Preoperative Hydronephrosis Predicts Advanced Bladder Cancer but Is Not an Independent Factor for Cancer-Specific Survival after Radical Cystectomy

Höfner, Thomas; Haferkamp, Axel; Knapp, Lena; Pahernik, Sascha; Hadaschik, Boris; Wagener, Nina; Hohenfellner, Markus

doi:10.1159/000321008

Cited by 13 publications

(14 citation statements)

References 36 publications

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“…All studies were published between 2004 and 2015, with the mean duration of follow-up varying from 20 to 148 months. Of the 36 studies, 14 were conducted in North America [4, 8–20], 8 in Europe [21–28], 6 in Asia [7, 29–33] and 8 at international multicenters [34–41]. The meta-analysis was based on a total sample size of 38,384 patients, of which 4,354 patients were reported to have positive surgical margins.…”

Section: Resultsmentioning

confidence: 99%

Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis

Hong

Ling

et al. 2016

Oncotarget

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Data regarding the association between surgical margin status and the outcome of bladder cancer treated by radical cystectomy (RC) are conflicting. Therefore, the present meta-analysis was performed to assess the associations between the outcomes of bladder cancer, in terms of recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS), and the presence of positive surgical margins versus negative surgical margins following treatment with RC. Research articles published prior to April 2016 were identified from Pubmed, Embase and the Cochrane Library databases. A total of 36 articles were included, with a sample size of 38,384 bladder cancer patients. Of these, 4,354 patients were reported to have positive surgical margins. Significant associations were detected between positive surgical margins following RC and unfavorable RFS [summary relative risk estimate (SRRE), 1.63; 95% confidence interval (CI), 1.46-1.83; P = 0.105], CSS (SRRE, 1.82; 95% CI, 1.63-2.04; P = 0.001) and OS (SRRE, 1.68; 95% CI, 1.58-1.80; P = 0.805), by fixed or random effects models. The findings were consistent independently of age, sample size, publication year, follow-up duration, study type and geographical region. In summary, the present findings demonstrate that the presence of positive surgical margins is associated with poor survival outcomes in bladder cancer following RC, indicating that avoidance of positive surgical margins during surgery is helpful to improve the prognosis of patients with bladder cancer.

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Section: Resultsmentioning

confidence: 99%

Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis

Hong

Ling

et al. 2016

Oncotarget

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“…Many patients with bladder cancer were found to have hydronephrosis due to ureteral orifice obstruction by tumor. Although pathologic stage is regarded as crucial prognostic characteristic after radical cystectomy, the prognostic role of hydronephrosis has been investigated with conflicting results . To the best our knowledge, the relationship between the presence of preoperative hydronephrosis and prognosis after RARC has not yet been investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Although pathologic stage is regarded as crucial prognostic characteristic after radical cystectomy, the prognostic role of hydronephrosis has been investigated with conflicting results. [19][20][21][22] To the best our knowledge, the relationship between the presence of preoperative hydronephrosis and F I G U R E 1 Receiver operating characteristic (ROC) curves for overall survival prognosis after RARC has not yet been investigated. In our study, we found that preoperative hydronephrosis was significantly associated with 1-year mortality after RARC according to univariate cox regression.…”

Section: Discussionmentioning

confidence: 99%

Preoperative predictors of early death risk in bladder cancer patients treated with robot‐assisted radical cystectomy

Zhu

Wang

et al. 2019

Cancer Medicine

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Background Early identification of early death for bladder cancer patients undergoing radical cystectomy based on the laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for bladder cancer patients. Methods A total of 186 bladder cancer patients who underwent robot‐assisted radical cystectomy (RARC) were identified between October 2014 and May 2017. The probability of dying within 1 year after RARC was defined as the end point “early death.” Predictive factors including clinical features and laboratory findings at diagnosis were retrospectively collected. Results Median follow‐up time after RARC was 20.6 months (1.2‐43.7 months). Fifty‐one patients (27.4%) died during follow‐up and 31 within 1 year from surgery (1‐year mortality rate: 16.7%). All potentially prognostic factors were assessed on univariate analyses, which revealed the following factors as being associated with higher risk of early death within 1 year after RARC: older age ( P = 0.004), advanced clinical stage ( P = 0.005), presence of hydronephrosis ( P = 0.021), higher fibrinogen ( P = 0.007), higher PLR ( P = 0.031), and lower PNI ( P = 0.016). In a multivariate Cox proportional hazard regression model analysis, age >60 years (HR = 7.303, 95% CI 1.734‐30.764; P = 0.007) and fibrinogen ≥3.295 g/L (HR = 2.396, 95% CI 1.138‐5.045; P = 0.007) at diagnosis were independent prognostic factors of early death after RARC. Conclusion Age and preoperative elevated plasma fibrinogen level were independent predictors for 1‐year mortality after RARC. We believe that plasma fibrinogen levels may become a useful biomarker, which may help guide the treatment decision‐making process for patients with bladder cancer.

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“…Thus, most studies identify patient comorbidity as an important risk factor for complications after radical prostatectomy. Importantly, obesity by itself does not seem to be an independent risk factor [29]. …”

Section: Discussionmentioning

confidence: 99%

Systematic Assessment of Complications and Outcome of Radical Cystectomy Undertaken with Curative Intent in Patients with Comorbidity and over 75 Years of Age

Hakenberg

Froehner²,

Zastrow³

et al. 2013

Urol Int

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Objective: To evaluate the complications, survival and oncological outcome of patients ≥75 years of age after radical cystectomy for muscle-invasive bladder cancer. Patients and Methods: Between April 1993 and August 2010, 765 patients with muscle-invasive bladder cancer underwent radical cystectomy at one high-volume center. Of these, 70 patients were ≥75 years of age. All 70 patients had at least one severe systemic comorbidity with an American Society of Anesthesiologists score of 3. Primary endpoints of this retrospective study were overall and recurrence-free survival with a mean follow-up of 22 months (1-159). Perioperative parameters such as need for blood transfusions, hospital stay, mortality, short- and long-term complications were also assessed. Complications were graded according to the Clavien-Dindo classification. Results: Perioperative complications occurred in 23/70 patients (33%) with a 30-day mortality rate of 1.4%. 16/70 patients (23%) developed late complications requiring hospitalization. Within 30 days of surgery, according to the Clavien-Dindo grading, 27% had no complications, 3% grade 1, 49% grade 2, 14% grade 3, 6% grade 4 and 1.4% grade 5 complications. Within 31-90 days after surgery, 76% had grade 1 complications, 3% grade 2, 6% grade 3, 9% grade 4 and 6% grade 4 complications. The calculated 5- and 8-year overall survival rates were 30 and 25%, respectively, with a recurrence-free survival rate of 52% at 5 and 42% at 8 years. Conclusions: Radical cystectomy is an appropriate and effective treatment for comorbid elderly patients. The oncological long-term outcome is the same as in younger patients while overall survival is comparatively lower. Mortality and complication-related morbidity are comparable to those in younger patients with modern perioperative management.

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Preoperative Hydronephrosis Predicts Advanced Bladder Cancer but Is Not an Independent Factor for Cancer-Specific Survival after Radical Cystectomy

Cited by 13 publications

References 36 publications

Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis

Impact of surgical margin status on the outcome of bladder cancer treated by radical cystectomy: a meta-analysis

Preoperative predictors of early death risk in bladder cancer patients treated with robot‐assisted radical cystectomy

Systematic Assessment of Complications and Outcome of Radical Cystectomy Undertaken with Curative Intent in Patients with Comorbidity and over 75 Years of Age

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