-
Clinical Genitourinary Cancer Aug 2024Trimodal therapy (TMT) is guideline-recommended for the management of organ confined urothelial carcinoma of urinary bladder (UCUB). However, temporal trends in TMT use...
INTRODUCTION
Trimodal therapy (TMT) is guideline-recommended for the management of organ confined urothelial carcinoma of urinary bladder (UCUB). However, temporal trends in TMT use and cancer-specific mortality free-survival (CSM-FS) between historical TMT versus contemporary TMT have not been assessed. We addressed this knowledge gap.
MATERIAL AND METHODS
Within the Surveillance, Epidemiology, and End Results database (2004-2020), we identified nonmetastatic UCUB patients with cT2-T4aN0-N2 treated with TMT, defined as the combination of transurethral resection of bladder tumor, chemotherapy and radiotherapy. Temporal trends described TMT use over time. Subsequently, patients were divided between historical (2004-2012) versus contemporary (2013-2020) cohorts. Survival analyses consisting of Kaplan-Meier plots and multivariable Cox regression (MCR) models addressed CSM-FS. Separate analyses addressed patients with organ confined (OC: cT2N0M0) versus nonorgan confined (NOC: cT3-4a and/or cN1-2) clinical stages.
RESULTS
Of 4,097 assessable UCUB TMT patients, 1744 (43%) were treated in the historical period (2004-2012) versus 2353 (58%) in the contemporary period (2013-2020). TMT use increased over time in OC patients (EAPC:+3.4%, P < .001), as well as in NOC (EAPC:+2.7%, P < .001). In OC stage, median CSM-FS was 55.3% in historical versus 49.0% in contemporary patients (HR:0.75, P < .001). Similarly, in NOC stage, 5-year median CSM-FS was 43.0% in historical versus 32.8% in contemporary patients (HR:0.78, P = .01).
CONCLUSION
TMT rates have increased over time in both OC and NOC patients. Contemporary TMT patients benefit of better cancer-specific survival. Interestingly, this benefit applies equally to OC and NOC TMT-treated patients.
Topics: Humans; Urinary Bladder Neoplasms; Male; Female; Aged; Middle Aged; SEER Program; Carcinoma, Transitional Cell; Neoplasm Staging; Combined Modality Therapy; Cystectomy; Aged, 80 and over; Retrospective Studies; Neoplasm Invasiveness; Kaplan-Meier Estimate
PubMed: 38852435
DOI: 10.1016/j.clgc.2024.102119 -
Surgery Jun 2024Although organs are preserved and quality of life is improved, insufficient evidence is available for the oncologic safety of partial cystectomy in patients with...
BACKGROUND
Although organs are preserved and quality of life is improved, insufficient evidence is available for the oncologic safety of partial cystectomy in patients with colorectal cancer with suspected bladder invasion. Therefore, we aimed to compare partial and total cystectomy outcomes in patients with pathologically confirmed or clinically suspected bladder invasion.
METHODS
Patients with colorectal cancer with suspected bladder invasion who underwent R0 resection from 2000 to 2020 were evaluated. Long-term outcomes were determined in patients with histologically confirmed bladder invasion.
RESULTS
Of the 151 consecutive patients, 96 (64.6%) had histologically confirmed bladder involvement, and 105 (69.5%) underwent partial cystectomy. Operative time, estimated blood loss, and reoperation rate in ≤30 days were significantly worse in the total cystectomy group than in the partial cystectomy group. The overall recurrence rate was significantly higher in the total cystectomy group than in the partial cystectomy group (39.1% vs 21.9%; P = .046). Five-year overall survival (75.8% vs 53.2%; P = .006) rates were higher in the partial cystectomy group than in the total cystectomy group; however, disease-free survival (60.8% vs 41.6%; P = .088) rates were similar in patients with suspected bladder invasion. In patients with histologically confirmed bladder invasion, 5-year overall survival rates (78.1% vs 52.1%; P = .017) were higher in the partial cystectomy group than in the total cystectomy group; however, disease-free survival rates (53.4% vs 41.2%; P = .220) did not differ significantly.
CONCLUSION
R0 resection is associated with favorable long-term outcomes in patients with locally advanced colorectal cancer. If R0 resection is possible, partial cystectomy is considered safe.
PubMed: 38851902
DOI: 10.1016/j.surg.2024.04.007 -
European Urology Focus Jun 2024Approximately 25% of bladder cancers exhibit variant histology, an updated term used in the 2022 World Health Organization histological classification of bladder cancer.... (Review)
Review
Approximately 25% of bladder cancers exhibit variant histology, an updated term used in the 2022 World Health Organization histological classification of bladder cancer. These variant histologies differ by molecular pattern and clinical behaviour, and there are some differences in treatment recommendations in comparison to pure urothelial carcinoma (UC). Some UCs also exhibit nonconventional histologic features in addition to a urothelial component. Treatment is similar for UCs with nonconventional and conventional histologies. Data on neoadjuvant treatment, bladder preservation, adjuvant treatment, and the impact of new therapies are limited for plasmacytoid, micropapillary, sarcomatoid, neuroendocrine, squamous, and adenocarcinoma variants. Therefore, upfront radical cystectomy is traditionally recommended for local management. It is important to recognise UC subtypes and their differential management. Clinical trials focusing specifically on these variant subtypes of bladder cancer are needed. PATIENT SUMMARY: In this paper we summarize key points for the management of uncommon bladder cancer types. We highlight the importance of correct diagnosis of these tumours for selection of the most suitable treatment.
PubMed: 38849276
DOI: 10.1016/j.euf.2024.05.015 -
The French Journal of Urology Jun 2024The objective of our study is to demonstrate the practical application of continent cutaneous urinary diversion (CCUD) in oncological patients, with a focus on various...
OBJECTIVES
The objective of our study is to demonstrate the practical application of continent cutaneous urinary diversion (CCUD) in oncological patients, with a focus on various aspects of the procedure: surgical challenges, functional outcomes, and quality of life.
MATERIALS AND METHODS
We studied the perioperative and follow-up data of patients who underwent cystectomy for cancer associated with CCUD (Mitrofanoff, Monti or Casale). We retrospectively analyzed complications within 30days and beyond 30days post-surgery. We evaluated oncological outcomes. Patients' quality of life was assessed using the Bladder Cancer Index (BCI) questionnaire. Results are given on an intention-to-treat basis.
RESULTS
A total of 24 patients were included in the study (July 2001 and May 2022), with a median follow-up of 62.5months. We report three deaths due to neoplasic recurrence. Forty-six percent had an early postoperative complication, two of whom required revision surgery. Overall, the medium-term complication rate was 70% and the reoperation rate was 62%. There were 8 stomal cutaneous stenoses (33%) and 3 uretero-ileal stenoses (12.5%). Overall satisfaction was rated at 9.2/10 on average, and body image was unaltered or slightly altered in 62.5% of patients. Of the patients who responded to the BCI, 75% had complete continence.
DISCUSSION
The experience gained with continent stomas in neuro-urology has allowed, in carefully selected cases, to offer patients an alternative that can improve their quality of life in a context already burdened by the shadow of cancer. CCUD can be proposed as an alternative to Bricker diversion in cases of urethral invasion or a high risk of neobladder incontinence, in selected patients.
PubMed: 38849033
DOI: 10.1016/j.fjurol.2024.102665 -
Cureus May 2024Urinary bladder cancer (UBC) is amongst the most common urological malignancies.
BACKGROUND
Urinary bladder cancer (UBC) is amongst the most common urological malignancies.
AIM
To study different types of urinary bladder lesions in the north Indian population and to correlate various clinical and pathological findings.
MATERIALS AND METHODS
The present prospective study was conducted on 100 cases undergoing transurethral resection of bladder tumor (TURBT) and/or radical cystectomy over a period of 2.5 years followed by histopathological examination. Liquid-based cytology for malignant cells in urine was also performed. Immunohistochemistry was employed for tumor typing wherever needed.
RESULTS
A total of 100 cases were studied. Male to female ratio was 15.7:1 and most of the patients were in the sixth decade (40%). Painless hematuria was the commonest clinical presentation (60%) and smoking was the commonest risk factor (80%). The most common lesion was infiltrating urothelial carcinoma seen in 72 cases followed by papillary urothelial neoplasm of low malignant potential (PUNLMP) seen in eight cases. Grade and depth of invasion were assessed and correlated. Several variants of infiltrating urothelial carcinoma such as squamous differentiation, glandular differentiation, microcystic, clear cell, nested, and micropapillary were also identified. Clinical, cystoscopic and histopathological findings were correlated in all the cases.
CONCLUSION
Infiltrating urothelial carcinoma high grade was the most common bladder lesion identified and muscle invasion was more common with higher-grade lesions. A decade-younger age group was found to be more affected in the present series. Urine cytology for malignant cells is useful for early diagnosis of cancer. Immunohistochemistry is an important ancillary adjunct.
PubMed: 38846211
DOI: 10.7759/cureus.59792 -
Minerva Urology and Nephrology Jun 2024Radical cystectomy (RC) shows an important impact on quality of life (QoL), for various clinical aspects. The aim of our study was to evaluate the short-term bowel...
BACKGROUND
Radical cystectomy (RC) shows an important impact on quality of life (QoL), for various clinical aspects. The aim of our study was to evaluate the short-term bowel function in patients that underwent RC.
METHODS
Two hundred and six patients with MIBC underwent RC with ONB or IC urinary diversion. QoL was measured using the EORTC QLQ C30 and the Short-Form SF-36 questionnaires before surgery and at 12 months postoperatively. Baseline characteristics, including demographic profile, BMI, Charlson Comorbidity Index (CCI), modified Frailty Index (m-FI), pathological tumor stage, Clavien-Dindo grade, and neo-adjuvant chemotherapy were recorded and compared.
RESULTS
The uni-variate and multivariate analysis (OR) were performed for constipation, diarrhea and m-FI of patients underwent RC for localized MIBC according to global health status score (poor/good vs very good). Multivariate analysis showed that constipation medium/high was significant associated with global health status poor/good (OR=2.39; 95% CI: 1.22-4.71; P=0.01); Diarrhea medium/high was associated with global health status poor/good (OR=2.85; 95% CI:1.18-6.92; P=0.02), and m-FI ≥2 score (OR=2.13; 95% CI: 0.99-4.57; P=0.05).
CONCLUSIONS
Diarrhea and constipation are associated with a lower QoL in cystectomized patients, both with ONB or IC urinary diversion; such association is especially significant in more fragile patients (Frailty Index ≥2).
PubMed: 38842052
DOI: 10.23736/S2724-6051.24.05730-6 -
Cureus May 2024Malignant tumors metastasizing to the bladder are uncommon, and bladder metastasis from uterine cancer is particularly rare. Several cases of bladder metastasis from...
Malignant tumors metastasizing to the bladder are uncommon, and bladder metastasis from uterine cancer is particularly rare. Several cases of bladder metastasis from malignant melanoma, gastric cancer, breast cancer, and renal cancer have been documented. However, to our knowledge, only four cases of bladder metastasis from endometrial cancer had been reported up until 2024. Here, we present a case of bladder metastasis of endometrial cancer following modified radical hysterectomy, which was successfully treated through multidisciplinary intervention.
PubMed: 38841040
DOI: 10.7759/cureus.59713 -
Archives of Gynecology and Obstetrics Jul 2024Anterior enterocele is a rare but potentially serious complication after cystectomy with heterogeneous treatment options. (Review)
Review
PURPOSE
Anterior enterocele is a rare but potentially serious complication after cystectomy with heterogeneous treatment options.
METHODS
Here we report on the management of a 71-year-old patient with recurrence of anterior enterocele after cystectomy and provide a systematic review of the literature using the PubMed/MEDLINE database.
RESULTS
The 71-year-old patient with recurrence of anterior enterocele after cystectomy was successfully treated with colpocleisis and anterior colporrhaphy at the Department of Gynecology and Gynecological Oncology, University Hospital Bonn. The use of a synthetic mesh was not needed. At 16-month follow-up postoperatively, the patient was asymptomatic and had no signs of recurrence. n = 14 publications including n = 39 patients were identified for the systematic review including case reports and reviews. The median duration of developing an anterior enterocele after cystectomy was 9 months (range 3 months to 8 years). Patients had a median age of 71 years (range 44-84). In all cases, a surgical approach was described using a wide variety of surgical procedures. In total, 36% of all patients developed a recurrence with an average time period of 7 months after primary surgery. A rare complication represents a vaginal evisceration with the need of urgent surgery. Furthermore, the occurrence of a fistula is a possible long-term complication.
CONCLUSION
Anterior enterocele after cystectomy is a rare complication requiring an individual and interdisciplinary treatment.
Topics: Humans; Female; Aged; Cystectomy; Urinary Bladder Neoplasms; Postoperative Complications; Hernia; Recurrence
PubMed: 38839608
DOI: 10.1007/s00404-024-07569-0 -
Clinical Case Reports Jun 2024The "gold standard" treatment for Squamous cell carcinoma (SCC) is radical cystectomy and different management approaches that combine chemotherapy and radiation in a...
KEY CLINICAL MESSAGE
The "gold standard" treatment for Squamous cell carcinoma (SCC) is radical cystectomy and different management approaches that combine chemotherapy and radiation in a neoadjuvant or adjuvant setting have been attempted with varying degrees of effectiveness. For certain individuals, partial cystectomy offers sufficient local control for muscle-invasive bladder cancer. Lifelong follow-up with cystoscopy is advised due to the possibility of potentially fatal late recurrence.
ABSTRACT
Squamous cell carcinoma (SCC) of the bladder is a rare urologic malignancy that is estimated to affect 3%-5% of the bladder cases. SCC of the bladder remains the most common subtype throughout Africa. Most of the literatures focused on the management of Urothelial carcinoma (UC), with fewer discussions on SCC management. UC typically presents with painless hematuria, whereas SCC presents with painful hematuria, bladder mass, and necroturia. SCC is mostly radioresistant and does not respond to chemotherapy. The mainstay treatment is partial cystectomy or radical cystectomy, which can be performed through open surgery or laparoscopic or robot-assisted approaches, all of which have acceptable results. We report a patient with a favorable outcome following partial cystectomy who was managed by open surgery. At the 12-month follow-up, the patient remained asymptomatic with good surgical outcomes.
PubMed: 38836113
DOI: 10.1002/ccr3.9019 -
European Urology Focus Jun 2024
Re: Riccardo Mastroianni, Gabriele Tuderti, Mariaconsiglia Ferriero, et al. Robot-assisted Radical Cystectomy with Totally Intracorporeal Urinary Diversion Versus Open Radical Cystectomy: 3-Year Outcomes from a Randomised Controlled Trial. Eur Urol 2024;85:422-30.
PubMed: 38834426
DOI: 10.1016/j.euf.2024.04.010