Comparison of oncologic outcomes for robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) among locally advanced and node-positive patients: An analysis of the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17002-e17002
Author(s):  
Akshay G Reddy ◽  
Andrew D Sparks ◽  
Christina Darwish ◽  
Michael Joseph Whalen
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Inpatient Stay ◽  
Lymph Node Yield ◽  
Node Positive

e17002 Background: Despite recent concerns of atypical recurrence following RARC, utilization of the modality is increasing. The presumed mechanisms are especially relevant in more aggressive disease, where the metastatic potential of tumor cells may be greater. This study aims to compare the oncologic efficacy of RARC to ORC among patients with stage pT3-4 or node-positive bladder cancer. Methods: A retrospective cohort analysis of pT3-4N0-3 and pT(any)-4N1-3 patients who underwent RARC or ORC from 2010-2016 was performed using the NCDB. Appropriate univariate and multivariable analysis were performed between treatment cohorts. Results: RARC was significantly associated with superior unadjusted survival compared to ORC (median survival relative to ORC; 23.6 mo. vs. 21.6 mo.; P= 0.001). Additionally, RARC was associated with lower proportions of unadjusted 30- and 90-day mortality, positive margin status, and shorter surgical inpatient stay (all respective P< 0.05). However, after adjusting for confounding covariates, multivariable analysis revealed no difference in mortality hazard or odds of secondary outcomes with the exception of inpatient stay (Table). RARC was also significantly associated with higher lymph node yield (increased incidence of > 14 lymph nodes examined relative to ORC; 55% vs. 40%; P< 0.01). Conclusions: RARC is no less safe than ORC for patients with locally advanced or node-positive bladder cancer on the basis of overall, 30- and 90-day survival outcomes. Unadjusted mortality and surgical outcomes in this population demonstrate advantages to the robotic modality. Perioperative benefits may favor RARC, but further randomized control studies are necessary to better elucidate differences between surgical approaches. [Table: see text]

The role of cytoreductive nephrectomy (CN) for patients with metastatic renal cell carcinoma (mRCC) in the setting of retroperitoneal lymphadenopathy: An analysis of the National Cancer Database (NCDB).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 688-688
Author(s):  
Akshay Reddy ◽  
Andrew D Sparks ◽  
Michael Joseph Whalen
Keyword(s):  
Hospital Readmission ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Open Approach ◽  
Day Hospital ◽  
Aggressive Approach ◽  
Lymph Node Yield ◽  
Node Positive ◽  
Metastatic Setting

688 Background: Recent evidence has suggested systemic therapy alone (ST) may be comparable to CN in treating mRCC. This study aims to understand oncologic outcomes and survival of those with node positive mRCC treated with ST compared to CN and explore the role of LAD at the time of surgery. Methods: A retrospective cohort analysis of patients who had undergone either ST or CN for clinically node-positive mRCC was performed using the NCDB. The CN group was subdivided into no LND vs. LND (based on reported lymph node yield, “LNY” (i.e. 0 vs. ≥1). Demographic and clinicopathological variables were compared to adjust for confounding covariates in multivariable analysis. Patients who underwent palliative treatments or LAD without nephrectomy were excluded. Results: The majority of CN were performed via open approach (70.1%). CN was associated with decreased mortality hazard relative to ST, while no difference in survival was detected between LAD and no LAD (Table). Median LNY was 2. Inpatient stay was significantly longer for LAD relative to no LAD (median 5 vs. 4 days; P=0.02). CN was associated with increased odds of 30 day hospital readmission relative to ST (aOR=8.6; 95% CI: 5.5 – 13.4; P<0.01), while LAD was significantly associated with decreased odds of 30 day hospital readmission relative to no LAD (aOR=0.6; 95% CI: 0.4 – 0.9; P=0.02). Conclusions: CN is associated with a significant survival advantage but potentially greater complications compared to those receiving ST in node-positive mRCC. Despite offering diagnostic information via a more aggressive approach, there does not appear to be therapeutic benefit of LAD with CN in the metastatic setting where patients receive concomitant ST.[Table: see text]

Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series

2021 ◽  
pp. 039156032110351
Author(s):  
Alessandro Uleri ◽  
Rodolfo Hurle ◽  
Roberto Contieri ◽  
Pietro Diana ◽  
Nicolòmaria Buffi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Advanced Disease ◽  
Independent Predictor ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Small Sample ◽  
Locally Advanced Disease ◽  
Increased Risk

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

MP58-19 SURGICAL TREATMENT FOR CLINICAL NODE POSITIVE BLADDER CANCER PATIENTS TREATED WITH RADICAL CYSTECTOMY

2017 ◽  
Vol 197 (4S) ◽  
Author(s):  
Marco Moschini ◽  
Andrea Gallina ◽  
Giovanni La Croce ◽  
Ettore Di Trapani ◽  
Giusy Burgio ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Surgical Treatment ◽  
Cancer Patients ◽  
Radical Cystectomy ◽  
Node Positive

Disease Progression in Bladder Cancer: Which Developments since 1994

2009 ◽  
Vol 76 (2) ◽  
pp. 115-117
Author(s):  
V. Varca ◽  
A. Simonato ◽  
P. Traverso ◽  
A. Romagnoli ◽  
F. Venzano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bladder Cancer ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Radical Cystectomy ◽  
Public Awareness ◽  
Locally Advanced ◽  
Node Dissection ◽  
Group 2

Objectives The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006. Methods 456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition. Results For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group. Conclusions Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.

Unmarried men have worse oncologic outcomes after radical cystectomy for nonmetastatic urothelial bladder cancer

2020 ◽  
Vol 38 (3) ◽  
pp. 76.e1-76.e9 ◽  
Author(s):  
Giuseppe Rosiello ◽  
Carlotta Palumbo ◽  
Sophie Knipper ◽  
Angela Pecoraro ◽  
Cristina Dzyuba-Negrean ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Oncologic Outcomes ◽  
Urothelial Bladder Cancer ◽  
Urothelial Bladder

scholarly journals Natural history of pT3-4 or node positive bladder cancer treated with radical cystectomy and no neoadjuvant chemotherapy in a contemporary North-American multi-institutional cohort

2012 ◽  
Vol 6 (6) ◽  
pp. 217 ◽  
Author(s):  
Nicholas E. Power ◽  
Wassim Kassouf ◽  
David Bell ◽  
Armen Aprikian ◽  
Yves Fradet ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Natural History ◽  
Radical Cystectomy ◽  
Node Positive ◽  
Number Of Patients ◽  
History Of ◽  
Modern Era

Background: The present study documents the natural history and outcomes of high-risk bladder cancer after radical cystectomy (RC) in patients who did not receive neoadjuvant chemotherapy during a contemporary time period.Methods: We analyzed 1180 patients from 1993 to 2008 with >pT3N0 or pT0-4N+ bladder cancer who underwent RC ± standard (sLND) or extended (eLND) lymph node dissection from 8 Canadian centres.Results: Of the 1180 patients, 55% (n = 643) underwent sLND, 34% (n = 402) underwent ePLND and 11% did not undergo a formal LND. Of the total number of patients, 321 (27%) received adjuvant chemotherapy. The median follow-up was 2.1 years (range: 0.6 to 12.9). Overall 30-day mortality was 3.2%. Clinical and pathological stages T3-4 were present in 6.1% and 86.7% of the patients, respectively; this demonstrates a dramatic understaging. Overall survival (OS) at 2 and 5 years was 60% and 43%, respectively. Patients who received adjuvant chemotherapy hada 2- and 5-year disease-specific survival (DSS) of 72% and 57% versus 64% and 51% for those who did not (log-rank p = 0.0039). The 2- and 5-year OS for high-risk node-negative disease was 67%and 52%, respectively, whereas for node-positive patients, the OS was 52% and 32%, respectively (p < 0.001). The OS, DSS and RFS for patients with pN0 were significantly improved compared to those who did not undergo a LND (log-rank p = 0.0035, 0.0241 and 0.0383, respectively).Interpretation: This series suggests that bladder cancer outcomes inadvanced disease have improved in the modern era. The need for improved staging investigations, use of neoadjuvant chemotherapyand performance of complete LND is emphasized.

Sign in / Sign up

Export Citation Format

Share Document