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Cost NG, Delacroix SE, Sleeper JP, Smith PJ, Youssef RF, Chapin BF, Karam JA, Culp S, Abel EJ, Brugarolas J, Raj GV, Sagalowsky AI, Wood CG, Margulis V. The impact of targeted molecular therapies on the level of renal cell carcinoma vena caval tumor thrombus. Eur Urol 2011; 59:912-8. [PMID: 21367518 DOI: 10.1016/j.eururo.2011.02.032] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 02/15/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND Targeted molecular therapies (TMTs) previously have demonstrated oncologic activity in renal cell carcinoma (RCC) by reducing the size of primary tumors and metastases. OBJECTIVE To assess the cytoreductive effect of TMTs on inferior vena cava tumor thrombi. DESIGN, SETTING, AND PARTICIPANTS A multi-institutional database of patients treated with TMTs for RCC was reviewed. The subset with in situ level II or higher caval thrombi (above renal vein) was assessed for radiographic response in thrombus size and level. Pre- and posttreatment characteristics of this population were assessed for predictors of response in height, diameter, and level of the tumor thrombi. MEASUREMENTS The main outcome measured was a change in the clinical level of tumor thrombus following TMT. We also measured radiographic responses in thrombus size and location before and after TMT. RESULTS AND LIMITATIONS Twenty-five patients met the inclusion criteria. Before TMT, thrombus level was II in 18 patients (72%), III in 5 patients (20%), and IV in 2 patients (8%). The first-line therapy was sunitinib in 12 cases; alternative TMTs were administered in 13. The median duration of therapy was two cycles (range: one to six cycles). Following TMT, 7 patients (28%) had a measurable increase in thrombus height, 7 (28%) had no change, and 11 (44%) had a decrease. One patient (4%) had an increase in thrombus-level classification, 21 (84%) had stable thrombi, and in 3 (12%) the thrombus level decreased. There was only one case (4%) where the surgical approach was potentially affected by tumor thrombus regression (level IV to III). No statistically significant predictors of tumor thrombus response to TMTs were found. Limitations include the descriptive and retrospective study design. Because TMTs were initiated according to physician and/or patient preferences, and not all patients were treated in anticipation of surgery, no conclusions could be drawn regarding selection and duration of therapy. Thus it may not be appropriate to extrapolate our experience to all patients with locally advanced RCC. Although this is the largest reported experience with in situ caval tumor thrombi treated with TMT, this series lacks sufficient statistical power to assess the usefulness of TMTs adequately in tumor thrombus cytoreduction. CONCLUSIONS TMT had a minimal clinical effect on RCC tumor thrombi. Only patients treated with sunitinib had clinical thrombus regression; however, the clinical magnitude and relevance of this effect is not clear and should be investigated prospectively.
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Youssef RF, Shariat SF, Lotan Y, Wood CG, Sagalowsky AI, Zigeuner R, Kikuchi E, Weizer A, Raman JD, Remzi M, Kabbani W, Langner C, Guo CC, Roscigno M, Montorsi F, Bolenz C, Kassouf W, Margulis V. Upper urinary tract urothelial carcinoma with loco-regional nodal metastases: insights from the Upper Tract Urothelial Carcinoma Collaboration. BJU Int 2011; 108:1286-91. [DOI: 10.1111/j.1464-410x.2011.10075.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The most common causes of hematuria in adults include urinary tract infections, urolithiasis, benign prostatic enlargement, and urologic malignancy. Once hematuria is confirmed, its cause should be investigated through a comprehensive history, a focused physical examination, laboratory studies, an image-based assessment of the upper urinary tract, and a cystoscopic evaluation of the lower urinary system. Prompt evaluation and appropriate referral of patients with documented hematuria should be initiated in the primary care setting according to the proposed guidelines, and aimed at cost-effective and early detection of urologic abnormality.
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Youssef RF, Shariat SF, Lotan Y, Wood CG, Sagalowsky AI, Zigeuner R, Langner C, Montorsi F, Bolenz C, Margulis V. Prognostic effect of urinary bladder carcinoma in situ on clinical outcome of subsequent upper tract urothelial carcinoma. Urology 2010; 77:861-6. [PMID: 21167566 DOI: 10.1016/j.urology.2010.09.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 09/14/2010] [Accepted: 09/18/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the effect of a history of bladder carcinoma in situ (CIS) on relapse and survival after surgical management of metachronous upper tract urothelial carcinoma (UTUC). Urinary bladder CIS was previously reported to be among the independent risk factors for the development of UTUC. METHODS Using a multi-institutional database of patients treated with radical nephroureterectomy (RNU) for UTUC, we compared the clinicopathologic parameters and clinical outcomes of patients with and without a history of bladder CIS. Multivariate Cox regression analysis was performed to determine the independent predictors of disease recurrence and cancer-specific mortality after RNU. RESULTS The study included 1316 patients, 884 men and 432 women, with median follow-up of 36 months after RNU. The patients with a history of bladder CIS (n = 91) were more likely to have high-grade and sessile UTUC (P < .05). The 5 year disease-free survival and cancer-specific survival rate was 53% and 59% in those with a history of bladder CIS and 71% and 75% in those without a history of bladder CIS, respectively (P = .031 and P = .045, respectively). On multivariate Cox regression analysis, a history of bladder CIS was an independent predictor of disease recurrence and cancer-specific mortality after RNU (P = .006 and P = .045, respectively). CONCLUSIONS The results of our study have shown that patients with a history of bladder CIS are more likely to develop aggressive UTUC and demonstrate a greater risk of recurrence and death from cancer after RNU. Our findings suggest the need for aggressive surveillance regimens and multimodal management strategies for patients who develop UTUC in the setting of previous bladder CIS.
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Karam JA, Huang S, Fan J, Stanfield J, Schultz RA, Pong RC, Sun X, Mason RP, Xie XJ, Niu G, Chen X, Frenkel EP, Sagalowsky AI, Hsieh JT. Upregulation of TRAG3 gene in urothelial carcinoma of the bladder. Int J Cancer 2010; 128:2823-32. [PMID: 20734393 DOI: 10.1002/ijc.25631] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 08/03/2010] [Indexed: 11/11/2022]
Abstract
Conventional chemotherapy is commonly used for advanced stages of bladder cancer with modest success and high morbidity. Identifying markers of resistance will allow clinicians to tailor treatment to a specific patient population. T24-tumorigenic cell line was grown orthotopically in nude mice and monitored using bioluminescence imaging and microcomputed tomography until they developed metastases. Stable sublines were then developed from primary bladder (T24-P), lung (T24-L) and bone (T24-B) tissues. Chromosomal analysis and DNA microarray were used to characterize these sublines. Real-time quantitative polymerase chain reaction and immunohistochemistry were used for validation. Epigenetic modifiers were used to study gene regulation. The cell viability was quantified with MTT assay. Chromosomal analysis revealed multiple alterations in metastatic cell lines compared to T24-P. DNA microarray analysis showed that taxol resistance-associated gene (TRAG) 3 was the most upregulated gene. From real-time quantitative polymerase chain reaction and immunohistochemistry, TRAG3 was significantly higher in T24-L and T24-B than T24-P. TRAG3 gene expression is likely controlled by DNA methylation but not histone acetylation. Interestingly, T24-B and T24-L cells were more resistant than T24-P to treatment with antimicrotubule agents such as docetaxel, paclitaxel and vinblastine. TRAG3 mRNA expression was higher in 20% of patients with ≤ pT2 (n = 10) and 60% of patients with ≥ pT3 (n = 20) compared to normal adjacent tissue (p = 0.05). In addition, the median TRAG3 expression was 6.7-fold higher in ≥ pT3 tumors compared to ≤ pT2 tumors. Knowing the status of TRAG3 expression could help clinicians tailor treatment to a particular patient population that could benefit from treatment, while allocating patients with resistant tumors to new experimental therapies.
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Sagalowsky AI. Re: Androgen-Deprivation Therapy in Prostate Cancer and Cardiovascular Risk: A Science Advisory From the American Heart Association, American Cancer Society, and American Urological Association: Endorsed by the American Society for Radiation Oncology. Eur Urol 2010; 58:630. [DOI: 10.1016/j.eururo.2010.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tilki D, Svatek RS, Novara G, Seitz M, Godoy G, Karakiewicz PI, Kassouf W, Fradet Y, Fritsche HM, Sonpavde G, Izawa JI, Ficarra V, Lerner SP, Schoenberg M, Stief CG, Dinney CP, Skinner E, Lotan Y, Sagalowsky AI, Reich O, Shariat SF. Stage pT0 at Radical Cystectomy Confers Improved Survival: An International Study of 4,430 Patients. J Urol 2010; 184:888-94. [PMID: 20643448 DOI: 10.1016/j.juro.2010.04.081] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Indexed: 10/19/2022]
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Tilki D, Svatek RS, Karakiewicz PI, Novara G, Seitz M, Sonpavde G, Gupta A, Kassouf W, Fradet Y, Ficarra V, Skinner E, Lotan Y, Sagalowsky AI, Stief CG, Reich O, Shariat SF. pT3 Substaging is a Prognostic Indicator for Lymph Node Negative Urothelial Carcinoma of the Bladder. J Urol 2010; 184:470-4. [DOI: 10.1016/j.juro.2010.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Indexed: 11/30/2022]
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Svatek RS, Shariat SF, Lasky RE, Skinner EC, Novara G, Lerner SP, Fradet Y, Bastian PJ, Kassouf W, Karakiewicz PI, Fritsche HM, Müller SC, Izawa JI, Ficarra V, Sagalowsky AI, Schoenberg MP, Siefker-Radtke AO, Millikan RE, Dinney CPN. The effectiveness of off-protocol adjuvant chemotherapy for patients with urothelial carcinoma of the urinary bladder. Clin Cancer Res 2010; 16:4461-7. [PMID: 20651056 DOI: 10.1158/1078-0432.ccr-10-0457] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The role of adjuvant chemotherapy for patients with high-risk urothelial carcinoma of the bladder (UCB) is not well defined. Here we address the value of adjuvant chemotherapy in patients undergoing radical cystectomy for UCB in an off-protocol routine clinical setting. EXPERIMENTAL DESIGN We collected and analyzed data from 11 centers contributing retrospective cohorts of patients with UCB treated with radical cystectomy without neoadjuvant chemotherapy. Patients were grouped into quintiles based on their risk of disease progression using estimates from a fitted multivariable Cox proportional hazards model. The association of adjuvant chemotherapy with survival was explored across separate quintiles. RESULTS The cohort consisted of 3,947 patients, 932 (23.6%) of whom received adjuvant chemotherapy. Adjuvant chemotherapy was independently associated with improved survival (hazard ratio, 0.83; 95% confidence interval, 0.72-0.97%, P = 0.017). However, the effect of adjuvant chemotherapy was significantly modified by the individual's risk of disease progression such that an increasing benefit from adjuvant chemotherapy was seen across higher-risk subgroups (P < 0.001). There was a significant improvement in survival between the treated and nontreated patients in the highest-risk quintile (hazard ratio, 0.75; 95% confidence interval, 0.62-0.90; P = 0.002). This group was characterized by an estimated 32.8% 5-year probability of cancer-specific survival, with 86.6% of patients having both advanced pathologic stage (> or =T(3)) and nodal involvement. CONCLUSION Adjuvant chemotherapy is associated with a significant improvement in survival for patients treated in an off-protocol clinical setting. Selective administration in patients at the highest risk for disease progression, such as those with advanced pathologic stage and nodal involvement, may optimize the therapeutic benefit of adjuvant chemotherapy.
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Tilki D, Reich O, Karakiewicz PI, Novara G, Kassouf W, Ergün S, Fradet Y, Ficarra V, Sonpavde G, Stief CG, Skinner E, Svatek RS, Lotan Y, Sagalowsky AI, Shariat SF. Validation of the AJCC TNM Substaging of pT2 Bladder Cancer: Deep Muscle Invasion Is Associated with Significantly Worse Outcome. Eur Urol 2010; 58:112-7. [PMID: 20097469 DOI: 10.1016/j.eururo.2010.01.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
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Margulis V, Sagalowsky AI. Penile cancer: management of regional lymphatic drainage. Urol Clin North Am 2010; 37:411-9. [PMID: 20674696 DOI: 10.1016/j.ucl.2010.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Presence and magnitude of the inguinal nodal metastases are the most important determinants of oncologic outcome in patients with squamous carcinoma of the penis (SCP). Surgical removal of the inguinal lymph nodes provides an important staging and therapeutic benefit to SCP patients, while the methodology of appropriate patient selection for lymph node dissection continues to evolve. Compliant, motivated, and reliable patients with low risk of harboring metastatic inguinal lymph nodes can be managed with careful inguinal surveillance. In SCP patients whose primary tumors demonstrate pathologic features of aggressive disease, modified bilateral inguinal lymph node dissection should be performed and converted to classic ilioinguinal lymph node dissection if metastatic disease is confirmed on frozen sections. Patients with bulky inguinal metastases are unlikely to be cured by surgery alone. Integration of systemic therapy, especially in a presurgical setting, is an attractive strategy for management of patients with advanced SCP, and is currently being studied prospectively.
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Bolenz C, Ho R, Nuss GR, Ortiz N, Raj GV, Sagalowsky AI, Lotan Y. Management of elderly patients with urothelial carcinoma of the bladder: guideline concordance and predictors of overall survival. BJU Int 2010; 106:1324-9. [DOI: 10.1111/j.1464-410x.2010.09417.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shariat SF, Youssef RF, Gupta A, Chade DC, Karakiewicz PI, Isbarn H, Jeldres C, Sagalowsky AI, Ashfaq R, Lotan Y. Association of Angiogenesis Related Markers With Bladder Cancer Outcomes and Other Molecular Markers. J Urol 2010; 183:1744-50. [DOI: 10.1016/j.juro.2010.01.018] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Indexed: 11/15/2022]
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Tilki D, Reich O, Svatek RS, Karakiewicz PI, Kassouf W, Novara G, Ficarra V, Chade DC, Fritsche HM, Gerwens N, Izawa JI, Lerner SP, Schoenberg M, Stief CG, Skinner E, Lotan Y, Sagalowsky AI, Shariat SF. Characteristics and Outcomes of Patients With Clinical Carcinoma In Situ Only Treated With Radical Cystectomy: An International Study of 243 Patients. J Urol 2010; 183:1757-63. [PMID: 20299059 DOI: 10.1016/j.juro.2010.01.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Indexed: 11/27/2022]
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Levine GN, D'Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, Milani RV, Sagalowsky AI, Smith MR, Zakai N. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. CA Cancer J Clin 2010; 60:194-201. [PMID: 20124400 PMCID: PMC3049943 DOI: 10.3322/caac.20061] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Lotan Y, Youssef R, Shariat SF, Alhalbi F, Ashfaq R, Sagalowsky AI. Abstract 1193: Prospective validation of multiple biomarkers for improved clinical decision-making in patients with urothelial carcinoma of the bladder. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-1193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objectives: To prospectively assess the predictive value of a panel of biomarkers (cyclin E1, p53, p21, p27 and pRB/Ki-67) for staging of patients with urothelial carcinoma of the bladder (UCB).
Methods: 174 consecutive patients treated with transurethral resection (TUR) and/or radical cystectomy (RC) for UCB were prospectively included in the study starting in January 2007. Standardized, automated immunohistochemical staining and scoring was performed. A prognostic score (PS; ≤2 altered biomarkers=Favorable; >2 altered biomarkers=Unfavorable) was defined and correlated with clinical and pathological data.
Results: The study comprised of 102 RC patients and 72 TURBT cases. Unfavorable PS were noted in 36.3 % of RC cases and 16.6 % of TURBT cases matching the more advanced pathological stages of RC patients. In RC group; an unfavorable PS was significantly associated with advanced tumor stage (p=0.02), the presence of LVI (p=0.017), recurrence (p=0.02) and survival (p=0.048). In the subgroup of patients who had biomarker evaluation at TUR and then underwent RC (n=32), 75 % and 50% of the cases with unfavorable PS showed upstaging and LN involvement at RC versus 25 % and 12.5 % in cases with favorable PS. Unfavorable PS at TUR was associated with the presence of LVI (p=0.001) and LN metastasis (p=0.026). Conclusions: The preliminary analysis of our ongoing prospective trial strongly suggests that a panel of five biomarkers improves the identification of patients at risk of upstaging at RC. An unfavorable PS may identify patients who are most likely to benefit from neo-adjuvant and adjuvant chemotherapy combined with RC.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1193.
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Bolenz C, Shariat SF, Karakiewicz PI, Ashfaq R, Ho R, Sagalowsky AI, Lotan Y. 1716 HER-2 EXPRESSION STATUS PROVIDES INDEPENDENT PROGNOSTIC INFORMATION IN PATIENTS WITH UROTHELIAL CARCINOMA OF THE BLADDER. J Urol 2010. [DOI: 10.1016/j.juro.2010.02.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sagalowsky AI. Editorial comment. J Urol 2010; 183:1341-2. [PMID: 20171685 DOI: 10.1016/j.juro.2009.12.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shariat SF, Svatek RS, Tilki D, Skinner E, Karakiewicz PI, Capitanio U, Bastian PJ, Volkmer BG, Kassouf W, Novara G, Fritsche HM, Izawa JI, Ficarra V, Lerner SP, Sagalowsky AI, Schoenberg MP, Kamat AM, Dinney CP, Lotan Y, Marberger MJ, Fradet Y. International validation of the prognostic value of lymphovascular invasion in patients treated with radical cystectomy. BJU Int 2010; 105:1402-12. [DOI: 10.1111/j.1464-410x.2010.09217.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levine GN, D'Amico AV, Berger P, Clark PE, Eckel RH, Keating NL, Milani RV, Sagalowsky AI, Smith MR, Zakai N. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. Circulation 2010; 121:833-40. [PMID: 20124128 DOI: 10.1161/circulationaha.109.192695] [Citation(s) in RCA: 261] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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97
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Shariat SF, Bolenz C, Karakiewicz PI, Fradet Y, Ashfaq R, Bastian PJ, Nielsen ME, Capitanio U, Jeldres C, Rigaud J, Müller SC, Lerner SP, Montorsi F, Sagalowsky AI, Cote RJ, Lotan Y. p53 expression in patients with advanced urothelial cancer of the urinary bladder. BJU Int 2010; 105:489-95. [DOI: 10.1111/j.1464-410x.2009.08742.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Sagalowsky AI. Editorial comment. J Urol 2010; 183:928. [PMID: 20089270 DOI: 10.1016/j.juro.2009.11.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bolenz C, Shariat SF, Karakiewicz PI, Ashfaq R, Ho R, Sagalowsky AI, Lotan Y. Human epidermal growth factor receptor 2 expression status provides independent prognostic information in patients with urothelial carcinoma of the urinary bladder. BJU Int 2010; 106:1216-22. [DOI: 10.1111/j.1464-410x.2009.09190.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Tilki D, Svatek RS, Karakiewicz PI, Isbarn H, Reich O, Kassouf W, Fradet Y, Novara G, Fritsche HM, Bastian PJ, Izawa JI, Stief CG, Ficarra V, Lerner SP, Schoenberg M, Dinney CP, Skinner E, Lotan Y, Sagalowsky AI, Shariat SF. Characteristics and outcomes of patients with pT4 urothelial carcinoma at radical cystectomy: a retrospective international study of 583 patients. J Urol 2010; 183:87-93. [PMID: 19942232 DOI: 10.1016/j.juro.2009.08.145] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We describe cancer specific outcomes in patients with pT4 bladder urothelial carcinoma at radical cystectomy in a large international cohort. MATERIALS AND METHODS We reviewed the records of 4,257 patients treated with radical cystectomy for bladder urothelial carcinoma at 12 centers. No patient received any preoperative systemic chemotherapy or radiotherapy. RESULTS Of the 4,257 patients 583 (14%) had pT4 bladder urothelial carcinoma, of whom 83.7% were male, 85.2% had substage pT4a disease, 24.9% had positive soft tissue surgical margins, 57.8% had lymphovascular invasion and 53.5% had lymph node metastasis. Median followup was 55.0 months. Overall estimated 5-year recurrence-free and cancer specific survival was 29% (95% CI 22-32) and 31% (95% CI 25-36), respectively. On multivariate analysis female gender (p = 0.005 and p = 0.001), positive soft tissue surgical margins (p = 0.014 and p <0.001), lymphovascular invasion (p = 0.016 and p = 0.005), pT4b substage (p = 0.041 and p = 0.002, respectively) and lymph node involvement (each p <0.001) were independently associated with disease recurrence and cancer specific mortality. CONCLUSIONS Patients with pT4 bladder urothelial carcinoma have highly variable outcomes. Features associated with metastatic tumor dissemination (ie lymph node invasion and lymphovascular invasion) and local disease burden (ie soft tissue surgical margins and pT4 substage) are associated with poor outcomes in patients with pT4 bladder urothelial carcinoma. Further research is needed to understand why female patients with pT4 bladder urothelial carcinoma have a worse outcome than their male counterparts.
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