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Afferi L, Zamboni S, Karnes RJ, Roghmann F, Sargos P, Montorsi F, Briganti A, Gallina A, Mattei A, Schulz GB, Hendricksen K, Voskuilen CS, Rink M, Poyet C, De Cobelli O, di Trapani E, Simeone C, Soligo M, Simone G, Tuderti G, Alvarez-Maestro M, Martínez-Piñeiro L, Aziz A, Shariat SF, Abufaraj M, Xylinas E, Moschini M. The impact of treatment modality on survival in patients with clinical node-positive bladder cancer: results from a multicenter collaboration. World J Urol 2020; 39:443-451. [PMID: 32356226 DOI: 10.1007/s00345-020-03205-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/08/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the impact of perioperative chemotherapy on survival in cN+ BCa patients and analyze it according to the pN status. METHODS A retrospective analysis was conducted on 639 BCa patients with cTanyN1-3M0 BCa treated with radical cystectomy (RC) and bilateral lymph node dissection (LND) with or without perioperative chemotherapy in ten tertiary referral centers from 1990 to 2017. Selected cN+ patients received induction chemotherapy (IC), whereas adjuvant chemotherapy (ACT) was delivered to selected pN+ patients. Univariable and multivariable Cox regression analyses were used to predict overall mortality (OM) after surgery, adjusting for clinicopathological confounders. Kaplan-Meier analyses assessed OM according to the treatment modality. RESULTS Overall, 356 (56%) patients were treated with surgery alone, 155 (24%) with IC followed by surgery, and 128 (20%) with ACT following surgery. Over a median follow-up of 25 months, 316 deaths were recorded. At univariable analysis, patients treated with IC and surgery had lower OM both considering cN+ [hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.49-0.87, p = 0.004] and cN+pN- patients (HR 0.61, 95% CI 0.37-0.99, p = 0.05) compared to those treated with surgery alone. cN+pN+ patients treated with ACT experienced lower OM compared to those treated with IC or surgery alone at multivariable analysis (HR 0.40, 95% CI 0.22-0.74, p = 0.003). CONCLUSION Patients with cTany cN+ cM0 BCa benefit more in terms of OS when treated with IC followed by RC + LND compared to RC + LND alone, regardless of LNMs at final histopathology examination. More data are needed to assess the role of ACT in the management of cN+ patients.
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Affiliation(s)
- Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefania Zamboni
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Florian Roghmann
- Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany
| | - Paul Sargos
- Department of Radiation Oncology, Jewish General Hospital, McGill University Health Centre, Montreal, Canada
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Gerald Bastian Schulz
- Urologische Klinik Und Poliklinik, Klinikum Der Universität München, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Charlotte S Voskuilen
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cedric Poyet
- Department of Urology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | | | | | - Claudio Simeone
- Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | | | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Mario Alvarez-Maestro
- Department of Urology, La Paz University Hospital, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Luis Martínez-Piñeiro
- Department of Urology, La Paz University Hospital, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Atiqullah Aziz
- Department of Urology, München Klinik Bogenhausen, Munich, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
- The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Marco Moschini
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland.
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60, 20132, Milan, Italy.
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Schulz GB, Grimm T, Buchner A, Jokisch F, Kretschmer A, Stief CG, Knüchel R, Kraywinkel K, Karl A. Bladder Cancer Stage Development, 2004-2014 in Europe Compared With the United States: Analysis of European Population-based Cancer Registries, the United States SEER Database, and a Large Tertiary Institutional Cohort. Clin Genitourin Cancer 2019; 18:162-170.e4. [PMID: 31956010 DOI: 10.1016/j.clgc.2019.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/23/2019] [Accepted: 10/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to analyze trends of bladder cancer (BC) stages and incidence in Europe and the United States (US). MATERIALS AND METHODS Tumor stages after radical cystectomy were assessed in a monocentric cohort from 2006 to 2016. BC incidence was assessed between 2004 and 2014 based on the German Center for Cancer Registry Data dataset at the Robert Koch Institute (n = 111,002), the Netherland Cancer Registry (n = 64,226), cancer registration statistics of England (n = 179,883), and the pooled data from the Scandinavian cancer registries, NORDCAN (n = 77,585) and the SEER (Surveillance, Epidemiology, and End Results) database (n = 184,519) for the complete populations and gender-specific subgroups. The average annual percent changes (AAPC) were used for statistical evaluation. RESULTS Non-muscle-invasive BC (NMIBC) and muscle-invasive BC (MIBC) did not change in the institutional cohort at the point of radical cystectomy. The incidence of total BC (AAPC, -0.3), NMIBC (AAPC, -0.1), and non-metastasized MIBC (AAPC, 0.1) did not change in Germany during the time period under survey. BC total incidence in the Netherlands did not change significantly. In England and the Nordic countries, the incidence of total BC increased (AAPC, 0.8 and 0.5, respectively). In contrast, both the incidence of total BC (AAPC, -1.4), NMIBC (AAPC, -1.6), and non-metastasized MIBC (AAPC, -1.6) significantly decreased in the US. CONCLUSIONS Between 2004 and 2014 the incidence of BC was significantly sinking in the US, was stable in Germany and the Netherlands, and increased in England and the Nordic countries. Predominantly, differences in the smoking prevalence within the last decades but also gender-specific factors might be responsible for this discrepancy.
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Affiliation(s)
- Gerald B Schulz
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Alexander Buchner
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Christian G Stief
- Department of Urology, Ludwig-Maximilians-University, Munich, Germany
| | - Ruth Knüchel
- Department of Pathology, University Hospital RWTH Aachen, Germany
| | - Klaus Kraywinkel
- German Center for Cancer Registry Data (ZfKD), Robert Koch Institute, Berlin, Germany
| | - Alexander Karl
- Department of Urology, Barmherzige Brüder, Munich, Germany
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Pure but Not Mixed Histologic Variants Are Associated With Poor Survival at Radical Cystectomy in Bladder Cancer Patients. Clin Genitourin Cancer 2016; 15:e603-e607. [PMID: 28040422 DOI: 10.1016/j.clgc.2016.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/28/2016] [Accepted: 12/03/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the impact of pure and mixed histologic variant versus pure urothelial carcinoma in nonmetastatic bladder cancer (BCa) patients treated with radical cystectomy (RC). PATIENTS AND METHODS We evaluated data from 1067 patients treated with RC and pelvic lymph node dissection between 1990 and 2013 at a single institution tertiary-care referral center. All specimens were evaluated by dedicated uropathologists. Univariable and multivariable Cox regression analyses tested the impact of the presence of pure and mixed histologic variants versus pure urothelial on recurrence, cancer-specific mortality, and overall mortality after accounting for all available confounders. RESULTS In total, 201 (19%) and 137 (13%) patients were found with mixed and pure variants at RC, respectively. Mixed preponderant variants were sarcomatoid, lymphoepitelial, squamous, and glandular; small-cell and micropapillary variants were found mostly as pure variants. With a median follow-up of 6.5 years, patients who harbored pure variant were found by multivariable analyses to have lower survival outcomes compared to pure urothelial carcinoma (all P < .01). Conversely, no differences were found between mixed variant versus pure urothelial by multivariable Cox regression analyses predicting recurrence, cancer-specific mortality, and overall mortality (all P > .1). CONCLUSION The presence of histologic variants at RC is a common finding, accounting for approximately 30% of specimens. In this setting, the presence of a pure variant but not the presence of mixed variant with urothelial carcinoma is related to a detrimental effect on survival outcomes after RC.
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