Radical Cystectomy For Treatment Research Articles

Comparative efficacy of Bacillus Calmette-Guérin instillation and radical cystectomy treatments for high-risk non-muscle-invasive urothelial cancer classified as high-grade T1 in initial and repeat transurethral resection of bladder tumor.

To compare the differential therapeutic effects of Bacillus Calmette-Guérin (BCG) instillation and radical cystectomy (RC) for high-risk non-muscle-invasive urothelial cancer (NMIBC) classified as high-grade T1 in initial and repeat transurethral resection of bladder tumors (TURBT) and to construct a prediction model. We retrospectively analyzed the clinical data of patients with malignant bladder tumors treated at the First Affiliated Hospital of Soochow University from January 2016 to December 2017 and compared the differences in 1-year, 2-year, 3-year, 5-year, and comprehensive overall survival (OS) and progression-free survival (PFS) between BCG instillation treatment and RC treatment. Survival curves were drawn to show differences in OS and PFS between the two groups. Concurrently, univariate and multivariate COX analyses were performed to identify risk factors affecting OS and PFS, and a nomogram was created. In total, 146 patients were included in the study, of whom 97 and 49 were in the BCG and RC groups, respectively. No statistical differences were observed in the 1- and 2-year OS and PFS between the two groups, whereas significant statistical differences were found in the 3-year, 5-year, and comprehensive OS and PFS. Survival curves also confirmed the statistical differences in OS and PFS between the BCG and RC groups. Multivariate COX analysis revealed that the treatment method, concomitant satellite lesions, and albumin-to-alkaline phosphatase ratio (AAPR) were independent risk factors affecting OS and PFS. The nomogram that was further plotted showed good predictive ability for OS and PFS. For patients who exhibit high-level T1 pathology after both initial and repeat TURBT, especially those with low AAPR, and concomitant satellite lesions, choosing RC as a treatment method offers a better prognosis.

Comparing trimodal therapy with radical cystectomy in muscle-invasive bladder cancer: an updated meta-analysis.

We conducted this meta-analysis to compare the two muscle-invasive bladder cancer (MIBC) treatment modalities in terms of cancer-specific survival (CSS) and other outcome indicators. A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. The search was conducted using various academic databases including Scopus, PubMed, Cochrane database, EMBASE, Chinese biomedical literature database, Wan fang databases, and China National Knowledge Internet databases between 1966 and December 2023. This review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) No. (CRD42023398977). This study included a total of 54,816 patients diagnosed with bladder cancer from 14 studies, of which 6,228 patients were assigned to the trimodal therapy (TMT) group and 48,588 patients were assigned to the radical cystectomy (RC) group. Based on the results, the RC group exhibited a higher rate of survival than the TMT group [pooled hazard ratio (HR) = 1.23, 95% CI: 1.18-1.28, Z = 1.46, P < 0.001]. In terms of CSS, patients in the RC group had a longer CSS compared with those in the TMT group (pooled HR = 1.47, 95% CI: 1.29-1.67, Z = 5.893, P < 0.001). Compared with RC, TMT is significantly associated with an increased risk of both types of mortality (pooled HR: 1.30, P < 0.001). Overall, the findings of this meta-analysis suggest that RC treatment may be associated with improved overall survival. Moreover, it was observed that cancer-specific survival was significantly prolonged among patients in the RC group as opposed to those who received TMT. In addition, it was shown that patients who received TMT exhibited a higher risk of all-cause mortality when compared with those who underwent RC.

Comparison of Laparoscopic and Open Radical Cystectomy for Muscle-Invasive Bladder Cancer.

The goal of the study was to compare laparoscopic and open radical cystectomy in treatment of muscle-invasive bladder cancer in the Department of Urology and Oncological Urology PUM in Szczecin. A total of 78 patients in the study group underwent laparoscopic cystectomy between 2016−2018, and 81 patients from the control group had open cystectomy between 2014−2016. Both groups were comparable in terms of age, stage, and concomitant diseases. The 3 year overall survival was comparable in both groups (37.7% for laparoscopy and 44.4% for open, p = 0.64). There was no difference in positive surgical margin rate. Lymph node yield during cystectomy was higher in open cystectomy (14 vs. 11.5, p = 0.001). Post-operative blood loss and transfusion rates were lower in laparoscopic cystectomy. Decrease in hemoglobin level was lower in laparoscopy (0.9 mmol/L, p < 0.001). Intraoperative transfusion rate was 11.8% in laparoscopy vs. 34.8% in open cystectomy (p = 0.002). Operation time, duration of hospitalisation, and time to full oral alimentation were comparable in both groups. Patients with BMI > 30 kg/m2 and those with pT3-T4 cancer in the laparoscopy group had less septic complications post-operatively. Patients with ASA score ≥ 3 from the laparoscopy group had fewer reoperations due to ileus. Laparoscopic cystectomy is less invasive and offers similar oncological outcomes to the open method. Patients benefit from less tissue trauma, less blood loss, and faster recovery. The presented results, as well as other publications, should encourage a wider use of this procedure in everyday urological practice.

Incidence and outcomes of nodal metastasis in clinically nonmuscle-invasive bladder cancer.

577 Background: Radical cystectomy (RC) is recommended in NMIBC patients with high risk of progression or persistent disease despite intravesical therapy. The role and extent of lymphadenectomy is controversial and not universally performed in this population. The objective of this study is to evaluate the incidence and pattern of nodal metastasis in patients undergoing radical cystectomy for treatment of clinically non-muscle invasive bladder cancer. Methods: Prospectively collected data of patients who underwent RC and ‘super-extended’ LND with intent-to-cure for urothelial carcinoma of the bladder between 2002 and 2019 were examined. Inclusion criteria were(a) clinical stage Ta, Tis,or T1, (b) muscle present and not involved,(c) no prior diagnosis of T2 disease, (d) no prior neoadjuvant therapy, and (e) super-extended lymphadenectomy performed to level of IMA with mapping information available. Logistic regression analysis was used to evaluate for predictors of node metastasis. Results: A total of 223 patients met inclusion criteria with a median follow up of 8.2 years (IQR 4.1-10.7). Lymph node metastasis was identified in 8.1% (18/223) of the cohort. Nodal metastasis was present in 0 patients with cTis, 0 patients with cTa, and 11.6% (18/155) of patients with cT1 disease. Of the 18 patients with LNM in cT1 disease, 61% (11/18) had positive nodes below the common ileac vessel bifurcation, 6% (1/18) had positive nodes below the level of aortic bifurcation, and 33% (6/18) had distant metastasis to lymph nodes beyond aortic bifurcation. No skip metastasis were identified. After RC, 89% of cT1 with nodal metastasis had muscle invasive disease. On logistic regression analysis, presence of LVI on TURBT specimen was a significant predictor of LNM (OR 6.8, CI 2.2-20.9). Five-year RFS was 91%, 82%, and 61% in patients with pNMIBC, cNMIBC, and pMIBC, respectively. Conclusions: Routine lymph node dissection is necessary in patients undergoing RC for cT1 disease due to risk of upstaging and LNMs. Presence of LVI in TURBT specimen of cNMIBC is a predictor of nodal metastasis. In patients with nodal disease, metastasis beyond the limits of a standard lymph node template occurred in two-thirds of patients, however a standard pelvic node dissection would have identified all patients with node positive disease.

Small cell carcinoma of the bladder: A population-based analysis of long-term outcomes after radical cystectomy and bladder conservation with chemoradiotherapy.

We aimed to describe the oncological outcomes after radical cystectomy and chemo-radiation for localized small cell bladder cancer (SCBC). This population-based analysis of localized SCBC from 1985-2018 in British Columbia included an analysis (analysis 1) of cancer-specific survival (CSS) and overall survival (OS) of patients treated with curative-intent radical cystectomy (RC) and radiation (RT), and an analysis (analysis 2) of CSS and OS in patients treated with RC and chemoRT consistent with the SCBC Canadian consensus guideline. Seventy-seven patients who were treated with curative intent were identified: 33 patients had RC and 44 had RT. For analysis 1, five-year OS was 29% and 39% for RC and RT, respectively (p=0.51), and five-year CSS was 35% and 52% for RC and RT, respectively (p=0.29). On multivariable analysis, higher Charlson comorbidity index (CCI) and the lack of neoadjuvant chemotherapy (NAC) were associated with worse OS, while higher CCI and Eastern Cooperative Oncology Group (ECOG) were associated with worse CSS. For analysis 2, five-year OS was 56% and 58% for the RC and chemoRT groups, respectively (p=0.90), and five-year CSS was 56% for RC and 71% for chemoRT (p=0.71). Four of 42 (9.5%) chemoRT patients had RC at relapse. SCBC is a rare entity with a poor prognosis. RC and chemoRT offer similar CSS and OS for localized SCBC, even when focusing the analysis on patients treated according to the modern consensus guidelines. NAC should be considered for eligible patients. Both chemoRT and RC treatment options should be discussed with patients with SCBC.

KEYNOTE-905/EV-303: Perioperative pembrolizumab or pembrolizumab plus enfortumab vedotin (EV) and cystectomy compared to cystectomy alone in cisplatin-ineligible patients with muscle-invasive bladder cancer (MIBC).

TPS507 Background: Patients with MIBC who are ineligible for neoadjuvant cisplatin-based chemotherapy receive the standard-of-care treatment of radical cystectomy (RC) and pelvic lymph node dissection (PLND); however, RC + PLND alone is associated with high rates of recurrence and relatively poor overall survival (OS). The PURE-01 study (NCT02736266) demonstrated a pathologic complete response (pCR) rate of 37% (95% CI, 28%-36%) with neoadjuvant pembrolizumab in MIBC (Necchi, Eur Urol, 2020). The combination of pembrolizumab plus EV demonstrated encouraging antitumor activity in metastatic urothelial cancer (Rosenberg, ASCO GU, 2020). KEYNOTE-905/EV-303 (NCT03924895) is a randomized, multinational phase 3 study that will assess efficacy and safety of perioperative pembrolizumab plus RC + PLND versus perioperative EV with pembrolizumab plus RC + PLDN versus RC + PLND alone for patients with MIBC. Methods: Approximately 836 patients will be randomly assigned 1:1:1 to 3 cycles of neoadjuvant pembrolizumab followed by RC + PLND and 14 cycles of adjuvant pembrolizumab or 3 cycles of neoadjuvant EV and pembrolizumab followed by RC+PLND and 6 cycles of adjuvant EV and pembrolizumab and then 8 cycles of adjuvant pembrolizumab or RC + PLND alone. Neoadjuvant or adjuvant pembrolizumab 200 mg will be administered intravenously every 3 weeks (Q3W). Neoadjuvant or adjuvant EV 1.25 mg/kg will be administered on days 1 and 8 Q3W. Stratification factors will be PD-L1 status (combined positive score [CPS] ≥10 vs &lt; 10), disease stage (T2N0 vs T3/T4N0 vs T1-T4aN1), and region (United States vs European Union vs most of the world). Adults with histologically confirmed MIBC (T2-T4aN0M0 or T1-T4aN1M0) with predominant (≥50%) urothelial histology will be enrolled. These patients must also be previously untreated with systemic therapies for MIBC, be ineligible for cisplatin, have Eastern Cooperative Oncology Group performance status of 0-2, and have tumor tissue for histology and PD-L1 analysis. Imaging (CT or MRI) will be performed 5 weeks or fewer before cystectomy and at 6 weeks after cystectomy. Scans will then be performed every 12 weeks up to year 2 after cystectomy and at discontinuation. At year 3 and beyond imaging will be every 24 weeks. Coprimary end points are pCR and event-free survival (EFS) (expressing PD-L1 [CPS ≥10] and all patients regardless of CPS). Secondary end points are OS, disease-free survival, pathologic downstaging, safety, and patient-reported outcomes. Adverse events graded according to Common Terminology Criteria for Adverse Events v4.0 will be monitored from randomization through 30 days after last dose of study drug (90 days for serious adverse events). KEYNOTE-905/EV-303 is ongoing or planned in 25 countries across Asia, Australia, Europe, and North America. Clinical trial information: NCT03924895.

Biphasic Change in Renal Function after Radical Cystectomy and Urinary Diversion

Purpose: Radical cystectomy (RC) with urinary diversion has been established as the gold standard treatment for muscle invasive bladder cancer. This provides excellent local control and increases the survival rate. The postoperative renal function (RF) usually declines, especially with those with risky conditions such as increasing age, hypertension, diabetes, or the presence of preoperative hydronephrosis (HN). However, there are limited data about the potential preoperative factors to predict the postoperative RF following the RC. The current retrospective article aims at reviewing patients treated with RC with urinary diversion presenting demographics data, assessing the RF after performing the operation and identifying the associated factors that reduce the RF. Materials and Methods: Bladder cancer patients who underwent RC with a urinary diversion from January 2001 to December 2017 were reviewed. RF was assessed by using the estimated glomerular filtration rate (eGFR) through the MDRD formula. Multivariate analysis was performed to evaluate the association of the changing of RF. Results: One hundred and fifty-six patients were included in the study. The median age was 65 years (interquartile ranges [IQR] 57, 72), and the median follow-up time was 16.4 months (IQR 7.1, 33.4). Overall, 86 patients (55.12%) had HN at the initial treatment of RC. Baseline mean eGFR was 57.7 mL/min/1.73 m2 (standard deviation [SD] = 23.7). The value of eGFR observed at 1, 12, and 60 months was 67.2 (SD = 29.5), 55.7 (SD = 26.3), and 55.8 (SD = 21.4) mL/min/1.73 m2, respectively. At 1 month, female gender, no HN, and neobladder were independently associated with worse RF outcomes in both univariate and multivariate analysis (P &lt; 0.05). The factors associated with eGFR under 60 mL/min/1.73 m2 at 1 year were age, presence of HN, and adjuvant treatment. Conclusion: RF after cystectomy and urinary diversion improves for 1 month after the procedure, especially in patients with the presence of preoperative HN and then RF gradually decreases. There are no significant differences in preoperative and postoperative RF after a 5-year follow-up.

Abstract IA26: Targeting hypoxia and personalizing chemoradiation

Abstract There are multiple management options for muscle-invasive bladder cancer. Approaches include radical cystectomy and trimodality treatment with transurethral resection of bladder tumor and organ-preserving radiotherapy. Trials provided high-quality evidence for the superiority of multimodality treatments over radiotherapy alone. The BC2001 phase III trial showed adding concurrent 5-fluorouracil (5-FU) and mitomycin-C to radiotherapy increased 2-year locoregional control by 14%. The Gemtrans phase II trial, and a follow-on pooled analysis of eight trials, showed high survival outcomes (5-year overall survival rates of 59%) for gemcitabine-based chemoradiotherapy. The BCON phase III trial showed a 13% improvement in 3-year overall survival when hypoxia-targeting carbogen and nicotinamide (CON) were given with radiotherapy. Bladder-preserving trimodality treatments have equivalent survival outcomes to the previously considered gold-standard treatment of radical cystectomy for localized bladder cancer, and trials have shown it is not feasible to randomize to cystectomy or selective bladder preservation. Decisions for selecting primary cystectomy or bladder-sparing treatment are now governed largely by patient and clinician preferences. Given the poor survival outcomes for muscle-invasive bladder cancer and multiple options for its management, there is an unmet clinical need to validate predictive biomarkers to aid rational treatment selection and personalization. Personalization based on measuring tumor hypoxia is attractive. Approaches for measuring tumor hypoxia have been studied for many years. Although there are advantages and disadvantages to the different methods, gene expression signatures show promise for clinical application. The signatures can be applied using readily available pretreatment paraffin-embedded tumor samples. Signatures have been derived for multiple cancer types including bladder. A 24-gene signature was shown to have strong and independent prognostic and predictive value. The signature was validated in multiple cohorts and shown to identify patients likely to benefit from the addition of CON to radiotherapy. A key aspect for progressing personalized treatment is biomarker application, i.e., identifying a platform for clinical use. Ongoing work is taking the 24-gene signature forward and comparing platforms. Customized Taqman Low Density Array (TLDA) cards were used to take a head and neck signature forward for prospective testing in a trial, but other technologies (e.g., nanostring) are of interest. Work is also generating transcriptomic data for samples collected from patients enrolled in the BC2001 trial to test whether patients with hypoxic tumors do not benefit from having concurrent 5-FU plus mitomycin-C. A biomarker-driven trial is also being developed. Citation Format: Catharine West. Targeting hypoxia and personalizing chemoradiation [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2019 May 18-21; Denver, CO. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(15_Suppl):Abstract nr IA26.

PD55-03 COST-EFFECTIVENESS OF RADICAL CYSTECTOMY VS. TRIMODALITY THERAPY FOR MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive V (PD55)1 Apr 2020PD55-03 COST-EFFECTIVENESS OF RADICAL CYSTECTOMY VS. TRIMODALITY THERAPY FOR MUSCLE INVASIVE BLADDER CANCER Nathan Suskovic*, Ann Raldow, Trevor Royce, and Angela Smith Nathan Suskovic*Nathan Suskovic* More articles by this author , Ann RaldowAnn Raldow More articles by this author , Trevor RoyceTrevor Royce More articles by this author , and Angela SmithAngela Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000965.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Muscle invasive bladder cancer (MIBC) comprises 25% of all bladder cancers at the time of diagnosis. Radical Cystectomy (RC) has traditionally been the gold standard curative treatment for MIBC. Trimodality therapy (TMT) with maximal transurethral resection of bladder tumor, chemotherapy, and radiation is a treatment alternative and Category 1 recommendation by the NCCN. TMT has shown equivalent survival for carefully selected patients. However, the comparative cost effectiveness between RC and TMT is unknown. Therefore, the purpose of this study was to compare the cost-effectiveness of RC versus TMT for MIBC. METHODS: We developed a Markov model using TreeAge software to simulate a 5-year outcome for one million 65-year old hypothetical patients with MIBC undergoing either RC or TMT (Figure 1). Hypothetical patients in the RC treatment pathway would have an adverse event, no adverse event, or immediate death after surgery. After RC, patients either would have no evidence of disease or transition to locoregional recurrence, metastatic recurrence, or death. Hypothetical patients in the TMT treatment pathway would either have an adverse event or no adverse from treatment. After TMT, patients either would have disease-free bladder intact survival or transition to locoregional failure, metastatic recurrence, or death. Patients with locoregional failure from TMT transition into non-salvageable disease or salvageable disease. Patients with salvageable disease prompted a salvage cystectomy. Model probabilities and utilities were extracted from the literature. Costs were derived from 2019 National Medicare Fee Schedule. RESULTS: RC and TMT were associated with quality adjusted life years (QALY) of 2.88 and 3.38 respectively (incremental QALYs of 0.5 favoring TMT). The mean costs of RC and TMT were $37,107 and $23,916 respectively. TMT was less expensive with an incremental cost of $13,191. CONCLUSIONS: In patients aged 65 and older with MIBC, TMT was the dominant strategy as compared to RC, as it was both cheaper and associated with increased QALYs based upon model assumptions. The results of this study are the first to evaluate the cost effectiveness of RC and TMT and can inform the ongoing discussion regarding the use of TMT and RC in MIBC. Source of Funding: Office of Research at the University of North Carolina at Chapel Hill © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1182-e1183 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Suskovic* More articles by this author Ann Raldow More articles by this author Trevor Royce More articles by this author Angela Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

Cost-effectiveness of radical cystectomy versus trimodality therapy for muscle invasive bladder cancer.

575 Background: Muscle invasive bladder cancer (MIBC) comprises 25% of all bladder cancers at the time of diagnosis. Radical Cystectomy (RC) has traditionally been the gold standard curative treatment for MIBC. Trimodality therapy (TMT) with maximal transurethral resection of bladder tumor, chemotherapy, and radiation is a treatment alternative and Category 1 recommendation by the NCCN. TMT has shown equivalent survival for carefully selected patients. However, the comparative cost effectiveness between RC and TMT is unknown. Therefore, the purpose of this study was to compare the cost-effectiveness of RC versus TMT for MIBC. Methods: We developed a Markov model using TreeAge software to simulate a 5-year outcome for one million 65-year old hypothetical patients with MIBC undergoing either RC or TMT. Hypothetical patients in the RC treatment pathway would have an adverse event, no adverse event, or immediate death after surgery. After RC, patients either would have no evidence of disease or transition to locoregional recurrence, metastatic recurrence, or death. Hypothetical patients in the TMT treatment pathway would either have an adverse event or no adverse from treatment. After TMT, patients either would have disease-free bladder intact survival or transition to locoregional failure, metastatic recurrence, or death. Patients with locoregional failure from TMT transition into non-salvageable disease or salvageable disease. Patients with salvageable disease prompted a salvage cystectomy. Model probabilities and utilities were extracted from the literature. Costs were derived from 2019 National Medicare Fee Schedule. Results: RC and TMT were associated with quality adjusted life years (QALY) of 2.88 and 3.38 respectively (incremental QALYs of 0.5 favoring TMT). The mean costs of RC and TMT were $37,107 and $23,916 respectively. TMT was less expensive with an incremental cost of $13,191. Conclusions: In patients aged 65 and older with MIBC, TMT was the dominant strategy as compared to RC, as it was both cheaper and associated with increased QALYs based upon model assumptions. The results of this study are the first to evaluate the cost effectiveness of RC and TMT.

Adjuvant Treatment of Residual Disease Following Neoadjuvant Chemotherapy and Radical Cystectomy for Muscle Invasive Bladder Cancer

BACKGROUND: Cisplatin-based neoadjuvant chemotherapy (NAC) has shown overall survival benefit for patients with muscle invasive bladder cancer (MIBC). In contrast, there is limited data for adjuvant treatment options in patients with residual muscle invasive disease after NAC followed by radical cystectomy (RC). OBJECTIVE: This systematic review aims to give an overview of studies examining adjuvant treatment options for patients with residual MIBC at RC despite NAC. METHODS: We systematically searched the PubMed database and Clinicaltrials.gov (end point August 2019) for publications and registered trials combining NAC, RC, and adjuvant treatment options. RESULTS: After removal of duplicates, 659 articles and registered trials were further analyzed. Finally, 10 studies and 7 registered clinical trials met inclusion criteria. While 5 publications did not further characterize NAC and adjuvant regimens, the remaining 5 studies reported mainly platinum-based regimens. Altogether, the selected studies showed conflicting results regarding the potential role of adjuvant treatment strategies in the setting of residual disease after NAC and RC. CONCLUSION: Although there is an urgent need for adjuvant treatment options for patients with MIBC after NAC and residual muscle invasive disease at RC, there has been very limited evidence available. Inclusion of such patients into ongoing adjuvant clinical trials is urgently needed; active surveillance is strongly recommended in the absence of trials.

Robot-assisted radical cystectomy: state of art and future perspectives

Bladder cancer (BC) remains one of the most common cancer worldwide. Radical cystectomy (RC) and pelvic lymph node dissection (PLND) with urinary diversion (UD) is still considered the gold standard treatment for non-metastatic muscle invasive bladder cancer (MIBC) and for recurrent non-muscle invasive disease. The open approach remains the reference option of treatment for RC, even if robotic surgery is rapidly increasing. Nowadays, several studies have reported perioperative, functional and oncological outcomes of robot-assisted radical cystectomy (RARC), but data are still immature to compare both procedures. All the current randomized controlled trials (RCTs), did not prove any significant difference between open RC and RARC, underlining no superiority between both procedures. Therefore, RARC is still considered an investigational procedure. On the other hand, modern robotic surgical practice has been evolved by the introduction of innovative technologies. The technological progress is improving, in particular in robotic surgery, offering several future perspectives, such as the ICG technique. The aim of the review is to describe the state of art, and to outline future perspectives of RARC, in order to establish the role of robotic surgery in the complex field of radical cystectomy.

A pilot study to evaluate patient reported outcome measures of bladder cancer patients undergoing radical cystectomy at Guy’s and St Thomas’ NHS Foundation Trust.

Event Abstract Back to Event A pilot study to evaluate patient reported outcome measures of bladder cancer patients undergoing radical cystectomy at Guy’s and St Thomas’ NHS Foundation Trust. Katie Hare1*, Kathryn Chatterton2, Charlotte L. Moss1, Beth Russell1, Sue Amery2 and Mieke Van Hemelrijck1 1 King's College London, United Kingdom 2 Guy's and St Thomas' NHS Foundation Trust, United Kingdom Objective This is a feasibility pilot to measure patient reported outcomes of bladder cancer patients undergoing radical cystectomy surgery. This study focuses onspecific areas of the FACT-BL-CYS such as emotional and sexual activity effects to better see the effect on patients. Methods Thirty-three patients undergoing radical cystectomy at Guy’s and St Thomas’ NHS Foundation Trust between 2015 and October 2018 were given the FACT-BL-CYS pre-operatively and at 1 year post-operatively. This data, along with demographic information, was analysed with a paired t test to look for statistically significant differences pre and post operatively. Results Overall, statistically significant differences were noted in 3 areas. GE4 ‘I feel nervous’ showed a different with p=0.02. We believe this to be due to scan anxiety before the 1 year follow up CT scan. ITU5 ‘I have to limit my sexual activity because of my condition reported a difference with p=0.01, similarly question B15 ‘I am able to have and maintain an erection’ had a statistically significant value of p=0.04. These findings are consistent with other data showing sexual dysfunction follow radical cystectomy surgery. Conclusion The FACT-BL-CYS patient evaluation of HRQOL outcomes following radical cystectomy showed that there were significant differences in patient nervousness and their sexual activity following radical cystectomy treatment at GSTT. Looking to the future of this pilot we should expand the patient population and look at multiple time points to see the short- and long-term effects and educate patients on this. Keywords: Bladder cancer, Radical cystectomy, Quality of Life, Patient related outcome measures (PROMs), FACT-BL-CYS Conference: Bladder Cancer Translational Research Meeting, London, United Kingdom, 29 Mar - 29 Mar, 2019. Presentation Type: Poster Topic: Elimination of uncertainty during surveillance following radical therapy Citation: Hare K, Chatterton K, Moss CL, Russell B, Amery S and Van Hemelrijck M (2019). A pilot study to evaluate patient reported outcome measures of bladder cancer patients undergoing radical cystectomy at Guy’s and St Thomas’ NHS Foundation Trust.. Front. Oncol. Conference Abstract: Bladder Cancer Translational Research Meeting. doi: 10.3389/conf.fonc.2019.01.00013 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 28 Feb 2019; Published Online: 27 Sep 2019. * Correspondence: Miss. Katie Hare, King's College London, London, United Kingdom, katie.hare@kcl.ac.uk Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Katie Hare Kathryn Chatterton Charlotte L Moss Beth Russell Sue Amery Mieke Van Hemelrijck Google Katie Hare Kathryn Chatterton Charlotte L Moss Beth Russell Sue Amery Mieke Van Hemelrijck Google Scholar Katie Hare Kathryn Chatterton Charlotte L Moss Beth Russell Sue Amery Mieke Van Hemelrijck PubMed Katie Hare Kathryn Chatterton Charlotte L Moss Beth Russell Sue Amery Mieke Van Hemelrijck Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Comparative Effectiveness of Treatment Strategies for Squamous Cell Carcinoma of the Bladder

BackgroundWhile there is established evidence supporting the use of radical cystectomy (RC) and perioperative chemotherapy for muscle-invasive urothelial carcinoma of the bladder, such evidence does not exist for squamous cell carcinoma. ObjectiveWe present the largest study to date of patients with squamous cell carcinoma and compare the effectiveness of possible treatment regimens for overall survival. Design, setting, and participantsThe National Cancer Data Base was queried for cases of localized, muscle-invasive pure squamous cell bladder cancer, classified as clinical stage T2/3N0M0. Permutations of surgery (RC), chemotherapy, and external beam radiation were selected. Outcome measurements and statistical analysisA multinomial propensity score method was used to create treatment weights based on clinical characteristics predicting the probability of treatment receipt. These were then applied in weighted Cox proportional hazards models to assess the comparative effectiveness of treatments for overall survival, adjusting for age, TNM clinical stage, Charlson comorbidity index, race, sex, and facility and county level variables. Results and limitationsA total of 828 cases were included, comprising 465 RC alone, 53 neoadjuvant chemotherapy+RC, 48 RC+adjuvant chemotherapy, 72 chemotherapy alone, 88 radiation alone, and 102 chemoradiation cases. On weighted regression, RC treatment with or without perioperative chemotherapy was associated with significantly better overall survival compared to the other treatment modalities; chemotherapy alone, radiation alone, and chemoradiation were associated with a hazard ratio (HR) of death of 2.43 (95% confidence interval [CI] 1.65–3.59), 4.78 (95% CI 3.33–6.86), and 1.61 (95% CI 1.16–2.25), respectively, compared to RC alone (all p<0.005). A combination of RC and neoadjuvant chemotherapy was comparable to RC alone, with HR of death 1.33 (95% CI 0.89–1.98). The combination of RC and adjuvant chemotherapy was also similar to RC alone (HR 1.11, 95% CI 0.66–1.85). These findings are limited by small numbers and the retrospective nature of the study. ConclusionsRC with or without perioperative chemotherapy should be considered an upfront therapy for squamous cell carcinoma of the bladder. Patient summaryUsing a national database, we compared treatments for muscle-invasive squamous cell bladder cancer. Patients undergoing radical cystectomy with or without chemotherapy had longer survival. Radical cystectomy with or without chemotherapy should be the standard of care for this disease.

Orthotopic urinary diversion after radical cystectomy in treatment of muscle invasive bladder cancer

Surgical treatment of invasive carcinoma of the bladder in males includes total cystectomy removal of the prostate, seminal vesicles, and the distal parts of the urethers and the pelvic lymph node dissection as well. At this moment it is not possible to recommend a particular type of urinary diversion, but today in clinical practice commonly used derivative are ileal orthotopic neobladder as the continent one and ileal conduit as non-continent urinary diversion. Continent urinary diversion after radical cystectomy are the result of the application of technological innovation in surgery, but also knowledge, imagination and skill of well trained urologist. This type of operation significantly improves the quality of life in patients who underwent radical cystectomy, and the proposal is to operate whenever there is a possibility for this type of procedure. Also it is very important, during surgery to respect oncological principles, of complete removal of tumorous tissue and that the functional principle of ensur- ing that the patients have daytime and also nighttime continence later on after the surgery.

Comparison of Radical Cystectomy with Conservative Treatment in Geriatric ( 80) Patients with Muscle-Invasive Bladder Cancer

The aim of this study was to compare overall survival in elderly patients (≥ 80 years) with muscle-invasive bladder cancer (MIBC) undergoing either radical cystectomy (RC) or conservative treatment. We performed a retrospective, comparative analysis of overall- and cancer-specific survival in octagenarians with MIBC (≥ pT2) submitted to RC or conservative treatment. Uni- and multivariable Cox regression analysis were performed to assess predictors of overall survival. Cumulative hospital stay was also analyzed for all patients. The RC-group consisted of 33 patients with a mean age of 82.3 years (IQR 80.4-85.4 years) and the bladder preservation a cohort of 35 patients aged 83.8 years (IQR 81.8-88.2 years). No difference was detectable for overall survival (15.9 months versus 9.5 months; p = 0.18) and cancer-specific survival (23.5 months versus 19.5 months p = 0.71) or 90-day mortality (6.1% versus 14.3%; p = 0.43) between the two groups. Patients who received conservative treatment had a shorter cumulative length of hospital stay (p = 0.001). Age at the time of transurethral resection of the bladder (TUR-B) was an independent predictor of the overall survival (p = 0.004). In this retrospective study, no clear survival benefit was observed for patients ≥80 years submitted either to radical cystectomy or conservative treatment. There was however a trend favoring radical cystectomy but this did not approach statistical significance. Octagenarians that underwent RC however spent more of their remaining lifetime in the hospital than those treated conservatively.

Prostate Sparing Cystectomy versus Nerve Sparing Radical Cystectomy in Treatment of Invasive Bladder Cancer : Randomized Controlled Prospective Study

Prostate Sparing Cystectomy versus Nerve Sparing Radical Cystectomy in Treatment of Invasive Bladder Cancer : Randomized Controlled Prospective Study

Continent Catheterizable Pouches for Urinary Diversion

Context Catheterizable pouches represent a good alternative in patients with continent urinary diversion (CUD) when neobladder reconstruction is contraindicated. Objective This review summarizes the different techniques, indications and contraindications, functional results, outcomes, and complications of continent catheterizable pouches. Evidence acquisition A PubMed Medline database research was performed, identifying publications of CUD using a catheterizable pouch after radical cystectomy for treatment of bladder cancer. Evidence synthesis In some patients with infiltrating bladder cancer, a continent cutaneous diversion is indicated when the urethra is involved. Some authors also recommend a catheterizable pouch in patients with carcinoma in situ and in female patients. Different bowel segments have been used to build the reservoir: ileocecum, colon, and ileum. Especially in patients with previous pelvic irradiation, the transverse colonic pouch represents a feasible urinary diversion. Reservoirs with high volume and low pressures can be fashioned by antimesenteric opening and spherical reconfiguration of the bowel. The need for antirefluxive ureteral implantation is questioned and there is a trend towards refluxive implantation. Simple and reproducible techniques (eg, appendix stoma, flap-valve T mechanism, serosa-lined extramural tunnel) have been developed for creation of a continence mechanism. Satisfactory continence rates >90% are reported for most techniques and quality of life is comparable with orthotopic continent diversion. The overall incidence of complications varies from 28–57%. However, most urinary tract complications (eg, pouch calculi, ureteroenteric anastomotic strictures, efferent limb strictures, mucous retention) are corrected by endoscopic means. Open surgery is mainly performed in strictures of the afferent limb. Conclusions Cutaneous catheterizable pouches represent an established and good opportunity for CUD after radical cystectomy for treatment of bladder cancer. Most of the problems that occurred during creation of continent cutaneous reservoirs in the past have been solved. Long-term data of different surgical techniques show excellent continence and acceptable complication rates.