Objectives

To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC).

Material and methods

A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan–Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10–55).

Results

Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence.

Conclusions

In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer.

With the increased awareness that cancer and its treatments may have a substantial impact upon quality of life before, during, and after therapy, fertility preservation is now widely recognized as an essential component of care for all patients with a new cancer diagnosis. The emergence of formal fertility preservation guidelines from multiple professional societies has provided a framework for incorporating fertility preservation into clinical practice. Providers should discuss fertility considerations with new cancer patients at the earliest possible opportunity, prior to initiation of potentially gonadotoxic cancer treatments. Sperm banking via masturbation remains the easiest and most reliable method for fertility preservation, though a variety of alternatives exist for adolescents and adult males with azoospermia or those who are unable to provide a sample. Ultimately, care can be optimally delivered through a formal fertility preservation program that includes providers from multiple disciplines with the resources to provide comprehensive and expedient care.

Chemotherapy is extensively used in healthcare and its usage is only increasing. Since DNA and DNA modifiers (epigenetics) are altered by chemotherapy, the long-term effects in exposed individuals are important to clinicians and researchers. For example, animal studies have shown evidence of both genetic and epigenetic changes in progeny several generations downstream from the initial exposure. At present, there is extremely limited available research in humans but the study of the generational effects of chemotherapy could prove to be significant.