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• W2914247680 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2019Accurate Quantification of Residual Cancer Cells in Pelvic Washing Reveals Association with Cancer Recurrence Following Robot-Assisted Radical CystectomyThis article is commented on by the following:Editorial CommentEditorial Comment Lei Wei, Ahmed A. Hussein, Yingyu Ma, Gissou Azabdaftari, Youssef Ahmed, Lai Ping Wong, Qiang Hu, Wei Luo, Victoria N. Cranwell, Brittany L. Bunch, Justen D. Kozlowski, Prashant K. Singh, Sean T. Glenn, Gary Smith, Candace S. Johnson, Song Liu, and Khurshid A. Guru Lei WeiLei Wei Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York Equal study contribution. More articles by this author , Ahmed A. HusseinAhmed A. Hussein Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York Department of Urology, Cairo University, Cairo, Egypt Equal study contribution. More articles by this author , Yingyu MaYingyu Ma Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York Equal study contribution. More articles by this author , Gissou AzabdaftariGissou Azabdaftari Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Youssef AhmedYoussef Ahmed Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Lai Ping WongLai Ping Wong Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Qiang HuQiang Hu Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Wei LuoWei Luo Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Victoria N. CranwellVictoria N. Cranwell Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Brittany L. BunchBrittany L. Bunch Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Justen D. KozlowskiJusten D. Kozlowski Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Prashant K. SinghPrashant K. Singh Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Sean T. GlennSean T. Glenn Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Gary SmithGary Smith Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Candace S. JohnsonCandace S. Johnson Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , Song LiuSong Liu Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author , and Khurshid A. GuruKhurshid A. Guru †Correspondence: Department of Urology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Sts., Buffalo, New York 14263 (e-mail: E-mail Address: [email protected]). Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000142AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Bladder cancer recurrence following cystectomy remains a significant cause of bladder cancer specific mortality. Residual cancer cells contribute to cancer recurrence due to tumor spillage or undetectable preexisting micrometastatic tumor clones. We detected and quantified residual cancer cells in pelvic washing using ultradeep targeted sequencing. We compared the levels of residual cancer cells with clinical variables and cancer recurrence. Materials and Methods: The primary tumor specimen was available in 17 patients who underwent robot-assisted radical cystectomy. All tumors had negative surgical margins. Pelvic washes and blood were collected intraoperatively before and after robot-assisted radical cystectomy, after pelvic lymph node dissection and in the suction fluid collected during the procedure. Two-step sequencing, including whole exome sequencing followed by ultradeep targeted sequencing (× greater than 50,000), was done to quantify residual cancer cells in each sample. Eight patients were excluded from study due to sample quality issues. The final analysis cohort comprised 9 patients. The residual cancer cell level was quantified for each sample as the relative cancer cell fraction and compared between time points. The peak relative cancer cell fraction of each patient was correlated with clinical and pathological variables. Results: Residual cancer cells were detected in approximately half of the pelvic washing specimens during or after but not before robot-assisted radical cystectomy. Higher residual cancer cell levels were associated with aggressive variant histology and cancer recurrence. Verifying the feasibility of using residual cancer cells as a novel biomarker for recurrence requires larger cohorts. Conclusions: Detection of residual cancer cells in intraoperative peritoneal washes of patients with bladder cancer who undergo radical cystectomy may represent a robust biomarker of tumor aggressiveness and metastatic potential. References 1. : Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2015; 68: 721. Google Scholar 2. : Disease-free survival at 2 or 3 years correlates with 5-year overall survival of patients undergoing radical cystectomy for muscle invasive bladder cancer. J Urol 2011; 185: 456. Link, Google Scholar 3. : Implantation metastasis after a suprapubic catheter in a case of bladder cancer. Eur Urol 1992; 22: 86. Google Scholar 4. : Extravesical transitional cell carcinoma as a result of implantation after perforation of the bladder. BJU Int 2000; 85: 1150. Google Scholar 5. : Psoas abscess-like metastasis from transitional cell carcinoma of urinary bladder. Indian J Cancer 2002; 39: 78. Google Scholar 6. : Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol 2007; 178: 2308. 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Link, Google Scholar 19. : Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer. Eur Urol 2015; 68: 399. Google Scholar 20. : Re: Daniel P. Nguyen, Bashir Al Hussein Al Awamlh, Xian Wu, et al. Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer. Eur Urol 2015; 68: 399–405. Eur Urol 2016; 69: e35. Google Scholar 21. : Transurethral bladder tumor resection can cause seeding of cancer cells into the bloodstream. J Urol 2015; 193: 53. Link, Google Scholar 22. : The hydra phenomenon of cancer: why tumors recur locally after microscopically complete resection. Cancer Res 2005; 65: 2997. Google Scholar 23. : Intraperitoneal chemotherapy for the initial management of primary epithelial ovarian cancer. Cochrane Database Syst Rev 2011; CD005340. Google Scholar 24. : Intraoperative hyperthermic intraperitoneal chemotherapy as adjuvant chemotherapy for advanced gastric cancer patients with serosal invasion. J Chin Med Assoc 2013; 76: 425. Google Scholar 25. : A new standard of care for the management of peritoneal surface malignancy. Curr Oncol 2011; 18: e84. Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the Roswell Park Alliance Foundation, Friends of Urology, NCI (National Cancer Institute) Grant P30CA016056 and NIH (National Institutes of Health) Grant U24 CA232979. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. To view an animated video briefly describing this research, click Pelvic Washing_FINAL.mp4. Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1216 and 1217. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHussein A, Elsayed A, Aldhaam N, Jing Z, Osei J, Kaouk J, Redorta J, Menon M, Peabody J, Dasgupta P, Khan M, Mottrie A, Stöckle M, Hemal A, Richstone L, Hosseini A, Wiklund P, Schanne F, Kim E, Ho Rha K and Guru K (2019) Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 202, NO. 5, (927-935), Online publication date: 1-Nov-2019.Chang S (2019) Re: Characterization of Late Recurrence after Radical Cystectomy in a Large Multicenter Cohort of Bladder Cancer PatientsJournal of Urology, VOL. 202, NO. 2, (209-209), Online publication date: 1-Aug-2019.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 6, (1025-1026), Online publication date: 1-Jun-2019.Related articlesJournal of Urology8 May 2019Editorial CommentJournal of Urology8 May 2019Editorial Comment Volume 201Issue 6June 2019Page: 1105-1114Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsresidualwhole exome sequencingneoplasm metastasisurinary bladder neoplasmscystectomyneoplasmMetricsAuthor Information Lei Wei Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York Equal study contribution. More articles by this author Ahmed A. Hussein Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York Department of Urology, Cairo University, Cairo, Egypt Equal study contribution. More articles by this author Yingyu Ma Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York Equal study contribution. More articles by this author Gissou Azabdaftari Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Youssef Ahmed Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Lai Ping Wong Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Qiang Hu Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Wei Luo Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Victoria N. Cranwell Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Brittany L. Bunch Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Justen D. Kozlowski Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Prashant K. Singh Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Sean T. Glenn Department of Cancer Genetics and Genomics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Gary Smith Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Candace S. Johnson Department of Pharmacology and Therapeutics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Song Liu Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York More articles by this author Khurshid A. Guru Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, New York †Correspondence: Department of Urology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Sts., Buffalo, New York 14263 (e-mail: E-mail Address: [email protected]). More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the Roswell Park Alliance Foundation, Friends of Urology, NCI (National Cancer Institute) Grant P30CA016056 and NIH (National Institutes of Health) Grant U24 CA232979. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. To view an animated video briefly describing this research, click Pelvic Washing_FINAL.mp4. Editor's Note: This article is the third of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1216 and 1217. Advertisement PDF downloadLoading ..." @default.
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