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Abozaid M, Tan WS, Khetrapal P, Baker H, Duncan J, Sridhar A, Briggs T, Selim M, Abdallah MM, Elmahdy AA, Elserafy F, Kelly JD. Recovery of health-related quality of life in patients undergoing robot-assisted radical cystectomy with intracorporeal diversion. BJU Int 2021; 129:72-79. [PMID: 34092021 DOI: 10.1111/bju.15505] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/17/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the health-related quality of life (HRQoL) after robot-assisted radical cystectomy and intracorporeal urinary diversion (iRARC), and to identify factors impacting on return to baseline. PATIENTS AND METHODS Consecutive patients undergoing iRARC between January 2016 and December 2017 completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30-item core (EORTC-QLQ-C30) and EORTC-QLQ-Muscle-Invasive Bladder Cancer Module (EORTC-QLQ-BLM30) questionnaires before surgery and had a minimum of 12 months follow-up postoperatively. RESULTS A total of 76 patients met the inclusion criteria at 12 months. Neobladder (NB) cases (n = 24) were younger (57.0 vs 71.0 years, P < 0.001) and fitter than ileal conduit (IC) cases (n = 52), and had higher physical (100.0 vs 93.3, P = 0.039) and sexual functioning (66.7 vs 50.0, P = 0.013) scores at baseline. Longitudinal analysis of the EORTC-QLQ-C30 showed that physical (NB: 93.3 vs 100.0, P = 0.020; IC: 80.0 vs 93.3, P < 0.001) and role functioning scores (NB: 83.3 vs 100.0, P = 0.010; IC: 83.3 vs 100.0, P = 0.017) decreased and fatigue score (NB: 22.2 vs 11.1, P = 0.026; IC: 33.3 vs 22.2, P = 0.008) increased at 3 months in both diversion groups. Scores returned to baseline at 6 months except physical functioning score in IC patients that remained below baseline until 12 months (86.7 vs 93.3, P = 0.012). The global HRQoL score did not show significant change postoperatively in both groups. A major 90-day Clavien-Dindo complication was a significant predictor (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02-0.62; P = 0.012) of deteriorated global HRQoL score at 3 months, while occurrence of a late complication (OR 0.14, 95% CI 0.03-0.65; P = 0.013) was a predictor of deteriorated global HRQoL score at 12 months. Longitudinal analysis of the EORTC-QLQ-BLM30 showed that urinary problems (NB: 14.3 vs 38.3, P < 0.001; IC: 5.6 vs 19.1, P < 0.001) and future perspective (NB: 33.3 vs 44.4, P = 0.004; IC: 22.2 vs 44.4, P < 0.001) scores were better than baseline at 3 months. Sexual function deteriorated significantly at 3 months (NB: 8.3 vs 66.7, P < 0.001; IC: 4.2 vs 50.0, P < 0.001) and then showed improvement at 12 months but was still below baseline (NB: 33.3 vs 66.7, P = 0.001; IC: 25.0 vs 50.0, P < 0.001). Involvement in penile rehabilitation was shown to be a significant predictor (β 18.62, 95% CI 6.06-30.45; P = 0.005) of higher sexual function score at 12 months. CONCLUSION While most functional domains and symptoms scales recover to or exceed baseline within 6 months of iRARC, physical function remains below baseline in IC patients up to 12 months. Global HRQoL is preserved for both types of urinary diversion; however, postoperative complications seem to be the main driving factor for global HRQoL. Sexual function is adversely affected after iRARC suggesting that structured rehabilitation of sexual function should be an integral part of the RC pathway.
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Affiliation(s)
- Mohammed Abozaid
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Wei Shen Tan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - Pramit Khetrapal
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Hilary Baker
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jacqueline Duncan
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
| | - Tim Briggs
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mohamed Selim
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | | | - Alaa Aldin Elmahdy
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Fatma Elserafy
- Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - John D Kelly
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Interventional Science, University College London, London, UK
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Elsherif E, Elbaky TA, Elserafy F, Elkady N, Dawood M, Gaber MA, Badawy A, Gharabawy ME. β-catenin and SKP2 proteins as predictors of grade and stage of non-muscle invasive urothelial bladder carcinoma. Chin Clin Oncol 2017; 5:6. [PMID: 26932430 DOI: 10.3978/j.issn.2304-3865.2016.02.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/20/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND To evaluate the expression of beta-catenin (β-catenin) and SKP2 proteins in superficial bladder cancer cases and their correlation with tumor grade and stage. METHODS After institutional review board approval, we retrospectively evaluated the expression of β-catenin and SKP2 proteins in tissue specimens from patients with non-muscle invasive bladder cancer (NMIBC) and compared their results with a cohort of chronic nonspecific cystitis's. Then we and explored these markers association with tumor grade and stage. RESULTS A total of 40 patients were retrospectively identified, 50% was NMIBC and the rest were chronic nonspecific cystitis. β-catenin was expressed in 18 (90%) patients of the NMIBC group in comparison to 14 (70%) of the control group with (P=0.1), while SKP2 protein was only expressed in NMIBC groups (P=0.03). A statistically significant correlation was identified between nucleocytoplasmic localization of β-catenin and SKP2 with tumor grade, stage. CONCLUSIONS β-catenin and SKP2 expression are providing promising results for differentiating higher grade and stage non muscle invasive bladder cancers.
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Affiliation(s)
- Eid Elsherif
- Department of Urology, Menoufia University, Menoufia, Egypt
| | | | - Fatma Elserafy
- Department of Urology, Menoufia University, Menoufia, Egypt
| | - Noha Elkady
- Department of Pathology, Menoufia University, Menoufia, Egypt
| | - Marwa Dawood
- Department of Pathology, Menoufia University, Menoufia, Egypt
| | | | - Atef Badawy
- Department of Urology, Menoufia University, Menoufia, Egypt
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