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For: Mastroianni R, Tuderti G, Ferriero M, Anceschi U, Bove AM, Brassetti A, Misuraca L, D'Annunzio S, Guaglianone S, Gallucci M, Simone G. Open versus robot-assisted radical cystectomy: pentafecta and trifecta achievement comparison from a randomised controlled trial. BJU Int 2023;132:671-677. [PMID: 37470132 DOI: 10.1111/bju.16134] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]

For:	Mastroianni R, Tuderti G, Ferriero M, Anceschi U, Bove AM, Brassetti A, Misuraca L, D'Annunzio S, Guaglianone S, Gallucci M, Simone G. Open versus robot-assisted radical cystectomy: pentafecta and trifecta achievement comparison from a randomised controlled trial. BJU Int 2023;132:671-677. [PMID: 37470132 DOI: 10.1111/bju.16134] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]

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Cited by Other Article(s)

Flammia RS, Tuderti G, Bologna E, Minore A, Proietti F, Licari LC, Mastroianni R, Bove AM, Anceschi U, Brassetti A, Ferriero MC, Guaglianone S, Chiacchio G, Calabrò F, Leonardo C, Simone G. Stratifying the Risk of Disease Progression among Surgically Treated Muscle-Invasive Bladder Cancer Eligible for Adjuvant Nivolumab. J Clin Med 2024;13:5466. [PMID: 39336951 PMCID: PMC11432608 DOI: 10.3390/jcm13185466] [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: 08/12/2024] [Revised: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open

Abstract

Background: Check-Mate 274 has demonstrated the disease-free survival (DFS) benefit of adjuvant nivolumab in surgically treated muscle-invasive bladder cancer (MIBC). Since immunotherapy represents an expensive treatment with potential side effects, a better understanding of patient-specific risks of disease progression might be useful for clinicians when weighing the indication for adjuvant nivolumab. Objective: To identify the criteria for risk stratification of disease progression among MIBC patients eligible for adjuvant nivolumab. Materials and methods: A single-institution, prospectively maintained database was queried to identify patients eligible for adjuvant nivolumab according to Check-Mate 274 criteria. To account for immortal bias, patients who died or were lost to follow-up within 3 months of undergoing a radical cystectomy (RC) were excluded. Kaplan-Meier and Cox regression analyses addressed DFS, defined as the time frame from diagnosis to the first documented recurrence or death from any cause, whichever occurred first. Regression tree analysis was implemented to identify criteria for risk stratification. Results: Between 2011 and 2022, 304 patients were identified, with a median follow-up of 50 (IQR 24-72) months. After multivariable adjustment, including NAC as a potential confounder, higher CCI (HR 1.56, 95%CI 1.10-2.21, p = 0.013), T stage (HR 2.06, 95%CI 1.01-4.17, p = 0.046), N stage (HR 1.73, 95%CI 1.26-2.38, p = 0.001) and presence of LVI (HR 1.52, 95%CI 1.07-2.15, p = 0.019) increased the risk of disease recurrence or death. Finally, a two-tier classification was developed. Here, five-year DFS rates were 56.1% vs. 18.1 for low vs. high risk (HR: 2.54, 95%CI 1.79-3.62, p < 0.001). Conclusions: The current risk classification, if externally validated on larger samples, may be useful when weighing the risk and benefit of adjuvant nivolumab treatment and making patients more aware about their disease and about the need for additional treatment after RC.

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Affiliation(s)

Rocco Simone Flammia Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.) Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
Gabriele Tuderti Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Eugenio Bologna Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.) Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
Antonio Minore Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Flavia Proietti Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.) Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
Leslie Claire Licari Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Riccardo Mastroianni Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Alfredo Maria Bove Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Umberto Anceschi Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Aldo Brassetti Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Maria Consiglia Ferriero Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Salvatore Guaglianone Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Giuseppe Chiacchio Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Fabio Calabrò Department of Oncology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy;
Costantino Leonardo Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)
Giuseppe Simone Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00128 Rome, Italy; (R.S.F.); (G.T.); (E.B.); (L.C.L.); (R.M.); (A.M.B.); (U.A.); (A.B.); (M.C.F.); (S.G.); (G.C.); (G.S.)

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Chiacchio G, Mastroianni R, Simone G. Continent or Incontinent Urinary Diversion: That is the Question. Ann Surg Oncol 2024;31:5497-5498. [PMID: 38896230 DOI: 10.1245/s10434-024-15525-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 06/21/2024]

Wong CHM, Ko ICH, Kang SH, Kitamura K, Horie S, Muto S, Ohyama C, Hatakeyama S, Patel M, Yang CK, Kijvikai K, Youl LJ, Chen HG, Zhang RY, Lin TX, Lee LS, Teoh JYC, Chan E. Long-Term Outcomes of Orthotopic Neobladder Versus Ileal Conduit Urinary Diversion in Robot-Assisted Radical Cystectomy (RARC): Multicenter Results from the Asian RARC Consortium. Ann Surg Oncol 2024;31:5785-5793. [PMID: 38802711 PMCID: PMC11300606 DOI: 10.1245/s10434-024-15396-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024]

Abstract

PURPOSE

Robot-assisted radical cystectomy (RARC) has gained traction in the management of muscle invasive bladder cancer. Urinary diversion for RARC was achieved with orthotopic neobladder and ileal conduit. Evidence on the optimal method of urinary diversion was limited. Long-term outcomes were not reported before. This study was designed to compare the perioperative and oncological outcomes of ileal conduit versus orthotopic neobladder cases of nonmetastatic bladder cancer treated with RARC.

PATIENTS AND METHODS

The Asian RARC consortium was a multicenter registry involving nine Asian centers. Consecutive patients receiving RARC were included. Cases were divided into the ileal conduit and neobladder groups. Background characteristics, operative details, perioperative outcomes, recurrence information, and survival outcomes were reviewed and compared. Primary outcomes include disease-free and overall survival. Secondary outcomes were perioperative results. Multivariate regression analyses were performed.

RESULTS

From 2007 to 2020, 521 patients who underwent radical cystectomy were analyzed. Overall, 314 (60.3%) had ileal conduit and 207 (39.7%) had neobladder. The use of neobladder was found to be protective in terms of disease-free survival [Hazard ratio (HR) = 0.870, p = 0.037] and overall survival (HR = 0.670, p = 0.044) compared with ileal conduit. The difference became statistically nonsignificant after being adjusted in multivariate cox-regression analysis. Moreover, neobladder reconstruction was not associated with increased blood loss, nor additional risk of major complications.

CONCLUSIONS

Orthotopic neobladder urinary diversion is not inferior to ileal conduit in terms of perioperative safety profile and long-term oncological outcomes. Further prospective studies are warranted for further investigation.

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Affiliation(s)

Chris Ho-Ming Wong S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
Ivan Ching-Ho Ko S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China
Seok Ho Kang Department of Urology, Korea University Anam Hospital, Seoul, Republic of Korea
Kousuke Kitamura Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
Shigeo Horie Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
Satoru Muto Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
Chikara Ohyama Department of Urology, Hirosaki University, Hirosaki, Japan
Shingo Hatakeyama Department of Urology, Hirosaki University, Hirosaki, Japan
Manish Patel Department of Urology, The University of Sydney, Sydney, Australia
Cheung-Kuang Yang Department of Urology, Taichung Veterans General Hospital, Taichung, Taiwan
Kittinut Kijvikai Department of Urology, Ramathibodi Hospital, Mahidol University, Salaya, Thailand
Lee Ji Youl Department of Urology, Catholic University of Korea, Seoul, Republic of Korea
Hai-Ge Chen Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
Rui-Yun Zhang Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
Tian-Xin Lin Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
Lui Shiong Lee Department of Urology, Sengkang General Hospital, Singapore, Singapore
Jeremy Yuen-Chun Teoh S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China.
Eddie Chan S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine, Clinical Sciences Building, Prince of Wales Hospital, New Territories, The Chinese University of Hong Kong, Hong Kong SAR, China

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Mastroianni R, Iannuzzi A, Ragusa A, Flammia RS, Tuderti G, Anceschi U, Bove AM, Brassetti A, D'Annunzio S, Ferriero M, Misuraca L, Proietti F, Anselmi M, Guaglianone S, Leonardo C, Papalia R, Simone G. Long survivors after radical cystectomy versus healthy population: propensity score matched analysis of health-related quality of life. World J Urol 2024;42:484. [PMID: 39143260 DOI: 10.1007/s00345-024-05187-8] [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: 04/30/2024] [Accepted: 07/19/2024] [Indexed: 08/16/2024] Open

Tuderti G, Chiacchio G, Mastroianni R, Anceschi U, Bove AM, Brassetti A, D'Annunzio S, Ferriero M, Misuraca L, Proietti F, Flammia RS, Guaglianone S, Lombardo R, Anselmi M, Zampa A, Nunzio C, Pastore AL, Galosi AB, Leonardo C, Gallucci M, Simone G. Impact of diabetes mellitus on oncologic outcomes in patients receiving robot-assisted radical cystectomy for bladder cancer. World J Urol 2024;42:479. [PMID: 39133312 DOI: 10.1007/s00345-024-05178-9] [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: 06/25/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open

Abstract

PURPOSE

Aim of this study is to investigate the association between DM and oncological outcomes among patients with muscle-invasive (MI) or high-risk non-muscle invasive (NMI) bladder cancer (BC) who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion (RARC).

METHODS

An IRB approved multi-institutional BC database was queried, including patients underwent RARC between January 2013 and June 2023. Patients were divided into two groups according to DM status. Baseline, clinical, perioperative, pathologic data were compared. Chi-square and Student t tests were performed to compare categorical and continuous variables, respectively. Kaplan-Meier method and Cox regression analyses were performed to assess the association between DM and oncologic outcomes.

RESULTS

Out of 547 consecutive patients, 97 (17.7%) had DM. The two cohorts showed similar preoperative features, except for ASA score (p = 0.01) and Hypertension rates (p < 0.001). No differences were detected for perioperative complications, pT stage, pN stages and surgical margins status (all p > 0.12). DM patients displayed significantly lower 5-yr disease-free survival (DFS) (44.6% vs. 63.3%, p = 0.007), 5-yr cancer-specific survival (CSS) (45.1% vs. 70.1%, p = 0.001) and 5-yr Overall survival (OS) (39.9% vs. 63.8%, p = 0.001). At Multivariable Cox-regression analyses DM status was identified as independent predictor of worse cancer-specific survival (CSS) (HR 2.1; p = 0.001) and overall survival (OS) (HR 2.05; p < 0.001).

CONCLUSION

Among BC patients who underwent RARC, DM patients showed worse oncologic outcomes than the non-DM patients, with DM status playing an independent negative predicting role in CSS and OS. Future prospective studies are awaited, stimulating basic and translational research to identify possible mechanisms of interaction between DM and BC.

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Affiliation(s)

Gabriele Tuderti Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Giuseppe Chiacchio Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy.
Riccardo Mastroianni Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Umberto Anceschi Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Alfredo Maria Bove Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Aldo Brassetti Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Simone D'Annunzio Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Mariaconsiglia Ferriero Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Leonardo Misuraca Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Flavia Proietti Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Rocco Simone Flammia Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Salvatore Guaglianone Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Riccardo Lombardo Department of Urology, "Sapienza" University of Rome-Ospedale Sant'Andrea, Rome, Italy
Marianna Anselmi Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Ashanti Zampa Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
CosimoDe Nunzio Department of Urology, "Sapienza" University of Rome-Ospedale Sant'Andrea, Rome, Italy
Antonio Luigi Pastore Department of Urology, "Sapienza" University of Rome -ICOT Latina Polo Pontino, Latina, Italy
Andrea Benedetto Galosi Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
Costantino Leonardo Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Michele Gallucci Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy
Giuseppe Simone Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Via Elio, Chianesi 53, Rome, Italy

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Tuderti G, Mastroianni R, Anceschi U, Bove AM, Brassetti A, Ferriero M, Misuraca L, Flammia RS, Proietti F, D'Annunzio S, Leonardo C, Guaglianone S, Anselmi M, Zampa A, Torregiani G, Gallucci M, Simone G. Learning curve for intracorporeal robotic Padua ileal bladder: 10-year functional assessment from a high-volume single-centre series. BJU Int 2024;134:103-109. [PMID: 38459659 DOI: 10.1111/bju.16328] [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: 03/10/2024]

Abstract

OBJECTIVES

To assess the impact of the learning curve (LC) on perioperative and long-term functional outcomes of a consecutive single-centre series of robot-assisted radical cystectomy with Padua intracorporeal orthotopic neobladder.

PATIENTS AND METHODS

Patients treated between 2013 and 2022 were included, with ≥1 year of follow-up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1-year day- and night-time continence. Uni- and multivariable Cox regression analyses identified predictors of day- and night-time continence recovery. Day-time continence was defined as 'totally dry' (no pads), night-time continence as pad wetness ≤50 mL (one safety pad).

RESULTS

Overall, 200 patients were included. The mean hospital stay (P = 0.002) and 30-day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1-year day- and night-time continence probabilities displayed a significant improving trend (day-time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night-time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day- (hazard ratio [HR] 1.008; P < 0.001) and night-time continence (HR 1.004; P = 0.03) over time.

CONCLUSION

Patients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10-year analyses, we observed a significant improving trend for both the 1-year day- and night-time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day- and night-time continence rates.

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Song W, Yu J, Chung JH, Kang M, Sung HH, Jeon HG, Seo SI, Jeon SS, Jeong BC. A Proposal for Standardization of Early Outcomes Following Robot-Assisted Radical Cystectomy (RARC): RARC Tetrafecta. Ann Surg Oncol 2024;31:4752-4761. [PMID: 38538821 DOI: 10.1245/s10434-024-15138-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/17/2024] [Indexed: 06/14/2024]

Mastroianni R, Chiacchio G, Simone G. Reply to Wei He, Shuxiong Zeng, and Chuanliang Xu's Letter to the Editor re: Riccardo Mastroianni, Gabriele Tuderti, Mariaconsiglia Ferriero, et al. Robot-assisted Radical Cystectomy with Totally Intracorporeal Urinary Diversion Versus Open Radical Cystectomy: 3-Year Outcomes from a Randomised Controlled Trial. Eur Urol 2024;85:422-30. Eur Urol Focus 2024:S2405-4569(24)00092-0. [PMID: 38880713 DOI: 10.1016/j.euf.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]

Gavi F, Foschi N, Fettucciari D, Russo P, Giannarelli D, Ragonese M, Gandi C, Balocchi G, Francocci A, Bizzarri FP, Marino F, Filomena GB, Palermo G, Totaro A, Racioppi M, Bientinesi R, Sacco E. Assessing Trifecta and Pentafecta Success Rates between Robot-Assisted vs. Open Radical Cystectomy: A Propensity Score-Matched Analysis. Cancers (Basel) 2024;16:1270. [PMID: 38610948 PMCID: PMC11011078 DOI: 10.3390/cancers16071270] [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: 02/06/2024] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open

Affiliation(s)

Filippo Gavi Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Nazario Foschi Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Daniele Fettucciari Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Pierluigi Russo Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Diana Giannarelli Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy
Mauro Ragonese Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Carlo Gandi Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Giovanni Balocchi Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Alessandra Francocci Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Francesco Pio Bizzarri Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Filippo Marino Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Giovanni Battista Filomena Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Giuseppe Palermo Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Angelo Totaro Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Marco Racioppi Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Riccardo Bientinesi Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco 8 Vito 1, 00168 Rome, Italy (G.P.)
Emilio Sacco Postgraduate School of Urology, Catholic University Medical School, Largo Francesco 6 Vito 1, 00168 Rome, Italy; (F.G.); (F.P.B.); (F.M.); (M.R.) Urology Department, Isola Tiberina Gemelli Isola Hospital, Catholic University Medical School, 00168 Rome, Italy

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Pyrgidis N, Schulz GB, Volz Y, Ebner B, Rodler S, Westhofen T, Eismann L, Marcon J, Stief CG, Jokisch F. The impact of perioperative risk factors on long-term survival after radical cystectomy: a prospective, high-volume cohort study. World J Urol 2024;42:164. [PMID: 38489039 PMCID: PMC10942871 DOI: 10.1007/s00345-024-04887-5] [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: 11/14/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open

Abstract

INTRODUCTION

Radical cystectomy (RC) is the gold standard for muscle-invasive bladder cancer. Nevertheless, RC is associated with substantial perioperative morbidity and mortality. We aimed to evaluate the role of important perioperative risk factors in predicting long-term survival after RC.

METHODS

An analysis of the prospective cohort of patients undergoing open RC from 2004 to 2023 at our center was performed. Patients who died within one month after RC were excluded from the study. A univariate and multivariable Cox regression analysis was performed to assess the role of sex, age, urinary diversion, preoperative values of creatinine and hemoglobin, first-day postoperative values of CRP, leucocytes, and thrombocytes, perioperative Clavien-Dindo complications, perioperative chemotherapy, admission to the intensive or intermediate care unit, as well as type of histology, pathologic T-stage, positive lymph nodes, and positive surgical margins on predicting the long-term overall survival after RC. For all analyses hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) were estimated.

RESULTS

A total of 1,750 patients with a median age of 70 years (IQR: 62-76) were included. Of them, 1,069 (61%) received ileal conduit and 650 (37%) neobladder. Overall, 1,016 (58%) perioperative complications occurred. At a median follow-up of 31 months (IQR: 12-71), 884 (51%) deaths were recorded. In the multivariable Cox regression analysis, increasing age (HR: 1.03, 95%CI: 1.02-1.04, p < 0.001), higher preoperative creatinine values (HR: 1.27, 95%CI: 1.12-1.44, p < 0.001), lower preoperative hemoglobin values (HR: 0.93, 95%CI: 0.89-0.97, p = 0.002), higher postoperative thrombocyte values (HR: 1.01, 95%CI: 1.01-1.02, p = 0.02), Clavien-Dindo 1-2 complications (HR: 1.26, 95%CI: 1.03-1.53, p = 0.02), Clavien-Dindo 3-4 complications (HR: 1.55, 95%CI: 1.22-1.96, p < 0.001), locally advanced bladder cancer (HR: 1.29, 95%CI: 1.06-1.55, p = 0.009), positive lymph nodes (HR: 1.74, 95%CI: 1.45-2.11, p < 0.001), and positive surgical margins (HR: 1.61, 95%CI: 1.29-2.01, p < 0.001) negatively affected long-term survival.

CONCLUSION

Beside increased age and worse oncological status, impaired renal function, lower preoperative hemoglobin values, higher postoperative thrombocyte values, and perioperative complications are independent risk factors for mortality in the long term in patients undergoing open RC.

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Morra S, Scheipner L, Baudo A, Jannello LMI, de Angelis M, Siech C, Goyal JA, Touma N, Tian Z, Saad F, Califano G, Creta M, Celentano G, Shariat SF, Ahyai S, Carmignani L, de Cobelli O, Musi G, Briganti A, Chun FKH, Longo N, Karakiewicz PI. The Association between Urinary Diversion Type and Other-Cause Mortality in Radical Cystectomy Patients. Cancers (Basel) 2024;16:429. [PMID: 38275870 PMCID: PMC10813972 DOI: 10.3390/cancers16020429] [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: 12/13/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open

Affiliation(s)

Simone Morra Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.) Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
Lukas Scheipner Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.) Department of Urology, Medical University of Graz, 8010 Graz, Austria;
Andrea Baudo Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.) Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy;
Letizia Maria Ippolita Jannello Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.) Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.) Department of Urology, Università degli Studi di Milano, 20126 Milan, Italy
Mario de Angelis Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.) Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
Carolin Siech Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.) Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany;
Jordan A. Goyal Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
Nawar Touma Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
Zhe Tian Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
Fred Saad Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)
Gianluigi Califano Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
Massimiliano Creta Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
Giuseppe Celentano Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
Shahrokh F. Shariat Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, 1090 Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY 10065, USA Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA Hourani Center of Applied Scientific Research, Al-Ahliyya Amman University, Amman 19328, Jordan
Sascha Ahyai Department of Urology, Medical University of Graz, 8010 Graz, Austria;
Luca Carmignani Department of Urology, IRCCS Policlinico San Donato, 20097 Milan, Italy; Department of Urology, IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
Ottavio de Cobelli Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.) Department of Oncology and Haemato-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
Gennaro Musi Department of Urology, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (O.d.C.); (G.M.) Department of Oncology and Haemato-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
Alberto Briganti Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
Felix K. H. Chun Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 39120 Frankfurt am Main, Germany;
Nicola Longo Department of Neurosciences, Science of Reproduction and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (G.C.); (M.C.); (G.C.); (N.L.)
Pierre I. Karakiewicz Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada; (L.S.); (A.B.); (L.M.I.J.); (M.d.A.); (C.S.); (J.A.G.); (N.T.); (Z.T.); (F.S.); (P.I.K.)

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Pyrgidis N, Volz Y, Ebner B, Kazmierczak PM, Enzinger B, Hermans J, Buchner A, Stief C, Schulz GB. The effect of hospital caseload on perioperative mortality, morbidity and costs in bladder cancer patients undergoing radical cystectomy: results of the German nationwide inpatient data. World J Urol 2024;42:19. [PMID: 38197902 PMCID: PMC10781819 DOI: 10.1007/s00345-023-04742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/21/2023] [Indexed: 01/11/2024] Open

Mastroianni R, Iannuzzi A, Ragusa A, Tuderti G, Ferriero M, Anceschi U, Bove AM, Brassetti A, Misuraca L, D’Annunzio S, Guaglianone S, Papalia R, Simone G. Health Related Quality of Life in Patients with Bladder Cancer Receiving a Radical Cystectomy. Cancers (Basel) 2023;15:5830. [PMID: 38136375 PMCID: PMC10741964 DOI: 10.3390/cancers15245830] [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: 11/08/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open

Abstract

Radical Cystectomy (RC) and Urinary Diversion (UD) is a complex surgery associated with a significant impact on health-related quality of life (HRQoL). However, HRQoL assessment is too often overlooked, with survival and complications being the most commonly investigated outcomes. This study aimed to identify the most impaired HRQoL features in patients receiving RC, compared to a healthy population (HP) control, as well as patients' recovery after surgery, differentiating between patients receiving ORC and RARC. Patients with Bca, who were candidates for RC with curative intent, were enrolled in the "BCa cohort". HRQoL outcomes were collected with an EORTC QLQ-C30 questionnaire. These were collected at baseline, and then at 6-, 12- and 24 mo after surgery in the BCa cohorts, and at baseline in the HP cohort. A 1:1 propensity score matched (PSM)-analysis, adjusted for age, Charlson Comorbidity Index (CCI) and smoking history, was performed. Between January 2018 and February 2023, a total of 418 patients were enrolled in the study, 116 and 302 in the BCa and HP cohorts, respectively. After applying the 1:1 propensity scored match (PSM) analysis, two homogeneous cohorts were selected, including 85 patients in each group. Baseline HRQoL assessment showed a significant impairment in terms of emotional and cognitive functioning, appetite loss and financial difficulties for the BCa cohort. Among secondary outcomes, we investigated patients' recovery after RC and UD, comparing HRQoL outcome questionnaires between the HP and BCa cohorts at 6-, 12- and 24 mo after surgery, and a subgroup analysis was performed differentiating between patients receiving ORC and RARC with totally intracorporeal UD. Interestingly, ORC compared to RARC provided a major impact on HRQoL recovery across the early, mid and long term. In particular, the ORC cohort experienced a major impairment in terms of symptoms scales items such as fatigue, nausea and vomiting, pain and appetite loss. Consequently, comparing ORC and RARC vs. HP reported a major HRQoL impairment in the ORC cohort, possibly defining a benefit of RARC in early, mid- and long-term recovery. To conclude, this study confirmed the undeniable impact of RC on HRQoL. Interestingly, we highlighted the benefit of RARC in early, mid- and long-term recovery, expressed as less impairment of symptoms scales.

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Affiliation(s)

Riccardo Mastroianni Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Andrea Iannuzzi Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.I.); (A.R.); (R.P.)
Alberto Ragusa Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.I.); (A.R.); (R.P.)
Gabriele Tuderti Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Mariaconsiglia Ferriero Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Umberto Anceschi Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Alfredo Maria Bove Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Aldo Brassetti Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Leonardo Misuraca Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Simone D’Annunzio Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Salvatore Guaglianone Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)
Rocco Papalia Department of Urology, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy; (A.I.); (A.R.); (R.P.)
Giuseppe Simone Department of Urology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (G.T.); (M.F.); (U.A.); (A.M.B.); (A.B.); (L.M.); (S.D.); (S.G.); (G.S.)

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