1
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Swinton M, Mariam NBG, Tan JL, Murphy K, Elumalai T, Soni M, Ferrera A, Richardson C, Walshaw R, Mistry H, Ramani V, Song Y, Birtle A, Henry A, Chan J, Hoskin P, Choudhury A. Bladder-Sparing Treatment With Radical Dose Radiotherapy Is an Effective Alternative to Radical Cystectomy in Patients With Clinically Node-Positive Nonmetastatic Bladder Cancer. J Clin Oncol 2023; 41:4406-4415. [PMID: 37478391 DOI: 10.1200/jco.23.00725] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice. METHODS Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors. RESULTS A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis. CONCLUSION Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC-in a patient group with poor survival-this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.
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Affiliation(s)
- Martin Swinton
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Jean Ling Tan
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Katherine Murphy
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Thiraviyam Elumalai
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Manjusha Soni
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | - Richard Walshaw
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Hitesh Mistry
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Vijay Ramani
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Yeepei Song
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joachim Chan
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Peter Hoskin
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Ananya Choudhury
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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2
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Małkiewicz B, Gurwin A, Karwacki J, Nagi K, Knecht-Gurwin K, Hober K, Łyko M, Kowalczyk K, Krajewski W, Kołodziej A, Szydełko T. Management of Bladder Cancer Patients with Clinical Evidence of Lymph Node Invasion (cN+). Cancers (Basel) 2022; 14:5286. [PMID: 36358705 PMCID: PMC9656528 DOI: 10.3390/cancers14215286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/29/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022] Open
Abstract
The purpose of this review is to present the current knowledge about the diagnostic and treatment options for bladder cancer (BCa) patients with clinically positive lymph nodes (cN+). This review shows compaction of CT and MRI performance in preoperative prediction of lymph node invasion (LNI) in BCa patients, along with other diagnostic methods. Most scientific societies do not distinguish cN+ patients in their guidelines; recommendations concern muscle-invasive bladder cancer (MIBC) and differ between associations. The curative treatment that provides the best long-term survival in cN+ patients is a multimodal approach, with a combination of neoadjuvant chemotherapy (NAC) and radical cystectomy (RC) with extended pelvic lymph node dissection (ePLND). The role of adjuvant chemotherapy (AC) remains uncertain; however, emerging evidence indicates comparable outcomes to NAC. Therefore, in cN+ patients who have not received NAC, AC should be implemented. The response to ChT is a crucial prognostic factor for cN+ patients. Recent studies demonstrated the growing importance of immunotherapy, especially in ChT-ineligible patients. Moreover, immunotherapy can be suitable as adjuvant therapy in selected cases. In cN+ patients, the extended template of PLND should be utilized, with the total resected node count being less important than the template. This review is intended to draw special attention to cN+ BCa patients, as the oncological outcomes are significantly worse for this group.
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Affiliation(s)
- Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Adam Gurwin
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Jakub Karwacki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Krystian Nagi
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Klaudia Knecht-Gurwin
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Krzysztof Hober
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Kamil Kowalczyk
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Anna Kołodziej
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Tomasz Szydełko
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
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3
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Impact of carcinoma in situ on survival of patients treated by adjuvant chemotherapy after cystectomy. Prog Urol 2021; 32:53-60. [PMID: 34756696 DOI: 10.1016/j.purol.2021.09.010] [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: 07/19/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Factors predicting response to adjuvant chemotherapy (AC) are required to identify patients who will most benefit from it. The aim of this study was to evaluate the impact of carcinoma in situ (CIS) at radical cystectomy (RC) on recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) of patients treated by AC. MATERIALS AND METHODS A single-center retrospective study was performed on patients who received AC after RC without pre-RC chemotherapy or trimodal therapy. RESULTS Among the 150 patients analyzed, 52,7% had CIS on the RC specimens. Baseline characteristics were not significantly different between the CIS negative and positive groups. Most patients received a cisplatin-based AC (74%). The median follow-up of the cohort was 36,4 months. The presence of CIS was not significantly associated to disease-recurrence (OR=0.67; 95%CI=0.35-1.29; P=0.23), cancer related death (OR=0.70; 95%CI=0.36-1.33; P=0.27) or death by any cause (OR=0.80; 95%CI=0.42-1.52; P=0.50). The presence of CIS had no significant impact on RFS (HR=0.86; 95%CI=0.56-1.33; P=0.49), CSS (HR=0.85; 95%CI=0.53-1.36; P=0.50) or OS (HR=0.93; 95%CI=0.60-1.45; P=0.74). CONCLUSION The presence of CIS on RC specimens did not have an impact on survival of patients treated by AC. CIS could be evaluated as a prognostic factor of response to novel adjuvant regimens such as immunotherapy.
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4
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Tian Z, Meng L, Wang X, Diao T, Hu M, Wang M, Zhang Y, Liu M. Predictive Nomogram and Risk Factors for Lymph Node Metastasis in Bladder Cancer. Front Oncol 2021; 11:690324. [PMID: 34222019 PMCID: PMC8242250 DOI: 10.3389/fonc.2021.690324] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Lymph node metastasis (LNM) is an important prognostic factor for bladder cancer (BCA) and determines the treatment strategy. This study aimed to determine related clinicopathological factors of LNM and analyze the prognosis of BCA. A total of 10,653 eligible patients with BCA were randomly divided into training or verification sets using the 2004-2015 data of the Surveillance, Epidemiology, and End Results database. To identify prognostic factors for the overall survival of BCA, we utilized the Cox proportional hazard model. Independent risk factors for LNM were evaluated via logistic regression analysis. T-stage, tumor grade, patient age and tumor size were identified as independent risk factors for LNM and were used to develop the LNM nomogram. The Kaplan-Meier method and competitive risk analyses were applied to establish the influence of lymph node status on BCA prognosis. The accuracy of LNM nomogram was evaluated in the training and verification sets. The areas under the receiver operating characteristic curve (AUC) showed an effective predictive accuracy of the nomogram in both the training (AUC: 0.690) and verification (AUC: 0.704) sets. In addition, the calibration curve indicated good consistency between the prediction of deviation correction and the ideal reference line. The decision curve analysis showed that the nomogram had a high clinical application value. In conclusion, our nomogram displayed high accuracy and reliability in predicting LNM. This could assist the selection of the optimal treatment for patients.
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Affiliation(s)
- Zijian Tian
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Tongxiang Diao
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Maolin Hu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaqun Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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5
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Ahmed Y, Hussein AA, May PR, Ahmad B, Khan A, Benkowski J, Durrani A, Khan S, Kozlowski J, Saar M, Wijburg CJ, Richstone L, Wagner A, Yuh B, Redorta JP, Dasgupta P, Khan MS, Menon M, Peabody JO, Hosseini A, Gaboardi F, Pini G, Schanne F, Mottrie A, Rha KH, Hemal A, Stockle M, Kelly J, Tan WS, Maatman TJ, Poulakis V, Kaouk J, Canda AE, Balbay MD, Wiklund P, Guru KA. Quality of surgical care can impact survival in patients with bladder cancer after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00031-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although pathological factors remain the main determinate of survival for patients with bladder cancer, quality of surgical care is crucial for satisfactory outcomes. Using a validated quality score, we investigated the impact of surgical factors on the overall survival (OS), recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with locally advanced and organ-confined disease (OCD). Retrospective review of IRCC database includes 2460 patients from 29 institutions across 11 countries. The final cohort included 1343 patients who underwent RARCs between 2005 and 2016. Patients with locally advanced disease (LAD) (> pT2 and/or N +) were compared with OCD (≤ pT2/N0). Validated Quality Cystectomy Score (QCS) based on four sets of quality metrics was used to compare surgical performance. Kaplan–Meier method was used to compute RFS, CSS and OS rates. Multivariable stepwise logistic regression was used to evaluate variables associated with RFS, DSS and OS.
Results
48% had LAD. When compared to patients with OCD, they received neobladders less frequently (17% vs. 28%, p < 0.001) and experienced higher estimated blood loss (513 vs. 376 ml, p = 0.05). Postoperatively, more patients in the LAD group received adjuvant chemotherapy (24% vs. 4%, p < 0.001) and positive surgical margins (14% vs. 2%, p < 0.001) and had higher 90-day mortality (6% vs. 2%, p < 0.001). On multivariable analysis, female gender, higher QCS score, intracorporeal diversion, pT stage, positive lymph node status and recurrence are considered as predictors of survival. Patients with OCD exhibited better RFS, DSS and OS than patients with LAD. For patients with OCD, higher QCS was associated with improved OS but not RFS or DSS. On the other hand, patients with LAD and higher QCS exhibited higher RFS, DSS and OS when compared to those with lower QCS.
Conclusion
Quality of surgical care can affect disease control and OS in patients with bladder cancer treated with robot-assisted radical cystectomy.
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6
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Darwish C, Sparks A, Amdur R, Reddy A, Whalen M. Trends in Treatment Strategies and Comparison of Outcomes in Lymph Node Positive Bladder Cancer: An Analysis of the National Cancer Database. Urology 2020; 146:168-176. [PMID: 32866509 DOI: 10.1016/j.urology.2020.06.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/25/2020] [Accepted: 06/10/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To utilize a national dataset to compare outcomes and demonstrate trends in treatment for lymph node positive bladder cancer (N+ BC). METHODS The National Cancer Database (2006-2014) was queried for cT2-4N1-3M0 N+ BC patients treated with radical cystectomy alone (RC), neoadjuvant chemotherapy (NAC), adjuvant chemotherapy (AC), chemoradiation (CRT), chemotherapy alone (CT), or no definitive treatment (NT). Survival by treatment was analyzed using Kaplan-Meier and multivariable Cox-proportional hazards regression. Pathologic down-staging was analyzed using univariable and multivariable logistic regression models. A univariable logistic regression model of treatment by year identified treatment trends. RESULTS Among 3241 patients (cN1, 46%; cN2, 44%; cN3 10%), the majority underwent combined chemotherapy and RC (NAC, 418; AC, 591; RC, 567; CRT, 392; CT, 1068; NT, 205). Overall survival did not differ between NAC and AC, but both had improved survival compared to RC. All other treatment groups had worse survival outcomes compared to NAC. Down-staging to pT0 (adjusted odds ratio = 26.39) and pN0 (adjusted odds ratio = 6.88) was higher for NAC than RC. Utilization of NAC has increased, AC and RC has declined, and CRT and NT is unchanged. CONCLUSION Combined chemotherapy and RC demonstrates best survival outcomes for N+ BC, with complete pathologic response to pT0N0 after NAC associated with a 5-year overall survival rate of ∼85%. However, there is no significant difference between NAC and AC. CRT is associated with worse oncologic outcomes compared to RC with perioperative chemotherapy, but improved survival compared to RC or CT.
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Affiliation(s)
- Christina Darwish
- Department of Urology and Urologic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC.
| | - Andrew Sparks
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Richard Amdur
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Akshay Reddy
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Michael Whalen
- George Washington University School of Medicine and Health Sciences, Washington, DC
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7
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Diamantopoulos LN, Khaki AR, Grivas P, Gore JL, Schade GR, Hsieh AC, Lee JK, Yezefski T, Yu EY, Schweizer MT, Cheng HH, Psutka SP, Lin DW, Tretiakova MS, Vakar-Lopez F, Montgomery RB, Wright JL. Plasmacytoid urothelial carcinoma: response to chemotherapy and oncologic outcomes. Bladder Cancer 2020; 6:71-81. [PMID: 34109262 DOI: 10.3233/blc-190258] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasmacytoid urothelial carcinoma is a rare bladder cancer variant with scarce data on outcomes and prognostic factors. OBJECTIVE We report our institutional experience with this histology to determine response to neoadjuvant chemotherapy, definitive surgery and survival. METHODS We conducted a retrospective chart review of consecutive patients with plasmacytoid, as well as conventional urothelial carcinoma (for comparison) seen in our institution (2007 - 2018). Baseline characteristics, clinicopathologic and treatment data were captured. T-test, chi-squared and log-rank test was used for group comparison. Kaplan Meier method was used for estimation of overall survival and Cox regression for identification of prognostic factors. RESULTS 64 patients with plasmacytoid and 418 with conventional urothelial histology were identified; 53% of those with plasmacytoid presented with cT3/4 stage and 67% underwent extirpative surgery. Patients with plasmacytoid histology had higher rates of pT3/4 (65% vs. 28%), nodal disease (37% vs. 16%) and positive surgical margins (23% vs. 5%) compared to urothelial group (p < 0.01), as well as higher incidence of post-operative recurrence (47% vs. 29%, p = 0.05) and lower ypT0N0 rates after neoadjuvant chemotherapy (10% vs. 33%, p = 0.03). Plasmacytoid histology was associated with lower median overall survival compared to conventional urothelial (24 vs. 154 months, p < 0.01). CONCLUSIONS Plasmacytoid urothelial carcinoma frequently presented with advanced stage at diagnosis and extirpative surgery, poor pathologic response to neoadjuvant chemotherapy, and inferior outcomes, when compared to conventional urothelial. Prospective trials evaluating upfront cystectomy versus preoperative chemotherapy and/or novel treatments should be considered.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - John L Gore
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - George R Schade
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Andrew C Hsieh
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - John K Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Todd Yezefski
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Michael T Schweizer
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Heather H Cheng
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.,Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Robert B Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.,Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
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8
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Wang YC, Wu J, Dai B, Shen YJ, Ma CG, Ye DW, Zhu YP. Extended versus non-extended lymphadenectomy during radical cystectomy for patients with bladder cancer: a meta-analysis of the effect on long-term and short-term outcomes. World J Surg Oncol 2019; 17:225. [PMID: 31864368 PMCID: PMC6925870 DOI: 10.1186/s12957-019-1759-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/25/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pelvic lymphadenectomy (PLND) is an integral part of curative surgery for high-risk non-muscle invasive and muscle-invasive bladder cancer. The therapeutic value of extended PLND is controversial. METHODS We conducted a comprehensive online search in PubMed, EMBASE, and the Cochrane Library databases for relevant literature directly comparing extended PLND (e-PLND) with non-extended PLND (ne-PLND) from database inception to June 2019. We performed the meta-analysis to evaluate the impact of PLND templates on recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), rates of postoperative major complications, and mortality within 90 days of surgery. RESULTS A total of 10 studies involving 3979 patients undergoing either e-PLND or ne-PLND were included. The results showed that e-PLND was significantly associated with better RFS (HR 0.74, 95% CI 0.62-0.90, p = 0.002) and DSS (HR 0.66, 95% CI 0.55-0.79, p < 0.001). However, no correlation was found between e-PLND template and a better OS (HR 0.93, 95% CI 0.55-1.58, p = 0.79). Postoperative major complications were similar between e-PLND group and ne-PLND group, as was mortality within 90 days of surgery. CONCLUSION e-PLND template is correlated with favorable RFS and DSS outcomes for patients with bladder cancer. e-PLND did not have more postoperative major complications than did ne-PLND.
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Affiliation(s)
- Yu-Chen Wang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
| | - Jie Wu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Yi-Jun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Chun-Guang Ma
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Yi-Ping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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9
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Bonfill X, Martinez-Zapata MJ, Vernooij RWM, Sánchez MJ, Suárez-Varela MM, De la Cruz J, Emparanza JI, Ferrer M, Pijoan JI, Palou J, Schmidt S, Madrid E, Abraira V, Zamora J. Clinical interval and diagnostic characteristics in a cohort of bladder cancer patients in Spain: a multicenter observational study. BMC Res Notes 2017; 10:708. [PMID: 29212556 PMCID: PMC5719559 DOI: 10.1186/s13104-017-3024-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We performed a cohort study in seven hospitals in Spain to determine the clinical characteristics of incident patients with bladder cancer, the diagnostic process, and the conditions that might affect health care interval times. RESULTS 314 patients with bladder cancer were included, 70.3 (Standard Deviation [SD] 11.2) years old and 85.0% male. Clinical stage was T1 in 45.9% of patients. The median interval time between first consultation and diagnosis was of 104.0 days (Inter quartile range [IQR]:112.0; range from 0 to 986), being shorter for those patients who attended a hospital for their first consultation. The median interval time between diagnosis and first treatment was of 0.0 days (IQR: 0.0; range from 0 to 366), being longer when the patient had a pathologic tumor stage ≥ T2a.
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Affiliation(s)
- Xavier Bonfill
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain.,Public Health and Clinical Epidemiology Service, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - María José Martinez-Zapata
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. .,Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain.
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Institute of Biomedical Research Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - María José Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada, Barcelona, Spain
| | - María Morales Suárez-Varela
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Javier De la Cruz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Hospital 12 de Octubre, Madrid, Spain
| | - José Ignacio Emparanza
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Clinical Epidemiology Unit, Hospital Universitario Donostia, BioDonostia, San Sebastian, Spain
| | - Montserrat Ferrer
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - José Ignacio Pijoan
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Clinical Epidemiology Unit, Hospital, Universitario Cruces. Biocruces, Barakaldo, Spain
| | - Joan Palou
- Fundació Puigvert, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Stefanie Schmidt
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eva Madrid
- Iberoamerican Cochrane Centre, Barcelona, Spain.,Biomedical Research Centre-Universidad de Valparaiso-Chile, Valparaiso, Chile.,Department of Public Health-School of Medicine, Universidad de Valparaiso-Chile, Valparaiso, Chile
| | - Víctor Abraira
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Javier Zamora
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.,Barts and the London School of Medicine and Dentistry, Queen Mary University London, London, UK
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10
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Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer. BIOMED RESEARCH INTERNATIONAL 2015; 2015:154392. [PMID: 26819948 PMCID: PMC4706858 DOI: 10.1155/2015/154392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/08/2015] [Accepted: 12/09/2015] [Indexed: 11/17/2022]
Abstract
Objective. To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy. Materials and Methods. In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months. Results. Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months. Conclusions. Immediate surgical management seems feasible, safe, and efficacious.
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11
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Paquet ÉR, Hovington H, Brisson H, Lacombe C, Larue H, Têtu B, Lacombe L, Fradet Y, Lebel M. Low level of the X-linked ribosomal protein S4 in human urothelial carcinomas is associated with a poor prognosis. Biomark Med 2015; 9:187-97. [PMID: 25731206 DOI: 10.2217/bmm.14.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We determined whether the Y-box binding protein-1 (YB-1) and its binding partner, the X-linked ribosomal protein S4 (RPS4X), are associated with clinical outcome in bladder cancer. MATERIALS & METHODS A population of 167 patients with muscle-invasive bladder tumor without evidence of metastasis at time of cystectomy was analyzed retrospectively. YB-1 and RPS4X expressions were evaluated immunohistochemically in tumors and analyzed for association with clinical variables and survival. RESULTS Kaplan-Meier and multivariate Cox regression analyses indicated that low expression of RPS4X was associated with a higher risk of death or disease recurrence. In contrast, YB-1 was not significantly associated with either recurrence-free or overall survival. CONCLUSION Low RPS4X expression is associated with poor disease-specific and recurrence-free survival in bladder cancer.
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Affiliation(s)
- Éric R Paquet
- Centre de Recherche sur le Cancer de l'Université Laval, 9 McMahon Street, Québec City, Québec, Canada
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12
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Lucca I, Rouprêt M, Kluth L, Rink M, Tilki D, Fajkovic H, Kassouf W, Hofbauer SL, de Martino M, Karakiewicz PI, Briganti A, Trinh QD, Seitz C, Fritsche HM, Burger M, Lotan Y, Kramer G, Shariat SF, Klatte T. Adjuvant cisplatin-based combined chemotherapy for lymph node (LN)-positive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC): a retrospective international study of >1500 patients. BJU Int 2015; 115:722-7. [DOI: 10.1111/bju.12829] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ilaria Lucca
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
- Department of Urology; Centre Hospitalier Universitaire Vaudois; Lausanne Switzerland
| | - Morgan Rouprêt
- Department of Urology; Groupe Hospitalier Pitié - Salpêtrière; Assistance Publique Hopitaux de Paris; Faculty of Medicine Pierre et Marie Curie; Institut Universitaire de Cancérologie GRC5; University Paris 6; Paris France
| | - Luis Kluth
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Michael Rink
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Department of Urology; University of California; Davis CA USA
| | - Harun Fajkovic
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Wassim Kassouf
- Department of Urology; McGill University; Montreal QC Canada
| | - Sebastian L. Hofbauer
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Michela de Martino
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal Health Centre; Montreal QC Canada
| | - Alberto Briganti
- San Raffaele Scientific Institute; Urological Research Institute; Department of Urology; Milan Italy
| | - Quoc-dien Trinh
- School of Medicine; Sacramento CA USA
- Department of Surgery; Division of Urology; Brigham and Women's Hospital/Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | - Christian Seitz
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Hans-Martin Fritsche
- Department of Urology; Caritas St. Josef Medical Center; University of Regensburg; Regensburg Germany
| | - Maximilian Burger
- Department of Urology; Caritas St. Josef Medical Center; University of Regensburg; Regensburg Germany
| | - Yair Lotan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Gero Kramer
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
| | - Shahrokh F. Shariat
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
- Department of Urology; Weill Cornell Medical College; New York-Presbyterian Hospital; New York NY USA
| | - Tobias Klatte
- Department of Urology; Comprehensive Cancer Center; Medical University of Vienna; Vienna General Hospital; Vienna Austria
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13
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Raghavan D, Bawtinhimer A, Mahoney J, Eckrich S, Riggs S. Adjuvant chemotherapy for bladder cancer—why does level 1 evidence not support it? Ann Oncol 2014; 25:1930-1934. [DOI: 10.1093/annonc/mdu092] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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14
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Al-Daghmin A, Kauffman EC, Shi Y, Badani K, Balbay MD, Canda E, Dasgupta P, Ghavamian R, Grubb R, Hemal A, Kaouk J, Kibel AS, Maatman T, Menon M, Mottrie A, Nepple K, Pattaras JG, Peabody JO, Poulakis V, Pruthi R, Palou Redorta J, Rha KH, Richstone L, Schanne F, Scherr DS, Siemer S, Stöckle M, Wallen EM, Weizer A, Wiklund P, Wilson T, Wilding G, Woods M, Guru KA. Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: results from the International Radical Cystectomy Consortium (IRCC). BJU Int 2014; 114:98-103. [PMID: 24219170 DOI: 10.1111/bju.12569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer. PATIENTS AND METHODS Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomised patients based on pathological stage (≤pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality. RESULTS In all, 1000 ≤pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the ≤pT3 patients (P = 0.001). The median operating time and blood loss were 386 min and 350 mL vs 396 min and 350 mL for p T4 and ≤pT3, respectively. The complication rate was similar (54% vs 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for ≤pT3 vs pT4 patients (P < 0.001), respectively. The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality. CONCLUSIONS RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.
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15
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Kwon T, Jeong IG, You D, Hong B, Hong JH, Ahn H, Kim CS. Long-term oncologic outcomes after radical cystectomy for bladder cancer at a single institution. J Korean Med Sci 2014; 29:669-75. [PMID: 24851023 PMCID: PMC4024950 DOI: 10.3346/jkms.2014.29.5.669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 03/03/2014] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to evaluate our experience using radical cystectomy to treat patients with bladder cancer and to describe the associations between pathologic features and clinical outcomes. All 701 patients who underwent radical cystectomy for bladder cancer were evaluated. The patient population consisted of 623 men and 78 women. The overall 5 and 10 yr recurrence-free survival (RFS) rates were 61.8% and 57.7%, respectively, and the 5 and 10 yr cancer-specific survival (CSS) rates were 70.8% and 65.1%, respectively. Multivariate analysis showed that factors significantly predictive of RFS and CSS included extravesical extension (P = 0.001), lymph node metastasis (P = 0.001), and lymphovascular invasion (P < 0.001 and P = 0.007). The 5 and 10 yr RFS rates for patients with lymph node metastasis were 25.6% and 20.8%, respectively, and the 5 and 10 yr CSS rates were 38.6% and 30.9%, respectively. Adjuvant chemotherapy significantly improved RFS (P = 0.002) and CSS (P = 0.001) in patients with lymph node metastasis. Radical cystectomy provides good survival results in patients with invasive bladder cancer. Pathologic features significantly associated with prognosis include extravesical extension, node metastasis, and lymphovascular invasion. Adjuvant chemotherapy improves survival in patients with advanced stage disease.
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Affiliation(s)
- Taekmin Kwon
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dalsan You
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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16
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Yelfimov DA, Frank I, Boorjian SA, Thapa P, Cheville JC, Tollefson MK. Adjuvant chemotherapy is associated with decreased mortality after radical cystectomy for locally advanced bladder cancer. World J Urol 2014; 32:1463-8. [PMID: 24420616 DOI: 10.1007/s00345-014-1236-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 01/03/2014] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We sought to evaluate the association of adjuvant chemotherapy with the risk of subsequent mortality among patients with locally advanced urothelial carcinoma (UC) of the bladder undergoing radical cystectomy (RC). METHODS We identified 675 patients who underwent RC for pT2-4 and/or N+ UC between 1980 and 2005. Adjuvant chemotherapy was defined as treatment within 90 days of RC. Survival was estimated using the Kaplan-Meier method and compared according to receipt of adjuvant chemotherapy with the log-rank test. Multivariate models were used to analyze the impact of adjuvant chemotherapy on disease progression and survival. RESULTS A total of 80 (12 %) patients received adjuvant chemotherapy. Median age was 69 years [interquartile range (IQR) 63, 76]. Median follow-up was 11 years (IQR 8, 16). Patients receiving adjuvant chemotherapy were more likely to have pT3-4 tumors (71 vs. 61 %; p < 0.001) and pN+ (85 vs. 19 %; p < 0.001). The 5-year cancer-specific survival was 46 % in those receiving adjuvant chemotherapy and 51 % in those that did not (p = 0.63). The 5-year overall survival was 39 % in those receiving adjuvant chemotherapy and 38 % in those that did not (p = 0.24). When controlling for age, sex, stage, and performance status, adjuvant chemotherapy was associated with a 29 % decrease in the risk of bladder cancer death (HR 0.71, p = 0.06) and a 39 % decrease in the risk of all-cause mortality (HR 0.61, p = 0.002). CONCLUSIONS After controlling patient and tumor features, adjuvant chemotherapy was associated with a trend toward reduction in cancer-specific mortality and a statistically significant reduction in all-cause mortality.
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Affiliation(s)
- Daniel A Yelfimov
- Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA,
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17
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[Muscle invasive bladder cancer after radical cystectomy. Prognostic factors of adjuvant chemotherapy]. Urologe A 2013; 52:1233-41. [PMID: 23975218 DOI: 10.1007/s00120-013-3311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The indications to administer adjuvant systemic chemotherapy to patients with urothelial carcinoma of the bladder who underwent radical cystectomy is discussed controversially and all international guidelines are very restrictive with regard to its recommendation for routine daily practice due to the low scientific evidence concerning its therapeutic benefit. Currently, adjuvant systemic chemotherapy should be preferably administered within clinical trials. In the daily routine adjuvant treatment might be given in patients with lymph node positive disease. Clinical, pathohistological and molecular biomarkers which might be associated with a positive or negative treatment response have been evaluated sparsely in the past. RESULTS The presence of hemangiosis/lymphangiosis carcinomatosa and/or extranodal expansion in patients with lymph node metastases appears to be associated with a poor outcome. The markers ERCC-1, XAF and anti-apoptotic proteins of the Bcl-2 family seem to represent the most promising biomarkers associated with response to adjuvant cisplatin-based chemotherapy.
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