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Savin Z, Levin L, Lazarovich A, Rosenzweig B, Shashar R, Hoffman A, Gal J, Haifler M, Pilosov I, Freifeld Y, Shpitzer SA, Golan S, Mano R, Yossepowitch O. Evaluating the Survival Benefits of Perioperative Chemotherapy in Frail and Morbid Muscle-Invasive Bladder Cancer Patients. J Pers Med 2024; 14:954. [PMID: 39338209 PMCID: PMC11433015 DOI: 10.3390/jpm14090954] [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: 08/09/2024] [Revised: 08/27/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Current guidelines endorse the use of perioperative chemotherapy (POC) in muscle-invasive bladder cancer (MIBC) to enhance the long-term overall survival (OS) compared to radical cystectomy (RC) alone. This study aims to assess the impact of POC on the OS in frail and morbid (F-M) patients undergoing RC. METHODS A retrospective multicenter study of 291 patients who underwent RC between 2015 and 2019 was performed. Patients with both a Charlson comorbidity index ≥ 4 and Modified Frailty Index ≥ 2 were classified as the F-M cohort. We compared the clinical and pathological characteristics and outcomes of the F-M patients who received POC to those who underwent RC alone. Univariable and multivariable analyses were performed to identify the predictors of the OS. RESULTS The F-M cohort included 102 patients. POC was administered to 44% of these patients: neoadjuvant (NAC) to 31%, adjuvant (AC) to 19%, and both to 6 (6%). The OS was significantly lower in the F-M cohort compared to in the healthier patients (median OS 42 months, p = 0.02). The F-M patients who received POC were younger, less morbid and had better renal function. Although POC was marginally associated with improved OS in the univariable analysis (p = 0.06), this was not significant in the multivariable analysis (p = 0.50). NAC was associated with improved OS in the univariable analysis (p = 0.004) but not after adjustment for competing factors (p = 1.00). AC was not associated with the OS. CONCLUSIONS POC does not improve the OS in F-M patients undergoing RC. Personalized treatment strategies and further prospective studies are needed to optimize care in this unique vulnerable population.
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Affiliation(s)
- Ziv Savin
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
| | - Lin Levin
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel;
| | - Alon Lazarovich
- Department of Urology, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan 5266202, Israel (B.R.)
| | - Barak Rosenzweig
- Department of Urology, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan 5266202, Israel (B.R.)
- Israeli Urologic Oncology Collaboration (IUOC); (Y.F.); (S.G.)
| | - Reut Shashar
- Department of Urology, Rambam Health Center, Technion Israel Institute of Technology, Haifa 3109601, Israel
| | - Azik Hoffman
- Israeli Urologic Oncology Collaboration (IUOC); (Y.F.); (S.G.)
- Department of Urology, Rambam Health Center, Technion Israel Institute of Technology, Haifa 3109601, Israel
| | - Jonathan Gal
- Department of Urology, Shamir Medical Center, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Miki Haifler
- Israeli Urologic Oncology Collaboration (IUOC); (Y.F.); (S.G.)
- Department of Urology, Meir Medical Center, Tel-Aviv University, Kfar-Saba 4428164, Israel
| | - Ilona Pilosov
- Department of Urology, Carmel Medical Center, Technion Israel Institute of Technology, Haifa 3436212, Israel
| | - Yuval Freifeld
- Israeli Urologic Oncology Collaboration (IUOC); (Y.F.); (S.G.)
- Department of Urology, Carmel Medical Center, Technion Israel Institute of Technology, Haifa 3436212, Israel
| | - Sagi Arieh Shpitzer
- Department of Urology, Rabin Medical Center, Tel-Aviv University, Petach-Tikva 4941492, Israel
| | - Shay Golan
- Israeli Urologic Oncology Collaboration (IUOC); (Y.F.); (S.G.)
- Department of Urology, Rabin Medical Center, Tel-Aviv University, Petach-Tikva 4941492, Israel
| | - Roy Mano
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
- Israeli Urologic Oncology Collaboration (IUOC); (Y.F.); (S.G.)
| | - Ofer Yossepowitch
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv 6423906, Israel
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Magnuson A, Loh KP, Stauffer F, Dale W, Gilmore N, Kadambi S, Klepin HD, Kyi K, Lowenstein LM, Phillips T, Ramsdale E, Schiaffino MK, Simmons JF, Williams GR, Zittel J, Mohile S. Geriatric assessment for the practicing clinician: The why, what, and how. CA Cancer J Clin 2024. [PMID: 39207229 DOI: 10.3322/caac.21864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/25/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Older adults with cancer heterogeneously experience health care, treatment, and symptoms. Geriatric assessment (GA) offers a comprehensive evaluation of an older individual's health status and can predict cancer-related outcomes in individuals with solid tumors and those with hematologic malignancies. In the last decade, randomized controlled trials have demonstrated the benefits of GA and GA management (GAM), which uses GA information to provide tailored intervention strategies to address GA impairments (e.g., implementing physical therapy for impaired physical function). Multiple phase 3 clinical trials in older adults with solid tumors and hematologic malignancies have demonstrated that GAM improves treatment completion, quality of life, communication, and advance care planning while reducing treatment-related toxicity, falls, and polypharmacy. Nonetheless, implementation and uptake of GAM remain challenging. Various strategies have been proposed, including the use of GA screening tools, to identify patients most likely to benefit from GAM, the systematic engagement of the oncology workforce in the delivery of GAM, and the integration of technologies like telemedicine and mobile health to enhance the availability of GA and GAM interventions. Health inequities in minoritized groups persist, and systematic GA implementation has the potential to capture social determinants of health that are relevant to equitable care. Caregivers play an important role in cancer care and experience burden themselves. GA can guide dyadic supportive care interventions, ultimately helping both patients and caregivers achieve optimal health.
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Affiliation(s)
- Allison Magnuson
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Fiona Stauffer
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - William Dale
- Department of Supportive Care, City of Hope, Antelope Valley, Duarte, California, USA
| | - Nikesha Gilmore
- Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Sindhuja Kadambi
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Heidi D Klepin
- Section on Hematology and Oncology, Department of Medicine, Wake Forest School of Medicine, Wake Forest, North Carolina, USA
| | - Kaitlin Kyi
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Lisa M Lowenstein
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics, City of Hope, Antelope Valley, Duarte, California, USA
| | - Erika Ramsdale
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Melody K Schiaffino
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
| | - John F Simmons
- Cancer and Aging Research Group SCOREboard, City of Hope, Duarte, California, USA
| | - Grant R Williams
- Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jason Zittel
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Supriya Mohile
- Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
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Tanaka S, Kitano G, Kato M, Ogura Y, Kojima T. Complete retroperitoneal cutaneous ureterostomy with robot-assisted radical cystectomy. IJU Case Rep 2024; 7:250-254. [PMID: 38686063 PMCID: PMC11056249 DOI: 10.1002/iju5.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/20/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Cutaneous ureterostomy is beneficial for older patients in a hypoalimentation state, providing less invasive options than intestinal tract reconstruction techniques. However, complications such as ileus and stoma site hernia still pose risks owing to the anatomical location of the ureter. We introduce a novel method, complete retroperitoneal cutaneous ureterostomy, performed simultaneously with robot-assisted radical cystectomy. Case presentation Our technique involves extending the retroperitoneal space to minimize complications and achieve stent-free outcomes. The median procedure time for complete retroperitoneal cutaneous ureterostomy was approximately 30 min. The stent-free rates at 1 and 4 months postoperatively were 66.7% and 100%, respectively; no case of stent reinsertion after stent removal was reported. Conclusion Our approach is promising for avoiding postoperative intestinal tract complications.
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Affiliation(s)
| | - Goshi Kitano
- Department of UrologyAichi Cancer CenterNagoyaJapan
| | - Manabu Kato
- Department of UrologyAichi Cancer CenterNagoyaJapan
| | - Yuji Ogura
- Department of UrologyKuwana City Medical CenterKuwanaJapan
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Vitug C, Lajkosz K, Chavarriaga J, Llano A, Din S, Villegas E, Kuk C, Chan A, Gao B, Hemminki O, Kot D, Misurka J, van der Kwast TH, Wallis C, Jewett MAS, Soloway MS, Fleshner NE, Kulkarni GS, Zlotta AR. Long-term outcomes and cost savings of office fulguration of papillary Ta low-grade bladder cancer. BJU Int 2024; 133:289-296. [PMID: 38105525 DOI: 10.1111/bju.16269] [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] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To assess whether office-based fulguration (OF) under local anaesthesia for small, recurrent, pathological Ta low-grade (LG) non-muscle-invasive bladder cancer (NMIBC) is an effective alternative to transurethral resection of bladder tumour (TURBT), avoiding the costs and risks of procedure, and anesthesia. PATIENTS AND METHODS Of 521 patients with primary TaLG NMIBC, this retrospective study included 270 patients who underwent OF during follow-up for recurrent, small, papillary LG-appearing tumours at a university centre (University Health Network, University of Toronto, Canada). We assessed the cumulative incidence of cancer-specific mortality (CSM) and disease progression (to MIBC or metastases), as well as possible direct cost savings. RESULTS In the 270 patients with recurrent TaLG NMIBC treated with OF, the mean (sd) age was 64.9 (13.3) years, 70.8% were men, and 60.3% had single tumours. The mean (sd, range) number of OF procedures per patient was 3.1 (3.2, 1-22). The median (interquartile range) follow-up was 10.1 (5.8-16.2) years. Patients also underwent a mean (sd) of 3.6 (3.0) TURBTs during follow-up in case of numerous or bulkier recurrence. In all, 44.4% of patients never received intravesical therapy. The 10-year incidence of CSM and progression were 0% and 3.1% (95% confidence interval 0.8-5.4%), respectively. Direct cost savings in Ontario were estimated at $6994.14 (Canadian dollars) per patient over the study follow-up. CONCLUSIONS This study supports that properly selected patients with recurrent, apparent TaLG NMIBC can be safely managed with OF under local anaesthesia with occasional TURBT for larger or numerous recurrent tumours, without compromising long-term oncological outcomes. This approach could generate substantial cost-saving to healthcare systems, is patient-friendly, and could be adopted more widely.
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Affiliation(s)
- Christian Vitug
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Julian Chavarriaga
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Andres Llano
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Shayan Din
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Eunice Villegas
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Cynthia Kuk
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Amy Chan
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Bruce Gao
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Otto Hemminki
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Dhiral Kot
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Misurka
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | | | - Christopher Wallis
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Michael A S Jewett
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Mark S Soloway
- Division of Urology, Memorial Physician Group, Memorial Healthcare System, Hollywood, FL, USA
| | - Neil E Fleshner
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Divisions of Urology and Surgical Oncology, Department of Surgery, University Health Network, Toronto, Ontario, Canada
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Wang W, Shen T, Wang J. Analysis of the impact of radiotherapy and surgical treatment regimens based on the SEER database on the survival outcomes of rectal cancer patients over 70 years. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2024; 21:4463-4484. [PMID: 38549336 DOI: 10.3934/mbe.2024197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
OBJECTIVE This study evaluates the impact of different combinations of treatment regimens, such as additional radiation, chemotherapy, and surgical treatments, on the survival of elderly rectal cancer patients ≥ 70 years of age to support physicians' clinical decision-making. METHODS Data from a sample of elderly rectal cancer patients aged ≥ 70 years diagnosed from 2005-2015 from the US surveillance, epidemiology, and end results (SEER) database were retrospectively analyzed. The best cut-off point was selected using the x-tile software for the three continuity indices: age, tumor size, and number of regional lymph nodes. All patients were categorized into either the neoadjuvant radiotherapy and surgery group (R_S group), the surgical treatment group (S group), or the surgery and adjuvant radiotherapy group (S_R group). The propensity score allocation was used to match each included study subject in a 1:1 ratio, and the restricted mean survival time method (RMST) was used to predict the mean survival of rectal cancer patients within 5 and 10 years. The prognostic risk factors for rectal cancer patients were determined using univariate and multivariate Cox regression analyses, and nomograms were constructed. A subgroup stratification analysis of patients with different treatment combination regimens was performed using the Kaplan-Meier method, and log-rank tests were used for between-group comparisons. The model's predictive accuracy was assessed by receiver operating characteristic (ROC) curves, correction curves, and a clinical decision curve analysis (DCA). RESULTS A total of 7556 cases of sample data from 2005 to 2015 were included, which were categorized into 6639 patients (87.86%) in the S group, 408 patients (5.4%) in the R_S group, and 509 patients (6.74%) in the S_R group, according to the relevant order of radiotherapy and surgery. After propensity score matching (PSM), the primary clinical characteristics of the groups were balanced and comparable. The difference in the mean survival time before and after PSM was not statistically significant in both R_S and S groups (P value > 0.05), and the difference in the mean survival time after PSM was statistically substantial in S_R and S groups (P value < 0.05). In the multifactorial Cox analysis, the M1 stage and Nodes ≥ 9 were independent risk factors. An age between 70-75 was an independent protective factor for patients with rectal cancer in the R_S and S groups. The Marital_status, T4 stage, N2 stage, M1 stage, and Nodes ≥ 9 were independent risk factors for patients with rectal cancer in the S_R and S groups, and an age between 70-81 was an independent protective factor. The ROC curve area, the model C index, and the survival calibration curve suggested good agreement between the actual and predicted values of the model. The DCA for 3-year, 5-year, and 10-year survival periods indicated that the model had some potential for application. CONCLUSIONS The results of the study showed no significant difference in the overall survival (OS) between elderly patients who received neoadjuvant radiotherapy and surgery and those who received surgery alone; elderly patients who received surgery and adjuvant radiotherapy had some survival benefits compared with those who received surgery alone, though the benefit of adjuvant radiotherapy was not significant. Therefore, radiotherapy for rectal cancer patients older than 70 years old should be based on individual differences in condition, and a precise treatment plan should be developed.
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Affiliation(s)
- Wei Wang
- The First Affiliated Hospital, Anhui University of Chinese Medicine, Hefei, China
| | - Tongping Shen
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
- Graduate School, Angeles University Foundation, Angeles, Philippines
| | - Jiaming Wang
- School of Information Engineering, Anhui University of Chinese Medicine, Hefei, China
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Silver JK, Flores LE. Integrating Prehabilitation into the Cancer Survivorship Framework. Eur Urol Focus 2024; 10:23-25. [PMID: 37996272 DOI: 10.1016/j.euf.2023.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
The aim of prehabilitation is to improve the physical and emotional health of patients before upcoming surgery or therapies. This mini-review focuses on current advances in urological prehabilitation and how it can be used together with enhanced recovery after surgery and conventional rehabilitation protocols. Urological prehabilitation has primarily focused on improving urinary continence, erectile function, bone density, and lean body mass, with some promising results for all of these outcomes. Although all cancer patients should be considered for prehabilitation, older or medically frail individuals may derive the greatest benefit. PATIENT SUMMARY: This mini-review discusses prehabilitation as part of the care for cancer patients. Although the research on prehabilitation is evolving, current studies generally demonstrate that it may help to enhance a patient's strength and endurance before upcoming surgery or other treatments.
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Affiliation(s)
- Julie K Silver
- Harvard Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA, USA.
| | - Laura E Flores
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Thoft Jensen B, Bjerggaard Jensen J. One-Year Follow-Up after Multimodal Prehabilitation Interventions in Radical Cystectomy. Cancers (Basel) 2023; 15:5785. [PMID: 38136331 PMCID: PMC10741904 DOI: 10.3390/cancers15245785] [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: 10/26/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Multimodal prehabilitation is the process of enhancing physiological, nutritional, and psychological resilience to increase patients' functional capacity before major cancer surgery and aims to empower the patient to withstand the pending stress of major surgery and ultimately to improve long-term outcomes. The effect of physical prehabilitation to counteract the physical decline in surgical cancer patients has been documented; however, long-term results have not yet been published. This follow-up study aims to evaluate 1-year results on the efficacy of physical prehabilitation after bladder cancer surgery. The efficacy of prehabilitation was measured over the course of 1 year in 107 patients randomized to (1) pre- and rehabilitation or (2) standard care divided by n = 50 in the intervention (I) and n = 57 in the standard group (S). Physical function was measured by muscle leg power, and nutritional status was expressed with handgrip strength. Prehabilitation in major bladder cancer surgery can significantly improve physical function with 19.8 Watt/kg (p = 0.04), lean body mass (p = 0.047) and body cell mass (p = 0.03), and regained nutritional status one year after surgery. The results demonstrate that the restoration of physical function is vital to a full recovery.
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Affiliation(s)
- Bente Thoft Jensen
- Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Public Health, Aarhus University, 8200 Aarhus, Denmark
| | - Jørgen Bjerggaard Jensen
- Department of Urology, Aarhus University Hospital, 8200 Aarhus, Denmark;
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
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Ademaj A, Puric E, Marder D, Timm O, Kern T, Hälg RA, Rogers S, Riesterer O. Radiotherapy combined with deep regional hyperthermia in elderly and frail patients with muscle-invasive bladder cancer: quality analysis of hyperthermia and impact on clinical results. Int J Hyperthermia 2023; 40:2275540. [PMID: 37932002 DOI: 10.1080/02656736.2023.2275540] [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: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 11/08/2023] Open
Abstract
Purpose: Radiotherapy (RT) in combination with deep regional hyperthermia (HT) after transurethral removal of bladder tumor (TURBT) can be offered to elderly and frail patients with muscle-invasive bladder cancer (MIBC).Methods: In total, 21 patients (mean age 84 years) with unifocal or multifocal MIBC received radiation to a dose of 48-50 Gy/16-20 fractions with weekly HT. The primary endpoint was the variation in temperature metrics, thermal dose expressed as cumulative equivalent minutes at 43 °C when the measured temperature is T90 (CEM43T90) and net power applied in target volume per each HT session. Secondary endpoints were three-year overall survival (OS), disease-free survival (DFS), local progression-free survival (LPFS) and toxicity.Results: The temperature metrics, CEM43T90, mean and maximum net power applied did not differ significantly among the HT sessions of the 21 patients. With a median follow-up of 65 months, 52% (95% CI 32-72%) of patients had died 3 years after treatment. The three-year DFS and LPFS rates were 62% (95%CI 41-79%) and 81% (95%CI 60-92%), respectively. The three-year bladder preservation rate was 100%. Three out of four patients with local failure received a thermal dose CEM43T90 below a median of 2.4 min. The rates of acute and late grade-3 toxicities were 10% and 14%, respectively.Conclusion: The reproducibility of HT parameters between sessions was high. A moderately high CEM43T90 (> 2.4 min) for each HT session seems to be preferable for local control. RT combined with HT is a promising organ-preservation therapy for elderly and frail MIBC patients.
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Affiliation(s)
- Adela Ademaj
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
- Doctoral Clinical Science Program, Medical Faculty, University of Zürich, Zürich, Switzerland
| | - Emsad Puric
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Dietmar Marder
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Olaf Timm
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Thomas Kern
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Roger A Hälg
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
- Institute of Physics, Science Faculty, University of Zürich, Zürich, Switzerland
| | - Susanne Rogers
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Centre for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
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Bouzan J, Willschrei P, Horstmann M. Additional Value of Mini-Cog© in Urogeriatric Patients Concurrently Screened by G8 Scores. MEDICINES (BASEL, SWITZERLAND) 2023; 10:56. [PMID: 37887263 PMCID: PMC10608063 DOI: 10.3390/medicines10100056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/09/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
Background: Cognitive impairment is poorly addressed in G8 screening. The aim of the present study was to evaluate the additional value of Mini-Cog© in urogeriatric patients concurrently screened by G8 scores. Methods: Seventy-four consecutive urogeriatric patients aged 75 and above were evaluated. All patients underwent G8 and Mini-Cog© screening. Patients with a G8 score above 14 were considered geriatric "healthy or fit". A Mini-Cog© from four to five points was considered inconspicuous in screening for cognitive impairment. The additional information of a Mini-Cog© screening during G8 screening was evaluated by looking at G8 "fit and healthy" patients who had conspicuous Mini-Cog© tests and vice versa. Additionally, the results of the neuropsychological subitem "E" of the G8 score were compared with the results of the Mini-Cog© screening. Results: The mean age of the patients was 83 y (min. 75-max. 102). Sixty-one of the patients were males, and 13 were females. Twenty-nine of the patients had a normal G8 score and were considered "healthy or fit", and 45 were not. Forty-three of the patients had an inconspicuous Mini-Cog©, and 31 had a conspicuous Mini-Cog© of less than four points. The majority of G8 "healthy or fit" patients (n = 24/29) had an inconspicuous Mini-Cog© test. However, of them, five patients had a Mini-Cog© of less than four points, which is suspicious for cognitive disorders. Furthermore, of the 43 patients with a normal G8 subscore in item "E" of two points, 6 patients had a conspicuous Mini-Cog© of less than four points. Conclusions: As shown by the present study, the Mini-Cog© might extend the G8 screening with regard to the detection of cognitive functional impairments that are not detected by the G8 screening alone. It can be easily added to G8 screening.
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Affiliation(s)
- Jobar Bouzan
- Department of Urology, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany;
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuersten Str. 69, 47829 Krefeld, Germany
| | - Peter Willschrei
- Department of Geriatrics, Evang. Hospital Essen-Steele, Am Deimelsberg 34, 45276 Essen, Germany
| | - Marcus Horstmann
- Department of Urology, University of Duisburg-Essen, Hufeland Str. 55, 45147 Essen, Germany;
- Department of Urology, Helios Hospital St. Josefshospital, Krefeld Uerdingen, Kurfuersten Str. 69, 47829 Krefeld, Germany
- Department of Urology, Klinikum Guetersloh, Reckenberger Str. 19, 33332 Gütersloh, Germany
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Okada M, Shindo T, Fujino K, Maeda T, Ito N, Takahashi A, Hotta H, Kunishima Y, Matsukawa M, Takayanagi A, Wanifuchi A, Nofuji S, Kato R, Fukuta F, Hashimoto K, Kobayashi K, Tanaka T, Masumori N. Prevention of local symptoms in muscle invasive bladder cancer patients: clinical significance of local radiation therapy. Support Care Cancer 2023; 31:607. [PMID: 37787829 DOI: 10.1007/s00520-023-08087-6] [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: 05/15/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To evaluate the significance of local radiation therapy (LRT) for prevention of local symptoms (LSs) caused by muscle-invasive bladder cancer (MIBC). METHODS We retrospectively reviewed the clinical records of 133 patients from 13 hospitals. MIBC patients with or without metastases who were treated with LRT alone from January 2015 through December 2020 were enrolled. Exclusion criteria were urinary diversion (UD) prior to LRT, non-MIBC, or lack of clinical information. LSs were defined as hematuria requiring invasive treatment or transfusion, UD after LRT, bladder tamponade, and opioid use for bladder pain. RESULTS One hundred fourteen patients were finally enrolled in the study. During the median follow-up period of 13.5 months, 30 patients (26.3%) had LSs. Risk factors of LSs in multivariate analysis were a prior history of non-MIBC (NMIBC) (hazard ratio [HR] 2.99; 95% confidence interval [CI], 1.36 to 6.56; P < 0.01), radiation dose of less than 50 Gray (Gy) (HR 3.99; 95% CI, 1.80 to 8.82; P < 0.01), and tumor stage 3 or more (HR 2.43; 95% CI, 1.14 to 5.21; P = 0.02). Risk factors of overall survival (OS) in multivariate analysis were being female (HR 3.32; 95% CI, 1.68 to 6.58; P < 0.01), an age-adjusted Charlson Comorbidity index of 6 or more (HR 2.19; 95% CI, 1.18 to 4.10; P = 0.01), distant metastases (HR 3.20; 95% CI, 1.39 to 6.58; P < 0.01), and tumor size of 40 mm or more (HR 2.38; 95% CI, 1.34 to 4.52; P < 0.01). Toxicity (all grades) occurred in 40.4% of the patients, 4.8% with grade 3 or more and 95.2% with lower grades. CONCLUSIONS We determined the risk factors for LSs in MIBC patients treated with LRT alone. An escalated-dose of 50 Gy or more may contribute to prevention of LSs caused by MIBC. Thus, dose-escalated LRT for MIBC patients who can expect favorable survival may be a good option to avoid future annoying LSs.
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Affiliation(s)
- Manabu Okada
- Department of Urology, Obihiro Kyokai Hospital, Obihiro, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan.
| | - Keiko Fujino
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Toshihiro Maeda
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Naoki Ito
- Department of Urology, NTT East Medical Center Sapporo, Sapporo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Hiroshi Hotta
- Department of Urology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | | | | | - Akio Takayanagi
- Department of Urology, Japan Community Health Care Organization Hokkaido Hospital, Sapporo, Japan
| | - Atsushi Wanifuchi
- Department of Urology, Japanese Red Cross Kushiro Hospital, Kushiro, Japan
| | - Seisuke Nofuji
- Department of Urology, Hokkaido Medical Center, Sapporo, Japan
| | - Ryuichi Kato
- Department of Urology, Muroran City General Hospital, Muroran, Japan
| | - Fumimasa Fukuta
- Department of Urology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Toshiaki Tanaka
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, S1W16, Chuo-Ku, Sapporo, 060-8543, Japan
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Ishii N, Hatakeyama S, Miura H, Tanaka R, Oishi T, Horiguchi H, Hosogoe S, Fujita N, Iwamura H, Okamoto T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. Trends in the age of hospitalized patients with urological cancers: A 17-year experience. Int J Urol 2023; 30:572-578. [PMID: 36941076 DOI: 10.1111/iju.15180] [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: 11/21/2022] [Accepted: 02/28/2023] [Indexed: 03/22/2023]
Abstract
OBJECTIVES To investigate the impact of global aging on the trends in the age of hospitalized patients with a urological cancer diagnosis. METHODS We retrospectively evaluated a cumulative total of 10 652 cases of referred patients (n = 6637) with a urological disease who were hospitalized in our institution between January 2005 and December 2021. We compared age and the proportion of patients aged ≥80 years among patients who were hospitalized in the urological ward between the period of 2005-2013 and that of 2014-2021. RESULTS We identified 8168 hospitalized patients with urological cancer. The median age was significantly increased in patients with urological cancer between the periods of 2005-2013 and 2014-2021. The proportion of hospitalized patients with urological cancer aged ≥80 years was significantly increased between the periods of 2005-2013 (9.3%) and 2014-2021 (13.8%). The median ages of the patients with urothelial cancer (UC) and renal cell carcinoma (RCC), but not the median age of those with prostate cancer (PC), were significantly increased between the study periods. The proportion of hospitalized patients with UC, but not the proportions of those with PC and RCC, aged ≥80 years was significantly increased between the study periods. CONCLUSIONS The age of patients with urological cancer who were hospitalized in the urological ward and the proportion of patients with UC aged ≥80 years significantly increased over the entire study period.
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Affiliation(s)
- Noritaka Ishii
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hikari Miura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Ryuma Tanaka
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Takuya Oishi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Shogo Hosogoe
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University School of Medicine, Hirosaki, Japan
- Department of Advanced Blood Purification Therapy, Hirosaki University School of Medicine, Hirosaki, Japan
- Department of Advanced Regenerative Medicine, Hirosaki University School of Medicine, Hirosaki, Japan
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12
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Lemiński A, Michalski W, Masojć B, Kaczmarek K, Małkiewicz B, Kienitz J, Zawisza-Lemińska B, Falco M, Słojewski M. Combined Modality Bladder-Sparing Therapy for Muscle-Invasive Bladder Cancer: How (Should) We Do It? A Narrative Review. J Clin Med 2023; 12:1560. [PMID: 36836093 PMCID: PMC9960746 DOI: 10.3390/jcm12041560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Organ-sparing combined-modality treatment for muscle-invasive bladder cancer remains underutilized despite high-quality evidence regarding its efficacy, safety, and preservation of quality of life. It may be offered to patients unwilling to undergo radical cystectomy, as well as those unfit for neoadjuvant chemotherapy and surgery. The treatment plan should be tailored to each patient's characteristics, with more intensive protocols offered to patients who are fit for surgery but opt for organ-sparing. After a thorough, debulking transurethral resection of the tumor and neoadjuvant chemotherapy, the response evaluation should trigger further management with either chemoradiation or early cystectomy in non-responders. A hypofractionated, continuous radiotherapy regimen of 55 Gy in 20 fractions with concurrent radiosensitizing chemotherapy with gemcitabine, cisplatin, or 5-fluorouracil and mitomycin C is currently preferred based on clinical trials. The response should be evaluated with repeated transurethral resections of the tumor bed and abdominopelvic-computed tomography after chemoradiation, with quarterly assessments during the first year. Salvage cystectomy should be offered to patients fit for surgery who failed to respond to treatment or developed a muscle-invasive recurrence. Non-muscle-invasive bladder recurrences and upper tract tumors should be treated in line with guidelines for respective primary tumors. Multiparametric magnetic resonance can be used for tumor staging and response monitoring, as it may distinguish disease recurrence from treatment-induced inflammation and fibrosis.
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Affiliation(s)
- Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Wojciech Michalski
- Department of Urological Cancer, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Roentgena 5, 02-781 Warsaw, Poland
| | - Bartłomiej Masojć
- Department of Radiotherapy, West-Pomeranian Oncology Center, 71-730 Szczecin, Poland
| | - Krystian Kaczmarek
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, Borowska 213, 50-556 Wrocław, Poland
| | - Jakub Kienitz
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | | | - Michał Falco
- Department of Radiotherapy, West-Pomeranian Oncology Center, 71-730 Szczecin, Poland
| | - Marcin Słojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland
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Kochergin M, Fahmy O, Esken L, Goetze T, Xylinas E, Stief CG, Gakis G. Systematic Review and Meta-Analysis on the Role of Perioperative Blood Transfusion in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma. Bladder Cancer 2022; 8:315-327. [PMID: 38993684 PMCID: PMC11181769 DOI: 10.3233/blc-201534] [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: 01/12/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radical cystectomy (RC) is the standard of care in patients with muscle-invasive bladder cancer. The impact of perioperative red blood cell (RBC) transfusion on oncological outcomes after RC is not clearly established as the existing publications show conflicting results. OBJECTIVES The aim of this systematic review and meta-analysis was to investigate the prognostic role of perioperative RBC transfusion on oncological outcomes after RC. METHODS Systematic online search on PubMed was conducted, based on PRISMA criteria for publications reporting on RBC transfusion during RC. Publications with the following criteria were included: (I) reported data on perioperative blood transfusion; (II) Reported Hazard ratio (HR) and 95% -confidence interval (CI) for the impact of transfusion on survival outcomes. Primary outcome was the impact of perioperative RBC transfusion on recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Risk of bias assessment was performed using Newcastle-Ottawa Scale. Statistical analysis was performed using Revman 5.4 software. RESULTS From 27 primarily identified publications, 19 eligible articles including 22897 patients were selected. Perioperative RBC transfusion showed no impact on RFS (Z = 1.34; p = 0,18) and significant negative impact on CSS (Z = 2.67; p = 0.008) and OS (Z = 3.22; p = 0.001). Intraoperative RBC transfusion showed no impact on RFS (Z = 0.58; p = 0.56) and CSS (Z = 1.06; p = 0.29) and OS (Z = 1.47; p = 0.14).Postoperative RBC transfusion showed non-significant trend towards improved RFS (Z = 1.89; p = 0.06) and no impact on CSS (Z = 1.56; p = 0.12) and OS (Z = 0.53 p = 0.60). CONCLUSION In this meta-analysis, we found perioperative blood transfusion to be a significant predictor only for worse CSS and OS but not for RFS. This effect may be determined by differences in tumor stages and patient comorbidities for which this meta-analysis cannot control due to lack of respective raw data.
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Affiliation(s)
- Maxim Kochergin
- Department of Urology and Neurourology, BG Unfallkrankenhaus Berlin, Berlin, Germany
| | - Omar Fahmy
- Department of Urology, Universiti Putra Malaysia (UPM), Selangor, Malaysia
| | - Lisa Esken
- Department of Urology and Pediatric Urology, Nordwest Hospital, Frankfurt am Main, Germany
| | - Thorsten Goetze
- Institute of Clinical Cancer Research, Nordwest Hospital, Frankfurt am Main, Germany
| | - Evanguelos Xylinas
- Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | - Christian G. Stief
- Department of Urology, University Hospital Ludwig-Maximilians-University, Munich, Germany
| | - Georgios Gakis
- Department of Urology, University Hospital Würzburg, Würzburg, Germany
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14
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Garrido Siles M, López-Beltran A, Pelechano P, García Vicente AM, Gironés Sarrió R, González-Haba Peña E, Rodríguez Antolín A, Zapatero A, Arranz JÁ, Climent MÁ. Advances in Transversal Topics Applicable to the Care of Bladder Cancer Patients in the Real-World Setting. Cancers (Basel) 2022; 14:3968. [PMID: 36010964 PMCID: PMC9406347 DOI: 10.3390/cancers14163968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
Recommendations regarding transversal topics applicable to bladder cancer patients independent of tumor grade and stage were established by members of the Spanish Oncology Genitourinary Multidisciplinary Working Group (SOGUG). Liquid biopsy in urine and blood samples is useful in the surveillance of non-muscle-invasive and muscle-invasive bladder cancer, respectively. Multiparametric MRI is an accurate, faster and non-invasive staging method overcoming the understaging risk of other procedures. The combination of FDG-PET/MRI could improve diagnostic reliability, but definite criteria for imaging interpretation are still unclear. Hospital oncology pharmacists as members of tumor committees improve the safety of drug use. Additionally, safety recommendations during BCG preparation should be strictly followed. The initial evaluation of patients with bladder cancer should include a multidimensional geriatric assessment. Orthotopic neobladder reconstruction should be offered to motivated patients with full information of self-care requirements. Bladder-sparing protocols, including chemoradiation therapy and immune checkpoints inhibitors (ICIs), should be implemented in centers with well-coordinated multidisciplinary teams and offered to selected patients. The optimal strategy of treatment with ICIs should be defined from the initial diagnostic phase with indications based on scientific evidence. Centralized protocols combined with the experience of professional groups are needed for the integral care of bladder cancer patients.
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Affiliation(s)
- Marga Garrido Siles
- Oncology Pharmacy Department, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | - Antonio López-Beltran
- Department of Morphology Sciences, University of Cordoba Medical School, 14004 Cordoba, Spain
| | - Paula Pelechano
- Radiodiagnosis Service, Fundación Instituto Valenciano de Oncología-IVO, 46009 Valencia, Spain
| | | | - Regina Gironés Sarrió
- Medical Oncology Service, Hospital Universitari i Politècnic la Fe, 46026 Valencia, Spain
| | | | | | - Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de la Princesa, Instituto Investigación Sanitaria IIS-IP, 28006 Madrid, Spain
| | - José Ángel Arranz
- Genitourinary and Gynecologic Section, Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
| | - Miguel Ángel Climent
- Medical Oncology Service, Fundación Instituto Valenciano de Oncología-IVO, 46009 Valencia, Spain
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Abstract
OBJECTIVE This article provides a map of key knowledge gaps regarding the evidence supporting prehabilitation and its integration with enhanced recovery after surgery (ERAS) programs. Filling this lack of knowledge with future research will further establish the effectiveness of prehabilitation. DATA SOURCES These are electronic databases including PubMed and CINAHL. CONCLUSION Future efforts must embrace the elderly frail or cognitively impaired patient with specific needs to further promote restoration of postoperative function throughout the surgical pathway. Prehabilitation should be coupled and integrated within the existent concept of the ERAS framework, to facilitate the continuous evolution of screening, assessment, and optimization of high-risk surgical patients who are at risk of not being restored to physical and psychological function after surgery, including independence. IMPLICATIONS FOR NURSING PRACTICE In the future, the ERAS nurse will be an essential figure of the prehabilitation program, proactively coordinating the assessment, optimization, and adjustment of perioperative comorbidity and guiding the rehabilitation process to improve patients' outcomes. These skills and characteristics will be required to provide optimal nursing care in the context of an integrated prehabilitation ERAS pathway.
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16
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Beardo P, Pinto R, Ayerra H, Agüera J, Armijos S, Álvarez-Ossorio JL. Optimizing treatment for non muscle-invasive bladder cancer with an app. Actas Urol Esp 2022; 46:230-237. [PMID: 35307306 DOI: 10.1016/j.acuroe.2021.12.010] [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: 09/28/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To evaluate overall and recurrence-progression rate-adjusted concordance of treatment prescription in non-muscle-invasive bladder cancer (NMIBC) of an app based on the best available scientific evidence and the urologist's opinion. METHODS Development of an app (APPv) specifically designed for the treatment and follow-up of NMIBC and validation of the proposed APPv treatment endpoint by means of a prospective double-blind observational concordance study of related samples in 100 patients with initial or successive histological diagnosis of NMIBC. RESULTS The treatment prescribed by the urologist agrees with that proposed by the APPv in 64% of cases (kappa index 0.55, P < 0.0001). Regarding low risk, the agreement is 77% (kappa 0.55, P = 0.002), 63% (kappa 0.52, P < 0.0001) for intermediate risk, 17% (kappa 0.143, P = 0.014) in high risk and 66% (kappa 0.71, P = 0.01) for very high risk. Of patients receiving adjuvant intravesical treatment according to APPv, 89.1% remain free of recurrence vs. 61.1% of those with disagreement (P = 0.0004), with a RR 0.46 (95%CI: 0.25-0.86) vs. RR 2.4 (95%CI: 1.5-3.8, P = 0.001). In the APPv-urologist agreement group, 100% of patients are free of progression and 88.9% in the disagreement group (P = 0.004) with a RR 1 vs. RR 1.125 (95%CI: 1-1.26, P = 0.004). CONCLUSIONS APPv can improve adherence to treatment recommendations according to clinical practice guidelines and health outcomes at NMIBC.
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Affiliation(s)
- P Beardo
- UGC Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - R Pinto
- Servicio de Urología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - H Ayerra
- Servicio de Urología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - J Agüera
- UGC Urología, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - S Armijos
- e-processmed, Vitoria-Gasteiz, Spain
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Xing W, Zeng S, Xu Z, Xing S, Liu Q. Comparison of Health-Related Quality of Life Between Ileal Conduit Diversion and Orthotopic Neobladder in Women: A Meta-Analysis. Front Oncol 2022; 12:862884. [PMID: 35419290 PMCID: PMC8996170 DOI: 10.3389/fonc.2022.862884] [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] [Received: 01/26/2022] [Accepted: 02/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background Orthotopic neobladder (ONB) reconstruction and ileal conduit diversion (ICD) can have different impacts on health-related quality of life (HRQOL) in patients with bladder cancer. Purpose To conduct a meta-analysis to explore the comparison of HRQOL between ICD and ONB in women. Methods PubMed, Embase, and the Cochrane Library were searched for available papers published from inception up to December 2020. The outcomes were the score data from HRQOL questionnaires. The random-effects model was used for all analyses. Results Four studies (six datasets; 283 patients) were included. In the EORTC-QLQ-C30, there were no differences between ICD and ONB regarding cognitive functioning (weighted mean difference (WMD)=1.18, 95% confidence interval (CI): -20.52,22.88, P=0.915), global health (WMD=1.98, 95%CI: -15.26,19.22, P=0.822), emotional functioning (WMD=0.86, 95%CI: -19.62,21.33, P=0.935), physical functioning (WMD=0.94, 95%CI: -11.61,13.49, P=0.883), role functioning (WMD=-4.94, 95%CI: -12.15,2.27, P=0.180), and social functioning (WMD=-4.71, 95%CI: -20.83,11.40, P=0.567). There were no differences between ONB and ICD for specific symptoms (fatigue, nausea and vomiting, and pain) and single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties) (all P>0.05). In EORTC-QLQ-BLM30, there were no differences between ICD and ONB regarding bowel symptoms (WMD=5.45, 95%CI: -15.30,26.20, P=0.607), body image (WMD=-13.12, 95%CI: -31.15,4.92, P=0.154), sexual functioning (WMD=-5.55, 95%CI: -14.96,3.85, P=0.247), and urinary symptom (WMD=5.50, 95%CI: -7.34,18.34, P=0.401), but one study reported better future perspective with ONB (WMD=-14.9, 95%CI: -27.14,-2.66, P=0.017). Conclusion Women who underwent ONB do not appear to have a statistically significantly better HRQOL than women who underwent ICD, based on EORTC-QLQ-C30 and EORTC-QLQ-BML30.
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Affiliation(s)
- Wenzhou Xing
- Department of Urology, Tianjin First Central Hospital, Tianjin, China
| | - Sheng Zeng
- Department of Urology, Tianjin First Central Hospital, Tianjin, China
| | - Zhaoliang Xu
- Department of Urology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Shaoqiang Xing
- Department of Urology, Weihai Central Hospital, Shandong, China
| | - Qian Liu
- Department of Urology, Tianjin First Central Hospital, Tianjin, China
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18
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Management of Advanced Urothelial Carcinoma in Older and Frail Patients: Have Novel Treatment Approaches Improved Their Care? Drugs Aging 2022; 39:271-284. [PMID: 35344197 DOI: 10.1007/s40266-022-00933-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 11/03/2022]
Abstract
Patients with urothelial carcinoma tend to be older and frailer with a large number of chronic medical conditions. This is particularly pronounced in those with unresectable locally advanced and metastatic urothelial carcinoma. Prior to 2016, treatment options in advanced urothelial carcinoma were limited to chemotherapy, and as a result, a large number of patients were not receiving disease-directed management. Over the last 6 years, multiple alternative modalities including immune checkpoint inhibitors and targeted therapies have been introduced. They are being utilized clinically in older and frail patients, but there are limited studies investigating outcomes in these specific populations. Based upon current evidence, age does not impact the efficacy and tolerance of immune checkpoint inhibitors if patients are fit enough to receive therapy. In frailer patients, immune checkpoint inhibitors appear to be safe, but outcomes from largely retrospective studies demonstrate mixed data regarding their efficacy. Although there are indications from clinical trials that enfortumab vedotin, sacituzumab govitecan, and erdafitinib are also efficacious irrespective of age, there is still not enough evidence to draw definitive conclusions about their use in older and frail patients. Regardless, in all older patients with advanced urothelial carcinoma, it is critical to evaluate for frailty through geriatric screening tools and comprehensive assessments. Combining these evaluations with consideration of an individual patient's goals should be the foundation upon which therapeutic decisions are made in this population of patients.
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From Fast-track to Enhanced Recovery after Surgery (ERAS) in Radical Cystectomy Pathways –a Nursing Perspective. Asia Pac J Oncol Nurs 2022; 9:100048. [PMID: 35647225 PMCID: PMC9136268 DOI: 10.1016/j.apjon.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 01/02/2023] Open
Abstract
Objective The purpose of this narrative review is to summarize existing knowledge and evidence about the establishment of enhanced recovery after surgery (ERAS) pathways with emphasize on radical cystectomy (RC), and the emerging and prominent role of nursing within the ERAS pathway. The current status of implementation and adherence to ERAS protocol in RC is discussed and the impact on primary outcomes according to ERAS is summarized. Methods The review was conducted based on a focused search in PubMed and CINAHL. Results The goal of a modern RC enhanced recovery protocols (ERPs) anno 2022 is to have a positive impact on patient care from diagnosis throughout recovery with focus on the quality, rather than speed, of recovery. This may be more in alignment with the patient's needs and preferences. Conclusions Nursing has been in the forefront since the establishment of ERAS, and the nurse-coordinator must be skilled in evidence-based medicine and have excellent communicative competencies to support the patient journey. Implementation of ERAS have reduced hospitalization by improved minimal surgery, optimized anesthetic regimes without increasing readmission rates. It is not known which items can reduce post-operative complications. In the future, nurses should seek a more prominent and leading role during the implementation process and take responsibility for continued education of the staff. Likewise, future nursing interventions will focus on early identification of modifiable risk factors, and a deeper exploration of the patients personally needs and preferences to upcoming surgery could optimize adherence throughout the pathway, which may add to positive outcomes.
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Chen L, Gan Z, Huang S, Liang T, Sun X, Yi M, Wu S, Fan B, Chen J, Chen T, Ye Z, Chen W, Li H, Jiang J, Guo H, Yao Y, Liao S, Yu C, Liu C, Zhan X. Blood transfusion risk prediction in spinal tuberculosis surgery: development and assessment of a novel predictive nomogram. BMC Musculoskelet Disord 2022; 23:182. [PMID: 35216570 PMCID: PMC8876452 DOI: 10.1186/s12891-022-05132-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 02/17/2022] [Indexed: 11/26/2022] Open
Abstract
Objective The present study attempted to predict blood transfusion risk in spinal tuberculosis surgery by using a novel predictive nomogram. Methods The study was conducted on the clinical data of 495 patients (167 patients in the transfusion group and 328 patients in the non-transfusion group) who underwent spinal tuberculosis surgery in our hospital from June 2012 to June 2021. The least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression analyses were used to screen out statistically significant parameters, which were included to establish a novel predictive nomogram model. The receiver operating characteristic (ROC) curve, calibration curves, C-index, and decision curve analysis (DCA) were used to evaluate the model. Finally, the nomogram was further assessed through internal validation. Results The C-index of the nomogram was 0.787 (95% confidence interval: 74.6%–.82.8%). The C-value calculated by internal validation was 0.763. The area under the curve (AUC) of the predictive nomogram was 0.785, and the DCA was 0.01–0.79. Conclusion A nomogram with high accuracy, clinical validity, and reliability was established to predict blood transfusion risk in spinal tuberculosis surgery. Surgeons must prepare preoperative surgical strategies and ensure adequate availability of blood before surgery.
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Affiliation(s)
- Liyi Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Zhaoping Gan
- Department of Hematology, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Shengsheng Huang
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Tuo Liang
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Xuhua Sun
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Ming Yi
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Shaofeng Wu
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Binguang Fan
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Jiarui Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Tianyou Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Zhen Ye
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Wuhua Chen
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Hao Li
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Jie Jiang
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Hao Guo
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Yuanlin Yao
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Shian Liao
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Chaojie Yu
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China
| | - Chong Liu
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China.
| | - Xinli Zhan
- Spine and osteopathy ward, First Affiliated Hospital of GuangXi Medical University, Nanning, Guangxi Province, China.
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21
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Messaoud M, Vercherin P, Chanelière AF, Mottet N. [Geriatric assessment and treatment of nonmetastatic muscle-invasive bladder cancer in patients over 75 years of age. Retrospective and multicentric study of 121 cases]. Prog Urol 2022; 32:419-425. [PMID: 34998681 DOI: 10.1016/j.purol.2021.12.003] [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: 02/01/2021] [Revised: 11/04/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of our study was to assess prevalence of geriatric assessment (GA) in patients over 75years with nonmetastatic invasive bladder cancer (MIBC). MATERIAL AND METHODS We performed a retrospective study between 2000 and 2015. We assessed comobidity by Charlson score and ASA score, geriatric assessement (GA) and treatments. RESULTS One hundred and twenty one patients were inclued. Median age was 81 (73-95) at diagnosis. Thirty nine patients (32%) were evaluated by GA, G8 screening tool was performed in 16% of patients. Patients without GA were older (82 vs. 81years) and had less comorbidities (Charlson≥2 à 61% vs. 69%). Seventy-four percent of patients received a curarive therapy: 60% were treated by RC, 9% by chemoradiotherapy, 26% received palliative therapy and 15% were only in observation. CONCLUSION Patients with MIBC over 75years were less evaluated and less treated. Patients in pallative care received mostly observation. Although practices have improved, GA was underused. Care of these patients needs standardization in order to adapt therapeutic to their comorbidities and to treat them with curative intent. LEVEL OF PROOF 4.
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Affiliation(s)
- M Messaoud
- Service d'urologie, hôpital Nord, Centre hospitalo-universitaire de Saint-Étienne, Hôpital Nord, Saint-Priest en Jarez, France.
| | - P Vercherin
- Service de santé publique et information médicale, Hôpital Nord, centre hospitalo-universitaire de Saint-Étienne, hôpital Nord, Saint-Priest en Jarez, France
| | - A-F Chanelière
- Service de gériatrie et gérontologie clinique, Hôpital de la Charité, Centre hospitalo-universitaire de Saint-Étienne, Saint-Étienne, France
| | - N Mottet
- Service d'urologie, hôpital Nord, Centre hospitalo-universitaire de Saint-Étienne, Hôpital Nord, Saint-Priest en Jarez, France
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22
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Grossmann NC, Pradere B, D'Andrea D, Schuettfort VM, Mori K, Rajwa P, Quhal F, Laukhtina E, Katayama S, Fankhauser CD, Xylinas E, Margulis V, Moschini M, Abufaraj M, Bandini M, Lonati C, Nyirady P, Karakiewicz PI, Fajkovic H, Shariat SF. Neoadjuvant Chemotherapy in Elderly Patients with Upper Tract Urothelial Cancer: Oncologic Outcomes from a Multicenter Study. Clin Genitourin Cancer 2022; 20:227-236. [DOI: 10.1016/j.clgc.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 12/11/2021] [Accepted: 01/04/2022] [Indexed: 01/24/2023]
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23
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Optimización del tratamiento del cáncer de vejiga no músculo invasivo mediante una app. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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24
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Hatakeyama S, Narita S, Okita K, Narita T, Iwamura H, Fujita N, Inokuchi J, Matsui Y, Kitamura H, Ohyama C. Management of bladder cancer in older patients. Jpn J Clin Oncol 2021; 52:203-213. [PMID: 34905776 DOI: 10.1093/jjco/hyab187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/13/2021] [Indexed: 11/14/2022] Open
Abstract
Evidence has shown that patients with bladder cancer are diagnosed at a much older age compared with those with other cancers. Given that co-morbidities and frailty are prevalent in older patients with advanced bladder cancer, they are easily excluded from randomized controlled trials. As little evidence has been available regarding assessment tools for frailty, the management of those patients remains challenging. This weakness is strongly manifested in muscle-invasive bladder cancer. Despite radical cystectomy is the standard of care for bladder cancer, there is an extensive undertreatment of older adult patients with potentially curative muscle-invasive bladder cancer. However, it is also true that radical cystectomy is often unsuitable for vulnerable or frail patients. Bladder preservation using trimodality therapy has been utilized as an alternative option, but the appropriate selection criteria for trimodality therapy remain unclear. Cisplatin-based regimens have been the first choice for advanced disease among eligible patients. Moreover, immunotherapy appears to have similar benefits and tolerability in both older and younger patients. Furthermore, palliative or supportive interventions need to be initiated earlier in patients with metastatic disease. Accumulating evidence suggests that frailty may play a key role in the selection of treatment modalities. Older patients should be considered for standard treatment based on frailty and not chronological age. Moreover, older patients with bladder cancer need to undergo geriatric assessment for proper decision-making.
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Affiliation(s)
- Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazutaka Okita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hiromichi Iwamura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Chikara Ohyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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25
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Complications and Discharge after Radical Cystectomy for Older Patients with Muscle-Invasive Bladder Cancer: The ELCAPA-27 Cohort Study. Cancers (Basel) 2021; 13:cancers13236010. [PMID: 34885120 PMCID: PMC8656698 DOI: 10.3390/cancers13236010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Radical cystectomy is associated in older patients with an increased risk of post-operative complications. However, these studies did not take into account geriatric variables. In our study, all patients had a standardized geriatric assessment prior to radical cystectomy. Although geriatric variables were not associated with 30-day complications, our study found that frailty (measured as a G8 score ≤ 14), a loss of autonomy, anemia, and severe comorbidities were associated with a higher risk of not being discharged home at one month after the surgery. Abstract Radical cystectomy is the standard of care for localized bladder cancer but is associated with high morbidity and mortality rates—especially among older patients with comorbidities. The association between geriatric assessment parameters on post-operative complications and discharge has not previously been investigated. The present analysis of the Elderly Cancer Patient (ELCAPA) prospective cohort included all patients aged ≥70 having undergone a geriatric assessment and then radical cystectomy for localized muscle-invasive bladder cancer between 2007 and 2018. The primary endpoint was the proportion of patients with one or more complications in the first 30 days after cystectomy. The secondary endpoints were the length of hospital stay (LOS), the 30-day mortality, and discharge rates. Sixty-two patients (median age: 81; range: 79–83.8) were included. The 30-day complication rate was 73%, and 49% of the patients had experienced a major complication, according to the Clavien-Dindo classification. The 30-day mortality rate was 4%. None of the geriatric, oncological, or laboratory parameters were significantly associated with the occurrence or severity of complications. The median (interquartile range) LOS was 18 days (15–23) overall and was longer in patients with complications (19 days vs. 15 days in those without complications; p = 0.013). Thirty days after cystectomy, 25 patients (53%) had been discharged to home and 22 (47%) were still in a rehabilitation unit. In a univariate analysis, a Geriatric-8 score ≤ 14, a loss of one point on the Activities of Daily Living Scale, anemia, at least one grade ≥ 3 comorbidity on the Cumulative Illness Rating Scale-Geriatric, and an inpatient geriatric assessment were associated with a risk of not being discharged to home. In older patients having undergone a geriatric assessment, radical cystectomy is associated with a high complication rate, a longer LOS, and functional decline at 30 days.
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26
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[Locally advanced or oligometastatic bladder cancer-role of local treatment of the primary tumor and metastases]. Urologe A 2021; 60:1555-1560. [PMID: 34825935 PMCID: PMC8654709 DOI: 10.1007/s00120-021-01712-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/15/2022]
Abstract
Hintergrund Das muskelinvasive Blasenkarzinom stellt in seiner Behandlung eine besondere Herausforderung dar, da die Therapie mit signifikanten Nebenwirkungen und Komplikationsraten einhergeht, insbesondere bei Patienten mit relevanten Begleiterkrankungen. Im metastasierten Stadium besteht der Therapiezweck in der Palliation, wobei das Vorliegen einer Oligometastasierung eine gesonderte Rolle einnimmt. In diesem Stadium kann auch die Therapie des Primärtumors relevant sein, wenn die Metastasen neben einer systemischen Therapie ebenso lokal behandelt werden können – insbesondere auch in Hinblick auf die über die letzten Jahre die Therapielandschaft erweiternden neuen medikamentösen Möglichkeiten. Ziel der Arbeit In diesem Reviewartikel sollen die Einflüsse einer definitiven Therapie des Primärtumors bei Patienten mit oligometastasiertem Urothelkarzinom der Harnblase dargelegt werden. Material und Methoden Basierend auf einer nicht-systemischen Literaturrecherche soll ein Überblick über bestehende Ergebnisse zur Therapie des oligometastasierten Blasenkarzinoms in Hinblick auf den Einfluss der Therapie des Primärtumors geben, wobei die Daten meist auf retrospektiven Studien und Metaanalysen bestehen. Schlussfolgerung Eine Lokaltherapie des Primärtumors im Rahmen eines multimodalen Therapiekonzepts kann bei selektionierten Patienten mit lymphogen metastasiertem und oligometastasiertem Blasenkarzinom einen positiven Einfluss auf Überleben, Lebensqualität und Vermeidung von Lokalkomplikationen nehmen, wobei für die Wahl der lokalen Therapie dieselben Kriterien angewendet werden sollten wie im nicht-metastasierten Stadium.
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27
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Basile G, Bandini M, Raggi D, Marandino L, Pederzoli F, Salonia A, Briganti A, Montorsi F, Kulkarni SB, Necchi A. Bladder-sparing combination treatments for muscle-invasive bladder cancer: A plea for standardized assessment and definition of clinical trials endpoints. Urol Oncol 2021; 40:37-44. [PMID: 34840076 DOI: 10.1016/j.urolonc.2021.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/03/2021] [Accepted: 10/23/2021] [Indexed: 10/19/2022]
Abstract
Radical cystectomy is the standard of care for muscle invasive bladder cancer, although it represents a surgical procedure with high complication and mortality burden. Thus, more and more emphasis has been placed in favor of alternative treatments especially for patients who are unfit for or aim to avoid radical cystectomy. In this context, preclinical studies highlighted that chemoradiation therapy (CRT) may have immunomodulatory properties on tumor microenvironment with a consequent increase in immune biomarkers. Thus, following the encouraging results reached by immune checkpoint inhibitors (ICIs) in both metastatic and localized disease, CRT and ICIs combination treatment gained momentum as bladder-sparing option and several clinical trials were recently launched both as concurrent and sequential treatments. A narrative review of the literature was performed to summarize the rationale and clinical outcomes of trials testing CRT and ICIs combination. Promising results were recently released mainly from phase II trials reporting clinal complete response rates from 48% to 83%. Moreover, combination treatment, both as concurrent and sequential schedules, appeared to be quite tolerable. However, interpretation of preliminary findings is made difficult due to the heterogeneity of clinical endpoints among trials, patient population included and different measurement of response to treatment. Novel bladder-sparing strategies are finally gaining momentum in bladder cancer treatment. Despite preliminary findings are encouraging, harmonization of terminology and definition of clinical endpoints among trials will be mandatory to correctly assess the potential role of CRT and immunotherapy combination as bladder-sparing solution in routine clinical practice.
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Affiliation(s)
- Giuseppe Basile
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Bandini
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Raggi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Marandino
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Filippo Pederzoli
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute (URI), Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Andrea Necchi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
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28
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Sari Motlagh R, Rajwa P, Mori K, Laukhtina E, Aydh A, Katayama S, Yanagisawa T, König F, Grossmann NC, Pradere B, Mostafai H, Quhal F, Karakiewicz PI, Babjuk M, Shariat SF. Comparison of Clinicopathologic and Oncological Outcomes Between Transurethral En Bloc Resection and Conventional Transurethral Resection of Bladder Tumor: A Systematic Review, Meta-Analysis and Network Meta-Analysis with Focus on Different Energy Sources. J Endourol 2021; 36:535-547. [PMID: 34693740 DOI: 10.1089/end.2021.0688] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: It has been hypothesized that transurethral en bloc (TUEB) of bladder tumor offers benefits over conventional transurethral resection of bladder tumor (cTURBT). This study aimed to compare disease outcomes of TUEB and cTURBT with focus on the different energy sources. Methods: A systematic search was performed using PubMed and Web of Science databases in June 2021. Studies that compared the pathological (detrusor muscle presence), oncological (recurrence rates) efficacy, and safety (serious adverse events [SAEs]) of TUEB and cTURBT were included. Random- and fixed-effects meta-analytic models and Bayesian approach in the network meta-analysis was used. Results: Seven randomized clinical trials (RCTs) and seven non-RCTs (NRCT), with a total of 2092 patients. The pooled 3- and 12-month recurrence risk ratios (RR) of five and four NRCTs were 0.46 (95% CI 0.29-0.73) and 0.56 (95% CI 0.33-0.96), respectively. The pooled 3- and 12-month recurrence RRs of four and seven RCTs were 0.57 (95% CI 0.25-1.27) and 0.89 (95% CI 0.69-1.15), respectively. The pooled RR for SAEs such as prolonged hematuria and bladder perforation of seven RCTs was 0.16 (95% CI 0.06-0.41) in benefit of TUEB. Seven RCTs (n = 1077) met our eligibility criteria for network meta-analysis. There was no difference in 12-month recurrence rates between hybridknife, laser, and bipolar TUEB compared with cTURBT. Contrary, laser TUEB was significantly associated with lower SAEs compared with cTURBT. Surface under the cumulative ranking curve ranking analyses showed with high certainty that laser TUEB was the best treatment option to access all endpoints. Conclusion: While NRCTs suggested a recurrence-free benefit to TUEB compared with cTURBT, RCTs failed to confirm this. Conversely, SAEs were consistently and clinically significantly better for TUEB. Network meta-analyses suggested laser TUEB has the best performance compared with other energy sources. These early findings need to be confirmed and expanded upon.
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Affiliation(s)
- Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Abdulmajeed Aydh
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Faisal Medical City, Abha, Saudi Arabia
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Frederik König
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nico C Grossmann
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Hadi Mostafai
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada
| | - Marek Babjuk
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Department of Urology, Motol University Hospital, 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, Weill Cornell Medical College, New York, New York, USA.,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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29
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Campi R, Berni A, Amparore D, Bertolo R, Capitanio U, Carbonara U, Erdem S, Ingels A, Kara O, Klatte T, Kriegmair M, Marchioni M, Minervini A, Mir MC, Papalia R, Pavan N, Pecoraro A, Gomez Rivas J, Rivasi G, Roussel E, Ungar A, Serni S, Esperto F. Impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for renal cancer: a systematic review. Minerva Urol Nephrol 2021; 74:146-160. [PMID: 34714036 DOI: 10.23736/s2724-6051.21.04583-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Frailty has been recognized as a major risk factor for adverse perioperative and oncological outcomes in patients with genitourinary malignancies. Yet, the evidence supporting such an association in patients with renal cell carcinoma (RCC) is still sparse. Herein we provide an updated comprehensive overview of the impact of frailty on perioperative and oncologic outcomes in patients undergoing surgery or ablation for RCC. EVIDENCE ACQUISITION A systematic review of the English-language literature was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42021242516). The overall quality of evidence was assessed according to GRADE recommendations. EVIDENCE SYNTHESIS Overall, 18 studies were included in the qualitative analysis. Most of these were retrospective single-centre series including patients undergoing surgery for non-metastatic RCC. The overall quality of evidence was low. A variety of measures were used for frailty assessment, including the Canadian Study of Health and Aging Frailty Index, the five-item frailty index, the Modified Rockwood's Clinical Frailty Scale Score, the Hopkins Frailty score, the Groningen Frailty Index, and the Geriatric nutritional risk index. Sarcopenia was defined based on the Lumbar skeletal muscle mass at cross-sectional imaging, the skeletal muscle index, the total psoas area, or the psoas muscle index. Overall, available studies point to frailty and sarcopenia as potential independent risk factors for worse perioperative and oncological outcomes after surgery or ablation for different RCC stages. Increased patient's frailty was indeed associated with higher risk of perioperative complications, healthcare resources utilization, readmission rates and longer hospitalization periods, as well as potentially lower cancer specific or overall survival. CONCLUSIONS Frailty has been consistently associated with worse outcomes after surgery for RCC, reinforcing the value of preoperative frailty assessment in carefully selected patients. Given the low quality of the available evidence (especially in the setting of tumour ablation), prospective studies are needed to standardize frailty assessments and to identify patients who are expected to benefit most from preoperative geriatric evaluation, aiming to optimize decision-making and postoperative outcomes in patients with RCC.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy - .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy - .,European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group -
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Daniele Amparore
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Bertolo
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, San Carlo Di Nancy Hospital, Rome, Italy
| | - Umberto Capitanio
- Department of Urology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Umberto Carbonara
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Selcuk Erdem
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Division of Urologic Oncology, Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alexandre Ingels
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, University Hospital Henri Mondor, APHP, Créteil, France.,Biomaps, UMR1281, INSERM, CNRS, CEA, Université Paris Saclay, Villejuif, France
| | - Onder Kara
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Maximilian Kriegmair
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, University Medical Centre Mannheim, Mannheim, Germany
| | - Michele Marchioni
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Medical, Oral and Biotechnological Sciences, Laboratory of Biostatistics, University G D'Annunzio Chieti-Pescara, Chieti, Italy.,Department of Urology, SS Annunziata Hospital, G D'Annunzio University of Chieti, Chieti, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Maria C Mir
- Department of Urology, Fundacion Instituto Valenciano Oncologia, Valencia, Spain
| | - Rocco Papalia
- Department of Urology, Campus Bio-Medico University, Rome, Italy
| | - Nicola Pavan
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Angela Pecoraro
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Juan Gomez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
| | - Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Eduard Roussel
- European Association of Urology (EAU) Young Academic Urologists (YAU) Renal Cancer Working Group.,Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Andrea Ungar
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Esperto
- Department of Urology, Campus Bio-Medico University, Rome, Italy.,European Society of Residents in Urology (ESRU), Arnhem, the Netherlands
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Sargos P, Baumann BC, Faye MD, Fonteyne V, Eccles CL. A Tailored Radiation Therapy Strategy for Older Patients With Localized Bladder Cancer Not Eligible for Curative Treatment. Int J Radiat Oncol Biol Phys 2021; 110:425-428. [PMID: 33989576 DOI: 10.1016/j.ijrobp.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Paul Sargos
- Department of Radiation Oncology, Institut Bergonié, Bordeaux, France.
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Mame Daro Faye
- Department of Radiation Oncology, McGill University Health Centre, Montréal, Canada
| | - Véronique Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Cynthia L Eccles
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
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31
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Zimmermann K, Mostafaei H, Heidenreich A, Schmelz HU, Shariat SF, Mori K. Health-related quality of life in bladder cancer patients: general and cancer-specific instruments. Part 1. Curr Opin Urol 2021; 31:297-303. [PMID: 33965980 DOI: 10.1097/mou.0000000000000893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Although survival outcomes are the primary outcomes to determine the effectiveness of treatment options, quality of life (QoL) is gaining in importance in addition to classic oncological outcomes. The present review aims to state and critically assess the challenges in health-related QoL (HRQoL) assessment especially in bladder cancer (BC) patients. RECENT FINDINGS General QoL-instruments do not address concerns specific to cancer patients or BC patients. Domains, such as sexual functioning, embarrassment, self-consciousness, psychological distress, and urinary incontinence, are not adequately covered by any of the available instruments. With these QoL-instruments becoming increasingly specialized, the general aspects of QoL and possible unanticipated adverse effects are no longer likely to be accurately assessed. Sex-specific requirements have not been properly addressed by these QoL-instruments. HRQoL is reported to be lower in the elderly population, which may be due to their associated comorbidities and limitations, rather than treatment-related issues. SUMMARY Due to their specifications, BC-specific instruments need to be used together with general QoL instruments to assess overall well being and disease- and treatment-specific QoL. Assessment of age-specific HRQoL is essential to understanding the QoL burden in each age group. QoL assessment calls for more detailed sex-specific questions to accurately address the HRQoL dimensions in men and women alike.
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Affiliation(s)
- Kristin Zimmermann
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Axel Heidenreich
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urologic Surgery, University Hospital Cologne, Cologne, Germany
| | - Hans U Schmelz
- Department of Urology, Federal Armed Services Hospital Koblenz, Koblenz, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, University of Jordan, Amman, Jordan
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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32
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Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study. J Clin Med 2021; 10:jcm10132797. [PMID: 34202030 PMCID: PMC8267645 DOI: 10.3390/jcm10132797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/19/2022] Open
Abstract
Open radical cystectomy is associated with a substantial rate of perioperative blood transfusion. Early detection of potentially modifiable perioperative factors could reduce the need for perioperative blood transfusion and thus positively impact the outcome. We conducted an observational, single-center cohort study of 1168 patients undergoing cystectomy. Perioperative blood transfusion was defined as the need for packed red blood cells and/or fresh frozen plasma units within the first 24 h after the initiation of surgery. Multiple logistic regression analysis was performed to model the association between risk factors and blood transfusion, and a nomogram was developed. Blood transfusion occurred in 370/1168 patients (31.7%). Significant predictors were age (OR: 1.678, (95% CI: 1.379–2.042); p < 0.001), blood loss ratio (6.572, (4.878–8.853); p < 0.001), preoperative hemoglobin (0.316, (0.255–0.391); p < 0.001), tumor stage (2.067, (1.317–3.244); p = 0.002), use of oral anticoagulants (2.70, (1.163–6.270), p = 0.021), and interaction between female sex and blood loss ratio (1.344, (1.011–1.787); p = 0.042). Of the major predictors found to affect perioperative blood transfusion, two can be influenced: blood loss ratio by meticulous surgery and hemoglobin by preoperative optimization. Others such as age or advanced disease are not modifiable. This emphasizes the importance of optimal management of patients prior to surgery.
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Hoffman-Censits J, Kanesvaran R, Bangs R, Fashoyin-Aje L, Weinstock C. Breaking Barriers: Addressing Issues of Inequality in Trial Enrollment and Clinical Outcomes for Patients With Kidney and Bladder Cancer. Am Soc Clin Oncol Educ Book 2021; 41:e174-e181. [PMID: 34061566 DOI: 10.1200/edbk_320273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite recent treatment advances, kidney and bladder cancer cases have continued to rise in both incidence and mortality over the last few decades. Not every demographic subgroup of patients diagnosed with these cancers has an equivalent outcome. Women diagnosed with bladder cancer have worse overall survival than men diagnosed with bladder cancer. Older adults with muscle-invasive bladder cancer have worse cancer-specific outcomes than do younger patients. Black patients diagnosed with kidney and bladder cancers appear to have worse overall survival than White patients diagnosed with these cancers. Although these differences in outcomes are likely multifactorial, in many cases they may be based on modifiable approaches to screening, diagnosing, and treating patients. We explore various causes of these differences in outcomes between patients and address patient engagement strategies and avenues to effect change. In 2021, equity in cancer and cancer care delivery has a more prominent place in the hierarchy of the continuum of medicine. Continued focus on this topic is critical, with clear accountabilities established and barriers to best care for patients eliminated.
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Affiliation(s)
| | | | | | - Lola Fashoyin-Aje
- Office of Oncologic Diseases, U.S. Food and Drug Administration, White Oak, MD
| | - Chana Weinstock
- Office of Oncologic Diseases, U.S. Food and Drug Administration, White Oak, MD
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34
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Varughese M. Overcoming the Chasm Between Evidence and Routine Practice for Bladder Cancer; Just a Quixotic Notion? Clin Oncol (R Coll Radiol) 2021; 33:e274-e284. [PMID: 33840534 DOI: 10.1016/j.clon.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/16/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022]
Abstract
There has been a failure to improve outcomes in bladder cancer over the last 30 years. This is despite clinical trial evidence showing a benefit of interventions such as neoadjuvant chemotherapy or concurrent radiosensitisation for non-metastatic muscle-invasive bladder cancer. The bladder cancer population is characteristically elderly, who typically suffer from multiple comorbidities. Historically, radical cystectomy has been heralded as the treatment of choice, with radiotherapy being reserved for those with inoperable tumours or those unfit for major pelvic surgery, despite a lack of robust comparative or quality of life data to support one treatment recommendation over the other. Although patients with non-metastatic muscle-invasive bladder cancer have potentially curable disease, a growing body of population-based analyses persistently highlights that most patients do not undergo curative-intent treatments - a trend that remains static. The causes for the disparity between evidence and routine practice is not clearly understood. Here, the facets of patient-centred evidence-based care, with respect to bladder conservation therapy, are examined, with proposals to reverse this unacceptable status quo.
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Affiliation(s)
- M Varughese
- Department of Oncology, Royal Devon & Exeter Hospital, Exeter, UK.
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35
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Varughese M, Treece S, Drinkwater K, Williams M. Failing to Close the Gap between Evidence and Clinical Practice in Radical Bladder Cancer Radiotherapy: A Critical Unmet Need. Clin Oncol (R Coll Radiol) 2021; 33:340-341. [PMID: 33495067 DOI: 10.1016/j.clon.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/06/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - S Treece
- North West Anglia NHS Foundation Trust, Huntingdon, UK
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36
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Jensen BT, Lauridsen SV, Scheede-Bergdahl C. The Potential of Prehabilitation in Radical Cystectomy Pathways: Where Are We Now? Semin Oncol Nurs 2021; 37:151107. [PMID: 33446382 DOI: 10.1016/j.soncn.2020.151107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The growing recognition of prehabilitation has caused an emerging paradigm shift in surgical cancer care and an integrated component of the cancer care continuum. This narrative review aims to update and inform the urological community of the potential of prehabilitation before radical cystectomy. DATA SOURCES A nonsystematic narrative review was performed through a database search in PubMed, and CINAHL using the following search terms: enhanced recovery after surgery (ERAS); Frailty; Prehabilitation and/or Rehabilitation; Physical Activity and/or exercises; Nutrition; Nutritional Care; Smoking cessation; Alcohol cessation; Prevention; Supportive Care; and combined with Radical Cystectomy. CONCLUSION A multimodal and multi-professional approach during the preoperative period may offer an opportunity to preserve or enhance physiological integrity and optimize surgical recovery. Studies indicate a positive effect of prehabilitation on postoperative functional capacity and earlier return to daily activities and health related quality of life. Meaningful outcomes that reflect recovery from a patient's perspective and clinical outcome measures, as well as validating metrics, are necessary to establish whether prehabilitation diminish the risk of developing long-term disability in high-risk patients. IMPLICATIONS FOR NURSING PRACTICE Uro-oncology nurses are at the forefront in every ERAS program and vital in screening patients ahead of surgery for common risk factors, current impairments, and limitations that can compromise baseline functional capacity. The growing movement to standardize clinical implementation of prehabilitation, indicate there is a clear need for further investigation, optimization of a multimodal approach and an open discussion between health care providers from different areas of expertise who might best support and promote these initiatives.
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Affiliation(s)
| | - Susanne Vahr Lauridsen
- Department of Urology, Copenhagen University Hospital, Denmark and WHO-CC, Parker Institute Bispebjerg & Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, Department of Anesthesiology, McGill University, Montreal, Quebec, Canada
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37
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Tellini R, Mari A, Muto G, Cacciamani GE, Ferro M, Stangl-Kremser J, Campi R, Soria F, Rink M, Xylinas E, Minervini A, Briganti A, Montorsi F, Roupret M, Shariat SF, Moschini M. Impact of Smoking Habit on Perioperative Morbidity in Patients Treated with Radical Cystectomy for Urothelial Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2020; 4:580-593. [PMID: 33160975 DOI: 10.1016/j.euo.2020.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 12/24/2022]
Abstract
CONTEXT Smoking habit at the time of surgery is associated with higher perioperative complications and mortality across different types of surgeries. In recent years, several studies have attempted to explore the influence of smoking on perioperative outcomes following radical cystectomy (RC) for urothelial bladder cancer (UBC) with contradictory results. OBJECTIVE To systematically investigate and meta-analyze the association between smoking habit and perioperative morbidity and mortality in UBC patients treated with RC. EVIDENCE ACQUISITION A systematic review of the literature published between January 2000 and January 2020 investigating the impact of smoking habit on perioperative outcomes of patients treated with RC for UBC was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and the Cochrane Handbook for Systematic Reviews of Interventions. EVIDENCE SYNTHESIS Overall, 27 articles involving 27 854 patients were included in the systematic review, and of these, 11 studies were included in the meta-analysis. The studies included showed a moderate to high risk of bias. Smoking status (smokers vs nonsmokers) was significantly associated with the onset of major postoperative complications (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.51-2.32; I2 = 0%), infections (HR 1.34, 95% CI 1.02-1.72; I2 = 66.2%), and mortality (HR 1.84, 95% CI 1.14-2.98; I2 = 4.9%). CONCLUSIONS Smoking status at the time of RC is associated with increased risk for major postoperative complications, infections, and mortality. These results suggest the need for strict postoperative monitoring in smokers due to the increased risk of experiencing adverse events and underline the need for intensive smoking cessation interventions in the preoperative setting. PATIENT SUMMARY In this study, we reviewed the impact of smoking habit on perioperative outcomes following radical cystectomy (RC). Based on the available data, the impact of smoking on morbidity and mortality after RC is significant and relevant; as such, every effort should be made in the preoperative setting to encourage smoking cessation.
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Affiliation(s)
- Riccardo Tellini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Gianluca Muto
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Giovanni Enrico Cacciamani
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology-IRCCS, Milan, Italy
| | - Judith Stangl-Kremser
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, APHP, Paris University, Paris, France
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Morgan Roupret
- Urology, GRC 5 PREDICTIVE ONCO-URO, AP-HP, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Shahrokh F Shariat
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Jordan, Amman, Jordan; European Association of Urology research foundation, Arnhem, The Netherlands
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
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38
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Incidence and outcome of salvage cystectomy after bladder sparing therapy for muscle invasive bladder cancer: a systematic review and meta-analysis. World J Urol 2020; 39:1757-1768. [PMID: 32995918 PMCID: PMC8217031 DOI: 10.1007/s00345-020-03436-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023] Open
Abstract
Objective We conducted a systematic review and meta-analysis to assess the available literature regarding the surgical and oncologic outcomes of patients undergoing salvage radical cystectomy (SV-RC) for recurrence or failure of bladder sparing therapy (BST) for muscle-invasive bladder cancer (MIBC). Methods We searched MEDLINE (PubMed), EMBASE and Google Scholar databases in May 2020. We included all studies of patients with ≥ cT2N0/xM0 bladder cancer that were eligible for all treatment modalities at the time of treatment decision who underwent BST including radiotherapy (RTX). A meta-analysis was conducted to calculate the pooled rate of several variables associated with an increased need for SV-RC. Study quality and risk of bias were assessed using MINORS criteria. Results 73 studies comprising 9110 patients were eligible for the meta-analysis. Weighted mean follow-up time was 61.1 months (range 12–144). The pooled rate of non-response to BST and local recurrence after BST, the two primary reasons for SV-RC, was 15.5% and 28.7%, respectively. The pooled rate of SV-RC was 19.2% for studies with a follow-up longer than 5 years. Only three studies provided a thorough report of complication rates after SV-RC. The overall complication rate ranged between 67 and 72% with a 30-day mortality rate of 0–8.8%. The pooled rates of 5 and 10-year disease-free survival after SV-RC were 54.3% and 45.6%, respectively. Conclusion Approximately one-fifth of patients treated with BST with a curative intent eventually require SV-RC. This procedure carries a proportionally high rate of complications and is usually accompanied by an incontinent urinary diversion. Electronic supplementary material The online version of this article (10.1007/s00345-020-03436-0) contains supplementary material, which is available to authorized users.
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39
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Adomi S, Fujita K, Yoshimura K, Uemura H. Editorial Comment from Dr Adomi et al. to Frailty is significantly associated with the type of urinary diversion in patients with muscle-invasive bladder cancer. Int J Urol 2020; 27:655-656. [PMID: 32500535 DOI: 10.1111/iju.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shogo Adomi
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Kazutoshi Fujita
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Hirotsugu Uemura
- Department of Urology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
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40
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Ashrafizadeh M, Zarrabi A, Samarghandian S, Najafi M. PTEN: What we know of the function and regulation of this onco-suppressor factor in bladder cancer? Eur J Pharmacol 2020; 881:173226. [PMID: 32485246 DOI: 10.1016/j.ejphar.2020.173226] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 12/13/2022]
Abstract
Bladder cancer accounts for high morbidity and mortality around the world and its incidence rate is suggested to be higher in following years. A number of factors involve in bladder cancer development such as lifestyle and drugs. However, it appears that genetic factors play a significant role in bladder cancer development and progression. Phosphatase and tensin homolog (PTEN) is a cancer-related transcription factor that is corelated with reduced proliferation and invasion of cancer cells by negatively targeting PI3K/Akt/mTOR signaling pathway. In the present review, we aimed to explore the role of PTEN in bladder cancer cells and how upstream modulators affect PTEN in this life-threatening disorder. Down-regulation of PTEN is associated with poor prognosis, chemoresistance and progression of cancer cells. Besides, microRNAs, long non-coding RNAs, circular RNAs and other molecular pathways such as NF-kB are able to target PTEN in bladder cancer cells. Notably, anti-tumor drugs such as kaempferol, β-elemene and sorafenib upregulate the expression of PTEN to exert their inhibitory effects on bladder cancer cells.
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Affiliation(s)
- Milad Ashrafizadeh
- Department of Basic Science, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Ali Zarrabi
- Sabanci University Nanotechnology Research and Application Center (SUNUM), Tuzla, 34956, Istanbul, Turkey
| | - Saeed Samarghandian
- Healthy Ageing Research Center, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Masoud Najafi
- Radiology and Nuclear Medicine Department, School of Paramedical Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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