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  • Bladder Cancer
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  • 1
    Language: English
    In: European Urology, May 2013, Vol.63(5), pp.830-831
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.eururo.2012.12.061 Byline: Peter C. Black Author Affiliation: Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
    Keywords: Medicine
    ISSN: 0302-2838
    E-ISSN: 1873-7560
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  • 2
    Language: English
    In: PLoS ONE, 01 January 2013, Vol.8(2), p.e57284
    Description: Fibroblast growth factor receptors (FGFRs) are activated by mutation and overexpressed in bladder cancers (BCs), and FGFR inhibitors are currently being evaluated in clinical trials in BC patients. However, BC cells display marked heterogeneity in their responses to FGFR inhibitors, and the...
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 3
    Language: English
    In: The Journal of Urology, April 2015, Vol.193(4), pp.e843-e843
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.juro.2015.02.2416 Byline: Roland Seiler, Lucia Lam, Nicolas Erho, Elai Davicioni Author Affiliation: Vancouver, Canada Article Note: (footnote) Source of Funding: Genome British Columbia
    Keywords: Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 4
    Language: English
    In: The Journal of Urology, October 2016, Vol.196(4), pp.1036-1041
    Description: Clinical staging in patients with muscle invasive bladder cancer misses up to 25% of lymph node metastasis. These patients are at high risk for disease recurrence and improved clinical staging is critical to guide management. Whole transcriptome expression profiles were generated in 199 patients who underwent radical cystectomy and extended pelvic lymph node dissection. The cohort was divided randomly into a discovery set of 133 patients and a validation set of 66. In the discovery set features were identified and modeled in a KNN51 (K-nearest neighbor classifier 51) to predict pathological lymph node metastases. Two previously described bladder cancer gene signatures, including RF15 (15-gene cancer recurrence signature) and LN20 (20-gene lymph node signature), were also modeled in the discovery set for comparison. The AUC and the OR were used to compare the performance of these signatures. In the validation set KNN51 achieved an AUC of 0.82 (range 0.71–0.93) to predict lymph node positive cases. It significantly outperformed RF15 and LN20, which had an AUC of 0.62 (range 0.47–0.76) and 0.46 (range 0.32–0.60), respectively. Only KNN51 showed significant odds of predicting LN metastasis with an OR of 2.65 (range 1.68–4.67) for every 10% increase in score (p 〈0.001). RF15 and LN20 had a nonsignificant OR of 1.21 (range 0.97–1.54) and 1.39 (range 0.52–3.77), respectively. The new KNN51 signature was superior to previously described gene signatures for predicting lymph node metastasis. If validated prospectively in transurethral resection of bladder tumor samples, KNN51 could be used to guide patients at high risk to early multimodal therapy.
    Keywords: Urinary Bladder Neoplasms ; Neoplasm Metastasis ; Lymph Nodes ; Genomics ; Biomarkers, Tumor ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 5
    Language: English
    In: The Journal of Urology, January 2016, Vol.195(1), pp.53-59
    Description: Selected patients with bladder cancer with pelvic lymphadenopathy (cN1-3) are treated with induction chemotherapy followed by radical cystectomy. However, the data on clinical outcomes in these patients are limited. In this study we assess pathological and survival outcomes in patients with cN1-3 disease treated with induction chemotherapy and radical cystectomy. Data were collected on patients from 19 North American and European centers with cT1-4aN1-N3 urothelial carcinoma who received chemotherapy followed by radical cystectomy between 2000 and 2013. The primary end points were pathological complete (pT0N0) and partial (pT1N0 or less) response rates, with overall survival as a secondary end point. Logistic regression and Cox proportional hazard ratios were used for multivariate analysis of factors predicting these outcomes. The total of 304 patients had clinical evidence of lymph node involvement (cN1-N3). Methotrexate/vinblastine/doxorubicin/cisplatin was used in 128 (42%), gemcitabine/cisplatin in 132 (43%) and other regimens in 44 (15%) patients. The pN0 rate was 48% (cN1—56%, cN2—39%, cN3—39%, p=0.03). The complete and partial pathological response rates for the entire cohort were 14.5% and 27%, respectively. The estimated median overall survival time for the cohort was 22 months (IQR 8.0, 54). On Cox regression analysis overall survival was associated with pN0, negative surgical margins, removal of 15 or more pelvic nodes and cisplatin therapy. Complete pathological nodal response can be achieved in a proportion of patients with cN1-3 disease receiving induction chemotherapy. The best survival outcomes are observed in male patients on cisplatin regimens with subsequent negative radical cystectomy margins and complete nodal response (pN0) with excision of 15 or more pelvic nodes.
    Keywords: Urinary Bladder Neoplasms ; Cystectomy ; Neoadjuvant Therapy ; Survival ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 6
    Language: English
    In: The Journal of Urology, June 2018, Vol.199(6), pp.1452-1458
    Description: Level I evidence supports the usefulness of neoadjuvant cisplatin based chemotherapy for muscle invasive bladder cancer. Since dose dense MVAC (methotrexate, vinblastine, doxorubicin and cisplatin) has mostly replaced traditional MVAC, we compared pathological response and survival rates in patients with locally advanced bladder cancer who received neoadjuvant chemotherapy with dose dense MVAC vs gemcitabine and cisplatin. We retrospectively reviewed the records of patients with urothelial cancer who received neoadjuvant chemotherapy and underwent cystectomy at a total of 20 contributing institutions from 2000 to 2015. Patients with cT3-4aN0M0 disease were selected for this analysis. The rates of ypT0N0 and ypT1N0 or less were compared between the gemcitabine and cisplatin, and dose dense MVAC regimens. Two multivariable Cox proportional hazards regression models of overall mortality were generated using preoperative and postoperative data. Of the patients who underwent neoadjuvant chemotherapy and radical cystectomy during the study period 319 met our inclusion criteria. A significantly lower rate of ypT0N0 was observed in the gemcitabine and cisplatin arm than in the dose dense MVAC arm (14.6% vs 28.0%, p = 0.005). The rate of ypT1N0 or less was 30.1% for gemcitabine and cisplatin compared to 41.0% for dose dense MVAC (p = 0.07). The mean Kaplan-Meier estimates of overall survival in the gemcitabine and cisplatin, and dose dense MVAC groups were 4.2 and 7.0 years, respectively (p = 0.001). On multivariable cox regression analysis based on preoperative data patients who received gemcitabine and cisplatin were at higher risk for death than patients who received dose dense MVAC (HR 2.07, 95% CI 1.25–3.42, p = 0.003). Lymph node invasion (HR 1.97, 95% CI 1.15–3.36, p = 0.01) and hydronephrosis (HR 2.18, 95% CI 1.43–3.30, p 〈0.001) were also associated with higher risk of death. In our retrospective cohort of patients with locally advanced bladder cancer dose dense MVAC was associated with higher complete pathological response and improved survival rates compared to gemcitabine and cisplatin. A clinical trial is warranted to validate these hypothesis generating results to test the superiority of neoadjuvant dose dense MVAC in patients with locally advanced bladder cancer.
    Keywords: Urinary Bladder Neoplasms ; M-Vac Protocol ; Gemcitabine ; Cisplatin ; Mortality ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 7
    Language: English
    In: World Journal of Urology, 2016, Vol.34(1), pp.1-2
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00345-015-1755-5 Byline: Peter C. Black (1), Wassim Kassouf (2) Author Affiliation: (1) Department of Urologic Sciences, Vancouver Prostate Centre, University of British Columbia, Level 6, 2775 Laurel St, Vancouver, BC, V5Z 1M9, Canada (2) Department of Surgery (Urology), McGill University Health Center, 1001 Decarie Blvd, D02.7210, Montreal, QC, H4A 3J1, Canada Article History: Registration Date: 21/12/2015 Online Date: 07/01/2016
    Keywords: Bladder Cancer;
    ISSN: 0724-4983
    E-ISSN: 1433-8726
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  • 8
    Language: English
    In: Canadian Urological Association journal = Journal de l'Association des urologues du Canada, June 2017, Vol.11(6Suppl2), pp.S160-S162
    Keywords: Bladder Cancer -- Research ; Bladder Cancer -- Care And Treatment;
    ISSN: 1911-6470
    E-ISSN: 19201214
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  • 9
    In: PLoS ONE, 2014, Vol.9(10)
    Description: Objective To characterize the frequency and timing of complications following radical cystectomy in a cohort of patients treated at community and academic hospitals. Patients and Methods Radical cystectomy patients captured from NSQIP hospitals from January 1 2006 to December 31 2012 were included. Baseline information and complications were abstracted by study surgical clinical reviewers through a validated process of medical record review and direct patient contact. We determined the incidence and timing of each complication and calculated their associations with patient and operative characteristics. Results 2303 radical cystectomy patients met inclusion criteria. 1115 (48%) patients were over 70 years old and 1819 (79%) were male. Median hospital stay was 8 days (IQR 7–13 days). 1273 (55.3%) patients experienced at least 1 post-operative complication of which 191 (15.6%) occurred after hospital discharge. The most common complication was blood transfusion (n = 875; 38.0%), followed by infectious complications with 218 (9.5%) urinary tract infections, 193 (8.4%) surgical site infections, and 223 (9.7%) sepsis events. 73 (3.2%) patients had fascial dehiscence, 82 (4.0%) developed a deep vein thrombosis, and 67 (2.9%) died. Factors independently associated with the occurrence of any post-operative complication included: age, female gender, ASA class, pre-operative sepsis, COPD, low serum albumin concentration, pre-operative radiotherapy, pre-operative transfusion 〉4 units, and operative time 〉6 hours (all p〈0.05). Conclusion Complications remain common following radical cystectomy and a considerable proportion occur after discharge from hospital. This study identifies risk factors for complications and quality improvement needs.
    Keywords: Research Article ; Medicine And Health Sciences
    E-ISSN: 1932-6203
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  • 10
    In: PLoS ONE, 2014, Vol.9(6)
    Description: Purpose To explore the morbidity, mortality and oncological results of laparoscopic radical cystectomy (LRC) in the elderly patients over 75-year-old in contrast with open radical cystectomy (ORC). Materials and Methods We analyzed 46 radical cystectomies from January 2009 to December 2013 in patients over 75-year-old in our institute, 21 patients in the LRC group and 25 in the ORC group. Demographic parameters, operative variables and perioperative outcome were retrospectively collected and analyzed between the two groups. Perioperative morbidity and mortality were categorized as early (within 90 days after surgery) or late (more than 90 days) according to the time of occurrence. Results Patients in both groups had comparable preoperative characteristics. A significant longer operative time (418 vs. 337 min, p = 0.018) and less estimated blood loss (400 vs. 500 ml p = 0.038) were observed in LRC group compared with ORC group. Infection and ileus were the most common early complications after surgery. Patients underwent ORC suffered from significantly more postoperative ileus (28.0% vs. 4.8%, P = 0.038) and infection (40% vs. 9.5%, P = 0.019) than LRC group within 90 days after surgery. The mortality rate was 4.7% (1/21) and 4% (1/25) for LRC group and ORC group respectively. At a median follow-up of 21 months (range 2–61 months), the Kaplan-Meier survival curves and log-rank analysis demonstrate that there were no significant differences between the LRC and ORC groups in the 3-year overall, cancer-specific, or recurrence-free survival rates. Conclusions It is suggested that LRC should be recommended as the primary intervention to treat muscle invasive or high risk non-muscle invasive bladder cancer in elderly patients with a relative long life expectancy.
    Keywords: Research Article ; Medicine And Health Sciences
    E-ISSN: 1932-6203
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