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Purpose: While previous retrospective or phase II studies in Western populations showed that dose‐dense methotrexate, vinblastine, doxorubicin, and cisplatin (ddMVAC) as neoadjuvant chemotherapy (NAC) was beneficial, no studies have been reported in Asian populations. This prospective phase II study aimed to evaluate efficacy and safety of ddMVAC in Korean patients with muscle‐invasive bladder cancer (MIBC) or locally advanced urothelial cancer (UC). Materials and Methods: Patients with MIBC (cT2–4aN0M0) or locally advanced UC (cTanyN1–3M0) eligible for radical cystectomy (RC) were enrolled prospectively. The participants were treated with four cycles of ddMVAC with pegfilgrastim every 2 weeks. The primary endpoint was pathologic response rate (≤ypT1N0). Secondary endpoints were pathologic complete response (pCR, ypT0N0), relapse‐free survival (RFS), overall survival (OS), and safety. Results: Among 24 patients enrolled between December 2019 and August 2021, 23 were evaluable (52%, cT2–4aN0; 48%, cTanyN1–3). Eighteen patients (78%) completed four cycles of ddMVAC, while remaining five patients experienced early discontinuation. Dose modification (91%) and dose delay (70%) occurred, and the dose intensity of ddMVAC was 79%. Nineteen patients underwent RC and four patients declined. Of 19 patients who underwent RC, eight patients (42%) achieved ≤ypT1N0. With a median follow‐up of 22.8 months, the median RFS was 13.5 months (95% CI, not yet evaluable) and the median OS was 28.9 months (95% confidence interval, 19.9–37.9). Conclusion: Our study showed substantial efficacy and safety of ddMVAC, even in patients with locally advanced UC. The ddMVAC still should be a promising option as NAC in Asian patients with UC. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate postoperative complications following robot‐assisted radical cystectomy in patients diagnosed with bladder cancer and reveal if there are predictors for postoperative complications. Methods: Prospectively collected medical records of 730 robot‐assisted radical cystectomy patients between 2007/04 and 2019/05 in 13 tertiary referral centers were reviewed. Perioperative outcomes were compared between two groups by postoperative complications (complication vs non‐complication). We assessed recurrence‐free survival, cancer‐specific survival, and overall survival between groups. Regression analyses were implemented to identify factors associated with postoperative complications. Results: Any total and high‐grade complication (Clavien–Dindo grade ≥3) rates were 57.8% and 21.1%, respectively. Patients in complication group had significantly higher proportion of diabetes mellitus (P = 0.048), chronic kidney disease (P = 0.011), dyslipidemia (P < 0.001), longer operation time (P = 0.001), more estimated blood loss (P = 0.001), and larger intraoperative fluid volume (P < 0.001). There was a significant difference in cancer‐specific survival (log‐rank P = 0.038, median cancer‐specific survival: both groups not reached). Dyslipidemia (odds ratio 2.59, P = 0.002) and intraoperative fluid volume (odds ratio 1.0002, P = 0.040) were significantly associated with high‐grade postoperative complications. Diabetes mellitus (odds ratio 1.97, P = 0.028), chronic kidney disease (odds ratio 1.89, P = 0.046), dyslipidemia (odds ratio 5.94, P = 0.007), and intraoperative fluid volume (odds ratio 1.0002, P = 0.009) were significantly associated with any postoperative complications. Conclusions: Patients with diabetes mellitus, chronic kidney disease, dyslipidemia, or a relatively large intraoperatively infused fluid volume are more likely to develop postoperative complications. Patients with postoperative complications might have a possibility of lower cancer‐specific survival rate. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the oncological significance of a robot‐assisted radical cystectomy (RARC)‐related pentafecta in patients with bladder cancer. Patients and Methods: Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien–Dindo grade 3–5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer‐specific survival (CSS) using multivariate Cox proportional analysis was then carried out. Results: Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow‐up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non‐attainment group (10‐year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10‐year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). Conclusions: Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results. [ABSTRACT FROM AUTHOR]

Objectives To determine whether bilateral seminal vesicle invasion is associated with worse biochemical recurrence-free survival than unilateral seminal vesicle invasion after radical prostatectomy. Methods We reviewed the clinicopathological data of 598 men who underwent radical prostatectomy between 2008 and 2015. Among them, 107 (17.9%) had seminal vesicle invasion. After excluding cases with neo-/adjuvant hormone treatment or radiotherapy, 93 were included in the analysis. We compared biochemical recurrence-free survival rates in subgroups with or without bilateral seminal vesicle invasion using Kaplan-Meier estimates. Cox proportional hazard regression models were used to determine the predictors of biochemical recurrence-free survival. Results Bilateral prostatic lobes and bilateral seminal vesicles were involved by prostate cancers in 85 (91.4%) and 35 patients (37.6%), respectively. Actuarial 3-year and 5-year biochemical recurrence-free survival rates in patients with pT3b tumors with/without bilateral seminal vesicle invasion were 13.0%/34.3%, and 4.3%/19.8%, respectively. On multivariable analysis, preoperative prostate-specific antigen (hazard ratio 1.01, 95% confidence interval 1.00-1.02, P = 0.034), lymph node metastasis (hazard ratio 2.88, 95% confidence interval 1.43-5.81, P = 0.003) and bilateral seminal vesicle invasion (hazard ratio 1.75, 95% confidence interval 1.01-3.05, P = 0.047) were independent predictors of biochemical recurrence-free survival. After excluding cases with lymph node metastasis, preoperative prostate-specific antigen, surgical margin status and bilateral seminal vesicle invasion were independent predictors of biochemical recurrence-free survival. Conclusions Although most men with seminal vesicle invasion experience biochemical recurrences after radical prostatectomy, their survival outcome is not uniform. Bilateral seminal vesicle invasion seems to represent an independent prognostic factor for pT3b patients, together with the preoperative prostate-specific antigen and lymph node status. [ABSTRACT FROM AUTHOR]