Uncovering the epidemiology of bladder cancer in the Arab world: A review of risk factors, molecular mechanisms, and clinical features

Objective:Bladder cancer(BC)is a significant public health concern in the Middle East and North Africa,but the epidemiology and clinicopathology of the disease and contributors to high mortality in this region remain poorly understood.The aim of this systematic review was to investigate the epidemiological features of BC in the Arab world and compare them to those in Western countries in order to improve the management of this disease.Methods:An extensive electronic search of the PubMed/PMC and Cochrane Library databases was conducted to identify all articles published until May 2022,following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.A total of 95 articles were included in the final analysis after title,abstract,and full-text screening,with additional data obtained from the GLOBOCAN and WHO 2020 databases.

Bladder cancer epidemiology and genetic susceptibility

Bladder cancer is the most common malignancy of the urinary system. The incidence of bladder cancer of men is higher than that of women （approximately 4：1）. Here, we summarize the bladder cancer-related risk factors, in- cluding environmental and genetic factors. In recent years, although the mortality rate induced by bladder cancer has been stable or decreased gradually, the public health effect may be pronounced. The well-established risk fac- tors for bladder cancer are cigarette smoking and occupational exposure. Genetic factors also play important roles in the susceptibility to bladder cancer. A recent study demonstrated that hereditary non-polyposis colorectal cancer is associated with increased risk of bladder cancer. Since 2008, genome-wide association study （GWAS） has been used to identify the susceptibility loci for bladder cancer. Further gene-gene or gene-environment interaction stud- ies need to be conducted to provide more information for the etiology of bladder cancer.

Polymorphism of N-acetyltransferase 2 (NAT2) Gene Polymorphism in Shanghai population: Occupational and Non-occupational Bladder Cancer Patient Groups

Objective Arylamine N-acetyltransferases (NATs) are involved in the detoxification of aromatic amines and hydrazine. In order to explore the possible association of NAT2 polymorphism with bladder cancer risk in benzidine exposed or non-exposed Chinese individuals, healthy subjects, subjects with bladder cancer of a former benzidine exposed cohort in Shanghai dyestuff industry and a group of bladder cancer patients without known occupational exposure to aromatic amines were genotyped for NAT2 gene polymorphism. Methods NAT2 genotyping was performed with a set of RFLP procedures at seven major polymorphic loci of gene coding area: G191A, C282T, T341C, C481T, G590A, A803G and G857A. Results The wild allele NAT2 *4 was the most prevalent allele (59%) in healthy individuals. The alleles NAT2*6A and NAT2*7B were also frequently observed (21% and 17%, respectively). In contrast to Caucasians, the percentage of slow acetylators was lower (12% in Chinese vs. 58% in Caucasians, P<0.001). No relevant differences were observed for homogenous rapid, heterogeneous rapid/slow and homogeneous slow acetylation genotypes between the healthy subjects and both groups of bladder cancer patients. Conclusion The present work did not support the association of slow acetylating genotypes of NAT2 gene with elevated risk of bladder cancer in Chinese whereas it was documented as an important genetically determined risk factor in Caucasians. Different mechanisms might play a role in individual susceptibility to bladder cancer related with aromatic amine exposure in various races or ethnic groups.

Bladder Cancer: Epidemiological, Clinical and Histopathological Aspects at the University Hospital Point G, Mali

Introduction: Bladder cancer is a new tissue formation most often of urothelial origin with potential for local, locoregional and distant invasion. Among its risk factors, urinary bilharzia is endemic in our study area. The aim of our study was to present the epidemiological, clinical and histopathological aspects of bladder cancer in our department. Patients and method: This was a descriptive cross-sectional study over a 12-month period from January 1 to December 31, 2019. The study took place in the urology department of the university hospital Point “G”. It included all patients hospitalized for bladder cancer. The epidemiological, clinical and histopathological characteristics have been sought and described. Results: A total of 74 patients were included in the study. Bladder cancer was the leading cause of cancer, accounting for 57.9% of all urological cancers. The mean age of the patients was 52.8 ± 16.25 years. A slight male predominance was observed with a sex-ratio of 1.2. Housewives were the most represented with 43.2% followed by farmers with 24.3%. Hematuria was the reason for consultation in 87.8% cases. The main risk factors found were urinary schistosomiasis (48.6%) and smoking (31.1%). These two factors were associated in 23.0% of cases. At diagnosis, 85.7% of patients were classified as T3 or T4 stage. Squamous cell carcinoma with 58.2% was the most common histological type followed by urothelial carcinoma in 26.0% of cases. Conclusion: Bladder cancer is very common of cancer in hospitalized patients in our department. Diagnosis is more often made at an advanced stage. The most common histological type is squamous cell carcinoma.

Epidemiological and Clinical Aspects of Bladder Tumours at the Nianankoro Fomba Hospital in Segou in the Urology Department

Objectives: To study the epidemiological, diagnostic and prognostic aspects of bladder tumours in Segou Hospital. Patients and Methods: We conducted a descriptive cross-sectional study of bladder tumours over the period from 1 April 2012 to 1 April 2017, in the urology department of the Nianankoro Fomba Hospital in Segou. The first three years were used for patient recruitment, and the last two years for follow-up of the patients in the series. Results: Over a period of three years, we collected 165 cases of bladder tumours hospitalised out of 1308 hospitalisations from 7007 consultations, i.e. 12.6% of hospitalisations and 2.3% of consultations. The sex ratio was 1.2 in favour of men. A history of treated bilharzia was reported in 78.8% of cases and untreated bilharzia in 9.1% of cases. Haematuria was the most common reason for consultation. The majority of our patients were at stage T4 and T3 at the time of diagnosis, i.e. 53.3% and 44.3% respectively. Most patients consulted within 13 to 24 months after the first sign, i.e. 44.8%. Conclusion: The prognosis is still clouded by the delay in management. All the patients diagnosed had a bladder tumour infiltrating the muscle.

中国联苯胺作业工人职业性膀胱癌发病率和死亡率流行病学调查

本文研究了1972年至1977年在册的累计专业工龄一年以上天津、上海和吉林1972名联苯胺男工的膀胱癌发病率和死亡率。与上海市普通居民相比联苯胺工人膀胱癌的标化死亡比(SMR)为17.5(95%可信限:7.5～34.5)、标化发病比(SIR)为25.0(95%可信限:16.9～35.7)。联苯胺工人膀胱癌发病率增高25倍,与接触水平有关。低接触组SIR=4.8;中接触组SIR=36.2;高接触组SIR=158.4(X^2趋势检验P<0.01)。联苯胺生产工人SIR=45.7(95%可信限:20.9～86.8),联苯胺使用工人SIR=20.9(95%可信限:12.9～32.0)。联苯胺吸烟者危险度增加31倍(95%可信限:20.4～46.4),而非吸烟者仅11倍(95%可信限:3.6～25.8)。

接触联苯胺工人及膀胱癌患者染色体研究

报道了联苯胺接触者及其膀胱癌患者和正常对照者淋巴细胞染色体畸变和膀胱癌发病的关系。观察对象包括三组，Ａ组为联苯胺接触者发生膀胱癌的病人（１５例）Ｂ组为联苯胺接触者（１５人），Ｃ组为正常对照工人（１４人）。三组中淋巴细胞畸变的人数分别占６０．０％，５８．３％及１４．０％，其淋巴细胞畸变率分别为１．１％，０．７％及０．３％。Ａ、Ｂ组显著高于Ｃ组，且膀胱癌组比非膀胱癌组细胞畸变率高。Ａ组有４例发现有２个以上的淋巴细胞畸变，Ｂ组仅有２例，其中１例在染色体畸变检验后１年发生了膀胱癌。对有染色体畸变者作Ｇ带分析的结果表明主要是缺失、易位、断裂和插入，其中多数在９号、８号、６号染色体，且Ａ组至少牵涉３次。表明具有较高畸变的个体可能有较高的膀胱癌危险性。外周血淋巴细胞染色体畸变及／或先天的遗传缺陷（通称为染色体不稳定性）反映了癌症的易感性。作者认为联苯胺工人淋巴细胞染色体畸变率增高可与其它生物学标记相结合作为膀胱癌早期监测的指标。

联苯胺接触人群尿细胞学监护的一些特点

目的 对上海联苯胺接触人群中医学监护 16年 ( 1983～ 1998年 )作初步总结。方法 监护人群为联苯胺职业接触者 ,采用巴氏分级法作尿脱落细胞检查。巴氏分级为 5级 ,介于相邻两级之间的结果以 0 5表达。受监护 5次以上者列入统计范围 ,采用平均级数和出现过 2 5级以上者的构成比两个指标 ,以t检验和卡方试验进行分析。结果 监护中发生 8例膀胱癌 ,诊断前监护中出现过 2 5级以上者 4例 ( 50 % )。不同工种和不同吸烟情况之间的两指标均无显著差异。女性的平均级数显著高于男性 (t=5 80 4 ,P <0 0 1) ,而出现过 2 5级以上的人数构成比无显著差异。 90年代的两个指标均显著高于 80年代。结论 尿脱落细胞巴氏法仍应作为该人群膀胱癌筛检的一项重要方法 ;规范开展常规医学监护在膀胱癌高危人群的筛检中有重要意义。

尿脱落细胞检查在联苯胺作业工人健康监护中的作用

目的研究通过在职业性膀胱癌高发人群中进行尿脱落细胞检查,以早期发现,早期治疗膀胱肿瘤,说明其在健康监护中的作用。方法对染化行业在职和退休职工,有联苯胺接触史1年以上的男性,进行尿脱落细胞病理学检查。结果对联苯胺作业人群进行20年的尿脱落细胞健康监护工作,并已取得肯定效果。结论通过尿脱落细胞检查可以检出尚无临床症状的早期患者,可使患者早期发现早期治疗膀胱肿瘤,所以尿脱落细胞学检查对于联苯胺作业人群的职业健康监护有着重要的意义。

上海地区膀胱癌患者中医证型分布及临床特征的多中心研究

目的探讨上海地区膀胱癌患者中医证型分布情况以及临床特征。方法选择上海地区膀胱癌患者525例,采用中医证候问卷的方法调查中医证型分布情况,同时调查病理结果(是/非浸润性膀胱癌),然后在非浸润性膀胱癌患者中再进一步调查患者的病理细胞分级(高/低危)、膀胱镜检查的相关情况(肿瘤数目:单发/多发)、病史情况(发病年龄;发病情况:首发/复发),采用生活质量问卷评定患者的生存质量。结果①525例患者中,男性患者占比68.0%,女性患者占比32.0%。中医证型中,瘀毒蕴结型、湿热下注型占比较高,其后依次是肾阴不足型、无证可辨/其他型和脾肾两虚型;病理显示非浸润性膀胱癌和浸润性膀胱癌患者的中医证型分布存在差异(P<0.05)。非浸润性膀胱癌患者占比最多的中医证型为湿热下注型,浸润性膀胱癌患者占比最多为瘀毒蕴结型。②非浸润性膀胱癌患者中,低级别占比最多的中医证型是湿热下注型,高级别是瘀毒蕴结型。③非浸润性膀胱癌主要中医证型中,湿热下注型的排尿症状、肠道症状评分明显高于其他证型(P<0.05),瘀毒蕴结型疼痛症状评分明显高于其他证型(P<0.05)。结论上海地区膀胱癌的中医证型以湿热下注、瘀毒蕴结两型为主,发病最多的非浸润性膀胱癌患者中亦是呈现此两种证型占比最多。非浸润性膀胱癌与浸润性膀胱癌中医证型分布特征比较有差异,非浸润性膀胱癌患者中瘀毒蕴结型因较其他证型病理级别、浸润性和复发率等方面差异明显,尤需引起临床重视。

Case study approach to modeling historical disinfection by-product exposure in Iowa drinking waters

In the 1980 s, a case–control epidemiologic study was conducted in Iowa（USA） to analyze the association between exposure to disinfection by-products（DBPs） and bladder cancer risk. Trihalomethanes（THMs）, the most commonly measured and dominant class of DBPs in drinking water, served as a primary metric and surrogate for the full DBP mixture.Average THM exposure was calculated, based on rough estimates of past levels in Iowa. To reduce misclassification, a follow-up study was undertaken to improve estimates of past THM levels and to re-evaluate their association with cancer risk. In addition, the risk associated with haloacetic acids, another class of DBPs, was examined. In the original analysis, surface water treatment plants were assigned one of two possible THM levels depending on the point of chlorination. The re-assessment considered each utility treating surface or groundwater on a case-by-case basis. Multiple treatment/disinfection scenarios and water quality parameters were considered with actual DBP measurements to develop estimates of past levels. The highest annual average THM level in the re-analysis was156 μg/L compared to 74 μg/L for the original analysis. This allowed the analysis of subjects exposed at higher levels（〉 96 μg/L）. The re-analysis established a new approach, based on case studies and an understanding of the water quality and operational parameters that impact DBP formation, for determining historical exposure.

p53蛋白在联苯胺接触人群和膀胱癌患者血清中的表达

目的研究职业性联苯胺接触者和膀胱癌患者突变型p53蛋白的表达。方法用免疫PCR法测定职业性联苯胺接触人群和膀胱癌患者血中突变型p53蛋白,用巴氏分级法对尿脱落细胞进行分级。结果随着联苯胺接触强度指数的增高,人群突变型p53蛋白的阳性率不断增加,膀胱癌患者组突变型p53蛋白的阳性率(83.3%)高于接触强度指数1组(33.3%)。PCR扩增条带经扫描积分后,膀胱癌患者组和接触强度指数2组的平均扫描积分(24016.11±2979.99、12960.79±903.27)高于1组(9231.58±1140.74),差异有统计学意义(P<0.01,P<0.05)。在联苯胺接触人群的各组中以巴氏分级作为组内分层因素,接触强度指数2组中,巴氏2、3级层PCR扩增条带平均扫描积分(12960.79±903.27、13612.78±1697.38)高于1级层(9231.58±1140.74),差异有统计学意义(P<0.05)。接触强度指数3组中,巴氏3级层的突变型p53蛋白的阳性率(46.9%)高于1级层(33.3%),差异有统计学意义(P<0.05)。结论在联苯胺接触强度较低的范围内,随着接触强度的增加,接触工人血清中p53突变蛋白的阳性表达不但更频繁,而且更加强烈;但接触强度超过了这个范围,工人血中p53突变蛋白的阳性率以及表达量将不再随着接触强度的上升而增高,而尿脱落细胞病变程度在联苯胺接触强度较高的情况下与p53基因突变率?

天津市职业性膀胱癌危险因素的病例对照研究

目的探讨天津市联苯胺职业接触人群膀胱癌的主要危险因素,以确定高危人群。方法对天津市联苯胺职业接触人群中106例膀胱癌和同时期、同车间的未发生膀胱癌的106人进行成组病例-对照研究,通过单因素和多因素非条件Logistic回归分析筛选职业人群中膀胱癌的主要危险因素,同时分析病例组与对照组尿中脱落细胞检查情况,为职业肿瘤的早期发现及高危人群的确定提供参考依据。结果单因素及多因素分析结果显示,联苯胺职业接触人群膀胱癌危险因素包括接触联苯胺浓度、专业工龄、吸烟（P〈0.05）;多因素分析结果表明,联苯胺职业接触人群膀胱癌的主要危险因素为高接触浓度（OR=4.752,95%CI=2.458-9.190）、专业工龄（OR=2.557,95%CI=1.394-4.692）、吸烟（OR=2.011,95%CI=1.020-3.966）。病例组巴氏分级Ⅱ级及以上和定量荧光影像分析（QFIA）阳性检出均高于对照组,P〈0.05。结论高浓度接触、专业工龄超过5年、吸烟是联苯胺职业接触人群发生膀胱癌的主要危险因素,应以此确定高危人群;尿脱落细胞检查巴氏分级Ⅱ级及以上和QFIA阳性者,也应加强监护。

2004-2018年全国膀胱癌死亡率的流行特征及变化趋势

【目的】分析2004—2018年全国膀胱癌死亡情况的流行病学特征。【方法】收集来自中国疾病预防控制中心定期公开发表的基于全国605个监测点的2004—2018年膀胱癌死亡病例数据集,并依照中国2000年的人口结构进行年龄标化,计算膀胱癌粗死亡率(CMR)、年龄标化死亡率(ASMR)、城乡ASMR比值(RR),分析膀胱癌死亡病例的年龄、性别、地区(城市/农村,东部/中部/西部)和时间的分布特征。【结果】2004—2018年全国膀胱癌CMR为1.69/10万,ASMR为1.09/10万。2004—2018年全国膀胱癌CMR呈上升趋势(APC=2.91%,P<0.001);ASMR有所下降(APC=−1.29,P=0.008)。男性膀胱癌CMR呈上升趋势(APC=3.29%,P<0.001),ASMR基本持平(APC=−0.83,P=0.070);女性膀胱癌CMR略有上升(APC=2.12%,P<0.001),ASMR略有下降(APC=−1.94,P=0.008)。城市的膀胱癌CMR和ASMR高于农村(P<0.05),但城市膀胱癌ASMR呈下降趋势(APC=−2.05%,P=0.002),主要分布在东部、西部地区的城市,东部地区城市ASMR高于西部城市。农村地区膀胱癌ASMR无明显变化(P>0.05),且东、中、西部农村之间未见明显差异。东、西部地区的城乡差距在缩小(东部P<0.001,西部P=0.002)。虽然城市≥40岁年龄组ASMR下降趋势较为明显,但城市≥60岁年龄组人群膀胱癌ASMR远高于城市其他年龄组及农村各个年龄组。【结论】城市≥60岁年龄组是膀胱癌防治的主要群体,应加强农村地区的膀胱癌筛查和诊断治疗。

大气污染与主要癌症相关性研究进展

大气污染是癌症明确的危险因素，对人类的健康构成严重威胁。本文介绍了大气污染的组成成分和WHO与我国的空气质量标准，并总结了国内外对于大气污染与肺癌、乳腺癌和膀胱癌等主要癌症的关联性的最新研究。

联苯胺致职业性膀胱癌患者术后生存质量及恐惧疾病现状调查

目的调查联苯胺致职业性膀胱癌患者术后生存质量及恐惧疾病的现状。方法选择2018年1月—2019年8月于空军军医大学西京医院就诊的苯胺致职业性膀胱癌患者85例,选择同期进行健康检查健康人群85例,利用一般情况调查表统计患者的一般情况,用世界卫生组织生存质量测定量表对两组患者生存质量进行评价,同时采用恐惧疾病进展简化量表对患者的恐惧疾病状态进行评价。结果观察组患者心理状态、生理健康、社会关系、环境影响、个人信仰及独立能力等生存质量评分远远低于对照组(P<0.01),观察组年龄<60岁,文化程度为大专及以上,联苯胺接触时间<15年,膀胱癌分期为III期,未出现淋巴结转移,社会、家庭支持高的患者生存质量较高(P<0.01);观察组患者生理健康、社会维度等恐惧疾病得分明显高于对照组(P<0.01),观察组中患者年龄<60岁,文化程度为大专及以上,肿瘤病灶发生转移,肿瘤出现复发,肿瘤TNM为III期IV期,有社会支持患者恐惧疾病评分高,恐惧疾病程度高(P<0.01)。结论通过对联苯胺致职业性膀胱癌患者生存质量及恐惧疾病现状的调查,可以为医护人员及家属尽早发现患者对疾病的恐惧点,及时给予患者干预,提高患者的生存质量。

Pediatric genitourinary tumors:Distribution,demographics,and outcomes

Importance:The diversity of pediatric genitourinary malignancies requires a timely resource detailing tumor characteristics and survival.Objective:To determine the incidence,demographics,and outcomes of all pediatric genitourinary tumors within the United States.Methods:A population-based search for patients diagnosed with genitourinary cancers under age 15 was performed using the National Cancer Institute’s Surveillance,Epidemiology,and End Results 18 registry.Information on primary tumor location,histologic type,patient age,sex,year of diagnosis,race,treatment,cause of death,and survival months was extracted.Descriptive epidemiological and survival statistics were calculated for all variables.Results:A total of 4576 cases from 1973 through 2015 were identified.The most common primary tumor sites were the kidney(80.3%),testis(12.3%),bladder(2.8%),and vagina(1.5%).Nephroblastoma(87.9%)and sarcoma(3.4%)were the most common renal malignancies.Rhabdomyosarcoma was common in the vagina,bladder,and testis at rates of 66.2%,61.2%,and 24.6%,respectively.Germ cell tumors(71.0%)were the most common primary tumor of the testis.Ten-year overall survival(OS)for renal nephroblastoma and sarcoma was 88%and 82%,respectively.Ten-year OS for RMS of the testis was 91%,the bladder was 79%,the vagina was 79%,and the prostate was 56%.Germ cell tumor 10-year OS were 96%in the testis and 100%in the vagina.Interpretation:A better understanding of the overall distribution and outcomes associated with pediatric genitourinary cancers allows physicians to best understand the patient’s disease in the context of current frequency in a genitourinary setting and reported outcomes.