Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival

Türk, Hakan; Ün, Sıtkı; Cinkaya, Ahmet; Kodaz, Hilmi; Parvizi, Murtaza; Zorlu, Ferruh

doi:10.5301/tj.5000626

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…We identified a total of 30 studies with 32,591 patients ( Table 2 ). There were varied definitions of delay to RC, with 11 studies identifying the “start point” as “diagnosis of bladder cancer” ( 18 – 28 ), while another 10 used “time of transurethral resection of bladder tumour” (TURBT) ( 6 , 7 , 29 – 36 ). Five studies evaluated the delay between neoadjuvant chemotherapy and RC ( 29 , 37 – 40 ).…”

Section: Evidence Synthesismentioning

confidence: 99%

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Leow¹,

Tan²,

Tan³

et al. 2022

Front. Surg.

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PurposeThe COVID-19 pandemic has led to competing strains on hospital resources and healthcare personnel. Patients with newly diagnosed invasive urothelial carcinomas of bladder (UCB) upper tract (UTUC) may experience delays to definitive radical cystectomy (RC) or radical nephro-ureterectomy (RNU) respectively. We evaluate the impact of delaying definitive surgery on survival outcomes for invasive UCB and UTUC.MethodsWe searched for all studies investigating delayed urologic cancer surgery in Medline and Embase up to June 2020. A systematic review and meta-analysis was performed.ResultsWe identified a total of 30 studies with 32,591 patients. Across 13 studies (n = 12,201), a delay from diagnosis of bladder cancer/TURBT to RC was associated with poorer overall survival (HR 1.25, 95% CI: 1.09–1.45, p = 0.002). For patients who underwent neoadjuvant chemotherapy before RC, across the 5 studies (n = 4,316 patients), a delay between neoadjuvant chemotherapy and radical cystectomy was not found to be significantly associated with overall survival (pooled HR 1.37, 95% CI: 0.96–1.94, p = 0.08). For UTUC, 6 studies (n = 4,629) found that delay between diagnosis of UTUC to RNU was associated with poorer overall survival (pooled HR 1.55, 95% CI: 1.19–2.02, p = 0.001) and cancer-specific survival (pooled HR of 2.56, 95% CI: 1.50–4.37, p = 0.001). Limitations included between-study heterogeneity, particularly in the definitions of delay cut-off periods between diagnosis to surgery.ConclusionsA delay from diagnosis of UCB or UTUC to definitive RC or RNU was associated with poorer survival outcomes. This was not the case for patients who received neoadjuvant chemotherapy.

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Section: Evidence Synthesismentioning

confidence: 99%

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Leow¹,

Tan²,

Tan³

et al. 2022

Front. Surg.

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“…They found that patients with noninvasive bladder cancer who underwent surgical treatment had an increased incidence of muscle-invasive bladder cancer, which was associated with worse survival outcomes. Türk et al [ 18 ] retrospectively analyzed the case data from 530 patients who underwent radical cystectomy or pelvic lymphadenectomy by selected surgeons between May 2005 and April 2016. They found that patients with early radical cystectomy had better disease-free survival and overall survival time than patients with pelvic lymphadenectomy.…”

Section: Introductionmentioning

confidence: 99%

Prognosis Analysis and Perioperative Research of Elderly Patients with Non‐Muscle‐Invasive Bladder Cancer under Computed Tomography Image of Three‐Dimensional Reconstruction Algorithm

Qiu

Cong

2022

Contrast Media & Molecular Imaging

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To analyze the application value of computed tomography (CT) based on a three-dimensional reconstruction algorithm in perioperative nursing research and prognosis analysis of non-muscle-invasive bladder cancer (NMIBC), a retrospective study was performed on 124 patients with NMIBC who underwent surgical treatment in the hospital. All patients underwent CT examination based on the three-dimensional reconstruction algorithm before surgery, and transurethral resection of the bladder tumor was performed. The patients receiving conventional care were classified as the control group, and those receiving comprehensive care were classified as the case group, and the recovery status and recurrence of the two groups were compared. The results showed that the accuracy, specificity, and sensitivity of CT imaging information based on the three-dimensional reconstruction algorithm for NMIBC patients were 89.38, 93.77, and 84.39, respectively. The incidence of bladder spasm (9.68%), bladder flushing time (1.56 d), and retention of drainage tube time (2.68 d) in the case group were obviously lower compared with the control group (30.65%, 2.32 d, and 5.19 d) ( P < 0.05). Serum BLCA-1 (3.72 ng/mL) and CYFRA21-1 (5.68 μg/mL) in the case group were significantly lower than those in the control group, with a statistically considerable difference ( P < 0.05). Compared with the control group, the scores of role function (89.82 points), emotional function (84.76 points), somatic function (79.23 points), and social function (73.93 points) in the case group were observably higher ( P < 0.05). In addition, one year after the operation, CT examination showed that the recurrence rate in the case group (6.45%) was significantly lower than that in the control group (22.58%) ( P < 0.05). Therefore, CT detection based on the three-dimensional reconstruction algorithm was particularly important for preoperative diagnosis, prognosis, and recurrence monitoring of NMIBC patients. It could provide great clinical value for the diagnosis and prognosis monitoring of NMIBC.

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“…However, a significant number of patients do not respond to NAC, with reported pT0 rates of 38% to neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) and accelerated MVAC [6,7], as well as pT0 rates of 42% to dose-dense MVAC (ddMVAC) and 36% to gemcitabine, cisplatin (GC) [8]. The NAC nonresponders suffer from unnecessary adverse effects and a delay in time to cystectomy leading to worse overall survival [9,10]. Subsequently, there remains a critical need to understand the molecular biology behind NAC responsiveness, in order to better tailor individual NAC therapy.…”

Section: Introductionmentioning

confidence: 99%

Predictive molecular biomarkers for determining neoadjuvant chemosensitivity in muscle invasive bladder cancer

et al. 2022

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Introduction: Identifying neoadjuvant chemotherapy (NAC) response in patients with muscle invasive bladder cancer (MIBC) has had limited success based on clinicopathological features and molecular subtyping. Identification of chemotherapy responsive cohorts would facilitate delivery to those most likely to benefit. Objective: Develop a molecular signature that can identify MIBC NAC responders (R) and non-responders (NR) using a cohort of known NAC response phenotypes, and better understand differences in molecular pathways and subtype classifications between NAC R and NR. Materials and Methods: Presented are the messenger RNA (mRNA) and microRNA (miRNA) differential expression profiles from initial transurethral resection of bladder tumor (TURBT) specimens of a discovery cohort of MIBC patients consisting of 7 known NAC R and 11 NR, and a validation cohort consisting of 3 R and 5 NR. Pathological response at time of cystectomy after NAC was used to classify initial TURBT specimens as R (pT0) versus NR (≥pT2). RNA and miRNA from FFPE blocks were sequenced using RNAseq and qPCR, respectively. Results: The discovery cohort had 2309 genes, while the validation cohort had 602 genes and 13 miRNA differentially expressed between R and NR. Gene set enrichment analysis identified mitochondrial gene expression, DNA replication initiation, DNA unwinding in the R discovery cohort and positive regulation of vascular associated smooth muscle cell proliferation in the NR discovery cohort. Canonical correlation (CC) analysis was applied to differentiate R versus NR. 3 CCs (CC13, CC16, and CC17) had an AUC >0.65 in the discovery and validation dataset. Gene ontology enrichment showed CC13 as nucleoside triphosphate metabolic process, CC16 as cell cycle and cellular response to DNA damage, CC17 as DNA packaging complex. All patients were classified using established molecular subtypes: Baylor, UNC, CIT, Lund, MD Anderson, TCGA, and Consensus Class. The MD Anderson p53-like subtype, CIT Oncotarget 1189 www.oncotarget.com MC4 subtype and Consensus Class stroma rich subtype had the strongest correlation with a NR phenotype, while no subtype had a strong correlation with the R phenotype. Conclusions: Our results identify molecular signatures that can be used to differentiate MIBC NAC R versus NR, salient molecular pathway differences, and highlight the utility of molecular subtyping in relation to NAC response.

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Effect of delayed radical cystectomy for invasive bladder tumors on lymph node positivity, cancer-specific survival and total survival

Cited by 3 publications

References 19 publications

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

Prognosis Analysis and Perioperative Research of Elderly Patients with Non‐Muscle‐Invasive Bladder Cancer under Computed Tomography Image of Three‐Dimensional Reconstruction Algorithm

Predictive molecular biomarkers for determining neoadjuvant chemosensitivity in muscle invasive bladder cancer

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