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Kim KH, Lee HW, Ha HK, Seo HK. Perioperative systemic therapy in muscle invasive bladder cancer: Current standard method, biomarkers and emerging strategies. Investig Clin Urol 2023; 64:202-218. [PMID: 37341001 DOI: 10.4111/icu.20230006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/18/2023] [Indexed: 06/22/2023] Open
Abstract
Bladder cancer ranks as the 10th most common cancer type globally, and muscle-invasive disease accounts for approximately 25% of newly diagnosed bladder cancers. Despite definitive treatment, 50% of patients with muscle-invasive bladder cancer (MIBC) develop metastasis within 2 years, leading to death. Perioperative systemic therapy is generally recommended to control local relapse or distant metastasis after surgical resection for patients with MIBC. Cisplatin-based neoadjuvant chemotherapy followed by radical cystectomy is the current standard treatment to improve oncologic control and survival outcomes. Adjuvant chemotherapy is recommended for patients with pathological T3-4 or positive lymph nodes after radical cystectomy if no neoadjuvant chemotherapy was given. Nonetheless, perioperative systemic therapy is not applied widely because of its toxicity, and less than 25% of patients receive cisplatin-based neoadjuvant chemotherapy. Therefore, the development of predictive biomarkers for neoadjuvant chemotherapy efficacy and alternative effective regimens for cisplatin-ineligible patients are important. Furthermore, recently, novel anticancer agents such as immune checkpoint inhibitors and antibody-drug conjugates have proven survival benefits in the metastatic setting, thereby expanding their therapeutic applications to the perioperative setting for non-metastatic MIBC. Herein, we discuss the current status and future perspectives of perioperative systemic strategies for MIBC.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hye Won Lee
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ho Kyung Seo
- Department of Urology, Center for Urologic Cancer, National Cancer Center, Goyang, Korea
- Division of Tumor Immunology, Research Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Fujita N, Momota M, Horiguchi H, Hamano I, Mikami J, Hatakeyama S, Ito H, Yoneyama T, Hashimoto Y, Nishimura S, Yoshikawa K, Ohyama C. Combination of Muscle Quantity and Quality Is Useful to Assess the Necessity of Surveillance after a 5-Year Cancer-Free Period in Patients Who Undergo Radical Cystectomy: A Multi-Institutional Retrospective Study. Cancers (Basel) 2023; 15:cancers15051489. [PMID: 36900280 PMCID: PMC10000682 DOI: 10.3390/cancers15051489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Although continuous surveillance after a 5-year cancer-free period in patients with bladder cancer (BC) who undergo radical cystectomy (RC) is recommended, optimal candidates for continuous surveillance remain unclear. Sarcopenia is associated with unfavorable prognosis in various malignancies. We aimed to investigate the impact of low muscle quantity and quality (defined as severe sarcopenia) on prognosis after a 5-year cancer-free period in patients who underwent RC. METHODS We conducted a multi-institutional retrospective study assessing 166 patients who underwent RC and had five years or more of follow-up periods after a 5-year cancer-free period. Muscle quantity and quality were evaluated using the psoas muscle index (PMI) and intramuscular adipose tissue content (IMAC) using computed tomography images five years after RC. Patients with lower PMI and higher IMAC values than the cut-off values were diagnosed with severe sarcopenia. Univariable analyses were performed to assess the impact of severe sarcopenia on recurrence, adjusting for the competing risk of death using the Fine-Gray competing risk regression model. Moreover, the impact of severe sarcopenia on non-cancer-specific survival was evaluated using univariable and multivariable analyses. RESULTS The median age and follow-up period after the 5-year cancer-free period were 73 years and 94 months, respectively. Of 166 patients, 32 were diagnosed with severe sarcopenia. The 10-year RFS rate was 94.4%. In the Fine-Gray competing risk regression model, severe sarcopenia did not show a significant higher probability of recurrence, with an adjusted subdistribution hazard ratio of 0.525 (p = 0.540), whereas severe sarcopenia was significantly associated with non-cancer-specific survival (hazard ratio 1.909, p = 0.047). These results indicate that patients with severe sarcopenia might not need continuous surveillance after a 5-year cancer-free period, considering the high non-cancer-specific mortality.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
- Correspondence: ; Tel.: +81-172-39-5091
| | - Masaki Momota
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
- Department of Urology, Mutsu General Hospital, 1-2-8 Kogawamachi, Mutsu 035-8601, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
- Department of Urology, Hakodate Municipal Hospital, 1-10-1 Minatomachi, Hakodate 041-8680, Japan
| | - Itsuto Hamano
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
- Department of Urology, Towada City Central Hospital, 14-8 Nishijyunibancho, Towada 034-0093, Japan
| | - Jotaro Mikami
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
- Department of Urology, Mutsu General Hospital, 1-2-8 Kogawamachi, Mutsu 035-8601, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
| | - Hiroyuki Ito
- Department of Urology, Aomori Rosai Hospital, 1 Minamigaoka Shiroganemachi, Hachinohe 031-8551, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
| | - Shoji Nishimura
- Department of Urology, Hakodate Municipal Hospital, 1-10-1 Minatomachi, Hakodate 041-8680, Japan
| | - Kazuaki Yoshikawa
- Department of Urology, Aomori City Hospital, 1-14-20 Katsuta, Aomori 030-0821, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki 036-8562, Japan
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Nientiedt M, Waldbillig F, Stroop F, Nuhn P, Erben P, Popovic ZV, Weis CA, Michel MS, Kriegmair MC. Upper Tract Urinary Cancer Recurrence after Radical Cystectomy: Risk Assessment of Intraoperative Frozen Section. Urol Int 2022; 106:816-824. [DOI: 10.1159/000521804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Upper tract urinary cancer recurrence (UTUCR) after radical cystectomy (RC) is outcome-limiting. Surgical recommendations on intraoperative performance of frozen section analysis (FSA) and management of positive ureteral margin (PUM) are lacking. <b><i>Methods:</i></b> 634 RC cases were identified (2010–2018). In patients with PUM, sequential ureteral resections up to a negative margin were performed. We investigated the accuracy of FSA, significance of PUM, and identified risk factors (RFs) to stratify patients for UTUCR. <b><i>Results:</i></b> FSA was performed in 355 patients, including a total of 693 ureters. FSA sensitivity was 0.93 and specificity 0.99. PUM conversion was possible in 52 (91.2%) cases. UTUCR occurred in 17 (4.8%) patients. Identified UTUCR RFs are non-muscle invasive bladder carcinoma (NMIBC) (OR 3.8, 95% confidence intervals [CI] 1.4–10.2, <i>p</i> = 0.008), multifocal bladder cancer in cystectomy specimen (OR 4.7, CI 1.1–20.8, <i>p</i> = 0.042), and recurrent NMIBC (OR 4.1, CI 1.5–10.9, <i>p</i> = 0.006). Risk-group stratification showed a six-fold increase in UTUCR risk (low-to high-risk). <b><i>Conclusion:</i></b> FSA is a sensitive and specific method to identify PUM. UTUCR occurs significantly more often in patients with recurrent, multifocal NMIBC at the time of RC. Patients can be risk stratified for UTUCR. In case of NMIBC-PUM, surgeons can safely opt for a kidney preserving strategy.
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Soliman K, Taha DE, Aboumarzouk OM, Koraiem IO, Shokeir AA. Can frozen-section analysis of ureteric margins at the time of radical cystectomy predict upper tract recurrence? Arab J Urol 2020; 18:155-162. [PMID: 33029425 PMCID: PMC7473000 DOI: 10.1080/2090598x.2020.1751923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To summarise the currently available literature and analyse available results of the outcome of intraoperative frozen-section analysis (FSA) on upper urinary tract recurrence (UUTR) after radical cystectomy (RC). Materials and methods A systematic review of the literature was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles discussing ureteric FSA with RC were identified. Results The literature search yielded 21 studies, on which the present analysis was done. The studies were published between 1997 and 2019. There were 10 010 patients with an age range between 51 and 95 years. Involvement of the ureteric margins was noted in 2–9% at RC. The sensitivity and specificity of FSA were ~75% and 99%, respectively. Adverse pathology on FSA and on permanent section, prostatic urothelial carcinoma involving the stroma but not prostatic duct, and ureteric involvement on permanent section were all more likely to develop UUTR. Neither evidence of ureteric involvement nor ureteric margin status on permanent section were significant predictors of overall survival. Conclusion Routine FSA is mandatory for a tumour-free uretero–enteric anastomosis and is predictive of UUTR. To lower the UUTR, FSA is not necessary if the ureters are resected at the level where they cross the common iliac vessels. FSA is indicated whenever the surgeon encounters findings suspicious of malignancy, e.g. ureteric obstruction, periureteric fibrosis, diffuse carcinoma in situ, induration or frank tumour infiltration of the distal ureter is discovered unexpectedly during surgery, and prostatic urethral involvement. Abbreviations CIS: carcinoma in situ; FSA: frozen-section analysis; HR: hazard ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RC: radical cystectomy; (UT)UC: (upper tract) urothelial carcinoma; UUT(R): upper urinary tract (recurrence)
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Affiliation(s)
- Karim Soliman
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Diaa-Eldin Taha
- Department of Urology, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Omar M Aboumarzouk
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK.,School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Islam Osama Koraiem
- Department of Urology, Damanhour International Medical Institute, Beheira, Egypt
| | - Ahmed A Shokeir
- Department of Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Ballas L, Wei O, Daneshmand S, Schuckman A, Djaladat H, Aron M, D'Souza A, Quinn D, Dorff TB. Chemoradiation for Management of Locally Recurrent or Residual Bladder Cancer: A Case Series and Review of the Literature. Clin Genitourin Cancer 2020; 18:e473-e477. [PMID: 32044240 DOI: 10.1016/j.clgc.2019.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Leslie Ballas
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, CA.
| | - Oren Wei
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
| | - Siamak Daneshmand
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anne Schuckman
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Hooman Djaladat
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Monish Aron
- Institute of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Anishka D'Souza
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - David Quinn
- Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Tanya B Dorff
- Department of Medical Oncology and Therapeutics Research, City of Hope, Duarte, CA
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Abstract
Follow-up care of patients with muscle-invasive bladder cancer is subdivided into oncological and functional surveillance. More than 80% of local relapses and distant metastases occur within the first 2 years. Recurrences in the remnant urothelium also occur several years after radical cystectomy. Urinary cytology and a computed tomography (CT) scan of the abdomen and thorax including a urography phase are the standard diagnostics for tumor follow-up. There is no clear evidence for a survival benefit for the detection of asymptomatic vs. symptomatic recurrences. After partial cystectomy or trimodal treatment, there is no established follow-up schedule; however, the relatively high incidence of intravesical recurrences should be considered as there are curative treatment approaches including salvage cystectomy. Functional surveillance, which should be carried out lifelong, encompasses prevention and diagnostics of metabolic complications, urethral/ureteral strictures, problems with the urinary stoma, urinary incontinence, sexual dysfunction and urinary tract infections.
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7
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Health related quality of life after urinary diversion. Which technique is better? J Egypt Natl Canc Inst 2018; 30:93-97. [DOI: 10.1016/j.jnci.2018.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/29/2018] [Accepted: 08/05/2018] [Indexed: 11/18/2022] Open
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8
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Ha YS, Kim TH. The Surveillance for Muscle-Invasive Bladder Cancer (MIBC). Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00030-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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Pichler R, Tulchiner G, Oberaigner W, Schaefer G, Horninger W, Brunner A, Heidegger I. Effect of Urinary Cytology for Detecting Recurrence in Remnant Urothelium After Radical Cystectomy: Insights From a 10-year Cytology Database. Clin Genitourin Cancer 2017; 15:e783-e791. [DOI: 10.1016/j.clgc.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/20/2017] [Accepted: 03/06/2017] [Indexed: 01/24/2023]
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10
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Sonpavde G, Preston MA. Editorial comment. Urology 2017. [DOI: 10.1016/j.urology.2017.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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11
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Characterization of Late Recurrence After Radical Cystectomy in a Large Multicenter Cohort of Bladder Cancer Patients. Urology 2017; 106:119-124. [DOI: 10.1016/j.urology.2017.04.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/01/2017] [Accepted: 04/06/2017] [Indexed: 11/21/2022]
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12
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Alimi Q, Verhoest G, Kammerer-Jacquet SF, Mathieu R, Rioux-Leclercq N, Manunta A, Laguerre B, Guille F, Bensalah K, Peyronnet B. Role of routine computed tomography scan in the oncological follow up of patients treated by radical cystectomy for bladder cancer. Int J Urol 2016; 23:840-846. [DOI: 10.1111/iju.13164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/14/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Quentin Alimi
- Department of Urology; University Hospital of Rennes; Rennes France
| | - Grégory Verhoest
- Department of Urology; University Hospital of Rennes; Rennes France
| | | | - Romain Mathieu
- Department of Urology; University Hospital of Rennes; Rennes France
| | | | - Andréa Manunta
- Department of Urology; University Hospital of Rennes; Rennes France
| | | | - François Guille
- Department of Urology; University Hospital of Rennes; Rennes France
| | - Karim Bensalah
- Department of Urology; University Hospital of Rennes; Rennes France
| | - Benoit Peyronnet
- Department of Urology; University Hospital of Rennes; Rennes France
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Al-Marrawi MY, Mackley HB, Ali S, Wagner H, Joshi M, Holder S, Kaag M, Mallon C, Talamo G, Drabick JJ. Consolidation With Radiation or Concurrent Chemo-Radiation After Chemotherapy Results in Durable Complete Remissions of Isolated Nodal Recurrences of Urothelial Cancer: A Case Series and Review. Clin Genitourin Cancer 2016; 14:e393-9. [PMID: 26877063 DOI: 10.1016/j.clgc.2016.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Mhd Yaser Al-Marrawi
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA.
| | - Heath B Mackley
- Division of Radiation Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Suhail Ali
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Henry Wagner
- Division of Radiation Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Monika Joshi
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Sheldon Holder
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Mathew Kaag
- Division of Urological Surgery, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Carol Mallon
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Giampaolo Talamo
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
| | - Joseph J Drabick
- Division of Hematology and Oncology, Penn State University/Hershey Cancer Institute, Hershey, PA
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Strope SA. Comparative effectiveness research in urologic cancers. Cancer Treat Res 2015; 164:221-35. [PMID: 25677026 DOI: 10.1007/978-3-319-12553-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Controversies abound in urologic cancers. While some work in comparative effectiveness research has been performed, most controversies remain unresolved. In this chapter, we examine the three most common urologic malignancies: Prostate cancer, kidney cancer, and bladder cancer. We will review progress made in comparative effectiveness research for each cancer and outline important topics where future research is needed.
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Affiliation(s)
- Seth A Strope
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, MO, USA,
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Mitra AP, Alemozaffar M, Harris BN, Schuckman AK, Skinner EC, Daneshmand S. Outcomes After Urothelial Recurrence in Bladder Cancer Patients Undergoing Radical Cystectomy. Urology 2014; 84:1420-6. [DOI: 10.1016/j.urology.2014.05.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/08/2014] [Accepted: 05/03/2014] [Indexed: 10/24/2022]
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Late Recurrence after Radical Cystectomy: Patterns, Risk Factors and Outcomes. J Urol 2014; 191:1256-61. [DOI: 10.1016/j.juro.2013.11.103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2013] [Indexed: 11/23/2022]
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17
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Reynolds JP, Voss JS, Kipp BR, Karnes RJ, Nassar A, Clayton AC, Henry MR, Sebo TJ, Zhang J, Halling KC. Comparison of urine cytology and fluorescence in situ hybridization in upper urothelial tract samples. Cancer Cytopathol 2014; 122:459-67. [PMID: 24604675 DOI: 10.1002/cncy.21414] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/21/2014] [Accepted: 01/30/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND The cytologic diagnosis of urothelial carcinoma (UC) of the upper urothelial tract (UT) is challenging. Using the UroVysion probe set adds diagnostic value for the detection of bladder cancer in voided urine. In instrumented UT specimens, the authors encountered positive UT cytology and fluorescence in situ hybridization (FISH) cases that did not demonstrate subsequent UT carcinoma. METHODS The performance of cytology and FISH in the presence or absence of concomitant bladder cancer within 2 years was compared in 61 patients (112 samples) from 2003 through 2009. The mean follow-up was 3.2 years. The authors also compared the performance of near-tetrasomy versus hypertetrasomy. Biopsy confirmation of UTUC in 21 patients was considered the gold standard. RESULTS Cytology alone was found to be poorly sensitive (38%) but highly specific (89%) for the detection of UTUC. FISH was found to increase the sensitivity of cytology and decrease specificity. Tetrasomy FISH resulted in many false-positive cases. Other false-positive FISH results were likely due to the presence of bladder cancer cells contaminating the UT specimen. CONCLUSIONS Caution should be used when evaluating instrumented urine specimens of the UT from patients with a previous history of bladder carcinoma, and tetrasomy FISH results should not be interpreted as abnormal because it significantly lowers the specificity of the test. The combination of cytology and FISH appears to have good specificity while maintaining good sensitivity in evaluating UTUC when using modified scoring criteria for the appropriate patient population.
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Affiliation(s)
- Jordan P Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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18
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Strope SA, Chang SH, Chen L, Sandhu G, Piccirillo JF, Schootman M. Survival impact of followup care after radical cystectomy for bladder cancer. J Urol 2013; 190:1698-703. [PMID: 23727308 PMCID: PMC3896325 DOI: 10.1016/j.juro.2013.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE Due to substantial variation in patient followup after radical cystectomy for bladder cancer, we sought to understand the effect of urine and laboratory tests, physician visits and imaging on overall survival. MATERIALS AND METHODS We analyzed a cohort of patients treated in the fee for service Medicare population from 1992 through 2007 using Surveillance Epidemiology and End Results (SEER)-Medicare data. Using propensity score analysis, we assessed the relationship between time and geography standardized expenditures on followup care and overall survival during 3 postoperative periods, including perioperative (0 to 3 months), early followup (4 to 6 months) and later followup (7 to 24 months). Using instrumental variable analysis, we assessed the overall survival impact of the quantity of followup care by category, including physician visits, imaging, and laboratory and urine tests. RESULTS We found no improvement in survival due to followup care in the perioperative and early followup periods. Receiving followup care during later followup was associated with improved survival in the low, middle and high expenditure tertiles (HR 0.23, 95% CI 0.15-0.35, HR 0.27, 95% CI 0.18-0.40 and HR 0.47, 95% CI 0.31-0.71, respectively). Instrumental variable analysis suggested that only physician visits and urine testing improved survival (HR 0.96, 0.93-0.99 and 0.95, 0.91-0.99, respectively). CONCLUSIONS Followup care after radical cystectomy in the later followup period was associated with improved survival. Physician visits and urine tests were associated with this improved survival. Our results suggest that aspects of followup care significantly improve patient outcomes but imaging could be done more judiciously after cystectomy.
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Affiliation(s)
- Seth A Strope
- Division of Urology, Department of Surgery, Washington University, St. Louis, Missouri.
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19
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Diffusion-weighted MRI in bladder carcinoma: the differentiation between tumor recurrence and benign changes after resection. ACTA ACUST UNITED AC 2013; 39:135-41. [DOI: 10.1007/s00261-013-0038-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mitsui Y, Yasumoto H, Anjiki H, Koike C, Arichi N, Hiraoka T, Sumura M, Honda S, Igawa M, Shiina H. Hybrid procedure using perineal and abdominal approaches for radical prostatocystectomy: initial experience with 16 select cases. SPRINGERPLUS 2013; 2:348. [PMID: 23961412 PMCID: PMC3737479 DOI: 10.1186/2193-1801-2-348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/26/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To validate the feasibility and implications of a hybrid procedure using perineal and abdominal approaches for a radical prostatocystectomy. METHODS Between March 2007 and May 2012, we performed 16 prostatocystectomy and simultaneous urethrectomy under a hybrid procedure using perineal and abdominal approach for advanced bladder cancer. The hybrid procedure was selected in each case, because of prostatic urethra involvement in 13 and prior treatment in 3 (irradiation, radical retropubic prostatectomy, and sigmoidectomy, respectively). Two surgical teams, one responsible for the perineal approach and the other for the abdominal portion, performed the operation. RESULTS The median operation time for the prostatocystectomy procedure was 207 minutes and median intraoperative blood loss was 1665 ml. The en bloc removal of the specimen was perfectly performed and no intraoperative difficulties and intraoperative complications such as rectal injury were recognized in all cases. As for postoperative complications associated with the exaggerated lithotomy position, neurologic complications and rhabdomyolysis which could be treated conservately were found in 1 case. Although 5 patients died from distant metastasis, local recurrence was not seen in any of the 16 patients during the follow-up period. CONCLUSION The hybrid procedure using perineal and abdominal approach for radical prostatocystectomy is a well-organized procedure that can provide good visualization of the surgical structure around the prostate, leading to a reduction in or prevention of local recurrence and surgical complications even in the selected patient.
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Affiliation(s)
- Yozo Mitsui
- Department of Urology, Shimane University School of Medicine, 89-1 Enya-cho, 693-8501 Izumo, Japan
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21
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Huguet J. Follow-up after radical cystectomy based on patterns of tumor recurrence and its risk factors. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.acuroe.2013.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Huguet J. Follow-up after radical cystectomy based on patterns of tumour recurrence and its risk factors. Actas Urol Esp 2013; 37:376-82. [PMID: 23611464 DOI: 10.1016/j.acuro.2013.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 01/07/2013] [Indexed: 11/29/2022]
Abstract
CONTEXT Following cystectomy, approximately 50% of patients will present tumour recurrence. A recurrence may be local, systemic or occur in the urethra or upper urinary tract. OBJECTIVE To analyse the characteristics, risk factors and outcomes of patients with tumour recurrence following cystectomy so as to subsequently propose a cancer follow-up protocol. ACQUISITION OF EVIDENCE Analysis of original articles and reviews related to tumour recurrence and follow-up after radical cystectomy for urothelial tumour. Articles were obtained from Pubmed searches. SUMMARY OF THE EVIDENCE Systemic and local recurrences following cystectomy appear in 20%-35% and 5%-15% of cases, respectively. Some 80%-90% are diagnosed in the first 3 years, with the majority concentrated in the first 24 months. Common factors related to an increased risk of local and systemic recurrence are a pathologic stage ≥pT3, the presence of positive margins and the extension of the lymphadenectomy. The incidence of recurrence in the upper urinary tract and urethra is 2%-6% and 4%-6%, respectively. Both types of recurrence may appear late and share risk factors such as signs of multifocal disease, a history of non-muscle-invasive bladder cancer, multiplicity, presence of ISC, urinary tract tumours and prostatic urethral tumours. Tumours in the distal ureteral cystectomy specimen and tumours in the prostatic urethra are also risk factors related to the appearance of tumours in the urinary tract and urethra, respectively. CONCLUSION Understanding the natural history of urothelial bladder carcinoma and the risk factors related to the appearance of tumour recurrence following cystectomy are essential for designing an appropriate follow-up protocol. The follow-up of patients with risk factors for local or systemic recurrence will achieve maximum efficiency during the first 3 years. The follow-up should be extended for patients with risk factors for presenting upper urinary tract or urethral tumours.
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Affiliation(s)
- J Huguet
- Servicio de Urología, Hospital Clínic, Barcelona, España.
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Iwasaki K, Obara W, Kato Y, Takata R, Tanji S, Fujioka T. Neoadjuvant Gemcitabine Plus Carboplatin for Locally Advanced Bladder Cancer. Jpn J Clin Oncol 2012; 43:193-9. [DOI: 10.1093/jjco/hys213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Upper Urinary Tract Recurrence Following Radical Cystectomy for Bladder Cancer: A Meta-Analysis on 13,185 Patients. J Urol 2012; 188:2046-54. [DOI: 10.1016/j.juro.2012.08.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Indexed: 11/17/2022]
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25
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Kim B, Choi HJ, Kim MH, Cho KS. Recurrence patterns of bladder transitional cell carcinoma after radical cystectomy. Acta Radiol 2012; 53:943-9. [PMID: 22893727 DOI: 10.1258/ar.2012.110700] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multidetector computed tomography (MDCT) is widely accepted as an effective imaging modality in monitoring for bladder cancer recurrence after radical cystectomy. Elucidating the pattern of bladder cancer recurrence on CT can increase the diagnostic accuracy. PURPOSE To evaluate the recurrence patterns of transitional cell carcinoma of the bladder and the factors associated with cancer recurrence. MATERIAL AND METHODS One hundred and forty-nine consecutive patients (mean age, 66.55 years; range, 32-86 years) who underwent preoperative contrast-enhanced CT and radical cystectomy were included in this study. The presence, site, and time of tumor recurrence were recorded retrospectively by two radiologists in a consensus fashion. The association of tumor recurrence and tumor factors (T stage, lymph node metastasis, nuclear grade, and tumor diameter) were also evaluated using multiple logistic regression analysis and Kaplan-Meier statistics. RESULTS Tumor recurrence occurred in 60 patients (40.3%) with a mean time of 14 months (range, 1-64 months). The sites of recurrence included the operation site (n = 20), lymph node (n = 20), bone (n = 11), liver (n = 6), lung (n = 5), upper urinary tract (n = 4), colon (n = 3), adrenal gland (n = 2), peritoneum (n = 1), abdominal wall (n = 1), psoas muscle (n = 1), and penile skin (n = 1). Tumor recurrence was found to be associated with advanced T stage (P = 0.002) and lymph node metastasis (P < 0.001). CONCLUSION Transitional cell carcinomas of the bladder recur more frequently at the operation site and lymph node, and T-stage and lymph node metastasis are closely associated with tumor recurrence.
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Affiliation(s)
- Bohyun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Hyuck Jae Choi
- Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Mi-hyun Kim
- Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Kyung-Sik Cho
- Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea
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Patterns of local recurrence after radical cystectomy in a contemporary series of patients with muscle-invasive bladder cancer. World J Urol 2012; 30:821-6. [DOI: 10.1007/s00345-012-0936-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/20/2012] [Indexed: 10/27/2022] Open
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27
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Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, Shipley WU, Heidenreich A, Schoenberg MP, Sagaloswky AI, Soloway MS, Stenzl A. ICUD-EAU International Consultation on Bladder Cancer 2012: Radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2012; 63:45-57. [PMID: 22917985 DOI: 10.1016/j.eururo.2012.08.009] [Citation(s) in RCA: 293] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 08/06/2012] [Indexed: 11/16/2022]
Abstract
CONTEXT New guidelines of the International Consultation on Urological Diseases for the treatment of muscle-invasive bladder cancer (MIBC) have recently been published. OBJECTIVE To provide a comprehensive overview of the current role of radical cystectomy (RC) in MIBC. EVIDENCE ACQUISITION A detailed Medline analysis was performed for original articles addressing the role of RC with regard to indication, timing, surgical extent, perioperative morbidity, oncologic outcome, and follow-up. The analysis also included radiation-based bladder-preserving strategies. EVIDENCE SYNTHESIS The major findings are presented in an evidence-based fashion and are based on large retrospective unicenter and multicenter series with some prospective data. CONCLUSIONS Open RC is the standard treatment for locoregional control of MIBC. Delay of RC is associated with reduced cancer-specific survival. In males, standard RC includes the removal of the bladder, prostate, seminal vesicles, and distal ureters; in females, RC includes an anterior pelvic exenteration including the bladder, entire urethra and adjacent vagina, uterus, and distal ureters. A procedure sparing the urethra and the urethra-supplying autonomous nerves can be performed in case of a planned orthotopic neobladder. Further technical variations (ie, seminal-sparing or vaginal-sparing techniques) aimed at improving functional outcomes must be weighed against the risk of a positive margin. Laparoscopic surgery is promising, but long-term data are required prior to accepting it as an option equivalent to the open procedure. Lymphadenectomy should remove all lymphatic tissue around the common iliac, external iliac, internal iliac, and obturator region bilaterally. Complications after RC should be reported according to the modified Clavien grading system. In selected patients with MIBC, bladder-preserving therapy with cystectomy reserved for tumor recurrence represents a safe and effective alternative to immediate RC.
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Affiliation(s)
- Georgios Gakis
- Department of Urology, University Hospital Tuebingen, Germany.
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Yoshida T, Takayama H, Uemura M, Nakai Y, Nonomura N, Tsujimura A. Solitary skin metastasis adjacent to ureterocutaneostomy 4 years after radical cystectomy for bladder cancer. Jpn J Clin Oncol 2012; 42:331-4. [PMID: 22389275 DOI: 10.1093/jjco/hys017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 65-year-old Japanese woman underwent radical cystectomy and right nephroureterectomy for muscle-invasive bladder cancer. A left ureterocutaneostomy was constructed for urinary diversion. There was no evidence of recurrence for 4 years after the surgery. At 54 months after the surgery, however, she was referred with a chief complaint of painless skin erosion around the stoma. An incisional biopsy of the lesion showed no evidence of malignancy. Thereafter, the lesion was treated as a benign skin erosion. However, the erosion expanded over the next 4 months, and a second incisional biopsy revealed that the erosion was overlying malignant cells. Computed tomography showed a skin tumor of 4 cm in diameter. No other metastases were revealed on whole-body imaging examinations. Urine cytology was negative. A skin tumor extirpation was performed, and the specimen showed that the skin tumor consisted of malignant growth of papillary cells adjacent to the ureter, which were identical to those of the primary bladder cancer. A malignant component was not observed in the lumen of the resected ureter. No evidence of disease was observed in the first 3 months after extirpation. Reports of solitary skin metastasis from bladder cancer are rare, and only a few cases have been reported in the English literature. Because skin metastasis from bladder cancer can mimic a number of different benign conditions, a high index of suspicion may be necessary to make a definitive diagnosis.
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Affiliation(s)
- Takahiro Yoshida
- Department of Urology, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0871, Japan
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Laparoscopic radical cystectomy for bladder cancer with prostatic and neurovascular sparing: initial experience. Int Urol Nephrol 2012; 44:787-92. [DOI: 10.1007/s11255-011-0121-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
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Takayanagi A, Masumori N, Takahashi A, Takagi Y, Tsukamoto T. Upper urinary tract recurrence after radical cystectomy for bladder cancer: Incidence and risk factors. Int J Urol 2011; 19:229-33. [DOI: 10.1111/j.1442-2042.2011.02916.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Upper urinary tract (UUT) transitional cell carcinoma (TCC) is relatively rare tumor. Approximately 0.7-4% of patients with primary bladder cancer develops UUT-TCC. The symptoms related to an UUT-TCC often occur with an advanced stage which leads one to emphasize a surveillance strategy to monitor the UUT to allow for an earlier diagnosis. Although the risk of UUT-TCC after bladder cancer is well established, there is a paucity of recommendations suggesting the optimal method and frequency of monitoring the UUT and there is no consensus among them. This article reviews the recommendations on monitoring the UUT in patients with bladder cancer.
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32
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Mitra AP, Quinn DI, Dorff TB, Skinner EC, Schuckman AK, Miranda G, Gill IS, Daneshmand S. Factors influencing post-recurrence survival in bladder cancer following radical cystectomy. BJU Int 2011; 109:846-54. [PMID: 21812902 DOI: 10.1111/j.1464-410x.2011.10455.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anirban P Mitra
- Department of Pathology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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33
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Feasibility of Radical Transurethral Resection as Monotherapy for Selected Patients With Muscle Invasive Bladder Cancer. J Urol 2010; 184:475-80. [DOI: 10.1016/j.juro.2010.04.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Indexed: 11/21/2022]
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34
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Yoshimine S, Kikuchi E, Matsumoto K, Ide H, Miyajima A, Nakagawa K, Oya M. The clinical significance of urine cytology after a radical cystectomy for urothelial cancer. Int J Urol 2010; 17:527-32. [DOI: 10.1111/j.1442-2042.2010.02516.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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35
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Facteurs prédictifs et résultats carcinologiques à long terme des patients n’ayant plus de tumeur résiduelle (stade pT0) sur la pièce de cystectomie totale réalisée pour cancer de vessie. Prog Urol 2010; 20:130-7. [DOI: 10.1016/j.purol.2009.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/02/2009] [Accepted: 07/07/2009] [Indexed: 11/18/2022]
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36
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External Beam Radiation Therapy Followed by Interstitial Radiotherapy with Iridium-192 for Solitary Bladder Tumours: Results of 111 Treated Patients. Eur Urol 2009; 56:113-21. [DOI: 10.1016/j.eururo.2008.07.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 07/15/2008] [Indexed: 11/15/2022]
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37
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Kato S, Honma I, Tsukamoto T. Local recurrence of bladder cancer occurring eight years after radical cystectomy. Int J Urol 2009; 16:532. [PMID: 19467124 DOI: 10.1111/j.1442-2042.2009.02290.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Lee SE, Byun SS, Hong SK, Chang IH, Kim YJ, Gill MC, Song SH, Kim KT. Significance of Cancer Involvement at the Ureteral Margin Detected on Routine Frozen Section Analysis during Radical Cystectomy. Urol Int 2009; 77:13-7. [PMID: 16825809 DOI: 10.1159/000092928] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 12/21/2005] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We investigated the clinical significance of preoperatively-unsuspected ureteral involvement of cancer detected on intraoperative frozen section analysis of ureteral margins during radical cystectomy. PATIENTS AND METHODS We performed a retrospective study of 115 patients who received radical cystectomy for locally-advanced but node-negative transitional cell carcinoma of the bladder between 1995 and 2002 by reviewing their records. RESULTS Of 115 total patients, 5 (4.3%) demonstrated carcinoma in situ at the ureteral margin with 2 of 5 having a positive margin on final pathologic analysis. Meanwhile, only 3 of 115 total patients (2.6%) later showed upper urinary tract recurrence at a median interval of 30 months after cystectomy. And all 3 patients had intramural or juxtavesical ureter involvement of disease (p = 0.006), while not demonstrating carcinoma in situ in ureteral margins resected during cystectomy. On multivariate analysis, only the stage and grade of bladder cancer along with pathologic feature of vascular invasion were observed to be independent prognostic predictors of disease-specific survival. CONCLUSIONS Cancer involvement of the distal ureteral margin detected through intraoperative frozen section analysis may not be a significant factor regarding upper tract recurrence and survival of patients with locally-advanced bladder cancer after radical cystectomy. Upper tract recurrence may be more prone to occur in patients with cancer involvement at the intramural or juxtavesical ureter.
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Affiliation(s)
- Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Kyunggi-do, Korea
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39
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Schumacher MC, Studer UE. URETERIC FROZEN SECTIONS DURING RADICAL CYSTECTOMY FOR TRANSITIONAL CELL CARCINOMA OF THE BLADDER - TO DO OR NOT TO DO? BJU Int 2009; 103:1149-50. [DOI: 10.1111/j.1464-410x.2008.08291.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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40
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Wright JL, Hotaling J, Porter MP. Predictors of Upper Tract Urothelial Cell Carcinoma After Primary Bladder Cancer: A Population Based Analysis. J Urol 2009; 181:1035-9; discussion 1039. [DOI: 10.1016/j.juro.2008.10.168] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan L. Wright
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - James Hotaling
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Michael P. Porter
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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41
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Woo KJ, Kwak KW, Choi HY, Lee HM. Grade Concordance between Transitional Cell Carcinoma of the Bladder and the Upper Urinary Tract. Korean J Urol 2008. [DOI: 10.4111/kju.2008.49.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kwang Jae Woo
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Won Kwak
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
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42
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Bergman J, Reznichek RC, Rajfer J. Surveillance of patients with bladder carcinoma using fluorescent in-situ hybridization on bladder washings. BJU Int 2007; 101:26-9. [PMID: 17850364 DOI: 10.1111/j.1464-410x.2007.07183.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the sensitivity and specificity of the UroVysion (Abbott Laboratories Inc., Downers Grove, IL, USA) fluorescent in-situ hybridization (FISH) assay to that of urinary cytology obtained from bladder irrigation during cystoscopic surveillance in patients with bladder carcinoma. PATIENTS AND METHODS The medical records were retrospectively reviewed for 41 consecutive patients screened at the authors' institution between August 2000 and December 2006 for recurrence of pathologically confirmed bladder cancer. All 162 cytology examinations and 141 FISH assay results obtained from bladder washing were included. Recurrence was determined by cystoscopy, bladder biopsy and upper-tract imaging. Sensitivity, specificity, positive predictive and negative predictive values were assessed using a chi-square distribution with one degree of freedom. RESULTS There were 24 men and 17 women (male to female ratio 0.59), the mean (range) age was 56 (33-73) years and the mean follow-up 30 (2-57) months. At the initial diagnosis, 35 of the 41 patients (85%) had superficial tumours (stage <or= T1), while six (15%) had muscle-invasive tumours (stage >or=T2). Twenty-six (63%) had low-grade and 15 (37%) had high-grade tumours. In 16 of 141 (11%) of the FISH assays and 16 of 162 (10%) of the cytological samples that were collected from bladder irrigations, there were too few cells for an adequate analysis. The FISH assay correctly correlated with subsequent cystoscopy, bladder biopsy or upper-tract imaging in 110/125 (88%) cases but not in 15/125 (12%). Cytology correctly correlated with the subsequent evaluation in 112/146 (77%) cases but did not in 34/146 (23%). When the FISH was compared with cytology in this setting, the sensitivity was 77% (30/39) vs 74% (37/50; P > 0.1), the specificity was 93% (80/86) vs 78% (75/96; P < 0.01), the positive predictive value was 83% (30/36) vs 64% (37/58; P < 0.05), and the negative predictive value was 90% (80/89) vs 85% (75/88; P > 0.1), respectively. CONCLUSION The UroVysion FISH assay obtained from bladder washings during cystoscopic surveillance of patients with a history of bladder cancer provides a similar specificity but greater sensitivity than that of cytology for detecting bladder cancer recurrences. Given the better specificity and similar sensitivity of UroVysion compared with urine cytology obtained from bladder washings, a reasonable approach might be to use the UroVysion assay as the primary marker for recurrence, with urine cytology used as a complementary examination.
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Affiliation(s)
- Jonathan Bergman
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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43
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Sanderson KM, Rouprêt M. Upper urinary tract tumour after radical cystectomy for transitional cell carcinoma of the bladder: an update on the risk factors, surveillance regimens and treatments. BJU Int 2007; 100:11-6. [PMID: 17428248 DOI: 10.1111/j.1464-410x.2007.06841.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urothelial carcinoma is characterized by multiple, multifocal recurrences throughout the genitourinary tract; approximately 3% of patients treated by radical cystectomy (RC) for invasive transitional cell carcinoma (TCC) of the bladder will subsequently develop a subsequent TCC in the upper urinary tract (UUT) urothelium. Metachronous upper UUT tumours (mUUT-TCC) typically occur as a late oncological event (>3 years after RC). The vast majority of mUUT-TCCs are detected only after the progression to tumour-related symptoms, e.g. haematuria, flank pain or pyelonephritis, despite strict adherence to surveillance protocols. Failure of imaging and cytology to detect most asymptomatic tumours has led to questions about the need for routine UUT surveillance. Some authors have advocated a more tailored approach to surveillance after RC, targeting high-risk patients and with limiting imaging in those patients at lowest risk of developing a subsequent UUT-TCC. mUUT-TCCs are most common in patients with TCC in the ureter or urethra, and with organ-confined bladder cancer. Although the prognosis is generally poor, long-term survival can be achieved in a subset of patients after radical nephroureterectomy (NU). Minimally invasive techniques, e.g. ureteroscopic and percutaneous resection, have been proposed as renal-sparing alternatives to radical surgery for patients with low-stage and -grade de novo UUT-TCC. However, oncological control of renal-sparing therapies in those with high-risk mUUT-TCC remains largely unconfirmed. Until oncological outcomes equivalent to the standard, radical NU, are reported in patients after RC, conservative treatment strategies should be avoided.
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Affiliation(s)
- Kristin M Sanderson
- Urologic Oncology, Department of Urology, Keck School of Medicine, University of Southern California, USC/Norris Cancer Center, Los Angeles, CA, USA
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44
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Sanderson KM, Cai J, Miranda G, Skinner DG, Stein JP. Upper Tract Urothelial Recurrence Following Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: An Analysis of 1,069 Patients With 10-Year Followup. J Urol 2007; 177:2088-94. [PMID: 17509294 DOI: 10.1016/j.juro.2007.01.133] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE Risk factors for upper tract recurrence following radical cystectomy for transitional cell carcinoma of the bladder are not yet well-defined. We reviewed our population of patients who underwent radical cystectomy to identify prognostic factors and clinical outcomes associated with upper tract recurrence. MATERIALS AND METHODS From our prospective database of 1,359 patients who underwent radical cystectomy we identified 1,069 patients treated for transitional cell carcinoma of the bladder between January 1985 and December 2001. Univariate analysis was completed to determine factors predictive of upper tract recurrence. RESULTS A total of 853 men and 216 women were followed for a median of 10.3 years (maximum 18.5). There were 27 (2.5%) upper tract recurrences diagnosed at a median of 3.3 years (range 0.4 to 9.3). Only urethral tumor involvement was predictive of upper tract recurrence. In men superficial transitional cell carcinoma of the prostatic urethra was associated with an increased risk of upper tract recurrence compared with prostatic stromal invasion or absence of prostatic transitional cell carcinoma (p <0.01). In women urethral transitional cell carcinoma was associated with an increased risk of upper tract recurrence (p = 0.01). Despite routine surveillance 78% of upper tract recurrence was detected after development of symptoms. Median survival following upper tract recurrence was 1.7 years (range 0.2 to 8.8). Detection of asymptomatic upper tract recurrence via surveillance did not predict lower nephroureterectomy tumor stage, absence of lymph node metastases or improved survival. CONCLUSIONS Patients with bladder cancer are at lifelong risk for late oncological recurrence in the upper tract urothelium. Patients with evidence of tumor involvement within the urethra are at highest risk. Surveillance regimens frequently fail to detect tumors before symptoms develop. However, radical nephroureterectomy can provide prolonged survival.
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Affiliation(s)
- Kristin M Sanderson
- Department of Urology, Keck School of Medicine, University of Southern California, University of Southern California/Norris Cancer Center, Los Angeles, CA, USA.
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Raj GV, Bochner BH. Radical cystectomy and lymphadenectomy for invasive bladder cancer: towards the evolution of an optimal surgical standard. Semin Oncol 2007; 34:110-21. [PMID: 17382794 DOI: 10.1053/j.seminoncol.2006.12.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The surgical management of invasive bladder cancer has undergone a significant evolution in technique since its initial introduction. Changes in the extent of surgery have largely reflected a better understanding of the natural history of bladder cancer and the recognized pathways of progression. Incorporation of contemporary surgical techniques that target the perivesical soft tissues, regional lymph nodes, and adjacent organs appear to enhance oncologic outcomes. A growing body of evidence indicates that the quality of radical cystectomy (RC) directly affects patient outcome. Recently, quality of life and functional considerations have led to surgical modifications such as nerve-, prostate-, vaginal wall-, and urethra-sparing approaches. While some modifications in appropriate candidates appear not to decrease cancer control, further studies will be needed to establish their role and safety. This ongoing evolution in the technique of RC and pelvic lymph node dissection (PLND) may help define a new surgical standard that provides optimal benefit in patients with invasive bladder cancer.
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Affiliation(s)
- Ganesh V Raj
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Romero FR, Muntener M, Permpongkosol S, Kavoussi LR, Jarrett TW. Laparoscopic-assisted nephroureterectomy after radical cystectomy for transitional cell carcinoma. Int Braz J Urol 2007; 32:631-8; discussion 638-9. [PMID: 17201940 DOI: 10.1590/s1677-55382006000600003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report our experience with laparoscopic-assisted nephroureterectomy for upper tract transitional cell carcinomas after radical cystectomy and urinary diversion. MATERIALS AND METHODS Seven patients (53-72 years-old) underwent laparoscopic-assisted nephroureterectomy 10 to 53 months after radical cystectomy for transitional cell carcinoma at our institution. Surgical technique, operative results, tumor features, and outcomes of all patients were retrospectively reviewed. RESULTS Mean operative time was 305 minutes with a significant amount of time spent on the excision of the ureter from the urinary diversion. Estimate blood loss and length of hospital stay averaged 180 mL and 10.8 days, respectively. Intraoperative and postoperative complications occurred in two patients each. There was one conversion to open surgery. Pathology confirmed upper-tract transitional cell carcinoma in all cases. Metastatic disease occurred in two patients after a mean follow-up of 14.6 months. CONCLUSIONS Nephrouretectomy following cystectomy is a complex procedure due to the altered anatomy and the presence of many adhesions. A laparoscopic-assisted approach can be performed safely in properly selected cases but does not yield the usual benefits seen with other laparoscopic renal procedures.
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Affiliation(s)
- Frederico R Romero
- The James Buchanan Brady Urological Institute, Baltimore, Maryland 21287-8915, USA.
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Raj GV, Bochner BH, Serio AM, Vickers A, Donat SM, Herr H, Lin O, Dalbagni G. Natural history of positive urinary cytology after radical cystectomy. J Urol 2007; 176:2000-5; discussion 2005. [PMID: 17070236 DOI: 10.1016/j.juro.2006.07.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE The natural history and risk of disease progression in patients with positive urine cytology after radical cystectomy for urothelial carcinoma has not been adequately elucidated. MATERIALS AND METHODS An institutional review board approved, retrospective review in patients undergoing radical cystectomy was performed to identify those with positive urinary cytology after radical cystectomy. Cox proportional hazards regression was used to determine factors associated with positive cytology after radical cystectomy and upper tract recurrence after positive cytology. Survival curves and probabilities were examined by Kaplan-Meier analysis. RESULTS A total of 101 patients with at least a single positive urinary cytology result after radical cystectomy were identified. Ureteral involvement in the radical cystectomy specimen was significantly associated with subsequent positive cytology. At the first positive urinary cytology only 9 of 101 patients (9%) had documented urothelial recurrence but eventually 57 of 101 had radiographic evidence of urothelial recurrence. Median freedom from radiological evidence of urothelial recurrence after positive cytology was 2.1 years and ureteral involvement was associated with a higher likelihood of urothelial recurrence. Despite surgical and chemotherapeutic interventions median survival after urothelial recurrence was 2.1 years. CONCLUSIONS Urine cytology may have a valuable role for detecting upper tract recurrence after radical cystectomy. Most patients with positive cytology after radical cystectomy eventually have radiological evidence of urothelial recurrence. These data may help clarify natural history in patients with positive cytology after radical cystectomy. Additionally, these data indicate the need for diligent evaluation for recurrent disease and potentially the role of early adjuvant therapy in patients with positive cytology after radical cystectomy.
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Affiliation(s)
- Ganesh V Raj
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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Parekh DJ, Bochner BH, Dalbagni G. Superficial and Muscle-Invasive Bladder Cancer: Principles of Management for Outcomes Assessments. J Clin Oncol 2006; 24:5519-27. [PMID: 17158537 DOI: 10.1200/jco.2006.08.5431] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bladder cancer is a heterogeneous disease. Non–muscle-invasive bladder cancer embraces a spectrum of tumors with varying degrees of clinical behavior. Transurethral resection remains the surgical mainstay for the treatment of non–muscle-invasive bladder cancer. In an attempt to decrease the recurrence or progression rate, intravesical chemotherapy or immunotherapy is also used. Radical cystectomy with bilateral pelvic lymph node dissection remains the gold standard for treating muscle-invasive bladder cancer. Over the last decade, the orthotopic neobladder has gained widespread popularity as the preferred mode of urinary diversion in both males and females with similar oncologic and functional outcomes. Well-designed trials with effective chemotherapy have shown a beneficial role for neoadjuvant chemotherapy.
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Affiliation(s)
- Dipen J Parekh
- Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Akkad T, Gozzi C, Deibl M, Müller T, Pelzer AE, Pinggera GM, Bartsch G, Steiner H. Tumor Recurrence in the Remnant Urothelium of Females Undergoing Radical Cystectomy for Transitional Cell Carcinoma of the Bladder: Long-Term Results From a Single Center. J Urol 2006; 175:1268-71; discussion 1271. [PMID: 16515977 DOI: 10.1016/s0022-5347(05)00643-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE We analyzed the risk factors and incidence of secondary TCC of the remnant urothelium in women following radical cystectomy for TCC of the bladder. MATERIALS AND METHODS A total of 85 women with a mean age of 64.5 years with clinically localized TCC of the bladder underwent radical cystectomy between 1992 and 2004. Orthotopic bladder substitution was performed in 46 females, while 39 underwent nonorthotopic urinary diversion. Of the entire cohort 22 (26%) patients underwent cystectomy for multifocal or recurrent TCC. Followup examinations were performed at 6-month intervals. RESULTS Mean followup in the entire cohort was 49.8 months (median 42). Intraoperative frozen sections obtained from the urethra and distal ureters were negative for TCC and CIS in all patients. Four women (4.7%) had TCC in the remnant urothelium at a mean of 56 months postoperatively. These patients had undergone cystectomy for multifocal or recurrent TCC (4 of 22 or 18%). No secondary TCC was seen in the 63 patients with solitary invasive or nonrecurrent bladder cancer (p <0.05). Urethral recurrence was found in 2 patients (4.3%) 65 and 36 months after orthotopic neobladder surgery, respectively. In the orthotopic group 1 patient (2.1%) had an upper urinary tract tumor 76 months after surgery, while in the nonorthotopic group 1 (2.5%) was found to have an upper urinary tract tumor 48 months postoperatively. CONCLUSIONS Recurrent or multifocal TCC may represent a risk factor for secondary TCC of the remnant urothelium after cystectomy. In our series all recurrent tumors were late recurrences (more than 36 months postoperatively). Because the rate of urethral recurrence in the current series corresponds to that reported in men (2% to 6%), urethra sparing cystectomy with orthotopic bladder replacement does not appear to compromise the oncological outcome in women.
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Affiliation(s)
- Thomas Akkad
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
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Mallén Mateo E, Gil Martínez P, Gil Sanz MJ, Sancho Serrano C, Pascual Regueriro D, Rioja Sanz LA. Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie. Actas Urol Esp 2006; 30:763-71. [PMID: 17078573 DOI: 10.1016/s0210-4806(06)73533-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. MATERIALS AND METHODS between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. RESULTS In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progression-free survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126), since the date of the cistectomia. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy, with a cancer-specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). CONCLUSION In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection (T3, 32 months) and the ganglionary affectation (pN+ 45 months).
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Affiliation(s)
- E Mallén Mateo
- Servicio de Urología, Hospital Universitario Miguel Servet, Zaragoza.
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