Skip to main content

Advertisement

SpringerLink
Log in

Preliminary study on the application of en bloc resection combined with near-infrared molecular imaging technique in the diagnosis and treatment of bladder cancer

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Background

To evaluate the surgical safety of en bloc resection of bladder tumor (ERBT) and the effectiveness of ERBT combined with near-infrared (NIR) imaging technique in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC).

Methods

From October 2017 to June 2018, 26 patients newly diagnosed with single NMIBC were included in this retrospectively trial. All patients received ERBT with monopolar current. After surgery, the fresh specimen was incubated with anti-CD47-Alexa Fluor 790, and then imaged under NIR imaging technique. Operative details, intraoperative and postoperative complications of ERBT regarded as safety outcomes, the mean fluorescence intensity (MFI) of tumor tissue and adjacent normal background tissue, and 12 months follow-up data were analyzed.

Results

Of 26 collected patients, obturator nerve reflex was occurred in six patients during tumor resection, and only one patient was observed with bladder perforation. In NIR gray image, the gray scale of MFI of tumor tissue were 132.31 ± 6.67 and the adjacent normal background tissue were 52.27 ± 12.09. The result showed a significantly higher MFI signals in tumor tissue compared to adjacent normal background tissue (P < 0.001). The recurrence-free survival rate at 12 month was 96.15%.

Conclusions

ERBT with monopolar current is a safe and feasible technique to treat patients with NMIBC. A integrated bladder tumor tissue-bound anti-CD47-Alexa Fluor 790 was detected under NIR light, and the NIR image indicates that higher MFI signals in surgical margin is a predictive factor for residual tumor in patients with NMIBC after ERBT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

NIR:

Near-infrared

NMIBC:

Non-muscle invasive bladder cancer

ERBT:

En bloc resection of bladder tumor

MFI:

Mean fluorescence intensity

BC:

Bladder cancer

PDD:

Photodynamic diagnosis

HAL:

Hexaminolevulinate

ALA:

5-Aminolaevulinic acid

CIS:

Carcinoma in situ

TURBT:

Transurethral resection of bladder tumor

cTURBT:

Conventional TURBT

e-ERBT:

Electrical ERBT

l-ERBT:

Laser ERBT

DM:

Detrusor muscle

WHO:

World Health Organization

TBR:

Tumor-to-background ratio

RC:

Radical cystectomy

BCG:

Bacillus Calmette–Guerin

References

  1. Global Burden of Disease Cancer Collaboration, Christina F, Degu A et al (2019) Global regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017. JAMA Oncol 5:1749–1768. https://doi.org/10.1001/jamaoncol.2019.2996

    Article  PubMed Central  Google Scholar 

  2. Chen WQ, Zheng RS, Baade PD et al (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66:115–132

    Article  Google Scholar 

  3. Cumberbatch MGK, Jubber I, Black PC et al (2018) Epidemiology of bladder cancer: a systematic review and contemporary update of risk factors in 2018. Eur Urol 74:784–795

    Article  Google Scholar 

  4. Sylvester RJ, van der Meijden AP, Oosterlinck W et al (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol 49:466–475 (discussion 475–477)

    Article  Google Scholar 

  5. Svatek RS, Hollenbeck BK, Holmäng S et al (2014) The economics of bladder cancer: costs and considerations of caring for this disease. Eur Urol 66:253–262

    Article  Google Scholar 

  6. Avallone MA, Sack BS, El-Arabi A et al (2017) Ten-year review of perioperative complications after transurethral resection of bladder tumors: analysis of monopolar and plasma-kinetic bipolar cases. J Endourol 31:767–773

    Article  Google Scholar 

  7. Guo CC, Al-Ahmadie HA, Flaig TW et al (2018) Contribution of bladder cancer pathology assessment in planning clinical trials. Urol Oncol. https://doi.org/10.1016/j.urolonc.2018.01.001

    Article  PubMed  Google Scholar 

  8. Kramer MW, Bach T, Wolters M et al (2011) Current evidence for transurethral laser therapy of non-muscle invasive bladder cancer. World J Urol 29:433–442

    Article  Google Scholar 

  9. Kramer MW, Rassweiler JJ, Klein J et al (2015) En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol 33(12):1937–1943

    Article  Google Scholar 

  10. Kramer MW, Altieri V, Hurle R et al (2017) Current evidence of transurethral en-bloc resection of nonmuscle invasive bladder cancer. Eur Urol Focus 3:567–576

    Article  Google Scholar 

  11. Babjuk M, Böhle A, Burger M et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71:447–461

    Article  Google Scholar 

  12. Bernhard K, van den Berg Nynke S, Robert E et al (2019) CD47-targeted near-infrared photoimmunotherapy for human bladder cancer. Clin Cancer Res 25:3561–3571

    Article  Google Scholar 

  13. Panchuk-Voloshina N, Haugland RP, Bishop-Stewart J et al (1999) Alexa dyes, a series of new fluorescent dyes that yield exceptionally bright, photostable conjugates. J Histochem Cytochem 47:1179–1188

    Article  CAS  Google Scholar 

  14. Naselli A, Introini C, Germinale F et al (2012) En bloc transurethral resection of bladder lesions: a trick to retrieve specimens up to 4.5 cm. BJU Int 109:960–963

    Article  Google Scholar 

  15. Pan Y, Volkmer JP, Mach KE et al (2014) Endoscopic molecular imaging of human bladder cancer using a CD47 antibody. Sci Transl Med 6:260ra148

    Article  Google Scholar 

  16. De NC, Franco G, Cindolo L et al (2014) Transuretral resection of the bladder (TURB): analysis of complications using a modified Clavien system in an Italian real life cohort. Eur J Surg Oncol 40(1):90–95

    Article  Google Scholar 

  17. Perlis N, Zlotta AR, Beyene J et al (2013) Immediate post-transurethral resection of bladder tumor intravesical chemotherapy prevents non-muscle-invasive bladder cancer recurrences: an updated meta-analysis on 2548 patients and quality-of-evidence review. Eur Urol 64:421–430

    Article  Google Scholar 

  18. Kramer MW, Rassweiler JJ, Klein J et al (2015) En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol 33:1937–1943

    Article  Google Scholar 

  19. Asfour V, Gibbs K, DaSilva AS et al (2018) Validation study of ultrasound bladder wall thickness measurements. Int Urogynecol J. https://doi.org/10.1007/s00192-018-3802-4

    Article  PubMed  Google Scholar 

  20. Comploj E, Dechet CB, Mian M et al (2014) Perforation during TUR of bladder tumours influences the natural history of superficial bladder cancer. World J Urol 32:1219–1223

    Article  Google Scholar 

  21. Mori K, D'Andrea D, Enikeev DV et al (2020) En bloc resection for nonmuscle invasive bladder cancer: review of the recent literature. Curr Opin Urol 30:41–47

    Article  Google Scholar 

  22. Cumberbatch MGK, Foerster B, Catto JWF et al (2018) Repeat transurethral resection in non-muscle-invasive bladder cancer: a systematic review. Eur Urol 73(6):925–933

    Article  Google Scholar 

  23. Guzzo TJ, Magheli A, Bivalacqua TJ et al (2009) Pathological upstaging during radical cystectomy is associated with worse recurrence-free survival in patients with bacillus Calmette–Guerin-refractory bladder cancer. Urology 74:1276–1280

    Article  Google Scholar 

  24. Gontero P, Sylvester R, Pisano F et al (2015) Prognostic factors and risk groups in T1G3 non-muscle -invasive bladder cancer patients initially treated with Bacillus Calmette–Guérin: results of a retrospective multicenter study of 2451 patients. Eur Urol 67:74–82

    Article  Google Scholar 

  25. Zhang D, Yao L, Yu S et al (2020) Safety and efficacy of en bloc transurethral resection versus conventional transurethral resection for primary non muscle-invasive bladder cancer: a meta-analysis. World J Surg Oncol 18:4

    Article  Google Scholar 

  26. Yang H, Lin J, Gao P et al (2020) Is the en bloc transurethral resection more effective than conventional transurethral resection for non-muscle-invasive bladder cancer? A systematic review and meta-analysis. Urol Int 7:1–8. https://doi.org/10.1159/000503734

    Article  Google Scholar 

  27. Onishi T, Sugino Y, Shibahara T et al (2017) Randomized controlled study of the efficacy and safety of continuous saline bladder irrigation after transurethral resection for the treatment of non-muscle-invasive bladder cancer. BJU Int 119:276–282

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors are thankful to all the patients and physicians who took part in this study. We also thank Jing Lian for the pathological assistance.

Funding

This research was supported by the National Natural Science Foundation of China (NSFC, Grant no. 81172444). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. First Clinical Medical College, Shanxi Medical University, Taiyuan, China

    Yongjun Yang, Xiaofeng Yang, Chao Liu & Jiawei Li

Authors
  1. Yongjun Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaofeng Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiawei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YY performed the laboratory work, collected clinical data and wrote the manuscript. CL performed statistical analysis and drew schematic diagram. JL performed the laboratory work. XY designed the study, supervised the research, contributed to experimental discussion and reviewed the manuscript.

Corresponding author

Correspondence to Xiaofeng Yang.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

The study was approved by the Ethics Committee of First Affiliated Hospital of Shanxi Medical University (2011033/2011) and conducted according to the principles of the Declaration of Helsinki.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, Y., Yang, X., Liu, C. et al. Preliminary study on the application of en bloc resection combined with near-infrared molecular imaging technique in the diagnosis and treatment of bladder cancer. World J Urol 38, 3169–3176 (2020). https://doi.org/10.1007/s00345-020-03143-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-020-03143-w

Keywords

Search

Navigation