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Rahman ZA, Hidayatullah F, Lim J, Hakim L. A systematic review and meta-analysis of intraarterial chemotherapy for non muscle invasive bladder cancer: Promising alternative therapy in high tuberculosis burden countries. Arch Ital Urol Androl 2024; 96:12154. [PMID: 38363237 DOI: 10.4081/aiua.2024.12154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Local therapies for high risk non-muscle-invasive bladder cancer (NMIBC) such as intravesical chemotherapy (IVC) have shown a high rate of progression and recurrence. Intravesical Bacillus Calmette-Guérin (BCG) for local therapies has been shown to reduce progression and recurrence in patient with NMIBC. However, its potential role is limited in high burden countries for tuberculosis (TB) due to its low specificity that can cause wrong diagnosis or false positive in patients with clinically diagnosed tuberculosis. BCG vaccine that has to be given for most people in tuberculosis endemic countries will induce trained immunity that could reduce the effectivity of intravesical BCG for NMIBC. Moreover, intravesical BCG is contraindicated in patient with or previous tuberculosis. The potential clinical benefit of intraarterial chemotherapy (IAC) in delaying the recurrence and progression of high-risk NMIBC have been investigated with promising results. We aimed to conduct a meta-analysis to evaluate the potential anti-tumor effect of IAC in NMIBC. METHODS We conducted a comprehensive search of published articles in Cochrane Library, Pubmed, and Science-Direct to identify relevant randomized controlled trials (RCTs) and observational studies comparing IAC alone or combined with IVC versus IVC/BCG alone in NMIBC. The protocol of preferred reporting items for systematic review and meta-analysis (PRISMA) was applied to this study. RESULTS Four RCTs and 4 cohort observational studies were eligible in this study and 5 studies were included in meta-analysis. The risk ratio of tumor recurrence was reduced by 35% (RR = 0.65; 95% CI 0.49-0.87; p = 0.004) in IAC plus IVC, while recurrence-free survival (RFS) was prolonged by 45% (HR: 0.55; 95% CI, 0.44-0.69; p < 0.001). The risk of tumor progression was reduced by 45% (RR = 0.55; 95% CI 0.41-0.75; p = 0.002) and tumor progression-free survival (PFS) was also prolonged by 53% (HR: 0.47; 95% CI, 0.34-0.65; p<0.001). Some RCT's had high or unclear risk of bias, meanwhile 4 included cohort studies had overall low risk of bias, therefore the pooled results need to be interpreted cautiously. Subgroup analysis revealed that the heterogeneity outcome of tumour recurrence might be attributed to the difference in NMIBC stages and grades. CONCLUSIONS The IAC alone or combined with IVC following bladder tumor resection may lower the risk of tumor recurrence and progression. These findings highlight the importance of further multi institutional randomized controlled trials with bigger sample size using a standardized IAC protocol to validate the current results.
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Affiliation(s)
- Zakaria Aulia Rahman
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Furqan Hidayatullah
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java.
| | - Jasmine Lim
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur.
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine, Universitas Airlangga; Universitas Airlangga Teaching Hospital, Surabaya, East Java.
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Sun D, Hadjiiski L, Gormley J, Chan HP, Caoili EM, Cohan RH, Alva A, Gulani V, Zhou C. Survival Prediction of Patients with Bladder Cancer after Cystectomy Based on Clinical, Radiomics, and Deep-Learning Descriptors. Cancers (Basel) 2023; 15:4372. [PMID: 37686647 PMCID: PMC10486459 DOI: 10.3390/cancers15174372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Accurate survival prediction for bladder cancer patients who have undergone radical cystectomy can improve their treatment management. However, the existing predictive models do not take advantage of both clinical and radiological imaging data. This study aimed to fill this gap by developing an approach that leverages the strengths of clinical (C), radiomics (R), and deep-learning (D) descriptors to improve survival prediction. The dataset comprised 163 patients, including clinical, histopathological information, and CT urography scans. The data were divided by patient into training, validation, and test sets. We analyzed the clinical data by a nomogram and the image data by radiomics and deep-learning models. The descriptors were input into a BPNN model for survival prediction. The AUCs on the test set were (C): 0.82 ± 0.06, (R): 0.73 ± 0.07, (D): 0.71 ± 0.07, (CR): 0.86 ± 0.05, (CD): 0.86 ± 0.05, and (CRD): 0.87 ± 0.05. The predictions based on D and CRD descriptors showed a significant difference (p = 0.007). For Kaplan-Meier survival analysis, the deceased and alive groups were stratified successfully by C (p < 0.001) and CRD (p < 0.001), with CRD predicting the alive group more accurately. The results highlight the potential of combining C, R, and D descriptors to accurately predict the survival of bladder cancer patients after cystectomy.
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Affiliation(s)
- Di Sun
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - Lubomir Hadjiiski
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - John Gormley
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - Heang-Ping Chan
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - Elaine M. Caoili
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - Richard H. Cohan
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - Ajjai Alva
- Department of Internal Medicine-Hematology/Oncology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Vikas Gulani
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
| | - Chuan Zhou
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA; (L.H.); (J.G.); (H.-P.C.); (E.M.C.); (R.H.C.); (V.G.); (C.Z.)
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3
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Azhar RA, Nassir AM, Saada H, Munshi S, Alghamdi MM, Bugis AM, Elkoushy MA. High-Grade Non-Muscle Invasive Bladder Cancer: When to Move to Early Radical Cystectomy? Cureus 2021; 13:e19399. [PMID: 34926001 PMCID: PMC8656290 DOI: 10.7759/cureus.19399] [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: 11/09/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives To compare the outcomes of bladder preservation therapy with early or deferred radical cystectomy (RC) in high-grade non-muscle invasive bladder cancer. Methods Prospectively collected data were obtained for patients undergoing transurethral resection of bladder tumor (TURBT) at a tertiary care center between 2007 and 2018. Patients with a high-grade tumor (HGT1) were divided into three groups, depending on the treatment plan: conservative (GI), early RC (GII), or deferred RC (GIII). Kaplan-Meier analysis was performed to assess the cancer-specific survival (CSS). Results Seventy-one patients were included, and the patients had a median (range) age of 49 (32-72) years. The GI, GII, and GIII groups included 34 (47.9%), 14 (19.7%), and 23 (32.4%) patients, respectively. A significantly lower number of GII patients underwent >2 TURBTs (14.3% vs. 100%, p<0.001). Compared to GIII patients, GII patients had a shorter time to RC from the initial diagnosis (5.7 vs. 36.2 months, p=0.03). Ileal conduit and orthotropic bladder diversions were comparable between both groups, with significantly higher postoperative complications in GIII patients. The median (IQR) follow-up times for the groups were 84 (49-102), 82 (52-112), and 73 (36-89) months, respectively. The five-year and 10-year CSS for GII and GIII patients was 79% vs. 75% and 78% vs. 64%, respectively (log rank=0.19). Conclusion Early RC should be considered an alternative treatment option in selected patients with HGT1 BC with expected longer life expectancy, which may significantly decrease postoperative complications and improve the CSS. However, selection bias in the current retrospective study may influence these outcomes.
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Affiliation(s)
- Raed A Azhar
- Department of Urology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Anmar M Nassir
- Department of Surgery, Umm Al-Qura University, Makkah, SAU
| | - Hesham Saada
- Department of Urology, King Abdullah Medical City, Makkah, SAU
| | - Sameer Munshi
- Department of Urology, King Abdullah Medical City, Makkah, SAU
| | - Musab M Alghamdi
- Department of Urology, International Medical Center, Jeddah, SAU
| | - Ahmad M Bugis
- Department of Urology, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mohamed A Elkoushy
- Department of Urology, King Abdullah Medical City, Makkah, SAU.,Department of Urology, Suez Canal University, Ismailia, EGY
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Abdou Hassan W, Shalaby E, Abo-Hashesh M, Ibrahim Ali R. Evaluation of the Expression of HER2 and c-KIT Proteins as Prognostic Markers in Superficial Bladder Urothelial Carcinoma. Res Rep Urol 2021; 13:197-206. [PMID: 33981633 PMCID: PMC8109022 DOI: 10.2147/rru.s296974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background The roles of c-KIT and HER2 protein expression in bladder cancer are still debated, and the prognostic value of these proteins as markers of tumor progression is inconclusive. Objective To assess the impact of HER2 and c-KIT protein expressions in the progression of non-muscle-invasive bladder cancer. Methods All patients undergoing transurethral resection of bladder tumors for non-muscle-invasive urothelial carcinoma, with standard regimen of BCG, between January 2017 and November 2019, were evaluated pathologically and immunohistochemically for HER1 and c-KIT proteins in urothelial carcinoma cells. Follow-up cystoscopy was performed for 100 patients every 3 months for the first 2-years and any recurred tumors were excised and examined pathologically, as well as stained for HER2 and c-KIT protein expression. Results HER2 and c-KIT positive expressions were detected in 49% and 38% of cases, respectively. After a mean follow-up of 26.4±7.2 months, the overall recurrence and progression rates were significantly correlated with overexpression of HER2 and c-KIT. In high-grade non-invasive muscle neoplasms, tumor cells showed weak expression for both HER2 and c-KIT proteins, but with progression to muscle-invasion, tumor cells strongly expressed HER2 and lost expression to c-KIT. In the multivariate model, overexpression of HER2 rather than c-KIT protein significantly predicted increased progression. Conclusion Recurrence and progression of non-muscle-invasive bladder cancer correlate with overexpression of HER2 and c-KIT proteins in tumor cells.
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Affiliation(s)
- Wael Abdou Hassan
- Department of Basic Sciences, College of Medicine, Suliman Al Rajhi University, Al Bukayriyah, Kingdom of Saudi Arabia
| | - Essam Shalaby
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Rehab Ibrahim Ali
- Department of Pathology, College of Medicine, El-Jouf University, Sakaka, Kingdom of Saudi Arabia.,Department of Pathology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Chen DY, Cheng L, Dong LX, He WJ, Cao HF, Wang P, Yue CF. Efficacy of pirarubicin for nonmuscle invasive bladder cancer: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20415. [PMID: 32501988 PMCID: PMC7306322 DOI: 10.1097/md.0000000000020415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This study will aim to appraise the efficacy and safety of pirarubicin for the treatment of patients with nonmuscle invasive bladder cancer (NMIBC). METHODS We will perform a comprehensive literature search in MEDLINE, EMBASE, Cochrane Library, Scopus, PsycINFO, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their beginning to the February 29, 2020. All randomized controlled trials of pirarubicin for NMIBC will be included regardless limitations related to the language and publication time. Two researchers will independently select studies from searched records, extract data from included randomized controlled trials, and assess study quality using Cochrane risk of bias tool. Any differences between them will be solved with the help of another researcher. RevMan 5.3 software will be utilized for statistical analysis. RESULTS This study will provide a synthesis of current evidence to investigate the efficacy and safety of pirarubicin for NMIBC using overall survival, progression-free survival, recurrence-free survival, quality of, rates of recurrence, and adverse events. CONCLUSION This study will explore whether or not pirarubicin can be used as an effective and safety treatment for patients with NMIBC. REGISTRATION NUMBER INPLASY202040113.
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Affiliation(s)
| | | | | | - Wen-Jie He
- Department of Outpatient, The First Affiliated Hospital of Jiamusi University
| | | | - Ping Wang
- Forensic Identification Center, Criminal Technology Division of Jiamusi Public Security Bureau
| | - Cai-Fang Yue
- Department of Critical Care Medicine, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Koch GE, Luckenbaugh AN, Chang SS. High-Risk Nonmuscle Invasive Bladder Cancer: Selecting the Appropriate Patient for Timely Cystectomy. Urology 2020; 147:7-13. [PMID: 32445767 DOI: 10.1016/j.urology.2020.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/18/2020] [Accepted: 05/10/2020] [Indexed: 11/26/2022]
Abstract
The heterogenous nature of high-risk nonmuscle invasive bladder cancer encompasses a wide range of tumor biologies with varying recurrence and progression risks. Radical cystectomy provides excellent oncologic outcomes but is often underutilized. Timing for these patients is critical, however, to its effectiveness. Certain unfavorable tumor characteristics predict worse outcomes and may help select the most appropriate patients for more aggressive initial therapy. This manuscript aims to outline factors that predict worse outcomes in high-risk nonmuscle invasive bladder cancer and proposes which patients may benefit most from a timely radical cystectomy.
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Affiliation(s)
- George E Koch
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Amy N Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN.
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7
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The Role and Importance of Timely Radical Cystectomy for High-Risk Non-muscle-Invasive Bladder Cancer. Cancer Treat Res 2019; 175:193-214. [PMID: 30168123 DOI: 10.1007/978-3-319-93339-9_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Non-muscle-invasive bladder cancer accounts for the majority of incident bladder cancers but is a heterogeneous disease with variation in clinical presentation, course, and outcomes. Risk stratification techniques have attempted to identify those at highest risk of cancer recurrence and progression to help personalize and individualize treatment options. Radical cystectomy during the optimal window of curability could improve cancer outcomes; however, identifying the disease and patient characteristics as well as the correct timing to intervene remains difficult. We review the natural history of non-muscle-invasive bladder cancer, discuss different risk-stratification techniques and how they can help identify those most likely to benefit from radical treatment, and examine the evidence supporting the benefit of timely cystectomy.
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8
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Shen PL, lin ME, Hong YK, He XJ. Bladder preservation approach versus radical cystectomy for high-grade non-muscle-invasive bladder cancer: a meta-analysis of cohort studies. World J Surg Oncol 2018; 16:197. [PMID: 30285788 PMCID: PMC6169022 DOI: 10.1186/s12957-018-1497-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND High-grade non-muscle-invasive bladder cancer is superficial; nonetheless, it is an aggressive cancer. Proper management strategy selection following transurethral resection between bladder preservation (BP) and radical cystectomy (RC) could result in delayed or excessive treatment. Hence, selecting the optimal treatment modality remains controversial to date. METHODS We searched MEDLINE, The Cochrane Library, EMBASE, China National Knowledge Infrastructure, and Wanfang database through 12 April 2018. Quality and publication bias were assessed using the Newcastle-Ottawa Scale and Begg's/Egger's test. We collected 2-year, 5-year, 10-year, and 15-year survival rate and hazard ratio (HR) for overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS). Using the Review Manager 5.2 software, we used the odds ratio (OR) of specific years and HR for meta-analysis. Subgroup analysis was performed by the original tumor state, radical cystectomy timing, bladder preservation modality, and age. RESULTS In total, 11 cohorts with 1735 patients were selected for the meta-analysis. All OR of OS supported BP as a better treatment option; however, all OR of PFS had no significant differences. As for CSS, only the 15-year OR reflected a statistical significance preferring RC. Subgroup analysis showed that BP is more appropriate for patients older than 65 and G3 tumor. Limited data demonstrated that late RC (> 3 months) is more effective compared to early RC (< 3 months) and intravesical Bacillus Calmette-Guerin was not statistically different from that of RC. The mixed BP modalities were significantly better compared to RC in OS and worse in CSS, with both having a very low evidence strength. CONCLUSIONS BP is a superior treatment modality compare to RC, especially for older patients and T1G3 or lower grade tumors. However, the superior BP modality was unclear. Conversely, RC could be a better option for younger patients. More specifically, late RC may be more beneficial but had a very-low-level of evidence. Quality of life should be considered equal to survival outcome; hence, post-treatment follow-up needs to be performed. Prospective randomized studies should be performed to overcome the limitations of this meta-analysis study. REGISTRATION Registration ID is CRD42018093491 .
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Affiliation(s)
- Pei-lin Shen
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Jinping District, Shantou, Guangdong China
- Shantou University Medical College, No. 22, Xinling Road, Jinping District, Shantou, Guangdong China
| | - Ming-en lin
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Jinping District, Shantou, Guangdong China
| | - Ying-kai Hong
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Jinping District, Shantou, Guangdong China
| | - Xue-jun He
- Department of Urology, The First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Jinping District, Shantou, Guangdong China
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Aragon-Ching JB, Werntz RP, Zietman AL, Steinberg GD. Multidisciplinary Management of Muscle-Invasive Bladder Cancer: Current Challenges and Future Directions. Am Soc Clin Oncol Educ Book 2018; 38:307-318. [PMID: 30231340 DOI: 10.1200/edbk_201227] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The treatment of muscle-invasive bladder cancer (MIBC) is complex and requires a multidisciplinary collaboration among surgery, radiation, and medical oncology. Although neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC) and lymph node dissection has been considered the standard treatment for MIBC, many patients are unfit for surgery or cisplatin-ineligible, and considerations for bladder-preservation strategies not only are increasingly recognized as optimal treatment alternatives, but also should feature in the range of management options presented to patients at the time of diagnosis. Apart from chemotherapy, immunotherapy has also been used with success in locally advanced and metastatic bladder cancer and is moving into the MIBC space. Prospective studies addressing trends in management that span systemic, surgical, and radiation options for patients are discussed in this article.
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Affiliation(s)
- Jeanny B Aragon-Ching
- From the Genitourinary Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA; Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ryan P Werntz
- From the Genitourinary Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA; Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anthony L Zietman
- From the Genitourinary Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA; Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Gary D Steinberg
- From the Genitourinary Medical Oncology, Inova Schar Cancer Institute, Fairfax, VA; Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL; Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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10
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Faiena I, Dombrovskiy VY, Sultan RC, Salmasi AH, Singer EA, Weiss RE. Effect of Uncontrolled Diabetes on Outcomes After Cystectomy in Patients With Bladder Cancer: A Population-Based Study. Clin Genitourin Cancer 2016; 14:e509-e514. [PMID: 26997576 DOI: 10.1016/j.clgc.2016.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/04/2016] [Accepted: 02/14/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND We evaluated the complications, mortality, hospital length of stay (LOS), and cost for patients with diabetes undergoing radical cystectomy (RC). MATERIALS AND METHODS Data were extracted from the National (Nationwide) Inpatient Sample for 2001 to 2012 using the "International Classification of Diseases, Ninth Revision, Clinical Modification" codes for patients with uncontrolled diabetes (UD) (patients with diabetes receiving treatment that did not keep the blood glucose at acceptable levels) and controlled diabetes (CD) (patients with diabetes not otherwise stated as uncontrolled) who had undergone RC. χ2 and Wilcoxon rank sum tests and multivariable regression analysis were used for statistics. The LOS and cost are presented as the median and interquartile range. RESULTS In the present study, 989 patients had UD, 15,693 CD, and 73,603 had no diabetes (ND). Postoperative complications were significantly more common in the UD group (73%) than in the CD (51%) and ND (52%) groups (P < .0001). On multivariable analysis, the UD group were more likely than the CD group to have any complication (odds ratio [OR], 2.3; 95% confidence interval [CI], 2.0-2.7), including renal (OR, 2.1; 95% CI, 1.8-2.4) and infectious (OR, 2.7; 95% CI, 2.3-3.1) complications. Patients with UD were also 4.3 times (95% CI, 3.1-5.8) more likely to die after surgery than were patients with CD. The ND group was slightly more likely than the CD group to experience any complication (OR, 1.13; 95% CI, 1.09-1.17) and death (OR, 1.6; 95% CI, 1.4-1.8). The LOS and cost for UD patients were greater than for CD patients. On multivariable analysis, UD patients had a 30% increase in LOS and 23% increase in cost (P < .0001). CONCLUSION The findings from the present study have demonstrated an increase in post-RC complications rates, hospital mortality, and hospital resource usage for patients with UD undergoing RC. UD might be a modifiable preoperative risk factor for post-RC morbidity and mortality. Further studies are needed to validate this association.
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Affiliation(s)
- Izak Faiena
- Division of Urology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
| | - Viktor Y Dombrovskiy
- Division of Urology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Raymond C Sultan
- Division of Urology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Amirali H Salmasi
- Division of Urology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Eric A Singer
- Division of Urology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Robert E Weiss
- Division of Urology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Pagano MJ, Badalato G, McKiernan JM. Optimal treatment of non-muscle invasive urothelial carcinoma including perioperative management revisited. Curr Urol Rep 2015; 15:450. [PMID: 25234184 DOI: 10.1007/s11934-014-0450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Non-muscle invasive urothelial carcinoma is a heterogeneous disease that requires the practicing urologist to implement a variety of surgical and non-surgical treatment strategies. The disease course can range from recurrent low grade papillary disease to aggressive disease concerning for progression from initial presentation. Depending on the particular patient and goals of care, treatments similarly span the range from minimally invasive fulgurations to immediate radical cystectomy. For most patients some form of intravesical therapy will bridge the gap between transurethral resections (TUR) and radical surgery. Recent advances in the field continue to emphasize the importance of quality TUR and its strong impact on outcomes. In addition, continued research to optimize intravesical therapies has provided more information about how, when, and in whom these agents should be utilized to enhance their efficacy. This review covers the current state of NMIBC and the standards of care for the management of this disease.
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Affiliation(s)
- Matthew J Pagano
- Department of Urology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave., 11th Floor, New York, NY, 10032, USA,
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12
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Badalato GM, Gaya JM, Hruby G, Patel T, Kates M, Sadeghi N, Benson MC, McKiernan JM. Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference? BJU Int 2012; 110:1471-7. [PMID: 22487512 DOI: 10.1111/j.1464-410x.2012.11116.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether a survival difference exists between patients with high grade (HG) cT1 urothelial cell carcinoma (UCC) receiving immediate radical cystectomy (IRC) as opposed to those choosing bladder-sparing therapy. PATIENTS AND METHODS Between January 1990 and August 2010, 349 patients were retrospectively identified with a diagnosis of HG cT1 UCC of the bladder. Patients were divided into two groups: those who underwent IRC and those treated with conservative management (CM), consisting of transurethral resection of the bladder tumour (TURBT) and intravesical therapy. IRC was defined as surgery within 90 days of HG cT1 diagnosis with no intervening transurethral resection (TUR) or intravesical therapy (IVT). Trends in patient selection and cancer-specific survival (CSS) were analyzed over consecutive decades. The primary outcome was to compare CSS among patients during consecutive decades whereby management paradigms shifted from IRC to CM. The secondary outcome was to examine whether patient selection changed over time for each respective intervention. RESULTS One hundred and thirteen patients underwent IRC and 236 had CM. From 1990 to 1999, only 90 patients were diagnosed with HG cT1 disease, and a majority of patients (n= 54) underwent IRC. From 2000 to 2010, only 23% (59/259) of the patients with HG cT1 underwent IRC. Despite 42.3% more patients successfully maintaining their bladder in the long-term, no difference in 5 year bladder CSS was noted between decades (77% vs 80% consecutively, P= 0.566). A subset analysis of risk factors for bladder cancer progression/recurrence demonstrated more patients with lymphovascular invasion (LVI) on TUR underwent IRC in the current era (13/59 (22.0%) vs 13/200 (6.5%), P < 0.001). These findings remain to be validated in prospective work at other institutions. CONCLUSION Conservative management strategies are a viable treatment option within a well selected subset of patients with HG cT1 UCC.
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Affiliation(s)
- Gina M Badalato
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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Klotz L. Prostate capsule sparing radical cystectomy: oncologic safety and clinical outcome. Ther Adv Urol 2011; 1:43-50. [PMID: 21789053 DOI: 10.1177/1756287209103921] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Prostate capsule sparing radical cystectomy (PSRC) is a modification of the traditional surgical approach to radical cystectomy and neobladder, which offers the prospect of improved preservation of erectile function and continence. METHODS This is a review of the literature regarding the oncologic and quality of life outcomes of this approach for transitional cell carcinoma of the bladder, and a comparison of these results to conventional cystoprostatectomy and neobladder. RESULTS There are a limited number of studies addressing prostate capsule or prostate sparing cystectomy. All are retrospective, non-comparative and not uniform in terms of patient selection and technique. Long-term follow-up is lacking. The incidence of synchronous and or metachronous prostate cancer and TCC of the prostatic urethra is lower than that found in conventional cystoprostatectomy. This is likely due to pre-operative patient selection, restricting the procedure to those with no evidence of prostatic involvement by either disease. The local recurrence rate is 5%, comparable to standard cystoprostatectomy. Recurrence free and overall survival rates are comparable.
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Affiliation(s)
- Laurence Klotz
- Professor of Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave. #MG408, Toronto, Ontario M4N 3M5, Canada
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Prasad SM, Decastro GJ, Steinberg GD. Urothelial carcinoma of the bladder: definition, treatment and future efforts. Nat Rev Urol 2011; 8:631-42. [PMID: 21989305 DOI: 10.1038/nrurol.2011.144] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The identification of patients with high-risk bladder cancer is important for the timely and appropriate treatment of this lethal disease. The understanding of the natural history of bladder cancer has improved; however, the criteria used to define high-risk disease and the relevant treatment strategies have remained the same for the past several decades, despite multiple large, randomized, prospective clinical trials that have evaluated the use of intravesical, surgical and systemic therapies. The genetic signature of high-risk bladder cancer has been a focus of investigation and has led to the discovery of potential molecular targets for disease identification, risk stratification and therapy. These advances, combined with a comprehensive risk assessment profile that incorporates available pathological and clinical characteristics, might improve the diagnosis and treatment of patients with bladder cancer.
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Affiliation(s)
- Sandip M Prasad
- Section of Urology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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Jäger W, Thomas C, Haag S, Hampel C, Salzer A, Thüroff JW, Wiesner C. Early vs delayed radical cystectomy for 'high-risk' carcinoma not invading bladder muscle: delay of cystectomy reduces cancer-specific survival. BJU Int 2011; 108:E284-8. [PMID: 21244611 DOI: 10.1111/j.1464-410x.2010.09980.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE •To analyze the impact of a delayed radical cystectomy (rCx) and clinical variables on cancer-specific survival (CSS) in patients presenting 'high-risk' carcinoma not invading bladder muscle (nmiBCA). PATIENTS AND METHODS •Between 1989 and 2006, 278 patients who presented 'high-risk' nmiBCA finally underwent rCx in our institution. •CSS was correlated with clinical variables such as the number of transurethral resections of the bladder (TURBs), interval between first TURB and rCx, adjuvant therapies, tumour upstaging at rCx, tumour stage and lymph node (LN) status. RESULTS •The overall 5- and 10-year CSS was 82% and 76%, respectively. Significant correlations were found between the 5-year CSS and categorized number of TURBs (≤2 vs >2: 88% vs 71%; P= 0.001), interval between first TURB and rCx (≤4 months vs >4 months: 86% vs 77%; P= 0.04), adjuvant therapies (no vs yes: 86% vs 66%; P= 0.001), tumour upstaging at rCx (no vs yes: 89% vs 67%; P < 0.001), tumour stage at rCx (bladder confined vs non-confined: 88% vs 56%; P < 0.001) and LN status (no vs yes: 88% vs 36%; P < 0.001). •Multivariate analysis identified categorized number of TURBs (hazard ratio, HR, 0.14; 95% CI, 0.07-0.44; P < 0.001), categorized interval between first TURB and rCx (HR, 3.27; 95% CI, 1.24-8.59; P= 0.017), LN status (HR, 0.13; 95% CI, 0.06-0.26; P < 0.001) and tumour stage at rCx (HR, 0.49; 95% CI, 0.26-0.92; P= 0.03) as independent risk factors for CSS. CONCLUSION •Delay of rCx in 'high-risk' nmiBCA deteriorates CSS and should be avoided. The number of TURBs and the interval between first TURB and rCx are causative factors for delayed rCx and are independently correlated with CSS.
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Affiliation(s)
- Wolfgang Jäger
- Department of Urology, University Medical Center Mainz, Germany.
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Ukai R, Hashimoto K, Iwasa T, Nakayama H. Transurethral resection in one piece (TURBO) is an accurate tool for pathological staging of bladder tumor. Int J Urol 2010; 17:708-14. [DOI: 10.1111/j.1442-2042.2010.02571.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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DeGraff DJ. Novel use of a combined artificial intelligence approach to identify patients with noninvasive urothelial cell carcinoma of the urinary bladder who are at greatest risk for progression to muscle-invasive disease: a step forward. Eur Urol 2009; 57:407-8; discussion 408-9. [PMID: 19945780 DOI: 10.1016/j.eururo.2009.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Accepted: 11/18/2009] [Indexed: 10/20/2022]
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Abstract
Benchmarks are established standards of operation developed by a given group or industry generally designed to improve outcomes. The health care industry is increasingly required to develop such standards and document adherence to meet demands of regulatory bodies. Although established practice patterns exist for the treatment of invasive bladder cancer, there is significant treatment variation. This article provides a rationale for the development of benchmarks in the treatment of invasive bladder cancer. Such benchmarks may permit advances in treatment application and potentially improve patient outcomes.
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Affiliation(s)
- Cheryl T Lee
- Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA.
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Cookson MS. Re: A Re-staging Transurethral Resection Predicts Early Progression of Superficial Bladder Cancer. Eur Urol 2006. [DOI: 10.1016/j.eururo.2006.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bibliography. Current world literature. Bladder cancer. Curr Opin Urol 2006; 16:386-9. [PMID: 16905987 DOI: 10.1097/01.mou.0000240314.93453.d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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