Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long-Term Results in 1,054 Patients

Stein, John P.; Lieskovsky, Gary; Côté, Richard J.; Groshen, Susan; Feng, An‐Chen; Boyd, Stuart D.; Skinner, Eila C.; Bochner, Bernard H.; Thangathurai, Duraiyah; Mikhail, Maged; Raghavan, Derek; Skinner, Donald G.

doi:10.1200/jco.2001.19.3.666

Cited by 3,251 publications

(2,415 citation statements)

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“…Bladder cancer is a major health problem in the United States, causing approximately 14,000 deaths per year. 2 Current chemotherapeutic regimens result in cure in only a small proportion of patients, and responses are not durable. At the current time, to our knowledge there are no real prognostic factors available other than tumor stage and grade, although attempts have been made to identify molecular markers such as p53 and Ki-67.…”

Section: Discussionmentioning

confidence: 99%

“…Despite recent refinement of various therapeutic strategies, including surgery, radiotherapy, chemotherapy, and combination therapy, the 5-year survival rate remains 50% to 60%. 1,2 One of the reasons for poor prognosis is that bladder cancer, being highly invasive, is frequently associated with extensive local invasion or regional lymph node metastasis, even at initial diagnosis. Targeted therapy with growth factor antagonists has not lived up to its promise.…”

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confidence: 99%

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Cytoplasmic mislocalization of the orphan nuclear receptor Nurr1 is a prognostic factor in bladder cancer

Inamoto

Czerniak

Dinney

et al. 2009

Cancer

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BACKGROUND:Nurr1 belongs to a novel class of orphan nuclear receptors (the NR4A family). The authors have previously shown that Nurr1 is important in carcinogenesis. In the current study, they examined the clinicopathologic relevance of expression patterns of Nurr1 in bladder tumors.METHODS:Nurr1 expression was determined using immunohistochemical staining in a bladder cancer tissue array (145 tumors). Tumors were classified according to Nurr1 protein levels in both cytoplasm and nucleus. Disease‐specific survival and recurrence‐free survival were investigated by Kaplan‐Meier analysis and Cox proportional hazards analysis in multivariate models and correlated with variables such as tumor stage, growth pattern, and clinical outcome (recurrence and survival). In vitro, Nurr1 was examined for its role in bladder cancer cell proliferation and migration using small interfering RNA silencing.RESULTS:Nurr1 expression in tumor cells correlated with increasing tumor stage and invasive growth pattern. Disease‐specific survival was significantly shorter in patients whose tumors demonstrated a high level of cytoplasmic Nurr1 compared with those with lower levels of cytoplasmic Nurr1 expression. Furthermore, cytoplasmic Nurr1 expression level was found to be an independent predictor of disease‐specific survival (odds ratio, 4.894; P < .001). In vitro, silencing of endogenous Nurr1 attenuated the migration of bladder cancer cells.CONCLUSIONS:The expression of Nurr1 in the cytoplasm correlates with adverse outcome and is an independent prognostic marker for tumor progression and survival in patients with bladder cancer. This might represent a novel target in bladder cancer therapy. Cancer 2010. © 2010 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Cytoplasmic mislocalization of the orphan nuclear receptor Nurr1 is a prognostic factor in bladder cancer

Inamoto

Czerniak

Dinney

et al. 2009

Cancer

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“…In evaluating patients for treatment, patients and physicians commonly focus on tumor characteristics such as grade and stage, which have proven to predict risk of recurrence, progression, metastasis, and death [1,2]. Efforts have been made to improve risk assessment by examining other pathological parameters such as number of lymph nodes [16], depth of tumor invasion [17], and biomarker status [18].…”

Section: Discussionmentioning

confidence: 99%

“…While prognostic factors for cancer in general and bladder cancer specifically traditionally focus on gross and microscopic tumor characteristics [1,2], overall health of patients often impacts survival. Comorbidity is defined as any coexisting disease or condition that may impact diagnosis, treatment, and prognosis for an index disease (in this study, bladder cancer).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Impact of Comorbidity in Patients with Bladder Cancer

Megwalu¹,

Vlahiotis²,

Radwan³

et al. 2008

European Urology

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Objective-To determine the impact of comorbidity on survival of bladder cancer patients.Methods-The population included 675 patients with newly diagnosed bladder cancer whose medical information was abstracted from a hospital cancer registry. Adult Comorbidity Evaluation-27, a validated instrument, was used to prospectively categorize comorbidity. Independent variables assessed include comorbidity, American Joint Committee on Cancer (AJCC) stage, grade, age, gender, and race. Outcome measure was overall survival. We analyzed the entire cohort, patients with noninvasive disease, and patients requiring cystectomy. Cox proportional hazards analysis was used to assess impact of independent variables on survival.Results-Median age at diagnosis for the entire cohort was 71 yr and median follow-up was 45 mo. Of 675 patients, 446 had at least one comorbid condition and 301 died during follow-up. On multivariable analysis for the entire cohort, comorbidity (p = 0.0001), AJCC stage (p = 0.0001), age (p = 0.0001), and race (p = 0.0045) significantly predicted overall survival. On subset analysis of noninvasive bladder cancer patients, comorbidity (p = 0.0001) and age (p = 0.0001) independently predicted overall survival, whereas stage, grade, race, and gender did not. On subset analysis of cystectomy patients, comorbidity (p = 0.0053), stage (p = 0.0001), and race (p = 0.0449) significantly predicted overall survival.Conclusions-Comorbidity is an independent predictor of overall survival in the entire cohort of bladder cancer patients, the subset with noninvasive disease, and the subset treated with cystectomy.

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“…Long-term oncological and functional outcomes are still needed though. Large series with long term follow-up in ORC have shown that approximately half of all cystectomy patients experience local recurrence or distant metastatic disease with subsequent mortality [3]. Surgeons should choose their patients early in their RARC learning curve due to concerns for oncologic control and the technically difficult nature of RARC [4,5].…”

Section: Introductionmentioning

confidence: 99%

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

Rao

Stegemann

Rehman

et al. 2012

Indian J Surg Oncol

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Robot-assisted radical cystectomy (RARC) for bladder cancer is increasingly becoming popular in specialist centres around the world. RARC has the advantage of being minimally invasive and also the dexterity of the instruments allow reconstruction such as ileal conduit urinary diversion or neobladder formation. Starting from the initial series demonstrating the feasibility of RARC and extended pelvic lymph node dissection, we now have mature series demonstrating equal oncological and functional outcomes in the medium term follow-up. In addition, literature suggests decreased hospital stay, less blood loss equating to less blood transfusion and a trend towards decreased complications as well. In the near future we would anticipate further refinement and reduced operating times with increased benefits for the patient undergoing RARC.

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Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long-Term Results in 1,054 Patients

Abstract: These data from a large group of patients support the aggressive surgical management of invasive bladder cancer. Excellent long-term survival can be achieved with a low incidence of pelvic recurrence.

Cited by 3,251 publications

References 21 publications

Cytoplasmic mislocalization of the orphan nuclear receptor Nurr1 is a prognostic factor in bladder cancer

Cytoplasmic mislocalization of the orphan nuclear receptor Nurr1 is a prognostic factor in bladder cancer

Prognostic Impact of Comorbidity in Patients with Bladder Cancer

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

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