Search Results (625)

Bacillus Calmette–Guérin (BCG)-unresponsive non-muscle-invasive bladder cancer (NMIBC) is a high-risk disease state for which early radical cystectomy remains the guideline-supported oncologic reference in surgically fit patients. Bladder-sparing therapy is necessary for patients ineligible for or declining cystectomy, but it is a preference-sensitive trade-off rather than an equivalent alternative: failure may permit high-grade recurrence, progression, and loss of a curative window. This targeted narrative review synthesizes the evidence for intravesical gemcitabine monotherapy, sequential gemcitabine–docetaxel, and the sustained-release gemcitabine intravesical system TAR-200/INLEXZO, updated through 4 August 2026. Because the review is not systematic and the evidence is dominated by single-arm and retrospective studies, cross-study comparisons are descriptive and establish neither superiority nor equivalence; many gemcitabine studies enrolled mixed BCG-failure cohorts that do not satisfy the contemporary definition. Gemcitabine monotherapy is active but shows declining disease control over time. Sequential gemcitabine–docetaxel has accumulated substantial multicenter observational experience, yet a 2026 retrospective comparison did not demonstrate improved high-grade recurrence-free survival over gemcitabine alone. TAR-200 achieved a centrally confirmed complete response at any time in 82.4% of patients, with a median duration of response of 25.8 months in the single-arm phase 2b SunRISe-1 study and is approved in the United States as INLEXZO for BCG-unresponsive carcinoma in situ with or without papillary tumors; no approved agent holds a papillary-only indication. Comparative patient-reported outcome evidence remains limited, and molecular markers, urinary tumor DNA and transcriptomic subtypes remain investigational rather than validated selection tools. Bladder-sparing treatment should therefore be phenotype- and label-aware, time-limited, and coupled to intensive surveillance with predefined triggers for cystectomy. Full article

This comprehensive literature review delves into the multifaceted roles of RNA-binding motif protein 3 (RBM3) in cellular processes, disease pathogenesis, and therapeutic potential. RBM3 has been implicated in shaping cell morphology, synaptic protection in neurodegenerative conditions, and regulating gene expression through binding to specific RNA sequences. In cancer, RBM3 exhibits contrasting effects, influencing cell proliferation, tumorigenic potential, and RNA splicing. Clinical studies suggest RBM3 as a predictive biomarker in chemotherapy response for muscle-invasive bladder cancer. Despite promising therapeutic implications in neuroprotection and cancer, challenges persist in understanding the regulatory mechanisms and clinical behavior of RBM3. Further research is warranted to elucidate the molecular mechanisms underlying RBM3’s diverse functions and its significance as a potential target for personalized medicine in cancer therapy. This review underscores the pivotal role of RBPs, particularly RBM3, in disease progression and highlights the need for continued investigation to harness their therapeutic potential effectively. This review evaluates evidence available through December 2025, with particular emphasis on studies published between 2010 and 2025. Full article

Introduction: To investigate the diagnostic and prognostic value of commonly used immunohistochemical markers regarding high-grade disease, muscle-invasion bladder cancer (MIBC) and survival in bladder cancer. Methods: A total of 477 patients diagnosed with bladder cancer at Peking University Cancer Hospital between 2009 and 2024 were included. The immunohistochemical markers included CK7, CK20, GATA3, Uroplakin 3, CK5/6, P40, P63, Syn, CD56, CGA, Vimentin, S100, LCA, Ki67, P53, Her2, EGFR, PD-L1, PD-1 tumor, PD-1 stroma, and Pan-TRK. Logistic analyses were used to determine the diagnostic value of the markers for high-grade disease and MIBC. Cox regression analyses were used to determine the prognostic value of the markers for survival. Results: We found Ki67 positivity (p < 0.001) and Her2 positivity (p = 0.001) might have an association with high-grade disease, while no marker demonstrated diagnostic value for MIBC. Patients with CK7 positivity (p = 0.012), Uroplakin 3 positivity (p = 0.004), and PD-1 (stroma) positivity (p = 0.037) had better overall survival (OS) than those with negative expression, while Cox regression analyses showed only CK7 positivity (p = 0.025) and Uroplakin 3 positivity (p = 0.008) had prognostic value for better OS. However, considering there were only 2 CK7-negative patients, the sample size might be insufficient to demonstrate its prognostic value. Conclusions: These results suggest that Ki67 positivity and Her2 positivity might have association with high-grade disease, and Uroplakin 3 positivity might have prognostic value for better OS. However, these conclusions require further clarification through larger-scale studies in the future. Full article

Background: Definitions of BCG-unresponsive non-muscle-invasive bladder cancer (NMIBC) have become central to therapeutic decision making and clinical trial eligibility. This perspective synthesizes regulatory frameworks with real-world observations to examine how structural conditions shape the applicability of current definitions. These definitions rely on structural prerequisites—adequate BCG exposure, routine maintenance therapy, standardized surveillance, timely access to early radical cystectomy, and complete tumour-level documentation—that are not consistently achievable across diverse health-care environments. This study examines the structural and operational factors that limit the applicability of current BCG-unresponsive criteria in real-world NMIBC care. Methods: A multilevel analysis was performed and integrated four complementary sources of evidence—regulatory frameworks, national claims datasets, multicenter clinical studies, and real-world practice observation—selected for their ability to capture distinct structural dimensions of NMIBC care. Operational assumptions embedded in contemporary definitions were compared with real-world treatment patterns. Structural barriers were categorized across macro-level system constraints, meso-level institutional practices, and micro-level clinical workflows. Results: As a result, a substantial proportion of patients cannot be classified under existing criteria because the exposure-based and time-dependent conditions required by regulatory definitions are not met in routine practice. Maintenance BCG is infrequently delivered, surveillance intervals vary widely, early radical cystectomy is limited by system-level and institutional factors, and key tumour-level variables required for classification are often missing in large-scale datasets. As a result, many patients cannot be reliably classified using existing criteria—not because of tumour biology or clinician behavior, but because the structural assumptions underlying the definitions are unmet. Conclusions: Current BCG-unresponsive criteria rely on structural conditions that are not universally present in real-world NMIBC care. These findings suggest that context-specific operational definitions, together with complementary strategies such as improving guideline implementation, enhancing data completeness, standardizing surveillance practices, and strengthening healthcare infrastructure, may help align regulatory expectations with real-world practice and support equitable access to bladder-sparing therapies. Full article

Bladder cancer (BC) is a common urological malignancy that lacks the non-invasive biomarkers that would make it suitable for early diagnosis. Human alpha-satellite DNA (hASAT) is a tandemly repeated centromeric/pericentromeric DNA family associated with chromosomal stability and cancer-related genomic instability. We quantified extracellular hASAT (ec-hASAT) in plasma circulating cell-free DNA by nanoplate-based digital PCR in a pilot cohort including 29 BC-negative samples, 10 patients with non-muscle-invasive BC (NMIBC), and 7 patients with muscle-invasive BC (MIBC). Plasma ec-hASAT copy number was higher in patients with BC than in the BC-negative group (Mann–Whitney U test, p = 6.61 × 10⁻⁷). BC-negative samples ranged from 225 to 11,864 copies/µL plasma, whereas BC samples ranged from 1138 to 16,097 copies/µL plasma. ROC analysis yielded an AUC of 0.944 for discriminating BC from BC-negative samples. At an exploratory threshold of 2000 copies/µL plasma, sensitivity was 94.1% (16/17; exact 95% CI, 71.3–99.9%) and specificity was 89.7% (26/29; exact 95% CI, 72.6–97.8%). These preliminary data support plasma ec-hASAT as a candidate minimally invasive biomarker for BC detection, including NMIBC, and justify validation in larger prospective cohorts. Full article

Radical cystectomy (RC) with urinary diversion (UD) is the standard treatment for muscle-invasive bladder cancer. Although the ileal conduit (IC) is the most commonly performed diversion, its reliance on bowel reconstruction leads to substantial perioperative morbidity and long-term complications. Cutaneous ureterostomy (CU) has re-emerged as an attractive alternative, particularly for elderly and medically frail patients, due to its technical simplicity and avoidance of intestinal manipulation. Recent single-stoma and tubeless modifications have aimed to overcome historical limitations of CU, including stomal stenosis and long-term stent dependence. Compared with IC, modern refinements of single-stoma CU showed shorter operative times and generally shorter hospital stays, largely reflecting avoidance of bowel reconstruction. Estimated blood loss and overall intraoperative complication rates were broadly comparable between diversion types. Contemporary retrospective data on single-stoma modifications showed lower rates of stomal stenosis and improved catheter-free outcomes compared with historical data, while infectious complications and readmission rates remained similar to those of IC in most series. Renal outcomes generally remained stable, with patient factors such as baseline renal function, hydronephrosis, and stent dependence appearing to be more influential for long-term deterioration than diversion type alone. Quality of life after contemporary single-stoma CU was similar to IC, based on the available retrospective evidence. Overall, contemporary single-stoma CU represents a valuable bowel-sparing urinary diversion that may potentially reduce operative burden while maintaining acceptable functional and quality-of-life outcomes. Current retrospective evidence supports its role as a particularly attractive option for elderly and frail patients, although prospective, multicenter comparative studies with standardized outcome reporting are still needed to better define patient selection and long-term outcomes. Full article

T1 high-grade (T1HG) urothelial carcinoma of the bladder presents a persistent clinical challenge: despite uniform high-risk classification under EAU guidelines, BCG failure and disease progression rates range from 10% to 40% across published series. Standard clinicopathological variables do not adequately explain this heterogeneity. Three pathological parameters evaluable from routine TURBT specimens—T1 substaging by lamina propria invasion depth, tumour budding at the invasion front, and E-cadherin (CDH1) immunohistochemistry—share a common mechanistic basis in CDH1-driven partial epithelial-to-mesenchymal transition and may refine escalation-oriented risk stratification without requiring additional tissue or molecular testing. We conducted a narrative critical review of PubMed/MEDLINE (January 2000–February 2026; 28 included studies) to evaluate the quantitative evidence for each parameter, with emphasis on reproducibility and BCG-specific outcome data. T1 substaging carries the strongest evidence: pooled progression HR 3.29 (95% CI 2.39–4.51) across 36 studies (n = 6781), with BCG failure of 41% vs. 21% in a centralised BCG-treated registry cohort of 264 patients on multivariable analysis. Tumour budding shows consistent adverse associations in BCG-treated pT1 NMIBC; zero progression was observed in the low-budding subgroup in the only available BCG-specific full-text cohort. CDH1 IHC is directionally supportive but limited by scoring heterogeneity (I² = 63%). All three parameters are mechanistically coherent and assessable from routine TURBT slides. Prospective validation with pre-specified thresholds and standardised scoring protocols is required before clinical implementation can be recommended. Full article

Background/Objectives: Transurethral resection of bladder tumors (TURBT) is the standard for diagnosing and treating non-muscle-invasive bladder cancer. For lateral bladder wall tumors, obturator nerve stimulation can trigger sudden adductor contractions, raising the risk of perforation, hemorrhage, incomplete resection, and poor specimen quality. We evaluated the impact of obturator nerve block (ONB) on specimen quality and perioperative complications. Methods: In this single-center retrospective study, patients with lateral wall tumors treated by TURBT between October 2022 and December 2024 were divided into an ONB group (spinal anesthesia plus ONB) and a non-ONB group (spinal anesthesia alone). Specimen quality, perioperative complications, and 12-month recurrence were analyzed. Results: In this retrospective cohort of 219 patients (135 ONB, 84 non-ONB), high-quality specimens were more frequent with ONB (71.1% vs. 35.7%, p < 0.001). No perforations occurred with ONB versus 5 (6.0%) without (p = 0.008); hematuria (11.1% vs. 28.6%, p = 0.002) and 12-month recurrence (4.4% vs. 16.7%, p = 0.005) were also lower. Conclusions: ONB added to spinal anesthesia during TURBT for lateral wall tumors was associated with improved specimen quality and fewer perioperative complications. The lower recurrence rate should be considered hypothesis-generating, given the retrospective design and the small number of recurrence events; prospective studies are needed. Full article

Bladder cancer is the fifth most common cancer in the United States, causing approximately 17,000 deaths annually. Due to its vast genetic and molecular heterogeneity, presentation, prognosis, and therapeutic response vary greatly between individuals. To improve patient outcomes, there is a need for better drug-screening platforms. The genetic heterogeneity of bladder cancer often leads to chemotherapy resistance or low response rates. Moreover, chemotherapies are often contraindicated in patients with select comorbidities. Organoids offer a better option to replicate the tumor microenvironment than traditional 2D cell cultures, improving drug development and personalized therapy. In this study, we bioprinted gelatin-methacrylol (GelMA)-based organoids containing bladder cancer cell lines of different grades to model muscle-invasive bladder cancer. In the organoids, we observed distinct grade-dependent tumor proliferation and progression dynamics. Treatment with standard-of-care chemotherapies revealed a grade-dependent tumor response consistent with in vivo patient data, highlighting the suitability of these organoids for rapid, reliable drug testing. Lastly, we used the organoids to test LCI139, a novel small-molecule inhibitor of PI3K, CDK4/6, and CDK9 designed for the treatment of epithelial cancers, underscoring the potential of our model to evaluate the efficacy of newly developed drugs. The ability to quickly biofabricate reproducible bladder cancer organoids that are adaptable to different tumor grades represents a novel strategy to create an in vitro platform with strong potential to predict treatment outcomes of bladder cancer patients. Full article

Background/Objectives: Non-muscle invasive bladder cancer (NMIBC) is characterized by high recurrence rates despite appropriate treatment and surveillance. Identifying inexpensive and readily available biomarkers capable of improving risk stratification remains an important clinical challenge. The platelet-to-lymphocyte ratio (PLR), a marker of systemic inflammation, has emerged as a potential prognostic indicator in several malignancies. This study aimed to evaluate the association between preoperative PLR, tumor recurrence, and recurrence-free survival (RFS) in NMIBC patients treated with intravesical Bacillus Calmette–Guérin (BCG) or thermochemotherapy. Methods: This retrospective study included 153 patients diagnosed with NMIBC between January 2020 and January 2024. All patients underwent transurethral resection of bladder tumor (TURBT) followed by intravesical BCG (n = 123) or thermochemotherapy (n = 30). Preoperative PLR was calculated from complete blood counts obtained before surgery. Receiver operating characteristic (ROC) analysis was used to determine the optimal PLR cut-off value. Recurrence-free survival was evaluated using Kaplan–Meier survival analysis and Cox proportional hazards regression models. Results: During a mean follow-up period of approximately 19 months, recurrence was observed in 35.8% of patients treated with BCG and 30% of those treated with thermochemotherapy. ROC analysis demonstrated good discriminatory ability for recurrence prediction (AUC = 0.831, 95% CI: 0.761–0.901, p < 0.001) and identified an optimal PLR threshold of 120. Patients with elevated PLR values demonstrated higher recurrence rates and shorter recurrence-free survival. Kaplan–Meier analysis revealed a clear separation of survival curves according to PLR status. In multivariable Cox regression analysis, PLR > 120 remained independently associated with recurrence-free survival in the BCG group (HR = 2.703, 95% CI: 1.118–6.534, p = 0.027), whereas only a borderline association was observed in the thermochemotherapy group (HR = 23.265, 95% CI: 0.952–568.336, p = 0.054). Conclusions: Elevated preoperative PLR was associated with recurrence and recurrence-free survival in patients with NMIBC. The prognostic value of PLR appeared to be more pronounced in patients receiving intravesical BCG therapy. Given its low cost, accessibility, and ease of calculation, PLR may serve as a useful adjunctive biomarker for clinical risk stratification when used alongside established clinicopathological prognostic factors. Further prospective multicenter studies are required to validate these findings. Full article

Background: Urothelial carcinoma requires frequent surveillance because of its high recurrence rate, particularly in patients with non-muscle-invasive disease. Although cystoscopy remains the standard method for diagnosis and follow-up, it is invasive, costly, and associated with patient discomfort. Urinary biomarkers have emerged as potential tools for improving surveillance and reducing unnecessary cystoscopies. Methods: We performed a narrative review of studies published between 2017 and 2026 evaluating urinary biomarkers in urothelial carcinoma. Particular attention was given to assay mechanisms, diagnostic performance, clinical applications, and integration into surveillance techniques. Results: The most extensively studied biomarkers were Xpert Bladder Cancer Monitor, Bladder EpiCheck, ADXBLADDER, and Cxbladder. Most molecular assays demonstrated higher sensitivity than urinary cytology, particularly for the detection of high-grade recurrence. Reported negative predictive values frequently exceeded 95%, suggesting potential utility in identifying patients at low risk of clinically significant recurrence. Xpert Bladder Cancer Monitor and Bladder EpiCheck were supported by the largest body of surveillance evidence, whereas Cxbladder and mutation-enhanced platforms showed promise for risk stratification and individualized follow-up. Evidence supports the use of urinary biomarkers as adjuncts to cystoscopy rather than replacements. Conclusions: Modern urinary biomarkers provide clinically useful information during the surveillance of urothelial carcinoma, especially for excluding high-grade recurrence and assisting the interpretation of equivocal findings. Future biomarker-guided surveillance strategies may reduce the burden of cystoscopy while maintaining oncological safety. Further studies are required to improve specificity and sensitivity in order to fully integrate these biomarkers into diagnostic and follow-up protocols. Full article

Bladder preservation has emerged as an established treatment option for selected patients with muscle-invasive bladder cancer (MIBC), offering durable oncologic control with the potential to maintain native bladder function and quality of life. Over the past several decades, prospective trials and large institutional experiences have refined trimodality therapy (TMT)—maximal transurethral resection followed by definitive radiation therapy with concurrent radiosensitizing systemic therapy—and clarified principles of patient selection, treatment delivery, surveillance, and salvage. Randomized evidence supports combined-modality therapy as the backbone of bladder preservation, and contemporary comparative analyses suggest outcomes comparable to radical cystectomy in appropriately selected populations. This review synthesizes the clinical foundations of bladder preservation, including radiobiologic considerations, advances in radiation technique, and patterns of recurrence following TMT. We discuss outcomes in higher-risk populations, including locally advanced and node-positive disease, and examine the evolving integration of systemic therapies. The emergence of immune checkpoint inhibitors and antibody–drug conjugates in urothelial carcinoma has reshaped the systemic treatment landscape and raises important questions regarding patient selection, sequencing, and the potential expansion of organ-preserving strategies. Finally, we outline future directions—including response-adaptive approaches, advances in image-guided and adaptive radiotherapy, and ctDNA-enabled risk stratification—while emphasizing the need for prospective validation and multidisciplinary collaboration to refine and optimize bladder-preserving care. Full article

Background/Objectives: Neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (RC) is a standard treatment for cisplatin-eligible patients with muscle-invasive bladder cancer (MIBC), yet baseline tools to refine prognostic stratification remain limited. We aimed to develop and internally validate a clinicopathological nomogram integrating the neutrophil-to-lymphocyte ratio (NLR) to estimate event-free survival (EFS) in patients with MIBC treated with NAC. Methods: We retrospectively analyzed 210 patients with cT2–T4aN0–1M0 MIBC treated with cisplatin-based NAC at two Spanish institutions between 2010 and 2021. Candidate predictors included demographic, clinicopathological, and routine laboratory variables. A multivariable Cox model with backward selection based on the Akaike information criterion (AIC) was used to derive the final model, and internal validation was performed using 1000 bootstrap resamples. Results: Sex, age, prior non–muscle-invasive bladder cancer (NMIBC), and NLR were retained in the final nomogram. The model showed moderate discrimination, with a Harrell’s c-index of 0.60 and an optimism-corrected c-index of 0.58. The nomogram stratified patients into low-, intermediate-, and high-risk groups, with median EFS not reached, 47.5 months, and 18.0 months, respectively. High-risk patients also showed lower pathological complete response (pCR) rates. Conclusions: This exploratory nomogram integrates an accessible systemic inflammatory marker with baseline clinical variables to identify patients with poorer outcomes despite NAC. External validation in contemporary cohorts is warranted before clinical implementation. Full article

Nectin-4 has emerged as a clinically relevant target in muscle-invasive bladder cancer (MIBC), primarily because of its role in antibody–drug conjugate-based therapies. However, the broader biological context of Nectin-4 expression and its association with tumor-promoting signaling pathways in MIBC remain insufficiently characterized. In this single-institution study, Nectin-4 expression (H-score 0–300) was assessed by immunohistochemistry in two independent MIBC cohorts. Associations between Nectin-4 expression and key markers related to growth signaling, metabolic regulation, and inflammation were analyzed alongside clinicopathological characteristics. Nectin-4 expression was significantly higher in malignant tissue than in non-malignant tissue (p = 0.0016 and p = 0.0302, respectively). Nectin-4 expression was not associated with demographic or clinicopathological parameters; however, a trend toward lower expression in more advanced disease stages was observed. Significant positive correlations were identified between Nectin-4 expression and protein kinase B (p = 0.0004), cytoplasmic (p = 0.0115) and membranous somatostatin receptor 2 (p = 0.0125), insulin receptor substrate 1 (p = 0.03), and interleukin-1 receptor antagonist (IL-1RA; p = 0.0045). In contrast, a negative correlation was observed with the IL-1β/IL-1RA ratio (p = 0.0246). Although Nectin-4 expression was not significantly associated with cancer-specific or overall survival, a trend toward shorter relapse-free survival was observed in patients with lower Nectin-4 expression (p = 0.0531). In multivariate analysis, patient age, but not Nectin-4 expression, emerged as an independent prognostic factor. Although Nectin-4 expression does not appear to have independent prognostic value, its biological associations suggest that it reflects an integrated tumor-related signaling context. These findings support further investigation of Nectin-4 as part of rational, biology-driven therapeutic strategies in bladder cancer. Full article