bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of radical cystectomy series in the management of muscle invasive bladder cancer: Liverpool experience.
Authors: Hussain Syed A. , Khattak Altaf Qadir , Cornford Philip , Weston Robin , Somov Pavlo , Jackson Richard 
Published: February 2017

396 Background: Cystectomy has become one of the standard forms of therapy for patients with muscle invasive bladder cancer with long term follow-up data supporting radical surgical management. Methods: Data are collected retrospectively on patients who underwent cystectomy at the Royal Liverpool University Hospital. The aim was to document the overall survival of patients undergoing cystectomy at this centre. Results: Data were collected on 147 patients between September 2007 and June 2013. Median patient age was 66 (IQR: 61, 72) with 33 (23%) females. 107 (73%) patients had muscle invasive TCC, 13 (9%) had recurrent non-muscle invasice disease, 9 (6%) had salvage surgery following radical radiotherapy and 6 (4%) had persistent carcinoma in situ. 28 patients (20%) had hydronephrosis. 34 (23%) patients underwent neo-adjuvant chemotherapy. 2 (1%) patients had Combined synchronous urethrectomy and 5 (3%) had Combined synchronous nephroureterectomy. Post operatively positive lymph nodes were observed in 22 (19%) of surgical specimens and 83 (72%) had persistent muscle invasive disease. Survival rates at 12 and 60 months are 0.92 (0.88, 0.97) and 0.52 (0.39, 0.71) respectively. Multivariate analysis show that post operative T (HR: 3.99 (1.05, 15.18)) and N (HR: 5.40 (2.17, 13.44)) status are both independent predictors of over all survival. Conclusions: Real life data from our centre showed that the patient population and overall survival estimates for patients with muscle invasive bladder cancer treated with radical cystectomy and lymph node dissection are consistent with previous published literature. .
Perioperative outcomes of open and minimally invasive nephroureterectomy and pre-operative predictors of complications: An analysis using the National Surgical Quality Improvement Program database.
Authors: Soodana-Prakash Nachiketh , Pavan Nicola , Balise Raymond R , Nahar Bruno , Rai Samarpit , Ritch Chad , Punnen Sanoj , Satyanarayana Ramgopal , Parekh Dipen , Gonzalgo Mark L. 
Published: February 2017

408 Background: Minimally invasive nephroureterectomy (MINU) is an alternative approach to open nephroureterectomy for management of upper tract urothelial carcinoma (UTUC). Oncological outcomes between the two methods has been shown to be similar. We analyzed the NSQIP database to determine if there was a significant difference in perioperative complications between MINU and open nephroureterectomy. Methods: Between 2005 and 2013, a total of 1,027 patients were identified in the National Surgical Quality Improvement Program Database (NSQIP) that underwent nephrouretectomy for UTUC. Pre−operative covariates were analyzed to predict the rates of severe (Clavien−Dindo grade ≥ 3) perioperative complications. Univariate and multivariate logistic regression models (controlling for demographic and comorbid conditions) were built to predict severe complications and exploratory analyses were done to predict 18 common complications. Results: A total of 669 (65%) and 359 (35%) patients underwent MINU and open nephroureterectomy, respectively. Open nephroureterectomy was associated with a higher rate of severe complications (OR 1.87, CI 1.02−3.4, p = 0.04). Post−operative occurrence of pneumonia (OR 4.5, CI 1.7−3.4, p < 0.001) and transfusions (OR 2.5, CI 1.7−3.6, p < 0.0001) were lower for MINU compared to open nephroureterectomy. There were no significant differences between the two surgical methods with respect to incidence of other complications. MINU took longer on average than open nephroureterectomy (median 219 mins vs. 200 mins, p < 0.001). Time to discharge was longer for open nephroureterectomy compared to MINU (median 6.25 days vs. 5 days, p < 0.0001). Conclusions: Post−operative pneumonia and occurrence of severe complications (Clavien−Dindo grade ≥ 3) were higher for the open nephroureterectomy group compared to MINU. These data suggest that MINU is an acceptable surgical approach for management of UTUC that is associated with lower morbidity compared to open nephroureterectomy.
Comorbidity and androgen deprivation therapy use in men undergoing high-dose radiation for unfavorable intermediate- and high-risk prostate cancer.
Authors: Dyer Michael A , Chen Ming-Hui , Braccioforte Michelle H. , Moran Brian Joseph , D'Amico Anthony V. 
Published: February 2017

41 Background: Despite evidence of prolonged survival when adding androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) in men with unfavorable intermediate- and high-risk prostate cancer (PC), some of these men are not receiving ADT. We explored whether comorbidity can explain this discrepancy given the observation that survival may be shortened in men with moderate to severe comorbidity who receive ADT. Methods: Between 10/1997 and 5/2013, 3,348 men with unfavorable intermediate- (2,380 patients; 70.7%) or high-risk (986 patients; 29.3%) PC were treated at the Prostate Cancer Foundation of Chicago using brachytherapy with or without neoadjuvant EBRT and/or ADT, and formed the study cohort. A multivariable logistic regression analysis was used to evaluate whether comorbidity (history of congestive heart failure [CHF] and/or myocardial infarction [MI]) was associated with decreased odds of ADT use in men with unfavorable intermediate- or high-risk PC, adjusting for age, PC prognostic factors, year of brachytherapy, and EBRT use. Results: Among patients with unfavorable-intermediate-risk PC, 31.2% received ADT, and in the high-risk cohort, 38.3%, 12.3%, and 4.8% received up to 6, >6-18, or >18 months of ADT respectively. In men with high-risk PC, a history of CHF/MI was not significantly associated with decreased odds of ADT use of any duration (all p values >0.71), but the odds of ADT use decreased over time (adjusted odds ratio (AOR) 0.87, 95% confidence interval (CI) [0.83,0.91], p<0.0001; AOR 0.93, 95% CI [0.87,0.99], p=0.023; AOR 0.92, 95% CI [0.83,1.01], p=0.089, for up to 6, >6-18, and >18 months respectively, with no ADT as the reference). Similarly, in men with unfavorable intermediate-risk PC, a history of CHF/MI was not significantly associated with decreased odds of ADT use (p=0.49), whereas the odds of ADT use decreased significantly over time (AOR 0.96, 95% CI [0.94,0.98], p=0.0009). Conclusions: While ADT use has decreased over time in men with unfavorable intermediate- and high-risk PC undergoing brachytherapy with or without supplemental EBRT, this decrease does not appear to be occurring in men with a history of CHF or MI.
Long-term oncological and functional outcomes of prostate sparing cystectomy: Single tertiary care institution experience.
Authors: Perez-Reggeti Jose Ignacio , Sanchez-Salas Rafael , Linares Espinos Estefania , Ingels Alexandre , Sivaraman Arjun , Saad Mohamed , Rozet Francois , Barret Eric , Galiano Marc , Cathala Nathalia , Mombet Annick , Prapotnich Dominique , Cathelineau Xavier 
Published: February 2017

413 Background: To analyze the oncological and functional outcome of Prostate Sparing Cystectomy (PSC) in the treatment of Bladder Cancer (BC) in a single tertiary care referral institution. Methods: At our institution, we treated 147 patients (1992 – 2014) with PSC for muscle invasive BC and recurrent high grade non-muscle invasive BC. Out of these, 64 patients received a standardized PSC technique featuring a Millin adenomectomy between 2001 – 2014 and composed the population of the study. Inclusion criteria were: Normal prostate examination and prostate specific antigen (PSA) +/- negative transrectal ultrasound guided biopsies; Frozen section negative for cancer in prostatic urethra prostate base, distal ureters and trigone. Oncological outcome was evaluated with Overall survival (OS); Cancer-specific survival (CSS); Recurrence-free survival (RFS). Functional outcomes: Continence - being pad-free or leak-free requiring ≤ 1 pad per day/night. Sexual function was assessed by self- reported erectile function sufficient for intercourse with or without medical treatment. Results: Median age was 62 years (IQR 55-67,5) with a median follow-up of 70 months (IQR 46-103). Thirty one (48,4%) patients ≤ pT1, 19 (29,7%) pT2, 14 (21,9%) ≥ pT3 at pathological diagnosis. Lymphadenectomy was performed in 95,3% of the cases. Positive lymph nodes were found in 4.9% patients and 3.1% patients showed positive surgical margins. Ten patients (15,7%) had Clavien grade 3–5 complications.The 5 and 10-y survival rates were OS: 84,7% and 68,3%; CSS: 84,7% and 77,5%; RFS: 76% and 65,5% respectively. No case of recurrence at the remnant prostatic urothelium was observed. Pad-free and leak-free continence, were achieved in 85.9% and 93.8% for daytime continence respectively, with 50% and 85,9% for night continence, respectively. Erectile function was maintained in 56,3%. Prostate cancer was diagnosed in 3 (4,7%) patients, 2 at the pathology report of the adenomectomy followed with active surveillance, and 1 was diagnosed during the follow up being treated with brachytherapy. Conclusions: PSC appears to be an oncologically safe procedure with adequate functional outcomes in treating selected patients with BC.
Incidence and characterization of pure non-urothelial bladder and upper tract cancers: A 10-year review.
Authors: Gupta Kanika , El Bahesh Ehab , Finianos Antoine Nafez , Clark Brandon , Simmens Samuel , Aragon-Ching Jeanny B. 
Published: February 2017

414 Background: Bladder cancer is the sixth most common malignancy in the United States. Urothelial carcinoma makes up 90% of bladder cancer histology, which may be pure or mixed. It includes adenocarcinoma (Ad), squamous (SqC), glandular, sarcomatoid (St), micropapillary, small cell (SC) and plasmacytoid variants. Pure non-urothelial cancers have worse overall survival compared to urothelial cancer with mixed histologic features. However, little research has been done to characterize pure non-urothelial histologies, and there are no randomized clinical trials evaluating treatment modalities for non-urothelial cancers. This retrospective study characterizes pure non-urothelial cancers and their treatments. Methods: A retrospective chart review of the last 10 years was performed using data from the George Washington University Cancer Center Tumor Registry Data. Statistical analysis was done using the Fisher’s test and Kaplan-Meier survival curves. Results: Out of 449 consecutive patients with bladder cancers, 19 patients had pure non-urothelial carcinoma (4.2%): 7 SqC, 6 Ad, 3 SC, 2 lymphoma (Ly), and 1 St. SqC and Ad were more likely than SC to be diagnosed at an advanced stage (p = 0.04), with median age of diagnosis at 53.5 years for Ad, 68 years for SC and 69 years for Sq. None of the SC metastasized. Primary treatment for 94% of patients was a surgical intervention (9 TURBT, 2 partial cystectomy, 2 radical cystectomy, and 2 nephroureterectomy); 1 received neoadjuvant therapy. 11 patients received adjuvant chemotherapy – 7 with gemcitabine-based regimens and 10 with platinum-based regimens. While not statistically significant, median overall survival varied – 404 days for Ad, 213 days for SqC, and 1567 days for SC. Conclusions: SC was a more favorable histology when compared to SqC or Ad, presenting at an earlier stage with lower incidence of metastasis that perhaps reflected the improved overall survival. Identifying patients with more aggressive disease earlier allows for the potential role for more aggressive therapies that may result in improved outcomes. While the sample size is small, it identifies characteristics and potential differences between bladder cancer with rare histologies.
Examining the effect that prior bladder manipulation and BCG treatment have on false positive rates of blue-light cystoscopy biopsies.
Authors: Mount Andrew , Williams Stephen Bentley , Dinney Colin P. N. , Grossman H. Barton , Pettaway Curtis Alvin , Chapin Brian Francis , Navai Neema , Matin Surena F. , Graber William F. , Kamat Ashish M. 
Published: February 2017

416 Background: One of the criticisms of blue-light cystoscopy (BL) is the relatively high rate of false positive biopsies when used in the real world setting. There is no consensus on which patient factors, if any, might be contributing to this high false positive rate. The purpose of this study is to determine whether having a cystoscopy, TURBT or BCG treatment recently resulted in higher rates of false positive blue-light (BL) biopsies. Methods: We performed an IRB-approved retrospective study looking at a total of 116 consecutive patients who underwent simultaneous BL and WL between January 2013 to December 2014. Pathology and operative reports were reviewed to determine the grade and stage of the tumors. Clinical notes were utilized to determine how recently they had a cystoscopy, TURBT, and BCG treatment. The false positive rates of both BL and WL were calculated, and Fisher’s exact test was utilized to determine if the time from the patients’ most recent bladder manipulation or BCG treatment had a significant effect on the false positive BL rate. Results: Of the 46 (28.6%) BL positive biopsies, 29 (63.0%) were false positives. When stratified by potential causes of false positive for BL we found the following: one (3.4%) had bladder manipulation within 14 days, 8 (27.6%) within 30 days, 19 (65.5%) within 60 days, and 10 (34.5%) had bladder manipulation beyond 60 days prior to the biopsy. When looking at intravesical BCG as a cause for false positive, we found prior BCG use in 18 (62%) patients of those with false positive BL compared to 12 (70.6%) patients of those with true positive BL biopsies (p = 1.0). Of the 18 patients with false positive BL biopsies who had BCG previously: 1 (5.6%) had BCG within 6 weeks, 5 (27.8%) had BCG within 12 weeks, and 13 (72.2%) had BCG greater than 12 weeks prior to biopsy. None of these associations were found to be statistically significant. Despite the high percentage of false positive lesions, it is important to note that in patients who had tumors visualized only with BL, 11 (26.8%) were high-grade, including one patient with T1 tumor and 8 with CIS. Conclusions: There was no relationship between recent bladder manipulation or BCG treatment and false positive BL biopsies.
The utility of neutrophil-to-lymphocyte ratio in determining survival outcomes in patients treated with neoadjuvant chemotherapy and radical cystectomy for high-risk bladder cancer.
Authors: Mmeje Chinedu O. , Slade Austen , Slack Rebecca , Navai Neema , Gao Jianjun , Siefker-Radtke Arlene O. , Kamat Ashish M. , Dinney Colin P. N. , Shah Jay Bakul 
Published: February 2017

419 Background: Pre-operative neutrophil-to-lymphocyte ratio (NLR) has been found to be associated with adverse pathological results and poor long-term outcomes in patients treated with radical cystectomy (RC) for urothelial carcinoma (UC). We aimed to evaluate the predictive utility of NLR in patients treated with neoadjuvant chemotherapy (NAC) and RC for high-risk UC. Methods: We reviewed the records of 585 patients treated with NAC and RC at our institution from 2000-2013. We calculated NLR before initiation of NAC (pre-chemo NLR) and during the recovery window between NAC and RC (post-chemo NLR).. We excluded patients with concomitant infection, blood disorder, or second malignancy. We used univariate and multivariate CART models to determine the optimal NLR cut-off for survival outcomes. We estimated disease-specific (DSS) and overall survival (OS) using the Kaplan-Meier method. We used Cox proportional hazards regression to explore the association of NLR with DSS and OS. Results: 584 patients had NLR information in our cohort. The median follow-up among survivors was 4.9 years (IQR 2.4 – 8.8 years). We identified optimal NLR cut-points of 7.1 for pre-chemo, 4.9 for post-chemo, and 1.9 for change in NLR [(post-chemo) – (pre-chemo)]. Post-chemo NLR showed the strongest association with OS and DSS. Patients with a post-chemo NLR ≥ 4.9 (n = 103) had a 5-yr DSS and OS of 42% and 33% respectively, compared to 69% and 58% for patients with an NLR < 4.9 (n = 481). In the multivariable analysis, post-chemo NLR ≥ 4.9 was an independent predictor of DSS (HR = 2.5 [95% CI:1.8, 3.6] p < 0.001 ), and OS (HR = 2.1 [95% CI:1.6, 2.8] p < 0.001). Conclusions: A post-chemo NLR ≥ 4.9 is associated with poor DSS and OS in patients treated with NAC and RC. These findings may help guide treatment planning for adjuvant therapy following RC in patients with high-risk clinically localized bladder cancer.
Human antigen R as a predictive marker for response to gemcitabine-based chemotherapy in advanced cisplatin-resistant urothelial cancer.
Authors: Miyata Yasuyoshi , Mitsunari Kensuke , Asai Akihiro , Matsuo Tomohiro , Ohba Kojiro , Sakai Hideki 
Published: February 2017

421 Background: In patients with advanced urothelial cancer (UC), a combined therapy of cisplatin (CDDP) and gemcitabine (GEM) is the most commonly used first (1st)-line systematic chemotherapy. Although no regimen for CDDP-resistant UC has been established, GEM-based regimens are often used in these patients. In other cancers, HuR status in cancer cells is closely associated with response to GEM. The aim of this study was to establish the predictive value of HuR expression for disease progression and survival in UC patients treated with GEM-based regimens as 1st or second (2nd)-line chemotherapy. Methods: Fifty patients with advanced UC were included in the study. As 1st-line chemotherapy, MVEC (methotrexate, vinblastine, epirubicin, and CDDP) and GC therapy were performed in 34 (68.0%) and 16 patients (32.0%), respectively. After progression, 45 patients (90.0%) were treated with combined GEM and paclitaxel (PTX) therapy, and 5 patients (10.0%) were treated with GEM monotherapy. Cytoplasmic and nuclear Human antigen R (HuR) expression was evaluated using immunohistochemical techniques. The relationships between HuR expression and local response and outcome were analyzed. Results: In 1st-line chemotherapy, no anti-cancer effects were associated with nuclear or cytoplasmic HuR expression. In 2nd-line chemotherapy, although nuclear HuR expression also had no significant relationship to anti-cancer effects, local tumor response was significantly better if there was positive cytoplasmic HuR expression (P = 0.002). Multivariate analyses revealed that cytoplasmic HuR expression was a significant predictive marker for longer overall survival (hazard ratio, 0.22; 95% confidential interval, 0.09–0.56; P = 0.001). There is no significant relationship between nuclear HuR expression and parameters of anti-cancer effects. Conclusions: Cytoplasmic HuR expression is a significant predictive marker of response to GEM-based chemotherapy in CDDP-resistant UC. Despite limitations of a small retrospective study, our results might have important information to discuss the treatment strategies and warrant further basic and clinical research.
MRI-transrectal ultrasound cognitive fusion-targeted transperineal template-guided saturation prostate biopsies in a consecutive cohort of men.
Authors: Matzkin Haim , Dekalo Snir , Mabjeesh Nicola J 
Published: February 2017

43 Background: MRI of the prostate may improve diagnostic accuracy of prostate cancer. Different fusion approaches with transrectal ultrasound images are employed. Objective: To determine the detection rate of prostate cancer in men undergoing transperineal template-guided saturation biopsy (TTSB) with MRI-based cognitive fusion. Methods: Between the years 2010-2015, 164 consecutive men underwent a multiple-core prostate TTSB. Univariable and multivariable logistic regression analyses were used to address the relationship between clinical TTSB parameters and prostate cancer detection rate. Covariates consisted of age, prostate-specific antigen (PSA), prostate volume, PSA density, digital rectal examination findings, existence of suspicious prostate lesions on MRI, number of previous negative biopsy sets, and number of cores taken during TTSB. Results: Mean age was 65 years and mean PSA was 14 ng/ml, mean prostate volume was 63 ml. Seventy percent of patients had at least two previous negative transrectal biopsy series and another 19% had at least one negative biopsy. One-hundred and fourteen patients (70%) underwent prostate MRI prior to the biopsy. The detection rate of prostate cancer among these patients was 46% of which 69% had Gleason score ≥ 7. Men with a suspicious lesion on MRI (n=80) had a detection rate of 50%, compared to 33% in patients with negative MRI study. On multivariate analysis, the most significant independent predictive factor was PSA density (p= 0.001). Other nearly significant parameters were suspicious MRI lesion, prostate volume and suspicious digital examination. Of note, the prostate cancer detection rate among patients with no MRI study prior to TTSB was 26%. Conclusions: Utilizing MRI cognitive fusion approach increases the detection rate of clinically significant prostate cancer (Gleason score ≥ 7). In patients with existing suspicion for prostate cancer after multiple negative standard TRUS-guided biopsies, performing TTSB after taking into consideration the findings on MRI and PSA density will increase dramatically the detection rate of significant disease.
Associations between health-related quality of life and physical activity in bladder cancer survivors: A cross-sectional study.
Authors: Gopalakrishna Ajay , Fantony Joseph J , Longo Thomas Andrew , Inman Brant Allen 
Published: February 2017

432 Background: Physical activity has been shown to significantly improve health-related quality of life (HRQOL) and survivorship in a variety of cancer patients. However, little is known about the physical activity patterns of bladder cancer survivors and how these are related to HRQOL in the United States. Our objective was to describe HRQOL and self-reported physical activity patterns and examine the association between these measures in a large cohort of bladder cancer survivors. Methods: Bladder cancer survivors identified through an institutional database were mailed a survey that included the Functional Assessment of Cancer Therapy Bladder Cancer (FACT-Bl) and the International Physical Activity Questionnaire (IPAQ-L). Results: A total of 466 subjects (49% response rate) completed the survey. The mean age was 73 years, 80% were male, and 88% were White. Linear regression indicated a positive correlation between physical activity and physical well being (PWB, P < 0.001), emotional well being (EWB, P < 0.001), and functional well being (FWB, P < 0.001) subscales, as well as the FACT-Bl (P < 0.001), FACT general (P < 0.001), and trial outcome index (TOI, P < 0.001) composite scores. Conversely, total daily sitting time was negatively correlated with all of the aforementioned indices. Adjusting for demographic factors did not alter the findings. Conclusions: Physical activity is positively associated with HRQOL in bladder cancer survivors. Further studies investigating the causal relationship between physical activity and HRQOL in the post-treatment setting in bladder cancer survivors are warranted.