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- Dansk, Viktor, et al.
(författare)
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Hexaminolevulinate hydrochloride blue-light flexible cystoscopy in the detection and follow-up of nonmuscle-invasive bladder cancer : cost consequences during outpatient surveillance in Sweden
- 2016
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Ingår i: Future Oncology. - : Future Medicine Ltd. - 1479-6694 .- 1744-8301. ; 12:8, s. 1025-1038
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study explored the cost consequences of introducing hexaminolevulinate hydrochloride-guided blue-light flexible cystoscopy (HAL BLFC) as an adjunct to white-light flexible cystoscopy compared with white-light flexible cystoscopy alone, for the detection and management of nonmuscle invasive bladder cancer in Sweden.Methods: The model evaluated 231 patients in the outpatient setting after successful initial transurethral resection of the bladder tumor.Results: HAL BLFC introduction across all risk groups resulted in minimal budget impact (+ 1.6% total cost/5 years, or 189 Swedish Krona [SEK] per patient/year), and translated to cost savings in intermediate-and high-risk groups from year 2.Conclusion: HAL BLFC allowed more outpatient treatment with improved recurrence detection and reduced transurethral resection of the bladder tumors, cystectomies, bed days and operating room time, with minimal cost impact across all risk groups, demonstrating the economic benefits of introducing HAL.
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- Holmberg, Lars, et al.
(författare)
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Cumulative incidence of and risk factors for BCG infection after adjuvant BCG instillations
- 2024
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Ingår i: BJU INTERNATIONAL. - : Blackwell Publishing. - 1464-4096 .- 1464-410X.
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo investigate the cumulative incidence proportion of disseminated or local Bacillus Calmette-Guerin (BCG) infections after adjuvant BCG instillations in patients with non-muscle-invasive bladder cancer (NMIBC).Patients and MethodsWe analysed the timing and occurrence of BCG infections and absolute and relative risk in relation to patient characteristics available in the Swedish nationwide database 'BladderBaSe 2.0'. The cumulative incidence proportion of a BCG infection was indicated by a reported diagnosis of tuberculosis (TB) in the patient registry or filing a prescription for tuberculostatic drugs.ResultsThe cumulative incidence proportion was 1.1% at the 5-year follow-up in 5033 patients exposed to adjuvant BCG instillations. The incidence rate was highest during the first 2 years after start of BCG instillations. Women had a lower risk than men (hazard ratio 0.23, 95% confidence interval 0.07-0.74). Age and calendar time at diagnosis, comorbidity, tumour risk group, previous medication with corticosteroids, immunosuppressive drugs, or time between transurethral resection of the bladder tumour and commencing the adjuvant BCG instillation were not associated with risk.ConclusionsThese data further supports that the overall risk of a BCG infection after BCG-instillation treatment for NMIBC is low. The great majority of infections occur in the first 2 years, calling for an awareness of the diverse symptoms of BCG infection during this period. We provide evidence for male sex as a risk factor; however, the statistical precision is low and with a risk of selection bias, making it difficult to rule out the other suggested risk factors without further studies with different approaches.
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- Kerzeli, Iliana Kyriaki, et al.
(författare)
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The immunological landscape in bladder cancer: a single cell RNA seq analysis of tumor bearing mouse bladders with a focus on sex differences
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- In urothelial bladder cancer differences in clinical outcomes and responses to immunotherapy associate with tumor stage and sex. However, the tumor microenvironment landscape in urothelial cancer and its contexture in different stages and sexes is not fully deciphered. We utilized an autochthonous urothelial cancer model sampled at the non-muscle and muscle invasive stage from both sexes. Single cell RNA sequencing was applied to analyze intercellular interactions and sex differences in the two stages with focus on immune cell subsets. We discerned the Cd6-Alcam interaction to occur between lymphoid, tumor and myeloid cells and that female tumor bearing bladders were enriched in cells of lymphoid lineage compared to males, although male lymphoid cells were metabolically more active. Furthermore, we identified two subsets of Macrophages, Ccl8+ and Spp1+ that were characteristic for NMIBC and MIBC respectively, however both were found to be more active in immune cell recruitment, activation and cytokine signaling in females than males. Analysis of intercellular interactions of immune cells subsets revealed the role of Lyc6c2+ and Ace+ Monocytes as antigen presenting cells equipped with co-stimulatory receptors, and the Anxa1-Fpr2 immune suppressive axis to be active among tumor cells and subsets of granulocytes, macrophages and monocytes. Collectively our results demonstrate the complexity and sex specific differences of the tumor microenvironment in urothelial cancer using a clinically relevant murine model of progressive disease, and distinguish the Cd6-Alcam and Anxa1-Fpr2 interaction pathways of lymphoid, myeloid and tumor cells as potential targets of immune modulation for cancer therapy.
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- Lundholm, Carl, et al.
(författare)
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A randomized prospective study comparing long-term intravesical instillations of mitomycin-c and BCG in patients with superficial bladder carcinoma
- 1996
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Ingår i: Journal of Urology. - 0022-5347 .- 1527-3792. ; 156:2, s. 372-376
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We compared the efficacy and toxicity of long-term mitomycin C versus bacillus Calmette-Guerin (BCG) instillation in patients at high risk for recurrence and progression of superficial bladder carcinoma. MATERIALS AND METHODS: Our randomized comparison study included 261 patients with primary dysplasia, or stage Tis, stage T1, grade 3 and multiple recurrent stage Ta/T1, grade 1 or 2 disease. Mitomycin C (40 mg.) or Pasteur strain BCG (120 mg.) was instilled weekly for 6 weeks, then monthly for up to 1 year and every 3 months during year 2. RESULTS: After a median followup of 39 months 49% of the patients given BCG and 34% given mitomycin C were disease-free (p < 0.03), compared to 48 and 35%, respectively, of those with stage Ta or T1 disease, and 54 and 33%, respectively, of those with dysplasia or stage Tis tumor. Tumor progressed in 13% of patients, with no statistically significant difference observed regarding progression between the mitomycin C and BCG groups. Side effects were more common after BCG instillation, with 5 cases of severe side effects compared to 1 in the mitomycin C group. Treatment was stopped due to toxicity in 10% of the patients. CONCLUSIONS: The majority of patients tolerated long-term intravesical therapy well. BCG instillation was hampered by more frequent side effects. BCG was superior regarding recurrence prophylaxis, since patients given BCG had fewer recurrences and a significantly longer time to treatment failure compared to those treated with mitomycin C. No statistically significant difference was observed regarding progression.
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