You have accessJournal of UrologyBladder Cancer: Invasive III (PD34)1 May 2024PD34-07 LONG-TERM ONCOLOGIC OUTCOMES OF TETRAMODAL BLADDER-PRESERVATION THERAPY INCORPORATING INDUCTION CHEMORADIOTHERAPY AND CONSOLIDATIVE PARTIAL CYSTECTOMY WITH PELVIC LYMPHNODE DISSECTION FOR MUSCLE-INVASIVE BLADDER CANCER Hajime Tanaka, Motohiro Fujiwara, Akira Hasegawa, Hiroki Tanaka, Kotaro Suzuki, Tomoki Kimura, Rikuto Yasujima, Tsubasa Ito, Riko Ikeda, Shunya Matsumoto, Kasumi Yoshitomi, Masaki Kobayashi, Yuki Nakamura, Bo Fan, Wei Chen, Yudai Ishikawa, Shohei Fukuda, Yuma Waseda, Soichiro Yoshida, Ryoichi Yoshimura, Kazunori Kihara, and Yasuhisa Fujii Hajime TanakaHajime Tanaka , Motohiro FujiwaraMotohiro Fujiwara , Akira HasegawaAkira Hasegawa , Hiroki TanakaHiroki Tanaka , Kotaro SuzukiKotaro Suzuki , Tomoki KimuraTomoki Kimura , Rikuto YasujimaRikuto Yasujima , Tsubasa ItoTsubasa Ito , Riko IkedaRiko Ikeda , Shunya MatsumotoShunya Matsumoto , Kasumi YoshitomiKasumi Yoshitomi , Masaki KobayashiMasaki Kobayashi , Yuki NakamuraYuki Nakamura , Bo FanBo Fan , Wei ChenWei Chen , Yudai IshikawaYudai Ishikawa , Shohei FukudaShohei Fukuda , Yuma WasedaYuma Waseda , Soichiro YoshidaSoichiro Yoshida , Ryoichi YoshimuraRyoichi Yoshimura , Kazunori KiharaKazunori Kihara , and Yasuhisa FujiiYasuhisa Fujii View All Author Informationhttps://doi.org/10.1097/01.JU.0001008768.36634.79.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemoradiation (CRT)-based bladder-preservation therapy is currently acknowledged as a curative treatment option for muscle-invasive bladder cancer (MIBC). However, one of the major concerns is the risk of MIBC recurrence, which may be originated from latent cancer cells remaining after CRT. We developed tetramodal bladder-preservation therapy (TeMT) incorporating induction CRT and consolidative partial cystectomy (PC) with pelvic lymphnode dissection (PLND). This study assessed the long-term oncologic outcomes of MIBC patients treated with TeMT. METHODS: Following the institutional review board approval (# M2000-453), we prospectively enrolled 201 patients with N0M0 MIBC between 1997 and 2020. All the patients met the inclusion criteria for the enrollment (Figure 1). After maximal transurethral resection and induction CRT, patients who had complete remission of cancer or small amount of microscopic Ta/is cancer remaining at the original tumor site underwent consolidative PC with PLND and achieved bladder preservation; salvage radical cystectomy was offered to the other patients. RESULTS: The median age was 69, and 157 patients (78%) were male. Overall 171 patients (85%) sufficiently responded to induction CRT. Among them, 148 (74%) underwent consolidative PC according to the protocol. Pathological examination of the PC specimens revealed that residual bladder cancer in 15 patients (10%) including 3 (2.0%)/2 (1.4%)/10 (6.8%) showing ypTis/T1/T2-3, respectively and lymphnode metastasis in 4 (2.7%) were surgically removed in this surgery. During the median follow up of 6.2 years (IQR: 4.1-9.8), 31 (15%) in the intent-to-treat (ITT) patients and 13 (8.8%) in those who underwent PC died of bladder cancer. 5/10 year-cancer-specific survival was 85%/82% in ITT patients, respectively, and 92%/90% in patients undergoing PC, respectively. The cumulative incidences of MIBC recurrence after PC were 6.0% at 5 years and 8.8% at 10 years. CONCLUSIONS: TeMT protocol incorporating induction CRT and consolidative PC with PLND yielded favorable long-term oncologic outcomes for optimally selected patients with MIBC. Consolidative PC may contribute to decreasing the risk of MIBC recurrence. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e721 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Hajime Tanaka More articles by this author Motohiro Fujiwara More articles by this author Akira Hasegawa More articles by this author Hiroki Tanaka More articles by this author Kotaro Suzuki More articles by this author Tomoki Kimura More articles by this author Rikuto Yasujima More articles by this author Tsubasa Ito More articles by this author Riko Ikeda More articles by this author Shunya Matsumoto More articles by this author Kasumi Yoshitomi More articles by this author Masaki Kobayashi More articles by this author Yuki Nakamura More articles by this author Bo Fan More articles by this author Wei Chen More articles by this author Yudai Ishikawa More articles by this author Shohei Fukuda More articles by this author Yuma Waseda More articles by this author Soichiro Yoshida More articles by this author Ryoichi Yoshimura More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

UV light is an immune system regulator. In a mouse model of contact hypersensitivity, UV irradiation causes immune tolerance in an antigen-specific manner by inducing regulatory T cells (Tregs). Expanded Tregs are observed in UVB-irradiated skin and draining lymph nodes. The best conditions to induce UV-expanded Tregs (UV-Tregs) are unknown. We focused on UVC to UVB wavelengths to investigate UV-Tregs induction and identify changes in functional gene expression. The minimal erythema dose (MED) of each wavelength was determined. RNA sequencing (RNA-seq) analysis of CD4+ T cells from lymph nodes on day 7 after 3MED of 260, 280, and 300nm irradiation revealed a 2-fold upregulation of IL-10 compared with sham irradiation. CCL22, which enhances the migratory activity of CCR4+ cells including Tregs, was upregulated 3-fold by UV irradiation. Nr4a1-3 mRNA levels, associated with T cell tolerance, increased 3-fold in the same specimens after UV irradiation compared with sham-irradiation. Non-negative matrix factorization applied to the RNA-seq data showed that CD4+ "Tregness" was increased by 3MED of 260, 280, and 300nm UV irradiation. Flow cytometry analysis showed that Helios+ and Neuropilin-1+ Tregs increased at 260nm compared with other wavelengths. These data suggest that a 260nm wavelength (UVC) facilitates UV-Tregs induction. UV-Tregs formed clusters with dendritic cells (DCs) and proliferated in situ. DCs expand UV-Tregs. DC clusters were observed with Tregs at 240–260nm (UVC). At 240, 260, 280, and 300nm on days 3 and 7 after UV irradiation, the numbers of Foxp3+ CD4+cells/5 different high-power fields (HPF) was 6, 9, 1, and 2, and 7, 4, 4, and 5, respectively. These data suggest that UVC irradiation expands UV-Treg induction with DC stimulation.

You have accessJournal of UrologyCME1 May 2022MP53-06 MRI AND MRI-TARGETED BIOPSY CAN DETECT CRIBRIFORM CANCER OF THE PROSTATE Sho Uehara, Yoh Matsuoka, Kurara Yamamoto, Yuki Nakamura, Yusuke Uchida, Shohei Fukuda, Hajime Tanaka, Soichiro Yoshida, Minato Yokoyama, Kenichi Ohashi, and Yasuhisa Fujii Sho UeharaSho Uehara More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kurara YamamotoKurara Yamamoto More articles by this author , Yuki NakamuraYuki Nakamura More articles by this author , Yusuke UchidaYusuke Uchida More articles by this author , Shohei FukudaShohei Fukuda More articles by this author , Hajime TanakaHajime Tanaka More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Kenichi OhashiKenichi Ohashi More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002628.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cribriform cancer (CC) of the prostate has been recognized as an aggressive entity. To date, whether cribriform component is less visible on multiparametric MRI (mpMRI) than other Gleason pattern 4 cancer or not is controversial. In addition, diagnostic performance of MRI-ultrasound fusion targeted biopsy (TB) for CC detection has not been well investigated. The aim of our study is to examine the visibility of CC on mpMRI and CC detection by TB, in reference to systematic biopsy (SB) and robot-assisted radical prostatectomy (RARP) findings. METHODS: Consecutive 103 prostate cancer patients were investigated who underwent RARP without neoadjuvant treatment. All patients had undergone TB concurrently with 12-core SB at diagnosis. PIRADS v2.1 scores were prospectively assigned prior to biopsy. The detection rate of CC and significant cancer (SC) on TB, SB, and RARP was examined. SC was defined as cancer with grade group ≥2. RESULTS: Median age, PSA, and prostate volume were 68 years, 9.0 ng/mL, and 29.7 mL, respectively. Median volume of index lesions was 0.72 mL and their PIRADS scores were 3/4/5 in 18/40/45 patients, respectively. In RARP specimens of 103 patients, CC and SC were found in 43 (42%) and 98 (95%) patients, respectively. On mpMRI, CC foci in RARP specimens were visible in 42 patients (98%) and scored as PIRADS 3/4/5 in 5/16/21patients, respectively. In one patient, CC was not identified as abnormal lesion on mpMRI. CC were identified by SB and TB in 15(35%), 24(56%) patients, respectively (SB vs TB, p = 0.01), and SC were detected by SB and TB in 33 (77%), 39 (91%) patients, respectively (SB vs TB, p = 0.01). In the remaining 60 patients without CC on RARP specimens, PIRADS score 3/4/5 were assigned in 13/24/23 patients. SC were detected by SB and TB in 33 (55%) and 47 (78%) patients, respectively (SB vs TB, p <0.01). MRI visibilities of prostate cancer were 98% in patients with CC and 100% in patients without CC. TB missed SC in 4 of 43 patients with CC and in 13 of 60 patients without CC (p=0.10). CONCLUSIONS: Majority (98%) of CC foci were visible on mpMRI, and CC were identified by TB in more than half (56%) of the patients with CC. SC detection by TB did not differ between patients with CC and those without CC. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e897 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sho Uehara More articles by this author Yoh Matsuoka More articles by this author Kurara Yamamoto More articles by this author Yuki Nakamura More articles by this author Yusuke Uchida More articles by this author Shohei Fukuda More articles by this author Hajime Tanaka More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Kenichi Ohashi More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement PDF downloadLoading ...

Durvalumab has been reported to significantly prolong progression-free survival and overall survival in patients with stage III unresectable non-small cell lung cancer (NSCLC) after chemoradiotherapy, compared with placebo. The aim of this retrospective study is to evaluate the eligibility of patients with unresectable stage III NSCLC able to receive consolidation therapy with durvalumab in clinical practice based on the PACIFIC study criteria. From January 2011 to May 2018, electronic data were collected from patients diagnosed with unresectable stage III NSCLC treated with definitive chemoradiotherapy. A total of 81 patients were identified. Of these, 73 were treated with platinum-based chemotherapy based on the criteria of the PACIFIC study. Radiation pneumonitis of any grade occurred in 54 patients (73.9%) who received definitive chemoradiotherapy. Of these, 12 (16.4%) developed radiation pneumonitis of grade 2 or more within 42 days after chemoradiotherapy and would be excluded from durvalumab treatment. Two patients (2.7%) developed other pneumonitis, 7 patients (9.6%) showed poor performance status, and 3 patients (4.1%) displayed disease progression at initial assessment. After considering overlapping cases mentioned above, 22 patients (30.1%) were ineligible to receive durvalumab by the criteria utilized in the PACIFIC study. In clinical practice, approximately 70% of patients with unresectable stage III NSCLC would be eligible to receive consolidation therapy with durvalumab.