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Nuijens ST, van Osch FHM, van Hoogstraten LMC, Witjes JA, Aben KKH, Hermans TJN. Longer time to radical cystectomy in patients treated with neoadjuvant chemotherapy is associated with worse oncological outcomes. Urol Oncol 2024; 42:117.e11-117.e16. [PMID: 38238116 DOI: 10.1016/j.urolonc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/17/2023] [Accepted: 12/24/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Current muscle-invasive bladder cancer (MIBC) guidelines recommend not delaying radical cystectomy (RC) >3 months after diagnosis as it decreases overall survival (OS). However, literature investigating the impact of delay in RC in patients who receive NAC is limited, especially on a population-based level. OBJECTIVE To investigate the association between time from diagnosis of MIBC to RC (TTRC) in patients with urothelial bladder cancer (UBC) treated with NAC and RC and 1) 2-year OS and 2) pathological lymph node status (pN+) in a population-based cohort. METHODS Patients were selected from the Netherlands Cancer Registry. The study included 237 patients with cT2-T4aN0M0 UBC, treated with NAC and RC between November 2017 and October 2019. Association between TTRC and OS was assessed using multivariable Cox regression analyses. Schoenfeld and Martingale residuals were used to investigate the proportional hazards assumption and whether a cut-off in the TTRC could be identified. Association between TTRC and pN+ was assessed using multivariable logistic regression analyses. RESULTS Median TTRC was 23 weeks (interquartile range (IQR) 19-26). 2-year OS was 67% (95%CI 59%-74%). Each week of delay in the TTRC was independently associated with 2-year OS (HR 1.06; P = 0.03) in the Cox regression analysis. The sensitivity analyses, defining TTRC as the time between last cycle of NAC and RC, revealed that each week of delay between NAC and RC was associated with 2-year OS (Hazard ratio (HR) 1.13; P < 0.0001), and with pN+ (Odds ratio (OR) 1.21; P = 0.01) in the Cox and logistic regression analyses, respectively. CONCLUSIONS A longer TTRC is associated with worse oncological outcomes in patients treated with NAC and RC.
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Affiliation(s)
- Siberyn T Nuijens
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - Frits H M van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands; Department of Epidemiology, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Lisa M C van Hoogstraten
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tom J N Hermans
- Department of Urology, VieCuri Medical Center, Venlo, the Netherlands; Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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Harraz AM, Elkarta A, Zahran MH, Mosbah A, Shaaban AA, Abol-Enein H. The impact of chemotherapy-naïve open radical cystectomy delay and perioperative transfusion on the recurrence-free survival: A perioperative parameters-based nomogram. Asian J Urol 2024; 11:294-303. [PMID: 38680591 PMCID: PMC11053321 DOI: 10.1016/j.ajur.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 09/14/2022] [Indexed: 05/01/2024] Open
Abstract
Objective To develop and internally validate a nomogram to predict recurrence-free survival (RFS) including the time to radical cystectomy (RC) and perioperative blood transfusion (PBT) as potential predictors. Methods Patients who underwent open RC and ileal conduit between January 1996 to December 2016 were split into developing (n=948) and validating (n=237) cohorts. The time to radical cystectomy (TTC) was defined as the interval between the onset of symptoms and RC. The regression coefficients of the independent predictors obtained by Cox regression were used to construct the nomogram. Discrimination, validation, and clinical usefulness in the validation cohort were assessed by the area under the curve, the calibration plot, and decision curve analysis. Results In the developing dataset, the 1-, 5-, and 10-year RFS were 83.0%, 47.2%, and 44.4%, respectively. On multivariate analysis, independent predictors were TTC (hazards ratio [HR] 1.07, 95% confidence interval [CI] 1.05-1.08, p<0.001), PBT (one unit: HR 1.40, 95% CI 1.03-1.90, p=0.03; two or more units: HR 1.72, 95% CI 1.29-2.29, p<0.001), bilateral hydronephrosis (HR 1.54, 95% CI 1.21-1.97, p<0.001), squamous cell carcinoma (HR 0.60, 95% CI 0.45-0.81, p=0.001), pT3-T4 (HR 1.77, 95% CI 1.41-2.22, p<0.001), lymph node status (HR 1.53, 95% CI 1.21-1.95, p<0.001), and lymphovascular invasion (HR 1.28, 95% CI 1.01-1.62, p=0.044). The areas under the curve in the validation dataset were 79.3%, 69.6%, and 76.2%, for 1-, 5-, and 10-year RFS, respectively. Calibration plots showed considerable correspondence between predicted and actual survival probabilities. The decision curve analysis revealed a better net benefit of the nomogram. Conclusion A nomogram with good discrimination, validation, and clinical utility was constructed utilizing TTC and PBT in addition to standard pathological criteria.
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Affiliation(s)
| | - Ahmed Elkarta
- Urology and Nephrology Center, Mansoura University, Egypt
| | | | - Ahmed Mosbah
- Urology and Nephrology Center, Mansoura University, Egypt
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Serrano M, Muñoz-Unceta N, Alonso LA, Azueta A, Gutiérrez Baños JL, Ferreira L, Domínguez M, Torres Zurita A, Ballestero R, Cacho D, López-Brea M, Sotelo M, Campos-Juanatey F, Ramos Barseló E, Duran I. Neoadjuvant chemotherapy with dose-dense MVAC in muscle-invasive bladder cancer: a tertiary center experience. Clin Transl Oncol 2024; 26:549-553. [PMID: 37566343 DOI: 10.1007/s12094-023-03277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/04/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Neoadjuvant chemotherapy in muscle-invasive bladder cancer (MIBC) patients has proven beneficial in overall survival. However, the optimal regimen is still a matter of debate. MATERIALS AND METHODS In this retrospective analysis, we evaluate the results obtained in 42 patients treated in our center with 4 cycles of neoadjuvant dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (dd-MVAC) followed by radical cystectomy from August 2015 to October 2020. All patients had cT2 or higher non-metastatic MIBC. Clinical and pathological outcomes are reported. RESULTS Of the 42 patients, 90.5% were men (n = 38) and the mean age was 65 years. All of them had ECOG 0-1 at diagnosis and most tumors had an initial clinical stage T2N0 (76%). Thirty-six patients (85.7%) completed 4 cycles of neoadjuvant treatment, and 21.4% required a dose reduction. The most frequent adverse event (AE) was grade 1-2 asthenia (81%), while neutropenia was the most frequent grade 3 or higher AE (38%). Complete pathological response (ypT0, ypN0) was achieved in 50% of patients (n = 21), and down-staging was observed in 57.1% (n = 24). Only one patient presented radiological progressive disease during neoadjuvant treatment (2.4%), and after a mean follow-up time of 31.5 months, 33.3% of patients experienced disease recurrence. CONCLUSIONS Neoadjuvant chemotherapy with 4 cycles of dd-MVAC is an effective regimen with high rates of pathological complete responses and down-staging along with an acceptable toxicity profile. DD-MVAC should be considered as an alternative to cisplatin and gemcitabine in patients with good clinical performance status.
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Affiliation(s)
- Marina Serrano
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Nerea Muñoz-Unceta
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Lucía Andrea Alonso
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ainara Azueta
- Pathology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Laura Ferreira
- Medical Oncology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mario Domínguez
- Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Albero Torres Zurita
- Medical Oncology Department, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Roberto Ballestero
- Urology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Diego Cacho
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Marta López-Brea
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Marta Sotelo
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | | | - Ignacio Duran
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
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Pan DL, Zhang LF, Li XJ, Zhang KP, Gao PF, Yang B, Li NC. Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer. BMC Cancer 2024; 24:159. [PMID: 38297199 PMCID: PMC10829394 DOI: 10.1186/s12885-024-11816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/01/2024] [Indexed: 02/02/2024] Open
Abstract
This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.
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Affiliation(s)
- Dong-Liang Pan
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Lu-Fang Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China.
| | - Xiao-Jian Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ke-Ping Zhang
- Department of Urology, Weifang People's Hospital, Weifang, Shandong, 261041, China
| | - Peng-Fei Gao
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Bing Yang
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Ning-Chen Li
- Department of Urology, Peking University Shougang Hospital, Beijing, 100144, China
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Castellarnau S, Gaya JM, Espinosa J, Sierra P, Huguet J, Palou J, Hernando D, Sabaté S, Breda A. Clinical impact of the suspension of the ERAS protocol on patients undergoing radical cystectomy during the COVID-19 pandemic. Actas Urol Esp 2023:S2173-5786(23)00014-8. [PMID: 36842706 PMCID: PMC9957335 DOI: 10.1016/j.acuroe.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 02/28/2023]
Abstract
INTRODUCTION During the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. MATERIAL AND METHODS Single-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st, 2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. RESULTS A total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. CONCLUSIONS Patients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.
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Affiliation(s)
- S Castellarnau
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - J M Gaya
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Espinosa
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Sierra
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Huguet
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Palou
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Hernando
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - S Sabaté
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - A Breda
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
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Castellarnau S, Gaya JM, Espinosa J, Sierra P, Huguet J, Palou J, Hernando D, Sabaté S, Breda A. [CLINICAL IMPACT OF THE SUSPENSION OF THE ERAS PROTOCOL ON PATIENTS UNDERGOING RADICAL CYSTECTOMY DURING THE COVID-19 PANDEMIC.]. Actas Urol Esp 2023; 47:S0210-4806(23)00012-8. [PMID: 36776227 PMCID: PMC9905094 DOI: 10.1016/j.acuro.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION During the beginning of the COVID-19 pandemic in our center, neither prehabilitation nor multimodal rehabilitation could be applied due to the excessive patient load on the health system and to reduce SARS-CoV-2 transmission. The objective of our study was to analyze the evolution, complications, and survival up to one year of patients who underwent radical cystectomy in our hospital from March 1st to May 31st, 2020 (period of the first wave COVID-19 pandemic in Spain). We also compared the results with cystectomized patients outside the pandemic period and with application of the ERAS (Enhanced Recovery After Surgery) protocol. MATERIAL AND METHODS Single-center, retrospective cohort study of patients scheduled for radical cystectomy from March 1st,2020 to May 31st, 2020. They were matched with previously operated patients using a 1:2 propensity matching score. The matching variables were demographic data, preoperative and intraoperative clinical conditions. RESULTS A total of 23 radical cystectomies with urinary diversion were performed in the period described. In none of the cases the prehabilitation or the follow-up of our ERAS protocol could be applied, and this was the only difference we found between the 2 groups. Although the minimally invasive approach was more frequent in the pandemic group, the difference was not statistically significant. Three patients were diagnosed with COVID-19 during their admission, presenting severe respiratory complications and high in-hospital mortality. Apart from respiratory complications secondary to SARS-CoV-2, we also found statistically significant differences in other postoperative complications. The hospital stay increased by 3 days in the pandemic group. CONCLUSIONS Patients who underwent radical cystectomy at our center during the first wave of the COVID-19 pandemic had a higher number and severity of respiratory and non-respiratory complications. Discontinuation of the ERAS protocol was the main difference in treatment between groups.
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Affiliation(s)
- S Castellarnau
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - J M Gaya
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - J Espinosa
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - P Sierra
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - J Huguet
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - J Palou
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - D Hernando
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - S Sabaté
- Servicio de Anestesiología y Reanimación, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
| | - A Breda
- Servicio de Urología, Fundació Puigvert, Universitat Autònoma de Barcelona, Spain
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Smelser WW, Tallman JE, Gupta VK, Al Hussein Al Awamlh B, Johnsen NV, Barocas DA, Kline-Quiroz C, Tomlinson CA, McEvoy MD, Hamilton-Reeves J, Chang SS. Implementation of a comprehensive prehabilitation program for patients undergoing radical cystectomy. Urol Oncol 2023; 41:108.e19-108.e27. [PMID: 36404231 DOI: 10.1016/j.urolonc.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/11/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Coordinated preoperative optimization programs for radical cystectomy (RC) are limited and non-comprehensive. We evaluated the feasibility and acceptability of a coordinated, multi-faceted prehabilitation program for RC patients at a high-volume bladder cancer referral center. METHODS We performed a narrative literature review for prehabilitation in bladder cancer management as of December 1, 2020, with specific emphasis on examining higher-level evidence sources. We selected domains with the highest level of evidence and recruited a multidisciplinary team of experts to design our program. We implemented a comprehensive prehabilitation program with a pre-defined order set as standard of care for all patients undergoing RC beginning February 1, 2021. Demographic and clinicopathologic data were collected prospectively. Rates of adherence to the prehabilitation program services were analyzed using Stata version 13. RESULTS A total of 82 patients were enrolled between February - December 2021, of which 67 (81%) had undergone RC at data cutoff. Mean age was 68 years (SD 11) and 63 (76%) identified as male. Neoadjuvant chemotherapy (NAC) was utilized in 48 (59%) patients. The mean Charlson Comorbidity Index was 3.8 (SD 2.3). 100% of patients were screened for malnutrition, with 82% consuming nutritional supplements. Fifty-two percent of patients attended physical therapy pre-op. The 30-day and 30- to 90-day rates of complications were 56% and 40%, respectively. Resource length of stay (RLOS) declined after implementation of prehabilitation. CONCLUSIONS Implementation of a comprehensive prehabilitation program at a high-volume bladder cancer referral center is feasible and has a modest effect on resource consumption and complications in our early experience.
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Affiliation(s)
- Woodson W Smelser
- Division of Urology, Washington University in St. Louis, MISSOURI, Saint Louis, MO.
| | | | | | | | | | | | - Cristina Kline-Quiroz
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Carey A Tomlinson
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center
| | - Matthew D McEvoy
- Department of Anesthesiology, Vanderbilt University Medical Center
| | | | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center
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Neuzillet Y, Audenet F, Loriot Y, Allory Y, Masson-Lecomte A, Leon P, Pradère B, Seisen T, Traxer O, Xylinas E, Roumiguié M, Roupret M. French AFU Cancer Committee Guidelines - Update 2022-2024: Muscle-Invasive Bladder Cancer (MIBC). Prog Urol 2022; 32:1141-1163. [PMID: 36400480 DOI: 10.1016/j.purol.2022.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update the CCAFU recommendations for the management of muscle invasive bladder carcinoma (MIBC). METHODS A systematic review (Medline) of the literature from 2020 to 2022 was performed taking account of the diagnosis, treatment options and surveillance of NMIBC and MIBC, while evaluating the references with their levels of evidence. RESULTS MIBC is diagnosed after the most complete tumour resection possible. MIBC grading is based on CTU along with chest CT. Multiparametric pelvic MRI could be an alternative. Cystectomy with extensive lymphadenectomy is the gold standard treatment for non-metastatic MIBC. It should be preceded by platinum-based neoadjuvant chemotherapy in patients in good general health with satisfactory renal function. Enterocystoplasty is proposed in men and women in the absence of contraindications and when the urethral resection is negative on extemporaneous examination. Otherwise, transileal cutaneous ureterostomy is the recommended method of urinary diversion. Inclusion of all patients in an ERAS (Enhanced Recovery After Surgery) protocol is recommended. For metastatic MIBC, first line treatment with platinum-based chemotherapy (GC or MVAC) is recommended, if general health (PS>1) and renal function (clearance>60mL/min) so allow (only 50% of the cases). Pembrolizumab immunotherapy has demonstrated an overall survival benefit in second-line treatment. CONCLUSION Updating the ccAFU recommendations should contribute to improving patient management, as well as the diagnosis and decision-making concerning MIBC treatment.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, université Paris Saclay, Suresnes, France.
| | - F Audenet
- Service d'urologie, hôpital européen Georges-Pompidou, AP-HP Centre, université Paris Cité, Paris, France
| | - Y Loriot
- Service d'oncologie médicale, institut Gustave Roussy, Villejuif, France
| | - Y Allory
- Service d'anatomopathologie, institut Curie, université Paris Saclay, Saint-Cloud, France
| | - A Masson-Lecomte
- Service d'urologie, hôpital Saint-Louis, AP-HP, université Paris Cité, France
| | - P Leon
- Service d'urologie, clinique Pasteur, Royan, France
| | - B Pradère
- Service d'urologie UROSUD, Clinique Croix Du Sud, 31130 Quint-Fonsegrives, France
| | - T Seisen
- Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
| | - O Traxer
- Sorbonne université, GRC#20 Lithiase Urinaire et EndoUrologie, AP-HP, urologie, hôpital Tenon, 75020 Paris, France
| | - E Xylinas
- Service d'urologie, hôpital Bichat-Claude Bernard, AP-HP, université Paris Cité, Paris, France
| | - M Roumiguié
- Service d'urologie, CHU de Toulouse, UPS, université de Toulouse, Toulouse, France
| | - M Roupret
- Sorbonne université, GRC 5 Predictive Onco-Uro, AP-HP, urologie, hôpital Pitié-Salpêtrière, 75013 Paris, France
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Spooner J, Lawen T, Ory J. Triaging urological surgeries to cope with the coronavirus-19 pandemic. Curr Opin Urol 2022; 32:131-140. [PMID: 34939597 PMCID: PMC8815629 DOI: 10.1097/mou.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus-19 (COVID-19) pandemic has led to strains on hospital resources and difficulties in safely and effectively triaging surgical procedures. In this article, we discuss the important considerations for triaging urologic surgeries during a global pandemic, mitigating factors on how to perform surgeries safely, and general guidelines for specific surgeries. RECENT FINDINGS Many urological procedures have been cut back due to the pandemic, with benign disease states being most affected whereas oncology cases affected least. Current recommendations in urology triage life-threatening conditions, or conditions that may lead to life-threatening ailments as a priority for treatment during the pandemic. Additionally, published recommendations have been put forth recommending all surgical patients be screened for COVID-19 to protect staff, prevent disease dissemination, and to educate patients on worse outcomes that can occur if infected with COVID-19 in the postoperative period. SUMMARY COVID-19 has caused worldwide shortages of healthcare resources and increased the need to ethically triage resources to adequately treat the urologic community. These resource limitations have led to increased wait times and cancellations of many urology surgeries that are considered 'elective'.
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Affiliation(s)
- Jesse Spooner
- Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
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10
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Ginting JT, Sigumonrong Y. Abol-Enein pouch modification after radical cystectomy in bladder rhabdomyosarcoma in 5 years old child during COVID-19 pandemic: A case report. Int J Surg Case Rep 2022; 90:106701. [PMID: 34956826 PMCID: PMC8686445 DOI: 10.1016/j.ijscr.2021.106701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To discuss the consideration of performing radical cystectomy for rhabdomyosarcoma in children during the COVID-19 pandemic in the urology department of Adam Malik Hospital, Medan. INTRODUCTION Rhabdomyosarcoma is a rare malignancy that develops from primitive mesenchymal stem cells. The gold standard for the treatment of rhabdomyosarcoma is radical cystectomy. However, during the COVID-19 pandemic, radical cystectomy becomes a concern due to the risk of virus transmission. This article reported a patient who underwent radical cystectomy during the COVID-19 pandemic. CASE PRESENTATION A five-year-old female child was admitted to the hospital with chief complaints of bloody urine 1 month before admission. A month before hospital admission, the patient had pain during urination and was treated with radical cystectomy with Abol-Enein pouch modification. RESULT After the surgery, the patient was able to urinate without any disturbance. Hematuria was not found. There was no complaint related to stricture of the ureter after the surgery. CONCLUSION In our center, radical cystectomy could be performed in child with bladder rhabdomyosarcoma during COVID-19 pandemic. The procedure is considered a high priority therapy in most regions during COVID-19 pandemic. Abol-Enein technique after radical cystectomy resulted in improvement of symptom with no reported complication in our case.
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Affiliation(s)
- Jeremy Thompson Ginting
- Urology Resident of Urology Department, Faculty of Medicine, Universitas Indonesia - H. Adam Malik Hospital, Medan, Indonesia.
| | - Yacobda Sigumonrong
- Urology Consultant of Urology Department, Faculty of Medicine, Universitas Indonesia - H. Adam Malik Hospital, Medan, Indonesia
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11
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Yang D, Ma Y, Zhao P, Ma J, He C. HMMR is a downstream target of FOXM1 in enhancing proliferation and partial epithelial-to-mesenchymal transition of bladder cancer cells. Exp Cell Res 2021; 408:112860. [PMID: 34624323 DOI: 10.1016/j.yexcr.2021.112860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 01/06/2023]
Abstract
Our previous that HMMR upregulation independently predicts poor survival in patients with papillary muscle-invasive bladder cancer (MIBC). In this study, we explored its downstream regulations and the potential transcriptional factors activating its expression. MIBC derived T24 cells, and non-MIBC (NMIBC) derived RT4 cells were used for in vitro and in vivo studies. HMMR expression enhanced cell proliferation, the expression of mesenchymal markers, and cell invasion. It induced the nuclear entry of β-catenin, increased its active form in the nuclear part, and elevated the relative TOP/FOP activity. The promoter region of HMMR has a canonical FKH motif. FOXM1 bound to this site and activated HMMR transcription. HMMR knockdown significantly weakened FOXM1 overexpression induced bladder cancer growth, invasion, partial epithelial-to-mesenchymal transition (pEMT), as well as the activation of the Wnt/β-catenin signaling pathway. In conclusion, the findings in this study expanded our understanding of the mechanisms underlying HMMR dysregulation and the functional role of the FOXM1-HMMR axis in bladder cancer.
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Affiliation(s)
- Dong Yang
- Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Yan Ma
- Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Pengcheng Zhao
- Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Jing Ma
- Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Chaohong He
- Department of Urology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, China.
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Rouprêt M, Pignot G, Masson-Lecomte A, Compérat E, Audenet F, Roumiguié M, Houédé N, Larré S, Brunelle S, Xylinas E, Neuzillet Y, Méjean A. [French ccAFU guidelines - update 2020-2022: bladder cancer]. Prog Urol 2021; 30:S78-S135. [PMID: 33349431 DOI: 10.1016/s1166-7087(20)30751-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE - To update French guidelines for the management of bladder cancer specifically non-muscle invasive (NMIBC) and muscle-invasive bladder cancers (MIBC). METHODS - A Medline search was achieved between 2018 and 2020, notably regarding diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. RESULTS - Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS <1) and renal function (creatinine clearance >60 mL/min) allow it (only in 50% of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. CONCLUSION - These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment of patients diagnosed with NMIBC and MIBC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne Université, GRC n° 5, Predictive onco-uro, AP-HP, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, Université Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne Université, GRC n° 5, ONCOTYPE-URO, 4, rue de la Chine, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, Université de Versailles - Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, 1, avenue du Professeur-Jean-Poulhès, 31400 Toulouse, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Carémeau, Université de Montpellier, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, Université Paris-Descartes, 46, rue Henri-Huchard, 75018 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, rue du Général Koenig, 51100 Reims, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, AP-HP, Université de Paris, 20, rue Leblanc, 75015 Paris, France
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13
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Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the post-COVID-19 era. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2021. [PMCID: PMC7946567 DOI: 10.1016/j.acuroe.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Methods Results Conclusions
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14
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García-Rojo E, Manfredi C, Santos-Pérez-de-la-Blanca R, Tejido-Sánchez Á, García-Gómez B, Aliaga-Benítez M, Romero-Otero J, Rodriguez-Antolín A. [Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era]. Actas Urol Esp 2021; 45:207-214. [PMID: 34017152 PMCID: PMC7648495 DOI: 10.1016/j.acuro.2020.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022]
Abstract
Introduction The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. Methods An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. Results A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). Conclusions The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.
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Affiliation(s)
- E García-Rojo
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - C Manfredi
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
- Departamento de Cirugía de la Mujer, el Niño y Cirugía General y Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
| | | | - Á Tejido-Sánchez
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - B García-Gómez
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - M Aliaga-Benítez
- Servicio de Admisión y Documentación Clínica, Hospital 12 de Octubre, Madrid, España
| | - J Romero-Otero
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - A Rodriguez-Antolín
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
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15
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Such M, Lavolle A, Popelin MB, Thibault C, Fontaine E, Dariane C, Oudard S, Mejean A, Timsit MO, Audenet F. Administration of neoadjuvant chemotherapy for muscle-invasive bladder cancer in real life: Are urologists still too cautious? Prog Urol 2021; 31:332-339. [PMID: 33468415 DOI: 10.1016/j.purol.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) is now recommended to treat muscle-invasive bladder cancer (MIBC) but is not always executed in real life. This study aims to evaluate the proportion of patients with MIBC who receive an optimal NAC, and to present the predictive factors of its achievement. METHODS This monocenter retrospective study included all the patients who underwent radical cystectomy for≥pT2NxM0 MIBC between 2013, January and 2018, December. NAC consisted in 4-6 cycles of MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) or 4 cycles of GC (gemcitabin, and carboplatin). Demographic (sex, age, ECOG-PS, glomerular filtration rate [GFR], and cN stage), surgical (urinary derivation, time of surgery, blood loss, and complications), and oncological characteristics were analyzed. Multivariate analysis are made to find predictors of administration of NAC. RESULTS One hundred and twenty-seven patients were included. Thirty received CNA (24%). Patients who underwent CNA were younger, with better ECOG and better GFR. Multivariate analysis showed that cN+ stage and better GFR were significantly associated to administration of NAC. Eight patients (27%) couldn't receive an optimal treatment due to toxicity. Perioperative complication rates were similar, with or without NAC. Patients who underwent NAC had a worse GFR after treatment (-17 versus +5mL/min, P<0.01). CONCLUSION Due to the risks of toxicity, NAC can only be proposed to selected population, which is not the current patients. Immunotherapy could allow to treat more patients because of better tolerance. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- M Such
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France.
| | - A Lavolle
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - M-B Popelin
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - C Thibault
- Service d'oncologie médicale, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, Paris, France
| | - E Fontaine
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - C Dariane
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - S Oudard
- Service d'oncologie médicale, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, Paris, France
| | - A Mejean
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - M-O Timsit
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
| | - F Audenet
- Service d'urologie, université de Paris, hôpital européen Georges-Pompidou, AP-HP centre, 20, rue Leblanc, 75015 Paris, France
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16
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Riaz IB, Hussain SA. Perioperative Treatment in Muscle-invasive Bladder Cancer: Analysis of Secondary Endpoints in a Randomized Trial Comparing Gemcitabine and Cisplatin Versus Dose-dense Methotrexate, Vinblastine, Adriamycin, and Cisplatin. Eur Urol 2020; 79:222-224. [PMID: 33012577 DOI: 10.1016/j.eururo.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Irbaz Bin Riaz
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, USA
| | - Syed A Hussain
- Department of Oncology and Metabolism, Academic Unit of Oncology, University of Sheffield Medical School, Sheffield, UK.
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17
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Jiang DM, North SA, Canil C, Kolinsky M, Wood LA, Gray S, Eigl BJ, Basappa NS, Blais N, Winquist E, Mukherjee SD, Booth CM, Alimohamed NS, Czaykowski P, Kulkarni GS, Black PC, Chung PW, Kassouf W, van der Kwast T, Sridhar SS. Current Management of Localized Muscle-Invasive Bladder Cancer: A Consensus Guideline from the Genitourinary Medical Oncologists of Canada. Bladder Cancer 2020. [DOI: 10.3233/blc-200291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND: Despite recent advances in the management of muscle-invasive bladder cancer (MIBC), treatment outcomes remain suboptimal, and variability exists across current practice patterns. OBJECTIVE: To promote standardization of care for MIBC in Canada by developing a consensus guidelines using a multidisciplinary, evidence-based, patient-centered approach who specialize in bladder cancer. METHODS: A comprehensive literature search of PubMed, Medline, and Embase was performed; and most recent guidelines from national and international organizations were reviewed. Recommendations were made based on best available evidence, and strength of recommendations were graded based on quality of the evidence. RESULTS: Overall, 17 recommendations were made covering a broad range of topics including pathology review, staging investigations, systemic therapy, local definitive therapy and surveillance. Of these, 10 (59% ) were level 1 or 2, 7 (41% ) were level 3 or 4 recommendations. There were 2 recommendations which did not reach full consensus, and were based on majority opinion. This guideline also provides guidance for the management of cisplatin-ineligible patients, variant histologies, and bladder-sparing trimodality therapy. Potential biomarkers, ongoing clinical trials, and future directions are highlighted. CONCLUSIONS: This guideline embodies the collaborative expertise from all disciplines involved, and provides guidance to further optimize and standardize the management of MIBC.
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Affiliation(s)
- Di Maria Jiang
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott A. North
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Christina Canil
- Department of Internal Medicine, Division of Medical Oncology, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON, Canada
| | - Michael Kolinsky
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Lori A. Wood
- Department of Medicine, Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, NS, Canada
| | - Samantha Gray
- Department of Oncology, Saint John Regional Hospital, Department of Medicine, Dalhousie University, Saint John, NB, Canada
| | - Bernhard J. Eigl
- Department of Medicine, Division of Medical Oncology, BC Cancer - Vancouver, University of British Columbia, Vancouver, BC, Canada
| | - Naveen S. Basappa
- Department of Oncology, Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Normand Blais
- Department of Medicine, Division of Medical Oncology and Hematology, Centre Hospitalier de l’Université de Montréal; Université de Montréal, Montreal, QC, Canada
| | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Som D. Mukherjee
- Department of Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON, Canada
| | | | - Nimira S. Alimohamed
- Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Piotr Czaykowski
- Department of Medical Oncology and Hematology, Cancer Care Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Girish S. Kulkarni
- Departments of Surgery and Surgical Oncology, Division of Urology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Peter W. Chung
- Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Srikala S. Sridhar
- Department of Medicine, Division of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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18
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. French ccAFU guidelines – Update 2018–2020: Bladder cancer. Prog Urol 2020; 28:R48-R80. [PMID: 32093463 DOI: 10.1016/j.purol.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Abstract
Objective To propose updated French guidelines for non-muscle invasive (NMIBC) and muscle-invasive (MIBC) bladder cancers. Methods A Medline search was achieved between 2015 and 2018, as regards diagnosis, options of treatment and follow-up of bladder cancer, to evaluate different references with levels of evidence. Results Diagnosis of NMIBC (Ta, T1, CIS) is based on a complete deep resection of the tumor. The use of fluorescence and a second-look indication are essential to improve initial diagnosis. Risks of both recurrence and progression can be estimated using the EORTC score. A stratification of patients into low, intermediate and high risk groups is pivotal for recommending adjuvant treatment: instillation of chemotherapy (immediate post-operative, standard schedule) or intravesical BCG (standard schedule and maintenance). Cystectomy is recommended in BCG-refractory patients. Extension evaluation of MIBC is based on contrast-enhanced pelvic-abdominal and thoracic CT-scan. Multiparametric MRI can be an alternative. Cystectomy associated with extended lymph nodes dissection is considered the gold standard for non-metastatic MIBC. It should be preceded by cisplatin-based neoadjuvant chemotherapy in eligible patients. An orthotopic bladder substitution should be proposed to both male and female patients with no contraindication and in cases of negative frozen urethral samples; otherwise transileal ureterostomy is recommended as urinary diversion. All patients should be included in an Early Recovery After Surgery (ERAS) protocol. For metastatic MIBC, first-line chemotherapy using platin is recommended (GC or MVAC), when performans status (PS < 1) and renal function (creatinine clearance > 60 mL/min) allow it (only in 50 % of cases). In second line treatment, immunotherapy with pembrolizumab demonstrated a significant improvement in overall survival. Conclusion These updated French guidelines will contribute to increase the level of urological care for the diagnosis and treatment for NMIBC and MIBC.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,GRC no 5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, Sorbonne université, AP–HP, 75013 Paris, France
| | - Y Neuzillet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’anatomie pathologique, GRC no 5, ONCOTYPE-URO, hôpital Tenon, HUEP, Sorbonne université, AP-HP, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital Saint-Louis, université Paris-Diderot, AP–HP, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie de l’hôpital Bichat-Claude-Bernard, université Paris-Descartes, AP–HP, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Département d’urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l’Association française d’urologie, groupe vessie, maison de l’urologie, 11, rue Viète, 75017 Paris, France,Service d’urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP–HP, 75015 Paris, France
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19
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Adanur S, Al S, Polat O. Coronavirus (COVID-19) Pandemic and Radical Cystectomy. Eurasian J Med 2020. [PMID: 32612413 DOI: 10.5152/eurasianjmed.2020.010620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Senol Adanur
- Departments of Urology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Salih Al
- Departments of Urology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ozkan Polat
- Departments of Urology, Ataturk University School of Medicine, Erzurum, Turkey
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20
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Leow JJ, Catto JWF, Efstathiou JA, Gore JL, Hussein AA, Shariat SF, Smith AB, Weizer AZ, Wirth M, Witjes JA, Trinh QD. Quality Indicators for Bladder Cancer Services: A Collaborative Review. Eur Urol 2020; 78:43-59. [PMID: 31563501 DOI: 10.1016/j.eururo.2019.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
CONTEXT There is a lack of accepted consensus on what should constitute appropriate quality-of-care indicators for bladder cancer. OBJECTIVE To evaluate the optimal management of bladder cancer and propose quality indicators (QIs). EVIDENCE ACQUISITION A systematic review was performed to identify literature on current optimal management and potential quality indicators for both non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer. A panel of experts was convened to select a recommended list of QIs. EVIDENCE SYNTHESIS For NMIBC, preoperative QIs include tobacco cessation counselling and appropriate imaging before initial transurethral resection of bladder tumour (TURBT). Intraoperative QIs include administration of antibiotics, proper safe conduct of TURBT using a checklist, and performing restaging TURBT with biopsy of the prostatic urethra in appropriate cases. Postoperative QIs include appropriate receipt of perioperative adjuvant therapy, risk-stratified surveillance, and appropriate decision to change therapy when indicated (eg, bacillus Calmette-Guerin [BCG] unresponsive). For MIBC, preoperative QIs include multidisciplinary care, selection for candidates for continent urinary diversion, receipt of neoadjuvant cisplatin-based chemotherapy, time to commencing radical treatment, consideration of trimodal therapy as a bladder-sparing alternative in select patients, preoperative counselling with stoma marking, surgical volume of radical cystectomy, and enhanced recovery after surgery protocols. Intraoperative QIs include adequacy of lymphadenectomy, blood loss, and operative time. Postoperative QIs include prospective standardised monitoring of morbidity and mortality, negative surgical margins for pT2 disease, appropriate surveillance after primary treatment, and adjuvant cisplatin-based chemotherapy in appropriate cases. Participation in clinical trials was highlighted as an important component indicating high quality of care. CONCLUSIONS We propose a set of QIs for both NMIBC and MIBC based on established clinical guidelines and the available literature. Although there is currently a lack of level 1 evidence for the benefit of implementing these QIs, we believe that the measurement of these QIs could aid in the improvement and benchmarking of optimal care for bladder cancer. PATIENT SUMMARY After a systematic review of existing guidelines and literature, a panel of experts has recommended a set of quality indicators that can help providers and patients measure and strive towards optimal outcomes for bladder cancer care.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James W F Catto
- Academic Urology Unit, The University of Sheffield, Sheffield, UK
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ahmed A Hussein
- Department of Urology, Cairo University, Cairo, Egypt; Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Angela B Smith
- Department of Urology, Lineberger Comprehensive Cancer Center, UNC-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - J Alfred Witjes
- Department of Urology, Radboud University, Nijmegen, The Netherlands
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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21
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Adanur S, Al S, Polat O. Coronavirus (COVID-19) Pandemic and Radical Cystectomy. Eurasian J Med 2020; 52:106-107. [PMID: 32612413 PMCID: PMC7311139 DOI: 10..5152/eurasianjmed.2020.010620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023] Open
Affiliation(s)
- Senol Adanur
- Departments of Urology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Salih Al
- Departments of Urology, Ataturk University School of Medicine, Erzurum, Turkey
| | - Ozkan Polat
- Departments of Urology, Ataturk University School of Medicine, Erzurum, Turkey
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22
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Stensland KD, Morgan TM, Moinzadeh A, Lee CT, Briganti A, Catto JWF, Canes D. Considerations in the Triage of Urologic Surgeries During the COVID-19 Pandemic. Eur Urol 2020; 77:663-666. [PMID: 32279903 PMCID: PMC7146681 DOI: 10.1016/j.eururo.2020.03.027] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/18/2020] [Indexed: 12/02/2022]
Affiliation(s)
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Alireza Moinzadeh
- Division of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - James W F Catto
- Academic Urology Unit, The University of Sheffield, Sheffield, UK
| | - David Canes
- Division of Urology, Lahey Hospital and Medical Center, Burlington, MA, USA.
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23
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Méjean A, Rouprêt M, Rozet F, Bensalah K, Murez T, Game X, Rebillard X, Mallet R, Faix A, Mongiat-Artus P, Fournier G, Neuzillet Y. [Recommendations CCAFU on the management of cancers of the urogenital system during an epidemic with Coronavirus COVID-19]. Prog Urol 2020; 30:221-231. [PMID: 32224294 PMCID: PMC7146722 DOI: 10.1016/j.purol.2020.03.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
Abstract
Objectif La population française est confrontée à la pandémie de COVID-19 et le système de santé a été réorienté en urgence pour la prise en charge des patients atteints du coronavirus. La prise en charge des cancers de l’appareil urinaire et génital masculin doit être adaptée à ce contexte. Matériel et méthode Un avis d’experts documenté par une revue de la littérature a été formulé par le Comité de Cancérologie de l’Association Française d’Urologie (CCAFU). Résultats La prise en charge médicale et chirurgicale des patients atteints de cancers de l’appareil urinaire et génital masculin doit être adaptée en modifiant les modalités de consultation, en priorisant les interventions en fonction du pronostic intrinsèque des cancers en tenant compte des comorbidités du patient. La protection des urologues vis-à-vis du COVID-19 doit être prise en considération. Conclusion Le CCAFU émet un avis d’experts quant aux mesures à prendre pour adapter la prise en charge des cancers de l’appareil urinaire et génital masculin au contexte de pandémie par COVID-19.
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Affiliation(s)
- A Méjean
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - F Rozet
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - K Bensalah
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - T Murez
- Comité de cancérologie de l'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - X Game
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - X Rebillard
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - R Mallet
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - A Faix
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - P Mongiat-Artus
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - G Fournier
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France
| | - Y Neuzillet
- Bureau du Conseil d'administration d'Association française d'urologie, 11, rue Viète, 75017 Paris, France.
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24
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Font A, Luque R, Villa JC, Domenech M, Vázquez S, Gallardo E, Virizuela JA, Beato C, Morales-Barrera R, Gelabert A, Maciá S, Puente J, Rubio G, Maldonado X, Perez-Valderrama B, Pinto A, Fernández Calvo O, Grande E, Garde-Noguera J, Fernández-Parra E, Arranz JÁ. The Challenge of Managing Bladder Cancer and Upper Tract Urothelial Carcinoma: A Review with Treatment Recommendations from the Spanish Oncology Genitourinary Group (SOGUG). Target Oncol 2020; 14:15-32. [PMID: 30694442 DOI: 10.1007/s11523-019-00619-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Bladder cancer is the fourth most common cancer in men and the ninth most common in women in the Western world. The management of bladder carcinoma requires a multidisciplinary approach. Optimal treatment depends on several factors, including histology, stage, patient status, and possible comorbidities. Here we review recent findings on the treatment of muscle-invasive bladder carcinoma, advanced urothelial carcinoma, upper tract urothelial carcinoma, non-urothelial carcinoma, and urologic complications arising from the disease or treatment. In addition, we present the recommendations of the Spanish Oncology Genitourinary Group for the treatment of these diseases, based on a focused analysis of clinical management and the potential of current research, including recent findings on the potential benefit of immunotherapy. In recent years, whole-genome approaches have provided new predictive biomarkers and promising molecular targets that could lead to precision medicine in bladder cancer. Moreover, the involvement of other specialists in addition to urologists will ensure not only appropriate therapeutic decisions but also adequate follow-up for response evaluation and management of complications. It is crucial, however, to apply recent molecular findings and implement clinical guidelines as soon as possible in order to maximize therapeutic gains and improve patient prognosis.
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Affiliation(s)
- Albert Font
- Medical Oncology Service, B-ARGO Group, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Ctra Canyet, s/n, 08916, Badalona, Spain.
| | - Raquel Luque
- Medical Oncology Service, H.U. Virgen de las Nieves, Granada, Spain
| | - José Carlos Villa
- Medical Oncology Service, Hospital General Universitario Ciudad Real, Ciudad Real, Spain
| | - Montse Domenech
- Medical Oncology Service, Hospital Fundació Althaia, Manresa, Spain
| | - Sergio Vázquez
- Medical Oncology Service, Hospital Universitario Lucus Augusti, EOXI de Lugo, Cervo e Monforte, Spain
| | - Enrique Gallardo
- Oncology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Carmen Beato
- Medical Oncology Service, Hospital Virgen de la Macarena, Seville, Spain
| | - Rafael Morales-Barrera
- Medical Oncology Service, Hospital Universitario Vall d'Hebron, Vall d'Hebron Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Sonia Maciá
- Medical Oncology Department, CRO Pivotal, Madrid, Spain
| | - Javier Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Gustavo Rubio
- Medical Oncology Service, Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
| | - Xavier Maldonado
- Radiation Oncology Service, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Alvaro Pinto
- Medical Oncology Service, Hospital Universitario La Paz, Madrid, Spain
| | | | - Enrique Grande
- Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | | | - Eva Fernández-Parra
- Medical Oncology Service, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | - José Ángel Arranz
- Medical Oncology Service, Hospital General Universitario Gregorio Marañon, Madrid, Spain
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25
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Audenet F, Sfakianos JP, Waingankar N, Ruel NH, Galsky MD, Yuh BE, Gin GE. A delay ≥8 weeks to neoadjuvant chemotherapy before radical cystectomy increases the risk of upstaging. Urol Oncol 2019; 37:116-122. [DOI: 10.1016/j.urolonc.2018.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 11/26/2022]
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26
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Ramakrishnan VM, Eswara JR. The timing of radical cystectomy following neoadjuvant chemotherapy. Transl Androl Urol 2018; 7:S758-S759. [PMID: 30687619 PMCID: PMC6323272 DOI: 10.21037/tau.2018.08.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Venkat M Ramakrishnan
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Jairam R Eswara
- Division of Urology, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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27
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Rouprêt M, Neuzillet Y, Pignot G, Compérat E, Audenet F, Houédé N, Larré S, Masson-Lecomte A, Colin P, Brunelle S, Xylinas E, Roumiguié M, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU — Actualisation 2018—2020 : tumeurs de la vessie French ccAFU guidelines — Update 2018—2020: Bladder cancer. Prog Urol 2018; 28:S46-S78. [PMID: 30366708 DOI: 10.1016/j.purol.2018.07.283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 12/24/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: doi:10.1016/j.purol.2019.01.006.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the doi:10.1016/j.purol.2019.01.006.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- M Rouprêt
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Sorbonne université, GRC no5, ONCOTYPE-URO, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
| | - Y Neuzillet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 92150 Suresnes, France
| | - G Pignot
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie oncologique 2, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Compérat
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'anatomie pathologique, hôpital Tenon, HUEP, Sorbonne université, GRC no5, ONCOTYPE-URO, 75020 Paris, France
| | - F Audenet
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
| | - N Houédé
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'oncologie médicale, CHU Caremaux, Montpellier université, 30000 Nîmes, France
| | - S Larré
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Reims, Reims, 51100 France
| | - A Masson-Lecomte
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital Saint-Louis, université Paris-Diderot, 75010 Paris, France
| | - P Colin
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital privé de la Louvière, 59800 Lille, France
| | - S Brunelle
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, institut Paoli-Calmettes, 13008 Marseille, France
| | - E Xylinas
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie de l'hôpital Bichat-Claude-Bernard, université Paris-Descartes, Assistance publique-Hôpitaux de Paris, 75018 Paris, France
| | - M Roumiguié
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Département d'urologie, CHU Rangueil, Toulouse, 31000 France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe vessie, maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, AP-HP, 75015 Paris, France
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28
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Boeri L, Soligo M, Frank I, Boorjian SA, Thompson RH, Tollefson M, Quevedo FJ, Cheville JC, Karnes RJ. Delaying Radical Cystectomy After Neoadjuvant Chemotherapy for Muscle-invasive Bladder Cancer is Associated with Adverse Survival Outcomes. Eur Urol Oncol 2018; 2:390-396. [PMID: 31277775 DOI: 10.1016/j.euo.2018.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delaying radical cystectomy (RC) after a diagnosis of muscle-invasive bladder cancer (MIBC) has been associated with adverse survival. However, data are lacking regarding the impact of RC delay in patients receiving neoadjuvant chemotherapy (NAC). OBJECTIVES To assess whether the time from last cycle of NAC to RC (time to cystectomy, TTC) is associated with survival among MIBC patients. DESIGN, SETTING, AND PARTICIPANTS The study cohort comprised 226 patients treated with NAC and RC between 1999 and 2015 for cT2-T4N0M0 bladder cancer. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics were used to test the association between TTC and clinicopathologic variables. Overall mortality (OM) and cancer-specific mortality (CSM) were analyzed via Kaplan-Meier estimation according to TTC. We assessed factors associated with OM and CSM using multivariable Cox regression analyses. RESULTS AND LIMITATIONS The median TTC was 7.57wk (interquartile range 5.2-10.8). Patients with a Charlson comorbidity index (CCI) ≥1 had a longer TTC than those with a score of <1 (p=0.027). The group with TTC >10wk had significantly lower OM-free (p=0.003) and CSM-free rates (p<0.001) than the group with TTC ≤10wk. TTC was independently associated with higher risk of OM (p=0.027) and CSM (p=0.004) after accounting for age, gender, pathologic extravesical disease, and nodal status. CONCLUSIONS TTC of >10wk after NAC was associated with adverse survival among patients with MIBC. Patients with a higher CCI were more likely to have prolonged TTC. PATIENT SUMMARY The impact of delaying radical cystectomy in patients who have received neoadjuvant chemotherapy (NAC) is unknown. In this study we assessed whether prolonged time to cystectomy (TTC) after NAC affects survival outcomes in patients with muscle-invasive bladder cancer. We found that TTC of >10wk was associated with adverse overall survival and cancer-specific survival, and attempts should be made to shorten TTC after preoperative chemotherapy.
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Affiliation(s)
- Luca Boeri
- Department of Urology, Mayo Clinic, Rochester, MN, USA; Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Matteo Soligo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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