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  • 1
    In: BJU International, January 2018, Vol.121(1), pp.101-110
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/bju.14012/abstract Byline: Malte W. Vetterlein, Philipp Gild, Luis A. Kluth, Thomas Seisen, Michael Gierth, Hans-Martin Fritsche, Maximilian Burger, Chris Protzel, Oliver W. Hakenberg, Nicolas Landenberg,Florian Roghmann, Joachim Noldus, Philipp Nuhn, Armin Pycha, Michael Rink, Felix K.-H. Chun, Matthias May, Margit Fisch,Atiqullah Aziz,, G Bartsch, C Bolenz, S Brookman-May, A Buchner, M Durschnabel, J Ellinger, M Froehner, G Georgieva, C Gilfrich, M Gorduk, MO Grimm, B Hadaschik, A Haferkamp, F Hartmann, E Herrmann, L Hertle, M Hohenfellner, G Janetschek, B Keck, N Kraischits, A Krausse, L Lusuardi, T Martini, MS Michel, R Moritz, SC Muller, V Novotny, S Pahernik, RJ Palisaar, A Ponholzer, J Roigas, M Schmid, P Schramek, C Seitz, D Sikic, CG Stief, I Syring, M Traumann, S Vallo, FM Wagenlehner, W Weidner, MP Wirth, B Wullich Keywords: blood transfusion; cystectomy; propensity score; recurrence; survival Objectives To evaluate the effect of peri-operative blood transfusion (PBT) on recurrence-free survival, overall survival, cancer-specific mortality and other-cause mortality in patients undergoing radical cystectomy (RC), using a contemporary European multicentre cohort. Patients and Methods The Prospective Multicentre Radical Cystectomy Series (PROMETRICS) includes data on 679 patients who underwent RC at 18 European tertiary care centres in 2011. The association between PBT and oncological survival outcomes was assessed using Kaplan-Meier, Cox regression and competing-risks analyses. Imbalances in clinicopathological features between patients receiving PBT vs those not receiving PBT were mitigated using conventional multivariable adjusting as well as inverse probability of treatment weighting (IPTW). Results Overall, 611 patients had complete information on PBT, and 315 (51.6%) received PBT. The two groups (PBT vs no PBT) differed significantly with respect to most clinicopathological features, including peri-operative blood loss: median (interquartile range [IQR]) 1000 (600-1500) mL vs 500 (400-800) mL (P 〈 0.001). Independent predictors of receipt of PBT in multivariable logistic regression analysis were female gender (odds ratio [OR] 5.05, 95% confidence interval [CI] 2.62-9.71; P 〈 0.001), body mass index (OR 0.91, 95% CI 0.87-0.95; P 〈 0.001), type of urinary diversion (OR 0.38, 95% CI 0.18-0.82; P = 0.013), blood loss (OR 1.32, 95% CI 1.23-1.40; P 〈 0.001), neoadjuvant chemotherapy (OR 2.62, 95% CI 1.37-5.00; P = 0.004), and a[yen]pT3 tumours (OR 1.59, 95% CI 1.02-2.48; P = 0.041). In 531 patients with complete data on survival outcomes, unweighted and unadjusted survival analyses showed worse overall survival, cancer-specific mortality and other-cause mortality rates for patients receiving PBT(P 〈 0.001, P = 0.017 and P = 0.001, respectively). After IPTW adjustment, those differences no longer held true. PBT was not associated with recurrence-free survival (hazard ratio [HR] 0.92, 95% CI 0.53-1.58; P = 0.8), overall survival (HR 1.06, 95% CI 0.55-2.05; P = 0.9), cancer-specific mortality (sub-HR 1.09, 95% CI 0.62-1.92; P = 0.8) and other-cause mortality (sub-HR 1.00, 95% CI 0.26-3.85; P 〉 0.9) in IPTW-adjusted Cox regression and competing-risks analyses. The same held true in conventional multivariable Cox and competing-risks analyses, where PBT could not be confirmed as a predictor of any given endpoint (all P values 〉0.05). Conclusion The present results did not show an adverse effect of PBT on oncological outcomes after adjusting for baseline differences in patient characteristics. Article Note: M.W.V. and P.G. contributed equally to the work. PROMETRICS 2011 Study Group members are present in Appendix 1.
    Keywords: Blood Transfusion ; Cystectomy ; Propensity Score ; Recurrence ; Survival
    ISSN: 1464-4096
    E-ISSN: 1464-410X
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  • 2
    Language: English
    In: Clinical Genitourinary Cancer, October 2017, Vol.15(5), pp.548-555.e3
    Description: Patients with locally advanced penile squamous-cell carcinoma have a poor prognosis. No difference in survival was noted when using chemotherapy before or after surgery. Uncertainties persist regarding the optimal management of these patients, and new treatments are urgently required, particularly for patients at highest risk, with bilateral and/or pelvic lymph node involvement. The prognosis of patients with locally advanced penile squamous-cell carcinoma is primarily related to the extent of lymph node metastases. Surgery alone yields suboptimal results, and there is a paucity of data on these patients' outcomes. This retrospective study evaluated patients who received neoadjuvant or adjuvant chemotherapy from 1990 onward at 12 centers. Cox models were used to investigate prognostic factors for relapse-free survival and overall survival (OS). Among the 201 included patients, 39 (19.4%) had disease of T3-4 and N0 clinical stage; the remaining patients had clinical lymph node involvement (cN+). Ninety-four patients received neoadjuvant chemotherapy (group 1), 78 received adjuvant chemotherapy (group 2), and 21 received both (group 3). Eight patients for whom the timing of perioperative chemotherapy administration was unavailable were included in the Cox analyses. Forty-three patients (21.4%) received chemoradiation. Multivariate analysis for OS (n = 172) revealed bilateral disease (  = .035) as a negative prognostic factor, while pelvic cN+ tended to be nonsignificantly associated with decreased OS (  = .076). One-year relapse-free survival was 35.6%, 60.6%, and 45.1% in the 3 groups, respectively. One-year OS was 61.3%, 82.2%, and 75%, respectively. No significant differences were seen on univariable analyses for OS between the groups (  = .45). Platinum type of chemotherapy and chemoradiation were not significantly associated with any outcome analyzed. Benchmark survival estimates for patients receiving perioperative chemotherapy for locally advanced penile squamous-cell carcinoma have been provided, with no substantial differences observed between neoadjuvant and adjuvant administration. This analysis may result in improved patient information, although prospective studies are warranted.
    Keywords: Penile Cancer ; Preoperative Chemotherapy ; Regional Lymph Nodes ; Squamous Cell Carcinoma ; Survival ; Medicine
    ISSN: 1558-7673
    E-ISSN: 1938-0682
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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: European Urology Focus, March 2018, Vol.4(2), pp.252-259
    Description: The benefit of adjuvant chemotherapy (AC) for muscle-invasive urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC) is controversial. To assess the effectiveness of AC after RC for muscle-invasive UCB in contemporary European routine practice. By using a prospectively collected European multicenter database, we compared survival outcomes between patients who received AC versus observation after RC for locally advanced (pT3/T4) and/or pelvic lymph node–positive (pN+) muscle-invasive UCB in 2011. AC versus observation after RC. Inverse probability of treatment weighting (IPTW)–adjusted Cox regression and competing risks analyses were performed to compare overall survival (OS) as well as cancer-specific and other-cause mortality between patients who received AC versus observation. Overall, 224 patients who received AC ( = 84) versus observation ( = 140) were included. The rate of 3-yr OS in patients who received AC versus observation was 62.1% versus 40.9%, respectively ( = 0.014). In IPTW-adjusted Cox regression analysis, AC versus observation was associated with an OS benefit (hazard ratio: 0.47; 95% confidence interval [CI]: 0.25–0.86; = 0.014). In IPTW-adjusted competing risks analysis, AC versus observation was associated with a decreased risk of cancer-specific mortality (subhazard ratio: 0.51; 95% CI: 0.26–0.98; = 0.044) without any increased risk of other-cause mortality (subhazard ratio: 0.48; 95% CI: 0.14–1.60; = 0.233). Limitations include the relatively small sample size as well as the potential presence of unmeasured confounders related to the observational study design. We found that AC versus observation was associated with a survival benefit after RC in patients with pT3/T4 and/or pN+ UCB. These results should encourage physicians to deliver AC and researchers to pursue prospective or large observational investigations. Overall survival and cancer-specific survival benefit was found in patients who received adjuvant chemotherapy relative to observation after radical cystectomy for locally advanced and/or pelvic lymph node–positive bladder cancer. In this observational multicenter study, adjuvant chemotherapy versus observation after radical cystectomy for locally advanced and/or node-positive muscle-invasive urothelial bladder cancer was associated with an overall and cancer-specific survival benefit without increased risk of other-cause mortality.
    Keywords: Adjuvant Chemotherapy ; Cystectomy ; Propensity Score ; Survival ; Urinary Bladder Neoplasms ; Medicine
    ISSN: 2405-4569
    E-ISSN: 2405-4569
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