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  • Radical Cystectomy
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  • 1
    Language: English
    In: Patient Preference and Adherence, 2016, Vol.10, p.2181(7)
    Description: PURPOSE: This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery.HYPOTHESIS: A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy.MATERIALS AND METHODS: Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien-Dindo classification.RESULTS: Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (P〈0.001). When placing patients into subgroups, significantly more complications in period A were also seen concerning sex (male, P〈0.001; female, P=0.003), age (〈70 years, P〈0.001; 〉70 years, P≤50.001) tumor grade (low grade, P〈0.001; high grade, P≤0.001), and UD (ileal conduit, P〈0.001; neobladder, P〈0.001). In a multivariable analysis, age (P=0.031) and type of UD (P=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (P=0.0417), age (P=0.041), and the time periods (A/B) (P〈0.001) show a significant association with the presence of complications.CONCLUSION: This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic outcome and quality of life.
    Keywords: Medicine;
    ISSN: 1177-889X
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  • 2
    In: BJU International, February 2016, Vol.117(2), pp.272-279
    Description: Byline: Atiqullah Aziz, Shahrokh F. Shariat, Florian Roghmann, Sabine Brookman-May, Christian G. Stief, Michael Rink, Felix K. Chun, Margit Fisch, Vladimir Novotny, Michael Froehner, Manfred P. Wirth, Marco J. Schnabel, Hans-Martin Fritsche, Maximilian Burger, Armin Pycha, Antonin Brisuda, Marko Babjuk, Stefan Vallo, Axel Haferkamp, Jan Roigas, Joachim Noldus, Regina Stredele, Bjorn Volkmer, Patrick J. Bastian, Evanguelos Xylinas, Matthias May Keywords: bladder cancer; radical cystectomy; mortality; nomograms; outcome Objective To externally validate the pT4a-specific risk model for cancer-specific survival (CSS) proposed by May etal. (Urol Oncol 2013; 31: 1141-1147) and to develop a new pT4a-specific nomogram predicting CSS in an international multicentre cohort of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB) Patients and Methods Data from 856 patients with pT4a UCB treated with RC at 21 centres in Europe and North-America were assessed. The risk model proposed by May etal., which includes female gender, presence of positive lymphovascular invasion (LVI) and lack of adjuvant chemotherapy administration as adverse predictors for CSS, was applied to our cohort. For the purpose of external validation, model discrimination was measured using the receiver-operating characteristic-derived area under the curve. A nomogram for predicting CSS in pT4a UCB after RC was developed after internal validation based on multivariable Cox proportional hazards regression analysis evaluating the impact of clinicopathological variables on CSS. Decision-curve analyses were applied to determine the net benefit derived from the two models. Results The estimated 5-year-CSS after RC was 34% in our cohort. The risk model devised by May etal. predicted individual 5-year-CSS with an accuracy of 60.1%. In multivariable Cox proportional hazards regression analysis, female gender (hazard ratio [HR] 1.45), LVI (HR 1.37), lymph node metastases (HR 2.54), positive soft tissue surgical margins (HR 1.39), neoadjuvant (HR 2.24) and lack of adjuvant chemotherapy (HR 1.67, all P 〈 0.05) were independent predictors of an adverse CSS rate and formed the features of our nomogram with a predictive accuracy of 67.1%. Decision-curve analyses showed higher net benefits for the use of the newly developed nomogram in our cohort over all thresholds. Conclusions The risk model devised by May etal. was validated with moderate discrimination and was outperformed by our newly developed pT4a-specific nomogram in the present study population. Our nomogram might be particularly suitable for postoperative patient counselling in the heterogeneous cohort of patients with pT4a UCB. Article Note: A.A. and S.F.S. contributed equally to the study.
    Keywords: Bladder Cancer ; Radical Cystectomy ; Mortality ; Nomograms ; Outcome
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 3
    Language: English
    In: Patient preference and adherence, 2016, Vol.10, pp.2181-2187
    Description: This study compares early complications after cystectomy and urinary diversion (UD) stratified by the surgical focus and case load of two different department chairpersons in a single institution in two time periods. Creating clear data about complications that can affect the quality of life is an important tool for patients to decide whether and where to perform this extensive surgery. A team of surgeons with a clear focus on pelvic surgery leads to lower complication rates in radical cystectomy. Radical cystectomy was performed in two separate time periods under the patronage of two different chairmen in the same university hospital. The patient data were analyzed retrospectively and the complications 30 days after surgery were assessed using the Clavien-Dindo classification. Statistical analysis showed a significant difference in the severity of complications between the two time periods, A and B, in total (70 years, ≤0.001) tumor grade (low grade, 〈0.001; high grade, ≤0.001), and UD (ileal conduit, 〈0.001; neobladder, 〈0.001). In a multivariable analysis, age (=0.031) and type of UD (=0.028) were determined as independent predictors for complications in period A. When joining the two periods together, the type of UD (=0.0417), age (=0.041), and the time periods (A/B) (〈0.001) show a significant association with the presence of complications. This study compares for the first time surgical complications in two time periods with different case load and surgical focus in one department. Categorization shows that patients should prefer radical cystectomy in centers of excellence or a high-volume hospital in order to keep complications at the lowest possible level and thus have the highest benefit for oncologic outcome and quality of life.
    Keywords: Clavien–Dindo Classification ; Ud ; Early Complications ; High-Volume Period ; Low-Volume Period ; Radical Cystectomy ; Urinary Diversion
    ISSN: 1177-889X
    Source: MEDLINE/PubMed (U.S. National Library of Medicine)
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  • 4
    Language: English
    In: World Journal of Urology, 2015, Vol.33(3), pp.343-350
    Description: Byline: Matthias May (1), Atiqullah Aziz (2,5), Sabine Brookman-May (3), Florian Roghmann (4), Joachim Noldus (4), Michael Rink (5), Felix Chun (5), Margit Fisch (5), Vladimir Novotny (6), Manfred Wirth (6), Roman Mayr (2,7), Armin Pycha (7), Antonin Brisuda (8), Bjorn Volkmer (9), Regina Stredele (9), Christopher Dechet (10), Stefan Vallo (11), Axel Haferkamp (11), Marco Schnabel (2), Stefan Denzinger (2), Jan Roigas (12), Christian G. Stief (3), Christian Gilfrich (1), Patrick J. Bastian (13), Jorg B. Engel (14), Maximilian Burger (2), Hans-Martin Fritsche (2) Keywords: Urothelial carcinoma; Bladder cancer; Radical cystectomy; Vaginal invasion; Uterine invasion; Prognosis Abstract: Purpose To evaluate for the first time the prognostic significance of female invasive patterns in stage pT4a urothelial carcinoma of the bladder in a large series of women undergoing anterior pelvic exenteration. Patients and methods Our series comprised of 92 female patients in total of whom 87 with known invasion patterns were eligible for final analysis. Median follow-up for evaluation of cancer-specific mortality (CSM) was 38 months (interquartile ranges, 21--82 months). The impact on CSM was evaluated using multivariable Cox proportional-hazards regression analysis predictive accuracy (PA) was assessed by receiver operating characteristic analysis. Results Vaginal invasion was noted in 33 patients (37.9 % group VAG), uterine invasion in 20 patients (23 % group UT), and infiltration of both vagina and uterus in 34 patients (39.1 % group VAG + UT). Groups VAG and UT significantly differed from group VAG + UT with regard to the presence of positive soft tissue margins (STM) only. Five-year-cancer-specific survival probabilities in the groups VAG, UT, and VAG + UT were 21, 20, and 21 %, respectively (p = 0.955). On multivariable analysis, only STM status (HR = 2.02, p = 0.023) independently influenced CSM. C-indices of multivariable models for CSM with and without integration of invasive patterns were 0.570 and 0.567, respectively (PA gain 0.3 %, p = 0.526). Conclusions Infiltration of the vagina, the uterus or both is associated with poor 5-year survival rates. With regard to CSM, no difference was detectable between patients with different invasion patterns, thus justifying further collectively including these invasive patterns as stage pT4a. Author Affiliation: (1) Department of Urology, St. Elisabeth Medical Centre Straubing, Straubing, Germany (2) Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany (3) Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany (4) Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany (5) Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany (6) Department of Urology, University Hospital "Carl Gustav Carus", Dresden Technical University, Dresden, Germany (7) Department of Urology, General Hospital of Bolzano, Bolzano, Italy (8) Department of Urology, 2nd Faculty of Medicine, Motol University Hospital, Prague, Czech Republic (9) Department of Urology, Kassel Medical Centre, Kassel, Germany (10) Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA (11) Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany (12) Department of Urology, Vivantes Medical Centre Im Friedrichshain and Am Urban, Berlin, Germany (13) Department of Urology, Paracelsus Medical Centre Golzheim, Dusseldorf, Germany (14) Department of Gynecology and Obstetrics, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany Article History: Registration Date: 22/04/2014 Received Date: 18/03/2014 Accepted Date: 22/04/2014 Online Date: 10/05/2014 Article note: Matthias May and Atiqullah Aziz have contributed equally to this work.
    Keywords: Urothelial carcinoma ; Bladder cancer ; Radical cystectomy ; Vaginal invasion ; Uterine invasion ; Prognosis
    ISSN: 0724-4983
    E-ISSN: 1433-8726
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  • 5
    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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  • 6
    Language: English
    In: World Journal of Urology, 2015, Vol.33(11), pp.1753-1761
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s00345-015-1502-y Byline: Vladimir Novotny (1), Michael Froehner (1), Matthias May (2), Chris Protzel (3), Katrin Hergenrother (3), Michael Rink (4), Felix K. Chun (4), Margit Fisch (4), Florian Roghmann (5), Rein-Juri Palisaar (5), Joachim Noldus (5), Michael Gierth (6), Hans-Martin Fritsche (6), Maximilian Burger (6), Danijel Sikic (7), Bastian Keck (7), Bernd Wullich (7), Philipp Nuhn (8), Alexander Buchner (8), Christian G. Stief (8), Stefan Vallo (9), Georg Bartsch (9), Axel Haferkamp (9), Patrick J. Bastian (10), Oliver W. Hakenberg (3), Stefan Propping (1), Atiqullah Aziz (4) Keywords: Bladder cancer; Radical cystectomy; Recurrence; Outcome Abstract: Purpose To externally validate the Christodouleas risk model incorporating pathological tumor stage, lymph node (LN) count and soft tissue surgical margin (STSM) and stratifying patients who develop locoregional recurrence (LR) after radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). In addition, we aimed to generate a new model including established clinicopathological features that were absent in the Christodouleas risk model. Methods Prospectively assessed multicenter data from 565 patients undergoing RC for UCB in 2011 qualified for final analysis. For the purpose of external validation, risk group stratification according to Christodouleas was performed. Competing-risk models were calculated to compare the cumulative incidences of LR after RC. Results After a median follow-up of 25 months (interquartile range 19--29), the LR-rate was 11.5 %. The Christodouleas model showed a predictive accuracy of 83.2 % in our cohort. In multivariable competing-risk analysis, tumor stage a[yen]pT3 (HR 4.32, p 〈 0.001), positive STSM (HR 2.93, p = 0.005), lymphovascular invasion (HR 3.41, p 〈 0.001), the number of removed LNs 〈10 (HR 2.62, p 〈 0.001) and the administration of adjuvant chemotherapy (HR 0.40, p = 0.008) independently predicted the LR-rate. The resulting risk groups revealed significant differences in LR-rates after 24 months with 4.8 % for low-risk patients, 14.7 % for intermediate-risk patients and 38.9 % for high-risk patients (p 〈 0.001 for all), with a predictive accuracy of 85.6 %, respectively. Conclusions The Christodouleas risk model has been successfully externally validated in the present prospective series. However, this analysis finds that overall model performance may be improved by incorporating lymphovascular invasion. After external validation of the newly proposed risk model, it may be used to identify patients who benefit from an adjuvant therapy and suit for inclusion in clinical trials. Author Affiliation: (1) Department of Urology, University Hospital "Carl Gustav Carus", Dresden, Germany (2) Department of Urology, St. Elisabeth Hospital, Straubing, Germany (3) Department of Urology, University Medical Center Rostock, Rostock, Germany (4) Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany (5) Department of Urology, Marienhospital Herne, Ruhr-University Bochum, Herne, Germany (6) Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany (7) Department of Urology, University Hospital Erlangen, Erlangen, Germany (8) Department of Urology, Ludwig-Maximilians-University Munich, Munich, Germany (9) Department of Urology, Goethe-University Frankfurt, Frankfurt am Main, Germany (10) Department of Urology, Paracelsus Medical Center Golzheim, Dusseldorf, Germany Article History: Registration Date: 27/01/2015 Received Date: 02/12/2014 Accepted Date: 25/01/2015 Online Date: 08/02/2015
    Keywords: Bladder cancer ; Radical cystectomy ; Recurrence ; Outcome
    ISSN: 0724-4983
    E-ISSN: 1433-8726
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  • 7
    Language: English
    In: Urologic Oncology: Seminars and Original Investigations, October 2016, Vol.34(10), pp.432.e1-432.e8
    Description: To evaluate the prognostic relevance of different prostatic invasion patterns in pT4a urothelial carcinoma of the bladder (UCB) after radical cystectomy. Our study comprised a total of 358 men with pT4a UCB. Patients were divided in 2 groups—group A with stromal infiltration of the prostate via the prostatic urethra with additional muscle-invasive UCB ( = 121, 33.8%) and group B with continuous infiltration of the prostate through the entire bladder wall ( = 237, 66.2%). The effect of age, tumor grade, carcinoma in situ, lymphovascular invasion, soft tissue surgical margin, lymph node metastases, administration of adjuvant chemotherapy, and prostatic invasion patterns on cancer-specific mortality (CSM) was evaluated using competing-risk regression analysis. Decision curve analysis was used to evaluate the net benefit of including the variable invasion pattern within our model. The estimated 5-year CSM-rates for group A and B were 50.1% and 66.0%, respectively. In multivariable competing-risk analysis, lymph node metastases (hazard ratio [HR] = 1.73, 〈0.001), lymphovascular invasion (HR = 1.62, = 0.0023), soft tissue surgical margin (HR = 1.49, = 0.026), absence of adjuvant chemotherapy (HR = 2.11, 〈0.001), and tumor infiltration of the prostate by continuous infiltration of the entire bladder wall (HR = 1.37, = 0.044) were significantly associated with a higher risk for CSM. Decision curve analysis showed a net benefit of our model including the variable invasion pattern. Continuous infiltration of the prostate through the entire bladder wall showed an adverse effect on CSM. Besides including these patients into clinical trials for an adjuvant therapy, we recommend including prostatic invasion patterns in predictive models in pT4a UCB in men.
    Keywords: Bladder Cancer ; Radical Cystectomy ; Mortality ; Outcome ; Prostatic Invasion Pattern ; Medicine
    ISSN: 1078-1439
    E-ISSN: 1873-2496
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