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Alfred Witjes J, Bruins HM, Carrión A, Cathomas R, Compérat E, Efstathiou JA, Fietkau R, Gakis G, Lorch A, Martini A, Mertens LS, Meijer RP, Milowsky MI, Neuzillet Y, Panebiaco V, Redlef J, Rink M, Rouanne M, Thalmann GN, Sæbjørnsen S, Veskimäe E, Mariappan P, van der Heijden AG. Corrigendum to "European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines" [Eur. Urol. 85 (2024) 17-31]. Eur Urol 2024:S0302-2838(24)02194-8. [PMID: 38492977 DOI: 10.1016/j.eururo.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Harman Max Bruins
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Albert Carrión
- Department of Urology, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Richard Cathomas
- Department of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Eva Compérat
- Department of Pathology, Medical University Vienna General Hospital, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Rainer Fietkau
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Alberto Martini
- Department of Urology, Institut Universitaire du Cancer-Toulouse-Oncopole, Toulouse, France; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Valeria Panebiaco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - John Redlef
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Michael Rink
- Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Mathieu Rouanne
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - George N Thalmann
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sæbjørn Sæbjørnsen
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery (EBCS), Western General Hospital, University of Edinburgh, Edinburgh, The United Kingdom
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Kuiper ST, Zweers D, Suelmann BBM, Meijer RP, Vervoort SCJM. Perspectives and Concerns on Late Effects Regarding Sexuality among Adolescents and Young Adults Treated for Testicular Germ Cell Tumor: The PRICELESS-Study-A Qualitative Study. Cancers (Basel) 2024; 16:715. [PMID: 38398106 PMCID: PMC10886665 DOI: 10.3390/cancers16040715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
This study aimed to explore perspectives and concerns regarding sexuality among adolescents and young adults (AYAs) possibly experiencing late effects after testicular germ cell tumor (TGCT) treatment. A qualitative study was performed in which semi-structured interviews were held with thirteen AYAs from a center of expertise for TGCT in the Netherlands. Data were analyzed using Braun and Clark's thematic analysis method. Seven interacting and interconnected themes were found: desire to have children, rediscovering sexuality, insecurity about sexual performance, acceptance of physical change, loss of masculinity, burden on relationship, and openness in discussing sexuality. Concerns about the desire to have children seem to play a significant role. In conclusion, TGCT patients face multiple changes (physical, emotional, relational, and sexual), followed by a difficult period of acceptance, after which a new phase of rediscovering sexuality appeared. These findings can help to make healthcare professionals aware of the underlying mechanisms and concerns about sexuality. Furthermore, insights can help to develop sexuality-themed items for a broader monitoring tool to structurally assess the late effects to support discussing sexuality.
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Affiliation(s)
- Stefan T. Kuiper
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Daniëlle Zweers
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Britt B. M. Suelmann
- Medical Oncology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (D.Z.); (B.B.M.S.)
| | - Richard P. Meijer
- Oncological Urology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sigrid C. J. M. Vervoort
- Julius Center for Health Sciences and Primary Care, General Practice & Nursing Science, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
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3
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van Doeveren T, Remmers S, Atema V, van den Bergh RC, Boevé ER, Cornel EB, van der Heijden AG, Hendricksen K, Cauberg EC, Jacobs RA, Kroon BK, Leliveld AM, Meijer RP, Merks B, Oddens JR, Roelofs L, Somford DM, de Vries P, Wijsman B, Windt WA, Zwaan PJ, van Leeuwen PJ, Boormans JL, Aben KK. Short-term Changes in Health-related Quality of Life of Patients Undergoing Radical Surgery for Upper Urinary Tract Urothelial Carcinoma: Results from a Prospective Phase 2 Clinical Trial. EUR UROL SUPPL 2024; 60:15-23. [PMID: 38375344 PMCID: PMC10874848 DOI: 10.1016/j.euros.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objective The possible negative impact of radical surgery on patients' health-related quality of life (HRQoL) plays an important role in preoperative counseling. Here, we analyzed the HRQoL of patients treated for upper urinary tract urothelial carcinoma (UTUC) in the context of a single-arm phase 2 multicenter study, in which the safety and efficacy of a single preoperative intravesical instillation with mitomycin C were investigated. Our objective was to investigate early changes in HRQoL in patients undergoing radical surgery for UTUC and identify factors associated with these outcomes. Methods Patients with pTanyN0-1M0 UTUC were prospectively included. HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) questionnaire at baseline, and at 1 and 3 mo after surgery. A linear mixed model was used to evaluate the changes in HRQoL over time and identify the variables associated with these outcomes. The clinical effect size was used to assess the clinical impact and level of perceptibility of HRQoL changes for clinicians and/or patients based on given thresholds. Key findings and limitations Between 2017 and 2020, 186 patients were included. At baseline, 1 mo after surgery, and 3 mo after surgery, response rates were 91%, 84%, and 78%, respectively. One month after surgery, a statistically significant and clinically relevant deterioration was observed in physical, role, and social functioning, and for the included symptom scales: constipation, fatigue, and pain. An improvement in emotional functioning was observed. At 3 mo, HRQoL returned to baseline levels, except emotional functioning, which improved at 1 mo and persisted to be better than that before surgery. Age >70 yr was associated with worse physical functioning, but better social and emotional functioning. Male patients reported better emotional functioning than females. Postoperative complications were negatively associated with social functioning. Conclusions and clinical implications UTUC patients treated with radical surgery experienced a significant, albeit temporary, decline in HRQoL. Three months following surgery, HRQoL outcomes returned to baseline levels. This information can be used to counsel UTUC patients before undergoing radical surgery and contextualize recovery after surgery. Patient summary We investigated the changes in quality of life as reported by patients who underwent surgery for upper tract urothelial carcinoma (UTUC). We found that patients experienced a decline in quality of life 1 mo after surgery, but this was temporary, with full recovery of quality of life 3 mo after surgery. These findings can help doctors and other medical staff in counseling UTUC patients before undergoing radical surgery.
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Affiliation(s)
- Thomas van Doeveren
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Vera Atema
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | | | - Egbert R. Boevé
- Department of Urology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Erik B. Cornel
- Department of Urology, Ziekenhuis Groep Twente, Hengelo, The Netherlands
| | | | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Rens A.L. Jacobs
- Department of Urology, Zuyderland Medical Center, Heerlen and Sittard, The Netherlands
| | - Bin K. Kroon
- Department of Urology, Rijnstate Medical Center, Arnhem, The Netherlands
| | - Annemarie M. Leliveld
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard P. Meijer
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bob Merks
- Department of Urology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - Jorg R. Oddens
- Department of Urology, AmsterdamUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Luc Roelofs
- Department of Urology, Treant Zorggroep, Emmen, The Netherlands
| | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Peter de Vries
- Department of Urology, Treant Zorggroep, Emmen, The Netherlands
| | - Bart Wijsman
- Department of Urology, Elisabeth-Tweesteden Medical Center, Tilburg, The Netherlands
| | | | - Peter J. Zwaan
- Department of Urology, Gelre Ziekenhuis, Apeldoorn, The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Joost L. Boormans
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, 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 Center, Nijmegen, The Netherlands
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Viergever BJ, Raats DAE, Geurts V, Mullenders J, Jonges TN, van der Heijden MS, van Es JH, Kranenburg O, Meijer RP. Urine-derived bladder cancer organoids (urinoids) as a tool for cancer longitudinal response monitoring and therapy adaptation. Br J Cancer 2024; 130:369-379. [PMID: 38102228 PMCID: PMC10844626 DOI: 10.1038/s41416-023-02494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Bladder cancer is one of the most common cancer types worldwide. Generally, research relies on invasive sampling strategies. METHODS Here, we generate bladder cancer organoids directly from urine (urinoids). In this project, we establish 12 urinoid lines from 22 patients with non-muscle and muscle-invasive bladder tumours, with an efficiency of 55%. RESULTS The histopathological features of the urinoids accurately resemble those of the original bladder tumours. Genetically, there is a high concordance of single nucleotide polymorphisms (92.56%) and insertions & deletions (91.54%) between urinoids and original tumours from patient 4. Furthermore, these urinoids show sensitivity to bladder cancer drugs, similar to their tissue-derived organoid counterparts. Genetic analysis of longitudinally generated tumoroids and urinoids from one patient receiving systemic immunotherapy, identify alterations that may guide the choice for second-line therapy. Successful treatment adaptation was subsequently demonstrated in the urinoid setting. CONCLUSION Therefore, urinoids can advance precision medicine in bladder cancer as a non-invasive platform for tumour pathogenesis, longitudinal drug-response monitoring, and therapy adaptation.
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Affiliation(s)
- Bastiaan J Viergever
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
- Department of Oncological Urology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
| | - Daniëlle A E Raats
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
- Utrecht Platform for Organoid Technology, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Veerle Geurts
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Utrecht, The Netherlands
| | - Jasper Mullenders
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Utrecht, The Netherlands
| | - Trudy N Jonges
- Department of Pathology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | | | - Johan H van Es
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT, Utrecht, The Netherlands
| | - Onno Kranenburg
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands
- Utrecht Platform for Organoid Technology, Utrecht University, 3584 CX, Utrecht, The Netherlands
| | - Richard P Meijer
- Laboratory Translational Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands.
- Department of Oncological Urology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584CX, Utrecht, The Netherlands.
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5
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Alfred Witjes J, Max Bruins H, Carrión A, Cathomas R, Compérat E, Efstathiou JA, Fietkau R, Gakis G, Lorch A, Martini A, Mertens LS, Meijer RP, Milowsky MI, Neuzillet Y, Panebianco V, Redlef J, Rink M, Rouanne M, Thalmann GN, Sæbjørnsen S, Veskimäe E, van der Heijden AG. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol 2024; 85:17-31. [PMID: 37858453 DOI: 10.1016/j.eururo.2023.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/18/2023] [Indexed: 10/21/2023]
Abstract
CONTEXT We present an overview of the updated 2023 European Association of Urology (EAU) guidelines for muscle-invasive and metastatic bladder cancer (MMIBC). OBJECTIVE To provide practical evidence-based recommendations and consensus statements on the clinical management of MMIBC with a focus on diagnosis and treatment. EVIDENCE ACQUISITION A broad and comprehensive scoping exercise covering all areas of the MMIBC guidelines has been performed annually since 2017. Searches cover the Medline, EMBASE, and Cochrane Libraries databases for yearly guideline updates. A level of evidence and strength of recommendation are assigned. The evidence cutoff date for the 2023 MIBC guidelines was May 4, 2022. EVIDENCE SYNTHESIS Patients should be counselled regarding risk factors for bladder cancer. Pathologists should describe tumour and lymph nodes in detail, including the presence of histological subtypes. The importance of the presence or absence of urothelial carcinoma (UC) in the prostatic urethra is emphasised. Magnetic resonance imaging (MRI) of the bladder is superior to computed tomography (CT) for disease staging, specifically in differentiating T1 from T2 disease, and may lead to a change in treatment approach in patients at high risk of an invasive tumour. Imaging of the upper urinary tract, lymph nodes, and distant metastasis is performed with CT or MRI; the additional value of flurodeoxyglucose positron emission tomography/CT still needs to be determined. Frail and comorbid patients should be evaluated by a multidisciplinary team. Postoperative histology remains the most important prognostic variable, while circulating tumour DNA appears to be an interesting predictive marker. Neoadjuvant systemic therapy remains cisplatin-based. In motivated and selected women and men, sexual organ-preserving cystectomy results in better functional outcomes without compromising oncological outcomes. Robotic and open cystectomy have comparable outcomes and should be combined with (extended) lymph node dissection. The diversion type is an individual choice after taking patient and tumour characteristics into account. Radical cystectomy remains a highly complex procedure with considerable morbidity and risk of mortality, although lower rates are observed for higher hospital volumes (>20 cases/yr). With proper patient selection, trimodal therapy (chemoradiation) has comparable outcomes to radical cystectomy. Adjuvant chemotherapy after surgery improves disease-specific survival and overall survival (OS) in patients with high-risk disease who did not receive neoadjuvant treatment, and is strongly recommended. There is a weak recommendation for adjuvant nivolumab, as OS data are not yet available. Health-related quality of life should be assessed using validated questionnaires at baseline and after treatment. Surveillance is needed to monitor for recurrent cancer and functional outcomes. Recurrences detected on follow-up seem to have better prognosis than symptomatic recurrences. CONCLUSIONS This summary of the 2023 EAU guidelines provides updated information on the diagnosis and treatment of MMIBC for incorporation into clinical practice. PATIENT SUMMARY The European Association of Urology guidelines panel on muscle-invasive and metastatic bladder cancer has released an updated version of the guideline containing information on diagnosis and treatment of this disease. Recommendations are based on studies published up to May 4, 2022. Surgical removal of the bladder and bladder preservation are discussed, as well as updates on the use of chemotherapy and immunotherapy in localised and metastatic disease.
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Affiliation(s)
- J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Harman Max Bruins
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Albert Carrión
- Department of Urology, Vall Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Richard Cathomas
- Department of Medical Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Eva Compérat
- Department of Pathology, Medical University Vienna General Hospital, Vienna, Austria
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Rainer Fietkau
- Department of Radiation Therapy, University of Erlangen, Erlangen, Germany
| | - Georgios Gakis
- Department of Urology and Pediatric Urology, University of Würzburg, Würzburg, Germany
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zürich, Zürich, Switzerland
| | - Alberto Martini
- Department of Urology, Institut Universitaire du Cancer-Toulouse-Oncopole, Toulouse, France; Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - John Redlef
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Michael Rink
- Department of Urology, Marienkrankenhaus Hamburg, Hamburg, Germany
| | - Mathieu Rouanne
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - George N Thalmann
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sæbjørn Sæbjørnsen
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Erik Veskimäe
- Department of Urology, Tampere University Hospital, Tampere, Finland
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Richters A, Robbrecht DG, Meijer RP, van der Heijden AG, Kiemeney LA, van den Bosch J, Suelmann BB, Özdemir BC, Mehra N, Aben KK. Treatment Patterns and Use of Immune Checkpoint Inhibitors Among Patients with Metastatic Bladder Cancer in a Dutch Nationwide Cohort. EUR UROL SUPPL 2024; 59:50-54. [PMID: 38213646 PMCID: PMC10776918 DOI: 10.1016/j.euros.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
Since 2017, two immune checkpoint inhibitors (ICIs) have become the standard of care for the treatment of metastatic urothelial carcinoma in Europe: pembrolizumab as second-line therapy and avelumab as maintenance therapy. Our aim was to describe the use of ICIs as first and later lines of treatment in patients with metastatic bladder cancer (mBC) in the Netherlands. We identified all patients diagnosed with primary mBC between 2018 and 2021 in the Netherlands from the Netherlands Cancer Registry (NCR). NCR data were supplemented with data from the Dutch nationwide Prospective Bladder Cancer Infrastructure (ProBCI) collected from medical files, with follow-up until death or end of data collection on January 1, 2023. A total of 1525 patients were diagnosed with primary mBC between 2018 and 2021 in the Netherlands. Of these, 34.7% received at least one line of systemic treatment with chemotherapy or ICI. After first-line platinum-based chemotherapy, 34.1% received second-line ICI and 3.9% received maintenance ICI. Among patients who completed or discontinued first-line cisplatin- or carboplatin-based chemotherapy after approval of maintenance ICI in the Netherlands, 40.7% and 19.7% received second-line ICI, and 9.3% and 14.1% received maintenance ICI, respectively. ICI use for mBC treatment has not increased considerably since their introduction in 2017. Future research should assess whether the introduction of maintenance avelumab (available since April 2021 in the Netherlands) has led to increases in the proportion of patients with mBC patients receiving systemic treatment and the proportion receiving ICI. Patient summary We assessed the rate of immunotherapy use for patients with metastatic bladder cancer in the Netherlands. Since its introduction, immunotherapy has been used in a minority of patients, mostly as second-line treatment after platinum-based chemotherapy.
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Affiliation(s)
- Anke Richters
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Debbie G.J. Robbrecht
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Lambertus A.L.M. Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joan van den Bosch
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Britt B.M. Suelmann
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berna C. Özdemir
- Department of Medical Oncology, Bern University Hospital, Bern, Switzerland
| | | | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K.H. Aben
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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van Dorp J, Pipinikas C, Suelmann BBM, Mehra N, van Dijk N, Marsico G, van Montfoort ML, Hackinger S, Braaf LM, Amarante T, van Steenis C, McLay K, Daletzakis A, van den Broek D, van de Kamp MW, Hendricksen K, de Feijter JM, Boellaard TN, Meijer RP, van der Heijden AG, Rosenfeld N, van Rhijn BWG, Jones G, van der Heijden MS. Author Correction: High- or low-dose preoperative ipilimumab plus nivolumab in stage III urothelial cancer: the phase 1B NABUCCO trial. Nat Med 2024; 30:304. [PMID: 37460757 DOI: 10.1038/s41591-023-02500-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Jeroen van Dorp
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
| | | | - Britt B M Suelmann
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niven Mehra
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nick van Dijk
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maurits L van Montfoort
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Linde M Braaf
- Core Facility Molecular Pathology & Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | - Antonios Daletzakis
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maaike W van de Kamp
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kees Hendricksen
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeantine M de Feijter
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Urological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoine G van der Heijden
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nitzan Rosenfeld
- Inivata Ltd., Babraham Research Park, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge, UK
- Cancer Research UK Major Centre Cambridge, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Bas W G van Rhijn
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Greg Jones
- Inivata Ltd., Babraham Research Park, Cambridge, UK.
| | - Michiel S van der Heijden
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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8
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Brück K, Meijer RP, Boormans JL, Kiemeney LA, Witjes JA, van Hoogstraten LMC, van der Heijden MS, Donders AR, Franckena M, Uyl de Groot CA, Leliveld AM, Aben KKH, Hulshof MCCM. Disease-Free Survival of Patients With Muscle-Invasive Bladder Cancer Treated With Radical Cystectomy Versus Bladder-Preserving Therapy: A Nationwide Study. Int J Radiat Oncol Biol Phys 2024; 118:41-49. [PMID: 37517601 DOI: 10.1016/j.ijrobp.2023.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Although level I evidence is lacking that radical cystectomy (RC) is superior to bladder-preserving therapy (BPT), RC is still advocated as the recommended treatment in patients with nonmetastatic muscle-invasive bladder cancer (MIBC). This study sought to compare the survival of patients with MIBC treated with BPT versus those treated with RC. METHODS AND MATERIALS All patients with nonmetastatic MIBC diagnoses were identified via the population-based Netherlands Cancer Registry. Only patients treated with BPT or RC were included. The primary endpoint was 2-year disease-free survival (DFS), defined as time from start of treatment until locoregional recurrence, distant metastasis, or death. The secondary endpoint was overall survival (OS). Inverse propensity treatment weighting (IPTW) was used based on propensity scores to adjust for baseline differences between treatment groups. Survival was analyzed with Kaplan-Meier and Cox proportional hazards models. RESULTS A total of 1432 patients were included, of whom 1101 underwent RC and 331, BPT. Median follow-up was 39 months (range, 27-51 months). The IPTW-adjusted 2-year DFS was 61.5% (95% CI, 53.5%-69.6%) with BPT and 55.3% (95% CI, 51.6%-59.1%) with RC, with an adjusted hazard ratio of 0.84 (95% CI, 0.69-1.05). The adjusted 2-year OS for patients treated with BPT versus RC was 74.0% (95% CI, 67.0%-80.9%) versus 66.0% (95% CI, 62.7%-68.8%), respectively, with an adjusted hazard ratio of 0.80 (95% CI, 0.64-0.98). CONCLUSIONS There was no statistically significant difference between the 2-year DFS of patients treated with BPT and RC. We propose that both RC and BPT should be offered as a curative treatment option to eligible patients with nonmetastatic MIBC.
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Affiliation(s)
- Katharina Brück
- Department of Radiotherapy, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Netherlands Comprehensive Cancer Organization, Nijmegen, The Netherlands.
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisa M C van Hoogstraten
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organization, Nijmegen, The Netherlands
| | | | - A Rogier Donders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Carin A Uyl de Groot
- Institute for Medical Technology Assessment, Rotterdam, The Netherlands; Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
| | - Annemarie M Leliveld
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - Katja K H Aben
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organization, Nijmegen, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiotherapy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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9
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Flach RN, Egevad L, Eklund M, van der Kwast TH, Delahunt B, Samaratunga H, Suelmann BBM, Willemse PPM, Meijer RP, van Diest PJ. Use of the ISUP e-learning module improves interrater reliability in prostate cancer grading. J Clin Pathol 2023; 77:22-26. [PMID: 36328436 DOI: 10.1136/jcp-2022-208506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
AIMS Prostate cancer (PCa) grading is an important prognostic parameter, but is subject to considerable observer variation. Previous studies have shown that interobserver variability decreases after participants were trained using an e-learning module. However, since the publication of these studies, grading of PCa has been enhanced by adopting the International Society of Urological Pathology (ISUP) 2014 grading classification. This study investigates the effect of training on interobserver variability of PCa grading, using the ISUP Education web e-learning on Gleason grading. METHODS The ISUP Education Prostate Test B Module was distributed among Dutch pathologists. The module uses images graded by the ISUP consensus panel consisting of 24 expert uropathologists. Participants graded the same 10 images before and after e-learning. We included those who completed the tests before and after training. We evaluated variation in PCa grading in a fully crossed study design, using linearly weighted kappa values for each pathologist, comparing them to other pathologists and to the ISUP consensus panel. We analysed the improvement in median weighted kappas before and after training, using Wilcoxon's signed rank-test. RESULTS We included 42 pathologists. Inter-rater reliability between pathologists improved from 0.70 before training to 0.74 after training (p=0.01). When compared with the ISUP consensus panel, five pathologists improved significantly, whereas the kappa of one pathologist was significantly lower after training. All pathologists who improved significantly, graded with less than substantial agreement before training. CONCLUSIONS ISUP Prostate Test B e-learning reduces variability in PCa grading. E-learning is a cost-effective method for standardisation of pathology.
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Affiliation(s)
- Rachel N Flach
- Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Brett Delahunt
- Pathology and Molecular Medicine, University of Otago, Dunedin, New Zealand
| | - Hemamali Samaratunga
- Aquesta Uropathology and University of Queensland, Brisbane, Queensland, Australia
| | | | | | - Richard P Meijer
- Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
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10
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Harrevelt SD, Meliado EFM, van Lier ALHMW, Reesink D, Meijer RP, Pluim JPW, Raaijmakers AJE. Deep learning based correction of RF field induced inhomogeneities for T2w prostate imaging at 7 T. NMR Biomed 2023; 36:e5019. [PMID: 37622473 DOI: 10.1002/nbm.5019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
At ultrahigh field strengths images of the body are hampered by B1 -field inhomogeneities. These present themselves as inhomogeneous signal intensity and contrast, which is regarded as a "bias field" to the ideal image. Current bias field correction methods, such as the N4 algorithm, assume a low frequency bias field, which is not sufficiently valid for T2w images at 7 T. In this work we propose a deep learning based bias field correction method to address this issue for T2w prostate images at 7 T. By combining simulated B1 -field distributions of a multi-transmit setup at 7 T with T2w prostate images at 1.5 T, we generated artificial 7 T images for which the homogeneous counterpart was available. Using these paired data, we trained a neural network to correct the bias field. We predicted either a homogeneous image (t-Image neural network) or the bias field (t-Biasf neural network). In addition, we experimented with the single-channel images of the receive array and the corresponding sum of magnitudes of this array as the input image. Testing was carried out on four datasets: the test split of the synthetic training dataset, volunteer and patient images at 7 T, and patient images at 3 T. For the test split, the performance was evaluated using the structural similarity index measure, Wasserstein distance, and root mean squared error. For all other test data, the features Homogeneity and Energy derived from the gray level co-occurrence matrix (GLCM) were used to quantify the improvement. For each test dataset, the proposed method was compared with the current gold standard: the N4 algorithm. Additionally, a questionnaire was filled out by two clinical experts to assess the homogeneity and contrast preservation of the 7 T datasets. All four proposed neural networks were able to substantially reduce the B1 -field induced inhomogeneities in T2w 7 T prostate images. By visual inspection, the images clearly look more homogeneous, which is confirmed by the increase in Homogeneity and Energy in the GLCM, and the questionnaire scores from two clinical experts. Occasionally, changes in contrast within the prostate were observed, although much less for the t-Biasf network than for the t-Image network. Further, results on the 3 T dataset demonstrate that the proposed learning based approach is on par with the N4 algorithm. The results demonstrate that the trained networks were capable of reducing the B1 -field induced inhomogeneities for prostate imaging at 7 T. The quantitative evaluation showed that all proposed learning based correction techniques outperformed the N4 algorithm. Of the investigated methods, the single-channel t-Biasf neural network proves most reliable for bias field correction.
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Affiliation(s)
- Seb D Harrevelt
- Department of Biomedical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
| | | | | | - Daan Reesink
- Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
| | - Josien P W Pluim
- Department of Biomedical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
| | - Alexander J E Raaijmakers
- Department of Biomedical Engineering, Technische Universiteit Eindhoven, Eindhoven, The Netherlands
- Department of Radiotherapy, UMC Utrecht, Utrecht, The Netherlands
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11
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Reesink DJ, Arteaga de Castro CS, Van der Velden T, Van Vooren J, Oost P, Jonges TGN, Lam MGEH, de Keizer B, Willemse PPM, Meijer RP, Klomp DWJ. Feasibility of clinical studies of chemical exchange saturation transfer magnetic resonance imaging of prostate cancer at 7 T. NMR Biomed 2023; 36:e4958. [PMID: 37094995 DOI: 10.1002/nbm.4958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
Chemical exchange saturation transfer (CEST) has been explored for differentiation between tumour and benign tissue in prostate cancer (PCa) patients. With ultrahigh field strengths such as 7-T, the increase of spectral resolution and sensitivity could allow for selective detection of amide proton transfer (APT) at 3.5 ppm and a group of compounds that resonate at 2 ppm (i.e., [poly]amines and/or creatine). The potential of 7-T multipool CEST analysis of the prostate and the detection of PCa was studied in patients with proven localised PCa who were scheduled to undergo robot-assisted radical prostatectomy (RARP). Twelve patients were prospectively included (mean age 68.0 years, mean serum prostate-specific antigen 7.8ng/mL). A total of 24 lesions larger than 2 mm were analysed. Used were 7-T T2-weighted (T2W) imaging and 48 spectral CEST points. Patients received 1.5-T/3-T prostate magnetic resonance imaging and galium-68-prostate-specific membrane antigen-positron emission tomography/computerised tomography to determine the location of the single-slice CEST. Based on the histopathological results after RARP, three regions of interest were drawn on the T2W images from a known malignant zone and benign zone in the central and peripheral zones. These areas were transposed to the CEST data, from which the APT and 2-ppm CEST were calculated. The statistical significance of the CEST between the central zone, the peripheral zone, and tumour was calculated using a Kruskal-Wallis test. The z-spectra showed that APT and even a distinct pool that resonated at 2 ppm were detectable. This study showed a difference trend in the APT levels, but no difference in the 2-ppm levels when tested between the central zone, the peripheral zone, and tumour (H(2) = 4.8, p = 0.093 and H(2) = 0.86, p = 0.651, respectively). Thus, to conclude, we could most likely detect APT and amines and/or creatine levels noninvasively in prostate using the CEST effect. At group level, CEST showed a higher level of APT in the peripheral versus the central zone; however, no differences of APT and 2-ppm levels were observed in tumours.
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Affiliation(s)
- Daan J Reesink
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catalina S Arteaga de Castro
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tijl Van der Velden
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeanette Van Vooren
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petri Oost
- Department of Urology, Tergooi Hospital Hilversum, Hilversum, The Netherlands
| | - Trudy G N Jonges
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marnix G E H Lam
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter-Paul M Willemse
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dennis W J Klomp
- Department of Precision Imaging, Division Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Richters A, van Ginkel N, Meijer RP, Wondergem M, Schoots I, Vis AN, Kiemeney LALM, van Rhijn BWG, Witjes JA, Aben KKH, Mertens LS. Staging fluorodeoxyglucose positron emission tomography/computed tomography for muscle-invasive bladder cancer: a nationwide population-based study. BJU Int 2023; 132:420-427. [PMID: 37246479 DOI: 10.1111/bju.16091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To provide insight into the use and staging information on lymph-node involvement added by fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in patients with muscle-invasive bladder cancer (MIBC), based on a nationwide population-based cohort study. PATIENTS AND METHODS We analysed a nationwide cohort of patients with MIBC without signs of distant metastases, newly diagnosed in the Netherlands between November 2017 and October 2019. From this cohort, we selected patients who underwent pre-treatment staging with CT only or CT and FDG-PET/CT. The distribution of patients, disease characteristics, imaging findings, nodal status (clinical nodal stage cN0 vs cN+) and treatment were described for each imaging modality group (CT only vs CT and FDG-PET/CT). RESULTS We identified 2731 patients with MIBC: 1888 (69.1%) underwent CT only; 606 (22.2%) underwent CT and FDG-PET/CT, 237 (8.6%) underwent no CT. Of the patients who underwent CT only, 200/1888 (10.6%) were staged as cN+, vs 217/606 (35.8%) who underwent CT and FDG-PET/CT. Stratified analysis showed that this difference was found in patients with clinical tumour stage (cT)2 as well as cT3/4 MIBC. Of patients who underwent both imaging modalities and were staged with CT as cN0, 109/498 (21.9%) were upstaged to cN+ based on FDG-PET/CT. Radical cystectomy (RC) was the most common treatment within both imaging groups. Preoperative chemotherapy was more frequently applied in cN+ disease and in FDG-PET/CT-staged patients. Concordance of pathological N stage after upfront RC was higher among patients staged as cN+ with CT and FDG-PET/CT (50.0% pN+) than those staged as cN+ with only CT (39.3%). CONCLUSION Patients with MIBC who underwent pre-treatment staging with FDG-PET/CT were more often staged as lymph node positive, regardless of cT stage. In patients with MIBC who underwent CT and FDG-PET/CT, FDG-PET/CT led to clinical nodal upstaging in approximately one-fifth. Additional imaging findings may influence subsequent treatment strategies.
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Affiliation(s)
- Anke Richters
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Noor van Ginkel
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Urology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncologic Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ivo Schoots
- Department of Radiology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - André N Vis
- Department of Urology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura S Mertens
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
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13
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Flach RN, van Dooijeweert C, Aben KKH, Suelmann BBM, Willemse PPM, van Diest PJ, Meijer RP. Interlaboratory Gleason grading variation affects treatment: a Dutch historic cohort study in 30 509 patients with prostate cancer. J Clin Pathol 2023; 76:690-697. [PMID: 35835545 DOI: 10.1136/jcp-2021-208067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Abstract
AIM Substantial variation in Gleason grading (GG) of prostate cancer (PCa) exists between Dutch pathology laboratories. This study investigates its impact on treatment strategies. METHODS Pathology reports of prostate needle biopsies and clinical data of patients with PCa diagnosed between 2017 and 2019 were retrieved from the Dutch nationwide network and registry of histopathology and cytopathology and The Netherlands Cancer Registry. We investigated the impact of grading variation on treatment strategy for patients whose grade was decisive in treatment choice. First, we evaluated the effect of grading practice (low, average or high grading) on active treatment (AT) versus active surveillance in patients with prostate-specific antigen (PSA) <10 ng/mL and cT1c/cT2a disease. Second, we assessed the association of grading practice with performance of pelvic lymph node dissection (PLND) in patients with PSA 10-20 ng/mL or cT2b disease. We used multivariable logistic regression to analyse the relation between laboratories' grading practices and AT or PLND. RESULTS We included 30 509 patients. GG was decisive in treatment strategy for 11 925 patients (39%). AT was performed significantly less often in patients diagnosed by laboratories that graded lower than average (OR=0.77, 95% CI 0.68 to 0.88). Conversely, patients received AT significantly more often when diagnosed in high-grading laboratories versus average-grading laboratories (OR=1.21, 95% CI 1.03 to1.43). PLND was performed significantly less often in patients diagnosed by low-grading versus average-grading laboratories (OR=0.66, 95% CI 0.48 to 0.90). CONCLUSION Our study shows that the odds that a patient undergoes AT or PLND, depends on laboratories' grading practices in a substantial number of patients. This likely influences patient prognosis and outcome, necessitating standardisation of GG to prevent suboptimal patient outcome.
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Affiliation(s)
- Rachel N Flach
- Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Katja K H Aben
- Department of Research & Development, Netherlands Comprehensive Cancer Centre, Utrecht, The Netherlands
- Radboud Institute for Health Sciences, Radboud UMC, Nijmegen, Gelderland, The Netherlands
| | | | | | | | - Richard P Meijer
- Department of Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
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14
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van Hoogstraten LMC, Man CCO, Witjes JA, Meijer RP, Mulder SF, Smilde TJ, Ripping TM, Kiemeney LA, Aben KKH. Low adherence to recommended use of neoadjuvant chemotherapy for muscle-invasive bladder cancer. World J Urol 2023; 41:1837-1845. [PMID: 37258902 PMCID: PMC10231297 DOI: 10.1007/s00345-023-04443-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/14/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE To evaluate guideline adherence and variation in the recommended use of neoadjuvant chemotherapy (NAC) and the effects of this variation on survival in patients with non-metastatic muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS In this nationwide, Netherlands Cancer Registry-based study, we identified 1025 patients newly diagnosed with non-metastatic MIBC between November 2017 and November 2019 who underwent radical cystectomy. Patients with ECOG performance status 0-1 and creatinine clearance ≥ 50 mL/min/1.73 m2 were considered NAC-eligible. Interhospital variation was assessed using case-mix adjusted multilevel analysis. A Cox proportional hazards model was used to evaluate the association between hospital specific probability of using NAC and survival. All analyses were stratified by disease stage (cT2 versus cT3-4a). RESULTS In total, of 809 NAC-eligible patients, only 34% (n = 277) received NAC. Guideline adherence for NAC in cT2 was 26% versus 55% in cT3-4a disease. Interhospital variation was 7-57% and 31-62%, respectively. A higher hospital specific probability of NAC might be associated with a better survival, but results were not statistically significant (HRcT2 = 0.59, 95% CI 0.33-1.05 and HRcT3-4a = 0.71, 95% CI 0.25-2.04). CONCLUSION Guideline adherence regarding NAC use is low and interhospital variation is large, especially for patients with cT2-disease. Although not significant, our data suggest that survival of patients diagnosed in hospitals more inclined to give NAC might be better. Further research is warranted to elucidate the underlying mechanism. As literature clearly shows the potential survival benefit of NAC in patients with cT3-4a disease, better guideline adherence might be pursued.
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Affiliation(s)
- Lisa M C van Hoogstraten
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands.
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Calvin C O Man
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Theodora M Ripping
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organisation, PO Box 1281, 6501 BG, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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15
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Weda S, Zweers D, Suelmann BBM, Meijer RP, Vervoort SCJM. From Surviving Cancer to Getting on With Life: Adult Testicular Germ Cell Tumor Survivors' Perspectives on Transition From Follow-Up Care to Long-Term Survivorship. Qual Health Res 2023:10497323231173808. [PMID: 37272758 PMCID: PMC10387718 DOI: 10.1177/10497323231173808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With an increasing incidence and a high cure rate, a growing number of testicular germ cell tumor (TGCT) survivors require specialized follow-up care. However, knowledge of these patients' needs is lacking, leaving TGCT survivors with unmet care needs at risk of symptom burden when transitioning to long-term survivorship. This grounded theory study aimed to understand the perspectives of TGCT survivors' transition from follow-up care to long-term survivorship. A total of 12 adult TGCT survivors in follow-up care or completion less than a year were in-depth semi-structured interviewed. Interviews were audiotaped and transcribed verbatim. Transcripts were analyzed by constant comparison, and the core category "Dealing with back-and-forth forces" emerged in the integrated concepts. Two comparative processes in dealing with those forces were identified: the process of Living beyond the sword of Damocles involved the transition from feeling threatened by cancer to overcoming those threats; the process of Getting on with one's life can be described as transitioning from a period where cancer overruled their lives to carrying on with everyday life. The processes toward long-term survivorship follow general characteristics; the transition itself is an individual journey that depends on (life) experiences. The constructed model can guide healthcare professionals and researchers involved in TGCT survivorship to understand TGCT survivors' individual and ensuing needs. When TGCT survivors receive individualized and tailored follow-up care, it can assist in preventing and reducing long-term and late effects on long-term survivorship.
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Affiliation(s)
- Sandrien Weda
- Department of Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Danielle Zweers
- Department of Medical Oncology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Richard P Meijer
- Department Oncological Urology, UMC Utrecht, Utrecht, The Netherlands
| | - Sigrid C J M Vervoort
- Department of Nursing Science at Julius Center for Health Science and Primary Care, UMC Utrecht, Utrecht, The Netherlands
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16
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Nuijens ST, van Hoogstraten LM, Meijer RP, Kiemeney LA, Aben KK, Witjes JA. Minimum Volume Standards: An Incentive To Perform More Radical Cystectomies? EUR UROL SUPPL 2023; 51:47-54. [PMID: 37187720 PMCID: PMC10175736 DOI: 10.1016/j.euros.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/03/2023] Open
Abstract
Background Minimum volume standards (MVS) for hospitals and/or surgeons remain a subject of debate. Opponents of MVS emphasize the possible negative effects of centralization, such as an unwanted incentive to perform surgery. Objective To evaluate whether the introduction of MVS for radical cystectomy (RC) in the Netherlands resulted in more RCs outside guideline-recommended indications. Design setting and participants All RCs performed for bladder cancer in the Netherlands between January 1, 2006 and December 31, 2017 were identified in the Netherlands Cancer Registry. During this period, two MVS were sequentially implemented for RC. RCs in intermediate-volume hospitals (hospitals that approximated the MVS) were compared with RCs in high-volume hospitals (hospitals exceeding the MVS by ≥5 RCs/yr) in a period before and a period after implementation of each of the two MVS. Outcomes measurements and statistical analysis Descriptive analyses were performed to evaluate whether hospitals performed more RCs outside the recommended indication (cT2-4a N0 M0) and whether an increase in the number of RCs towards the end of the year could be observed. Results and limitations After MVS implementation, no clear shift towards disease stages outside the recommended indication for RC was observed in comparison to the period before the MVS. Results for high-volume and intermediate-volume hospitals were similar. In addition, no increase in RCs towards the end of the year was evident. Conclusions We did not find evidence indicating an unwanted incentive to perform more RCs as a result of MVS in the Netherlands. Our results further strengthen the case for MVS implementation. Patient summary We evaluated whether criteria for the minimum number of radical cystectomies (surgical removal of the bladder) that hospitals have to perform caused urologists to perform more of these operations than necessary in order to meet the minimum level. We found no evidence that minimum criteria led to such an unwanted incentive.
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Akdemir E, Sweegers MG, Vrieling A, Rundqvist H, Meijer RP, Leliveld-Kors AM, van der Heijden AG, Rutten VC, Koldewijn EL, Bos SD, Wijburg CJ, Marcelissen TAT, Bongers BC, Retèl VP, van Harten WH, May AM, Groen WG, Stuiver MM. EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial. BMJ Open 2023; 13:e071304. [PMID: 36882246 PMCID: PMC10008243 DOI: 10.1136/bmjopen-2022-071304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION Radical cystectomy (RC) is the standard treatment for patients with non-metastatic muscle-invasive bladder cancer, as well as for patients with therapy refractory high-risk non-muscle invasive bladder cancer. However, 50-65% of patients undergoing RC experience perioperative complications. The risk, severity and impact of these complications is associated with a patient's preoperative cardiorespiratory fitness, nutritional and smoking status and presence of anxiety and depression. There is emerging evidence supporting multimodal prehabilitation as a strategy to reduce the risk of complications and improve functional recovery after major cancer surgery. However, for bladder cancer the evidence is still limited. The aim of this study is to investigate the superiority of a multimodal prehabilitation programme versus standard-of-care in terms of reducing perioperative complications in patients with bladder cancer undergoing RC. METHODS AND ANALYSIS This multicentre, open label, prospective, randomised controlled trial, will include 154 patients with bladder cancer undergoing RC. Patients are recruited from eight hospitals in The Netherlands and will be randomly (1:1) allocated to the intervention group receiving a structured multimodal prehabilitation programme of approximately 3-6 weeks, or to the control group receiving standard-of-care. The primary outcome is the proportion of patients who develop one or more grade ≥2 complications (according to the Clavien-Dindo classification) within 90 days of surgery. Secondary outcomes include cardiorespiratory fitness, length of hospital stay, health-related quality of life, tumour tissue biomarkers of hypoxia, immune cell infiltration and cost-effectiveness. Data collection will take place at baseline, before surgery and 4 and 12 weeks after surgery. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Medical Ethics Committee NedMec (Amsterdam, The Netherlands) under reference number 22-595/NL78792.031.22. Results of the study will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05480735.
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Affiliation(s)
- Emine Akdemir
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maike G Sweegers
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Alina Vrieling
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie M Leliveld-Kors
- Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Vera C Rutten
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Siebe D Bos
- Department of Urology, Noordwest Hospital Group, Alkmaar, The Netherlands
| | - Carl J Wijburg
- Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Tom A T Marcelissen
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Valesca P Retèl
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wim G Groen
- Department of Medicine for Older People, Amsterdam University Medical Center Locatie VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam, The Netherlands
| | - Martijn M Stuiver
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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18
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de Haar-Holleman A, van Hoogstraten LMC, Hulshof MCCM, Tascilar M, Brück K, Meijer RP, Alfred Witjes J, Kiemeney LA, Aben KKH. Chemoradiation for muscle-invasive bladder cancer using 5-fluorouracil versus capecitabine: A nationwide cohort study. Radiother Oncol 2023; 183:109584. [PMID: 36863459 DOI: 10.1016/j.radonc.2023.109584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND AND PURPOSE Oral capecitabine and intravenous 5-fluorouracil (5-FU) are both used as a radiosensitizer in chemoradiotherapy (CRT). A capecitabine-based regimen is more convenient for both patients and healthcare professionals. Since large comparative studies are lacking, we compared toxicity, overall survival (OS) and disease-free survival (DFS) between both CRT-regimens in patients with muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS All patients diagnosed with non-metastatic MIBC between November 2017-November 2019 were consecutively included in the BlaZIB study. Data on patient, tumor, treatment characteristics and toxicity were prospectively collected from the medical files. From this cohort, all patients with cT2-4aN0-2/xM0/x, treated with capecitabine or 5-FU-based CRT were included in the current study. Toxicity in both groups was compared using Fisher-exact tests. Propensity score-based inverse probability treatment weighting (IPTW) was applied to correct for baseline differences between groups. IPTW-adjusted Kaplan-Meier OS and DFS curves were compared using log-rank tests. RESULTS Of the 222 included patients, 111 (50%) were treated with 5-FU and 111 (50%) with capecitabine. Curative CRT was completed according to treatment plan in 77% of patients in the capecitabine-based group and 62% of the 5-FU group (p = 0.06). Adverse events (14 vs 21%, p = 0.29), 2-year OS (73% vs 61%, p = 0.07) and 2-year DFS (56% vs 50%, p = 0.50) did not differ significantly between groups. CONCLUSIONS Chemoradiotherapy with capecitabine and MMC is associated with a similar toxicity profile compared to 5-FU plus MMC and no difference in survival was found. Capecitabine-based CRT, as a more patient-friendly schedule, may be considered as an alternative to a 5-FU-based regimen.
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Affiliation(s)
- Amy de Haar-Holleman
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa M C van Hoogstraten
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Maarten C C M Hulshof
- Department of Radiotherapy, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Metin Tascilar
- Department of Oncology, Isala Hospital, Zwolle, the Netherlands
| | - Katharina Brück
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department of Radiotherapy, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Richard P Meijer
- Department of Urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud university medical center, Nijmegen, the Netherlands
| | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Katja K H Aben
- Department of Research & Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
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19
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van Dorp J, Pipinikas C, Suelmann BBM, Mehra N, van Dijk N, Marsico G, van Montfoort ML, Hackinger S, Braaf LM, Amarante T, van Steenis C, McLay K, Daletzakis A, van den Broek D, van de Kamp MW, Hendricksen K, de Feijter JM, Boellaard TN, Meijer RP, van der Heijden AG, Rosenfeld N, van Rhijn BWG, Jones G, van der Heijden MS. High- or low-dose preoperative ipilimumab plus nivolumab in stage III urothelial cancer: the phase 1B NABUCCO trial. Nat Med 2023; 29:588-592. [PMID: 36732628 DOI: 10.1038/s41591-022-02199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/22/2022] [Indexed: 02/04/2023]
Abstract
Cohort 1 of the phase 1B NABUCCO trial showed high pathological complete response (pCR) rates with preoperative ipilimumab plus nivolumab in stage III urothelial cancer (UC). In cohort 2, the aim was dose adjustment to optimize responses. Additionally, we report secondary endpoints, including efficacy and tolerability, in cohort 2 and the association of presurgical absence of circulating tumor DNA (ctDNA) in urine and plasma with clinical outcome in both cohorts. Thirty patients received two cycles of either ipilimumab 3 mg kg-1 plus nivolumab 1 mg kg-1 (cohort 2A) or ipilimumab 1 mg kg-1 plus nivolumab 3 mg kg-1 (cohort 2B), both followed by nivolumab 3 mg kg-1. We observed a pCR in six (43%) patients in cohort 2A and a pCR in one (7%) patient in cohort 2B. Absence of urinary ctDNA correlated with pCR in the bladder (ypT0Nx) but not with progression-free survival (PFS). Absence of plasma ctDNA correlated with pCR (odds ratio: 45.0; 95% confidence interval (CI): 4.9-416.5) and PFS (hazard ratio: 10.4; 95% CI: 2.9-37.5). Our data suggest that high-dose ipilimumab plus nivolumab is required in stage III UC and that absence of ctDNA in plasma can predict PFS. ClinicalTrials.gov registration: NCT03387761 .
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Affiliation(s)
- Jeroen van Dorp
- Department of Molecular Carcinogenesis, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
| | | | - Britt B M Suelmann
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niven Mehra
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nick van Dijk
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maurits L van Montfoort
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Linde M Braaf
- Core Facility Molecular Pathology & Biobanking, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | | | - Antonios Daletzakis
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daan van den Broek
- Department of Laboratory Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maaike W van de Kamp
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kees Hendricksen
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeantine M de Feijter
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Urological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antoine G van der Heijden
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nitzan Rosenfeld
- Inivata Ltd., Babraham Research Park, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge, UK
- Cancer Research UK Major Centre Cambridge, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Bas W G van Rhijn
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Greg Jones
- Inivata Ltd., Babraham Research Park, Cambridge, UK.
| | - Michiel S van der Heijden
- Dutch Uro-Oncology Study Group, Bilthoven, The Netherlands.
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
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20
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Enzlin R, Vervoort SCJM, Suelmann BBM, Meijer RP, Teunissen SCCM, Zweers D. The prevalence and intensity of late effects in patients with testicular germ cell tumors: A first step of instrument development using a stepwise approach. Eur J Oncol Nurs 2023; 64:102303. [PMID: 36931098 DOI: 10.1016/j.ejon.2023.102303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/13/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Patients with Testicular Germ Cell Tumors (TGCT) may suffer from several late effects due to their diagnosis or treatment. Follow-up care aims to identify the recurrence of cancer and support patients with TGCT in their experienced late effects. In the Netherlands, the validated Dutch version of the Edmonton Symptom Assessment System, Utrecht Symptom Diary (USD) is used to assess and monitor patient reported symptoms. As a first step to develop a specific USD module for TGCT-patients, it was necessary to identify the prevalence and intensity of late effects in patients with TGCT, covering the physical, social, psychical and existential domains of care. METHODS A cross-sectional study was conducted. First, literature was systematically assessed to create a comprehensive list of symptoms. This generated list was reviewed by expert healthcare professionals and the research group. Lastly, a survey was distributed amongst patients with TGCT in follow-up care in the University Medical Center Utrecht (UMCU) outpatient clinic. RESULTS In total, 65 TGCT-patients completed the survey. All described late effects were recognized by TGCT-patients, with 'fatigue', 'disturbed overall well-being', 'concentration problems' and 'neuropathy', indicated as most prevalent and scored with highest intensity. When prioritizing these late effects, patients assigned 'neuropathy' as most important. CONCLUSIONS This study provided insight into prevalence and intensity of late effects, as indicated by TGCT-patients. In clinical practice, follow-up care can improve by empowering patients to discuss important items in daily life with their health-care professionals.
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Affiliation(s)
- Roos Enzlin
- Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, the Netherlands; University Medical Center Utrecht, Department Medical Oncology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands.
| | - Sigrid C J M Vervoort
- University Medical Center Utrecht, Department of Nursing Science, Julius Center for Health Sciences and Primary Care, Heidelberglaan 100 3584CX, Utrecht, the Netherlands.
| | - Britt B M Suelmann
- University Medical Center Utrecht, Department Medical Oncology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands.
| | - Richard P Meijer
- University Medical Center Utrecht, Department of Oncological Urology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands.
| | - Saskia C C M Teunissen
- University Medical Center Utrecht, Department of Primary Care, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands.
| | - Danielle Zweers
- University Medical Center Utrecht, Department Medical Oncology, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands.
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21
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Vilaseca A, Guerrero F, Zainfeld D, Shore ND, Rodriguez Faba O, Meijer RP, Witjes AA, McRee AJ, Kalota A, Stone NL, Lauring JD, Zhu W, Beeharry N, O'Dondi LA, Jayram G. Safety and efficacy of the erdafitinib (erda) intravesical delivery system, TAR-210, in patients (pts) with non–muscle-invasive bladder cancer (NMIBC) or muscle-invasive bladder cancer (MIBC) harboring select FGFR mutations or fusions: Phase 1 first-in-human study. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.tps583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
TPS583 Background: Treatment options are limited for pts with NMIBC and MIBC who experience disease recurrence or who are ineligible for or refuse standard of care. Erda, an oral selective pan-FGFR tyrosine kinase inhibitor, is approved in adults with locally advanced or metastatic urothelial cancer with select FGFR3/2 alterations ( alt) who have progressed during or after ≥1 line of platinum-containing chemotherapy. FGFRalt are among the most common oncogenic drivers detected in NMIBC and MIBC, and are more prevalent in NMIBC. TAR-210 is an intravesical drug delivery system designed to provide local, continuous release of erda within the bladder, thus limiting systemic toxicity. This study evaluates the safety, pharmacokinetics (PK), and efficacy of TAR-210 in pts with NMIBC or MIBC with select FGFRalt. Methods: Open-label, multicenter phase 1 study of TAR-210 in pts with recurrent NMIBC or MIBC (NCT05316155). Eligible pts are aged ≥18 yrs with adequate organ function and tumors with select FGFRalt. A flexible molecular eligibility strategy is used to allow for local or central fresh/archival tissue-based FGFR testing by next-generation sequencing (NGS) or PCR, or urine cell-free DNA NGS testing. Four cohorts will be enrolled: pts with recurrent, bacillus Calmette-Guerin (BCG)-experienced papillary-only high-risk (HR) NMIBC (high-grade Ta/T1) refusing or ineligible for radical cystectomy (RC) (Cohort 1) or scheduled for RC (Cohort 2); pts with recurrent, intermediate-risk NMIBC (Ta/T1) with a history of low-grade disease (Cohort 3); pts with cT2-T3a MIBC scheduled for RC refusing or ineligible for neoadjuvant cisplatin (Cohort 4). Pts in Cohorts 1 and 2 will have TURBT with resection of all visible disease prior to dosing, whereas pts in Cohort 3 must have visible disease prior to dosing. The primary end point is safety (adverse events, including dose-limiting toxicity). Secondary end points include PK, recurrence-free survival (Cohorts 1 and 2), complete response (CR) rate and duration of CR (Cohort 3), and pathologic CR rate, pT0 rate, and rate of downstaging to <pT2 (Cohort 4). Dose escalation (Part 1; n≈12, Cohorts 1 and 3 only) will be followed by dose expansion (Part 2; n≈50-80). Cohorts 1 and 3: response assessment will be after a 3-mo dosing cycle; pts with CR may receive ≤3 additional 3-mo dosing cycles if no recurrence, progression, or unacceptable toxicity. Cohorts 2 and 4: response assessment will be at RC after 8 wks of dosing. Follow-up disease surveillance (cystoscopy, urine cytology, imaging) will be every 3 mos to end of Yr 2 and every 6 mos in Yr 3 in Cohorts 1 and 3 and at 3 mos post-RC in Cohorts 2 and 4. Four pts were enrolled since April 2022 (1 in Cohort 1, 3 in Cohort 3); enrollment for Cohorts 2 and 4 is planned soon. Clinical trial information: NCT05316155 .
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anna Kalota
- Janssen Research & Development, Spring House, PA
| | | | | | - Wei Zhu
- Janssen Research & Development, Raritan, NJ
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22
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Mertens LS, Meijer RP, Alfred Witjes J. Positron Emission Tomography/Computed Tomography for Staging of Bladder Cancer: A Continuing Clinical Controversy. Eur Urol 2023; 83:95-96. [PMID: 36202686 DOI: 10.1016/j.eururo.2022.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 02/01/2023]
Abstract
Fluorodeoxyglucose-based positron emission tomography/computed tomography is increasingly being used for staging of muscle-invasive bladder cancer before treatment. However, international clinical guidelines are hesitant to recommend this approach, as conclusive scientific evidence on its usefulness is lacking. The question is whether and how this evidence can be obtained.
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Affiliation(s)
- Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Richard P Meijer
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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23
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Huele EH, Veenboer PW, Wessels FJ, Jonges TN, Meijer RP. Value of multiparametric magnetic resonance imaging for local staging of invasive urinary bladder tumours. Urol Oncol 2023; 41:49.e7-49.e12. [PMID: 36441069 DOI: 10.1016/j.urolonc.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/21/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Initial tumour staging in bladder cancer mainly relies on the histo-pathological outcome of the transurethral bladder tumour resection (TURBT) and imaging by means of a CT-scan (CT-intravenous urography; CT-IVU). The reported risk of understaging varies from 24-50%. To further improve the the evaluation of depth of invasion of the bladder tumour the application of magnetic resonance imaging (MRI) may be useful. To substantiate the additional value of this imaging modality the present observational study was designed. STUDY DESIGN This is a prospective observational study to analyse bladder tumour staging with multiparametric magnetic resonance imaging (mpMRI) in patients with a known bladder tumour, who are planned for radical cystectomy. STUDY POPULATION Patients with an invasive bladder cancer who are planned for radical cystectomy. INTERVENTION Patients were accrued during their visit to the outpatient department of urology. They underwent routine cystoscopy, laboratory tests (including serum Creatinin) and CT-IVU investigations and subsequently a mpMRI. MAIN STUDY PARAMETERS/ENDPOINTS To demonstrate the value of mpMRI in the initial staging of bladder tumours using radiological bladder tumour stage (T-stage) based on mpMRI and pathological bladder tumour stage based on 'whole-mount' histo-pathology after radical cystectomy. RESULTS Thirty-seven participants with known bladder tumours underwent mpMRI and subsequent cystectomy. After mpMRI 10 participants were diagnosed with non-muscle-invasive bladder cancer (NMIBC) and 27 participants with muscle-invasive bladder cancer (MIBC). In the 'whole-mount' pathology results 12 participants had NMIBC and 25 participants had MIBC. We found a sensitivity and specificity of 0.88 en 0.58 respectively, for the evaluation of MIBC. The positive and negative predictive value were 81% and 70% respectively. The diagnostic accuracy of mpMRI to differentiate between NMIBC and MIBC was 78%. CONCLUSIONS We found a sensitivity of 88% and a specificity of 58% for mpMRI to discriminate NMIBC from MIBC.
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Affiliation(s)
- Eline H Huele
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Paul W Veenboer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands
| | - Frank J Wessels
- Department Radiology, University Medical Center Utrecht, The Netherlands
| | - Trudy N Jonges
- Department Pathology, University Medical Center Utrecht, The Netherlands
| | - Richard P Meijer
- Department Oncological Urology, University Medical Center Utrecht, The Netherlands.
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24
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van Hoogstraten LM, Witjes JA, Meijer RP, Ripping TM, Kiemeney LA, Aben KK, de Reijke TM, Goossens‐Laan CA, Hulshof MC, van Leenders GJ, Leliveld AM, Mulder SF, Noteboom JL, Oddens JR, Smilde TJ, Venderbosch GW, van der Heijden AG, van der Heijden MS, van Moorselaar RJ, van Rhijn BW, van Roermund JG, Wijsman BP. Non-metastatic muscle-invasive bladder cancer: the role of age in receiving treatment with curative intent. BJU Int 2022; 130:764-775. [PMID: 35064953 PMCID: PMC9790563 DOI: 10.1111/bju.15697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate which patient and tumour characteristics are associated with remaining untreated in patients with potentially curable, non-metastatic muscle-invasive bladder cancer (MIBC), and to compare survival of untreated vs treated patients with similar characteristics. PATIENTS AND METHODS For this cohort study, 15 047 patients diagnosed with cT2-T4aN0/xM0/x urothelial MIBC between 2005 and 2019 were identified in the Netherlands Cancer Registry. Factors associated with remaining untreated were identified using logistic regression analyses. Interhospital variation was assessed using multilevel analysis. Using a propensity score, the median overall survival (mOS) of untreated and treated patients was evaluated. Analyses were stratified by age (<75 vs ≥75 years). RESULTS One-third of patients aged ≥75 years remained untreated; increasing age, worse performance status, worse renal function, cT4a stage and previous radiotherapy in the abdomen/pelvic area increased the odds of remaining untreated. One in 10 patients aged <75 years remained untreated; significant associations were only found for performance status, renal function and cT4a stage. Interhospital variation for remaining untreated was largest for patients aged ≥75 years, ranging from 37% to 69% (case-mix-adjusted). Irrespective of age, mOS was significantly worse for untreated patients: 6.4 months (95% confidence interval [CI] 5.1-7.3) vs 16.0 months (95% CI 13.5-19.1) for treated patients. CONCLUSION On average, one in five patients with non-metastatic MIBC remained untreated. Untreated patients were generally older and had a more unfavourable prognostic profile. Untreated patients had significantly worse overall survival, regardless of age. Age alone should therefore not affect treatment decision-making. Considering the large interhospital variation, a proportion of untreated patients might be wrongfully denied life-prolonging treatment.
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Affiliation(s)
- Lisa M.C. van Hoogstraten
- Netherlands Comprehensive Cancer OrganizationUtrechtthe Netherlands,Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands
| | - J. Alfred Witjes
- Department of UrologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Richard P. Meijer
- Department of Oncological UrologyUniversity Medical Centre UtrechtUtrechtthe Netherlands
| | | | | | - Lambertus A. Kiemeney
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands,Department of UrologyRadboud University Medical CentreNijmegenthe Netherlands
| | - Katja K.H. Aben
- Netherlands Comprehensive Cancer OrganizationUtrechtthe Netherlands,Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands
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Wolters-Zwolle M, de Jongh MM, van Elst MW, Meijer RP, Vervoort SC. Patients' experiences with an audio-visual intervention, the use of a tailored explanimation video in patients with bladder cancer. PEC Innov 2022; 1:100042. [PMID: 37213743 PMCID: PMC10194105 DOI: 10.1016/j.pecinn.2022.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 05/23/2023]
Abstract
Objective This qualitative study explored the experiences of patients with bladder cancer with a tailored 'explanimation' video (EV) as a supportive information tool used before and during treatment. Methods Using a qualitative approach, data were collected through semi-structured interviews with 12 patients with bladder cancer and thematically analysed. Results Participants advised future use of the EV, noting it is user friendly and has a fitting difficulty level and clarifying animations. However, some mentioned practical information on 'life after treatment' was lacking, and some emphasized the importance of choosing the right moment of delivery. Patients' experiences were described in four major themes: taking own responsibility, providing opportunity for postponed information supply, easing decision-making processes and gaining a sense of calm. Conclusion Findings indicate the EV supported patients with bladder cancer in the process of being informed and in decision-making. Future use of the EV in the treatment of patients with bladder cancer is recommended. Innovation The use of audiovisual information in patient education is innovative. Tailored audiovisual information in shape of the EV is a step forward in streamlining information processes, meeting individual preferences and highlighting the most important general information for patients with bladder cancer.
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Affiliation(s)
- Marjon Wolters-Zwolle
- University Medical Centre Utrecht, Clinical Health Sciences, Nursing Science, Utrecht University, Utrecht, the Netherlands
| | - Marielle M.E. de Jongh
- University Medical Centre Utrecht, Clinical Health Sciences, Nursing Science, Utrecht University, Utrecht, the Netherlands
| | - Maarten W. van Elst
- Department of Urological Oncology, Division of Imaging & Oncology, University Medical Centre Utrecht, The Netherlands
| | - Richard P. Meijer
- Department of Urological Oncology, Division of Imaging & Oncology, University Medical Centre Utrecht, The Netherlands
| | - Sigrid C.J.M. Vervoort
- Division of Imaging & Oncology, University Medical Centre Utrecht, The Netherlands
- Corresponding author.
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Teunissen FR, Hehakaya C, Meijer RP, van Melick HHE, Verkooijen HM, van der Voort van Zyp JRN. Patient preferences for treatment modalities for localised prostate cancer. BJUI Compass 2022; 4:214-222. [PMID: 36816141 PMCID: PMC9931535 DOI: 10.1002/bco2.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/24/2022] [Accepted: 10/09/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives To assess the patient preferences and utility scores for the different conventional and innovative treatment modalities for localised prostate cancer (PCa). Subjects and Methods Patients treated for localised PCa and healthy volunteers were invited to fill out a treatment-outcome scenario questionnaire. Participants ranked six different treatments for localised PCa from most to least favourable, prior to information. In a next step, treatment procedures, toxicity, risk of biochemical recurrence and follow-up regimen were comprehensibly described for each of the six treatments (i.e. treatment-outcome scenarios), after which patients re-ranked the six treatments. Additionally, participants gave a visual analogue scale (VAS) and time trade-off (TTO) score for each scenario. Differences between utility scores were tested by Friedman tests with post hoc Wilcoxon signed-rank tests. Results Eighty patients and twenty-nine healthy volunteers were included in the study. Before receiving treatment-outcome scenario information, participants ranked magnetic resonance-guided adaptive radiotherapy most often as their first choice (35%). After treatment information was received, active surveillance was most often ranked as the first choice (41%). Utility scores were significantly different between the six treatment-outcome scenarios, and active surveillance, non- and minimal-invasive treatments received higher scores. Conclusions Active surveillance and non-invasive treatment for localised PCa were the most preferred options by PCa patients and healthy volunteers and received among the highest utility scores. Treatment preferences change after treatment information is received.
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Affiliation(s)
- Frederik R. Teunissen
- Department of Radiation OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Charisma Hehakaya
- Department of Radiation OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands,Imaging and Oncology DivisionUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Richard P. Meijer
- Department of Oncological UrologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Helena M. Verkooijen
- Imaging and Oncology DivisionUniversity Medical Center UtrechtUtrechtThe Netherlands,Utrecht UniversityUtrechtThe Netherlands
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Fallara G, Larcher A, Dabestani S, Fossati N, Järvinen P, Nisen H, Gudmundsson E, Lam TB, Marconi L, Fernandéz-Pello S, Meijer RP, Volpe A, Beisland C, Klatte T, Stewart GD, Bensalah K, Ljungberg B, Bertini R, Montorsi F, Bex A, Capitanio U. Recurrence pattern in localized RCC: results from a European multicenter database (RECUR). Urol Oncol 2022; 40:494.e11-494.e17. [DOI: 10.1016/j.urolonc.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/08/2022] [Accepted: 08/18/2022] [Indexed: 10/14/2022]
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Teunissen FR, Willigenburg T, Meijer RP, van Melick HHE, Verkooijen HM, van der Voort van Zyp JRN. The first patient-reported outcomes from the Utrecht Prostate Cohort (UPC): the first platform facilitating 'trials within cohorts' (TwiCs) for the evaluation of interventions for prostate cancer. World J Urol 2022; 40:2205-2212. [PMID: 35861861 PMCID: PMC9427931 DOI: 10.1007/s00345-022-04092-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/29/2022] [Indexed: 01/31/2023] Open
Abstract
Purpose To describe the development and first outcomes of the Utrecht Prostate Cohort (UPC): the first ‘trials within cohorts’ (TwiCs) platform for prostate cancer (PCa). Methods All non-metastasized, histologically proven PCa patients who are planned to receive standard of care are eligible for inclusion in UPC. Patients provide informed consent for the collection of clinical and technical patient data, physician-reported outcomes, and patient-reported outcomes (PROs) up to 10 years post-treatment. Additionally, patients may provide broad consent for future randomization for experimental-intervention trials (TwiCs). Changes in PROs (EPIC-26 questionnaire domains) of the participants who received standard of care were analyzed using Wilcoxon signed-rank tests. Results In two years, 626 patients were enrolled, 503 (80.4%) of whom provided broad consent for future randomization. Among these, 293 (46.8%) patients underwent magnetic resonance-guided adaptive radiotherapy (MRgRT), 116 (18.5%) CT-guided external beam radiation therapy (EBRT), 109 (17.4%) robot-assisted radical prostatectomy (RARP), and 65 (10.4%) patients opted for active surveillance. Patients treated with MRgRT and CT-guided EBRT showed a transient but significant decline in urinary irritative/obstructive and bowel domain scores at 1-month follow-up. RARP patients showed a significant deterioration of urinary incontinence domain scores between baseline and all follow-up moments and significant improvement of urinary irritative/obstructive domain scores between baseline and 9- and 12-month follow-up. All radical treatment groups showed a significant decline in sexual domain scores during follow-up. Active surveillance patients showed no significant deterioration over time in all domains. Conclusion The first results from the UPC study show distinct differences in PROs between treatment options for PCa. Registration No.: NCT04228211. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-04092-2.
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Affiliation(s)
- Frederik R Teunissen
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, The Netherlands.
| | - Thomas Willigenburg
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CZ, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncologic Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
- Utrecht University, Utrecht, The Netherlands
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van Hoogstraten LM, Kiemeney LA, Meijer RP, van Leenders GJ, Vanneste BG, Incrocci L, Smilde TJ, Siesling S, Witjes JA, Aben KK. The impact of the COVID-19 pandemic on bladder cancer care in the Netherlands. Bladder Cancer 2022. [DOI: 10.3233/blc-211608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The COVID-19 pandemic has disrupted regular health care with potential consequences for non-COVID diseases like cancer. To ensure continuity of oncological care, guidelines were temporarily adapted. OBJECTIVE: To evaluate the impact of the COVID-19 outbreak on bladder cancer care in the Netherlands. METHODS: The number of bladder cancer (BC) diagnoses per month during 2020-2021 was compared to 2018-2019 based on preliminary data from the Netherlands Cancer Registry (NCR). Additionally, detailed data were retrieved from the NCR for the cohort diagnosed between March 1st-May 31st 2020 (first COVID wave) and 2018-2019 (reference cohort). BC diagnoses, changes in age and stage at diagnosis, and time to first-line treatment were compared between both periods. Changes in treatment were evaluated using logistic regression. RESULTS: During the first COVID wave (week 9–22), the number of BC diagnoses decreased by 14%, corresponding with approximately 300 diagnoses, but increased again in the second half of 2020. The decline was most pronounced from week 13 onwards in patients≥70 years and patients with non-muscle invasive BC. Patients with muscle-invasive disease were less likely to undergo a radical cystectomy (RC) in week 17–22 (OR = 0.62, 95% CI = 0.40–0.97). Shortly after the start of the outbreak, use of neoadjuvant chemotherapy decreased from 34% to 25% but this (non-significant) effect disappeared at the end of April. During the first wave, 5% more RCs were performed compared to previous years. Time from diagnosis to RC became 6 days shorter. Overall, a 7% reduction in RCs was observed in 2020. CONCLUSIONS: The number of BC diagnoses decreased steeply by 14% during the first COVID wave but increased again to pre-COVID levels by the end of 2020 (i.e. 600 diagnoses/month). Treatment-related changes remained limited and followed the adapted guidelines. Surgical volume was not compromised during the first wave. Altogether, the impact of the first COVID-19 outbreak on bladder cancer care in the Netherlands appears to be less pronounced than was reported for other solid tumors, both in the Netherlands and abroad. However, its impact on bladder cancer stage shift and long-term outcomes, as well as later pandemic waves remain so far unexamined.
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Affiliation(s)
- Lisa M.C. van Hoogstraten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Lambertus A. Kiemeney
- Department of Urology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MCCancer Institute, Rotterdam, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, 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
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
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van der Leun JA, Siem G, Meijer RP, Brinkman WM. Improving robotic skills by video review. J Endourol 2022; 36:1126-1135. [PMID: 35262417 DOI: 10.1089/end.2021.0740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Since the transition of surgical robot systems into the medical field, physicians have had to develop new dexterity skills. The ideal learning environment for robotic surgery has yet to be discovered. Virtual-reality (VR) simulation is a possible safe and economic method. In VR-simulator training human feedback is hardly used, an alternative may be found in video revision. The purpose of this study is to investigate whether adding video review to VR-simulation-based training in novice physicians improves their ability to complete a complex robot task. In addition, the secondary goal is to investigate whether the skills learned on the robotic simulator can be transferred to a real robotic system. Methods 40 participants, medical students and, medical-PhD candidates, from one university hospital, were included. Baseline dexterity skills were measured through completion of a vesico-urethral anastomosis on a VR-robot simulator and the DaVinci robot. Participants were randomized into a video and control group. The video group practiced skills on the robot simulator with intermediate video revision, whereas the control group had intermediate pause instead. Post-intervention dexterity skills were measured using the same exercises as the baseline tests. Results No significant differences were found in baseline performance. Post-intervention results on the VR-simulator show that the video group commits significantly fewer injuries to the urethra and sutures at a greater optimal depth. The control group was significantly faster, had less camera travel, and had their instruments less out of view. On the DaVinci robot, participants in both groups performed significantly faster and had better GEARS-score after the training sessions on the VR simulator. Conclusions Video revision significantly improves the quality of robotic skills in novice surgeons on the VR-simulator, though at the expense of time. Furthermore, both groups demonstrated enhanced skills on the DaVinci robot after training sessions, which advocates the transferability of skill.
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Affiliation(s)
| | - Gabriel Siem
- Department of Oncological Urology, University Medical Centrum Utrecht, Utrecht, The Netherlands
- Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centrum Utrecht, Utrecht, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centrum Utrecht, Utrecht, The Netherlands
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Meijer RP. Urothelial cancer organoids: a tool for bladder cancer research. Pathologe 2021; 42:165-169. [PMID: 34623463 PMCID: PMC8695536 DOI: 10.1007/s00292-021-00988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/30/2022]
Abstract
Background Bladder cancer ranks among the top ten most common tumor types worldwide and represents a growing healthcare problem, accounting for a large part of total healthcare costs. Chemotherapy is effective in a subset of patients, while causing severe side effects. Tumor pathogenesis and drug resistance mechanisms are largely unknown. Precision medicine is failing in bladder cancer, as bladder tumors are genetically and molecularly very heterogeneous. Currently, therapeutic decision-making depends on assessing a single fragment of surgically acquired tumor tissue. Objective New preclinical model systems for bladder cancer are indispensable for developing therapeutic strategies tailored to individual patient and tumor characteristics. Organoids are small 3D tissue cultures that simulate small-size organs “in a dish” and tumoroids are a special type of cancer organoid (i.e., malignant tissue). Materials and methods Since 2016, we have collaborated with the renowned Hubrecht Institute to provide proof of concept of tissue-based bladder tumoroids mimicking parental tumors. We have developed a living biobank containing bladder organoids and tumoroids grown from over 50 patient samples, which reflect crucial aspects of bladder cancer pathogenesis. Results Histological and immunofluorescence analysis indicated that the heterogeneity and subclassification of tumoroids mimicked those of corresponding parental tumor samples. Thus, urothelial tumoroids mimic crucial aspects of bladder cancer pathogenesis. Conclusion Research with urothelial tumoroids will open up new avenues for bladder cancer pathogenesis and drug-resistance research as well as for precision medicine approaches.
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Affiliation(s)
- R P Meijer
- University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
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van Hoogstraten LMC, van Gennep EJ, Kiemeney LALM, Witjes JA, Voskuilen CS, Deelen M, Mertens LS, Meijer RP, Boormans JL, Robbrecht DGJ, Beerepoot LV, Verhoeven RHA, Ripping TM, van Rhijn BWG, Aben KKH, Hermans TJN. Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients. World J Urol 2021; 40:111-118. [PMID: 34585294 PMCID: PMC8813846 DOI: 10.1007/s00345-021-03839-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/09/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS).
Methods Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995–December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017–October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with <(y)pT2N0 vs. <(y)pT2N+ disease was estimated by the Kaplan–Meier method.
Results In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to <(y)pT2, 4.3% (N = 59) had occult LNM 4.1% (N = 49) of patients with cT2-disease and 5.6% (N = 10) with cT3-4a-disease. This was 4.0% (N = 44) in patients without NAC or NAR, 4.5% (N = 10) in patients with NAC, and 13.5% (N = 5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of <(y)pT2N+ disease was 4.2% (N = 48) in the NCR cohort and 4.6% (N = 11) in the NCR-BlaZIB cohort. For patients with <(y)pT2N+ and <(y)pT2N0, median OS was 3.5 years (95% CI 2.5–8.9) versus 12.9 years (95% CI 11.7–14.0), respectively.
Conclusion Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help in counseling patients for bladder-sparing treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03839-7.
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Affiliation(s)
- L M C van Hoogstraten
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - E J van Gennep
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - L A L M Kiemeney
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - J A Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C S Voskuilen
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - M Deelen
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - L S Mertens
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - R P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J L Boormans
- Department of Urology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D G J Robbrecht
- Department of Medical Oncology, Erasmus Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - L V Beerepoot
- Department of Medical Oncology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - R H A Verhoeven
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - T M Ripping
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - B W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - K K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - T J N Hermans
- Department of Urology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
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Wenmaekers S, Viergever BJ, Kumar G, Kranenburg O, Black PC, Daugaard M, Meijer RP. A Potential Role for HUWE1 in Modulating Cisplatin Sensitivity. Cells 2021; 10:cells10051262. [PMID: 34065298 PMCID: PMC8160634 DOI: 10.3390/cells10051262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/25/2022] Open
Abstract
Cisplatin is a widely used antineoplastic agent, whose efficacy is limited by primary and acquired therapeutic resistance. Recently, a bladder cancer genome-wide CRISPR/Cas9 knock-out screen correlated cisplatin sensitivity to multiple genetic biomarkers. Among the screen’s top hits was the HECT domain-containing ubiquitin E3 ligase (HUWE1). In this review, HUWE1 is postulated as a therapeutic response modulator, affecting the collision between platinum-DNA adducts and the replication fork, the primary cytotoxic action of platins. HUWE1 can alter the cytotoxic response to platins by targeting essential components of the DNA damage response including BRCA1, p53, and Mcl-1. Deficiency of HUWE1 could lead to enhanced DNA damage repair and a dysfunctional apoptotic apparatus, thereby inducing resistance to platins. Future research on the relationship between HUWE1 and platins could generate new mechanistic insights into therapy resistance. Ultimately, HUWE1 might serve as a clinical biomarker to tailor cancer treatment strategies, thereby improving cancer care and patient outcomes.
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Affiliation(s)
- Stijn Wenmaekers
- Laboratory Translational Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands; (S.W.); (B.J.V.); (O.K.)
- Department of Oncological Urology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands
| | - Bastiaan J. Viergever
- Laboratory Translational Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands; (S.W.); (B.J.V.); (O.K.)
- Department of Oncological Urology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands
| | - Gunjan Kumar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (G.K.); (P.C.B.)
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
| | - Onno Kranenburg
- Laboratory Translational Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands; (S.W.); (B.J.V.); (O.K.)
| | - Peter C. Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (G.K.); (P.C.B.)
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
| | - Mads Daugaard
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (G.K.); (P.C.B.)
- Vancouver Prostate Centre, Vancouver, BC V6H 3Z6, Canada
- Correspondence: (M.D.); (R.P.M.)
| | - Richard P. Meijer
- Laboratory Translational Oncology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands; (S.W.); (B.J.V.); (O.K.)
- Department of Oncological Urology, University Medical Center Utrecht, 3584CX Utrecht, The Netherlands
- Correspondence: (M.D.); (R.P.M.)
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Richters A, Meijer RP, Mehra N, Boormans JL, van der Heijden AG, van der Heijden MS, Kiemeney LA, Aben KK. Prospective bladder cancer infrastructure for experimental and observational research on bladder cancer: study protocol for the 'trials within cohorts' study ProBCI. BMJ Open 2021; 11:e047256. [PMID: 34006553 PMCID: PMC8130738 DOI: 10.1136/bmjopen-2020-047256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION A better understanding of the molecular profile of bladder tumours, the identification of novel therapeutic targets, and introduction of new drugs and has renewed research interest in the field of bladder cancer. We describe the design and setup of a Dutch Prospective Bladder Cancer Infrastructure (ProBCI) as a means to stimulate and accelerate clinically meaningful experimental and observational research. METHODS AND ANALYSIS ProBCI entails an open cohort of patients with bladder cancer in which the trials within cohorts (TwiCs) design can be embedded. Physicians in participating hospitals prospectively recruit invasive (≥T1) patients with bladder cancer on primary diagnosis for inclusion into the study. Extensive clinical data are collected and updated every 4 months, along with patient-reported outcomes and biomaterials. Informed consent includes participation in TwiCs studies and renewed contact for future studies. Consent for participation in questionnaires and molecular analyses that may yield incidental findings is optional. ETHICS AND DISSEMINATION The Dutch ProBCI is a unique effort to construct a nation-wide cohort of patients with bladder cancer including clinical data, patient-reported outcomes and biomaterial, to facilitate observational and experimental research. Data and materials are available for other research groups on request through www.probci.nl. Ethics approval was obtained from METC Utrecht (reference: NL70207.041.19). TRIAL REGISTRATION NUMBER NCT04503577.
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Affiliation(s)
- Anke Richters
- Research and Development, The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Richard P Meijer
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost L Boormans
- Cancer Institute - Department of Urology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Michiel S van der Heijden
- Department of Medical Oncology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands
| | - Lambertus A Kiemeney
- Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Katja K Aben
- Research and Development, The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson E, Lam TBL, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Bensalah K, Dabestani S, Bex A. Should patients with low-risk renal cell carcinoma be followed differently after nephron-sparing surgery vs radical nephrectomy? BJU Int 2021; 128:386-394. [PMID: 33794055 DOI: 10.1111/bju.15415] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/17/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate whether pT1 renal cell carcinoma (RCC) should be followed differently after partial (PN) or radical nephrectomy (RN) based on a retrospective analysis of a multicentre database (RECUR). SUBJECTS A retrospective study was conducted in 3380 patients treated for nonmetastatic RCC between January 2006 and December 2011 across 15 centres from 10 countries, as part of the RECUR database project. For patients with pT1 clear-cell RCC, patterns of recurrence were compared between RN and PN according to recurrence site. Univariate and multivariate models were used to evaluate the association between surgical approach and recurrence-free survival (RFS) and cancer-specific mortality (CSM). RESULTS From the database 1995 patients were identified as low-risk patients (pT1, pN0, pNx), of whom 1055 (52.9%) underwent PN. On multivariate analysis, features associated with worse RFS included tumour size (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14-1.39; P < 0.001), nuclear grade (HR 2.31, 95% CI 1.73-3.08; P < 0.001), tumour necrosis (HR 1.5, 95% CI 1.03-2.3; P = 0.037), vascular invasion (HR 2.4, 95% CI 1.3-4.4; P = 0.005) and positive surgical margins (HR 4.4, 95% CI 2.3-8.5; P < 0.001). Kaplan-Meier analysis of CSM revealed that the survival of patients with recurrence after PN was significantly better than those with recurrence after RN (P = 0.02). While the above-mentioned risk factors were associated with prognosis, type of surgery alone was not an independent prognostic variable for RFS nor CSM. Limitations include the retrospective nature of the study. CONCLUSION Our results showed that follow-up protocols should not rely solely on stage and type of primary surgery. An optimized regimen should also include validated risk factors rather than type of surgery alone to select the best imaging method and to avoid unnecessary imaging. A follow-up of more than 3 years should be considered in patients with pT1 tumours after RN. A novel follow-up strategy is proposed.
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Affiliation(s)
- Yasmin Abu-Ghanem
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B L Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Urology, Abdominal Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Karim Bensalah
- Department of Urology, University Hospital of Rennes, Rennes, France
| | - Saeed Dabestani
- Division of Urological Cancers, Department of Translational Medicine, Central Hospital Kristianstad, Lund University, Lund, Sweden
| | - Axel Bex
- UCL Division of Surgical and Interventional Science, Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Reesink DJ, van de Garde EM, Somford DM, Meijer RP, Los M, Biesma DH, Horenblas S, van Melick HH, van der Nat PB. Development of the First Patient-centred Set of Outcomes for Muscle-invasive and Metastatic Bladder Cancer: A Multicentre Initiative. EUR UROL SUPPL 2021; 26:18-26. [PMID: 34337504 PMCID: PMC8317903 DOI: 10.1016/j.euros.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To improve and compare outcomes in healthcare, it is necessary to standardise outcome measurements. There are no widely accepted standardised outcome measures reflecting quality of care for bladder cancer (BCa) patients. OBJECTIVE The aim of this study was to create a standardised set of outcomes for patients with muscle-invasive or metastatic BCa, using the value-based healthcare principles. DESIGN SETTING AND PARTICIPANTS A multidisciplinary working group of 25 healthcare professionals and patient representatives was assembled, to develop the set. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used an online RAND-modified Delphi process to prioritise, discuss, and reach consensus regarding the outcomes, case-mix variables, and treatment factors. RESULTS AND LIMITATIONS Recognising the heterogeneity of patients with BCa, the working group defined the scope as patients with muscle-invasive and metastatic BCa. A total of 24 outcomes, including ten patient-reported outcomes, were included in the standard set of outcomes, covering survival, complication rates, recurrence of disease, readmissions after treatment, and quality of life (QoL). Fourteen case-mix variables were included. The EQ-5D and European Organisation for Research and Treatment of Cancer quality of life (EORTC-QLQ) questionnaires were recommended to measure QoL. CONCLUSIONS We developed the first standardised set of patient-centred outcomes for muscle-invasive and metastatic BCa. The sue of this set enables institutions to monitor, compare, and improve the quality of BCa care, on an international level. PATIENT SUMMARY Our group of healthcare professionals and patient representatives recommended a standardised set of patient-centred outcomes to be followed during the treatment of patients with muscle-invasive or metastatic bladder cancer, in order to monitor, compare, and improve the quality of care.
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Affiliation(s)
- Daan J. Reesink
- Urology Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | | | - Diederik M. Somford
- Urology Department, Canisius Wilhelmina Hospital [CWZ], Nijmegen, The Netherlands
| | - Richard P. Meijer
- Urology Department, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Maartje Los
- Oncology Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Douwe H. Biesma
- Value Based Healthcare Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Simon Horenblas
- Urology Department, The Netherlands Cancer Institute – Antoni van Leeuwenhoek [NCI-AVL] Hospital, Amsterdam, The Netherlands
| | | | - Paul B. van der Nat
- Value Based Healthcare Department, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud UMC, Nijmegen, The Netherlands
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Blok JM, Groot HJ, Huele EH, de Wit R, Horenblas S, Nuver J, Groenewegen G, Bosch JR, Witjes JA, Tromp JM, de Brouwer PJ, van den Berg HA, Vanneste BG, Smilde TJ, Aarts MJ, Gietema JA, Meijer RP, Schaapveld M. Dose-Dependent Effect of Platinum-Based Chemotherapy on the Risk of Metachronous Contralateral Testicular Cancer. J Clin Oncol 2021; 39:319-327. [DOI: 10.1200/jco.20.02352] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Patients with testicular germ cell tumor (TGCT) are at increased risk of developing a contralateral TGCT (CTGCT). Although some studies suggest that prior treatment with platinum-based chemotherapy affects CTGCT risk, a relationship between CTGCT risk and platinum dose has not previously been assessed. We analyzed the association between the number of platinum-based chemotherapy cycles and CTGCT risk. PATIENTS AND METHODS The risk of developing a metachronous CTGCT was evaluated in a nationwide cohort of 4,755 patients diagnosed with primary TGCT in the Netherlands between 1989 and 2007. Standardized incidence ratios were computed to compare CTGCT incidence with expected TGCT on the basis of TGCT incidence in the general population. The cumulative incidence of CTGCT was estimated in the presence of death as competing risk. The effect of treatment with platinum-based chemotherapy on CTGCT risk was assessed using multivariable Cox proportional hazards regression models. RESULTS CTGCT was diagnosed in 136 patients (standardized incidence ratio, 14.6; 95% CI, 12.2 to 17.2). The cumulative incidence increased up to 20 years after primary diagnosis, reaching 3.4% (95% CI, 2.8% to 4.0%) after 20 years of follow up. The risk of developing a CTGCT decreased with age (hazard ratio [HR], 0.93; 95% CI, 0.90 to 0.96), was lower after nonseminomatous germ cell tumor (HR, 0.58; 95% CI, 0.35 to 0.96) and decreased with every additional cycle of chemotherapy (HRper cycle, 0.74; 95% CI, 0.64 to 0.85). CONCLUSION Approximately one in every 30 survivors of TGCT will develop a CTGCT, with CTGCT incidence increasing up to 20 years after a primary TGCT. Treatment with platinum-based chemotherapy shows a dose-dependent inverse association with CTGCT risk.
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Affiliation(s)
- Joost M. Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Harmke J. Groot
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Eline H. Huele
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ronald de Wit
- Department of Medical Oncology, Erasmus University Hospital, Rotterdam, the Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Janine Nuver
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Gerard Groenewegen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J.L.H. Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J. Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jacqueline M. Tromp
- Department of Medical Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Peter J.M. de Brouwer
- Department of Radiation Oncology, Dr Bernard Verbeeten Institute, Tilburg, the Netherlands
| | | | - Ben G.L. Vanneste
- Department of Radiation Oncology, MAASTRO-clinic, Maastricht, the Netherlands
| | - Tineke J. Smilde
- Department of Medical Oncology, Jeroen Bosch Hospital, ’s-Hertogenbosch, the Netherlands
| | - Maureen J.B. Aarts
- Department of Medical Oncology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jourik A. Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Richard P. Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
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Richters A, Ripping TM, Kiemeney LA, Leliveld AM, van Rhijn BWG, Oddens JR, van Moorselaar RJA, Goossens-Laan CA, Meijer RP, Boormans JL, Witjes JA, Aben KKH. Hospital volume is associated with postoperative mortality after radical cystectomy for treatment of bladder cancer. BJU Int 2021; 128:511-518. [PMID: 33404154 PMCID: PMC8519083 DOI: 10.1111/bju.15334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective To contribute to the debate regarding the minimum volume of radical cystectomies (RCs) that a hospital should perform by evaluating the association between hospital volume (HV) and postoperative mortality. Patients and Methods Patients who underwent RC for bladder cancer between 1 January 2008 and 31 December 2018 were retrospectively identified from the Netherlands Cancer Registry. To create a calendar‐year independent measure, the HV of RCs was calculated per patient by counting the RCs performed in the same hospital in the 12 months preceding surgery. The relationship of HV with 30‐ and 90‐day mortality was assessed by logistic regression with a non‐linear spline function for HV as a continuous variable, which was adjusted for age, tumour, node and metastasis (TNM) stage, and neoadjuvant treatment. Results The median (interquartile range; range) HV among the 9287 RC‐treated patients was 19 (12–27; 1–75). Of all the included patients, 208 (2.2%) and 518 (5.6%) died within 30 and 90 days after RC, respectively. After adjustment for age, TNM stage and neoadjuvant therapy, postoperative mortality slightly increased between an HV of 0 and an HV of 25 RCs and steadily decreased from an HV of 30 onwards. The lowest risks of postoperative mortality were observed for the highest volumes. Conclusion This paper, based on high‐quality data from a large nationwide population‐based cohort, suggests that increasing the RC volume criteria beyond 30 RCs annually could further decrease postoperative mortality. Based on these results, the volume criterion of 20 RCs annually, as recently recommended by the European Association of Urology Guideline Panel, might therefore be reconsidered.
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Affiliation(s)
- Anke Richters
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Theodora M Ripping
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Lambertus A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Urology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anna M Leliveld
- Department of Urology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Jorg R Oddens
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus MC Cancer Institute, Rotterdam, 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 Organization, Utrecht, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Richters A, Mehra N, Meijer RP, Boormans JL, van der Heijden AG, Smilde TJ, van der Heijden MS, Kiemeney LA, Aben KK. Utilization of systemic treatment for metastatic bladder cancer in everyday practice: Results of a nation-wide population-based cohort study. Cancer Treat Res Commun 2020; 25:100266. [PMID: 33316557 DOI: 10.1016/j.ctarc.2020.100266] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND With the introduction of new therapeutic options, the landscape of metastatic bladder cancer (mBC) management is shifting. We describe current clinical practice and outcomes of mBC patients as a benchmark for translation of developments into clinical practice in the near future. PATIENTS AND METHODS Nation-wide population-based cohort study including all patients diagnosed with synchronous metastatic bladder cancer in the Netherlands in 2016-2017, identified through the Netherlands Cancer Registry (NCR). Clinical data on patient and disease characteristics, treatments and survival from the NCR were supplemented with specific information from electronic health records and descriptively analyzed. This study was part of the Prospective Bladder Cancer Infrastructure. RESULTS Synchronous metastatic bladder cancer was diagnosed in 636 patients in the Netherlands in 2016 and 2017. 35% (221 patients) received systemic treatment, of whom 88 received multiple treatment lines. Most common first-line regimen was carboplatin-based chemotherapy (49%), followed by cisplatin-based chemotherapy (41%) and immunotherapy (8%). Factors associated with systemic treatment were: young age, <2 comorbidities, adequate renal function and performance-status (WHO-0-1/Karnofsky-80-100), urothelial carcinoma and lymph node only metastases. Median overall survival was 4.4 months for the total cohort, and 12.3, 12.9 and 11.1 months for patients treated with first-line immunotherapy, cisplatin-based and carboplatin-based chemotherapy, respectively. CONCLUSIONS Many mBC patients received no systemic treatment or received carboplatin-based chemotherapy, partly because of cisplatin-ineligibility. Observed survival corresponded relatively well with rates reported from trials among chemotherapy-treated patients. These data can serve as a benchmark for future studies evaluating the application of immunotherapy outside a trial setting.
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Affiliation(s)
- Anke Richters
- The Netherlands Comprehensive Cancer Organisation, Department of Research and Development, Utrecht, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Niven Mehra
- Radboud University Medical Center, Department of Medical Oncology, Nijmegen, The Netherlands
| | - Richard P Meijer
- University Medical Center Utrecht, Department of Oncological Urology, Utrecht, The Netherlands
| | - Joost L Boormans
- Erasmus MC Cancer Institute, Department of Urology, Rotterdam, The Netherlands
| | | | - Tineke J Smilde
- Jeroen Bosch Hospital, Department of Internal Medicine, 's Hertogenbosch, The Netherlands
| | | | - Lambertus A Kiemeney
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Katja K Aben
- The Netherlands Comprehensive Cancer Organisation, Department of Research and Development, Utrecht, The Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Abu-Ghanem Y, Powles T, Capitanio U, Beisland C, Järvinen P, Stewart GD, Gudmundsson EO, Lam TB, Marconi L, Fernandéz-Pello S, Nisen H, Meijer RP, Volpe A, Ljungberg B, Klatte T, Dabestani S, Bex A. The Impact of Histological Subtype on the Incidence, Timing, and Patterns of Recurrence in Patients with Renal Cell Carcinoma After Surgery-Results from RECUR Consortium. Eur Urol Oncol 2020; 4:473-482. [PMID: 33109495 DOI: 10.1016/j.euo.2020.09.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 06/30/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current follow-up strategies for patients with renal cell carcinoma (RCC) after curative surgery rely mainly on risk models and the treatment delivered, regardless of the histological subtype. OBJECTIVE To determine the impact of RCC histological subtype on recurrence and to examine the incidence, pattern, and timing of recurrences to improve follow-up recommendations. DESIGN, SETTING, AND PARTICIPANTS This study included consecutive patients treated surgically with curative intention (ie, radical and partial nephrectomy) for nonmetastatic RCC (cT1-4, M0) between January 2006 and December 2011 across 15 centres from 10 countries, as part of the euRopEan association of urology renal cell carcinoma guidelines panel Collaborative multicenter consortium for the studies of follow-Up and recurrence patterns in Radically treated renal cell carcinoma patients (RECUR) database project. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The impact of histological subtype (ie, clear cell RCC [ccRCC], papillary RCC [pRCC], and chromophobe RCC [chRCC]) on recurrence-free survival (RFS) was assessed via univariate and multivariate analyses, adjusting for potential interactions with important variables (stage, grade, risk score, etc.) Patterns of recurrence for all histological subtypes were compared according to recurrence site and risk criteria. RESULTS AND LIMITATIONS Of the 3331 patients, 62.2% underwent radical nephrectomy and 37.8% partial nephrectomy. A total of 2565 patients (77.0%) had ccRCC, 535 (16.1%) had pRCC, and 231 (6.9%) had chRCC. The median postoperative follow-up period was 61.7 (interquartile range: 47-83) mo. Patients with ccRCC had significantly poorer 5-yr RFS than patients with pRCC and chRCC (78% vs 86% vs 91%, p = 0.001). The most common sites of recurrence for ccRCC were the lung and bone. Intermediate-/high-risk pRCC patients had an increased rate of lymphatic recurrence, both mediastinal and retroperitoneal, while recurrence in chRCC was rare (8.2%), associated with higher stage and positive margins, and predominantly in the liver and bone. Limitations include the retrospective nature of the study. CONCLUSIONS The main histological subtypes of RCC exhibit a distinct pattern and dynamics of recurrence. Results suggest that intermediate- to high-risk pRCC may benefit from cross-sectional abdominal imaging every 6 mo until 2 yr after surgery, while routine imaging might be abandoned for chRCC except for abdominal computed tomography in patients with advanced tumour stage or positive margins. PATIENT SUMMARY In this analysis of a large database from 15 countries around Europe, we found that the main histological subtypes of renal cell carcinoma have a distinct pattern and dynamics of recurrence. Patients should be followed differently according to subtype and risk score.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK.
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Petrus Järvinen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | | | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Lorenzo Marconi
- Department of Urology, Coimbra University Hospital, Coimbra, Portugal
| | | | - Harry Nisen
- Abdominal Center, Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Alessandro Volpe
- Department of Urology, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Börje Ljungberg
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Tobias Klatte
- Department of Surgery, University of Cambridge, Cambridge, UK; Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK
| | - Saeed Dabestani
- Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Axel Bex
- Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, UCL Division of Surgical and Interventional Science, London, UK; Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Blok JM, van der Poel HG, Kerst JM, Bex A, Brouwer OR, Bosch JLHR, Horenblas S, Meijer RP. Clinical outcome of robot-assisted residual mass resection in metastatic nonseminomatous germ cell tumor. World J Urol 2020; 39:1969-1976. [PMID: 32955662 PMCID: PMC8217018 DOI: 10.1007/s00345-020-03437-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the outcome of robot-assisted residual mass resection (RA-RMR) in nonseminomatous germ cell tumor (NSGCT) patients with residual tumor following chemotherapy. PATIENTS AND METHODS Retrospective medical chart analysis of all patients with NSGCT undergoing RA-RMR at two tertiary referral centers between January 2007 and April 2019. Patients were considered for RA-RMR in case of a residual tumor between 10 and 50 mm at cross-sectional computed tomography (CT) imaging located ventrally or laterally from the aorta or vena cava, with normalized tumor markers following completion of chemotherapy, and no history of retroperitoneal surgery. RESULTS A total of 45 patients were included in the analysis. The Royal Marsden stage before chemotherapy was IIA in 13 (28.9%), IIB in 16 (35.6%), IIC in 3 (6.7%) and IV in 13 patients (28.9%). The median residual tumor size was 1.9 cm (interquartile range [IQR] 1.4-2.8; range 1.0-5.0). Five procedures (11.1%) were converted to an open procedure due to a vascular injury (n = 2), technical difficulty (n = 2) or tumor debris leakage (n = 1). A postoperative adverse event occurred in two patients (4.4%). Histopathology showed teratoma, necrosis and viable cancer in 29 (64.4%), 14 (31.1%), and two patients (4.4%), respectively. After a median follow-up of 41 months (IQR 22-70), one patient (2.2%) relapsed in the retroperitoneum. The one- and 2-year recurrence-free survival rate was 98%. CONCLUSION RA-RMR is an appropriate treatment option in selected patients, potentially providing excellent cure rates with minimal morbidity. Long-term outcome data are needed to further support this strategy and determine inclusion and exclusion criteria.
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Affiliation(s)
- Joost M Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Urology, The Netherlands Cancer Institute, Utrecht, The Netherlands.
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Utrecht, The Netherlands
| | - J Martijn Kerst
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Utrecht, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute, Utrecht, The Netherlands
| | - J L H Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Ripping TM, Witjes JA, Meijer RP, van Rhijn BWG, Oddens JR, Goossens-Laan CA, Mulder SF, van Moorselaar RJA, Kiemeney LA, Aben KKH. Hospital-specific probability of cystectomy affects survival from muscle-invasive bladder cancer. Urol Oncol 2020; 38:935.e9-935.e16. [PMID: 32917503 DOI: 10.1016/j.urolonc.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/15/2020] [Accepted: 08/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Radical cystectomies (RCs) are increasingly centralized, but bladder cancer can be diagnosed in every hospital The aim of this study is to assess the variation between hospitals of diagnosis in a patient's chance to undergo a RC before and after the volume criteria for RCs, to identify factors associated with this variation and to assess its effect on survival. METHODS AND MATERIALS Patients diagnosed with muscle-invasive bladder cancer (cT2-4a,N0/X,M0/X) without nodal or distant metastases between 2008 and 2016 were identified through the Netherlands Cancer Registry. Multilevel logistic regression analysis was used to investigate the hospital specific probability of undergoing a cystectomy. Cox proportional hazard regression analysis was used to assess the case-mix adjusted effect of hospital-specific probabilities on survival. RESULTS Of the 9,215 included patients, 4,513 (49%) underwent a RC. The percentage of RCs varied between 7% and 83% by hospital of diagnosis before the introduction of the first volume criteria (i.e., 2008-2009; minimum of 10 RCs). This variation decreased slightly to 17%-77% after establishment of the second volume criteria (i.e., 2015-2016; minimum of 20 RCs). Age, cT-stage and comorbidity were inversely and socioeconomic status was positively associated with RC. Both being diagnosed in a community hospital and/or being diagnosed in a hospital fulfilling the RC volume criteria were associated with increased use of RC compared to academic hospitals and hospitals not fulfilling the volume criteria. For each 10% increase in the percentage of RC in the hospital of diagnosis, 2-year case-mix adjusted survival increased 4% (hazard ratio 0.96, 95% confidence interval 0.94-0.98). CONCLUSION Probability of RC varied between hospitals of diagnosis and affected 2-year overall survival. Undergoing a RC was associated with age, cT-stage, socioeconomic status, type of hospital, and whether the hospital of diagnosis fulfilled the RC volume criteria. Future research is needed to identify patient, tumor, and hospital characteristics affecting utilization of curative treatment as this may benefit overall survival.
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Affiliation(s)
- Theodora M Ripping
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jorg R Oddens
- Department of Urology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - Sasja F Mulder
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Lambertus A Kiemeney
- Department of Urology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Katja K H Aben
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Cornelissen SWE, Veenboer PW, Wessels FJ, Meijer RP. Diagnostic Accuracy of Multiparametric MRI for Local Staging of Bladder Cancer: A Systematic Review and Meta-Analysis. Urology 2020; 145:22-29. [PMID: 32721515 DOI: 10.1016/j.urology.2020.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023]
Abstract
To evaluate diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for local staging of urothelial bladder carcinoma (UBC), a systematic review was performed. Of 2369 records, 20 studies met the inclusion criteria (n=1724). We found a pooled sensitivity and specificity for differentiating between stages ≤T1 and ≥T2 of 0.92 (95% CI 0.88-0.95) and 0.88 (95% CI 0.78-0.94). mpMRI shows high sensitivity and specificity for the differentiation between non-muscle invasive and muscle invasive bladder cancer, but does not appear to be useful for staging per T-stage. It can be used for confirmation when muscle invasive disease is suspected at initial diagnosis.
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Affiliation(s)
| | - Paul W Veenboer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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44
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Bakker WJ, Roos MM, Meijer RP, Burgmans JPJ. Influence of previous laparo-endoscopic inguinal hernia repair on performing radical prostatectomy: a nationwide survey among urological surgeons. Surg Endosc 2020; 35:2583-2591. [PMID: 32488655 DOI: 10.1007/s00464-020-07676-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 03/25/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is considerable demographic overlap of inguinal hernia patients and prostate cancer patients. Previous laparo-endoscopic inguinal hernia mesh repairs can complicate subsequent radical prostatectomies due to adhesions and distortion of anatomic planes. This study aims to assess the experience of urological surgeons on the safety and feasibility of performing radical prostatectomies after laparo-endoscopic inguinal hernia mesh repair. METHODS For this cross-sectional study, an online 24 question survey was developed regarding the experience in performing a radical prostatectomy and pelvic lymph node dissection (PLND) with a prior preperitoneal inguinal hernia mesh repair. Between June 2016 and December 2017, the questionnaire was sent to all 68 urological surgeons performing radical prostatectomy in the Netherlands. RESULTS The response rate of urological surgeons was 69% (n = 47). The majority (77%) of urological surgeons perform robot-assisted laparoscopic prostatectomies. A previous preperitoneal inguinal hernia repair was reported by 40% of urological surgeons in 10-30% of patients undergoing radical prostatectomy. Radical prostatectomy with prior preperitoneal inguinal hernia mesh repair is considered more difficult by 49%, predominantly because of (occasionally to always) experienced longer operating times (88.4%), increased blood loss (46.5%), difficult dissection of Retzius space (88.4%), nerve-sparing difficulties (32.6%), less adequate PLND (69.8%), and bladder- (16.3%) or peritoneal perforations (27.9%). Additionally, 11.6% had performed mesh explantation, 16.3% had aborted radical prostatectomies, and 35.7% experienced increased inguinal hernia recurrences after radical prostatectomies with prior preperitoneal inguinal hernia mesh repair. More experienced urological surgeons reported an increased difficulty for all outcomes. CONCLUSIONS Laparo-endoscopic inguinal hernia mesh repair has a significant impact on performing a radical prostatectomy and PLND. Surgeons should postpone the inguinal hernia repair of patients in the workup for a radical prostatectomy, with the preferable option of performing the radical prostatectomy and inguinal hernia repair in the same procedure. Alternatively, a Lichtenstein repair can be performed.
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Affiliation(s)
- Wouter J Bakker
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands.
| | - Marleen M Roos
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Josephina P J Burgmans
- Department of Surgery/Hernia Clinic, Diakonessenhuis Utrecht/Zeist, Secretariaat Heelkunde, Professor Lorentzlaan 76, 3707 HL, Zeist, The Netherlands
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45
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Blok JM, Meijer RP, van der Poel HG, Bex A, van Vooren J, van Urk JJ, Horenblas S, Bosch JLHR. Additional surgical procedures and perioperative morbidity in post-chemotherapy retroperitoneal lymph node dissection for metastatic testicular cancer in two intermediate volume hospitals. World J Urol 2020; 39:839-846. [PMID: 32372160 PMCID: PMC7969692 DOI: 10.1007/s00345-020-03229-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the perioperative morbidity of PC-RPLND in two intermediate volume centers and to identify predictors of high morbidity. Methods Retrospective analysis of 124 patients treated with open PC-RPLND at two tertiary referral centers between 2001 and 2018. Perioperative morbidity was determined by analyzing additional surgical procedures, intra-operative blood loss, and postoperative complications. Results An additional procedure was necessary for 33 patients (26.6%). The risk was higher in patients with IGCCCG intermediate/poor prognosis (OR 3.56; 95% CI 1.33–9.52) and residual tumor size > 5 cm (OR 3.53; 95% CI 1.39–8.93). Blood loss was higher in patients with IGCCCG intermediate/poor prognosis (β = 0.177; p = 0.029), large residual tumor (β = 0.570; p < 0.001), an additional intervention (β = 0.342; p < 0.001) and teratoma on retroperitoneal histology (β = − 0.19; p = 0.014). Thirty-one patients had a postoperative complication Clavien-Dindo Grade ≥ 2 (25.0%). Complication risk was highest in patients undergoing an additional intervention (OR 3.46; 95% CI 1.03–11.60; p = 0.044). Conclusions The rate of additional interventions in our series is comparable to what has been reported in high-volume centers. IGCCCG intermediate/poor prognosis patients with high-volume disease and patients undergoing an additional surgical procedure can be classified as high-risk patients. Electronic supplementary material The online version of this article (10.1007/s00345-020-03229-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joost M Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Axel Bex
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeanette van Vooren
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Japke J van Urk
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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46
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Blok JM, Groot HJ, Huele EH, De Wit R, Gietema JA, Groenewegen G, Witjes F, Van den Berg H, Nuver J, Tromp JM, De Brouwer P, Smilde TJ, Aarts MJ, Vanneste BG, Bosch RJ, Horenblas S, Schaapveld M, Meijer RP. Incidence and risk factors for contralateral testicular tumor. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
419 Background: Patients with testicular germ cell tumor (TGCT) are at increased risk of developing a metachronous contralateral testicular tumor (CLTT). It is unclear whether the histology of the primary tumor and treatment with platinum-based chemotherapy are associated with the risk of CLTT. The primary aim of this study was to analyze the association between number of chemotherapy cycles and risk of CLTT. Methods: We evaluated the incidence of metachronous CLTT (≥2 months after diagnosis of primary TGCT) in a nationwide cohort consisting of patients diagnosed with TGCT between 1989 and 2007. Standardized incidence ratios (SIRs) were computed to compare CLTT incidence with TGCT in the general population and the cumulative incidence of CLTT was estimated. We analyzed the association between treatment with chemotherapy and risk of CLTT in a multivariate Cox-model. Results: The entire cohort consisted of 4,755 patients (seminoma: n=2,612; 54.9%, nonseminomatous germ cell tumor [NSGCT]: n=2,143; 45.1%). The median age at diagnosis was 33 years (IQR 26-40). A total of 1,047 patients (22.0%) were treated with platinum-based chemotherapy for their primary TGCT (seminoma: n=189, NSGCT: n=858). Median follow-up was 17.0 years (IQR 12.7-22.0). A CLTT was diagnosed in 136 patients. The median interval to CLTT diagnosis was 6.1 years (range 0.8-19.7). The overall 20-year cumulative incidence was 3.4% (95% CI 2.8-4.0) and was higher after seminoma (4.0%; 95% CI 3.3-4.9), compared to NSGCT (2.6%; 95% CI 1.9-3.4). The SIRs were for seminoma: 22.1 (95% CI 17.8-27.1), for NSGCT: 8.6 (95% CI 6.3-11.6) and for the entire cohort: 14.6 (95% CI 12.2-17.2). In multivariate analysis, the risk of developing a CLTT decreased with age (HR 0.93; 95% CI 0.90-0.96), was lower after NSGCT (HR 0.58; 95% CI 0.35-0.96), and decreased with every additional cycle of chemotherapy (HR 0.74; 0.64-0.85). This corresponds to a 26% lower risk of CLTT per extra chemotherapy cycle. Conclusions: TGCT patients have an almost 15 times higher risk of developing a CLTT, compared to the general population. The risk is 2 times higher after a seminoma, compared to NSGCT, and decreases with every additional cycle of chemotherapy. Especially in high risk patients, lifelong self-examination is advised.
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Affiliation(s)
| | | | | | | | | | | | - Fred Witjes
- Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Janine Nuver
- University Medical Center Groningen, Groningen, Netherlands
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47
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Beulens AJW, Namba HF, Brinkman WM, Meijer RP, Koldewijn EL, Hendrikx AJM, van Basten JP, van Merriënboer JJG, Van der Poel HG, Bangma C, Wagner C. Analysis of the video motion tracking system "Kinovea" to assess surgical movements during robot-assisted radical prostatectomy. Int J Med Robot 2020; 16:e2090. [PMID: 32034977 DOI: 10.1002/rcs.2090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/16/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUNDS Robot-assisted surgery facilitated the possibility to evaluate the surgeon's skills by recording and evaluating the robot surgical images. The aim of this study was to investigate the possibility of using a computer programme (Kinovea) for objective assessment of surgical movements in previously recorded in existing robot-assisted radical prostatectomy (RARP) videos. METHODS Twelve entire RARP procedures were analysed by a trained researcher using the computer programme "Kinovea" to perform semi-automated assessment of surgical movements. RESULTS Data analysis showed Kinovea was on average able to automatically assess only 22% of the total surgical duration per video of the robot-assisted surgery. On average, it lasted 4 hours of continued monitoring by the researcher to assess one RARP using Kinovea. CONCLUSION Although we proved it is technically possible to use the Kinovea system in retrospective analysis of surgical movement in robot-assisted surgery, the acquired data do not give a comprehensive enough analysis of the video to be used in skills assessment.
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Affiliation(s)
- Alexander J W Beulens
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - Hanae F Namba
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Evert L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | - Henk G Van der Poel
- Department of Urology, Dutch Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Chris Bangma
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cordula Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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Blok JM, Pluim I, Daugaard G, Wagner T, Jóźwiak K, Wilthagen EA, Looijenga LHJ, Meijer RP, Bosch JLHR, Horenblas S. Lymphovascular invasion and presence of embryonal carcinoma as risk factors for occult metastatic disease in clinical stage I nonseminomatous germ cell tumour: a systematic review and meta-analysis. BJU Int 2020; 125:355-368. [PMID: 31797520 PMCID: PMC7065076 DOI: 10.1111/bju.14967] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective To systematically review the literature on the prognostic value of lymphovascular invasion (LVI) and embryonal carcinoma (EC) for occult metastatic disease in clinical stage I nonseminomatous germ cell tumour (CS I NSGCT). Materials and methods The PubMed, Embase (OVID) and SCOPUS databases were searched up to March 2019. Studies reporting on the association between LVI and/or EC and occult metastatic disease were considered for inclusion. The quality and risk of bias were evaluated by the Quality in Prognosis Studies tool. Results We screened 5287 abstracts and 207 full‐text articles. We included 35 studies in the narrative synthesis and 24 studies in a meta‐analysis. LVI showed the strongest effect. Pooled rates of occult metastasis were 47.5% and 16.9% for LVI‐positive and LVI‐negative patients, respectively (odds ratio [OR] 4.33, 95% confidence interval [CI] 3.55–5.30; P < 0.001). Pooled rates of occult metastasis were 33.2% for EC presence and 16.2% for EC absence (OR 2.49, 95% CI 1.64–3.77; P < 0.001). Pooled rates of occult metastasis were 40.0% for EC >50% and 20.0% for EC <50% (OR 2.62, 95% CI 1.93–3.56; P < 0.001). Conclusions LVI is the strongest risk factor for relapse. The prognostic value of EC is high, but there is no common agreement on how to define this risk factor. Both EC presence and EC >50% have similar ORs for occult metastasis. This shows that the assessment of EC presence is sufficient for the classification of EC.
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Affiliation(s)
- Joost M Blok
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ilse Pluim
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gedske Daugaard
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Wagner
- Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Katarzyna Jóźwiak
- Department of Epidemiology and Biostatistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Erica A Wilthagen
- Scientific Information Service, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J L H Ruud Bosch
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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van Putten K, Vernooij RWM, Meijer RP, Zhu X. En-bloc resection versus conventional transurethral resection for patients with non-muscle-invasive bladder cancer. Hippokratia 2019. [DOI: 10.1002/14651858.cd013473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Kim van Putten
- University Medical Center Utrecht; Department of Oncological Urology; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Robin WM Vernooij
- University Medical Center Utrecht; Department of Nephrology and Hypertension and Julius Center for Health Sciences and Primary Care; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Richard P Meijer
- University Medical Center Utrecht; Department of Oncological Urology; Heidelberglaan 100 Utrecht Netherlands 3584 CX
| | - Xiaoye Zhu
- Radboudumc, University Medical Center; Department of Urology; Nijmegen Netherlands
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50
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Blok JM, Kerst JM, Vegt E, Brouwer OR, Meijer RP, Bosch JLHR, Bex A, van der Poel HG, Horenblas S. Sentinel node biopsy in clinical stage I testicular cancer enables early detection of occult metastatic disease. BJU Int 2019; 124:424-430. [PMID: 30417511 PMCID: PMC6850062 DOI: 10.1111/bju.14618] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objectives To report the long‐term results of the sentinel node (SN) approach in patients with clinical stage I testicular tumours in our facility. Patients and Methods We conducted an analysis of 27 consecutive patients suspected of clinical stage I testicular germ cell tumour (TGCT) and treated with an SN procedure at our tertiary referral centre. SNs were identified using lymphoscintigraphy with or without single‐photo‐emission computed tomography with CT (SPECT/CT). Patients underwent laparoscopic retroperitoneal SN excision with inguinal orchiectomy. Patients with a tumour‐positive SN underwent adjuvant treatment. Follow‐up was conducted according to then‐current guidelines. Results In two patients, no SNs were visualized on scintigraphy. In the remaining 25 patients, a median (range) of 3 (1–4) SNs per patient were removed. Two patients showed no malignancy on histopathological examination of the testis. Of the 23 patients diagnosed with TGCT (16 seminomas, seven non‐seminomas), three (13.0%) had occult metastatic disease. All 23 patients were without evidence of disease at a median (range) follow‐up of 63.9 (29.0–143.4) months. Conclusion The SN procedure allows early identification of patients with occult metastatic disease in clinical stage I TGCT, enabling early treatment.
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Affiliation(s)
- Joost M Blok
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Martijn Kerst
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Erik Vegt
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Oscar R Brouwer
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Axel Bex
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Oncological Urology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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