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Antar RM, Xu VE, Adesanya O, Drouaud A, Longton N, Gordon O, Youssef K, Kfouri J, Azari S, Tafuri S, Goddard B, Whalen MJ. Income Disparities in Survival and Receipt of Neoadjuvant Chemotherapy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer. Curr Oncol 2024; 31:2566-2581. [PMID: 38785473 PMCID: PMC11119047 DOI: 10.3390/curroncol31050192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Muscle-invasive bladder cancer (MIBC) is a potentially fatal disease, especially in the setting of locally advanced or node-positive disease. Adverse outcomes have also primarily been associated with low-income status, as has been reported in other cancers. While the adoption of neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (RC) and pelvic lymph node dissection (PLND) has improved outcomes, these standard-of-care treatments may be underutilized in lower-income patients. We sought to investigate the economic disparities in NAC and PLND receipt and survival outcomes in MIBC. Methods: Utilizing the National Cancer Database, a retrospective cohort analysis of cT2-4N0-3M0 BCa patients with urothelial histology who underwent RC was conducted. The impact of income level on overall survival (OS) and the likelihood of receiving NAC and PLND was evaluated. Results: A total of 25,823 patients were included. This study found that lower-income patients were less likely to receive NAC and adequate PLND (≥15 LNs). Moreover, lower-income patients exhibited worse OS (Median OS 55.9 months vs. 68.2 months, p < 0.001). Our findings also demonstrated that higher income, treatment at academic facilities, and recent years of diagnosis were associated with an increased likelihood of receiving standard-of-care modalities and improved survival. Conclusions: Even after controlling for clinicodemographic variables, income independently influenced the receipt of standard MIBC treatments and survival. Our findings identify an opportunity to improve the quality of care for lower-income MIBC patients through concerted efforts to regionalize multi-modal urologic oncology care.
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Affiliation(s)
- Ryan M. Antar
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Vincent E. Xu
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | | | - Arthur Drouaud
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Noah Longton
- College of Medicine, Drexel University, Philadelphia, PA 19104, USA;
| | - Olivia Gordon
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Kirolos Youssef
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Jad Kfouri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sarah Azari
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sean Tafuri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Briana Goddard
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Michael J. Whalen
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
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Bahlburg H, Tully KH, Bach P, Butea-Bocu MC, Reike M, Roghmann F, Noldus J, Müller G. Improvements in urinary symptoms, health-related quality of life, and psychosocial distress in the early recovery period after radical cystectomy and urinary diversion in 842 German bladder cancer patients: data from uro-oncological rehabilitation. World J Urol 2024; 42:111. [PMID: 38421452 PMCID: PMC10904548 DOI: 10.1007/s00345-024-04839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
PURPOSE This study aims to investigate urinary symptoms (continence and stoma care), health-related quality of life (HRQoL) and psychosocial distress (PD) in the early postoperative period after radical cystectomy (RC) and urinary diversion for ileal conduit (IC) and ileal neobladder (INB) to obtain a better basis for patient counseling. METHODS Data for 842 bladder cancer patients, who underwent 3 weeks of inpatient rehabilitation (IR) after RC and urinary diversion (447 IC, 395 INB) between April 2018 and December 2019 were prospectively collected. HRQoL, PD, and urinary symptoms were evaluated by validated questionnaires at the beginning (T1) and the end of IR (T2). In addition, continence status and micturition volume were objectively evaluated in INB patients by 24-h pad test and uroflowmetry, respectively. RESULTS Global HRQoL was severely impaired at T1, without significant difference between the two types of urinary diversion. All functioning and symptom scales of HRQoL improved significantly from T1 to T2. In INB patients, all continence parameters improved significantly during IR, while patients with an IC reported fewer problems concerning urostomy management. The proportion of patients suffering from high PD decreased significantly from 50.7 to 34.9%. Age ≤ 59 years was the only independent predictor of high PD. Female patients and patients ≤ 59 years were more likely to use individual psycho-oncological counseling. CONCLUSION HRQoL, PD and urinary symptoms improved significantly in the early recovery period after RC. Patients with urinary continence reported higher HRQoL and less PD. Psychosocial support should be offered especially to younger patients.
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Affiliation(s)
- Henning Bahlburg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Karl Heinrich Tully
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Peter Bach
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | | | - Moritz Reike
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Guido Müller
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany
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Bahlburg H, Reicherz A, Reike M, Bach P, Butea-Bocu MC, Tully KH, Roghmann F, Noldus J, Müller G. A prospective evaluation of quality of life, psychosocial distress, and functional outcomes two years after radical cystectomy and urinary diversion in 842 German bladder cancer patients. J Cancer Surviv 2024:10.1007/s11764-024-01535-0. [PMID: 38291220 DOI: 10.1007/s11764-024-01535-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE This study aims to evaluate survival, health-related quality of life (HRQoL), psychosocial distress, and functional outcomes after radical cystectomy (RC) and urinary diversion for ileal neobladder (INB) or ileal conduit (IC) in a contemporary German cohort of bladder cancer patients. METHODS Patients undergoing inpatient rehabilitation after RC between April 2018 and December 2019 in one high-volume rehabilitation center were surveyed regarding HRQoL, psychosocial distress, and functional outcomes until two years after RC. RESULTS Eight-hundred forty-two patients (683 male, 159 female; 395 INB, 447 IC) were included. Patients with an IC suffered more often from locally advanced disease (≥ pT3; 41.4% vs. 24.1%, p < 0.001) and lymph node metastases (19.9% vs. 11.8%, p = 0.002), resulting in worse probability of survival (p < 0.001). Global HRQoL improved steadily during follow-up, but significant differences in subscales persisted between cohorts. Multivariable regression analysis identified IC, male sex, and patient age ≤ 59 years as independent predictors for persistent high psychosocial distress. Almost 42% of female patients reported severe urinary incontinence two years after RC. Most men reported severely diminished erectile function, even after nerve-sparing surgery. CONCLUSION Global HRQoL two years after RC is comparable to the general German population. Female patients should be informed about worse continence rates. Conversely, men should be educated about erectile dysfunction. Aftercare should include psycho-oncologic counseling, especially for patients at risk. IMPLICATIONS FOR CANCER SURVIVORS Patients should be counseled on long-term functional outcomes and persistent psychosocial distress after RC. Closer cooperation between urologists and psycho-oncologists is needed.
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Affiliation(s)
- Henning Bahlburg
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany.
| | - Alina Reicherz
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Moritz Reike
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Peter Bach
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | | | - Karl Heinrich Tully
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Florian Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Joachim Noldus
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
| | - Guido Müller
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Hölkeskampring 40, 44625, Herne, Germany
- Center for Urological Rehabilitation, Kliniken Hartenstein, Bad Wildungen, Germany
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Guo L, Zhang T, Liang T, Chen J, Gao H. Laparoscopic Radical Cystectomy with Ileal Orthotopic Neobladder for Bladder Cancer: Current Indications and Outcomes. Urol Int 2023; 108:242-253. [PMID: 37995673 PMCID: PMC11151991 DOI: 10.1159/000535032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Laparoscopic radical cystectomy (LRC) with ileal orthotopic neobladder (IONB) reconstruction is one of the most promising methods for bladder cancer treatment; its advantages include a small incision size, less blood loss, improved perioperative outcome and tumor prognosis, and a positive self-image postoperatively. The short-term benefits of various IONB reconstruction procedures reported thus far include a simple process, short operative time, less intraoperative bleeding, few postoperative complications, and good postoperative neobladder function; in the long term, these benefits engender good quality of life of the patients. Here, we explored and summarized the more novel and available IONB reconstruction procedures to identify the safest, most efficient, and simplest IONB reconstruction techniques for patients with bladder cancer. SUMMARY LRC with IONB reconstruction is technically feasible; however, most of the relevant studies have been short, employing a small sample size and a retrospective design. However, long-term, large-scale, prospective studies identifying the most appropriate bowel segments for IONB reconstruction, comparing intracorporeal and extracorporeal IONB reconstruction, assessing currently available IONBs, and resolving relevant postoperative complications further, with a focus on patients with bladder cancer, are warranted. KEY MESSAGE Several procedures for LRC with IONB reconstruction have been reported thus far. However, there is no consensus regarding the IONB reconstruction procedures most beneficial to patients with bladder cancer. Our review may aid researchers in developing a simple, safe, and efficient LRC with IONB reconstruction procedure for patients with bladder cancer.
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Affiliation(s)
- Lin Guo
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ting Zhang
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
| | - Taisheng Liang
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
- Guangxi Clinical Research Center for Kidney Diseases of Integrated Traditional Chinese and Western Medicine, Nanning, China
| | - Jibing Chen
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
- Guangxi Clinical Research Center for Kidney Diseases of Integrated Traditional Chinese and Western Medicine, Nanning, China
| | - Hongjun Gao
- Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, China
- Guangxi Clinical Research Center for Kidney Diseases of Integrated Traditional Chinese and Western Medicine, Nanning, China
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Wong WG, Perez Holguin RA, Butt M, Rigby A, Rogers AM, Shen C. Racial Differences in Bariatric Surgical Approach: a Cross-Sectional National Inpatient Sample Analysis. Obes Surg 2022; 32:3359-3367. [PMID: 35930116 DOI: 10.1007/s11695-022-06227-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Although racial inequalities in referral and access to bariatric surgical care have been well reported, racial difference in the selection of surgical techniques is understudied. This study examined factors associated with the utilization of the two main bariatric surgical techniques: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). MATERIALS AND METHODS The National Inpatient Sample database was queried for patients who underwent elective LSG or LRYGB for the treatment of severe obesity. Chi-square tests and multivariable logistic regression assessed associations of surgical approach with patient and facility characteristics. Sensitivity analyses examined the following body mass index (BMI) subgroups: < 40.0 kg/m2, 40.0-44.9 kg/m2, 45.0-49.9 kg/m2, and ≥ 50.0 kg/m2. RESULTS Within the final cohort (N = 86,053), 73.0% (N = 62,779) underwent LSG, and 27.0% (N = 23,274) underwent LRYGB. Patients with BMI 45.0-49.9 kg/m2 (OR = 0.85) and BMI ≥ 50.0 kg/m2 (OR = 0.80) were less likely to undergo LSG than patients with BMI 40.0-45.0 kg/m2 (all p < 0.001). However, Black (OR = 1.74) and White Hispanic patients (OR = 1.30) were more likely to undergo LSG than White non-Hispanic patients (all p < 0.005). In the BMI ≥ 50.0 kg/m2 group, Black patients were still more likely to undergo LSG compared to White non-Hispanic patients (OR = 1.69, p < 0.001), while Asians/Pacific Islanders were less likely to receive LSG than White non-Hispanic patients (OR = 0.41, p < 0.05). CONCLUSION In this observational study, we identified racial differences in the selection of common bariatric surgical approaches across various BMI categories. Future investigations are warranted to study and to promote awareness of the racial/ethnic influence in attitudes on obesity, weight loss, financial support, and surgical risks during bariatric discussions with minorities.
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Affiliation(s)
- William G Wong
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy A Perez Holguin
- Department of General Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Melissa Butt
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA
| | - Andrea Rigby
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Ann M Rogers
- Division of Minimally Invasive Surgery, Department of Surgery, Penn State Health, Hershey, PA, USA
| | - Chan Shen
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA. .,Division of Outcomes Research and Quality, Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA.
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Patient Selection and Outcomes of Urinary Diversion. Urol Clin North Am 2022; 49:533-551. [DOI: 10.1016/j.ucl.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Elshabrawy A, Wang H, Dursun F, Kaushik D, Liss M, Svatek RS, Mansour AM. Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion. Arab J Urol 2022; 20:159-167. [PMID: 35935907 PMCID: PMC9354633 DOI: 10.1080/2090598x.2022.2032562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objectives To assess the utilisation trends of robot-assisted radical cystectomy (RARC), rates of performing continent urinary diversions (CUDs), and impact of diffusion of RARC on CUD rates. Methods We investigated the National Cancer Database for patients with muscle-invasive bladder cancer (MIBC) who underwent RC between 2004 and 2015. Patients were stratified by surgical technique into open (ORC) and RARC groups, and by type of urinary diversion into continent (CUD) and ileal conduit (ICUD) groups. Linear regression models were fitted to evaluate time trends for surgery and conversion techniques. Multivariate logistic regression models were utilised to identify independent predictors of RARC and CUD. Results A total of 14466 patients underwent RC for MIBC, of which 4914 (34%) underwent RARC. There was a significant increase in adoption of RARC from 22% in 2010 to 40% in 2015 (R2 = 0.96, P < 0.001), this was not associated with a change in the rates of CUD over the same period (P = 0.22). Across all years, ICUD was the primary type of urinary diversion, CUD was only offered in 12% in 2010 compared to 9.9% in 2015 (R2 = 0.33, P = 0.22). Multivariate analysis identified male gender (odds ratio [OR] 1.18, P = 0.03), academic centres (OR 1.74, P = 0.001), and lower T stage (T4 vs T2; OR 0.78, P = 0.03) as independent predictors of CUD, while surgical technique was not associated with odds of receiving CUD (P = 0.8). Conclusions There is significant nationwide increasing trend of adoption of RARC. This diffusion was not associated with a decline in CUD, which remains significantly underutilised in both ORC and RARC groups. Abbreviations CUD: continent urinary diversion; ICD-O: International Classification of Diseases for Oncology; ICUD: ileal conduit urinary diversion; (N)MIBC: (non-)muscle-invasive bladder cancer; NAC, neoadjuvant chemotherapy; NCDB: National Cancer Database; OR: odds ratio;(O)(RA)RC: (open) (robot-assisted) radical cystectomy.
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Affiliation(s)
- Ahmed Elshabrawy
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Furkan Dursun
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Michael Liss
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Ahmed M. Mansour
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Prognostic impact of preoperative renal function in patients treated with radical cystectomy: a multi-institutional retrospective study. Int J Clin Oncol 2020; 25:1969-1976. [PMID: 32648134 DOI: 10.1007/s10147-020-01745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little data on the preoperative prognostic factors in radical cystectomy (RC) patients have made it difficult to choose the appropriate type of urothelial diversion (UD). This study aimed to investigate the prognostic role of UD, with a subgroup analysis of that of preoperative renal function. METHODS From 1990 to 2015, 279 patients underwent RC for bladder cancer at six hospitals affiliated with Kitasato University in Japan. All patients were divided into three groups: cutaneous ureterostomy (CU; n = 54), ileal conduit (IC; n = 139), and orthotopic neobladder (NB; n = 86). Patients were also stratified into three groups based on preoperative estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2): normal eGFR (> 60 mL/min/1.73 m2; n = 149), moderately reduced eGFR (45-60 mL/min/1.73 m2; n = 66), and severely reduced eGFR (< 45 mL/min/1.73 m2; n = 37). Statistical analyses were performed to investigate prognostic values of UD and preoperative eGFR. RESULTS Kaplan-Meier analyses showed that progression-free survival (PFS) and cancer-specific survival (CSS) did not differ between the three types of UD groups. With regard to renal function, the preoperative severely reduced group had significantly worse PFS and CSS than the other groups. The multivariate analysis showed that severely reduced preoperative eGFR was an independent risk factor of worse PFS and worse CSS. CONCLUSION The present study demonstrated that preoperative severe renal function was shown as an independent risk factor of both PFS and CSS.
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Nazemi A, Ghodoussipour S, Pearce S, Bhanvadia S, Daneshmand S. Socioeconomic and insurance status are independent prognostic indicators of higher disease stage and worse prognosis in bladder cancer. Urol Oncol 2019; 37:784-790. [DOI: 10.1016/j.urolonc.2019.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/28/2019] [Accepted: 04/17/2019] [Indexed: 12/27/2022]
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Sung JM, Martin JW, Jefferson FA, Sidhom DA, Piranviseh K, Huang M, Nguyen N, Chang J, Ziogas A, Anton-Culver H, Youssef RF. Racial and Socioeconomic Disparities in Bladder Cancer Survival: Analysis of the California Cancer Registry. Clin Genitourin Cancer 2019; 17:e995-e1002. [PMID: 31239240 DOI: 10.1016/j.clgc.2019.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To examine the California Cancer Registry (CCR) for bladder cancer survival disparities based on race, socioeconomic status (SES), and insurance in California patients. PATIENTS AND METHODS The CCR was queried for bladder cancer cases in California from 1988 to 2012. The primary outcome was disease-specific survival (DSS), defined as the time interval from date of diagnosis to date of death from bladder cancer. Survival analyses were performed to determine the prognostic significance of racial and socioeconomic factors. RESULTS A total of 72,452 cases were included (74.5% men, 25.5% women). The median age was 72 years (range, 18-109 years). The racial distribution among the patients was 81% white, 3.8% black, 8.8% Hispanic, 5.2% Asian, and 1.2% from other races. In black patients, tumors presented more frequently with advanced stage and high grade. Medicaid patients tended to be younger and had more advanced-stage, higher-grade tumors compared to patients with Medicare or managed care (P < .0001). Kaplan-Meier analysis demonstrated significantly poorer 5-year DSS in black, low SES, and Medicaid patients (P < .0001). When controlling for stage, grade, age, and gender, multivariate analysis revealed that black race (DSS hazard ratio = 1.295; 95% confidence interval, 1.212-1.384), low SES (DSS hazard ratio = 1.325; 95% confidence interval, 1.259-1.395), and Medicaid insurance (DSS hazard ratio = 1.349; 95% confidence interval, 1.246-1.460) were independent prognostic factors (P < .0001). CONCLUSION An analysis of the CCR demonstrated that black race, low SES, and Medicaid insurance portend poorer DSS. These findings reflect a multifaceted socioeconomic and public health conundrum, and efforts to reduce inequalities should be pursued.
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Affiliation(s)
- John M Sung
- Department of Urology, University of California, Irvine, CA.
| | | | | | | | | | - Melissa Huang
- Department of Urology, University of California, Irvine, CA
| | - Nobel Nguyen
- Department of Urology, University of California, Irvine, CA
| | - Jenny Chang
- Department of Epidemiology, University of California, Irvine, CA
| | - Argyrios Ziogas
- Department of Epidemiology, University of California, Irvine, CA
| | | | - Ramy F Youssef
- Department of Urology, University of California, Irvine, CA
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Farber NJ, Faiena I, Dombrovskiy V, Tabakin AL, Shinder B, Patel R, Elsamra SE, Jang TL, Singer EA, Weiss RE. Disparities in the Use of Continent Urinary Diversions after Radical Cystectomy for Bladder Cancer. Bladder Cancer 2018; 4:113-120. [PMID: 29430511 PMCID: PMC5798533 DOI: 10.3233/blc-170162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Radical cystectomy (RC) with ileal conduit (IC) or continent diversion (CD) is standard treatment for high-risk non-invasive and muscle-invasive bladder cancer. Objective: Our aim is to study contemporary trends in the utilization of ICs and CDs in patients undergoing RC. Methods: Using the National Inpatient Sample 2001–2012, we identified all patients diagnosed with a malignant bladder neoplasm who underwent RC followed by IC or CD. Patient demographics, comorbidities, length of stay (LOS), and in-hospital complications, mortality, and costs were compared. Multivariable logistic regression analysis, Chi square, and t-tests were used for analysis. Results: Between 2001–2012, approximately 69,049 ICs and 6,991 CDs were performed. CDs increased from 2001 to 2008, but declined after 2008 (p < 0.0001). Patients of all ages received ICs at a higher rate than CDs (40–59 years: 79.5% vs. 20.5%; 60–69 years: 88.0% vs. 12.0%; p < 0.0001). There was a difference in males vs. females (10.2% vs. 4.0%; OR 2.36) and Caucasians vs. African Americans (9.0% vs. 6.7%; OR 1.49) when comparing CD rates. CD rates were highest in the West, urban teaching centers, and large hospitals (p < 0.001). ICs were associated with higher rates of overall postoperative complications (p = 0.0185) including infection (p = 0.002) and mortality (p < 0.0001). In-hospital costs were greater for the CD group. Conclusions: The number of CDs has declined recently. Patients of all ages are more likely to receive ICs than CDs. Gender, racial, and geographic disparities exist among those receiving CDs. CDs are associated with lower rates of in-hospital complications and mortality, but higher in-hospital costs.
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Affiliation(s)
- Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Izak Faiena
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Viktor Dombrovskiy
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Alexandra L Tabakin
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brian Shinder
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Rutveej Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sammy E Elsamra
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Robert E Weiss
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Neuzillet Y, Rouprêt M. [Quality of life of patients carrying an urinary diversion]. Prog Urol 2017; 27:845-850. [PMID: 28684066 DOI: 10.1016/j.purol.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A urinary diversion is more often needed in the context of total cystectomy for bladder cancer. This pathology and this surgical resection alter the quality of life of patients. This article reviews the consequences of urinary diversions on patients' quality of life and ways to minimize them. MATERIAL AND METHOD A systematic review of the literature search was performed from the databases Medline (NLM, Pubmed) and Embase, focused on the following keywords: "cystectomy"; "urinary diversion"; "quality of life"; "stoma"; "education". Publications obtained were selected based on methodology, language, date of publication (last 30 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 218 articles. After reading titles and abstracts, 30 were included in the text, based on their relevance. RESULTS The informed choice of the urinary diversion contributes to its acceptance by the patient and to improve the urinary-related quality of life. The selection criteria must be analyzed and presented to the patient in a multidisciplinary way, involving surgeon, physician, nurse, physiotherapist and stomaterapist. By means of the care networks, the choice of the patient should not be limited by the experience of the surgical and paramedical team. There is no clear evidence about the superiority of a derivation over others regarding the quality of life of patients. CONCLUSION The quality of life of patients carrying an urinary diversion depends less on the type of diversion than on whether the diversion is chosen by the patient himself. Patient information by all stakeholders involved in its communication is therefore essential.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - M Rouprêt
- Service d'urologie, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 75013 Paris, France
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