Cancer incidence estimation at a district level without a national registry: A validation study for 24 cancer sites using French health insurance and registry data

Multicenter external validation of the radical cystectomy pentafecta in a European cohort of patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion for bladder cancer

OBJECTIVE

To perform an external validation of this RC-pentafecta.

METHOD

Between January 2014 and December 2019, 104 consecutive patients who underwent RARC with ICUD within 6 urological centers were analyzed retrospectively. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), a lymph node (LN) yield ≥ 16, absence of major (Clavien-Dindo grade III-V) 90-day postoperative complications, absence of UD-related long-term sequelae, and absence of 12-month clinical recurrence were considered to have achieved RC-pentafecta. A multivariable logistic regression model was used to measure predictors for achieving RC-pentafecta. We analyzed the influence of this RC-pentafecta on survival, and the impact ofthe surgical experience.

RESULTS

Since 2014, 104 patients who had completed at least 12 months of follow-up were included. Over a mean follow-up of 18 months, a LN yield ≥ 16, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤ 12 months were observed in 56%, 96%, 85%, 81%, and 91% of patients, respectively, resulting in a RC-pentafecta rate of 39.4%. Multivariate analysis showed that age was an independent predictor of pentafecta achievement (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.90. 0.99; p = 0.04). The surgeon experience had an impact on the validation of the criteria.

CONCLUSION

This study confirmed that the RC-pentafecta is reproducible and could be externally used for the outcome assessment after RARC with ICUD. Therefore, the RC-pentafecta could be a useful tool to assess surgical success and its impact on different outcomes.

How to produce sound predictions of incidence at a district level using either health care or mortality data in the absence of a national registry: the example of cancer in France

BACKGROUND

In many countries, epidemiological surveillance of chronic diseases is monitored by local registries (LR) which do not necessarily cover the whole national territory. This gap has fostered interest in using non-registry databases (e.g., health care or mortality databases) available for the whole territory as proxies for incidence at the local level. However, direct counts from these databases do not provide reliable incidence measures. Accordingly, specific methods are needed to correct proxies and assess their epidemiological usefulness.

METHODS

This study's objective was to implement a three-stage turnkey methodology using national non-registry data to predict incidence in geographical areas without an LR as follows: constructing a calibration model to make predictions including accurate prediction intervals; accuracy assessment of predictions and rationale for the criteria to assess which predictions were epidemiologically useful; mapping after spatial smoothing of the latter predictions. The methodology was applied to a real-world setting, whereby we aimed to predict cancer incidence, by gender, at the district level in France over the 2007-15 period for 24 different cancer sites, using several health care indicators and mortality. In the present paper, the spatial smoothing performed on predicted incidence of epidemiological interest is illustrated for two examples.

RESULTS

Predicted incidence of epidemiological interest was possible for 27/34 solid site-gender combinations and for only 2/8 haematological malignancies-gender combinations. Mapping of smoothed predicted incidence provided a clear picture of the main contrasts in incidence between districts.

CONCLUSIONS

The methodology implemented provides a comprehensive framework to produce valuable predictions of incidence at a district level, using proxy measures and existing LR.

Multidimensional penalized splines for incidence and mortality-trend analyses and validation of national cancer-incidence estimates

BACKGROUND

Cancer-incidence and mortality-trend analyses require appropriate statistical modelling. In countries without a nationwide cancer registry, an additional issue is estimating national incidence from local-registry data. The objectives of this study were to (i) promote the use of multidimensional penalized splines (MPS) for trend analyses; (ii) estimate the national cancer-incidence trends, using MPS, from only local-registry data; and (iii) propose a validation process of these estimates.

METHODS

We used an MPS model of age and year for trend analyses in France over 1990-2015 with a projection up to 2018. Validation was performed for 22 cancer sites and relied essentially on comparison with reference estimates that used the incidence/health-care ratio over the period 2011-2015. Alternative estimates that used the incidence/mortality ratio were also used to validate the trends.

RESULTS

In the validation assessment, the relative differences of the incidence estimates (2011-2015) with the reference estimates were <5% except for testis cancer in men and < 7% except for larynx cancer in women. Trends could be correctly derived since 1990 despite incomplete histories in some registries. The proposed method was applied to estimate the incidence and mortality trends of female lung cancer and prostate cancer in France.

CONCLUSIONS

The validation process confirmed the validity of the national French estimates; it may be applied in other countries to help in choosing the most appropriate national estimation method according to country-specific contexts. MPS form a powerful statistical tool for trend analyses; they allow trends to vary smoothly with age and are suitable for modelling simple as well as complex trends thanks to penalization. Detailed trend analyses of lung and prostate cancers illustrated the suitability of MPS and the epidemiological interest of such analyses.

Management of the Uncommon Bladder Cancers: A Single-Center Experience over 10 Years

Background

Under the name of uncommon bladder cancers are gathered rare histological entities which represent less than 5% of bladder tumors. There is not a clear and consensual therapeutic management for these entities.

Purpose

To review a single-institution 10-year experience with rare form of bladder cancers detailing the diagnosis, treatment, and patient outcome.

Materials and Methods

We performed a retrospective review of 27 medical records of rare bladder cancer form treated at our center between February 2006 and February 2015. The clinicopathologic features are reported with emphasis on treatment and survival.

Results

Mean patient age was 65.5 ± 20 yr and 70% of patients were males. Smoking background was found in 16 cases, chronic bladder irritation factors were found in 12 cases, and past urinary tract infection was found in 11 cases. The main symptom was total hematuria (93%) causing an anemia in 16 cases. The two mean histological forms were epidermoid carcinoma (37%) and adenocarcinoma (22%). 26% of patients were found to have extended invasive tumors (T4) at diagnosis. Metastatic disease was confirmed in 8 cases. Our patients were managed by a wide range of therapeutic modalities as total cystectomy with bilateral lymph node dissection (63%), palliative chemotherapy (30%), or concomitant radiochemotherapy (7%). 55.6% of patients were alive one year after diagnosis. Epidermoid carcinoma has the best prognosis followed by leiomyosarcoma and sarcomatoid carcinoma. Neuroendocrine carcinoma has the worst outcome. The overall 5-year survival rate is 33.3%.

Conclusion

The rarity and small size of these tumors justify the absence of clear and consensual therapeutic management. No role of total cystectomy concerning the conclusions could be drawn but elements suggest this may be the treatment of choice. The highly aggressive nature of those lesions justifies an aggressive and fast therapy when feasible which gives the best outcomes.

[Squamous cell carcinoma of the bladder: a retrospective study conducted in a Moroccan University Hospital and literature review]

Le carcinome épidermoïde de la vessie est une variété rare de tumeurs vésicales qui représente moins de 5% des cancers de vessie. Son sex ratio est équilibré et la population noire semble préférentiellement atteinte. Sa présentation clinique est non spécifique et dominée par l´hématurie. La résection endoscopique de la vessie avec un examen anatomo-pathologique permet de poser le diagnostic. Le traitement du carcinome épidermoïde de la vessie reste sujet à de nombreuses controverses du fait de la rareté des cas rapportés dans la littérature. Cependant le traitement de choix semble être une cystectomie totale avec curage ganglionnaire étendu. Nous rapportons une série de 10 cas de carcinome épidermoïde qui ont été traités et suivis au sein de notre service. Notre analyse est basée sur l´évaluation des caractéristiques épidémiologiques, cliniques, anatomo-pathologiques, et thérapeutiques du carcinome épidermoïde de la vessie, ainsi que sur l´étude des aspects évolutifs et des facteurs pronostiques.

French ccAFU guidelines – Update 2018–2020: Bladder cancer

Objective

To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers.

Methods

A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence.

Results

Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS < 1) and renal function (creatinine clearance > 60 mL/min) allow it (only in 50 % of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival.

Conclusion

These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.

Risk of acute arterial events associated with treatment of inflammatory bowel diseases: nationwide French cohort study

OBJECTIVE

Patients with IBD are at increased risk of acute arterial events. Antitumour necrosis factor (TNF) agents and thiopurines may, via their anti-inflammatory properties, lower the risk of acute arterial events. The aim of this study was to assess the impact of thiopurines and anti-TNFs on the risk of acute arterial events in patients with IBD.

DESIGN

Patients aged 18 years or older and affiliated to the French national health insurance with a diagnosis of IBD were followed up from 1 April 2010 until 31 December 2014. The risks of acute arterial events (including ischaemic heart disease, cerebrovascular disease and peripheral artery disease) were compared between thiopurines and anti-TNFs exposed and unexposed patients with marginal structural Cox proportional hazard models adjusting for baseline and time-varying demographics, medications, traditional cardiovascular risk factors, comorbidities and IBD disease activity.

RESULTS

Among 177 827 patients with IBD (96 111 (54%) women, mean age at cohort entry 46.2 years (SD 16.3), 90 205 (50.7%) with Crohn's disease (CD)), 4145 incident acute arterial events occurred (incidence rates: 5.4 per 1000 person-years). Compared with unexposed patients, exposure to anti-TNFs (HR 0.79, 95% CI 0.66 to 0.95), but not to thiopurines (HR 0.93, 95% CI 0.82 to 1.05), was associated with a decreased risk of acute arterial events. The magnitude in risk reduction was highest in men with CD exposed to anti-TNFs (HR 0.54, 95% CI 0.40 to 0.72).

CONCLUSION

Exposure to anti-TNFs is associated with a decreased risk of acute arterial events in patients with IBD, particularly in men with CD.

Reasons for intravesical instillation postponement during adjuvant treatment of non-muscle-invasive bladder cancer: A prospective study

INTRODUCTION

Intravesical instillations for adjuvant treatment of non-muscle-invasive bladder cancer (NMIBC) may be postponed of necessity. However, the frequency and reasons for postponement are unclear.

MATERIALS

We carried out a prospective, epidemiological study in an Urology department of the Île-de-France, between August 2016 and March 2017, to determine the frequency and reasons for postponement of intravesical instillations during adjuvant treatment of NMIBC. One-hundred consecutive patients treated by intravesical instillations of mitomycin C (MMC) or Bacillus Calmette-Guérin (BCG) were included. At each session and in case of instillation postponement, the medical team completed a specially designed questionnaire.

RESULTS

A total of 541 instillations were performed in the 100 patients. Twenty-four instillations (4.4%) were postponed in 19 patients. The major cause of postponement was an untreated positive urine analysis and culture (UAC) in 13/24 (54%) cases. The causes of cancellation did not differ significantly between MMC and BCG. The most frequently cancelled instillations were the first in the therapeutic protocol in 26% of cases. The number of instillations preceding those cancelled did not differ significantly between MMC and BCG (2.1±2.0 instillations for MMC vs. 1.5±1.6 for BCG; P=0.64).

CONCLUSIONS

There was a low rate of postponed instillations (4.4%). The main reasons, namely an untreated UAC and a positive dipstick test, based on the jurisprudence, are not included in the latest CC-AFU guidelines.

LEVEL OF EVIDENCE

3.

[Immunotherapy and bladder cancer]

Immunotherapy as a treatment of solid malignancy is based on the activation of the immune system against tumor cells. Since 1976, intravesical instillation of Bacillus Calmette-Guérin (BCG) has been used widely for the treatment of non muscle invasive bladder cancer and is nowadays recommended by all scientific guidelines. New targeted systemic immunotherapies and particularly checkpoints inhibitors are now widely used in several different cancers and notably in onco-urology. Immune checkpoint molecule inhibitors have opened the possibility of treatments for cancers and there are already phase 2 and 3 trials running with or without BCG in localized, muscle invasive and metastatic bladder cancer.

RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la vessie French ccAFU guidelines — Update 2018—2020: Bladder cancer

This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations. Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006. C’est cette nouvelle version qui doit être utilisée pour citer l’article. This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published. The replacement has been published at the doi:10.1016/j.purol.2019.01.006. That newer version of the text should be used when citing the article.

Increased risk of acute arterial events in young patients and severely active IBD: a nationwide French cohort study

OBJECTIVE

Magnitude and independent drivers of the risk of acute arterial events in IBD are still unclear. We addressed this question in patients with IBD compared with the general population at a nationwide level.

DESIGN

Using the French National Hospital Discharge Database from 2008 to 2013, all patients aged 15 years or older and diagnosed with IBD were identified and followed up until 31 December 2013. The rates of incident acute arterial events were calculated and the impact of time with active disease (period around hospitalisation for IBD flare or IBD-related surgery) on the risk was assessed by Cox regression adjusted for traditional cardiovascular risk factors.

RESULTS

Among 210 162 individuals with IBD (Crohn's disease (CD), n=97 708; UC, n=112 454), 5554 incident acute arterial events were identified. Both patients with CD and UC had a statistically significant overall increased risk of acute arterial events (standardised incidence ratio (SIR) 1.35; 95% CI 1.30 to 1.41 and SIR 1.10; 95 CI 1.06 to 1.13, respectively). The highest risk was observed in patients under the age of 55 years, both in CD and UC. The 3-month periods before and after IBD-related hospitalisation were associated with an increased risk of acute arterial events in both CD and UC (HR 1.74; 95 CI 1.44 to 2.09 and 1.87; 95% CI 1.58 to 2.22, respectively).

CONCLUSION

Patients with IBD are at increased risk of acute arterial events, with the highest risk in young patients. Disease activity may also have an independent impact on the risk.

[Evolution of the number of incident cases of prostate cancer in France from 2001 to 2012 from 5 hospital centers]

OBJECTIVES

The main objective is the study of the evolution of the number of incident cases of prostate cancer in France from 2001 to 2012 from 5 hospital centers of urology. The secondary objective is to describe the characteristics of the incident cases and to compare them to those of the patients of the national registers of cancer for the period.

MATERIAL AND METHODS

Prospective observational multicentric study from 01/01/2001 to 31/12/2012 of databases in 5 French, public and private hospital centers of urology. The inclusive centers were selected outside departments with cancer register. The collected data were the prostatic biopsies performed in every center and the number of positive biopsies. The biopsies in cases of already known cancer and in re-evaluation were excluded. The data of age and stage (PSA and Gleason grade) were collected. The estimation of the incidence standardized in France is established after a period of observation of 3 years. The data updated in 2009 show a peak of incidence in 2005 then a decrease from 2006 (64,518 cases) until 2009 (53,465 cases). The median age in the diagnosis was of 70 years in 2005.

RESULTS

Overall, 18,392 prostatic biopsies were included in the analysis. The average rate of positive biopsies was stable over the period 51.41% (IQR 0,02). The total number of cases of positive biopsies increased from 2001 to 2007 (482 cases in 1028 cases) in 2007, then decreased from 2008 to 2012 (649 cases). There was no difference in this variation between the centers. The median age in the diagnosis was of 70 years (EIQ=1.5) in 2001 and 68 years (EIQ=2.75) in 2012. PSA at diagnosis was<10ng/mL in 65% of cases and 10 to 20ng/mL in 22% of cases in 2012. The population of patients of the study differed significantly from that of FRANCIM on the distribution by age ranges (year 2005, P<0.0001 and year 2009, P<0.001), which explains the gap of one year (on 2007 instead of 2006) of the peak of incidental cases.

CONCLUSION

The evolution of the number of incidental cases of prostate cancer in France from 2001 to 2012 from hospital data of 5 centers are similar to those of the network of registers representative of the French population. This observed evolution represents data available for cancer registers to estimate incidence variation between 2 publications.

LEVEL OF EVIDENCE

4.