scholarly journals Impact of Lymphovascular Invasion on Prognosis in the Patients with Bladder Cancer—Comparison of Transurethral Resection and Radical Cystectomy

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 244
Author(s):  
Kei Yoneda ◽  
Naoto Kamiya ◽  
Takanobu Utsumi ◽  
Ken Wakai ◽  
Ryo Oka ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radical Cystectomy ◽  
Transurethral Resection ◽  
Lymphovascular Invasion ◽  
Medical Center ◽  
Univariate Analysis ◽  
The Other ◽  
Significant Prognostic Factor ◽  
Cancer Specific Survival ◽  
Positive Results

(1) Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. (2) Methods: We analyzed 216 patients who underwent first TURBT and 64 patients who underwent RC at Toho University Sakura Medical Center. (3) Results: LVI was identified in 22.7% of patients who underwent first TURBT, and in 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p = 0.009) and LVI at first TURBT (HR 9.205, p = 0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, presence of G3 and LVI was significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p < 0.05). (4) Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

scholarly journals Impact of lymphovascular invasion in bladder cancer ~Comparison of transurethral resection and total cystectomy: a retrospective cohort study

2020 ◽  
Author(s):  
Kei Yoneda ◽  
Naoto Kamiya ◽  
Takanobu Utsumi ◽  
Ken Wakai ◽  
Ryo Oka ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Transurethral Resection ◽  
Medical Records ◽  
Lymphovascular Invasion ◽  
Univariate Analysis ◽  
Urinary Cytology ◽  
Significant Prognostic Factor ◽  
Cancer Specific Survival ◽  
Positive Results

Abstract Background: This study aimed to evaluate the associations of lymphovascular invasion (LVI) at first transurethral resection of bladder (TURBT) and radical cystectomy (RC) with survival outcomes, and to evaluate the concordance between LVI at first TURBT and RC. Methods: We reviewed 216 patients who underwent first TURBT and 64 patients who underwent RC at our hospital. Medical records were reviewed uniformly, collecting the following data: age, sex, clinical and pathological T stage, neoadjuvant chemotherapy, grade, metastasis, urinary cytology, carcinoma in situ and LVI. Results: LVI was identified in 22.7% of patients who underwent first TURBT, and 32.8% of patients who underwent RC. Univariate analysis identified ≥cT3, metastasis and LVI at first TURBT as factors significantly associated with overall survival (OS) and cancer-specific survival (CSS). Multivariate analysis identified metastasis (hazard ratio (HR) 6.560, p=0.009) and LVI at first TURBT (HR 9.205, p=0.003) as significant predictors of CSS. On the other hand, in patients who underwent RC, ≥pT3, inclusion of G3 and LVI were significantly associated with OS and CSS in univariate analysis. Multivariate analysis identified inclusion of G3 as a significant predictor of OS and CSS. The concordance rate between LVI at first TURBT and RC was 48.0%. Patients with positive results for LVI at first TURBT and RC displayed poorer prognosis than other patients (p<0.05). Conclusions: We found that the combination of LVI at first TURBT and RC was likely to provide a more significant prognostic factor.

scholarly journals Preoperative Clinical Predictors of Lymphovascular Invasion of Bladder Tumors at Transurethral Resection Pathology

2020 ◽  
Vol 14 (3) ◽  
pp. 135-141
Author(s):  
Kei Yoneda ◽  
Takanobu Utsumi ◽  
Ken Wakai ◽  
Ryo Oka ◽  
Takumi Endo ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Lymphovascular Invasion ◽  
Medical Center ◽  
Preoperative Evaluation ◽  
Univariate Analysis ◽  
Urinary Cytology ◽  
High Grade ◽  
Clinical Predictors ◽  
Bladder Tumors

<b><i>Background</i></b>: The assessment of lymphovascular invasion (LVI) on the specimens of a transurethral resection of bladder tumors (TURBT) is very important for risk stratification and decision-making on further treatment for bladder cancer. <b><i>Objectives</i></b>: The present study aimed to identify clinical predictors associated with the risk of bladder cancer with LVI before a first TURBT. <b><i>Methods</i></b>: A total of 291 patients underwent a first TURBT for bladder cancer at Toho University Sakura Medical Center between January 2012 and December 2016. We analyzed predictors of LVI based on data from 217 patients and predictors of high grade and ≥ pT1 tumors based on data from the medical records of 237 patients for comparison with LVI risk factors. <b><i>Results</i></b>: Univariate analysis significantly associated LVI with episodes of gross hematuria, positive urinary cytology, and larger, non-papillary and sessile tumors. Multivariate analysis selected larger tumors [odds ratio (OR) 1.39; 95 % confidence interval (CI) 1.08-1.78; p = 0.01], and non-papillary (OR 10.05; 95% CI 3.75-26.91; p < 0.01) and sessile (OR 2.65; 95% CI 1.18-5.93; p = 0.02) tumors as significant predictors of LVI. Some predictors such as tumor size and non-papillary tumors overlapped between high-grade and ≥ pT1 bladder cancer. <b><i>Conclusions</i></b>: These predictors can help clinicians to identify patients with, or who are at high-risk for LVI before undergoing a first TURBT and to determine priorities for preoperative evaluation and scheduling consecutive treatments.

Complete Transurethral Resection before Radical Cystectomy May Improve Oncological Outcomes

2021 ◽  
pp. 1-8
Author(s):  
Vivien Graffeille ◽  
Grégory Verhoest ◽  
Alexandre Gryn ◽  
Solène-Florence Kammerer-Jacquet ◽  
Quentin Alimi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Multivariate Analysis ◽  
High Risk ◽  
Radical Cystectomy ◽  
Endoscopic Resection ◽  
Transurethral Resection ◽  
Preoperative Imaging ◽  
Cancer Specific Survival ◽  
Oncological Outcomes ◽  
The Impact

Objectives: The objective of this study was to assess the impact of complete transurethral resection of bladder tumors (TURBTs) before radical cystectomy on pathological and oncological outcomes of patients with muscle-invasive bladder cancer (MIBC) and high-risk non-MIBC. Materials and Methods: The charts of all patients who underwent radical cystectomy for bladder cancer in 2 academic departments of urology between 1996 and 2016 were retrospectively reviewed. Patients were divided into 2 groups according to the completeness of the last endoscopic resection before radical cystectomy: macroscopically complete transurethral resection (complete) or macroscopically incomplete transurethral resection (incomplete). The primary end point was the recurrence-free survival (RFS). Secondary end points included cancer-specific survival (CSS) and rates of pT0 and downstaging. Results: Out of 486 patients included for analysis, the TURBT immediately preceding radical cystectomy was considered macroscopically complete in 253 patients (52.1%) and incomplete in 233 patients (47.9%). In multivariate analysis, macroscopically complete TURBT was the strongest predictor of both pT0 disease (OR = 3.1; p = 0.02) and downstaging (OR = 7.1; p < 0.0001). After a median follow-up of 41 months, macroscopically complete TURBT was associated with better RFS (5-year RFS: 57 vs. 37%; p < 0.0001) and CSS (5-year CSS: 70.8 vs. 54.5%; p = 0.002). In multivariate analysis adjusting for multifocality, weight of endoscopic resection specimen, cT4 stage on preoperative imaging, interval between endoscopic resection and radical cystectomy, neoadjuvant chemotherapy, pT stage, and associated carcinoma in situ, macroscopically complete endoscopic resection remained the main predictor of better RFS (HR = 0.4; p = 0.0003) and the only preoperative factor associated with CSS (HR = 0.5; p = 0.01). Conclusion: A macroscopically complete TURBT immediately preceding radical cystectomy may improve pathological and oncological outcomes in patients with MIBC and high-risk MIBC.

Longitudinal evaluation of the concordance and prognostic value of lymphovascular invasion in transurethral resection and radical cystectomy specimens

2010 ◽  
Vol 107 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Matthew J. Resnick ◽  
Meredith Bergey ◽  
Laurie Magerfleisch ◽  
John E. Tomaszewski ◽  
S. Bruce Malkowicz ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Transurethral Resection ◽  
Prognostic Value ◽  
Lymphovascular Invasion ◽  
Longitudinal Evaluation

Regression Does Not Predict Nodal Metastasis or Survival in Patients with Cutaneous Melanoma

2011 ◽  
Vol 77 (8) ◽  
pp. 1009-1013 ◽  
Author(s):  
Alison L. Burton ◽  
Juliana Gilbert ◽  
Russell W. Farmer ◽  
Arnold J. Stromberg ◽  
Lee Hagendoorn ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cutaneous Melanoma ◽  
Clinical Decision Making ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Nodal Metastasis ◽  
Breslow Thickness ◽  
Significant Prognostic Factor ◽  
Superficial Spreading ◽  
Histologic Subtype

Controversy exists regarding the prognostic implications of regression in patients with cutaneous melanoma. Some consider regression to be an indication for sentinel lymph node (SLN) biopsy because regression may result in underestimation of the true Breslow thickness. Other data support regression as a favorable prognostic indicator, representing immune system recognition of the primary tumor. This analysis was performed to determine whether regression predicts nodal metastasis, disease-free survival (DFS), or overall survival (OS). Post hoc analysis was performed of a multicenter prospective randomized trial that included patients aged 18 to 70 years with cutaneous melanomas 1 mm or greater Breslow thickness. All patients underwent SLN biopsy; those with tumor-positive SLN underwent completion lymphadenectomy. Kaplan-Meier analysis of survival, univariate analysis, and multivariate analysis were performed. A total of 2220 patients (261 with regression; 1959 without regression) were included in this analysis with a median follow-up of 68 months. Patients with regression were more likely to be male, older than 50 years old, and have lower median Breslow thickness, superficial spreading histologic subtype, and a non-extremity anatomic location ( P < 0.05 in all cases). Regression was not significantly associated with Clark level, ulceration, lymphovascular invasion, number of SLNs removed, or SLN metastasis. On multivariate analysis, factors independently predictive of DFS included Breslow thickness, ulceration, and SLN status ( P < 0.05 in all cases); the same factors along with age, gender, and anatomic tumor location were significantly associated with OS ( P < 0.05 in all cases). Regression was not significantly associated with DFS (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.67-1.27; P = 0.68) or OS (RR, 1.01; 95% CI, 0.76-1.32; P = 0.93). These data suggest that regression is not a significant prognostic factor for patients with cutaneous melanoma and should not be used to guide clinical decision-making for such patients.

scholarly journals De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase) as a Significant Prognostic Factor in Patients Undergoing Radical Cystectomy with Bladder Urothelial Carcinoma: A Propensity Score-Matched Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Cheol Kwak ◽  
Hyeon Hoe Kim ◽  
Ja Hyeon Ku
Keyword(s):  
Prognostic Factor ◽  
Propensity Score ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Alanine Transaminase ◽  
Significant Prognostic Factor ◽  
Aspartate Transaminase ◽  
Cancer Specific Survival ◽  
T Stage ◽  
Kaplan Meier

Introduction. To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase (AST)/alanine transaminase (ALT)) and postoperative outcome in patients with urothelial cell carcinoma (UC) treated with radical cystectomy. Materials and Methods. We analyzed the clinical and pathological data of 771 patients who underwent radical cystectomy for bladder UC. Patients were divided into two groups according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed using the Kaplan–Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In addition, propensity score matching of 1 : 1 was performed between the two groups. Results. Median follow-up was 84.0 (36–275) months. Mean age was 64.8±10.0 years. According to the receiver operating characteristic (ROC) analysis, the optimal threshold of the AST/ALT ratio was 1.1. In Kaplan–Meier analyses, the high AST/ALT group showed worse outcomes in CSS and OS (all P<0.001). Also, RFS (P=0.001) in the Cox regression models of clinical and pathological parameters was used to predict CSS, OS, and AST/ALT ratio (HR 2.15, 95% CI 1.23-3.73, P=0.007) and pathological T stage (HR 4.80, 95% CI 1.19-19.28, P=0.003). To predict OS and AST/ALT ratio (HR 2.05, 95% CI 1.65–2.56, P<0.001), pathological T stage (HR 2.96, 95% CI 0.57–17.09, P=0.037) and positive lymph node (HR 1.71, 95% CI 1.50–1.91, P=0.021) were determined as independent prognostic factors. Conclusion. Preoperative AST/ALT ratio could be an independent prognostic factor in patients with UC treated with radical cystectomy.

DOES T STAGE AFFECT PROGNOSIS IN PATIENTS WITH STAGE IV B DIFFERENTIATED THYROID CANCER?

2019 ◽  
Vol 25 (9) ◽  
pp. 877-886 ◽  
Author(s):  
Mu Li ◽  
Nitin Trivedi ◽  
Chenyang Dai ◽  
Rui Mao ◽  
Yuning Wang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Univariate Analysis ◽  
Stage Iv ◽  
Papillary Thyroid ◽  
Follicular Thyroid Cancer ◽  
Cancer Specific Survival ◽  
T Stage

Objective: Differentiated thyroid cancer (DTC), the most common subtype of thyroid cancer, has a relatively good prognosis. The 8th edition of the American Joint Committee on Cancer (AJCC) pathologic tumor-node-metastasis (T [primary tumor size], N [regional lymph nodes], M [distant metastasis]) staging system did not take the T stage into consideration in stage IV B DTC patients. We evaluated the prognostic value of the T stage for advanced DTC survival. Methods: DTC cases that were considered stage IV B in the AJCC 8th edition were extracted from the Surveillance, Epidemiology, and End Results database. T stage (AJCC 6th standard) was categorized into T0–2, T3 and T4. We analyzed overall survival (OS) and cancer specific survival (CSS) in the overall group as well as in pathologic subgroups. We used the Kaplan-Meier method and log-rank test for univariate analysis and the Cox regression model for multivariate analysis. Results: A total of 519 cases were extracted. Patients with earlier T stages showed significantly better OS and CSS in univariate analysis. T stage was an independent prognostic factor for both OS and CSS in multivariate analysis. Subgroup analysis in papillary and follicular thyroid cancer showed that T4 was an independent prognostic factor for both OS and CSS. Conclusion: AJCC 8 stage IV B DTC patients could be further stratified by T stage. Further studies with larger samples and AJCC 8 T stage information are necessary. Abbreviations: AJCC = American Joint Committee on Cancer; CI = confidence interval; CSS = cancer specific survival; DTC = differentiated thyroid cancer; FTC = follicular thyroid cancer; FVPTC = follicular variant of papillary thyroid carcinoma; HR = hazard ratio; OS = overall survival; PTC = papillary thyroid cancer; SEER = surveillance, epidemiology, and end results database

The Prognostic Factor Evaluation of Febrile Neutropenia Before Chemotherapy to Hematologic Malignancies

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4842-4842
Author(s):  
Byung Soo Kim ◽  
Chul Won Choi ◽  
Seok Jin Kim
Keyword(s):  
Multivariate Analysis ◽  
Febrile Neutropenia ◽  
Treatment Outcomes ◽  
Medical Center ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Onset Time ◽  
Hematologic Malignancies ◽  
Underlying Disease ◽  
Laboratory Findings

Abstract Purpose Febrile neutropenia is one of the major toxicities-associated with chemotherapy especially in hematologic disorders. Thus, the occurrence of febrile neutropenia significantly can affect their treatment outcomes. But, it is difficult to predict their clinical courses and treatment outcomes. In this study, we analyzed the prechemothepeutic clinical characteristics of febrile neutropenia and their relationship with the prognosis of febrile neutropenia in the patients with hematologic malignancies. Methods We retrospectively analyzed 259 cases of febrile neutropenia developed after the chemotherapy for their hematologic malignacies from January 2006 to July 2008 at the Korea University Medical Center to identify the potential prognosis predicting factors. For the early detection of the high risk of febrile neutropenia, we focused on the findings before chemotherapy. Results With univariate analysis, age, underlying disease, recovery of neutropenia, onset time of febrile neutropenia, onset location, the duration of fever, infection sites, and type of cultured organism were significantly associated with mortality (p &lt; 0.05). Also, the risk of mortality was significantly associated with laboratory findings (hemoglobin, platelet count, BUN, AST, albumin, sodium, bicarbonate, PT, ESR, CRP) of prechemotherapy. In multivariate analysis, only three variables of laboratory findings were associated with poor outcomes: albumin, bicarbonate and C-reactive protein of prechemotherapy. The recoveries of neutropenia and respiratory tract infection were also the significant risk factors in multivariate analysis. The complication rate in the patients who had three poor variables (low albumin & bicarbonate level and high CRP level) was 82.8%, while in the patient who had no poor variables was only 5.7%. Conclusion The levels of albumin, bicarbonate and CRP, in prechemotherapic condition were associated with the prognosis of febrile neutropenia in our study. Therefore, the further prospective studies will be warranted to confirm the result of this study.

Prognostic factors in uterine sarcoma: A clinicopathologic and immunohistochemical (IHC) study of 30 cases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16071-16071
Author(s):  
F. Al-Safi ◽  
A. Al Kushi ◽  
S. Ameeri ◽  
N. Al Merri
Keyword(s):  
Patient Outcome ◽  
Multivariate Analysis ◽  
Tumor Cell ◽  
Lymphovascular Invasion ◽  
Univariate Analysis ◽  
Uterine Sarcoma ◽  
Low Grade ◽  
Cell Type ◽  
Survival Curves ◽  
P53 Expression

16071 Background: The objective of this study is to examine the prognostic relevance of traditional clinical, pathological and IHC features of uterine sarcoma (US). Methods: The study population consisted of thirty cases of US treated at our institute. Twenty- two cases are HGS (11 leiomyosarcoma, and 11 carcinosarcoma) and eight cases are LGS (5 mullerian adenosarcoma and 3 low grade endometrial stromal sarcoma). Clinical and pathological data including patient's age, parity, menopausal status, tumor cell type, lymphovascular invasion, nuclear grade, stage and mitotic index. Serial sections were immunostained with antibodies for p53, bcl-2, estrogen receptor (ER), Her2 and c-kit. The clinicopathological and IHC features were analysed by using Kaplan-Meier method for constructing survival curves, and log-rank statistic for survival curves comparison. Multivariate analysis was performed using Cox regression modeling. Results: The mean follow-up period of patients is 32 months (range 1- 120). Twelve (55%) patients with HGS died of the disease and none of the LGS group. In the HGS group, stage (p=0.01), myometrial invasion in early stage tumor (p=0.04), and lymphovascular invasion (p=0.043) were significant predicators of patient outcome in univariate analysis. Similarly, tumor cell type, ER, p53 and bcl-2 expression showed statistical significant correlation with tumor-specific survival (p=0.0039, p=0.001, p=0.03, and p=0.04, respectively). ER and bcl-2 expression were associated with better outcome and the opposite for p53 expression. In a multivariate analysis, only the tumor stage and cell type had independent statistical significance (p=0.04, and p=0.035, respectively). Overexpression of p53 and Her2 were observed in 40% and 60% of carcinosracomas respectively and not seen in any of the other tumors. The c-kit immunostain showed focal and weak staining in 40% of carcinosarcoma and only in 33% of leiomyosarcoma. None of LGS had this marker. The ER was expressed only in the LGS group. Conclusions: This study demonstrates that stage and tumor cell type are the most important prognostic indicators of patient outcome in US. IHC markers such as ER, p53, c-kit, and Her2 can be useful ancillary tools to discriminate between HGS and LGS in difficult cases. No significant financial relationships to disclose.

scholarly journals Comparison of Complications from Radical Cystectomy between Old-Old versus Oldest-Old Patients

2014 ◽  
Vol 94 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Evi Comploj ◽  
Jeremy West ◽  
Michael Mian ◽  
Luis Alex Kluth ◽  
Alexander Karl ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Radical Cystectomy ◽  
Medical Center ◽  
Oldest Old ◽  
Age Group ◽  
Cancer Specific Survival ◽  
Old Patients ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Introduction: The purpose of this study was to evaluate and compare complications after radical cystectomy in patients aged ≥75 years. Materials and Methods: 251 patients aged 75-95 years (median 79) underwent radical cystectomy between 2000 and 2012 at four institutions. The patients were divided into two groups: ≥75-84 years of age (group 1) versus ≥85 years of age (group 2). Comorbidities, body mass index, and complications were obtained retrospectively, except at the Central Hospital of Bolzano and Weill Cornell Medical Center, which collected data prospectively. Cancer-specific survival, overall mortality, hospital stay, clinical outcome and complications were assessed. Complications were categorized using the Clavien-Dindo classification reporting system. The mean follow-up was 21 months. Results: The median hospital stay was 17 (2-91) days. Perioperative Clavien-Dindo grade ≥III complications were seen in 24.1% (48/199) of group 1 patients and 19.2% (10/52) of group 2 patients (p = 0.045). 30- and 90-day mortality was 4.5 and 13.5% in group 1 and 6.5 and 32.3% in group 2, respectively. Only the 90-day mortality rate was statistically significant (p < 0.05) between the two groups. The 3-year overall survival was 40% in group 1 and 34% in group 2. The 3-year cancer-specific survival was 52% in group 1 and 50% in group 2. Conclusions: We evaluated a large series of elderly (≥75 years) patients undergoing radical cystectomy at four institutions. Comparing patients aged ≥75-84 and ≥85 years revealed no significant difference in complications, 30-day mortality, overall and cancer-specific survival rates. Only 90-day mortality rates were significantly higher in the ≥85-year-old patients.

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