Oncological and Functional Outcome of Radical Cystectomy in Patients With Bladder Cancer and Obstructive Uropathy

Gupta, Narmada P.; Kolla, Surendra B.; Seth, Amlesh; Hemal, Ashok K.; Dogra, Prem Nath; Kumar, Rajeev

doi:10.1016/j.juro.2007.05.142

Cited by 12 publications

(9 citation statements)

References 21 publications

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“…We recognize that the present study is limited by its retrospective design as well as by the fact that the preoperative imaging studies were not centrally reviewed by a single radiologist in the assessment of clinical stage, and that we do not have the data regarding the time interval from imaging to surgery to evaluate as a predictor of upstaging. Similarly, while we did find, as has been noted elsewhere [25,26], that preoperative renal obstruction was predictive of pathological extravesical disease, other clinical variables that may provide prognostic information for patients with cT2 tumours, such as noninvasive tumour stage at presentation [7] and the presence of lymphovascular invasion in the transurethral resection specimen [27], were not available in the present series for analysis. In addition, adjuvant chemotherapy regimens were not uniform, which may have limited our ability to discern the impact of postoperative treatment on survival.…”

Section: Discussionmentioning

confidence: 52%

Clinicopathological outcomes after radical cystectomy for clinical T2 urothelial carcinoma: further evidence to support the use of neoadjuvant chemotherapy

Canter¹,

Long²,

Kutikov³

et al. 2010

BJU International

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Systemic chemotherapy for muscle‐invasive bladder cancer is underutilized. Currently, debate centers on whether patients should be given neoadjuvant chemotherapy or be given chemotherapy after surgery, depending on the pathology of the specimen. In this paper, we found that greater than 73% of patients had evidence of bladder cancer that was locally advanced, a criteria that would designate these patients for adjuvant chemotherapy. Using this evidence and the knowledge that neoadjuvant chemotherapy confers a survival advantage, we argue that neoadjuvant chemotherapy should be the standard of care. OBJECTIVE To evaluate the clinicopathological outcomes for patients with clinical T2 (cT2) urothelial carcinoma treated with radical cystectomy (RC) without neoadjuvant chemotherapy (NC). PATIENTS AND METHODS We identified 212 patients with cT2 tumours who underwent RC at our institution without NC. Pathological assessment of RC specimens was correlated with clinical stage. The impact of various clinicopathological factors on the outcome of patients with cT2 disease was analysed. RESULTS In total, 153/212 (73.2%) patients with cT2 bladder cancer had either pT3/T4 or pN+ tumours at RC. Moreover, only 58/153 (37.9%) of these patients received adjuvant chemotherapy. The median follow‐up was 28 (months 0.6–107.5) (range). The 5‐year recurrence‐free survival and cancer‐specific survival (CSS) was 56.5% and 59.5%, respectively. On multivariate analysis, increasing age (hazard ratio [HR] 1.04; P= 0.04), advanced pathological stage (HR 1.83; P= 0.02), and positive lymph nodes (HR 3.72; P= 0.001) were adversely associated with CSS, while receipt of adjuvant chemotherapy was protective of disease‐specific mortality (HR 0.45; P= 0.04). CONCLUSIONS Pathological upstaging is prevalent and survival remains modest in patients with cT2 tumours treated with RC without NC. Unfortunately, only 40% of patients that had locally advanced and/or regionally metastatic disease received adjuvant treatment. These data further support the value of NC for patients with muscle‐invasive bladder cancer, even in those with apparent clinically organ‐confined tumours.

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Section: Discussionmentioning

confidence: 52%

Clinicopathological outcomes after radical cystectomy for clinical T2 urothelial carcinoma: further evidence to support the use of neoadjuvant chemotherapy

Canter¹,

Long²,

Kutikov³

et al. 2010

BJU International

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“…Gupta N et al . found that ileal conduit may not be ideal for patients with serum creatinine greater than 2.5 mg/dl 38 . To avoid severe renal toxicities caused by chemotherapeutic agents with nephrotoxic properties, drug dosages are usually reduced in patients with renal insufficiency, which may lead to sub-optimal drug concentrations and compromise treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Cao

Zhao

Zhong

et al. 2016

Sci Rep

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The effect of pre-operative renal insufficiency on urothelial carcinoma (UC) prognosis has been investigated by numerous studies. While the majority report worse UC outcomes in patients with renal insufficiency, the results between the studies differed wildly. To enable us to better estimate the prognostic value of renal insufficiency on UC, we performed a systematic review and meta-analysis based on the published literature. A total of 16 studies which involved 5,232 patients with UC, investigated the relationship between pre-operative renal insufficiency and disease prognosis. Estimates of combined hazard ratio (HR) for bladder urothelial carcinoma recurrence, cancer-specific survival (CSS) and overall survival (OS) were 1.65 (95% CI, 1.11–2.19), 1.59 (95% CI, 1.14–2.05) and 1.45 (95% CI, 1.19–1.71), respectively; and for upper urinary tract urothelial carcinoma recurrence, CSS and OS were 2.27 (95% CI, 1.42–3.12), 1.02 (95% CI, 0.47–1.57) and 1.52 (95% CI, 1.05–1.99), respectively. Our results indicate that UC patients with pre-operative renal insufficiency tend to have higher recurrence rates and poorer survival compared to those with clinically normal renal function, thus renal function should be closely monitored in these patients. The impact of intervention for renal insufficiency on the prognosis of UC needs to be further studied.

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“…[14] The perioperative mortality is higher compared to that reported by most of the contemporary series. [13] Systemic consequences of septic complications were the most common cause of perioperative death in our patients. Most of the septic complications are consequent to postoperative chest infection.…”

Section: Discussionmentioning

confidence: 99%

“…Ileal conduit, as the urinary diversion appears to be safe in patients with a serum creatinine of <2.5 mg% at surgery. [13]…”

Section: Discussionmentioning

confidence: 99%

Radical cystectomy for bladder cancer: A single center experience

et al. 2008

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We present the outcomes of a large series of patients treated with radical cystectomy and pelvic lymphadenectomy for transitional cell carcinoma of bladder.Materials and Methods:A total of 502 patients underwent radical cystectomy (RC) for bladder cancer from 1992 till December 2006. Of these, 432 patients with primary transitional cell carcinoma of bladder underwent RC with bilateral pelvic lymphadenectomy with a curative intent. The clinical course, pathologic characteristics and long-term clinical outcomes were evaluated in this group of patients.Results:The median follow-up was 62 months. There were 30 (6.9%) perioperative deaths and 111(25.7%) early complications. The recurrence-free survival (RFS) and overall survival (OAS) were 66% and 62% at five years and 62% and 40% respectively at 10 years. The RFS and OAS were significantly related to the pathological stage and lymph node status with increasing pathological stage and lymph node positivity associated with higher rate of recurrence and worse OAS (P < 0.001). A total of 145 patients (33.5%) developed bladder cancer recurrence. Of these, 40 (27.6%) developed local pelvic recurrence and 105 patients (72.4%) developed distant recurrence. The median time to local and distant recurrence was 12 and 16 months respectively.Conclusion:The clinical results reported from this large group of patients demonstrate that radical cystectomy provides good survival results for invasive bladder cancer patients with low incidence of pelvic recurrence.

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Oncological and Functional Outcome of Radical Cystectomy in Patients With Bladder Cancer and Obstructive Uropathy

Cited by 12 publications

References 21 publications

Clinicopathological outcomes after radical cystectomy for clinical T2 urothelial carcinoma: further evidence to support the use of neoadjuvant chemotherapy

Clinicopathological outcomes after radical cystectomy for clinical T2 urothelial carcinoma: further evidence to support the use of neoadjuvant chemotherapy

Prognostic Value of Pre-operative Renal Insufficiency in Urothelial Carcinoma: A Systematic Review and Meta-Analysis

Radical cystectomy for bladder cancer: A single center experience

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