|
1
|
Tripathi N, Gebrael G, Chigarira B, Sahu KK, Balasubramanian I, Caparas C, Mathew Thomas V, Cohan JN, Pelletier K, Maughan BL, Agarwal N, Swami U, Gupta S. Treatment Patterns and Outcomes by Age in Metastatic Urinary Tract Cancer: A Retrospective Tertiary Cancer Center Analysis. Cancers (Basel) 2024; 16:2143. [PMID: 38893262 PMCID: PMC11172373 DOI: 10.3390/cancers16112143] [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: 04/07/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Metastatic urinary tract cancer (mUTC) is challenging to treat in older adults due to comorbidities. We compared the clinical courses of younger and older (≥70 years) adults with mUTC receiving first-line (1L) systemic therapy in a tertiary cancer center. Baseline clinical characteristics, treatments received, tolerability, and survival outcomes were analyzed. Among 212 patients (103 older vs. 109 younger), the older patients had lower hemoglobin at baseline (84% vs. 71%, p = 0.03), the majority were cisplatin-ineligible (74% vs. 45%, p < 0.001), received more immunotherapy-based treatments in the 1L (52% vs. 36%, p = 0.01), received fewer subsequent lines of treatment (median 0 vs. 1, p = 0.003), and had lower clinical trial participation (30% vs. 18%, p = 0.05) compared to the younger patients. When treated with 1L chemotherapy, older patients required more dose adjustments (53.4% vs. 23%, p = 0.001) and received fewer cycles of chemotherapy (median 4 vs. 5, p= 0.01). Older patients had similar OS (11.2 months vs. 14 months, p = 0.06) and similar rates of treatment-related severe toxicity and healthcare visits, independent of the type of systemic treatment received, compared to younger patients. We conclude that select older adults with mUTC can be safely treated with immunotherapy and risk-adjusted regimens of chemotherapy with tangible survival benefits.
Collapse
Affiliation(s)
- Nishita Tripathi
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA
| | - Georges Gebrael
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Beverly Chigarira
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kamal Kant Sahu
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Ishwarya Balasubramanian
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Constance Caparas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Vinay Mathew Thomas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Jessica N. Cohan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Kaitlyn Pelletier
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Benjamin L. Maughan
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Neeraj Agarwal
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Umang Swami
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
| | - Sumati Gupta
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84112, USA; (N.T.); (G.G.); (B.C.); (K.K.S.); (I.B.); (C.C.); (V.M.T.); (J.N.C.); (K.P.); (B.L.M.); (N.A.); (U.S.)
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA
| |
Collapse
|
|
2
|
Pyrgidis N, Volz Y, Ebner B, Kazmierczak PM, Enzinger B, Hermans J, Buchner A, Stief C, Schulz GB. The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data. World J Urol 2024; 42:19. [PMID: 38197902 PMCID: PMC10781819 DOI: 10.1007/s00345-023-04742-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: 08/22/2023] [Accepted: 10/21/2023] [Indexed: 01/11/2024] Open
Abstract
OBJECTIVES To determine a data-based optimal annual radical cystectomy (RC) hospital volume threshold and evaluate its clinical significance regarding perioperative mortality, complications, length of hospital stay, and hospital revenues. MATERIAL AND METHODS We used the German Nationwide inpatient Data, provided by the Research Data Center of the Federal Bureau of Statistics (2005-2020). 95,841 patients undergoing RC were included. Based on ROC analyses, the optimal RC threshold to reduce mortality, ileus, sepsis, transfusion, hospital stay, and costs is 54, 50, 44, 44, 71 and 76 cases/year, respectively. Therefore, we defined an optimal annual hospital threshold of 50 RCs/year, and we also used the threshold of 20 RCs/year proposed by the EAU guidelines to perform multiple patient-level analyses. RESULTS 28,291 (29.5%) patients were operated in low- (< 20 RC/year), 49,616 (51.8%) in intermediate- (20-49 RC/year), and 17,934 (18.7%) in high-volume (≥ 50 RC/year) centers. After adjusting for major risk factors, high-volume centers were associated with lower inpatient mortality (OR 0.72, 95% CI 0.64-0.8, p < 0.001), shorter length of hospital stay (2.7 days, 95% CI 2.4-2.9, p < 0.001) and lower costs (457 Euros, 95% CI 207-707, p < 0.001) compared to low-volume centers. Patients operated in low-volume centers developed more perioperative complications such as transfusion, sepsis, and ileus. CONCLUSIONS Centralization of RC not only improves inpatient morbidity and mortality but also reduces hospital stay and costs. We propose a threshold of 50 RCs/year for optimal outcomes.
Collapse
Affiliation(s)
- Nikolaos Pyrgidis
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Yannic Volz
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Benedikt Ebner
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | | | - Benazir Enzinger
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Julian Hermans
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Christian Stief
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Gerald Bastian Schulz
- Department of Urology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| |
Collapse
|
|
3
|
Pyrgidis N, Sokolakis I, Haltmair G, Hatzichristodoulou G. The perioperative and long-term outcomes of patients with variant histology bladder cancer undergoing radical cystectomy: A propensity score-matched analysis with pure urothelial carcinoma. Actas Urol Esp 2023; 47:645-653. [PMID: 37355204 DOI: 10.1016/j.acuroe.2023.06.007] [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: 03/31/2023] [Accepted: 04/20/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES To assess the perioperative and long-term outcomes after open radical cystectomy in patients with histological variants versus pure urothelial carcinoma. METHODS Patients with a variant histology carcinoma of the urinary bladder were matched through a propensity score analysis with those with pure urothelial carcinoma on a 1:3 ratio. The two groups were compared in terms of perioperative and long-term morbidity and mortality. RESULTS Overall, 148 individuals were included in the present retrospective study (37 with variant histology and 111 with pure urothelial carcinoma). A total of 107 (72.3%) individuals presented at least one perioperative complication based on the Clavien-Dindo classification. This proportion was similar between patients with urothelial versus variant histology carcinoma (P = .22). In the long term, the number of patients with clinically significant incisional hernia requiring surgery [14 (12.7%) vs 3 (8.3%), P = .68], uretero-intestinal/uretero-cutaneous strictures or any other complication related to the applied urinary diversion [15 (13.6%) vs 7 (19.4%), P = .56], as well as the number of patients presenting with septicemia [17 (15.5%) vs 10 (27.8%), P = .16] or with urinary tract obstruction [12 (10.9%) vs 4 (11.1%), P > .99] at follow-up did not differ between urothelial versus variant histology carcinoma. The survival analysis with Kaplan-Meier curves and the univariate Cox regression model suggested that the risk of death from any cause was increased in patients with variant compared to pure urothelial histology (log-rank test = 0.045, hazard ratio: 1.7, 95% confidence interval: 1.01-2.87, P = .047). CONCLUSIONS Perioperative morbidity and mortality are comparable in patients with variant histology versus pure urothelial carcinoma.
Collapse
Affiliation(s)
- N Pyrgidis
- Servicio de Urología, Hospital 'Martha-Maria' de Núremberg, Núremberg, Alemania.
| | - I Sokolakis
- Servicio de Urología, Hospital 'Martha-Maria' de Núremberg, Núremberg, Alemania
| | - G Haltmair
- Servicio de Urología, Hospital 'Martha-Maria' de Núremberg, Núremberg, Alemania
| | | |
Collapse
|
|
4
|
Zhang W, Huang X, Lin B, Zheng W, Ke Z, Lin X, Chen J, Cai H, Lin Y, Chen Y, Zheng Q, Wei Y, Xue X, Li X, Xu N. The effect of body mass index on quality of life in modified single stoma cutaneous ureterostomy or ileal conduit after radical cystectomy. Cancer Med 2023; 12:20930-20939. [PMID: 37902236 PMCID: PMC10709730 DOI: 10.1002/cam4.6638] [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: 07/04/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To explore the influence of postoperative body mass index (BMI) change on postoperative quality of life (QOL) in patients undergoing radical cystectomy (RC) plus modified single stoma cutaneous ureterostomy (MSSCU) or ileal conduit (IC). METHODS Patients were divided into two groups according to different BMI change patterns: patients experiencing an elevated postoperative BMI level, along with a clinically significant increase in their BMI (an increase of more than 10%) were categorized as Group 1, while patients experiencing a decrease postoperative BMI level, along with a clinically significant reduction in their BMI (a decrease of more than 5%) were categorized as Group 2. Spearman correlation analysis was used to examine the correlations between quality-of-life scores and postoperative clinical parameters. RESULTS Spearman correlation analysis showed that postoperative BMI, late complications and catheter-free state were significantly associated with postoperative global QoL and symptom scale in MSSCU and postoperative global QoL and physical scale in IC patients. Additionally, postoperative BMI, catheter-free state and the use of adjuvant therapy were associated with bad performance in many scales of QoL like body image, future perspective, social scale, future perspective (MSSCU), and abdominal bloating (IC) (Table 2, p<0.05). Patients in Group 2 with significant weight loss had a better Global QoL, a lower rate of stomal stricture and a higher catheter-free state compared with those in Group 1 in both IC and MSSCU patients. MSSCU patients in Group 2 could achieve a comparable Global QoL as to IC patients in Group 1. CONCLUSION Controlling the substantial increase in body weight after surgery contributes to improving QoL, reducing the occurrence of stomal stricture, and ensuring a postoperative catheter-free state in BCa patients undergoing MSSCU.
Collapse
Affiliation(s)
- Wan‐Jin Zhang
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xu‐Yun Huang
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Bin Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Wen‐Cai Zheng
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Zhi‐Bin Ke
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xiao‐Dan Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Jia‐Yin Chen
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Hai Cai
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Yun‐Zhi Lin
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ye‐Hui Chen
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Qing‐Shui Zheng
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Yong Wei
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xue‐Yi Xue
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Xiao‐Dong Li
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| | - Ning Xu
- Department of Urology, Urology Research Institute, The First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Department of Urology, National Region Medical centre, Binhai Campus of the First Affiliated HospitalFujian Medical UniversityFuzhouChina
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated HospitalFujian Medical UniversityFuzhouChina
| |
Collapse
|