzyme telomerase that is thought to be expressed only in tumor and not in normal cells might help to identify CTCs that have down-regulated epithelial cell properties ( Table 1 ) ( 68 , 69 ).…”