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Zhang Y, Guo X, Zhang Y, Wei J, Yan P, Kang H, Shu Y, Liu C, Yang X. A preliminary investigation of precise visualization, localization, and resection of pelvic lymph nodes in bladder cancer by using indocyanine green fluorescence-guided approach through intracutaneous dye injection into the lower limbs and perineum. Front Oncol 2024; 14:1384268. [PMID: 38841156 PMCID: PMC11151086 DOI: 10.3389/fonc.2024.1384268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Objective This study aimed to investigate the feasibility and effectiveness of using indocyanine green (ICG) injected intracutaneously through the lower limbs and perineum for visualized tracking, localization, and qualitative assessment of pelvic lymph nodes (LNs) in bladder cancer to achieve their accurate resection. Methods First, ICG was injected into the LN metastasis model mice lower limbs, and real-time and dynamic in vivo and ex vivo imaging was conducted by using a near-infrared fluorescence imaging system. Additionally, 26 patients with bladder cancer were enrolled and divided into intracutaneous group and transurethral group. A near-infrared fluorescence imaging device with internal and external imaging probes was used to perform real-time tracking, localization, and resection of the pelvic LNs. Results The mice normal LNs and the metastatic LNs exhibited fluorescence. The metastatic LNs showed a significantly higher signal-to-background ratio than the normal LNs (3.9 ± 0.2 vs. 2.0 ± 0.1, p < 0.05). In the intracutaneous group, the accuracy rate of fluorescent-labeled LNs was 97.6%, with an average of 11.3 ± 2.4 LNs resected per patient. Six positive LNs were detected in three patients (18.8%). In the transurethral group, the accuracy rate of fluorescent-labeled LNs was 84.4%, with an average of 8.6 ± 2.3 LNs resected per patient. Two positive LNs were detected in one patient (12.5%). Conclusion Following the intracutaneous injection of ICG into the lower limbs and perineum, the dye accumulates in pelvic LNs through lymphatic reflux. By using near-infrared fluorescence laparoscopic fusion imaging, physicians can perform real-time tracking, localization, and precise resection of pelvic LNs.
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Affiliation(s)
- Yunmeng Zhang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xinyu Guo
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yueying Zhang
- Public Experiment Center, University of Shanghai for Science and Technology, Shanghai, China
| | - Jinzheng Wei
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Pengyu Yan
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Haiming Kang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yang Shu
- The Second Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Chao Liu
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaofeng Yang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College of Shanxi Medical University, Taiyuan, 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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Klose C, Gordon O, Sparks A, Whalen M. Trends of Lymph Node Outcomes in Partial Cystectomy for Muscle-Invasive Urothelial Carcinoma of the Bladder. Clin Genitourin Cancer 2023; 21:703-709. [PMID: 37336704 DOI: 10.1016/j.clgc.2023.05.020] [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: 02/05/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Local tumor invasion depth has been associated with lymph node metastasis in urothelial carcinoma, and, for muscle-invasive bladder cancer (MIBC), pelvic lymph node dissection (PLND) is a critical step in curative surgery. Gold standard treatment includes radical cystectomy (RC), but partial cystectomy (PC) is an important bladder-preserving modality reserved for patients with certain favorable prognostic indicators. There is poor evidence concerning the utility of PLND in PC and we seek to further define its role by comparing survival outcomes when PLND was cursory or omitted. METHODS A retrospective analysis of 13,652 cT2N0M0 patients who underwent PC or RC between 2004 and 2016 was performed using the National Cancer Database. Patients undergoing PC were stratified by the presence of PLND as well as by node yield >15. The primary outcome was overall survival, analyzed using the Kaplan-Meier Method and multivariable Cox-proportional hazards regression. Multivariable models were adjusted for confounding clinicopathologic variables. RESULTS From 2004 to 2016, PLND in PC increased from 44% to 57% with RC remaining over 90%. Compared to RC, PC was approximately twice as likely to be performed at community centers and approached laparoscopically/robotically (P < .001). When stratifying PC PLND yield into 1 to 15 and > 15 compared to PC without PLND, the adjusted hazard ratios for overall mortality were 0.78 and 0.54, respectively (P < .05). CONCLUSIONS PC patients had a significantly lower rate of PLND compared to RC and improved survival when performed versus PC alone. Furthermore, increased node yield was associated with a larger reduction of adjusted mortality hazard. For MIBC patients that are appropriately selected for PC, high-yield PLND should be prioritized given the significantly improved survival outcomes.
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Affiliation(s)
- Charles Klose
- The George Washington University School of Medicine and Health Sciences Department of Urology, Washington, DC; The Brody School of Medicine at East Carolina University, Greenville, NC.
| | - Olivia Gordon
- The George Washington University School of Medicine and Health Sciences Department of Urology, Washington, DC
| | - Andrew Sparks
- The University of Vermont Biomedical Statistics Research Core, Burlington, VT
| | - Michael Whalen
- The George Washington University School of Medicine and Health Sciences Department of Urology, Washington, DC
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Gödde D, Degener S, Walles C, Keller R, Graf K, Tosch M, Krege S, Musch M, Kvasnicka HM, Ackermann M, Störkel S, von Rundstedt FC. Degenerative Changes in Aging Human Pelvic Lymph Nodes-A Reason to Rethink Staging and Therapy of Regional Malignancies? Cancers (Basel) 2023; 15:4754. [PMID: 37835449 PMCID: PMC10571730 DOI: 10.3390/cancers15194754] [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: 05/23/2023] [Revised: 08/02/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Lymph node metastases are common in pelvic urological tumors, and the age-related remodeling process of the pelvic lymph nodes influences metastatic behavior. The aim of this work is to characterize age-related degenerative changes in the pelvic lymph nodes with respect to their occurrence and extent. A total of 5173 pelvic lymph nodes of 390 patients aged 44 to 79 years (median 68 years, IQR 62-71 years) were histologically examined for degenerative structural changes. Lymph node size, lipomatous atrophy, capsular fibrosis, framework fibrosis, and calcifications were recorded semi-quantitatively and evaluated by age group. Significantly more lymph nodes <10 mm were found in older patients (p = 0.001). The incidence of framework fibrosis, capsular fibrosis, and calcifications increased significantly with increasing patient age (p < 0.001). In lipomatous atrophy, an increase in mild to moderate lipomatous atrophy was observed with increasing age (p < 0.001). In this, the largest study to date on this topic, age-related degenerative changes in pelvic lymph nodes were proven. Due to the consecutive decrease in hte filtration function of pelvic lymph nodes with increasing age, staging and therapy of metastatic pelvic urologic carcinomas should be reconsidered.
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Affiliation(s)
- Daniel Gödde
- Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
| | - Stephan Degener
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
- Department of Urology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
| | - Christine Walles
- Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
| | - Rosalie Keller
- Clinic for Otolaryngology, HELIOS-Hospital, 47805 Krefeld, Germany
| | - Katharina Graf
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
- Centre for Clinical Trials, Witten/Herdecke University, 58448 Witten, Germany
| | - Marco Tosch
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
- Department of Nuclear Medicine, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
| | - Susanne Krege
- Department of Urology, Pediatric Urology and Urologic Oncology, Evangelische Kliniken Essen-Mitte, 45136 Essen, Germany
| | - Michael Musch
- Department of Urology, Pediatric Urology and Urologic Oncology, Evangelische Kliniken Essen-Mitte, 45136 Essen, Germany
| | - Hans Michael Kvasnicka
- Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
| | - Maximilian Ackermann
- Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
| | - Stephan Störkel
- Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
| | - Friedrich-Carl von Rundstedt
- Department of Medicine, Faculty of Health, Witten/Herdecke University, 58448 Witten, Germany
- Department of Urology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany
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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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Gross JT, Vetter JM, Sands KG, Palka JK, Bhayani SB, Figenshau RS, Kim EH. Initial Experience with Single-Port Robot-Assisted Radical Cystectomy: Comparison of Perioperative Outcomes Between Single-Port and Conventional Multiport Approaches. J Endourol 2021; 35:1177-1183. [PMID: 33677991 DOI: 10.1089/end.2020.1227] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The surgical techniques and devices used to perform radical cystectomy have evolved significantly with the advent of laparoscopic and robotic methods. The da Vinci® Single-Port (SP) platform (Intuitive Surgical, Inc., Sunnyvale, CA) is an innovation that allows a surgeon to perform robot-assisted radical cystectomy (RARC) through a single incision. To determine if this new tool is comparable to its multiport (MP) predecessors, we reviewed a single-surgeon experience of SP RARC. Materials and Methods: We identified patients at our institution who underwent RARC between August 2017 and June 2020 by one surgeon at our institution (n = 64). Using propensity scoring analysis, patients whose procedure were performed with the SP platform (n = 12) were matched 1:2 to patients whose procedure was performed with the MP platform (n = 24). Univariable analysis was performed to identify differences in any perioperative outcome, including operative time, estimated blood loss (EBL), lymph node yield, 90-day complication/readmission rates, and positive surgical margin (PSM) rates. Results: Patients who had an SP RARC on average had a lower lymph node yield than those who had an MP RARC (11.9 vs 17.1, p = 0.0347). All other perioperative outcomes, including operative time, EBL, 90-day complication rates, 90-day readmission rates, and PSM rates, were not significantly different between the SP and MP RARC groups. Conclusions: Based on their perioperative outcomes, the SP platform is a feasible alternative to the MP platform when performing RARC. The SP's perioperative outcomes should continue to be evaluated as more SP RARCs are performed.
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Affiliation(s)
- James T Gross
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joel M Vetter
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Kenneth G Sands
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Joshua K Palka
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Sam B Bhayani
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert S Figenshau
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Eric H Kim
- Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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The role of neoadjuvant chemotherapy, lymph node dissection, and treatment delay in patients with muscle-invasive bladder cancer undergoing partial cystectomy. Urol Oncol 2021; 39:496.e17-496.e24. [PMID: 33640225 DOI: 10.1016/j.urolonc.2021.01.016] [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: 10/28/2020] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To investigate treatment patterns of partial cystectomy (PC), neoadjuvant chemotherapy (NAC), lymph node dissection (LND), and treatment delays, and the associations with overall survival (OS) among patients with muscle-invasive bladder cancer. PATIENTS AND METHODS We identified patients with cT2-4cN0cM0 urothelial carcinoma of the bladder in the National Cancer Database who underwent PC from 2007 through 2015. We performed descriptive statistics and assessed temporal trends using the Cochrane-Armitage test. Our outcomes of interest were NAC, LND, and treatment delay defined as ≥8 or ≥12 weeks for patients who underwent NAC or upfront surgery, respectively. We used logistic regression and multivariable Cox proportional hazards models to evaluate predictors and associations with OS, respectively. RESULTS A total of 9,199 patients met inclusion criteria. Over the study period, PC utilization decreased from 9% to 7% (P = 0.06). Compared with patients who underwent radical cystectomy, patients treated with PC less frequently received NAC (7% vs. 17%, P < 0.01) and LND (57% vs. 91%, P < 0.01), but were less likely to experience treatment delays (25% vs. 31%, P < 0.01). Only 4.1% (27/655) of patients treated with PC received the combination of NAC, LND, and no treatment delay. In a Cox model, adequacy of LND was associated with improved OS (<10 nodes: HR 0.62, 95% CI 0.48-0.81 and ≥10 nodes: HR 0.48, 95% Cl 0.32-0.72). CONCLUSION PC is uncommon and associated with poorer utilization of NAC and LND, but fewer treatment delays. The adequacy of LND was associated with improved OS while NAC and treatment delay were not.
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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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9
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Liu SW, Woody NM, Wei W, Appachi S, Contrera KJ, Tsai JC, Ghanem AI, Matia B, Joshi NP, Geiger JL, Ku JA, Burkey BB, Scharpf J, Prendes BL, Caudell JJ, Dunlap NE, Adelstein DJ, Porceddu S, Liu H, Siddiqui F, Lee NY, Koyfman S, Lamarre ED. Evaluating compliance with process-related quality metrics and survival in oral cavity squamous cell carcinoma: Multi-institutional oral cavity collaboration study. Head Neck 2020; 43:60-69. [PMID: 32918373 DOI: 10.1002/hed.26454] [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: 02/04/2020] [Revised: 08/01/2020] [Accepted: 08/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Process-related measures have been proposed as quality metrics in head and neck cancer care. A recent single-institution study identified four key metrics associated with increased survival. This study sought to validate the association of these quality metrics with survival in a multi-institutional cohort. METHODS Multicenter retrospective study of patients with oral cavity squamous cell (1/2005-1/2015). Baseline patient and disease characteristics and compliance with quality metrics was evaluated. Association between compliance with quality metrics with overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) was evaluated using Cox proportional hazards models. RESULTS Failure to comply with two or more of the quality metrics was associated with worse OS, DFS, and DSS. Adherence to all or all but one of the quality metrics was found to be associated with improved survival. CONCLUSIONS Process-related quality metrics are associated with increased survival in patients with oral cavity squamous cell carcinoma in a multi-institutional cohort.
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Affiliation(s)
- Sara W Liu
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Neil M Woody
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Wei
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Swathi Appachi
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jillian C Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ahmed I Ghanem
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Brian Matia
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nikhil P Joshi
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital/University of Queensland, Brisbane, QLD, Australia
| | - Howard Liu
- Department of Radiation Oncology, Princess Alexandra Hospital/University of Queensland, Brisbane, QLD, Australia
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shlomo Koyfman
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, USA
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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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Chipollini J, Azizi M, Lo Vullo S, Mariani L, Zhu Y, Ye DW, Ornellas AA, Watkin N, Ager M, Hakenberg O, Heidenreich A, Raggi D, Catanzaro M, Ornellas P, Salvioni R, Cheriyan SK, Necchi A, Spiess PE. Identifying an optimal lymph node yield for penile squamous cell carcinoma: prognostic impact of surgical dissection. BJU Int 2019; 125:82-88. [PMID: 31356716 DOI: 10.1111/bju.14883] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the prognostic impact of lymph node yield (LNY) on survival outcomes for penile squamous cell carcinoma (SCC). PATIENTS AND METHODS In all, 532 patients who underwent inguinal LN dissection (ILND) across tertiary referral centres from Europe, China, Brazil and North America were retrospectively evaluated. From this cohort, 198 patients received pelvic LND (PLND).We identified threshold values for ILND and PLND using receiver operating characteristic curves. We tested prognostic value of LNY for recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) using the Kaplan-Meir method and Cox proportional hazard regression models. RESULTS The median (interquartile [IQR]) age was 59 (49-68) years and the median (IQR) follow-up after ILND was 28 (12-68.2) months. Overall, 85% of the patients had bilateral dissections. The median (IQR) number of inguinal LNs removed was 15 (10-22). Of those receiving PLND, The median (IQR) number of LNs was 13 (8-19). A LNY of ≥15 was used for dichotomisation of ILND patients, and a LNY of ≥9 was used in the PLND cohort. Patients with a LNY ≥15 had significantly better 5-year OS vs patients with a LNY <15 (70.1% vs 58.7%). On multivariable analyses, a LNY ≥15 was a predictor of OS (hazard ratio [HR] 0.68, P = 0.029). For cN0 patients, a LNY ≥15 was an independent predictor of RFS (HR 0.52, P = 0.043) and OS (HR 0.53, P = 0.021). In the PLND cohort, a LNY ≥9 was a predictor of RFS (HR 0.53, P = 0.032). CONCLUSIONS Using one of the largest LND datasets to date, we found LNY to be a significant predictor of outcomes after lymphatic staging for penile SCC. Prospective validation is warranted.
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Affiliation(s)
- Juan Chipollini
- The University of Arizona College of Medicine, Tucson, AZ, USA
| | - Mounsif Azizi
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Luigi Mariani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Yao Zhu
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ding W Ye
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | - Nick Watkin
- NHS Foundation Trust, St. George's University Hospitals, London, UK
| | - Michael Ager
- NHS Foundation Trust, St. George's University Hospitals, London, UK
| | | | | | - Daniele Raggi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Mario Catanzaro
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Paulo Ornellas
- Hospital Mário Kröeff and Brazilian Cancer Institute, Rio de Janeiro, Brazil
| | | | - Salim K Cheriyan
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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12
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Zhang L, Wu B, Zha Z, Qu W, Zhao H, Yuan J. Clinicopathological factors in bladder cancer for cancer-specific survival outcomes following radical cystectomy: a systematic review and meta-analysis. BMC Cancer 2019; 19:716. [PMID: 31324162 PMCID: PMC6642549 DOI: 10.1186/s12885-019-5924-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Assessing the prognostic significance of specific clinicopathological features plays an important role in surgical management after radical cystectomy. This study investigated the association between ten clinicopathological characteristics and cancer-specific survival (CSS) in patients with bladder cancer. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a literature search was conducted through the PubMed, EMBASE and Web of Science databases using appropriate search terms from the dates of inception until November 2018. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the CSS. Fixed- or random-effects models were constructed according to existence of heterogeneity. Results Thirty-three articles met the eligibility criteria for this systematic review, which included 19,702 patients. The overall results revealed that CSS was associated with advanced age (old vs. young: pooled HR = 1.01; 95% CI:1.00–1.01; P < 0.001), higher tumor grade (3 vs. 1/2: pooled HR = 1.29; 95% CI:1.15–1.45; P < 0.001), higher pathological stage (3/4 vs. 1/2: pooled HR = 1.60; 95% CI:1.37–1.86; P < 0.001), lymph node metastasis (positive vs. negative: pooled HR = 1.51; 95% CI:1.37–1.67; P < 0.001), lymphovascular invasion (positive vs. negative: pooled HR = 1.36; 95% CI:1.28–1.45; P < 0.001), and soft tissue surgical margin (positive vs. negative: pooled HR = 1.42; 95% CI:1.30–1.56; P < 0.001). However, gender (male vs. female: pooled HR = 0.98; 95% CI: 0.96–1.01; P = 0.278), carcinoma in situ (positive vs. negative: pooled HR = 0.98; 95% CI: 0.88–1.10; P = 0.753), histology (transitional cell cancer vs variant: pooled HR = 0.90; 95% CI: 0.79–1.02; P = 0.089) and adjuvant chemotherapy (yes vs. no: pooled HR = 1.16; 95% CI: 1.00–1.34; P = 0.054) did not affect CSS after radical resection of bladder cancer. Conclusions Our results revealed that several clinicopathological characteristics can predict CSS risk after radical cystectomy. Prospective studies are needed to further confirm the predictive value of these variables for the prognosis of bladder cancer patients after radical cystectomy. Electronic supplementary material The online version of this article (10.1186/s12885-019-5924-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China.
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Wei Qu
- Department of Pharmacy, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
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