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Ferro M, Chiujdea S, Vartolomei MD, Bove P, Porreca A, Busetto GM, Del Giudice F, Antonelli A, Foschi N, Racioppi M, Autorino R, Chiancone F, Longo N, Barone B, Crocetto F, Musi G, Luzzago S, Piccinelli ML, Mistretta FA, de Cobelli O, Tataru OS, Hurle R, Liguori G, Borghesi M, Veccia A, Greco F, Schips L, Marchioni M, Lucarelli G, Dutto D, Colucci F, Russo GI, Giudice AL, Montanari E, Boeri L, Simone G, Rosazza M, Livoti S, Gontero P, Soria F. Advanced Age Impacts Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Clin Genitourin Cancer 2024; 22:27-37. [PMID: 37661507 DOI: 10.1016/j.clgc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Upper tract urothelial carcinoma is rare but has a poor prognosis. Prognostic factors have been extensively studied in order to provide the best possible management for patients. We have aimed to investigate commonly available factors predictive of recurrence and survival in this patient population at high risk of death and recurrence, with an emphasis on the effects of age (using a cutoff of 70 years) on survival outcomes. PATIENTS AND METHODS From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant. RESULTS We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer). CONCLUSION This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.
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Affiliation(s)
- Matteo Ferro
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy.
| | - Sever Chiujdea
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, Medical University of Vienna, Wien, Austria; The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Mihai Dorin Vartolomei
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Urology, Medical University of Vienna, Wien, Austria; The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Pierluigi Bove
- San Carlo di Nancy Hospital, Rome, Italy; Department of Experimental Medicine, Tor vergata Oncoscience Research Centre of Excellence, TOR, University of Rome Tor Vergata, Rome, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV), IRCCS, Padua, Italy
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy
| | - Francesco Del Giudice
- Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Nazario Foschi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Nicola Longo
- Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Biagio Barone
- Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Felice Crocetto
- Urology Unit, Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Stefano Luzzago
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy
| | | | | | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Octavian Sabin Tataru
- The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania; Department of Simulation Applied in Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Giovanni Liguori
- Urology Clinic, Department of Medical, Surgical and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Marco Borghesi
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Integrated Sciences (DISC), Urology Section, University of Genova, Genova, Italy
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Francesco Greco
- Department of Urology, IRCCS Humanitas Gavazzeni, Bergamo, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio, University of Chieti, Chieti, Italy
| | - Michele Marchioni
- Department of Medical, Oral and Biotechnological Sciences, G. d'Annunzio, University of Chieti, Chieti, Italy
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Dutto
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Fulvia Colucci
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Giorgio Ivan Russo
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Arturo Lo Giudice
- Department of Surgery, Urology Section, University of Catania, Catania, Italy
| | - Emanuele Montanari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
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Soria F, Rosazza M, Livoti S, Dutto D, Colucci F, Sylvester RJ, Shariat SF, Babjuk M, Palou J, Gontero P. Repeat Transurethral Resection (TUR) + Bacillus Calmette-Guérin (BCG) Versus Upfront Induction BCG After TUR in High-risk Non-muscle-invasive Bladder Cancer: Feasibility Phase of a Randomized Controlled Study. Eur Urol Focus 2023:S2405-4569(23)00236-5. [PMID: 37923633 DOI: 10.1016/j.euf.2023.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND High-level evidence supporting the role of repeat transurethral resection (reTUR) in non-muscle-invasive bladder cancer (NMIBC) is lacking. A randomized controlled trial (RCT) assessing whether immediate reTUR has an impact on patient prognosis is essential. However, since such a RCT will require enrollment of a high number of patients, a preliminary feasibility study is appropriate. OBJECTIVE To assess the feasibility of an RCT investigating the impact of immediate reTUR + adjuvant bacillus Calmette-Guérin (BCG) versus upfront induction BCG after initial TUR in NMIBC. DESIGN, SETTING, AND PARTICIPANTS Eligible patients were randomly assigned to receive either reTUR + adjuvant BCG or upfront induction BCG after TUR. Patients with macroscopically completely resected high-grade T1 NMIBC, with or without concomitant carcinoma in situ, and with detrusor muscle (DM) present in the initial TUR specimen were considered eligible for inclusion. Exclusion criteria included lymphovascular invasion (LVI), histological subtypes, hydronephrosis, concomitant upper tract urothelial carcinoma (UTUC), or urothelial carcinoma within the prostatic urethra. The aim was to enroll 30 patients in this feasibility study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The patient recruitment rate was the primary outcome. Oncological outcomes (recurrence-free and progression-free survival) were secondary endpoints. RESULTS AND LIMITATIONS Overall, 30 patients (15 per arm) were randomized over a period of 14 mo (August 2020-October 2021). Two eligible patients refused the randomization, resulting in a patient compliance rate of 93.3% for the study protocol. We excluded 49 ineligible patients before randomization because of histological subtypes (n = 16, 33%), LVI (n = 9, 18%), DM absence in the TUR specimen (n = 12, 24%), metastatic disease (n = 5, 10%), concomitant UTUC (n = 3, 6%), or hydronephrosis (n = 4, 8%). At reTUR, persistent disease was found in four patients (29%) and upstaging to muscle-invasive disease in one (7%). Over median follow-up of 17 mo, disease recurrence was detected in three patients (23%) in the reTUR arm and six patients (40%) in the upfront BCG arm. Progression to muscle-invasive disease was observed in one patient treated with upfront BCG. CONCLUSIONS The feasibility of conducting an RCT comparing upfront BCG versus reTUR + BCG in high-grade T1 NMIBC has been demonstrated. Our results underline the need to screen a large number of patients owing to characteristics meeting the exclusion criteria in a high percentage of cases. PATIENT SUMMARY We found that a clinical trial of the role of a repeat surgical procedure to remove bladder tumors through the urethra would be feasible among patients with high-grade non-muscle-invasive bladder cancer. These preliminary results may help in refining the role of this repeat procedure for patients in this category.
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Affiliation(s)
- Francesco Soria
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy.
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Daniele Dutto
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Fulvia Colucci
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Richard J Sylvester
- European Association of Urology Non-Muscle-Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Marek Babjuk
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czechia
| | - Joan Palou
- Department of Urology, Fundaciò Puigvert, Barcelona, Spain
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
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Soria F, D'Andrea D, Barale M, Gust KM, Pisano F, Mazzoli S, De Bellis M, Rosazza M, Livoti S, Dutto D, Lillaz B, Pradere B, Moschini M, Tamandl D, Shariat SF, Gontero P. Sarcopenia Predicts Disease Progression in Patients with T1 High-grade Non–muscle-invasive Bladder Cancer Treated with Adjuvant Intravesical Bacillus Calmette-Guérin: Implications for Decision-making? EUR UROL SUPPL 2023; 50:17-23. [PMID: 37101772 PMCID: PMC10123412 DOI: 10.1016/j.euros.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/20/2023] Open
Abstract
Background Skeletal muscle loss (sarcopenia) has been linked to cancer cachexia and can predict survival in several tumors, including advanced genitourinary malignancies. Objective To investigate the predictive and prognostic role of sarcopenia in patients with T1 high grade (HG) non-muscle invasive bladder cancer (NMIBC) treated with adjuvant intravesical Bacillus Calmette-Guerin (BCG). Design setting and participants Oncological outcomes were evaluated for 185 patients with T1 HG NMIBC treated with BCG at two European referral centers. Sarcopenia, identified from computed tomography scans performed within 2 mo after surgery, was defined as a skeletal muscle index of <39 cm2/m2 for women and <55 cm2/m2 for men. Outcome measurements and statistical analysis The main endpoint was the association between sarcopenia and disease recurrence and progression. Kaplan-Meier curves and multivariable Cox models were built, and the clinical value of any association was assessed using Harrell's C index and decision curve analysis (DCA). Results and limitations Sarcopenia was present in 130 patients (70%). On multivariable Cox regression analyses that accounted for the effect of standard clinicopathological prognosticators, sarcopenia was independently associated with disease progression (hazard ratio 3.41; p = 0.02). Addition of sarcopenia to a standard model for prediction of disease progression improved the discrimination of the model from 62% to 70%. DCA revealed superior net benefits for the proposed model in comparison to the strategies of treating all or no patients with radical cystectomy, and in comparison to the existing predictive model. Limitations are inherent to the retrospective design. Conclusions We demonstrated the prognostic role of sarcopenia in T1 HG NMIBC. Pending external validation, this tool could be easily incorporated into existing nomograms for prediction of disease progression to improve clinical decision-making and patient counseling. Patient summary We looked at the role of loss of skeletal muscle (sarcopenia) as a factor in predicting prognosis for stage T1 high-grade non-muscle-invasive bladder cancer. We found that sarcopenia is a ready-to-use, cost-free marker that could be used to guide treatment and follow-up in this disease, although the results need to be confirmed in other studies.
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Affiliation(s)
- Francesco Soria
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
- Corresponding author. Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino School of Medicine, Torino, Italy. Fax: +39 6334603.
| | - David D'Andrea
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Maurizio Barale
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Kilian M. Gust
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Francesca Pisano
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Simone Mazzoli
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Matteo De Bellis
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Daniele Dutto
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Beatrice Lillaz
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
| | - Benjamin Pradere
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Marco Moschini
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Dietmar Tamandl
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F. Shariat
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, Torino School of Medicine, Torino, Italy
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Gontero P, Livoti S, Soria F. A Restaging Transurethral Resection of the Bladder Is Always Necessary for High-grade T1 Non–muscle-invasive Bladder Cancer: Con. Eur Urol Focus 2023:S2405-4569(23)00076-7. [PMID: 37005168 DOI: 10.1016/j.euf.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/23/2023] [Indexed: 04/03/2023]
Abstract
Repeat transurethral resection (re-TUR) remains the standard procedure for high-grade T1 non-muscle-invasive bladder cancer. However, en block resection together with improved imaging modalities (photodynamic diagnosis) may reduce the risk of persistent disease and/or upstaging at re-TUR. Thus, re-TUR may be spared in selected patients with a complete initial resection with well-represented and tumor-free detrusor muscle in the specimen, with a significant impact on patients' quality of life and health care costs.
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Hurle R, Soria F, Contieri R, Avolio PP, Mancon S, Lazzeri M, Bernasconi V, Mazzoli S, Pizzuto G, De Bellis M, Rosazza M, Livoti S, Lupia T, Corcione S, Lillaz B, De Rosa FG, Buffi NM, Kamat AM, Gontero P, Casale P. Evaluating the Protective Effect of Intravesical Bacillus Calmette-Guerin against SARS-CoV-2 in Non-Muscle Invasive Bladder Cancer Patients: A Multicenter Observational Trial. Cancers (Basel) 2023; 15:cancers15051618. [PMID: 36900409 PMCID: PMC10000457 DOI: 10.3390/cancers15051618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
We aim to evaluate the potential protective role of intravesical Bacillus Calmette-Guerin (BCG) against SARS-CoV-2 in patients with non-muscle invasive bladder cancer (NMIBC). Patients treated with intravesical adjuvant therapy for NMIBC between January 2018 and December 2019 at two Italian referral centers were divided into two groups based on the received intravesical treatment regimen (BCG vs. chemotherapy). The study's primary endpoint was evaluating SARS-CoV-2 disease incidence and severity among patients treated with intravesical BCG compared to the control group. The study's secondary endpoint was the evaluation of SARS-CoV-2 infection (estimated with serology testing) in the study groups. Overall, 340 patients treated with BCG and 166 treated with intravesical chemotherapy were included in the study. Among patients treated with BCG, 165 (49%) experienced BCG-related adverse events, and serious adverse events occurred in 33 (10%) patients. Receiving BCG or experiencing systemic BCG-related adverse events were not associated with symptomatic proven SARS-CoV-2 infection (p = 0.9) nor with a positive serology test (p = 0.5). The main limitations are related to the retrospective nature of the study. In this multicenter observational trial, a protective role of intravesical BCG against SARS-CoV-2 could not be demonstrated. These results may be used for decision-making regarding ongoing and future trials.
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Affiliation(s)
- Rodolfo Hurle
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Roberto Contieri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Pier Paolo Avolio
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Stefano Mancon
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Massimo Lazzeri
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Correspondence:
| | - Valentina Bernasconi
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Simone Mazzoli
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Giuseppe Pizzuto
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Matteo De Bellis
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Matteo Rosazza
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Simone Livoti
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Beatrice Lillaz
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Nicolò Maria Buffi
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy
| | - Ashish M. Kamat
- MD Anderson Cancer Center, University of Texas, Houston, TX 78712, USA
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, Torino School of Medicine, 10126 Turin, Italy
| | - Paolo Casale
- Department of Urology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Italy
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Rosazza M, Soria F, Moschini M, Del Giudice F, Pichler R, Hurle R, Mancon S, Carrion Monsalve D, Krajewski W, Mari A, Mazzoli S, Livoti S, Dutto D, De Bellis M, Ola L, Pisano F, Fiameni C, Lillaz B, Gontero P. Clinical validation of the EAU2021 intermediate risk NMIBC definition and implications for adjuvant treatment: A multicenter YAU Urothelial Collaboration. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00764-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Marquis A, Soria F, Oderda M, Allasia M, Destefanis P, Livoti S, Rosazza M, Dutto D, Lillaz B, Gontero P. Feasibility and safety of full retroperitoneoscopic radical nephroureterectomy: A single-center experience. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01453-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Livoti S, Soria F, Mazzoli S, De Bellis M, Rosazza M, Dutto D, Fiameni C, Lillaz B, Gontero P. Initial experience of ileal hetherotopic reservoir with catheterizable ileal conduit as an alternative to orthotopic ileal neobladder. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Soria F, Allasia M, Marquis A, Calleris G, Agnello M, Giordano A, Mazzoli S, De Bellis M, Rosazza M, Livoti S, Lillaz B, Gontero P. Radical cystectomy in renal transplant recipients: The advantages of the robotic approach. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Soria F, Barale M, D’Andrea D, Gust K, Pizzuto G, Mazzoli S, Debellis M, Rosazza M, Livoti S, Lillaz B, Shariat S, Gontero P. Skeletal muscle loss predicts oncological outcomes in T1HG patients treated with adjuvant intravesical BCG: implications for decision-making? EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00705-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Petitjean S, Stohler R, Déglon JJ, Livoti S, Waldvogel D, Uehlinger C, Ladewig D. Double-blind randomized trial of buprenorphine and methadone in opiate dependence. Drug Alcohol Depend 2001; 62:97-104. [PMID: 11173173 DOI: 10.1016/s0376-8716(00)00163-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study compared the safety and efficacy of sublingual buprenorphine tablets with oral methadone in a population of opioid-dependent individuals in a double-blind, randomized, 6-week trial using a flexible dosing procedure. Fifty-eight patients seeking treatment for opioid dependence were recruited in three outpatient facilities and randomly assigned to substitution with buprenorphine or methadone. The retention rate was significantly better in the methadone maintained group (90 vs. 56%; P<0.001). Subjects completing the study in both the treatment groups had similar proportions of opioid positive urine samples (buprenorphine 62%; methadone 59%) and positive urine specimens, as well as mean heroin craving scores decreased significantly over time (P=0.035 and P<0.001). The proportion of cocaine-positive toxicology results did not differ between groups. At week six mean stabilization doses were 10.5 mg per day for the sublingual buprenorphine tablet, and 69.8 mg per day for methadone, respectively. Patient performance during maintenance was similar in both the groups. The high attrition rate in the buprenorphine group during the induction phase might reflect inadequate induction doses. Thus, buprenorphine is a viable alternative for methadone in short-term maintenance treatment for heroin dependence if treatment induction is done with adequate dosages.
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Affiliation(s)
- S Petitjean
- Department of Psychiatry, University of Basel Wilhelm Klein-Strasse 27, CH-4025 Basel, Switzerland.
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Eap CB, Bourquin M, Martin J, Spagnoli J, Livoti S, Powell K, Baumann P, Déglon J. Plasma concentrations of the enantiomers of methadone and therapeutic response in methadone maintenance treatment. Drug Alcohol Depend 2000; 61:47-54. [PMID: 11064183 DOI: 10.1016/s0376-8716(00)00121-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Methadone is a 50:50 mixture of two enantiomers and (R)-methadone accounts for the majority of its opioid effect. The aim of this study was to determine whether a blood concentration of (R)-methadone can be associated with therapeutic response in addict patients in methadone maintenance treatment. Trough plasma concentrations of (R)-, (S)- and (R,S)-methadone were measured in 180 patients in maintenance treatment. Therapeutic response was defined by the absence of illicit opiate or cocaine in urine samples collected during a 2-month period prior to blood sampling. A large interindividual variability of (R)-methadone concentration-to-dose-to-weight ratios was found (mean, S.D., median, range: 112, 54, 100, 19-316 ng x kg/ml x mg). With regard to the consumption of illicit opiate (but not of cocaine), a therapeutic response was associated with (R)- (at 250 ng/ml) and (R,S)-methadone (at 400 ng/ml) but not with (S)-methadone concentrations. A higher specificity was calculated for (R)- than for (R,S)-methadone, as the number of non-responders above this threshold divided by the total number of non-responders was higher for (R,S)-methadone (19%) than for (R)-methadone (7%). The results support the use of therapeutic drug monitoring of (R)-methadone in cases of continued intake of illicit opiates. Due to the variability of methadone concentration-to-dose-to-weight ratios, theoretical doses of racemic methadone could be as small as 55 mg/day and as large as 921 mg/day to produce a plasma (R)-methadone concentration of 250 ng/ml in a 70-kg patient. This demonstrates the importance of individualizing methadone treatment.
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Affiliation(s)
- C B Eap
- Unité de Biochimie et Psychopharmacologie Clinique, Département Universitaire de Psychiatrie Adulte, Hôpital de Cery, CH-1008, Prilly-Lausanne, Switzerland.
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Uehlinger C, Déglon J, Livoti S, Petitjean S, Waldvogel D, Ladewig D. Comparison of buprenorphine and methadone in the treatment of opioid dependence. Swiss multicentre study. Eur Addict Res 1998; 4 Suppl 1:13-8. [PMID: 9767201 DOI: 10.1159/000052036] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A three-centre, randomised, double-blind study was designed to compare the efficacy and safety of buprenorphine and methadone. This was the first European study to compare these agents and was based on a previous trial performed in the US. Opioid-dependent subjects were randomised to receive either sublingual buprenorphine or oral methadone daily. Both objective and subjective measures of efficacy were monitored weekly, and safety parameters were regularly monitored over the entire six-week study. Urinalysis showed that the two treatments were similar with a slight increase in opioid-negative urines noted in both groups. The retention rate in the buprenorphine group was lower than in the methadone group, although it has been suggested that the buprenorphine dose may have been too low for some patients. None of the side effects noted were considered serious and all were attributable to chronic opioid dependence. Experience of two years substitution treatment in Fribourg suggests that initial induction onto buprenorphine allows for patients to be subgrouped before being given the most appropriate maintenance agent. Further investigation is required into the different dose-related effects of buprenorphine seen in particular subsets of addicts.
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Affiliation(s)
- C Uehlinger
- Psychosocial Centre of Fribourg, Fribourg, Switzerland
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