Search

INTRODUCTION & OBJECTIVES: Bladder cancer (BCa) is a heterogeneous disease with up to 25% of incidental diagnoses reported to be found muscle invasive at first episode. Numerous markers and an increased awareness have been recorded in the recent years. We sought to evaluate if those considerat ions may determine a change in BCa clinical presentation at radical cystectomy (RC) over years in a single high volume tert iary referral center. MATERIAL & METHODS: The study relied on 2,003 consecutive BCa pat ients treated with RC and extended pelvic lymphadenectomy (PLND) at a single inst itution between January 1990 and December 2014. Pat ients were st ratified into tertiles according to the year of surgery (1990-2000 vs. 2001-2009 vs. 2010-2014). Anova and chi-square trend tests were used to report the clinical and pathological characterist ics of the cohort over t ime. Mult ivariable Cox regression analysis was used to test the relationship between year of surgery and recurrence, cancer specific mortality (CSM) and overall mortality (OM). RESULTS: When considering clinical characterist ics, patient age (66.7 vs. 66.5 vs. 67.6 years, p=0.1) and gender (81.9% vs. 82.7% vs. 85.4% male, p=0.2) resulted steady over the three tertiles. Conversely body mass index (BMI) (24.7 vs. 25.6 vs. 26.0, p0.1) remain stable across years in the overall populat ion. At multivariable Cox regression analyses, year of surgery represent a predictor of recurrence (HR: 0.97), CSM (HR: 0.97) and OM (HR: 0.98), with a slight but constant reduction in all survival outcomes (all p

Scopo del lavoro To assess the correct number of lymph nodes (LNs) to removed at Radical Cystectomy (RC) to ensure an accurate lymph nodes metastasis (LNM) staging. Materiali e metodi Between 1995 and 2012, 1016 RC for bladder cancer (BCa) were completed at a single tertiary care institution. Demographical, clinical and pathological variables were recorded for each patient. The relationship between the number of removed LNs and the probability to find a LNI at definitive pathology examination was assessed by receiver operating characteristic (ROC) analyses. The ROC curve coordinates were used to graph the probability of finding LNI according to the number of LNs removed and examined with a sensibility of 90 and 95%. Risultati Among all patients who underwent RC, the prevalence of LNM was 35.7% (363 of 1016). T stage and grade, LVI, LND removed, type of BCa at last TUR and N Radiological Stage were strongly associated with the LNM (all p Discussione The objective of our study was to determine the minimum number of LND to remove during RC to maximize the probability to detect LNM. After assessed this for overall RC population we stratified for clinical and pathological variables in order to tailoring the extension of LN dissection. Conclusioni Our results confirms that an extend pelvic lymphadenectomy is needed in order to improve the sensibility of LNM staging. Considering the overall population, a minimum 28 nodes should be removed for achieving an adequate LNM staging (achieve 75% sensibility). In addition, more extended staging lymphadenectomy could be appropriate in selected cases in which, based on clinical information (such as pre operative CT scan) there are a low probability to have LNM.

Only few studies investigated the impact of the peri-operative blood transfusion (PBT) rate on both cancerspecific (CSM) and overall mortality (OM) after radical cystectomy (RC) for bladder cancer (Bca). To date, no study has taken into account the possible prognostic role of the pre-operative hemoglobin level (Hb). The aim of this study was to evaluate the impact of both pre-operative Hb level and PBT rate on CSS and OS of patients who underwent RC. Materiali e metodi The study cohort included 1575 patients treated with RC for BCa between 1990 and 2012 at a single tertiary referral center. Complete clinical, pathological and follow up-data was available for all the patients. Kaplan- Meier curves were adopted to assess the CSM and OM rates in the comprehensive population. At univariable (UVA) and multivariable (MVA) Cox regression analyses the impact on CSS and OS of both PBT and Hb were initially analyzed separately. In a following step, PBT and Hb were simultaneously included in the same statistical model. Age at surgery, Hb, PBT, pathological T stage, pathological N stage were used as covariates. Risultati Mean age at RC was 67 years. A total of 580 (36.8%) patients received a PBT (mean number of blood units received: 3). Mean and median Hb values were 12.4 and 12.6 mg/dL (range 8.0-17.5 mg /dL), respectively. With a mean follow-up time of 41 months, CSS and OS were 83.1 vs. 75.2 and 68.3 vs. 59.8%, at 2 and 5 years, respectively. At UVA, patients who received PBT experienced a CSM (HR: 2.11; p Discussione The influence of immune system on bladder cancer is well known even if not completely understood. This influence can have several consequences. Firstly hematologic disorders, like alteration in hemoglobin levels, and systemic inflammation. Secondly, the immunomodulation could are caused also by PBT and sub sequentially has an immunosuppressive effect. Our study, based on a population of patients with BCa (n = 1575) treated with RC demonstrated the impact of PBT on CSS and OS. Despite this, no association was found at multivariable analysis consider. Conclusioni At multivariate statistical analysis, including both the PBT rate and the pre-operative Hb level, only the latter parameter was shown to be significantly correlated with CS and OM. Further studies are needed in order to investigate the suggested immunosuppressive effect of the PBT and the suspected influence of the pre-operative Hb level as a factor favoring the systemic dissemination of BC cells.

Aim of the study Haematuria represents the most common symptom at presentation in patients with bladder Cancer (BCa). However, no study has tested the predictors of BCa in patients presenting with haematuria. This prospective study was aimed to assess the factors associated with the presence of BCa in patients presenting at our emergency unit due to gross-hematuria. Materials and methods All patients presenting at the emergency unit of our institution for their first episode of gross haematuria between January and December 2012 were evaluated. All clinical patient characteristics, including the ongoing antiplatelets and/or oral anticoagulative treatment, were recorded. Demographical, hematological and pharmacological data wa analyzed in order to predict the diagnosis of primary BCa. Results A total of 367 patients were registered at our emergency unit for gross-hematuria in 2012. Among them, 168 patients (45.8%) with previous history of bladder cancer (n=37, 22.0%), previous traumatic lesions (n=11, 6.5%) gross haematuria related to previous urological surgery (n= 70, 41.7%) or previous pelvic radiotherapy (n=50, 29.7 %), we excluded. Of the remaining 199 patients (54.2%), 30 (14.9%) were on oral anticoagulant therapy and 59 (29.4%) on antiplatelet therapy. After complete clinical assessment, the reason responsible for haematuria was documented to be: first episode of bladder cancer in 49 (24.6%), glomerulonephrites in 5 (2.5%), urinary tract infections in 19 (9.5%), prostatitis in 5 (2.5%), urethral pathology in 3 (1.5%), kidney cancer in 11 (5.5%), urolithiasis in 27 (13.6%), BPH in 53 (26.6%) and prostate cancer in17 (8.5%), respectively. At univariable analyses, hemoglobin value (HR:0.83; p=0.04) and age (HR:1.03; p Discussion The value of hemoglobin represented at MVA the only predictor of BCa. Other studies are designed in order to try to predict BCa in emergency room but no one take in considerations the Hemoglobin levels. Due to the paucity of improvement in the diagnosis improvement of BCa, Hemoglobin could represent a cheap indicator of first episode BCa. Conclusions Twenty-four percent of patients presenting to the emergency unit due to their first episode of gross haematuria was found with a primary BCa. The hemoglobin value at the time of patient presentation represents the only predictor of bladder cancer.