Optimizing staging and treatment of muscle-invasive bladder cancer

Contains fulltext : 148928.pdf (publisher's version ) (Open Access)Radboud Universiteit Nijmegen, 11 december 2015Promotores : Witjes, J.A., Skinner, E.C. Co-promotor : Heijden, A.G. van de

Management of upper urinary tract problems after radical cystectomy for urothelial carcinoma: tips and tricks

Purpose of review After radical cystectomy (RC) patients are at risk for both benign and malignant problems regarding the upper urinary tract (UUT). This review summarizes the recent literature and provides tips on how to manage problems of the UUT after RC. Recent findings Disease recurrence, kidney stones and ureteroenteric strictures (UES) are common after RC. Endourological techniques can be used to treat low-grade disease recurrence, either with a retrograde or antegrade approach. Treatment success depends on getting access to the UUT and on tumor characteristics; selecting the right approach is key. Kidney stones can be treated endourologically with good results. With use of minimal invasive techniques such as robot cystectomy, a higher incidence of UES is observed. The use of indocyanine green could help to prevent this complication. In case of a stricture, primary reconstruction should be the treatment strategy of choice. After RC, recurrence of the UUT remains a complicated problem. Choice of treatment method should be tailored to the patient and tumor characteristics. Kidney stones after cystectomy can be successfully managed endourological. Robot assisted RC introduced a higher rate of UES, which should be managed by primary revision

The effect of the time interval between diagnosis of muscle-invasive bladder cancer and radical cystectomy on staging and survival: A Netherlands Cancer Registry analysis

Item does not contain fulltextINTRODUCTION: Data from single-center series suggest that a delay in time to radical cystectomy (RC) more than 3 months after diagnosis of muscle-invasive bladder cancer (MIBC) is associated with pathological upstaging and decreased survival. However, limited data is available from population-based studies. In this study, the effect of delayed RC was assessed in a nationwide cohort. MATERIALS AND METHODS: Patients who underwent RC between 2006 and 2010 with primary clinical T2-T4N0M0 urothelial bladder cancer were selected using the Netherlands Cancer Registry database. Data from the Netherlands Cancer Registry was supplemented with data from the Nationwide Network and Registry of Histo- and Cytopathology database in case of incomplete information. The cohort was divided in patients who underwent RC 3 months (group II). Median time from MIBC diagnosis to RC, variables associated with delayed RC >3 and the effect of delayed RC on staging and overall survival (OS) were evaluated in patients who underwent neoadjuvant therapy and patients who did not. RESULTS: A total of 1,782 patients were included. Median follow-up time was 5.1 years for living patients and 1.3 years for deceased patients. Median time from MIBC diagnosis to RC was 50 days (interquartile range: 27 days) and 93% of patients underwent RC3 months was not associated with decreased OS adjusting for confounding variables (hazard ratio = 1.16; 95% CI: 0.91-1.48; P = 0.25). Median time from MIBC diagnosis to RC in patients that received neoadjuvant therapy (n = 105) was 133 days (interquartile range: 62 days). Adjusting for confounding variables, delayed RC>3 months was not associated with OS (hazard ratio = 0.90; 95% CI: 0.45-1.82). CONCLUSIONS: The vast majority of patient underwent RC within 3 months after diagnosis of MIBC, as recommended in the European Association of Urology MIBC guideline. Delayed RC for more than 3 months had no adverse effect on staging and survival

The length of positive surgical margins correlates with biochemical recurrence after radical prostatectomy.

Contains fulltext : 87806.pdf (publisher's version ) (Closed access)AIMS: To evaluate the prognostic role of the length of a positive surgical margin (+SM) for biochemical recurrence (BCR) after radical prostatectomy (RP) for prostatic cancer. METHODS AND RESULTS: Consecutive RP specimens (n = 267) with +SM were analysed. All RP specimens were sectioned at 4-mm intervals and completely embedded. Data were analysed using Kaplan-Meier survival analysis and proportional hazards models. In 267 patients the length of +SM ranged from 0.4 to 174.5 mm (median 11.2 mm) and correlated with preoperative prostate specific antigen (PSA) (P 10 mm this was 21% and 39%, respectively. On multivariable analysis BCR was associated with an increasing length of +SM (10 mm; hazard ratio 2.15; 95% confidence interval 1.12, 4.15; P = 0.022). CONCLUSIONS: The length of +SM is an independent prognostic factor for BCR in patients with undetectable PSA after RP.1 maart 201

Radical cystectomy in a Dutch University hospital: long-term outcomes and prognostic factors in a homogeneous surgery-only series

Contains fulltext : 136641.pdf (publisher's version ) (Closed access)BACKGROUND: The aim of this study was to present survival outcomes and identify prognostic factors in patients undergoing radical cystectomy (RC) for urothelial bladder cancer (UBC) in a homogeneous surgery-only series. PATIENTS AND METHODS: Patients who underwent RC for UBC with intent-to-cure between January 1998 and December 2010 without neoadjuvant or adjuvant treatment were included in this retrospective study. Clinical and histopathologic data were collected and institutional review board approval was obtained. Outcomes of interest were 30-day mortality (30dM), RFS, and OS. Univariable and multivariable analysis were performed. Median follow-up was 9.1 years. RESULTS: Two hundred forty-five patients were included with a median age of 65 years (range, 34-92 years). 30dM rate was in 5 out of 245 patients (2.0%) and 5-year RFS and OS rates were 67% and 58%, respectively. A total of 223 patients (91%) underwent lymph node (LN) dissection. Median number of removed and positive LNs were 9 and 1.5, respectively. Variables independently associated with decreased OS and RFS were tumor stage and LN status. In addition, positive soft tissue surgical margin (STSM) status was independently associated with decreased OS. In LN-positive patients, presence of extranodal extension (ENE) was associated with decreased RFS (39.7% vs. 7.3%; P = .005). CONCLUSION: Radical cystectomy for UBC was associated with low perioperative mortality rate and provided 5-year disease control in approximately two-thirds of patients. Independent prognostic factors included tumor stage, LN status (RFS and OS), and STSM status (OS). Presence of ENE in LN-positive patients was univariably associated with decreased RFS and OS

What Is the Prognostic and Clinical Importance of Urothelial and Nonurothelial Histological Variants of Bladder Cancer in Predicting Oncological Outcomes in Patients with Muscle-invasive and Metastatic Bladder Cancer? A European Association of Urology Muscle Invasive and Metastatic Bladder Cancer Guidelines Panel Systematic Review

Contains fulltext : 215744.pdf (publisher's version ) (Closed access)CONTEXT: Variant histology of muscle-invasive (MIBC) and metastatic (mBC) bladder cancer may define the cancer treatment modality and oncological outcomes. OBJECTIVE: To determine the prognostic effect and impact of therapy of urothelial and nonurothelial histological variants on the oncological outcomes of MIBC and mBC. EVIDENCE ACQUISITION: Medline, Embase, Cochrane controlled trial databases, and ClinicalTrials.gov were systematically searched. Patients with histological variants of MIBC or/and mBC from prospective and retrospective comparative studies and single-arm case series published after the year of 2000 were included. Treatment outcomes (overall, recurrence-free, and disease-specific survival) were extracted and reported. Risk of bias (RoB) assessment was performed using Quality in Prognosis Studies tool. EVIDENCE SYNTHESIS: The search yielded 2450 unique articles, of which 41 articles involving a total of 27 672 patients with histological variants were included. Twenty-eight studies had a comparative study design. Two different study settings were seen: large database studies without centralised pathological review and small series with re-review by uropathologists. Although most of the histological variants show similar oncological outcomes after radical cystectomy (RC), signet ring cell, spindle cell, and neuroendocrine tumours showed inferior survival compared with pure urothelial bladder cancer (PUC). Owing to potential misleading interpretations and reporting as well as large heterogeneity between studies, a narrative synthesis approach instead of subgroup analyses was used. Most studies had a moderate RoB. CONCLUSIONS: The data about prognosis and treatment of the variant histology are still immature and assessed mostly in cystectomy patients. Based on this systematic review, all patients with MIBC should be treated with RC. Neoadjuvant chemotherapy may be beneficial for patients with micropapillary, plasmacytoid, sarcomatoid, and mixed variants, and especially for patients with neuroendocrine tumours. Metastatic bladder cancer should be treated as PUC. PATIENT SUMMARY: In this report, we looked at the prognosis and treatment of different bladder cancer histologies. We found that outcomes varied with divergent histologies and appropriate treatment should be based on the histological finding

Chopped and dispersed food enhances foraging and reduces stress-related behaviours in captive white-naped mangabeys (Cercocebus lunulatus)

The white-naped mangabey is an endangered and rare zoo species, yet little is known concerning their welfare in captivity. The assessment of welfare should incorporate a net balance of negative and positive welfare behavioural indicators. These behaviours, and thus welfare, can be affected by the way food is presented based on its distribution, clumped or dispersed, and its size, chopped or whole. This study investigated the effect of food presentation on time-budget behaviours (i.e. forage, activity, inactivity, allogroom, self-groom, play) and stress-related measures (i.e., diarrhoea, aggression, self-directed behaviours), in four crossed-over test conditions of food distribution. The group-living mangabeys of Rotterdam Zoo were provided with vegetables that differed in distribution and size: clumped-chopped, dispersed-whole, dispersed-chopped, and clumped-whole. Mangabeys spent least time being inactive and subordinates and juveniles spent most time foraging during the dispersed-chopped condition, while the reversed was found during the clumped-whole condition. In addition, mangabeys stole food more often and engaged in less self-directed behaviours during dispersed-chopped, compared with dispersed-whole. In contrast, food distribution and size did not affect aggression, play, activity, self-grooming and diarrhoea. Consistent with most of the literature, chopped, dispersed items appeared to be the best, whereas presenting whole food items appeared to be the worst for welfare. In conclusion, presenting food in a distributed and chopped instead of whole manner is suggested to improve welfare of zoo-housed mangabeys