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Wei F, Li T, Zhang Y, Ding J, Zhang G, Li X, Gan W, Zhang S, Guo H, Yang R. A propensity-score-matched comparison of standard and extended pelvic lymph node dissection in robot-assisted laparoscopic radical cystectomy. J Robot Surg 2024; 18:295. [PMID: 39068352 DOI: 10.1007/s11701-024-01990-y] [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: 04/15/2024] [Accepted: 05/21/2024] [Indexed: 07/30/2024]
Abstract
To compare the difference in perioperative outcomes between standard pelvic lymph node dissection (sPLND) and extended pelvic lymph node dissection (ePLND) in robot-assisted radical cystectomy (RARC) and evaluate the survival outcomes. The clinical data were retrospectively collected from patients who underwent RARC between January 2016 and December 2020 in Nanjing Drum Hospital. The patients were divided into sPLND and ePLND group according to the extent of pelvic lymph node dissection. Finally, 80 pairs of patients obtained for two groups by propensity score matching (PSM) and their perioperative and survival outcomes were analyzed. The median number of dissected lymph nodes (LN) after PSM was 13 in sPLND group and 16 in ePLND group (P = 0.004). Perioperative complications were similar between 2 groups. After PSM, ePLND improved 5-year RFS and OS in all patients (85.74 vs. 61.94%, P = 0.004; 82.80 vs. 67.50%, P = 0.033), patients with ≥ T3 disease (73.66 vs. 23.86%; P = 0.007; 68.20 vs. 36.20%; P = 0.032) and patients with LN metastasis (67.70 vs. 7.33%; P = 0.004; 60.60 vs. 16.67%; P = 0.045) compared to sPLND. Extended PLND significantly increased lymph node yield without increasing complication and improved RFS and OS compared to sPLND.
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Affiliation(s)
- Fayun Wei
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tianhang Li
- Department of Urology, Affiliated Zhongda Hospital of Southeast University, Nanjing, Jiangsu, China
| | - Yulin Zhang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jiarong Ding
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Gutian Zhang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaogong Li
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Weidong Gan
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Shiwei Zhang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| | - Hongqian Guo
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| | - Rong Yang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
- Department of Urology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
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van Gennep EJ, Claps F, Bostrom PJ, Shariat SF, Neuzillet Y, Zlotta AR, Trombetta C, Eckstein M, Mertens LS, Bussani R, Burger M, Boormans JL, Wullich B, Hartmann A, Mayr R, Pavan N, Bartoletti R, Mir MC, Pouessel D, van der Hoeven J, van der Kwast TH, Allory Y, Zuiverloon TC, Lotan Y, van Rhijn BW. Multi-Center Assessment of Lymph-Node Density and Nodal-Stage to Predict Disease-Specific Survival in Patients with Bladder Cancer Treated by Radical Cystectomy. Bladder Cancer 2024; 10:119-132. [PMID: 39131875 PMCID: PMC11308645 DOI: 10.3233/blc-230086] [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: 10/21/2023] [Accepted: 04/08/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Prognostic tools in pathological-node (pN) patients after radical cystectomy (RC) are needed. OBJECTIVES To evaluate the prognostic impact of lymph node (LN)-density on disease-specific survival (DSS) in patients with bladder cancer (BC) undergoing RC with pelvic lymph node dissection. METHODS We analyzed a multi-institutional cohort of 1169 patients treated with upfront RC for cT1-4aN0M0 urothelial BCat nine centers. LN-densitywas calculated as the ratio of the number of positive LNs×100% to the number of LNs removed. The optimal LN-density cut-off value was defined by creating a time-dependent receiver operating characteristic (ROC) curve in pN patients. Univariable and multivariable Cox' regression analyses were used to assess the effect of conventional Tumor Nodes Metastasis (TNM) nodal staging system, LN-density and other LN-related variables on DSS in the pN-positive cohort. RESULTS Of the 1169 patients, 463 (39.6%) patients had LN-involvement. The area under the ROC curve was 0.60 and the cut-off for LN-density was set at 20%, 223 of the pN-positive patients (48.2%) had a LN-density ≥ 20%. In multivariable models, the number of LN-metastases (HR 1.03, p = 0.005) and LN-density, either as continuous (HR 1.01, p = 0.013) or as categorical variable (HR 1.37, p = 0.014), were independently associated with worse DSS, whereas pN-stage was not. CONCLUSIONS LN-density ≥ 20% was an independent predictor of worse DSS in BC patients with LN-involvement at RC. The integration of LN-density and other LN-parameters rather than only conventional pN-stage may contribute to a more refined risk-stratification in BC patients with nodal involvement.
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Affiliation(s)
- Erik J. van Gennep
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy
| | - Peter J. Bostrom
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- Department of Urology, Turku University Hospital and University of Turku, Turku, Finland
| | - Shahrokh F. Shariat
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, 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
| | - Yann Neuzillet
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Molecular Oncology Team, Institut Curie, CNRS, UMR144, PSL Research University, Paris, France
- Department of Urology, Hôpital Foch, UVSQ-Paris-Saclay University, Suresnes, France
| | - Alexandre R. Zlotta
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Carlo Trombetta
- Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy
| | - Markus Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Laura S. Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Rossana Bussani
- Department of Pathology, University of Trieste, Trieste, Italy
| | - Maximilian Burger
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Joost L. Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Roman Mayr
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Nicola Pavan
- Department of Medicine, Surgery and Health Sciences, Urological Clinic, University of Trieste, Trieste, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Unit of Urology, University of Pisa, Pisa, Italy
| | - M. Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Damien Pouessel
- Molecular Oncology Team, Institut Curie, CNRS, UMR144, PSL Research University, Paris, France
- Department of Medical Oncology, Claudius Regaud Institute, Toulouse University Cancer Center (IUCT) Oncopole, Toulouse, France
| | | | - Theo H. van der Kwast
- Department of Pathology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Yves Allory
- Molecular Oncology Team, Institut Curie, CNRS, UMR144, PSL Research University, Paris, France
- Department of Pathology, Institut Curie, Paris, France
| | - Tahlita C.M. Zuiverloon
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bas W.G. van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute – Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Surgery (Urology) and Surgical Oncology, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- Department of Urology, Caritas St Josef Medical Center, University of Regensburg, Regensburg, Germany
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Antar RM, Xu VE, Adesanya O, Drouaud A, Longton N, Gordon O, Youssef K, Kfouri J, Azari S, Tafuri S, Goddard B, Whalen MJ. Income Disparities in Survival and Receipt of Neoadjuvant Chemotherapy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer. Curr Oncol 2024; 31:2566-2581. [PMID: 38785473 PMCID: PMC11119047 DOI: 10.3390/curroncol31050192] [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: 04/02/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Background: Muscle-invasive bladder cancer (MIBC) is a potentially fatal disease, especially in the setting of locally advanced or node-positive disease. Adverse outcomes have also primarily been associated with low-income status, as has been reported in other cancers. While the adoption of neoadjuvant cisplatin-based chemotherapy (NAC) followed by radical cystectomy (RC) and pelvic lymph node dissection (PLND) has improved outcomes, these standard-of-care treatments may be underutilized in lower-income patients. We sought to investigate the economic disparities in NAC and PLND receipt and survival outcomes in MIBC. Methods: Utilizing the National Cancer Database, a retrospective cohort analysis of cT2-4N0-3M0 BCa patients with urothelial histology who underwent RC was conducted. The impact of income level on overall survival (OS) and the likelihood of receiving NAC and PLND was evaluated. Results: A total of 25,823 patients were included. This study found that lower-income patients were less likely to receive NAC and adequate PLND (≥15 LNs). Moreover, lower-income patients exhibited worse OS (Median OS 55.9 months vs. 68.2 months, p < 0.001). Our findings also demonstrated that higher income, treatment at academic facilities, and recent years of diagnosis were associated with an increased likelihood of receiving standard-of-care modalities and improved survival. Conclusions: Even after controlling for clinicodemographic variables, income independently influenced the receipt of standard MIBC treatments and survival. Our findings identify an opportunity to improve the quality of care for lower-income MIBC patients through concerted efforts to regionalize multi-modal urologic oncology care.
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Affiliation(s)
- Ryan M. Antar
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Vincent E. Xu
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | | | - Arthur Drouaud
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Noah Longton
- College of Medicine, Drexel University, Philadelphia, PA 19104, USA;
| | - Olivia Gordon
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Kirolos Youssef
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Jad Kfouri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sarah Azari
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Sean Tafuri
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Briana Goddard
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
| | - Michael J. Whalen
- Department of Urology, School of Medicine, George Washington University, Washington, DC 20052, USA; (V.E.X.); (A.D.); (K.Y.); (J.K.); (S.A.); (S.T.); (B.G.); (M.J.W.)
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Zennami K, Takahara K, Nukaya T, Takenaka M, Ichino M, Sasaki H, Kusaka M, Sumitomo M, Shiroki R. The Role of Lymph Node Dissection in Patients With Muscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy Following Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2024; 22:1-9. [PMID: 37423863 DOI: 10.1016/j.clgc.2023.06.016] [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: 05/12/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The interaction between lymph node dissection (LND) during radical cystectomy (RC) and neoadjuvant chemotherapy (NAC) remains unclear. This study aimed to evaluate the role of LND in patients undergoing RC after NAC. PATIENTS AND METHODS We retrospectively analyzed 259 patients with muscle-invasive bladder cancer (MIBC) who underwent RC following NAC at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2010 and 2022. Baseline characteristics, pathological outcomes, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between propensity score (PS)-matched cohorts. RESULTS PS matching analysis resulted in 94 matched pairs from the adequate (standard or extended template) and inadequate (limited template or unilateral- or no-LND) LND groups. The median number of dissected nodes was significantly higher in the adequate LND group than in the inadequate LND group (19 vs. 5, P < .001). Similarly, a higher pathological node-positive rate (ypN+) was observed in the adequate group than in the inadequate group (18.1% vs. 7.4%, P = .03). The adequate LND group identified more ypN+ with ≤ ypT1 cases than the inadequate group (4 vs. 1). There were no statistically significant differences between the adequate and inadequate groups in RFS (P = .94), CSS (P = .54), and OS (P = .65). Subgroup analysis also showed comparable survival rates, even in patients with ≥ pT3 or cN+ disease. ypN+ was an independent predictor of OS in the Cox regression analysis, while adequate LND and the number of lymph nodes removed (≥10 or ≥15) were not associated with survival. CONCLUSIONS Although adequate LND did not show a significant therapeutic effect in RC after NAC, adequate LND may have an important diagnostic role in detecting ypN+, which is a robust predictor, and is a useful biomarker to perform appropriate adjuvant immunotherapy especially in ≤ ypT1 cases.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Yu G, Wei R, Liu H, Liu Y, Guan X, Wang X, Jiang Z. Prognostic model for predicting the survival benefit of adjuvant chemotherapy for elderly patients with stage II colon cancer: a population-based study. Eur J Cancer Prev 2024; 33:105-114. [PMID: 38299664 DOI: 10.1097/cej.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVES Adjuvant chemotherapy benefits in elderly patients with stage II colon cancer (CC) remain controversial. We aimed to construct a nomogram to estimate the chemotherapy survival benefits in elderly patients. METHODS The training and testing cohort were patients with stage II CC older than 70 years from the Surveillance, Epidemiology, and End Results (SEER) database, while the external validation cohort included patients from the National Cancer Center (NCC). Cox proportional hazard models were used to determine the covariates associated with overall survival (OS). Using the risk factors identified by Cox proportional hazards regression, a nomogram was developed to predict OS. Nomogram precision was assessed using receiver operating characteristic and calibration curves. RESULTS The present study recruited 42 097 and 504 patients from the SEER database and NCC, respectively. The OS of patients who underwent surgery plus adjuvant chemotherapy was considerably longer than patients who underwent surgery alone. The nomogram included variables related to OS, including age, year of diagnosis, sex, AJCC T stage, tumor location, tumor size, harvested lymph nodes, and chemotherapy. According to the nomogram score, the elderly patients were separated into high- and low-risk groups, with high-risk group nomogram scores being greater than the median value, and vice versa. Patients in the high-risk group witnessed worse prognosis and were more likely to benefit from postoperative chemotherapy. CONCLUSION This nomogram can be regarded as a useful clinical tool for assessing the potential adjuvant chemotherapy benefits and for predicting survival in elderly patients with stage II CC.
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Affiliation(s)
- Guanhua Yu
- Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fan Z, Deng J, Wang Y, Fan X, Xie J. Bladder Cancer: Immunotherapy and Pelvic Lymph Node Dissection. Vaccines (Basel) 2024; 12:150. [PMID: 38400134 PMCID: PMC10893107 DOI: 10.3390/vaccines12020150] [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: 10/25/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 02/25/2024] Open
Abstract
Bladder cancer, a common malignancy of the urinary system, is routinely treated with radiation, chemotherapy, and surgical excision. However, these strategies have inherent limitations and may also result in various side effects. Immunotherapy has garnered considerable attention in recent years as a novel therapeutic approach. It harnesses and activates the patient's immune system to recognize and eliminate cancer cells, which not only prolongs therapeutic efficacy but also minimizes the toxic side effects. Several immune checkpoint inhibitors and cancer vaccines have been developed for the treatment of bladder cancer. Whereas blocking immune checkpoints on the surface of tumor cells augments the effect of immune cells, immunization with tumor-specific antigens can elicit the production of anti-tumor immune effector cells. However, there are several challenges in applying immunotherapy against bladder cancer. For instance, the efficacy of immunotherapy varies considerably across individual patients, and only a small percentage of cancer patients are responsive. Therefore, it is crucial to identify biomarkers that can predict the efficacy of immunotherapy. Pelvic lymph nodes are routinely dissected from bladder cancer patients during surgical intervention in order to remove any metastatic tumor cells. However, some studies indicate that pelvic lymph node dissection may reduce the efficacy of immunotherapy by damaging the immune cells. Therefore, the decision to undertake pelvic lymph node removal should be incumbent on the clinical characteristics of individual patients. Thus, although immunotherapy has the advantages of lower toxic side effects and long-lasting efficacy, its application in bladder cancer still faces challenges, such as the lack of predictive biomarkers and the effects of pelvic lymph node dissection. Further research is needed to explore these issues in order to improve the efficacy of immunotherapy for bladder cancer.
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Affiliation(s)
- Zhongru Fan
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Junpeng Deng
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
| | - Yutao Wang
- Department of Urology, Peking Union Medical Hospital, Beijing 100005, China
| | - Xin Fan
- Department of Radiology, The Second Affiliated Hospital of Dalian, Medical University, Dalian 116044, China
| | - Jianjun Xie
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Nanjing 211166, China
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Sodagum L, Passarelli R, Pfail J, Patel HV, Chua K, Doppalapudi SK, Golombos D, Elsamra SE, Singer EA, Jang TL, Srivastava A, Ghodoussipour S. Pelvic lymphadenectomy: Evaluating nodal stage migration and will rogers effect in bladder cancer. Urol Oncol 2024; 42:21.e9-21.e20. [PMID: 37953186 PMCID: PMC10842630 DOI: 10.1016/j.urolonc.2023.09.009] [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: 04/07/2023] [Revised: 08/28/2023] [Accepted: 09/19/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION Pelvic lymphadenectomy (PLND) alongside radical cystectomy (RC), provides crucial diagnostic and therapeutic value in patients with bladder cancer. With the advent of neoadjuvant chemotherapy and prospective data supporting standard PLND, controversy remains regarding the optimal PLND extent and patient selection. Nearly 40% of patients may not receive adequate PLND, even though 25% of patients have positive lymph nodes (LN) at time of RC. We hypothesized that PLND still remains an important facet of bladder cancer treatment. To clarify the prognostic importance of nodal yield, we performed a retrospective investigation of a heterogenous population (pTanyNx/0M0) of patients undergoing RC. METHODS From the Surveillance, Epidemiology, and End Results (SEER) program, we identified pTanyNx/0M0 bladder cancer patients undergoing RC from 2004 to 2015. Kaplan Meier curves and Cox proportional hazards models assessed cancer-specific survival. Patients were analyzed with PLND performed as the primary covariate. Survival analysis then stratified patients undergoing PLND by LN yield, both as a continuous and categorial variable (≤10, 11-20, 21-30, and >30), and T stage. RESULTS The final cohort included pTanyNx/0M0 patients with urothelial bladder cancer (n = 12,096); median follow up was 39 (IQR: 17-77) months. PLND was performed in 81.45% of patients with a median LN yield of 14 (IQR: 7-23). Most commonly, patients had T2 disease (44.68%). After controlling for age and T stage, patients receiving PLND had improved CSS (HR = 0.56, [95% CI: 0.51-0.62]) compared to those that did not receive PLND. When grouping patients by LN yield, survival improved in a "dose dependent" manner (>30 LN: HR = 0.76, [95% CI: 0.66-0.87]). We noted similar results when stratifying patients into non-muscle-invasive (NMIBC) and muscle-invasive bladder cancer (MIBC). CONCLUSIONS In a large contemporary series of pTanyNx/0M0 bladder cancer patients, we found a significant oncologic benefit to PLND. Higher LN yield correlated to improved CSS in non-muscle-invasive and muscle-invasive disease. Our data support the possibility of occult micrometastasis even in non-muscle-invasive disease. Additionally, in light of recent advances in adjuvant immunotherapy, our results emphasize the importance of adequate nodal yield for accurate staging and optimal treatment.
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Affiliation(s)
- Lohit Sodagum
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Rachel Passarelli
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - John Pfail
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Hiren V Patel
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Kevin Chua
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Sai Krishnaraya Doppalapudi
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - David Golombos
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Sammy E Elsamra
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Eric A Singer
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Thomas L Jang
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
| | - Arnav Srivastava
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ.
| | - Saum Ghodoussipour
- Division of Urology, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson University Hospital, New Brunswick, NJ
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8
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Ji H, Hu C, Yang X, Liu Y, Ji G, Ge S, Wang X, Wang M. Lymph node metastasis in cancer progression: molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduct Target Ther 2023; 8:367. [PMID: 37752146 PMCID: PMC10522642 DOI: 10.1038/s41392-023-01576-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 09/28/2023] Open
Abstract
Lymph nodes (LNs) are important hubs for metastatic cell arrest and growth, immune modulation, and secondary dissemination to distant sites through a series of mechanisms, and it has been proved that lymph node metastasis (LNM) is an essential prognostic indicator in many different types of cancer. Therefore, it is important for oncologists to understand the mechanisms of tumor cells to metastasize to LNs, as well as how LNM affects the prognosis and therapy of patients with cancer in order to provide patients with accurate disease assessment and effective treatment strategies. In recent years, with the updates in both basic and clinical studies on LNM and the application of advanced medical technologies, much progress has been made in the understanding of the mechanisms of LNM and the strategies for diagnosis and treatment of LNM. In this review, current knowledge of the anatomical and physiological characteristics of LNs, as well as the molecular mechanisms of LNM, are described. The clinical significance of LNM in different anatomical sites is summarized, including the roles of LNM playing in staging, prognostic prediction, and treatment selection for patients with various types of cancers. And the novel exploration and academic disputes of strategies for recognition, diagnosis, and therapeutic interventions of metastatic LNs are also discussed.
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Affiliation(s)
- Haoran Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Chuang Hu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xuhui Yang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuanhao Liu
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Guangyu Ji
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shengfang Ge
- Department of Ophthalmology, Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiansong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Mingsong Wang
- Department of Thoracic Surgery, Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
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9
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Katims AB, Bochner BH. Extended pelvic lymph node dissection in muscle invasive bladder cancer. Curr Opin Urol 2023; 33:252-257. [PMID: 37021936 DOI: 10.1097/mou.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
PURPOSE OF REVIEW Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND. RECENT FINDINGS A recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available. SUMMARY RC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND.
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Affiliation(s)
- Andrew B Katims
- Memorial Sloan Kettering Cancer Center, Department of Surgery, Urology Service, New York, New York, USA
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10
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Li Y, Chen T, Fu B, Luo Y, Chen L. Survival nomogram for high-grade bladder cancer patients after surgery based on the SEER database and external validation cohort. Front Oncol 2023; 13:1164401. [PMID: 37397381 PMCID: PMC10313206 DOI: 10.3389/fonc.2023.1164401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/02/2023] [Indexed: 07/04/2023] Open
Abstract
Background The aim of this study was to develop a comprehensive and effective nomogram for predicting overall survival (OS) rates in postoperative patients with high-grade bladder urothelial carcinoma. Methods Patients diagnosed with high-grade urothelial carcinoma of the bladder after radical cystectomy (RC) between 2004 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled. We randomly split (7:3) these patients into the primary cohort and the internal validation cohort. Two hundred eighteen patients from the First Affiliated Hospital of Nanchang University were collected as the external validation cohort. Univariate and multivariate Cox regression analyses were carried out to seek prognostic factors of postoperative patients with high-grade bladder cancer (HGBC). According to these significant prognostic factors, a simple-to-use nomogram was established for predicting OS. Their performances were evaluated using the concordance index (C-index), the receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). Results The study included 4,541 patients. Multivariate Cox regression analysis demonstrated that T stage, positive lymph nodes (PLNs), age, chemotherapy, regional lymph nodes examined (RLNE), and tumor size were correlated with OS. The C-index of the nomogram in the training cohort, internal validation cohort, and external validation cohort were 0.700, 0.717, and 0.681, respectively. In the training, internal validation, and external validation cohorts, the ROC curves showed that the 1-, 3-, and 5-year areas under the curve (AUCs) were higher than 0.700, indicating that the nomogram had good reliability and accuracy. The results of calibration and DCA showed good concordance and clinical applicability. Conclusion A nomogram was developed for the first time to predict personalized 1-, 3-, and 5-year OS in HGBC patients after RC. The internal and external validation confirmed the excellent discrimination and calibration ability of the nomogram. The nomogram can help clinicians design personalized treatment strategies and assist with clinical decisions.
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Affiliation(s)
- Yihe Li
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yixing Luo
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Luyao Chen
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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11
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Chau M, Thia I, Viswambaram P, Hawks C, Green W, Swarbrick N, McCombie SP, Hayne D. Lymph node assessment technique matters in radical cystectomy for bladder cancer. ANZ J Surg 2023; 93:675-679. [PMID: 36866609 DOI: 10.1111/ans.18292] [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: 10/27/2022] [Revised: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND For patients undergoing radical cystectomy with pelvic lymph node dissection for urothelial cancer, a lymph node count of at least 16 is associated with improved cancer-specific and overall survival. Lymph node yield is presumed to relate directly to extent of dissection and surgical quality, however limited studies have reviewed the impact of the pathological assessment process of lymph nodes on lymph node yield. METHOD A retrospective assessment of 139 patients who had radical cystectomy for urothelial cancer between March 2015 and July 2021 from Fiona Stanley Hospital (Perth, Australia) by a single surgeon was assessed. A change in pathological assessment process from assessment of only palpable lymph nodes to microscopic assessment of the entire submitted specimens occurred in August 2018. Patients were divided into two groups accordingly and other relevant demographic and pathological data was recorded. The impact of pathological processing technique on lymph node yield was assessed using the Student T test and logistical regression was used to assess the impact of other demographic variables. RESULTS The mean lymph node yield was 16.2 nodes (IQR 12-23) in 54 patients in the pre-process change group compared to 22.4 nodes (IQR 15-28.4) in 85 patients in the post-process change group (P < 0.0001). 53.7% had 16 or more nodes in the pre-process change group compared to 71.3% in the post-process change group (P = 0.04). Age, BMI, and gender were not significant predictors of lymph node yield. CONCLUSION The current study demonstrates that the microscopic assessment of all lymph node tissue detects significantly more lymph nodes than only examining palpably abnormal tissue. Pathologic assessment protocols should be standardized to this technique to ensure the utility of lymph node yield as a quality metric.
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Affiliation(s)
- Matthew Chau
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ivan Thia
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Pravin Viswambaram
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trial Group, Sydney, New South Wales, Australia
| | - Cynthia Hawks
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - William Green
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Nicole Swarbrick
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Division of Pathology and Laboratory Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Steve P McCombie
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
- The Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trial Group, Sydney, New South Wales, Australia
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12
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Rosenzweig SJ, Ranti D, Mehrazin R, Sfakianos JP, Wiklund PN, Waingankar N. Characteristics Contributing to Survival Differences Between Black and White Patients Following Cystectomy. Urol Oncol 2023; 41:207.e1-207.e7. [PMID: 36764890 DOI: 10.1016/j.urolonc.2023.01.013] [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: 09/02/2022] [Revised: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE Examine patient, tumor, and treatment characteristics effect on the disparity between black and white patients with muscle-invasive bladder cancer (MIBC) who undergo radical cystectomy (RC). METHODS 1,286 black patients in the 2004 to 2016 National Cancer Database fit inclusion criteria. A tapered match was performed from 17,374 white patients sequentially matched to the black cohort on demographics (age, gender, insurance, income, education, county, diagnosis year), presentation (demographic variables, stage, grade, tumor size, Charlson score), and treatment (demographic and presentation variables, lymph node count, hospital volume, neoadjuvant chemotherapy [NAC], treatment delay), creating 3 matched cohorts. Chi-square and Kruskal-Wallis tests were used to compare cohorts. Kaplan-Meier analysis was used to compare 5-year overall survival (OS). RESULTS 5-year OS rate was 40.4% and 35.6% for unmatched white and black cohorts (P < 0.001), respectively. Following demographics and presentation match, 5-year OS rate for white patients decreased to 39.2% (P = 0.003) and 39.10% (P = 0.019), respectively. After treatment match, 5-year OS rate decreased to 36.7% for white patient (P = 0.32). Following presentation match, 7.2% of black patients vs. 5.8% of white patients had treatment delay, and 10.1% of black patients vs. 11.2% of white patients received NAC. The treatment match resulted in a 0.3% difference between groups for treatment delay and NAC. CONCLUSIONS Our analysis demonstrates that disparity between black and white patients with muscle-invasive bladder cancer exists in demographic-, presentation-, and treatment-related variables. Treatment variables may be a large contributing factor to survival disparities. Further research is needed to identify social, biological, and organizational inputs that contribute to these disparities.
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Affiliation(s)
- Shoshana J Rosenzweig
- Department of Urology, Icahn School of Medicine at Mount Sinai. 1425 Madison Avenue, New York, NY.
| | - Daniel Ranti
- Department of Urology, Icahn School of Medicine at Mount Sinai. 1425 Madison Avenue, New York, NY
| | - Reza Mehrazin
- Department of Urology, Icahn School of Medicine at Mount Sinai. 1425 Madison Avenue, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai. 1425 Madison Avenue, New York, NY
| | - Peter N Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai. 1425 Madison Avenue, New York, NY
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai. 1425 Madison Avenue, New York, NY
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13
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Xiang J, Xu H, Pokharel S, Li J, Xue F, Zhang P. Building a knowledge base for colorectal cancer patient care using formal concept analysis. BMC Med Inform Decis Mak 2022; 21:369. [DOI: 10.1186/s12911-021-01728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Colorectal cancer (CRC) is a heterogeneous disease with different responses to targeted therapies due to various factors, and the treatment effect differs significantly between individuals. Personalize medical treatment (PMT) is a method that takes individual patient characteristics into consideration, making it the most effective way to deal with this issue. Patient similarity and clustering analysis is an important aspect of PMT. This paper describes how to build a knowledge base using formal concept analysis (FCA), which clusters patients based on their similarity and preserves the relations between clusters in hierarchical structural form.
Methods
Prognostic factors (attributes) of 2442 CRC patients, including patient age, cancer cell differentiation, lymphatic invasion and metastasis stages were used to build a formal context in FCA. A concept was defined as a set of patients with their shared attributes. The formal context was formed based on the similarity scores between each concept identified from the dataset, which can be used as a knowledge base.
Results
A hierarchical knowledge base was constructed along with the clinical records of the diagnosed CRC patients. For each new patient, a similarity score to each existing concept in the knowledge base can be retrieved with different similarity calculations. The ranked similarity scores that are associated with the concepts can offer references for treatment plans.
Conclusions
Patients that share the same concept indicates the potential similar effect from same clinical procedures or treatments. In conjunction with a clinician’s ability to undergo flexible analyses and apply appropriate judgement, the knowledge base allows faster and more effective decisions to be made for patient treatment and care.
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14
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Tochigi K, Nagayama J, Bando S, Ishiyama A, Yuba T, Yuguchi Y, Matsui H, Hattori K, Gotoh M. Relationship between the number of lymph nodes dissected and prognosis in muscle-invasive bladder cancer in the era of neoadjuvant chemotherapy. Int J Urol 2022; 29:1264-1270. [PMID: 35858759 DOI: 10.1111/iju.14974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Many studies have shown a good prognostic association with a large number of lymph node dissections. However, most of these studies did not include patients who have received neoadjuvant chemotherapy. The purpose of this study was to verify the relationship between survival outcomes and the number of lymph nodes removed during radical cystectomy in patients with muscle-invasive bladder cancer in the era of neoadjuvant chemotherapy. METHODS This retrospective study considered patients who were diagnosed with clinical ≥T2N0M0 muscle-invasive bladder cancer and treated with radical cystectomy at the Nagoya University Hospital and affiliated hospitals from January 2004 to December 2019. We excluded patients who had a history of upper tract urothelial cancer or non-urothelial carcinoma. The association between prognosis and the number of lymph nodes removed was investigated. RESULTS We retrospectively enrolled a total of 477 patients. The mean number of lymph nodes dissected was 14. Two hundred and twenty-six patients (47.4%) received neoadjuvant chemotherapy. More extensive lymphadenectomy (≥15 lymph nodes) correlated with better 5-year overall survival across all patients (68% vs. 57%, p = 0.01). In patients who received neoadjuvant chemotherapy, there was no difference in overall survival according to the number of dissected lymph nodes (66% vs. 71%, p = 0.433). In patients who did not receive neoadjuvant chemotherapy, ≥15 lymph nodes dissected was associated with significantly better overall survival (70.3% vs. 46.9%, p < 0.01). CONCLUSIONS No association between more aggressive lymph node dissection and prognosis was found in patients who underwent neoadjuvant chemotherapy. Conversely, extended lymph node dissection is desirable for patients who have not received neoadjuvant chemotherapy.
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Affiliation(s)
- Kosuke Tochigi
- Department of Urology, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Jun Nagayama
- Department of Urology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Shoko Bando
- Department of Urology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Akinobu Ishiyama
- Department of Urology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | - Takuma Yuba
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuri Yuguchi
- Department of Urology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hirotaka Matsui
- Department of Urology, Narita Memorial Hospital, Toyohashi, Japan
| | - Kyosuke Hattori
- Department of Urology, Komaki Municipal Hospital, Komaki, Japan
| | - Momokazu Gotoh
- Department of Urology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
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15
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Abdelatif A, Ali AI, Kattan M, Small RP, Gabr AH. Development of a nomogram for predicting lymph node metastasis in patients with urothelial carcinoma of the bladder. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221124021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Multiple nomograms have previously been described to predict recurrence, overall, and cancer-specific survival following radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB).Our aim was to develop a nomogram for the preoperative prediction of lymph node (LN) metastasis in UCB. Methods: We prospectively collected data from 483 patients which were used in construction of the statistical model. The variables considered as predictors in the model were demographic, histopathological and radiological factors. Results: The full model containing all 12 covariates produced an AIC (Akaike information criterion) value of 448.9. After model selection T-stage, grade, CIS (carcinoma in situ), pathology, LV (lymphovascular) invasion and CT (computed tomography) were included as the most parsimonious model while retaining predictive accuracy. Ta in 82 (17%), T1 in 214 (445) and T2 in 187 (38%) patients. This model had an AIC of 436.4, indicating a significant improvement in model fit after the removal of unimportant predictors. The C-indices were 0.821 and 0.808 for the reduced model and the full model, respectively, indicating greater discrimination ability for the reduced model.The nomogram further emphasises the effect of CT and LV invasion on the risk of LN positivity. Specifically, regardless of all other variables, a patient with a CT will have 100 points more than a patient without a CT, corresponding to a difference in risk of approximately 40%. The odds of LN positivity for patients with a CT are 7.45 times that of patients without a CT, regardless of all other covariates. LV invasion, pathology, CIS and T-stage are also statistically significant ( p = 0.05). Conclusion: This nomogram is a preoperative prediction tool that uses different preoperative variables with acceptable predictive accuracy for LN metastasis in patients with BC.
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Affiliation(s)
| | | | - Michael Kattan
- Department of Population and Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, USA
| | | | - Ahmed H Gabr
- Urology, Minia University, Egypt
- Urology, Royal Alexandra Hospital, Paisley, UK
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16
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Piazza P, Bravi CA, Puliatti S, Cacciamani GE, Knipper S, Amato M, Dell'Oglio P, Mazzone E, Rosiello G, Farinha R, Sarchi L, Scarcella S, Wisz P, Schiavina R, Develtere D, De Backer P, De Groote R, D'Hondt F, Mottrie A. Assessing pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: Results from a high-volume institution. Urol Oncol 2022; 40:272.e11-272.e20. [PMID: 35094932 DOI: 10.1016/j.urolonc.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/25/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at ≤12 months, absence of soft tissue surgical margins, ≥16 lymph nodes at final pathology and absence of clinical recurrence at ≤12 months) on oncological outcomes and the role of surgical experience on its achievement. MATERIALS AND METHODS We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox's regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship. RESULTS Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P < 0.001) and CSS (84% vs. 71%, P < 0.001) when compared with patients not achieving it. At multivariable Cox's regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT≥3 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P < 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT≥3 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed. CONCLUSIONS RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify "referral" centers for treatment of high-risk bladder cancer.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Carlo Andrea Bravi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Puliatti
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Sophie Knipper
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Martini-Klinik Prostate Cancer Center, Hamburg, Germany
| | - Marco Amato
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Elio Mazzone
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Rosiello
- Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Luca Sarchi
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Scarcella
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium; Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; University of Bologna, Bologna, Italy
| | - Dries Develtere
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Pieter De Backer
- ORSI Academy, Melle, Belgium; Department of Urology, University of Ghent, Ghent, Belgium
| | - Ruben De Groote
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Frederiek D'Hondt
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alexandre Mottrie
- Department of Urology, OLV Hospital, Aalst, Belgium; ORSI Academy, Melle, Belgium
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17
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Baron P, Khene Z, Lannes F, Pignot G, Bajeot AS, Ploussard G, Verhoest G, Gasmi A, Perrot O, Roumiguie M, Mori K, Cacciamani GE, Rouprêt M, Bruyère F, Pradere B. Multicenter external validation of the radical cystectomy pentafecta in a European cohort of patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion for bladder cancer. World J Urol 2021; 39:4335-4344. [PMID: 34216242 PMCID: PMC8602171 DOI: 10.1007/s00345-021-03753-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/29/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To perform an external validation of this RC-pentafecta. METHOD Between January 2014 and December 2019, 104 consecutive patients who underwent RARC with ICUD within 6 urological centers were analyzed retrospectively. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), a lymph node (LN) yield ≥ 16, absence of major (Clavien-Dindo grade III-V) 90-day postoperative complications, absence of UD-related long-term sequelae, and absence of 12-month clinical recurrence were considered to have achieved RC-pentafecta. A multivariable logistic regression model was used to measure predictors for achieving RC-pentafecta. We analyzed the influence of this RC-pentafecta on survival, and the impact ofthe surgical experience. RESULTS Since 2014, 104 patients who had completed at least 12 months of follow-up were included. Over a mean follow-up of 18 months, a LN yield ≥ 16, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤ 12 months were observed in 56%, 96%, 85%, 81%, and 91% of patients, respectively, resulting in a RC-pentafecta rate of 39.4%. Multivariate analysis showed that age was an independent predictor of pentafecta achievement (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.90. 0.99; p = 0.04). The surgeon experience had an impact on the validation of the criteria. CONCLUSION This study confirmed that the RC-pentafecta is reproducible and could be externally used for the outcome assessment after RARC with ICUD. Therefore, the RC-pentafecta could be a useful tool to assess surgical success and its impact on different outcomes.
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Affiliation(s)
- P Baron
- Department of Urology, University Hospital of Tours, Loire Valley, Tours, France
| | - Z Khene
- Department of Urology, Rennes University Hospital, Rennes, France
| | - F Lannes
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, Marseille, France
| | - G Pignot
- Service de Chirurgie Oncologique 2, Institut Paoli-Calmettes, Marseille, France
| | - A S Bajeot
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Toulouse, France
| | - G Ploussard
- Department of Urology, Clinique La Croix du Sud, Toulouse, France
| | - G Verhoest
- Department of Urology, Rennes University Hospital, Rennes, France
| | - A Gasmi
- Department of Urology, Rennes University Hospital, Rennes, France
| | - O Perrot
- Department of Urology, Sorbonne Université, GRC no 5, predictive onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, 75013, Paris, France
| | - M Roumiguie
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Toulouse, France
| | - K Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - G E Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - M Rouprêt
- Department of Urology, Sorbonne Université, GRC no 5, predictive onco-urology, AP-HP, Hôpital Pitié-Salpêtrière, Urology, 75013, Paris, France
| | - F Bruyère
- Department of Urology, University Hospital of Tours, Loire Valley, Tours, France
| | - B Pradere
- Department of Urology, University Hospital of Tours, Loire Valley, Tours, France.
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
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Kosiba M, Stolzenbach LF, Collà Ruvolo C, Nocera L, Mansour M, Tian Z, Roos FC, Becker A, Kluth LA, Tilki D, Shariat SF, Saad F, Chun FKH, Karakiewicz PI. Contemporary Trends and Efficacy of Pelvic Lymph Node Dissection at Radical Cystectomy for Urothelial and Variant Histology Carcinoma of the Urinary Bladder. Clin Genitourin Cancer 2021; 20:195.e1-195.e8. [PMID: 34906434 DOI: 10.1016/j.clgc.2021.10.010] [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: 04/07/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test 1) contemporary pelvic lymph node dissection (PLND) trends at radical cystectomy (RC) in variant histology bladder cancer (VHBC) patients and urothelial carcinoma of the urinary bladder (UCUB), as well as 2) to test the effect of PLND extent on cancer specific mortality (CSM) after RC. METHODS Within the Surveillance, Epidemiology and End Results Registry (SEER, 2004-2016), we identified non-metastatic stage T1-2 or T3-4 VHBC and UCUB patients, who underwent RC. CSM and lymph node invasion (LNI) rates were stratified according to PLND extent, as well as coded continuously in multivariate Cox and logistic regression models. RESULTS Of 19,020 patients, 1736 (9.1%) were coded as having VHBC (46.9% squamous cell carcinoma, 22.5% adenocarcinoma, 18.9% neuroendocrine carcinoma, 11.7% not otherwise specified) vs 17,284 (90.9%) UCUB. PLND was performed in 80.1 of VHBC vs. 83.5% UCUB patients. In both histological groups, PLND rates increased over time (70.9-89.6% and 76.2%-90.1%, both P < .01). PLND extent did not significantly affect CSM in stage T1-2 or T3-4 VHBC patients. Conversely, PLND extent was associated with lower CSM in T1-2, as well as in T3-4 UCUB patients, which was confirmed in multivariate Cox analyses (Hazard ratio [HR] 0.99, P < .001). Rates of LNI increased with extent of PLND in logistic regression analyses in stage T3-4 VHBC (Odds ratio [OR] 1.01, P = .001), stage T1-2 UCUB (OR 1.01, P < .001) and T3-4 UCUB (OR 1.01, P < .001), but not in stage T1-2 VHBC (OR 1.01, P = .3). CONCLUSION PLND rates do not differ between VHBC and UCUB patients. A potential survival benefit related to more extensive PLND is operational in UCUB patients, but not in VHBC patients.
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Affiliation(s)
- Marina Kosiba
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - L Franziska Stolzenbach
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Collà Ruvolo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, University of Naples Federico II, Naples, Italy
| | - Luigi Nocera
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Mila Mansour
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, University of Jordan, Amman, Jordan
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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19
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Huang J, Li C, Zhang W, Yang F, Wang R, Zhang J, Li W, Yao X. SULF2 is a novel diagnostic and prognostic marker for high-grade bladder cancer with lymphatic metastasis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1439. [PMID: 34733991 PMCID: PMC8506778 DOI: 10.21037/atm-21-4102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
Background Sulfatase 2 (SULF2) is a member of the sulfatase family, and its expression and clinical significance in bladder cancer (BCa) are not currently known. In this study, we attempted to evaluate SULF2 expression in BCa patients who underwent radical cystectomy (RC) and the relationship between SULF2 expression and clinical-pathological characteristics. Methods Data on SULF2 expression in BCa tissues was obtained from the Oncomine database and the Gene Expression Omnibus (GEO). The expression of SULF2 and vascular endothelial growth factor-D (VEGF-D) in BCa was evaluated by immunohistochemistry (IHC) in tissues from 203 patients who had undergone RC. We also explored the value of the measurement of SULF2 and VEGF-D expression for diagnosis and prognosis in BCa patients with lymphatic metastasis. Results We found an increase in SULF2 messenger RNA (mRNA) levels and gene amplification in BCa tissues from the Oncomine database. High expression of SULF2 was detected in 91/203 (44.8%) of BCa patients. Among these patients, 27 of 42 (64.3%) with lymphatic metastasis showed high SULF2 expression. Univariate analysis showed that tumor size, pathological stage, lymphatic metastasis, vascular infiltration, perineural infiltration, hydronephrosis, and VEGF-D and SULF2 expression were related to prognosis in BCa patients, and multivariable Cox regression analysis showed that SULF2 expression was an independent prognostic indicator. Receiver operating characteristic (ROC) analysis revealed that SULF2 expression resulted in an increased area under the curve (AUC) of 0.707, with a sensitivity of 71.4% and a specificity of 61.5%. Conclusions The upregulation of SULF2 is associated with poor prognosis in high-grade BCa patients. It might be a novel diagnostic marker for BCa patients with lymphatic metastasis.
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Affiliation(s)
- Jianhua Huang
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Cheng Li
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Wentao Zhang
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Fuhan Yang
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Ruiliang Wang
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Junfeng Zhang
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Wei Li
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
| | - Xudong Yao
- Department of Urology, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.,Institute of Urinary Oncology, School of Medicine, Tongji University, Shanghai, China
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20
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Laymon M, Mosbah A, Hashem A, Elsawy AA, Abol-Enein H, Shaaban AA, Harraz AM. Predictors and survival benefit of achieving pentafecta in a contemporary series of open radical cystectomy. Minerva Urol Nephrol 2021; 74:428-436. [PMID: 34156197 DOI: 10.23736/s2724-6051.21.04230-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Pentafecta provides a comprehensive approach for standardized reporting of surgical and oncologic outcomes after radical cystectomy and urinary diversion. We aimed to report the rate, predictors of achieving pentafecta and its impact on long-term survival in a contemporary series of open radical cystectomy (ORC). METHODS A retrospective analysis of a computerized database of patients treated with ORC between 2004 till 2014 was performed. Pentafecta criteria included negative soft tissue surgical margin (STSM), retrieval of ≥ 16 lymph nodes, absence of clinical recurrence within 12 months after surgery, absence of high-grade complication (GIII-V) within 90 days after surgery, and absence of urinary diversion related complications at 12 months follow up. Multivariate analysis was used to identify predictors of achieving pentafecta. RESULTS Pentafecta was achieved in 545 (33.6%) patients out of 1624 included in the study. Absence of ≥16 LN yield was the first cause of missing pentafecta (49.5%). Multivariate analysis identified: ASA score grades ≥ III (OR=0.7, 95%CI 0.6-0.9, P=0.04), BMI ≥ 35 (OR=0.5, 95%CI 0.3-0.8, P=0.007), perioperative blood transfusion (≥ 4 units) (OR=0.5, 95%CI 0.3-0.7, P=0.001), and ileal conduit (OR=0.7, 95%CI 0.5-0.9, P= 0.01) as independent predictors of missing pentafecta. Patients who achieved pentafecta had higher estimated 5-year RFS than their counterparts (81.7% vs 62.5%; p <0.0001). CONCLUSIONS Pentafecta was achieved in nearly one third of patients after ORC. Achievement of pentafecta was associated with better long-term recurrence-free survival. Obesity (class II, III), perioperative blood transfusion (> 4 units), associated comorbidities, and ileal conduit were independent predictors of missing pentafecta.
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Affiliation(s)
- Mahmoud Laymon
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt -
| | - Ahmed Mosbah
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Abdelwahab Hashem
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr A Elsawy
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Hassan Abol-Enein
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Atallah A Shaaban
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed M Harraz
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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21
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Jena R, Shrivastava N, Sharma AP, Choudhary GR, Srivastava A. The Adequacy of Pelvic Lymphadenectomy During Radical Cystectomy for Carcinoma Urinary Bladder: A Narrative Review of Literature. Front Surg 2021; 8:687636. [PMID: 34222323 PMCID: PMC8247657 DOI: 10.3389/fsurg.2021.687636] [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: 03/29/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
An adequate pelvic lymph node dissection (PLND) is an essential part of radical cystectomy for muscle invasive bladder cancer. However, the definition of what constitutes an adequate PLND is often shrouded in controversy. Various authors have defined different anatomic templates of PLND based on levels of pelvic lymph nodes. Some have suggested other surrogate markers of the adequacy of PLND, namely lymph node count and lymph node density. While individual studies have shown the efficacy and reliability of some of the above markers, none of them have been recommended forthright due to the absence of robust prospective data. The use of non-standardized nomenclature while referring to the above variables has made this matter more complex. Most of older data seems to favor use of extended template of PLND over the standard template. On the other hand, one recent randomized controlled trial (RCT) did not show any benefit of one template over the other in terms of survival benefit, but the study design allowed for a large margin of bias. Therefore, we conducted a systematic search of literature using EMBASE, Medline, and PubMed using PRISMA-P checklist for articles in English Language published over last 20 years. Out of 132 relevant articles, 47 articles were included in the final review. We have reviewed existing literature and guidelines and have attempted to provide a few suggestions toward a uniform nomenclature for the various anatomical descriptions and the extent of PLND done while doing a radical cystectomy. The results of another large RCT (SWOG S1011) are awaited and until we have a definitive evidence, we should adhere to these suggestions as much as possible and deal with each patient on a case to case basis.
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Affiliation(s)
- Rahul Jena
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Nikita Shrivastava
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, India
| | - Aditya Prakash Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Aneesh Srivastava
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Małkiewicz B, Kiełb P, Gurwin A, Knecht K, Wilk K, Dobruch J, Zdrojowy R. The Usefulness of Lymphadenectomy in Bladder Cancer-Current Status. ACTA ACUST UNITED AC 2021; 57:medicina57050415. [PMID: 33922894 PMCID: PMC8145304 DOI: 10.3390/medicina57050415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/13/2022]
Abstract
The purpose of this review is to present the current status of lymph node dissection (LND) during radical cystectomy in patients with bladder cancer (BCa). Despite the growing body of evidence of LND utility at the time of radical cystectomy (RC) in high-risk nonmuscle-invasive and muscle-invasive BCa (MIBC), therapeutic and prognostic value and optimal extent of LND remain unsolved issues. Recently published results of the first prospective, a randomized trial assessing the therapeutic benefit of extended versus limited LND during RC, failed to demonstrate survival improvement with the extended template. Although LND is the most accurate staging procedure, the direct therapeutic effect is still not evident from the current literature, limiting the possibility of establishing clear recommendations. This indicates the need for robust and adequately powered clinical trials.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
- Correspondence: ; Tel.: +48-506-158-136
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Adam Gurwin
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Klaudia Knecht
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Karol Wilk
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
| | - Jakub Dobruch
- First Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (P.K.); (A.G.); (K.K.); (K.W.); (R.Z.)
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Zhai W, Zheng Y, Rong Y, Li X, Yan Q, Duan F, Zhao Z, Chen J, Dai S, Wang J. The impact of an N1 lymph node examination in patients with early-stage non-small cell lung cancer: a retrospective cohort study. J Thorac Dis 2021; 13:2184-2193. [PMID: 34012569 PMCID: PMC8107558 DOI: 10.21037/jtd-20-3611] [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] [Indexed: 11/13/2022]
Abstract
Background The examination of lymph nodes (LNs) is critical for accurate node staging in patients with non-small cell lung cancer (NSCLC), but a consensus on the examinations of hilar and intrapulmonary (N1 station) LNs has not been reached. This study aimed to evaluate the role of LN dissection and pathological examination of N1 LN stations and their effects on survival in patients with stage IA-IIA NSCLC. Methods Data from patients pathologically staged as IA-IIA who underwent radical surgery and confirmed as lacking LN metastases from January 2008 to March 2018 were retrospectively reviewed. The Kaplan-Meier method was used to determine the overall survival (OS) and disease-free survival (DFS). After propensity score matching (PSM), a Cox model was used to determine the prognostic factors. Results Of the 1,935 patients investigated, the median number of N1 stations examined was 3. Patients with at least 2 N1 stations examined had apparently better OS (P=0.002) and DFS (P=0.001). All patients were divided into patients with 0–1 N1 station examined and patients with 2–5 N1 stations examined. After PSM, the number of N1 stations examined was an independent prognostic factor for DFS (P=0.004). Patients with 2–5 N1 stations examined experienced prolonged DFS (P=0.010). Patients in group 12 experienced prolonged OS (P=0.021) and DFS (P=0.026). Patients in group 13 or 14 experienced prolonged OS (P=0.028). Conclusions A larger extent of N1 station examination was associated with prolonged DFS in patients with stage IA-IIA NSCLC after lobectomy. The dissection and examination of at least 2 N1 stations included LNs from the lobar and segmental drainage fields.
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Affiliation(s)
- Wenyu Zhai
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yuzhen Zheng
- Department of Thoracic Surgery, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, China
| | - Yuming Rong
- VIP Region, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoqiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Qihang Yan
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Fangfang Duan
- VIP Region, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zerui Zhao
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jianlong Chen
- Department of Thoracic Surgery, The Second People's Hospital of Shan Tou, Shantou, China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Junye Wang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Dezube AR, Mazzola E, Bravo-Iñiguez CE, De León LE, Rochefort MM, Bueno R, Wiener DC, Jaklitsch MT. Analysis of Lymph Node Sampling Minimums in Early Stage Non-Small-Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2021; 33:834-845. [DOI: 10.1053/j.semtcvs.2020.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022]
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25
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Haywood S, Donahue TF, Bochner BH. Management of Common Complications After Radical Cystectomy, Lymph Node Dissection, and Urinary Diversion. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tian J, Sun J, Fu G, Xu Z, Chen X, Shi Y, Jin B. Population-based outcome of muscle-invasive bladder cancer following radical cystectomy: who can benefit from adjuvant chemotherapy? Transl Androl Urol 2021; 10:356-373. [PMID: 33532324 PMCID: PMC7844522 DOI: 10.21037/tau-20-960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background The benefit of adjuvant chemotherapy remains controversial in muscle-invasive bladder cancer (MIBC) after radical cystectomy. The present study’s primary objective was to construct a predictive tool for the reasonable application of adjuvant chemotherapy. Methods All of the patients analyzed in the present study were recruited from the Surveillance Epidemiology and End Results program between 2004 and 2015. Propensity score matching (PSM) was used to reduce inherent selection bias. Cox proportional hazards models were applied to identify the independent prognostic factors of overall survival (OS) and cancer-specific survival (CSS), which were further used to construct prognostic nomogram and risk stratification systems to predict survival outcomes. The prognostic nomogram’s performance was assessed by concordance index (C-index), receiver-operating characteristic (ROC) and calibration curves. Decision curve analysis (DCA) was performed to evaluate the clinical net benefit of the prognostic nomogram. Results A total of 6,384 patients with or without adjuvant chemotherapy were included after PSM. Several independent predictors for OS and CSS were identified and further applied to establish a nomogram for 3-, 5- and 10-year, respectively. The nomogram showed favorable discriminative ability for the prediction of OS and CSS, with a C-index of 0.709 [95% confidence interval (CI): 0.699–0.719] for OS and 0.728 (95% CI: 0.718–0.738) for CSS. ROC and calibration curves showed satisfactory consistency. The DCA revealed high clinical positive net benefits of the prognostic nomogram. The different risk stratification systems showed that adjuvant chemotherapy resulted in better OS (P<0.001) and CSS (P<0.001) than without adjuvant chemotherapy for high-risk patients; while the OS (P=0.350) and CSS (P=0.260) for low-risk patients were comparable. Conclusions We have constructed a predictive model and different risk stratifications for selecting a population that could benefit from postoperative adjuvant chemotherapy. Adjuvant chemotherapy was found to be beneficial for high-risk patients, while low-risk patients should be carefully monitored.
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Affiliation(s)
- Junjie Tian
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junjie Sun
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanghou Fu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhijie Xu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyi Chen
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Shi
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Aminoltejari K, Black PC. Radical cystectomy: a review of techniques, developments and controversies. Transl Androl Urol 2020; 9:3073-3081. [PMID: 33457280 PMCID: PMC7807330 DOI: 10.21037/tau.2020.03.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Radical cystectomy (RC) with urinary diversion is considered the standard treatment for muscle invasive bladder cancer (MIBC). As one of the most challenging surgical techniques performed by urologists, RC was described many decades ago, and yet patient morbidity rates have remained stagnant over the years. This review outlines the most recent indications and techniques for RC and analyses the current landscape of complications after cystectomy. There is significant room for improvement with respect to both oncologic and functional outcomes after RC. Future efforts will need to focus on unifying reporting methodology, optimal patient selection criteria, enhanced surgical techniques and peri-operative care pathways, and technological advances to improve patient outcomes.
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Affiliation(s)
- Khatereh Aminoltejari
- Department of Urologic Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Packiam VT, Tsivian M, Boorjian SA. The evolving role of lymphadenectomy for bladder cancer: why, when, and how. Transl Androl Urol 2020; 9:3082-3093. [PMID: 33457281 PMCID: PMC7807370 DOI: 10.21037/tau.2019.06.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Radical cystectomy (RC) represents a standard treatment for non-metastatic muscle-invasive and select high-risk non-muscle invasive bladder cancer. Lymphadenectomy performed at time of RC identifies nodal metastases in up to 25% of patients despite normal imaging. There has been an increasing utilization of pelvic lymph node dissection (PLND) with RC since 1950, and in fact lymph node dissection is now recommended in contemporary National Comprehensive Cancer Network (NCCN) guidelines. Benefits of removing of nodal disease include improved staging, guidance for adjuvant treatment, and potentially improved oncologic outcomes. Advantages of dissection have been suggested among both node-negative and node-positive patients. Numerous studies have attempted to define the optimal dissection characteristics of lymphadenectomy with regard to nodal yield and anatomic boundaries of dissection. The ideal extent of lymphadenectomy remains uncertain due to the retrospective and non-randomized nature of the majority of existing reports, which are thereby limited by significant confounding and selection bias. Two randomized controlled trials have investigated this issue, one of which LEA AUO AB 25/02 recently reported its outcomes, demonstrating no significant improvement in 5-year outcomes with an extended dissection. Meanwhile, the Southwest Oncology Group 1011 trial has completed enrollment and data are maturing. While current data preclude definitive recommendations, herein we review the why, when, and how to perform a PLND for bladder cancer.
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Guo L, Zhang L, Wang J, Zhang X, Zhu Z. Pelvic Lymph Node Dissection During Cystectomy for Patients With Bladder Carcinoma With Variant Histology: Does Histologic Type Matter? Front Oncol 2020; 10:545921. [PMID: 33194603 PMCID: PMC7604421 DOI: 10.3389/fonc.2020.545921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose Adding pelvic lymph node dissection (PLND) to cystectomy offers significant survival benefit. However, it remains unclear whether this benefit persists in all histologic types. The aim of the study was to examine the impact of PLND on overall survival (OS) after cystectomy in bladder carcinoma patients with histological variants. Methods Within the Surveillance, Epidemiology and End Results database, we identified 16,880 bladder carcinoma patients receiving cystectomy between 2004 and 2015. Patients were stratified according to the following histologic types: transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma, neuroendocrine carcinoma, signet ring cell carcinoma, pseudosarcomatous carcinoma, and other histology. Cox regression models were used to evaluate the effect of PLND on OS stratified by histologic type. Results Histologic types were significantly associated with the presence of lymph node metastasis in patients with bladder carcinoma (P < 0.001). In multivariable Cox regression analyses, PLND compared with non-PLND was associated with OS benefit in patients with transitional cell carcinoma (hazard ratio [HR], 0.595; 95% confidence interval [95% CI], 0.557-0.634 [P < 0.001]), squamous cell carcinoma (HR, 0.646; 95% CI, 0.494-0.846 [P = 0.002]), and signet ring cell carcinoma (HR, 0.233; 95% CI, 0.107-0.504 [P < 0.001]), whereas no significant differences in OS were observed in other histological subsets. Discussion Our analyses revealed a significant OS benefit from PLND in patients with transitional cell carcinoma, squamous cell carcinoma, and signet ring cell carcinoma. However, a survival benefit of PLND in patients with other histologic types was not demonstrated.
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Affiliation(s)
- Lijuan Guo
- Department of Disease Prevention and Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lianghao Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiange Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhaowei Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Li J, Gu J, Lu Y, Wang X, Si S, Xue F. Development and validation of a Super learner-based model for predicting survival in Chinese Han patients with resected colorectal cancer. Jpn J Clin Oncol 2020; 50:1133-1140. [PMID: 32596714 DOI: 10.1093/jjco/hyaa103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Improved prognostic prediction for patients with colorectal cancer stays an important challenge. This study aimed to develop an effective prognostic model for predicting survival in resected colorectal cancer patients through the implementation of the Super learner. METHODS A total of 2333 patients who met the inclusion criteria were enrolled in the cohort. We used multivariate Cox regression analysis to identify significant prognostic factors and Super learner to construct prognostic models. Prediction models were internally validated by 10-fold cross-validation and externally validated with a dataset from The Cancer Genome Atlas. Discrimination and calibration were evaluated by Harrell concordence index (C-index) and calibration plots, respectively. RESULTS Age, T stage, N stage, histological type, tumor location, lymph-vascular invasion, preoperative carcinoembryonic antigen and sample lymph nodes were integrated into prediction models. The concordance index of Super learner-based prediction model (SLM) was 0.792 (95% confidence interval: 0.767-0.818), which is higher than that of the seventh edition American Joint Committee on Cancer TNM staging system 0.689 (95% confidence interval: 0.672-0.703) for predicting overall survival (P < 0.05). In the external validation, the concordance index of the SLM for predicting overall survival was also higher than that of tumor-node-metastasis (TNM) stage system (0.764 vs. 0.682, respectively; P < 0.001). In addition, the SLM showed good calibration properties. CONCLUSIONS We developed and externally validated an effective prognosis prediction model based on Super learner, which offered more reliable and accurate prognosis prediction and may be used to more accurately identify high-risk patients who need more active surveillance in patients with resected colorectal cancer.
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Affiliation(s)
- Jiqing Li
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute for Medical Dataology, Shandong University, Jinan, China
| | - Jianhua Gu
- Department of Epidemiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yuan Lu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute for Medical Dataology, Shandong University, Jinan, China
| | - Xiaoqing Wang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Shucheng Si
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute for Medical Dataology, Shandong University, Jinan, China
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Nakagawa T. Lymph node dissection for bladder cancer: Current standards and the latest evidence. Int J Urol 2020; 28:7-15. [PMID: 33145855 DOI: 10.1111/iju.14398] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/13/2020] [Indexed: 12/23/2022]
Abstract
Lymph node dissection is an indispensable component of radical cystectomy for bladder cancer. Information obtained with lymph node dissection is highly predictive of patient survival, affecting decision-making for adjuvant therapy (diagnostic role). Also, lymph node dissection provides survival benefits in certain patients by removing metastasized nodes (therapeutic role). However, an optimal extent of lymph node dissection has not been established yet. Data from surgical mapping studies showed that approximately 10% of the primary lymphatic landing sites were common iliac nodes, suggesting that lymph node dissection below the common iliac bifurcation is suboptimal. Several retrospective studies have shown a possible survival advantage with more extended lymph node dissection. However, the results of the first prospective randomized controlled trial failed to prove the survival advantage of extended lymph node dissection up to the level of the inferior mesenteric artery, compared with lymph node dissection below the bifurcation of the common iliac artery. Currently, lymph node dissection templates recommended by major guidelines are not consistent with each other. Furthermore, the evidence is limited in the settings of neoadjuvant chemotherapy, robot-assisted surgery and high-risk non-muscle-invasive disease. Physicians need to decide the extent of lymph node dissection for each patient, taking into account the potential survival benefit and possible harms of extended lymph node dissection. Another randomized controlled trial is currently underway and will provide further evidence shortly.
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Affiliation(s)
- Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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32
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Zhai W, Duan F, Zheng Y, Yan Q, Dai S, Chen T, Chen J, Wang J. Significance of accurate hilar and intrapulmonary lymph node examination and prognostication in stage IA-IIA non-small cell lung cancer, a retrospective cohort study. World J Surg Oncol 2020; 18:258. [PMID: 32998771 PMCID: PMC7528488 DOI: 10.1186/s12957-020-02027-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/10/2020] [Indexed: 12/25/2022] Open
Abstract
Background The examination of lymph nodes (LNs) plays an important role in the nodal staging of non-small cell lung cancer (NSCLC). For patients without LN metastasis, the main role of thorough LN examination is accurate staging, which weakens the effect of staging migration. To date, the role of hilar and intrapulmonary (N1) station LNs has not been fully appreciated. In this study, we aimed to confirm the significance of N1 LNs in long-term survival for stage IA–IIA NSCLC patients and to find the minimum number of LN to examine. Methods The data of patients who underwent radical lobectomy and were confirmed as having non-metastatic LNs from January 2008 to March 2018 were retrospectively screened. Pathology records were reviewed for the number of LNs examined. The Kaplan-Meier method and Cox regression model were used to identify survival and prognostic factors. Results The median number of resected N1 LNs was 8. The number of patients with 0–2 N1 LNs, 3–5 N1 LNs, 6–8 N1 LNs, 9–11 N1 LNs, and more than 11 N1 LNs examined was 181, 425, 477, 414, and 531, respectively. Sex (P = 0.004), age (P < 0.001), tumor size (P = 0.004), differentiation degree (P = 0.001), and number of N1 LNs examined (P = 0.008) were independent prognostic factors of overall survival. Gender (P = 0.006), age (P = 0.031), tumor size (P = 0.001), differentiation degree (P = 0.001), vascular invasion (P = 0.034), and number of N1 LNs examined (P = 0.007) were independent prognostic factors of disease-free survival. Compared with patients with 0–5 N1 LNs examined, patients with more than 5 N1 LNs examined had better OS (P = 0.015) and had better DFS (P = 0.015) if only a landmark 5-year follow-up was performed. Conclusion Increasing the number of N1 LN examination might improve the long-term survival of T1-2N0 NSCLC patients. These data indicate that at least 6 N1 nodes examined is an essential part in surgical and pathological management but cannot prove this. This finding should be confirmed in a large, prospective randomized clinical study.
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Affiliation(s)
- Wenyu Zhai
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Fangfang Duan
- VIP Region, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Yuzhen Zheng
- Department of Thoracic Surgery, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong, People's Republic of China
| | - Qihang Yan
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Shuqin Dai
- Department of Laboratory Medicine, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China
| | - Tao Chen
- Department of Thoracic Surgery, The People's Hospital of Chao Zhou, Chao Zhou, Guangdong, People's Republic of China
| | - Jianlong Chen
- Department of Thoracic Surgery, The Second People's Hospital of Shan Tou, Shan Tou, Guangdong, People's Republic of China
| | - Junye Wang
- Department of Thoracic Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
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Heck MM, Gschwend JE. Extended Lymph Node Dissection for Bladder Cancer: Do Clinical Trials Rule Out a Benefit? Eur Urol Focus 2020; 6:617-619. [PMID: 31439506 DOI: 10.1016/j.euf.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022]
Abstract
Although previous studies indicated a therapeutic benefit from superextended or extended lymph node dissection in bladder cancer patients undergoing radical cystectomy, the first prospective randomized trial could not confirm a significant survival benefit. With multimodal approaches including neoadjuvant or adjuvant chemotherapy as a gold standard, demonstrating any benefit may become even more difficult.
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Affiliation(s)
- Matthias M Heck
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Boström PJ, Jensen JB, Jerlström T, Arum CJ, Gudjonsson S, Ettala O, Syvänen KT. Clinical markers of morbidity, mortality and survival in bladder cancer patients treated with radical cystectomy. A systematic review. Scand J Urol 2020; 54:267-276. [PMID: 32516016 DOI: 10.1080/21681805.2020.1773527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Context: Radical cystectomy and pelvic lymph node dissection (RC and PLND) are an essential part of the treatment paradigm in high risk bladder cancer. However, these patients have high rates of morbidity and mortality related both to the treatment and to the disease.Objective: To provide overview of current literature about clinical markers that can be used to predict and improve BC-patient outcomes at the time of RC and PLND and to study if they are properly validated.Evidence acquisition: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria between January 1990 and October 2018 to identify English written original and review articles relevant to this topic. Prospective and retrospective studies were included.Evidence synthesis: There are several risk factors identified from non-randomised trials that can be improved before surgery to reduce perioperative mortality and morbidity. These include poor nutritional status, anaemia, renal function and smoking. Preoperative nomograms have also been developed to help decision-making and to inform patients about the risks of surgery. They can be used to estimate risk of postoperative mortality after RC and PLND with accuracy varying from 70 to 86%. These nomograms are largely based on retrospective data. Likewise, nomograms developed to calculate estimates about patient's overall and cancer specific survival have the same limitations.Conclusion: Clinical markers to predict morbidity, mortality and survival in patients with bladder cancer treated with RC and PLND may help to improve patient outcomes and treatment decision-making, but available data come from small retrospective trials and have not been properly validated. Prospective, multi-centre studies are needed to implement and disseminate predictive clinical markers and nomograms such that they can be utilised in treatment decision-making in daily practice.
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Affiliation(s)
- Peter J Boström
- Department of Urology, Turku University Hospital, Turku, Finland
| | | | - Tomas Jerlström
- School of Medical Sciences, Faculty of Medicine and Health, University of Örebro, Örebro, Sweden
| | - Carl-Jørgen Arum
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Otto Ettala
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Kari T Syvänen
- Department of Urology, Turku University Hospital, Turku, Finland
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A Novel Nomogram including AJCC Stages Could Better Predict Survival for NSCLC Patients Who Underwent Surgery: A Large Population-Based Study. JOURNAL OF ONCOLOGY 2020; 2020:7863984. [PMID: 32565807 PMCID: PMC7256774 DOI: 10.1155/2020/7863984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/16/2020] [Indexed: 12/25/2022]
Abstract
Objective In this study, we aimed to establish a novel nomogram model which was better than the current American Joint Committee on Cancer (AJCC) stage to predict survival for non-small-cell lung cancer (NSCLC) patients who underwent surgery. Patients and Methods. 19617 patients with initially diagnosed NSCLC were screened from Surveillance Epidemiology and End Results (SEER) database between 2010 and 2015. These patients were randomly divided into two groups including the training cohort and the validation cohort. The Cox proportional hazard model was used to analyze the influence of different variables on overall survival (OS). Then, using R software version 3.4.3, we constructed a nomogram and a risk classification system combined with some clinical parameters. We visualized the regression equation by nomogram after obtaining the regression coefficient in multivariate analysis. The concordance index (C-index) and calibration curve were used to perform the validation of nomogram. Receiver operating characteristic (ROC) curves were used to evaluate the clinical utility of the nomogram. Results Univariate and multivariate analyses demonstrated that seven factors including age, sex, stage, histology, surgery, and positive lymph nodes (all, P < 0.001) were independent predictors of OS. Among them, stage (C-index = 0.615), positive lymph nodes (C-index = 0.574), histology (C-index = 0.566), age (C-index = 0.563), and sex (C-index = 0.562) had a relatively strong ability to predict the OS. Based on these factors, we established and validated the predictive model by nomogram. The calibration curves showed good consistency between the actual OS and predicted OS. And the decision curves showed great clinical usefulness of the nomogram. Then, we built a risk classification system and divided NSCLC patients into two groups including high-risk group and low-risk group. The Kaplan-Meier curves revealed that OS in the two groups was accurately differentiated in the training cohort (P < 0.001). And then, we validated this result in the validation cohort which also showed that patients in the high-risk group had worse survival than those in the low-risk group. Conclusion The results proved that the nomogram model had better performance to predict survival for NSCLC patients who underwent surgery than AJCC stage. These tools may be helpful for clinicians to evaluate prognostic indicators of patients undergoing operation.
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Wang Y, Wu J, He H, Ma H, Hu L, Wen J, Lyu J. Nomogram predicting cancer-specific mortality in early-onset rectal cancer: a competing risk analysis. Int J Colorectal Dis 2020; 35:795-804. [PMID: 32078716 DOI: 10.1007/s00384-020-03527-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence of rectal cancer has meaningfully increased in young patients. However, quantitative evaluation for the competing data of early-onset rectal cancer is lacking. So, we performed a competing risk analysis to calculate the cumulative incidence of death for patients with early-onset rectal cancer and developed a nomogram to predict the probability of cancer-specific mortality for these patients. METHODS We abstracted data of patients with early-onset rectal cancer between 2004 and 2016 by using the Surveillance, Epidemiology, and End Results program database. The cumulative incidence function was used to calculate the crude cancer-specific mortality of early-onset rectal cancer. Fine and Gray's proportional sub-distribution hazard model was adopted to explore the risk factors of cancer-specific death. Then, we establish a nomogram to predict their 3-, 5-, and 10-year probabilities. RESULTS We identified 9917 patients with early-onset rectal cancer, and they were randomly divided into training (n = 6941) and validation (n = 2976) cohorts. In the training cohort, the 3-, 5-, and 10-year cumulative incidences of cancer-specific death after diagnosis for early-onset rectal cancer were 11.4%, 19.9%, and 28.8%, respectively. Fine and Gray's model showed that sex, race, marital status, histology, T stage, N stage, M stage, examined lymph nodes, and pretreatment carcinoembryonic antigen were independently associated with cancer-specific mortality. Such factors were selected to develop a prognostic nomogram. CONCLUSION The competing risk nomogram has an ideal performance for predictive cancer-specific mortality in early-onset rectal cancer.
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Affiliation(s)
- Yufeng Wang
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
- School of Public Health, Guangdong Medical University, No. 2, Wenmin East Road, Zhanjiang, 524023, Guangdong, People's Republic of China
| | - Jiayuan Wu
- Department of Clinical Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Hairong He
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Huan Ma
- School of Public Health, Guangdong Medical University, No. 2, Wenmin East Road, Zhanjiang, 524023, Guangdong, People's Republic of China
| | - Liren Hu
- School of Public Health, Guangdong Medical University, No. 2, Wenmin East Road, Zhanjiang, 524023, Guangdong, People's Republic of China.
| | - Jiyu Wen
- Department of Oncology, Affiliated Hospital of Guangdong Medical University, No. 57, South of Renmin Avenue, Zhanjiang, 524001, Guangdong, People's Republic of China.
| | - Jun Lyu
- Clinical Research Center, First Affiliated Hospital of Xi'an Jiaotong University, No. 277, Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
- Clinical Research Center, First Affiliated Hospital of Jinan Unversity, Guangzhou, Guangdong, People's Republic of China.
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Salih Boğa M, Özsoy Ç, Aktaş Y, Aydın A, Savaş M, Ateş M. Single-center experience of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection. Turk J Urol 2020; 46:tud.2020.19265. [PMID: 32301693 PMCID: PMC7360165 DOI: 10.5152/tud.2020.19265] [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: 12/13/2019] [Accepted: 03/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report the outcomes of robot-assisted radical cystectomy (RARC) and extended pelvic lymph node dissection (ePLND) series for bladder cancer. MATERIAL AND METHODS Between October 2016 and June 2019, overall 57 patients (50 men, 7 women) were included in the study. Patient demographics, operative data, and postoperative pathological outcomes were evaluated. Patients who had a history of pelvic or Professional surgery due to other concurrent malignancy, radiation therapy, or lacked data were excluded from the study. RESULTS The mean age of the patients was 64.72±9.09 years. The mean operation time, intraoperative estimated blood loss, and hospitalization time were 418.58±85.66 minutes, 313.00±79.16mL, and 13.44±5.25 days, respectively. The postoperative pathological stages were reported as pT0 (n=8), pTis (n=4), pT1 (n=4), pT2 (n=22), pT3a (n=11), pT3b (n=2), pT4a (n=4), pT4b (n=1), and other (n=1). The mean lymph node (LN) yield was 23.45±9.43. Positive LNs were found in 16 (28.1%) patients. Surgical margins were positive in 3 (5.26%) patients. The mean follow-up period was 15.42±8.31 months. According to the modified Clavien-Dindo system, minor (Clavien 1-2) and major (Clavien 3-5) complications occurred in 18 (31.58%) and 9 (15.78%) patients during the early (0-30 days) period and in 4 (7.02%) and 5 (8.77%) patients in the late (31-90 days) period. CONCLUSION RARC and ePLND are complex but safe procedures with acceptable morbidity and excellent surgical and oncologic outcomes in muscle-invasive or high-risk bladder tumors.
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Affiliation(s)
- Mehmet Salih Boğa
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Çağatay Özsoy
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yasin Aktaş
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
| | - Arif Aydın
- Department of Urology, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey
| | - Murat Savaş
- Private Memorial Antalya Hospital, Antalya, Turkey
| | - Mutlu Ateş
- Department of Urology, Health Sciences University, Antalya Training and Research Hospital, Antalya, Turkey
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Wu K, Fan J, Liang H, Yao Y, He D. Rapid testicular metastasis from bladder transitional urothelial carcinoma after radical cystoprostatectomy: A case report. Medicine (Baltimore) 2019; 98:e18000. [PMID: 31770212 PMCID: PMC6890337 DOI: 10.1097/md.0000000000018000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Bladder cancer (BC) is commonly diagnosed in the urinary system and the most common subtype is transitional urothelial carcinoma (TCC). Even with the best treatment, tumor recurrence and metastases always occur. While clinicians commonly observe the metastases to pelvic lymph nodes, liver, lung, and bone, it may infrequently spread to some uncommon locations. PATIENT CONCERNS The patient was a 67-year-old man with a diagnosis of high-grade TCC with squamous differentiation in the bladder and prostate. Subsequently, radical cystoprostatectomy, adjuvant radiotherapy, and chemotherapy were performed. However, he felt intermittent right scrotal pain about 1 year later. DIAGNOSIS Ultrasound strongly suggested a testicular neoplasm of right testis, but the left was normal. INTERVENTIONS The patient underwent a right radical orchiectomy and histopathology confirmed testicular metastatic neoplasm from bladder. Moreover, further examination with positron emission tomography revealed no visible distant spread of the urothelial carcinoma. OUTCOMES No signs of tumor recurrence or distant metastasis were visible under follow-up 1 year after radical orchiectomy. LESSONS Testicular mass may be metastatic tumor during follow-up for patients who were diagnosed as BC, especially for TCC with variant histology. The reason of this could be explained of residual micrometastases after surgery and need more examination to discover local micrometastases to apply more aggressive treatment.
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Affiliation(s)
| | | | | | - Yu Yao
- Department of Medical Oncology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, P.R. China
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Perera M, McGrath S, Sengupta S, Crozier J, Bolton D, Lawrentschuk N. Pelvic lymph node dissection during radical cystectomy for muscle-invasive bladder cancer. Nat Rev Urol 2019; 15:686-692. [PMID: 30104615 DOI: 10.1038/s41585-018-0066-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Radical cystectomy is the gold-standard treatment option for muscle-invasive and metastatic bladder cancer. At the time of cystectomy, up to 25% of patients harbour metastatic lymph node deposits. These deposits most frequently occur in the obturator fossa, but can be as proximal as the interaortocaval region. Thus, the use of concurrent pelvic lymph node dissection (PLND) with cystectomy has been increasingly reported. Data from studies including many patients suggest substantial oncological benefit in PLND cohorts versus non-PLND cohorts, irrespective of pathological nodal status. Additionally, PLND provides useful prognostic information, including disease burden, lymph node density, and extracapsular extension of metastatic lymph nodes. Accordingly, the National Comprehensive Cancer Network guidelines advocate the use of PLND during radical cystectomy for muscle-invasive bladder cancer. Despite this recommendation, a lack of consensus exists regarding the optimal PLND template. Comparative series suggest that extended PLND provides improved recurrence-free survival and cancer-specific survival compared with more limited PLND templates. More extensive templates (such as super-extended PLND) provide no additional survival benefit at the potential cost of increased operative time and patient morbidity. In addition to extended PLND templates, increased nodal harvest confers an oncological benefit in patients with node-positive disease or in patients with node-negative disease. Accordingly, recommendations for a minimum nodal yield have been proposed. Despite the growing body of evidence, formal recommendations by oncological and urological authoritative bodies have been limited owing to the lack of randomized data and level I evidence.
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Affiliation(s)
- Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Shannon McGrath
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Shomik Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Jack Crozier
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Sharma M, Goto T, Yang Z, Miyamoto H. The impact of perivesical lymph node metastasis on clinical outcomes of bladder cancer patients undergoing radical cystectomy. BMC Urol 2019; 19:77. [PMID: 31419974 PMCID: PMC6697999 DOI: 10.1186/s12894-019-0507-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/02/2019] [Indexed: 12/24/2022] Open
Abstract
Background Perivesical lymph nodes (PVLNs) are occasionally isolated during grossing of cystectomy specimens. However, the prognostic implications of the involvement of PVLNs in bladder cancer patients, especially those with comparisons to pN0 disease, remain poorly understood. Methods A retrospective review identified 115 radical cystectomy cases where PVLNs had been histologically assessed. These cases were then divided into 4 groups – Group 1 (n = 76): PVLN-negative/other pelvic lymph node (non-PVLN)-negative; Group 2 (n = 5): PVLN-positive/non-PVLN-negative; Group 3 (n = 17): PVLN-negative/non-PVLN-positive; and Group 4 (n = 17): PVLN-positive/non-PVLN-positive. Results pT stage at cystectomy was significantly higher in Group 3 (P = 0.013), Group 4 (P < 0.001), Groups 2 and 4 (P < 0.001), or Groups 2–4 (P < 0.001) than in Group 1. However, the number of positive PVLNs (mean: 1.8 vs. 2.1; P = 0.718) or the rate of extracapsular extension in the PVLNs (40% vs. 65%, P = 0.609) was not significantly different between Group 2 and Group 4. Kaplan-Meier analysis and log-rank test revealed significantly (P < 0.05) higher risks of disease progression (Group 3/Group 4), cancer-specific mortality (Group 2/Group 3/Group 4), and overall mortality (Group 4), compared with Group 1. Multivariate analysis further showed metastasis to both PVLN and non-PVLN (Group 4), PVLN (Groups 2 and 4), or PVLN and/or non-PVLN (Groups 2–4) as an independent prognosticator for cancer-specific mortality and overall survival. There were also insignificant (P = 0.096) and significant (P = 0.036) differences in cancer-specific survival and overall survival, respectively, between Group 3 versus Group 4, and the trend of the latter was confirmed by subset multivariate analysis (hazard ratio = 3.769; P = 0.099). Conclusions Worse prognosis was observed in bladder cancer patients with isolated PVLN metastasis (vs. pN0 disease especially for cancer-specific survival), PVLN metastasis with or without non-PVLN metastasis (vs. pN0 disease), and concurrent PVLN and non-PVLN metastases (vs. PVLN-negative/non-PVLN-positive disease especially for overall survival). These findings indicate the importance of thorough histopathological assessment of PVLNs in radical cystectomy specimens.
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Affiliation(s)
- Meenal Sharma
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Takuro Goto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.,James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Zhiming Yang
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Hiroshi Miyamoto
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA. .,James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA. .,Department of Urology, University of Rochester Medical Center, Rochester, NY, USA.
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Cacciamani GE, Winter M, Medina LG, Ashrafi AN, Miranda G, Tafuri A, Landsberger H, Lin-Brande M, Rajarubendra N, De Castro Abreu A, Berger A, Aron M, Gill IS, Desai MM. Radical cystectomy pentafecta: a proposal for standardisation of outcomes reporting following robot-assisted radical cystectomy. BJU Int 2019; 125:64-72. [PMID: 31260600 DOI: 10.1111/bju.14861] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To propose a standardisable composite method for reporting outcomes of radical cystectomy (RC) that incorporates both perioperative morbidity and oncological adequacy. PATIENTS AND METHODS From July 2010 to December 2017, 277 consecutive patients who underwent robot-assisted RC with intracorporeal urinary diversion (UD) for bladder cancer at our Institution were prospectively analysed. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), ≥16 lymph node (LN) yield, absence of major (grade III-IV) complications at 90 days, absence of UD-related long-term sequelae and absence of clinical recurrence at ≤12 months, were considered as having achieved the RC-pentafecta. A multivariable logistic regression model was assessed to measure predictors for achieving RC-pentafecta. RESULTS AND LIMITATIONS Since 2010, 270 of 277 patients that had completed at least 12 months of follow-up were included. Over a mean follow-up of 22.3 months, ≥16 LN yield, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤12 months were observed in 93.0%, 98.9%, 76.7%, 81.5% and 92.2%, patients, respectively, resulting in a RC-pentafecta rate of 53.3%. Multivariable logistic regression analysis revealed age (odds ratio [OR] 0.95; P = 0.002), type of UD (OR 2.19; P = 0.01) and pN stage (OR 0.48; P = 0.03) as independent predictors for achieving RC-pentafecta. CONCLUSIONS We present a RC-pentafecta as a standardisable composite endpoint that incorporates perioperative morbidity and oncological adequacy as a potential tool to assess quality of RC. This tool may be useful for assessing the learning curve and calculating cost-effectiveness amongst others but needs to be externally validated in future studies.
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Affiliation(s)
- Giovanni E Cacciamani
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Matthew Winter
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Luis G Medina
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Akhbar N Ashrafi
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Alessandro Tafuri
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA.,Department of Urology, University of Verona, Verona, Italy
| | - Hannah Landsberger
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Michael Lin-Brande
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Nieroshan Rajarubendra
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Andre De Castro Abreu
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Andre Berger
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Monish Aron
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Inderbir S Gill
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Mihir M Desai
- USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
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Prendeville S, Berney DM, Bubendorf L, Compérat E, Egevad L, Hes O, Kristiansen G, Oxley J, van Leenders GJLH, Varma M, van der Kwast T. Handling and reporting of pelvic lymphadenectomy specimens in prostate and bladder cancer: a web-based survey by the European Network of Uropathology. Histopathology 2019; 74:844-852. [PMID: 30604878 DOI: 10.1111/his.13818] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 01/01/2019] [Indexed: 02/04/2023]
Abstract
AIMS Pathological evaluation of lymphadenectomy specimens plays a pivotal role in accurate lymph node (LN) staging. Guidelines standardising the gross handling and reporting of pelvic LN dissection (PLND) in prostate (PCa) and bladder (BCa) cancer are currently lacking. This study aimed to establish current practice patterns of PLND evaluation among pathologists. METHODS AND RESULTS A web-based survey was circulated to all members of the European Network of Uropathology (ENUP), comprising 29 questions focusing on the macroscopic handling, LN enumeration and reporting of PLND in PCa and BCa. Two hundred and eighty responses were received from pathologists throughout 23 countries. Only LNs palpable at grossing were submitted by 58%, while 39% routinely embedded the entire specimen. Average LN yield from PLND was ≥10 LNs in 56% and <10 LNs in 44%. Serial section(s) and immunohistochemistry were routinely performed on LN blocks by 42% and <1% of respondents, respectively. To designate a LN microscopically, 91% required a capsule/subcapsular sinus. In pN+ cases, 72% reported the size of the largest metastatic deposit and 94% reported extranodal extension. Isolated tumour cells were interpreted as pN1 by 77%. Deposits identified in fat without associated lymphoid tissue were reported as tumour deposits (pN0) by 36% and replaced LNs (pN+) by 27%. LNs identified in periprostatic fat were included in the PLND LN count by 69%. CONCLUSION This study highlights variations in practice with respect to the gross sampling and microscopic evaluation of PLND in urological malignancies. A consensus protocol may provide a framework for more consistent and standardised reporting of PLND specimens.
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Affiliation(s)
| | - Daniel M Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Eva Compérat
- Hôpital Tenon, Sorbonne University, Paris, France
| | | | - Ondrej Hes
- Charles University Hospital, Plzen, Czech Republic
| | | | - Jon Oxley
- North Bristol NHS Trust, Bristol, UK
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Li J, Li X, Gu J, Ma X, Xue F. A competing-risks nomogram for predicting probability of death from CRC in Chinese Han patients with Stage I-III CRC. Jpn J Clin Oncol 2019; 48:1088-1095. [PMID: 30257010 DOI: 10.1093/jjco/hyy136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background Many patients with colorectal cancer are elderly with competing comorbidities. When constructing nomogram for assessing survival, we should consider the influence of competing risk. A competing-risks nomogram was developed to estimate the probability of death due to colorectal cancer for patients after curative surgery. Methods A total of 2442 patients with non-metastatic colorectal cancer were included to develop competing-risks nomogram. Competing-risks nomogram were established based on the results of Fine and Gray competing-risks proportional hazards model. To maximize the accuracy of prediction, model selection was not carried out, and non-linear continuous variables were flexibly modeled with restricted cubic splines. The nomogram was internal-validated by bootstrapping, and externally validated with a separate database of 299 patients from The Cancer Genome Atlas. The performance of this model was assessed by concordance index and a calibration curve. Results There were 332 patients died of colorectal cancer and 46 died of other causes during the follow-up period. Age, T stage, N stage, histological type, tumor location, adjuvant chemotherapy, preoperative carcinoembryonic antigen, lymph vascular invasion, lymph node ratio and sample lymph nodes were integrated into competing-risks nomogram. The competing-risks nomogram for predicting probability of death due to colorectal cancer with a concordance index of 0.768, ameliorating the stratification provided by the seventh edition tumor-node-metastasis staging system of the American Joint Committee on Cancer (AJCC). The concordance index for validation dataset was 0.783. Conclusion We developed and externally validated a competing-risks nomogram for Chinese Han patients with non-metastatic colorectal cancer, which could provide probability of death from colorectal cancer in the presence of competing risks.
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Affiliation(s)
- Jiqing Li
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Xiao Li
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Jianhua Gu
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Xiaotian Ma
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Fuzhong Xue
- Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan, Shandong, China
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Ristau BT, Smaldone MC. Performance Measurement and Quality Improvement Initiatives for Bladder Cancer Care. Curr Urol Rep 2018; 19:100. [PMID: 30357590 DOI: 10.1007/s11934-018-0856-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Bladder cancer care is costly due to long surveillance periods for non-muscle-invasive bladder cancer (NMIBC) and comorbidities associated with the surgical treatment of muscle-invasive bladder cancer (MIBC). We reviewed current evidence-based practices and propose quality metrics for NMIBC and MIBC. RECENT FINDINGS For patients with NMIBC, we propose four categories of candidate quality metrics: (1) appropriate use of imaging, (2) re-staging transurethral resection of bladder tumor, (3) perioperative intravesical chemotherapy, and (4) induction and maintenance BCG in high-risk NMIBC. For patients with MIBC, we propose eight candidate quality measures: (1) neoadjuvant chemotherapy, (2) multidisciplinary consultation, (3) urinary diversion teaching, (4) appropriate perioperative antibiotics, (5) venous thromboembolic prophylaxis, (6) lymphadenectomy, (7) monitoring of complications, and (8) inclusion of enhanced recovery after surgery protocols. Marked variation in evidence-based practice exists among patients with bladder cancer and represents opportunity for quality improvement. Regional and national physician-led collaboratives may be the best vehicle to achieve quality improvement in bladder cancer.
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Affiliation(s)
- Benjamin T Ristau
- Urologic Oncology, Division of Urology, UConn Health, 263 Farmington Avenue, MC-8036, Farmington, CT, 06030, USA.
| | - Marc C Smaldone
- Division of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
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Gschwend JE, Heck MM, Lehmann J, Rübben H, Albers P, Wolff JM, Frohneberg D, de Geeter P, Heidenreich A, Kälble T, Stöckle M, Schnöller T, Stenzl A, Müller M, Truss M, Roth S, Liehr UB, Leißner J, Bregenzer T, Retz M. Extended Versus Limited Lymph Node Dissection in Bladder Cancer Patients Undergoing Radical Cystectomy: Survival Results from a Prospective, Randomized Trial. Eur Urol 2018; 75:604-611. [PMID: 30337060 DOI: 10.1016/j.eururo.2018.09.047] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The extent of lymph node dissection (LND) in bladder cancer (BCa) patients at the time of radical cystectomy may affect oncologic outcome. OBJECTIVE To evaluate whether extended versus limited LND prolongs recurrence-free survival (RFS). DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter, phase-III trial patients with locally resectable T1G3 or muscle-invasive urothelial BCa (T2-T4aM0). INTERVENTION Randomization to limited (obturator, and internal and external iliac nodes) versus extended LND (in addition, deep obturator, common iliac, presacral, paracaval, interaortocaval, and para-aortal nodes up to the inferior mesenteric artery). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was RFS. Secondary endpoints included cancer-specific survival (CSS), overall survival (OS), and complications. The trial was designed to show 15% advantage of 5-yr RFS by extended LND. RESULTS AND LIMITATIONS In total, 401 patients were randomized from February 2006 to August 2010 (203 limited, 198 extended). The median number of dissected nodes was 19 in the limited and 31 in the extended arm. Extended LND failed to show superiority over limited LND with regard to RFS (5-yr RFS 65% vs 59%; hazard ratio [HR]=0.84 [95% confidence interval 0.58-1.22]; p=0.36), CSS (5-yr CSS 76% vs 65%; HR=0.70; p=0.10), and OS (5-yr OS 59% vs 50%; HR=0.78; p=0.12). Clavien grade ≥3 lymphoceles were more frequently reported in the extended LND group within 90d after surgery. Inclusion of T1G3 tumors may have contributed to the negative study result. CONCLUSIONS Extended LND failed to show a significant advantage over limited LND in RFS, CSS, and OS. A larger trial is required to determine whether extended compared with limited LND leads to a small, but clinically relevant, survival difference (ClinicalTrials.gov NCT01215071). PATIENT SUMMARY In this study, we investigated the outcome in bladder cancer patients undergoing cystectomy based on the anatomic extent of lymph node resection. We found that extended removal of lymph nodes did not reduce the rate of tumor recurrence in the expected range.
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Affiliation(s)
- Jürgen E Gschwend
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany.
| | - Matthias M Heck
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
| | | | | | - Peter Albers
- Department of Urology, Heinrich Heine University, Düsseldorf, Germany
| | - Johannes M Wolff
- Department of Urology, Paracelsus Hospital Golzheim Düsseldorf, Düsseldorf, Germany
| | | | | | | | | | - Michael Stöckle
- Department of Urology, Saarland University Medical Center, Homburg, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University, Tübingen, Germany
| | - Markus Müller
- Department of Urology, Hospital Ludwigshafen, Germany
| | | | - Stephan Roth
- Department of Urology, Helios Hospital, Wuppertal, Germany
| | - Uwe-Bernd Liehr
- Department of Urology, Otto von Guericke University, Magdeburg, Germany
| | | | | | - Margitta Retz
- Department of Urology, Rechts der Isar Medical Center, Technical University of Munich, Munich, Germany
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Mehralivand S, van der Poel H, Winter A, Choyke PL, Pinto PA, Turkbey B. Sentinel lymph node imaging in urologic oncology. Transl Androl Urol 2018; 7:887-902. [PMID: 30456192 PMCID: PMC6212622 DOI: 10.21037/tau.2018.08.23] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022] Open
Abstract
Lymph node (LN) metastases in urological malignancies correlate with poor oncological outcomes. Accurate LN staging is of great importance since patients can benefit from an optimal staging, accordingly aligned therapy and more radical treatments. Current conventional cross-sectional imaging modalities [e.g., computed tomography (CT) and magnetic resonance imaging (MRI)] are not accurate enough to reliably detect early LN metastases as they rely on size criteria. Radical lymphadenectomy, the surgical removal of regional LNs, is the gold standard of invasive LN staging. The LN dissection is guided by anatomic considerations of lymphatic drainage pathways of the primary tumor. Selection of patients for lymphadenectomy heavily relies on preoperative risk stratification and nomograms and, as a result a considerable number of patients unnecessarily undergo invasive staging with associated morbidity. On the other hand, due to individual variability in lymphatic drainage, LN metastases can occur outside of standard lymphadenectomy templates leading to potential understaging and undertreatment. In theory, metastases from the primary tumor need to pass through the chain of LNs, where the initial node is defined as the sentinel LN. In theory, identifying and removing this LN could lead to accurate assessment of metastatic status. Radiotracers and more recently fluorescent dyes and superparamagnetic iron oxide nanoparticles (SPION) are injected into the primary tumor or peritumoral and the sentinel LNs are identified intraoperatively by a gamma probe, fluorescent camera or a handheld magnetometer. Preoperative imaging [e.g., single-photon emission computed tomography (SPECT)/CT or MRI] after tracer injection can further improve preoperative planning of LN dissection. While sentinel LN biopsy is an accepted and widely used approach in melanoma and breast cancer staging, its use in urological malignancies is still limited. Most data published so far is in penile cancer staging since this cancer has a typical echelon-based lymphatic metastasizing pattern. More recent data is encouraging with low false-negative rates, but its use is limited to centers with high expertise. Current guidelines recommend sentinel LN biopsy as an accepted alternative to modified inguinal lymphadenectomy in patients with pT1G2 disease and non-palpable inguinal LNs. In prostate cancer, a high diagnostic accuracy could be demonstrated for the sentinel approach. Nevertheless, due to lack of data or high false-negative rates in other urological malignancies, sentinel LN biopsy is still considered experimental in other urological malignancies. More high-level evidence and longitudinal data is needed to determine its final value in those malignancies. In this manuscript, we will review sentinel node imaging for urologic malignancies.
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Affiliation(s)
- Sherif Mehralivand
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henk van der Poel
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alexander Winter
- University Hospital for Urology, Oldenburg Hospital, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Li J, Gu J, Ma X, Li X, Liu X, Kang F, Xue F. Development and validation of a nomogram for predicting survival in Chinese han patients with resected colorectal cancer. J Surg Oncol 2018; 118:1034-1041. [PMID: 30196534 DOI: 10.1002/jso.25213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/29/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Estimates of survival after curative colorectal cancer (CRC) surgery are the basis of patient care and treatment planning. A nomogram is a useful tool for individualized cancer prognosis. METHODS A total of 2450 patients with nonmetastatic CRC were included to develop a nomogram. Prognostic factors were identified and integrated by the Cox proportional hazards model. Then, we developed and validated a prognostic nomogram. The performance of this model was assessed by the concordance index (C-index) and a calibration curve. The nomogram was internally validated by bootstrapping and externally validated with a separate database of 299 patients from The Cancer Genome Atlas. RESULTS Age, T stage, N stage, histological type, tumor location, lymph-vascular invasion, preoperative carcinoembryonic antigen, and sample lymph nodes were integrated into the nomogram. The C-index of the nomogram for predicting overall survival was higher than that of the seventh edition American Joint Committee on Cancer TNM staging system (training data set, 0.76 vs 0.68, respectively; P < 0.001; validation data set, 0.78 vs 0.69, respectively; P = 0.003). CONCLUSION We developed a prognostic nomogram for patients with nonmetastatic CRC, which could provide a more individualized outcome prognostication than that afforded by the TNM staging system by using common clinicopathologic factors.
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Affiliation(s)
- Jiqing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Jianhua Gu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Xiaotian Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Xiao Li
- Department of Gastroenterology, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Xiaojuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Fengling Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Fuzhong Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China
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Mari A, Kimura S, Foerster B, Abufaraj M, D'Andrea D, Gust KM, Shariat SF. A systematic review and meta-analysis of lymphovascular invasion in patients treated with radical cystectomy for bladder cancer. Urol Oncol 2018; 36:293-305. [PMID: 29685374 DOI: 10.1016/j.urolonc.2018.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/06/2018] [Accepted: 03/26/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Lymphovascular invasion (LVI) is an important step in bladder cancer cell dissemination. We aimed to perform a systematic review and meta-analysis of the literature to assess the prognostic value of LVI in radical cystectomy (RC) specimens. PATIENTS AND METHODS A systematic review and meta-analysis of the last 10 years was performed using the MEDLINE, EMBASE, and the Cochrane libraries in July 2017. The analyses were performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. RESULTS We retrieved 65 studies (including 78,107 patients) evaluating the effect of LVI on oncologic outcomes in patients treated with RC. LVI was reported in 35.4% of patients. LVI was associated with disease recurrence (pooled hazard ratio [HR] = 1.57; 95% CI: 1.45-1.70) and cancer-specific mortality (CSM) (pooled HR = 1.59; 95% CI: 1.48-1.73) in all studies regardless of tumor stage and node status (pT1-4 pN0-2). LVI was associated with recurrence and CSM in patients with node-negative bladder cancer (BC). In patients with node-negative BC, LVI rate increased and was associated with worse oncologic outcome. LVI had a lower but still significant association with disease recurrence and CSM in node-positive BC. CONCLUSIONS LVI is a strong prognostic factor of worse prognosis in patients treated with RC for bladder cancer. This association is strongest in node-negative BC, but it is also in node-positive BC. LVI should be part of all pathological reporting and could provide additional information for treatment-decision making regarding adjuvant therapy after RC.
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Affiliation(s)
- Andrea Mari
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Shoji Kimura
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Beat Foerster
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Special Surgery, Jordan University hospital, The University of Jordan, Amman, Jordan
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Kilian M Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY.
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49
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Mari A, Campi R, Tellini R, Gandaglia G, Albisinni S, Abufaraj M, Hatzichristodoulou G, Montorsi F, van Velthoven R, Carini M, Minervini A, Shariat SF. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol 2017; 36:157-170. [PMID: 29147759 PMCID: PMC5799348 DOI: 10.1007/s00345-017-2115-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To review the currently available literature reporting the patterns of recurrence and their predictive factors after open radical cystectomy (RC) for bladder cancer. Methods A review of the literature was performed using the MEDLINE, Scopus and Web of Sciences databases from January 1997 to May 2017. The PRISMA guidelines were followed for the conduct of the study. Results Local recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%. The mean follow-up of studies included in the analysis ranged from 18 to 350 months. Details on the most important demographic and epidemiological, clinical, histologic and pathologic predictors of recurrence after radical cystectomy are provided through an evidence-based approach. The impact of the extension of lymph node dissection on recurrence after RC is investigated. Conclusions A correct prognostic assessment is essential for patients undergoing radical cystectomy for bladder cancer, thereby potentially improving their oncologic outcomes. Electronic supplementary material The online version of this article (10.1007/s00345-017-2115-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Simone Albisinni
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Roland van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria. .,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. .,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA. .,Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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50
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Crozier J, Papa N, Perera M, Stewart M, Goad J, Sengupta S, Bolton D, Lawrentschuk N. Lymph node yield in node-negative patients predicts cancer specific survival following radical cystectomy for transitional cell carcinoma. Investig Clin Urol 2017; 58:416-422. [PMID: 29124240 PMCID: PMC5671960 DOI: 10.4111/icu.2017.58.6.416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/23/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose To determine the oncological implications of increased nodal dissection in node-negative bladder cancer during radical cystectomy in a contemporary Australian series. Materials and Methods We performed a multicenter retrospective study, including more than 40 surgeons across 5 sites over a 10-year period. We identified 353 patients with primary bladder cancer undergoing radical cystectomy. Extent of lymphadenectomy was defined as follows; limited pelvic lymph node dissection (PLND) (perivesical, pelvic, and obturator), standard PLND (internal and external iliac) and extended PLND (common iliac). Multivariable cox proportional hazards and logistic regression models were used to determine LNY effect on cancer-specific survival. Results Over the study period, the extent of dissection and lymph node yield increased considerably. In node-negative patients, lymph node yield (LNY) conferred a significantly improved cancer-specific survival. Compared to cases where LNY of 1 to 5 nodes were taken, the hazard ratio (HR) for 6 to 15 nodes harvested was 0.78 (95% confidence interval [CI], 0.43-1.39) and for greater than 15 nodes the HR was 0.31 (95% CI, 0.17-0.57), adjusted for age, sex, T stage, margin status, and year of surgery. The predicted probability of cancer-specific death within 2 years of cystectomy was 16% (95% CI, 13%-19%) with 10 nodes harvested, falling to 5.5% (95% CI, 0%-12%) with 30 nodes taken. Increasing harvest in all PLND templates conferred a survival benefit. Conclusions The findings of the current study highlight the improved oncological outcomes with increased LNY, irrespective of the dissection template. Further prospective research is needed to aid LND data interpretation.
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Affiliation(s)
- Jack Crozier
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia
| | - Nathan Papa
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia
| | - Marlon Perera
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia
| | | | | | - Shomik Sengupta
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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