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  • Prognosis
  • 1
    Language: English
    In: Expert Opinion on Emerging Drugs, 01 December 2009, Vol.14(4), pp.607-618
    Description: Bladder cancer is a very common and aggressive tumor entity. Unfortunately, common chemotherapy is not able to cure advanced bladder cancer. Therefore, several attempts have been made to improve the response to chemotherapy. Because changes...
    Keywords: Apoptosis ; Bladder Cancer ; Chemotherapy ; Pro-Apoptotic ; Sensitization ; Economics
    ISSN: 1472-8214
    E-ISSN: 1744-7623
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  • 2
    Language: English
    In: Urologic Oncology: Seminars and Original Investigations, January 2018, Vol.36(1), pp.11.e1-11.e6
    Description: To describe the course of disease of patients surgically treated for locally recurrent renal cell carcinoma (LRRCC) after nephrectomy and to identify potential predictive factors for long-term survival. We, retrospectively, identified 54 patients who underwent surgical resection of LRRCC after open nephrectomy for localized kidney cancer. The median age at time of surgery for LRRCC was 65 years. Survival rates were determined with the Kaplan-Meier method. Mantel-Haenszel hazard ratios were calculated. Comparisons were made with the log-rank test. Cox proportional hazard models were used to analyze combined effects of variables. Median time to local recurrence after nephrectomy was 36 months (5–242 months). Median follow-up after surgery for LRRCC was 39 months. At time of analysis 18 patients (33%) were alive without any evidence of disease, 8 patients (15%) were alive with disease, 20 patients (37%) died of renal cell carcinoma, and 8 patients (15%) died of other causes. A 5-year overall survival (OS) was 60% (95% CI: 0.44–0.73) and 10-year OS was 32% (95% CI: 0.15–0.51). The median survival after surgery for LRRCC was 79 months. In univariate analysis OS differed significantly by the time period between primary surgery and occurrence of LRRCC (〈2 years vs. ≥2 years: 10-year OS rate 31% (95% CI: 10.2–55.0) vs. 45% (95% CI: 21.5–65.8; hazard ratio = 0.26; = 0.0034). In multivariate analysis sarcomatoid features in the primary nephrectomy specimen, positive surgical margins of the LRRCC specimen and a Charlson score of ≥2 were associated with a significantly worse prognosis in this cohort. In patients with a disease-free interval of more than 2 years after surgery for the primary tumor, surgical removal of LRRCC may achieve long-term survival in most patients. In those with a shorter disease-free interval, long-term survival is unlikely.
    Keywords: Kidney Neoplasms ; Renal Cell Carcinoma ; Local Recurrence ; Prognosis ; Medicine
    ISSN: 1078-1439
    E-ISSN: 1873-2496
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  • 3
    Language: English
    In: Urologia Internationalis, July 2018, Vol.101(1), pp.16-24
    Description: Background/Aims/Objectives: To evaluate the influence of body mass index (BMI) on complications and oncological outcomes in patients undergoing radical cystectomy (RC). Methods: Clinical and histopathological parameters of patients have been prospectively collected within the “PROspective MulticEnTer RadIcal Cystectomy Series 2011”. BMI was categorized as normal weight (〈25 kg/m2), overweight (≥25–29.9 kg/m2) and obesity (≥30 kg/m2). The association between BMI and clinical and histopathological endpoints was examined. Ordinal logistic regression models were applied to assess the influence of BMI on complication rate and survival. Results: Data of 671 patients were eligible for final analysis. Of these patients, 26% (n = 175) showed obesity. No significant association of obesity on tumour stage, grade, lymph node metastasis, blood loss, type of urinary diversion and 90-day mortality rate was found. According to the ­American Society of Anesthesiologists score, local lymph node (NT) stage and operative case load patients with higher BMI had significantly higher probabilities of severe complications 30 days after RC (p = 0.037). The overall survival rate of obese patients was superior to normal weight patients (p = 0.019). Conclusions: There is no evidence of correlation between obesity and worse oncological outcomes after RC. While obesity should not be a parameter to exclude patients from cystectomy, surgical settings need to be aware of higher short-term complication risks and obese patients should be counselled ­accordingly.
    Keywords: Original Paper ; Urothelial Carcinoma ; Bladder Cancer ; Obesity ; Radical Cystectomy ; Prognosis ; Survival ; Medicine
    ISSN: 0042-1138
    E-ISSN: 1423-0399
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  • 4
    Language: English
    In: Annals of Surgical Oncology, 2015, Vol.22(3), pp.1032-1042
    Description: PURPOSEThe aim of this study was to examine preoperative patients' characteristics associated with the urinary diversion (UD) type (continent vs. incontinent) after radical cystectomy (RC) and UD-associated postoperative complications. MATERIALSIn 2011, 679 bladder cancer patients underwent RC at 18 European tertiary care centers. Data were prospectively collected within the 'PROspective MulticEnTer RadIcal Cystectomy Series 2011' (PROMETRICS 2011). Logistic regression models assessed the impact of preoperative characteristics on UD type and evaluated diversion-related complication rates. RESULTSOf 570 eligible patients, 28.8, 2.6, 59.3, and 9.3% received orthotopic neobladders, continent cutaneous pouches, ileal conduits, and ureterocutaneostomies, respectively. In multivariable analyses, female sex (odds ratio [OR] 3.9; p = 0.002), American Society of Anesthesiologists score ≥3 (OR 2.3; p = 0.02), an age-adjusted Charlson Comorbidity Index ≥3 (OR 4.1; p 〈 0.001), and a positive biopsy of the prostatic urethra in the last transurethral resection of the bladder prior to RC (OR 4.9; p = 0.03) were independently associated with incontinent UD. There were no significant differences in 30- and/or 90-day complication rates between the UD types. Perioperative transfusion rates and 90-day mortality were significantly associated with incontinent UD (p 〈 0.001, respectively). Limitations included the small sample size and a certain level of heterogeneity in the application of clinical pathways between the different participating centers. CONCLUSIONSWithin this prospective contemporary cohort of European RC patients treated at tertiary care centers, the majority of patients received an incontinent UD. Female sex and pre-existing comorbidities were associated with receiving an incontinent UD. The risk of overall complications did not vary according to UD type.
    Keywords: Aged–Adverse Effects ; Aged, 80 and Over–Mortality ; Comorbidity–Pathology ; Cystectomy–Surgery ; Female–Surgery ; Follow-Up Studies–Surgery ; Humans–Surgery ; Male–Surgery ; Middle Aged–Surgery ; Neoplasm Grading–Surgery ; Neoplasm Staging–Surgery ; Postoperative Complications–Surgery ; Prognosis–Surgery ; Prospective Studies–Surgery ; Quality of Life–Surgery ; Survival Rate–Surgery ; Urinary Bladder Neoplasms–Surgery ; Urinary Diversion–Surgery;
    ISSN: 1068-9265
    E-ISSN: 1534-4681
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