Prognostic impact of tumor-associated immune cell infiltrates at radical cystectomy for bladder cancer

Objectives: To assess whether the presence and location of tumor-associated immune cell infiltrates (TAIC) on histological slides obtained from cystectomy specimens impacts on oncological outcomes of patients with bladder cancer (BC). Material and methods: A total of 320 consecutive patients staged with cM0 bladder cancer underwent radical cystectomy (RC) between 2004 and 2013. The presence of TAIC (either located peritumorally [PIC] and/or intratumorally [IIC]) on histological slides was retrospectively assessed and correlated with outcomes. Kaplan-Meier analyses were used to estimate the impact of TAIC on recurrence-free (RFS), cancer-specific (CSS), and overall survival (OS). Multivariable Cox-regression analysis was carried out to evaluate risk factors of recurrence. The median follow-up was 37 months (IQR: 10-55). Results: Of the 320 patients, 42 (13.1%) exhibited IIC, 141 (44.1%) PIC and 137 (42.8%) no TAIC in the cystectomy specimens. Absence of TAIC was associated with higher ECOG performance status (P = 0.042), histologically advanced tumor stage (≥pT3a; P < 0.001), lymph node tumor involvement (pN+; P = 0.022), positive soft tissue surgical margins (P = 0.006), lymphovascular invasion (P < 0.001), and elevated serum C-reactive protein levels (P < 0.001). The rate of never smokers was significantly higher in the IIC-group (64.3%) compared to the PIC-group (39.7%, P = 0.007) and those without TAIC (35.8%, P = 0.001). The 3-year RFS/CSS/OS was 73.9%/88.5%/76.7% for patients with IIC, 69.4%/85.2%/70.1% for PIC and 47.6%/68.5%/56.1% for patients without TAIC (P < 0.001/<0.001/0.001 for TAIC vs. no TAIC). In multivariable analysis, adjusted for all significant parameters of univariable analysis, histologically advanced tumor stage (P = 0.003), node-positive disease (P = 0.002), and the absence of TAIC (P = 0.035) were independent prognosticators for recurrence. Conclusions: In this analysis, the presence and location of TAIC in cystectomy specimens was a strong prognosticator for RFS after RC. This finding suggests that the capability of immune cells to migrate into the tumor at the time of RC is prognostically important in invasive bladder cancer

Synchronous surgery for the combined treatment of post-radical prostatectomy erectile dysfunction and stress urinary incontinence: a lucrative evolution or an unnecessary complexity?

Aim of this review is to summarize and evaluate the current literature addressing the synchronous combined surgical treatment approach for co-existent post-radical prostatectomy erectile dysfunction and stress urinary incontinence. Severity of stress urinary incontinence is the basic element that defines which option of combined surgery will be offered to a patient. So, for cases of severe erectile dysfunction and severe stress urinary incontinence (>4 pads/day) the only available option is synchronous inflatable penile prosthesis plus artificial urinary sphincter dual implantation. When severe erectile dysfunction coexist with mild to moderate stress urinary incontinence synchronous inflatable penile prosthesis plus male sling or ProAct (Uromedica, Plymouth, MN, USA) device are the current available treatment options. Finally, when severe erectile dysfunction along with mild stress urinary incontinence and with or without climacturia are present, a new surgical technique of simultaneous inflatable penile prosthesis plus urethral mini-sling, named "Andrianne mini-jupette", implantation has been recently proposed. Synchronous combined surgery for post-radical prostatectomy erectile dysfunction and stress urinary incontinence seems to offer similar efficacy and safety results compared with two-stage implantation but in a more cost- and time effective approach. Thus, synchronous surgery, in the hands of experienced prosthetic surgeons, could be potentially a valuable alternative for the management of co-existent post-radical prostatectomy erectile dysfunction and stress urinary incontinence. Nevertheless, in order to acquire robust scientific data further prospective comparative studies on larger numbers of patients are surely needed.status: publishe