المؤلفون: Horovitz, David, Türker, Polat, Bostrom, Peter J., Mirtti, Tuomas, Nurmi, Martti, Kuk, Cynthia, Zlotta, Alexandre R.

مصطلحات موضوعية: bladder cancer, radical cystectomy, age, elderly, Bladder-Cancer, Elderly-Patients, Comorbidity, Older, Carcinoma, Outcomes, Surgery, Therapy

الوصف: OBJECTIVE To analyse the impact of patient age on survival after radical cystectomy (RC). PATIENTS AND METHODS After ethics review board approval, two databases of patients with bladder cancer (BC) undergoing RC at the University Heath Network, Toronto, Canada (1992-2008) and the University of Turku, Turku, Finland (1986-2005) were retrospectively analysed. A total of 605 patients who underwent this procedure between June 1985 and March 2010 were included. Patients were divided into four age groups: <= 59, 60-69, 70-79 and >= 80 years. Demographic, clinical and pathological data were compared, as well as recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OAS) rates. RESULTS Compared with younger patients (age <= 79 years), elderly patients (age >= 80 years) had higher American Society of Anesthesiologists scores (P < 0.001), a greater number of lymph nodes removed during surgical dissection (P < 0.001), and underwent less adjuvant treatment (P < 0.001). Choice of urinary diversion differed among the groups, with ileal conduit being used for all patients >= 80 years (P < 0.001). No differences were noted between age groups with respect to RFS (P = 0.3), DSS (P = 0.4) or OAS (P = 0.4). CONCLUSION Although RC is an operation with significant morbidity, it is a viable treatment option for carefully selected elderly patients. Senior patients (>= 80 years) should not be denied RC if they are deemed fit to undergo surgery. Senior adults do not suffer from adverse histopathological features as compared with younger patients.

العلاقة: Bju International; Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı; https://doi.org/10.1111/j.1464-410X.2012.11180.xTest; https://hdl.handle.net/20.500.11776/8493Test; 110; 11B; E486; E493; WOS:000315024200010; 2-s2.0-84876421963

الإتاحة: https://doi.org/20.500.11776/8493Test
https://doi.org/10.1111/j.1464-410X.2012.11180.xTest
https://hdl.handle.net/20.500.11776/8493Test

المؤلفون: Perlis, Nathan, Türker, Polat, Bostrom, Peter J., Kuk, Cynthia, Mirtti, Tuomas, Kulkarni, Girish, Zlotta, Alexandre R.

مصطلحات موضوعية: Urinary bladder neoplasm, Cystectomy, Neoplasm recurrence, Mortality, Urinary tract, Transitional-Cell Carcinoma, Urothelial Carcinoma, Bladder-Cancer, Surveillance

الوصف: To examine which patient-related and tumour-related characteristics predict upper urinary tract recurrence (UUTR) and urethral recurrence (UR) of bladder cancer post-radical cystectomy (RC). Secondary objective is to evaluate whether or not recurrence patterns are similar between two centres with different post-RC follow-up (F/U) protocols. A retrospective cohort study of 574 consecutive patients undergoing radical cystectomy for urothelial carcinoma of the bladder at two tertiary centres was performed. Clinicopathological factors associated with bladder cancer recurrence and patient-related outcomes, including time to recurrence and death, were collected. Risk factors for recurrences were examined using univariate and multivariable regression analyses. Likelihood of recurrence, time to recurrence, and survival were compared. There was a 3.7 % risk of UUTR (21/574) and a 3.6 % risk of UR (18/503) for the combined cohort at a median F/U of 45 months. When controlling for the effects of all variables modelled, female gender was a significant risk factor for UUT recurrence (OR 3.2, 95 % CI 1.0-9.5, p = 0.03) and prostatic urethral involvement was a significant risk factor for urethral recurrence (OR 7.8, 95 % CI 2.2-27.6, p = 0.001). UUTR were similar (p = 0.82) between Turku (8/205) and Toronto (12/369). Urethral recurrences trended (p = 0.06) towards being more common in Turku (9/151, 6.0 %) versus Toronto (9/352, 2.6 %), but no difference in overall survival was demonstrated between sites. The frequency of UUT and urethral recurrences post-cystectomy is relatively low and remained stable for the past 15 years. The ideal F/U protocol to maximize patient-survival remains unknown.

العلاقة: World Journal of Urology; Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı; https://doi.org/10.1007/s00345-012-0905-2Test; https://hdl.handle.net/20.500.11776/8503Test; 31; 161; 167; WOS:000314181900021; 2-s2.0-84873197515

الإتاحة: https://doi.org/20.500.11776/8503Test
https://doi.org/10.1007/s00345-012-0905-2Test
https://hdl.handle.net/20.500.11776/8503Test

المؤلفون: Türker, Polat, Bostrom, Peter J., Wroclawski, Marcelo L., van Rhijn, Bas, Kortekangas, Hannes, Kuk, Cynthia, Zlotta, Alexandre R.

مصطلحات موضوعية: bladder cancer, radical cystectomy, upstaging, 2nd Transurethral Resection, Lymphovascular Invasion, Bladder-Cancer, Evaluating Patients, Pathological Stage, Recurrence, Chemotherapy, Carcinoma, Specimens, Impact

الوصف: OBJECTIVES To analyse the details of bladder cancer (BC) staging in a large combined radical cystectomy (RC) database from two academic centres. To study rate and time trends, as well as risk factors for upstaging, especially clinical factors associated with staging errors after RC. PATIENTS AND METHODS Characteristics of patients undergoing RC at University Health Network, Toronto, Canada (1992-2010) and University of Turku, Turku, Finland (1986-2005) were analysed. RESULTS Among 602 patients undergoing RC, 306 (51%) had a discordance in clinical and pathological stages. Upstaging occurred in 240 (40%) patients and 192 (32%) patients were upstaged from organ-confined (OC) to non-organ-confined (nOC) disease. During the study period, upstaging became more common in both centres. In multivariate analyses, T2 disease at initial presentation (P = 0.001, odds ratio [OR] = 2.62, 95% confidence interval [CI] : 1.44-4.77), high grade disease (P = 0.01, OR = 2.85, 95% CI: 1.21-6.7), lymphovascular invasion (LVI) (P < 0.001, OR = 5.17, 95% CI: 3.48-7.68), female gender (P = 0.038, OR = 0.6, 95% CI: 0.38-0.97, and histological variants (P < 0.001, OR = 2.77, 95% CI: 1.6-4.8) were associated with a risk of upstaging from OC to nOC disease. Upstaged patients had worse survival rates than patients with correct staging. This was especially significant among patients with carcinoma invading bladder muscle before undergoing RC (16% vs 46% 10-year disease-specific mortality, P < 0.001). CONCLUSIONS Upstaging is a common problem and unfortunately no improvements have been observed during the last two decades. LVI and the presence of histological variants are strong predictors of upstaging at the time of RC. Pathologists should be encouraged to report LVI and any histological variant at the time of TURBT.

العلاقة: Bju International; Makale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı; https://doi.org/10.1111/j.1464-410X.2012.10939.xTest; https://hdl.handle.net/20.500.11776/8497Test; 110; 804; 811; WOS:000309058200012; 2-s2.0-84865471861

الإتاحة: https://doi.org/20.500.11776/8497Test
https://doi.org/10.1111/j.1464-410X.2012.10939.xTest
https://hdl.handle.net/20.500.11776/8497Test