Outcomes of radical cystectomy for micropapillary urothelial carcinoma at the University of Southern California.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 300-300
Author(s):  
Adrian Stuart Fairey ◽  
Siamak Daneshmand ◽  
Anne Schuckman ◽  
Gary Leiskovsky ◽  
Hooman Djaladat ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Survival Data ◽  
Southern California ◽  
Multivariable Analysis ◽  
University Of Southern California ◽  
Histologic Type ◽  
The University ◽  
The Impact

300 Background: The role of micropapillary urothelial carcinoma (MUC) variant histology as an independent prognostic factor for survival after radical cystectomy has not been studied. Our aim was to examine the impact of MUC on survival. Methods: A retrospective analysis of prospectively collected data from the University of Southern California (USC) Bladder Cancer Database was performed. Between 1985 and 2008, 1681 patients underwent radical cystectomy and extended pelvic lymph node dissection for primary bladder cancer. All surgical specimens underwent central pathologic review by dedicated genitourinary pathologists. Histologic type was categorized according to the WHO/ISUP 1998 classification as urothelial carcinoma (UC; n=1648) or MUC (n=33). The outcomes were overall survival (OS) and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression models were used to analyze survival data. Results: The median follow-up duration was 10 years (range, 0 to 25 years). Baseline characteristics were similar between histologic types except MUC was associated with advanced clinical (cTanyN1-3: 2% versus 9%, p=0.03) and pathologic (pTanyN1-3: 23% versus 46%, p=0.01) TNM stage, multifocality (37% versus 58%, p=0.02), and high nuclear grade (84% versus 97%, p=0.04). The predicted 5-year OS (59% and 67%, Log rank p=0.79) and RFS (67% and 58%, Log rank p=0.50) rates did not differ between patients with UC and MUC. Multivariable analysis showed that histologic type was not independently associated with OS (HR 0.92, 95% CI 0.56 to 1.50, p=0.73) or RFS (HR 0.92, 95% CI 0.52 to 1.63, p=0.77). Conclusions: Outcomes of radical cystectomy for patients with MUC are similar to those with UC when controlling for other clinical and pathologic factors.

The influence of variant histology on survival outcomes of radical cystectomy for bladder cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 278-278
Author(s):  
Adrian Stuart Fairey ◽  
Eila C. Skinner ◽  
Anne Schuckman ◽  
Gary Leiskovsky ◽  
Jie Cai ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Survival Data ◽  
Multivariable Analysis ◽  
High Risk Group ◽  
Kaplan Meier ◽  
Variant Histology ◽  
Primary Bladder ◽  
The Impact

278 Background: The role of variant histology bladder cancer as an independent prognostic factor for survival after radical cystectomy is poorly defined. Our aim was to examine the impact of variant histology on survival. Methods: A retrospective analysis of prospectively collected data from the University of Southern California Bladder Cancer Database was performed. Between 1971 and 2008, 2098 patients underwent radical cystectomy and extended pelvic lymph node dissection for primary bladder cancer. All surgical specimens underwent centralized pathologic review by dedicated genitourinary pathologists. Histologic type was categorized according to the WHO/ISUP 1998 classification as urothelial carcinoma (UC; n=1595), UC + variant (n=380), or non-urothelial carcinoma (Non-UC; n=123). The outcomes were overall survival (OS) and recurrence-free survival (RFS). The Kaplan-Meier method and Cox proportional regression models were used to analyze survival data. Results: The median follow-up duration was 12.8 years (range, 0 to 36.6 years). The predicted 5-year OS (61%, 53%, and 47%, Log rank p=0.005) and RFS (68%, 59%, and 58%, Log rank p=0.001) rates differed between patients with UC, UC + variant, and Non-UC histology. Multivariable analysis showed that Non-UC (but not UC + variant) histology was independently associated with OS (Non-UC versus UC: HR 1.26, 95% CI 1.01 to 1.57, p=0.040; UC + variant versus UC: HR 0.97, 95% CI 0.85 to 1.12, p=0.697) but not RFS (Non-UC versus UC: HR 1.14, 95% CI 0.83 to 1.56, p=0.411; UC + variant versus UC: HR 1.06, 95% CI 0.88 to 1.28, p=0.551). Conclusions: Non-UC histology was independently associated with poorer OS after radical cystectomy for bladder cancer. Clinical trials are needed to determine whether this high risk group will benefit from multimodal therapy.

RADICAL CYSTECTOMY FOR PRIMARY NEUROENDOCRINE TUMORS OF THE BLADDER: THE UNIVERSITY OF SOUTHERN CALIFORNIA EXPERIENCE

2005 ◽  
Vol 174 (1) ◽  
pp. 93-96 ◽  
Author(s):  
MARCUS L. QUEK ◽  
PETER W. NICHOLS ◽  
JONATHAN YAMZON ◽  
SIAMAK DANESHMAND ◽  
GUS MIRANDA ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Neuroendocrine Tumors ◽  
Southern California ◽  
University Of Southern California ◽  
The University

Impact of perivesical lymph nodes on survival after radical cystectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 350-350
Author(s):  
Brian Robin Hu ◽  
Raj Satkunasivam ◽  
Jie Cai ◽  
Gus Miranda ◽  
Siamak Daneshmand
Keyword(s):  
Bladder Cancer ◽  
Lymph Nodes ◽  
Urothelial Carcinoma ◽  
Radical Cystectomy ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Pelvic Lymphadenectomy ◽  
Lymph Node Staging ◽  
Prognostic Impact ◽  
Significant Difference

350 Background: Lymph node staging for bladder cancer is dependent upon both location and number. This study characterizes perivesical (PV) lymph nodes (LN) found at radical cystectomy and evaluates their prognostic impact. Methods: We reviewed our Institutional Review Board-approved database from 1971-2009 including all patients who underwent radical cystectomy with pelvic lymphadenectomy for curative intent for urothelial carcinoma. Clinical and pathologic data were obtained. Patients were analyzed in three groups: PV LN+/other LN-, PV LN+/other LN+, and PV LN-/other LN+. Kaplan-Meier curves were used to estimate recurrence free survival (RFS) and overall survival (OS). Multivariable Cox regression (including pathologic T stage, number of positive LN, highest level of positive LN, chemotherapy, and margin status) was performed to evaluate associations between PV LN status and survival. Results: A total of 2,045 patients underwent radical cystectomy for urothelial carcinoma of which 2011 met inclusion criteria. PV LN were identified in 936 (47%) patients, positive in 197 (10%) patients, and represented isolated LN positive disease in 101 (5%) patients. On univariate analysis, positive PV LN were associated with a higher likelihood of extravesical disease (>pT2) when compared with other positive LN (p=0.023). There was no significant difference in RFS or OS when comparing patients with negative PV LN to those with PV LN not identified. On multivariable analysis, patients with PV LN+/other LN+ had a significantly worse RFS (HR 1.75, 95% CI 1.29-2.38, p<0.001) and OS (HR 1.66, 95% CI 1.27-2.19, p<0.001) when compared with PV LN-/other LN+. There was no significant difference in RFS or OS when comparing patients with PV LN+/other LN- to PV LN-/other LN+. Conclusions: PV LN are identified in a significant portion of patients after radical cystectomy with pelvic lymphadenectomy. Positive PV LN, when in combination with other positive LN, portends worse survival even when correcting for the number of positive LN. No significant difference in survival was seen comparing patients with isolated positive PV LN to those with other positive LN. This study highlights the importance of PV LN in pathologic analysis and bladder cancer staging.

The impact of preoperative ASA score and serum albumin on early complication and survival rate of patients undergoing radical cystectomy for bladder cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4576-4576
Author(s):  
Hooman Djaladat ◽  
Adrian Stuart Fairey ◽  
Jie Cai ◽  
Gus Miranda ◽  
Eila C. Skinner ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Serum Albumin ◽  
Radical Cystectomy ◽  
Complication Rate ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Early Complication ◽  
Preoperative Serum ◽  
The Impact ◽  
Low Serum

4576 Background: American Society of Anesthesiologist Score (ASA-S) is used to evaluate patient physical status before surgery. Serum albumin (Alb) is also a marker of nutritional status. We evaluated the impact of preoperative ASA-S and Alb on early complication rate and survival of patients who underwent radical cystectomy for bladder cancer. Methods: 1964 patients with primary bladder cancer underwent radical cystectomy between 1971 and 2008 at USC. Preoperative serum Alb and ASA-S were available in 1471 and 1140 patients respectively. Post cystectomy early complication was defined as any surgery related/unrelated event leading to lengthening hospital stay or re-admission within 90 days of surgery. Recurrence free survival (RFS) and overall survival (OS) for these cohorts were reviewed using a Kaplan-Meier and Cox proportional hazards models. Results: The demographic data of patients based on their serum Alb and ASA-S is presented in the Table. The median follow up was 12.4 years (0 - 36.6 yrs). Low serum Alb (<3.4 g/dL) and high ASA-S (3 or 4) were associated with higher early complication rate (43% vs. 33%, p= 0.03 and 40% vs. 28%, p= 0.0001 respectively). In multivariable analysis, low serum Alb level was an independent predictor of RFS (HR 1.35, 95% CI 1.00-1.81) and OS (HR 1.62, 95% CI 1.29-2.04). High ASA-S was an independent predictor of OS (HR 1.45, 95% CI 1.13-1.85), but not RFS. Conclusions: Preoperative low serum Alb and high ASA-S are independently predictive of post cystectomy decreased OS. Low serum Alb is also a risk factor for recurrence after cystectomy. These parameters potentially could be used in nomograms to predict post-cystectomy prognosis. [Table: see text]

Ureteroenteric Strictures After Open Radical Cystectomy and Urinary Diversion: The University of Southern California Experience

Urology ◽  
2015 ◽  
Vol 86 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Swar H. Shah ◽  
Kamran Movassaghi ◽  
Donald Skinner ◽  
Leonard Dalag ◽  
Gus Miranda ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Southern California ◽  
University Of Southern California ◽  
Open Radical Cystectomy ◽  
The University
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