37 results on '"Moschini, Marco"'
Search Results
2. The optimal number of induction chemotherapy cycles in clinically lymph node‐positive bladder cancer.
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von Deimling, Markus, Mertens, Laura S., Furrer, Marc, Li, Roger, Tendijck, Guus A.H., Taylor, Jacob, Crocetto, Felice, Maas, Moritz, Mari, Andrea, Pichler, Renate, Moschini, Marco, Tully, Karl H., D'Andrea, David, Laukhtina, Ekaterina, Del Giudice, Francesco, Marcq, Gautier, Velev, Maud, Gallioli, Andrea, Albisinni, Simone, and Mori, Keiichiro
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INDUCTION chemotherapy ,BLADDER cancer ,LYMPHADENECTOMY ,LOGISTIC regression analysis ,SURVIVAL rate - Abstract
Objective: To investigate the optimal number of induction chemotherapy cycles needed to achieve a pathological response in patients with clinically lymph node‐positive (cN+) bladder cancer (BCa) who received three or four cycles of induction chemotherapy followed by consolidative radical cystectomy (RC) with pelvic lymph node dissection. Patients and Methods: We included 388 patients who received three or four cycles of cisplatin/gemcitabine or (dose‐dense) methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC), followed by consolidative RC for cTanyN1–3M0 BCa. We compared pathological complete (pCR = ypT0N0) and objective response (pOR = yp ≤T1N0) between treatment groups. Predictors of pCR and/or pOR were assessed using uni‐ and multivariable logistic regression analysis. The secondary endpoints were overall (OS) and cancer‐specific survival (CSS). We evaluated the association between the number of induction chemotherapy cycles administered and survival outcomes on multivariable Cox regression. Results: Overall, 101 and 287 patients received three or four cycles of induction chemotherapy, respectively. Of these, 72 (19%) and 128 (33%) achieved pCR and pOR response, respectively. The pCR (20%, 18%) and pOR (40%, 31%) rates did not differ significantly between patients receiving three or four cycles (P > 0.05). The number of cycles was not associated with pCR or pOR on multivariable logistic regression analyses. The 2‐year OS estimates were 63% (95% confidence interval [CI] 0.53–0.74) and 63% (95% CI 0.58–0.7) for patients receiving three or four cycles, respectively. Receiving three vs four cycles was not associated with OS and CSS on uni‐ or multivariable Cox regression analyses. Conclusion: Pathological response and survival outcomes did not differ between administering three or four induction chemotherapy cycles in patients with cN+ BCa. A fewer cycles (minimum three) may be oncologically sufficient in patients with cN+ BCa, while decreasing the wait for definitive local therapy in those patients who end up without a response to chemotherapy. This warrants further validation. [ABSTRACT FROM AUTHOR]
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- 2024
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3. The effect of androgen deprivation treatment on subsequent risk of bladder cancer diagnosis in male patients treated for prostate cancer
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Moschini, Marco, Zaffuto, Emanuele, Karakiewicz, Pierre, Mattei, Agostino, Gandaglia, Giorgio, Fossati, Nicola, Montorsi, Francesco, Briganti, Alberto, and Shariat, Shahrokh F.
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- 2019
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4. The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer.
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Ślusarczyk, Aleksander, Zapała, Piotr, Piecha, Tomasz, Rajwa, Paweł, Moschini, Marco, and Radziszewski, Piotr
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LYMPH node surgery ,LYMPHADENECTOMY ,NEPHRECTOMY ,URETHRA surgery ,CANCER patients ,CANCER ,URINARY organs ,DESCRIPTIVE statistics ,SURVIVAL analysis (Biometry) ,URETER tumors ,LONGITUDINAL method ,OVERALL survival - Abstract
Simple Summary: The benefit of lymph node dissection (LND) for node-negative (N0) upper urinary tract urothelial cancer (UTUC) remains uncertain. We aimed to evaluate the association between the extent of LND during radical nephroureterectomy (RNU) and survival by analyzing real-world population-based data. The removal of at least four lymph nodes was associated with improved overall and cancer-specific survival compared to no or less extensive LND. Propensity score matching was performed to adjust for confounders. Further risk-stratified subgroup analysis confirmed the survival benefit of more extensive LND, especially for muscle-invasive UTUC. Our findings underscore the significance of performing an adequate LND during RNU for N0 UTUC. Further prospective studies are crucial to confirm our results. The benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results database was searched to identify patients with non-metastatic chemotherapy-naïve cN0/pNx or pN0 UTUC who underwent RNU +/− LND between 2004 and 2019. Overall, 4649 patients with cN0/pNx or pN0 UTUC were analyzed, including 909 (19.55%) individuals who had LND. Among them, only in 368 patients (7.92%) was LND extended to at least four LNs, and the remaining 541 patients (11.64%) have had < four LNs removed. In the whole cohort, LND contributed to better cancer-specific survival (CSS) and overall survival (OS). Furthermore, a propensity score-matched analysis adjusted for confounders confirmed that improved CSS and OS was achieved only when ≥ four LNs had been removed, especially in muscle-invasive UTUC. A multivariable analysis further confirmed an association between the extent of LND and CSS. To conclude, adequate LND during RNU was associated with improved OS and CSS in LN-negative UTUC, particularly in muscle-invasive stage. This underscores that a sufficient LN yield is required to reveal a therapeutic benefit in patients undergoing RNU. [ABSTRACT FROM AUTHOR]
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- 2023
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5. Surgical treatment for clinical node-positive bladder cancer patients treated with radical cystectomy without neoadjuvant chemotherapy
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Moschini, Marco, Mattei, Agostino, Cornelius, Julian, Shariat, Shahrokh F., Dell’Oglio, Paolo, Zaffuto, Emanuele, Salonia, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, and Gallina, Andrea
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- 2018
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6. Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder
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Abufaraj, Mohammad, Shariat, Shahrokh F., Foerster, Beat, Pozo, Carmen, Moschini, Marco, D’Andrea, David, Mathieu, Romain, Susani, Martin, Czech, Anna K., Karakiewicz, Pierre I., and Seebacher, Veronika
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- 2017
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7. Prognostic role of expression of N-cadherin in patients with upper tract urothelial carcinoma: a multi-institutional study
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Abufaraj, Mohammad, Moschini, Marco, Soria, Francesco, Gust, Kilian, Özsoy, Mehmet, Mathieu, Romain, Rouprêt, Morgan, Margulis, Vitaly, Karam, Jose A., Wood, Christopher G., Briganti, Alberto, Bensalah, Karim, Haitel, Andrea, and Shariat, Shahrokh F.
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- 2017
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8. Neoadjuvant Chemotherapy in Elderly Patients With Upper Tract Urothelial Cancer: Oncologic Outcomes From a Multicenter Study.
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Grossmann, Nico C., Pradere, Benjamin, D'Andrea, David, Schuettfort, Victor M., Keiichiro Mori, Rajwa, Pawel, Quhal, Fahad, Laukhtina, Ekaterina, Satoshi Katayama, Fankhauser, Christian D., Xylinas, Evanguelos, Margulis, Vitaly, Moschini, Marco, Abufaraj, Mohammad, Bandini, Marco, Lonati, Chiara, Nyirady, Peter, Karakiewicz, Pierre I., Fajkovic, Harun, and Shariat, Shahrokh F.
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NEOADJUVANT chemotherapy ,TRANSITIONAL cell carcinoma ,URINARY organ cancer treatment ,CISPLATIN ,DOXORUBICIN - Abstract
This study evaluated elderly patients receiving neoadjuvant chemotherapy for upper tract urothelial carcinoma. Compared with their younger counterparts, cisplatin-eligible elderly patients showed similar pathologic response rates and survival outcomes. Cisplatin-ineligible elderly patients appeared to have lower pathologic response rates and might be therefore more likely to benefit from immediate radical nephroureterectomy. Introduction: Although upper tract urothelial carcinoma (UTUC) is more common in the elderly, outcomes of neoadjuvant chemotherapy (NAC) in this population have never been explored. The objective of the study was to assess the impact of NAC on pathologic response and oncological outcomes stratified by age. Patients and Methods: This multicenter study included 164 patients treated with NAC and radical nephroureterectomy (RNU) for clinically non-metastatic, high-risk UTUC. The cohort was stratified into two groups according to median age. Patients received either cisplatinbased or non-cisplatin-based chemotherapies. Pathologic responses were defined as pathologic objective response (pOR; = ypT1N0) and pathologic complete response (pCR; ypT0N0). Univariable and multivariable logistic and Cox regression analyses were performed to identify predictors for pathologic response and survival outcomes. Results: The cohorts' median age was 68 years with the elderly group (> 68 years) comprising 74 patients. Neoadjuvant chemotherapy included methotrexate-vinblastine-doxorubicin-cisplatin (MVAC) in 66 (40%), gemcitabine cisplatin (GC) in 66 (40%) and non-cisplatin chemotherapy in 32 patients (20%). Younger patients received more often MVAC (50% vs. 28%) while elderly received more GC (34% vs. 47%) or non-cisplatin chemotherapy (16% vs. 24%) (P = .02). Overall, pOR and pCR were similar across age groups (52% vs. 47%; P = .5 and 10% vs. 8%; P = .7). While GC and non-cisplatin chemotherapy showed a lower pCR of 5% and 3%, respectively, MVAC revealed a pCR of 17% (P = .03) and was independently associated with a higher pCR (OR 4.31; P = .03). Kaplan-Meier analysis showed no difference in recurrence-free and cancer-specific survival, whereas a lower rate was seen in overall survival for the elderly. Conclusion: Elderly patients with high-risk UTUC eligible for cisplatin-based NAC prior to RNU may benefit from this multimodal therapy equally as their younger counterparts. Cisplatin-ineligible patients undergoing non-cisplatin-based NAC appeared to have lower response rates and should be considered for immediate RNU. [ABSTRACT FROM AUTHOR]
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- 2022
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9. Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer.
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Katayama, Satoshi, Mori, Keiichiro, Pradere, Benjamin, Laukhtina, Ekaterina, Schuettfort, Victor M., Quhal, Fahad, Motlagh, Reza Sari, Mostafaei, Hadi, Grossmann, Nico C., Rajwa, Pawel, Moschini, Marco, Mathieu, Romain, Abufaraj, Mohammad, D'Andrea, David, Compérat, Eva, Haydter, Martin, Egawa, Shin, Nasu, Yasutomo, and Shariat, Shahrokh F.
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BLADDER cancer ,CANCER invasiveness ,PROGNOSIS ,DECISION making ,REGRESSION analysis ,PREDICTION models ,UROTHELIUM - Abstract
Purpose: We assessed the prognostic value of systemic immune-inflammation index (SII) to refine risk stratification of the heterogeneous spectrum of patients with non-muscle-invasive bladder cancer (NMIBC) Methods: In this multi-institutional cohort, preoperative blood-based SII was retrospectively assessed in 1117 patients with NMIBC who underwent transurethral resection of bladder (TURB) between 1996 and 2007. The optimal cut-off value of SII was determined as 580 using the best Youden index. Cox regression analyses were performed. The concordance index (C-index) and decision curve analysis (DCA) were used to assess the discrimination of the predictive models. Results: Overall, 309 (28%) patients had high SII. On multivariable analyses, high SII was significantly associated with worse PFS (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.23–2.77; P = 0.003) and CSS (HR 2.53; 95% CI 1.42–4.48; P = 0.001). Subgroup analyses, according to the European Association of Urology guidelines, demonstrated the main prognostic impact of high SII, with regards to PFS (HR 3.39; 95%CI 1.57–7.31; P = 0.002) and CSS (HR 4.93; 95% CI 1.70–14.3; P = 0.005), in patients with intermediate-risk group; addition of SII to the standard predictive model improved its discrimination ability both on C-index (6% and 12%, respectively) and DCA. In exploratory intergroup analyses of patients with intermediate-risk, the improved discrimination ability was retained the prediction of PFS and CSS. Conclusion: Preoperative SII seems to identify NMIBC patients who have a worse disease and prognosis. Such easily available and cheap standard biomarkers may help refine the decision-making process regarding adjuvant treatment in patients with intermediate-risk NMIBC. [ABSTRACT FROM AUTHOR]
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- 2021
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10. 18F-FDG PET/CT and Urothelial Carcinoma: Impact on Management and Prognosis—A Multicenter Retrospective Study
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Zattoni, Fabio, Incerti, Elena, Moro, Fabrizio Dal, Moschini, Marco, Castellucci, Paolo, Panareo, Stefano, Picchio, Maria, Fallanca, Federico, Briganti, Alberto, Gallina, Andrea, Fanti, Stefano, Schiavina, Riccardo, Brunocilla, Eugenio, Rambaldi, Ilaria, Lowe, Val, Karnes, Jeffrey R., Evangelista, Laura, Zattoni F, Incerti E, Dal Moro F, Moschini M, Castellucci P, Panareo S, Picchio M, Fallanca F, Briganti A, Gallina A, Fanti S, Schiavina R, Brunocilla E, Rambaldi I, Lowe V, Karnes JR, Evangelista L, Zattoni, F., Incerti, E., Dal Moro, F., Moschini, M., Castellucci, P., Panareo, S., Picchio, M., Fallanca, F., Briganti, A., Gallina, A., Fanti, S., Schiavina, R., Brunocilla, E., Rambaldi, I., Lowe, V., Karnes, J. R., and Evangelista, L.
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Survival ,PET/CT ,Bladder cancer ,upper tract urothelial carcinoma ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,survival ,lcsh:RC254-282 ,Article ,Upper tract urothelial carcinoma ,Urothelial carcinoma ,bladder cancer ,urothelial carcinoma - Abstract
Objectives: To evaluate the ability of 18F-labeled fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) to predict survivorship of patients with bladder cancer (BC) and/or upper urinary tract carcinoma (UUTC). Materials: Data from patients who underwent FDG PET/CT for suspicion of recurrent urothelial carcinoma (UC) between 2007 and 2015 were retrospectively collected in a multicenter study. Disease management after the introduction of FDG PET/CT in the diagnostic algorithm was assessed in all patients. Kaplan-Meier and log-rank analysis were computed for survival assessment. A Cox regression analysis was used to identify predictors of recurrence and death, for BC, UUTC, and concomitant BC and UUTC. Results: Data from 286 patients were collected. Of these, 212 had a history of BC, 38 of UUTC and 36 of concomitant BC and UUTC. Patient management was changed in 114/286 (40%) UC patients with the inclusion of FDG PET/CT, particularly in those with BC, reaching 74% (n = 90/122). After a mean follow-up period of 21 months (Interquartile range: 4&ndash, 28 mo.), 136 patients (47.4%) had recurrence/progression of disease. Moreover, 131 subjects (45.6%) died. At Kaplan-Meier analyses, patients with BC and positive PET/CT had a worse overall survival than those with a negative scan (log-rank <, 0.001). Furthermore, a negative PET/CT scan was associated with a lower recurrence rate than a positive examination, independently from the primary tumor site. At multivariate analysis, in patients with BC and UUTC, a positive FDG PET/CT resulted an independent predictor of disease-free and overall survival (p <, 0,01). Conclusions: FDG PET/CT has the potential to change patient management, particularly for patients with BC. Furthermore, it can be considered a valid survival prediction tool after primary treatment in patients with recurrent UC. However, a firm recommendation cannot be made yet. Further prospective studies are necessary to confirm our findings.
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- 2019
11. Delaying BCG immunotherapy onset after transurethral resection of non-muscle-invasive bladder cancer is associated with adverse survival outcomes.
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Krajewski, Wojciech, Moschini, Marco, Chorbińska, Joanna, Nowak, Łukasz, Poletajew, Sławomir, Tukiendorf, Andrzej, Afferi, Luca, Teoh, Jeremy Yuen-Chun, Muilwijk, Tim, Joniau, Steven, Tafuri, Alessandro, Antonelli, Alessandro, Cianflone, Francesco, Mari, Andrea, Di Trapani, Ettore, Hendricksen, Kees, Alvarez-Maestro, Mario, Rodríguez-Serrano, Andrea, Simone, Giuseppe, and Zamboni, Stefania
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BLADDER cancer , *SURVIVAL rate , *URETHRA , *DISEASE relapse , *IMMUNOTHERAPY , *REGRESSION analysis , *LOG-rank test - Abstract
Purpose: This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette–Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). Materials and methods: Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo's approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. Results: The median TTBCG was 95 days (interquartile range (IQR): 71–127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. Conclusion: This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression. [ABSTRACT FROM AUTHOR]
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- 2021
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12. Addition of neoadjuvant chemotherapy to a ‘quadrifecta’ composite in radical cystectomy.
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D’Andrea, David, Soria, Francesco, Moschini, Marco, Laukhtina, Ekaterina, Hurle, Rodolfo, Mancon, Stefano, Antonelli, Alessandro, Teoh, Jeremy Yuen‐Chun, Shariat, Shahrokh F., and Pradere, Benjamin
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Objectives Patients and Methods Results Conclusion To evaluate the impact of incorporating neoadjuvant chemotherapy (NAC) into the ‘quadrifecta’ outcomes composite for reporting outcomes of radical cystectomy (RC) creating a pentafecta score.This is a retrospective multicentre analysis of patients treated with RC, with or without NAC, for bladder cancer between 2002 and 2023. The primary outcome was the effect of adding NAC to a quadrifecta outcomes composite on cancer‐specific (CSS) and overall survival (OS). The quadrifecta outcomes composite included a yield of ≥16 lymph nodes, negative soft tissue surgical margin, absence of major complication within 30 days from surgery, and no delay in RC.A total of 590 patients were included in the analyses. A total of 233 (39.5%) patients achieved all quadrifecta outcomes and 82 (13.9%) patients were additionally treated with NAC, achieving the pentafecta. Achieving the quadrifecta outcomes composite was significantly associated with better CSS (hazard ratio [HR] 0.49, 95% confidence interval [CI] 0.32–0.75; P = 0.001) and OS (HR 0.48, 95% CI 0.34–0.69; P < 0.01). The addition of NAC to the quadrifecta composite outcomes significantly improved the discrimination of patients more likely to have better CSS (HR 0.21, 95% CI 0.08–0.57; P = 0.002) and OS (HR 0.26, 95% CI 0.12–0.55; P < 0.01).We propose a new pentafecta that may serve as a tool for standardising outcomes reporting and measuring the quality of RC. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Radical Cystectomy in Pathological T4a and T4b Bladder Cancer Patients: Is There Any Space for Sub Stratification?
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Moschini, Marco, Zamboni, Stefania, Mattei, Agostino, Baumeister, Philipp, Di Bona, Carlo, Cornelius, Julian, Shariat, Shahrokh F., Freschi, Massimo, Zaffuto, Emanuele, Salonia, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, and Gallina, Andrea
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CYSTECTOMY , *BLADDER cancer , *TUMOR classification , *TUMOR grading , *CANCER invasiveness , *CANCER prognosis , *BLADDER cancer patients , *BLADDER cancer treatment - Abstract
According to TNM staging, pathological T4ab are comprehensive of the invasion of prostate, seminal vesicles, uterus or vagina and pelvic or abdominal wall. However, few data are available on the perioperative and oncological outcomes of specific organ invasion.Introduction: A total of 917 consecutive bladder cancer (BCa) patients treated with radical cystectomy (RC) at a single institution between 1990 and 2015 were studies. Cox regression analyses were used to stratify pT4ab according to the site of invasion and survival.Materials and Methods: Overall, 176 (19.2%) and 40 (4.4%) patients harbored pT4a or pT4b disease. Specifically, 84 (9.2%) patients reported prostate and/or SVI invasion, 62 (6.8%) prostate only, 16 (1.7%) uterus, 14 (1.5%) vaginal, 24 (2.6%) pelvic wall, and 16 (1.7%) abdominal wall invasion. The median follow-up in pT4 patients was 48 months. The 1-year cancer-specific mortality (CSM) rates were 71, 65, 24, 50, 50, and 72%, for vaginal, uterus, prostate only, prostate and/or seminal vesicles, pelvic wall, and abdominal wall invasions, respectively. At multivariable Cox regression, the invasion of prostate only (hazard ratio [HR] 3.53), prostate and/or SVI (HR 4.98), uterus (HR 7.16), vagina (HR 6.12), pelvic (HR 11.81), abdominal (8.36) were associated with adverse CSM.Results: Our study described the differences in survival related to invasion site in pT4 patients, confirming poor survival expectancies in this subgroup. Patients with prostate invasion only seem to be associated with better survival than those affected by concomitant invasion of seminal vesicles. Uterus and vaginal invasions were associated with poor survival outcomes.Conclusions: In this study, we looked at the outcome of locally advanced invasive BCa (stage pT4) in patients treated with RC at a tertiary referral hospital. We analyzed the differences in survival related to the specific organ invasion. We confirmed poor survival in this subgroup of patients. Only patients who had prostate invasion only seem to have a better survival. [ABSTRACT FROM AUTHOR]Patients Summary: - Published
- 2019
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14. Accuracy and prognostic value of variant histology and lymphovascular invasion at transurethral resection of bladder.
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Abufaraj, Mohammad, Shariat, Shahrokh F., Foerster, Beat, Pozo, Carmen, Moschini, Marco, D’Andrea, David, Mathieu, Romain, Susani, Martin, Czech, Anna K., Karakiewicz, Pierre I., and Seebacher, Veronika
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TRANSURETHRAL prostatectomy ,CYSTECTOMY ,BLADDER ,LYMPHATIC metastasis ,HEALTH outcome assessment - Abstract
Objectives: To evaluate the concordance rate of lymphovascular invasion (LVI) and variant histology (VH) of transurethral resection (TUR) with radical cystectomy (RC) specimens. Furthermore, to evaluate the value of LVI and VH at TUR for predicting non-organ confined (NOC) disease, lymph node metastasis, and survival outcomes.Patients and methods: Two hundred and sixty-eight patients who underwent TUR and subsequent RC were reviewed. Logistic regression analyses were performed to evaluate the association of LVI and VH with NOC and lymph node metastasis at RC. Cox regression analyses were used to estimate recurrence-free survival (RFS) and cancer-specific survival (CSS).Results: LVI and VH were detected in 13.8 and 11.2% of TUR specimens, and in 30.2 and 25.4% of RC specimens, respectively. The concordance rate between LVI and VH at TUR and subsequent RC was 69.8 and 83.6%, respectively. They were both associated with adverse pathological features such as lymph node metastasis and advanced stage. TUR LVI and VH were both independently associated with lymph node metastasis and TUR VH was independently associated with NOC. On univariable Cox regression analyses, TUR LVI was associated with RFS and CSS while TUR VH was only associated with RFS. Only TUR LVI was independently associated with RFS.Conclusion: Detection of LVI is missed in a third of TUR specimens while VH seems more accurately identified. TUR LVI and VH are associated with more advanced disease and LVI predicts disease recurrence. Assessment and reporting of LVI and VH on TUR specimen are important for risk stratification and decision-making. [ABSTRACT FROM AUTHOR]
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- 2018
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15. Risk Stratification of pN+ Prostate Cancer after Radical Prostatectomy from a Large Single Institutional Series with Long-Term Followup.
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Moschini, Marco, Sharma, Vidit, Zattoni, Fabio, Boorjian, Stephen A., Frank, Igor, Gettman, Matthew T., Thompson, R. Houston, Tollefson, Matthew K., Kwon, Eugene D., and Karnes, R. Jeffrey
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PROSTATE cancer prognosis ,PROSTATE cancer treatment ,PROSTATECTOMY ,CANCER relapse ,CANCER-related mortality ,LONG-term care facilities ,FOLLOW-up studies (Medicine) - Abstract
Purpose Lymph node positive (pN+) prostate cancer after radical prostatectomy has wide variability in long-term oncologic outcomes. We present a large institutional series with extended followup to create an oncologic risk stratification system that clarifies the prognostic heterogeneity for patients with pN+ disease after radical prostatectomy. Materials and Methods Men with pN+ prostate cancer after radical prostatectomy during 1987 to 2012 were included in the study. Regression models were created to identify significant predictors of biochemical recurrence, metastasis, cancer specific mortality and overall mortality. A cancer specific mortality risk score was then created and internally validated to stratify patients in terms of risk of cancer specific mortality. Results For our cohort of 1,011 men with a median followup of 17.6 years the 20-year rate of cancer specific mortality was 31%. On multivariate Cox regression modeling 3 or more positive nodes (HR 1.75, p=0.003), pathological Gleason score 7 vs 6 (HR 1.74, p=0.04) and 8-10 vs 6 (HR 2.63, p=0.001), and positive surgical margins (HR 1.96, p=0.001) were significantly associated with increased cancer specific mortality, while adjuvant radiotherapy (HR 0.40, p=0.008) was associated with decreased cancer specific mortality. A cancer specific mortality risk score was then created using these 4 variables to stratify patients with markedly different prognoses, yielding 20-year cancer specific mortality rates of 19.1% vs 34% vs 46% (p <0.001) for low, intermediate and high risk categories, respectively. Conclusions The prognosis of patients with pN+ prostate cancer varied significantly after radical prostatectomy. A risk score created using the number of positive nodes, pathological Gleason score, margin status and adjuvant radiotherapy status successfully separated patients into low, intermediate and high risk groups. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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16. Extent of lymph node dissection at nephrectomy affects cancer-specific survival and metastatic progression in specific sub-categories of patients with renal cell carcinoma ( RCC).
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Capitanio, Umberto, Suardi, Nazareno, Matloob, Rayan, Roscigno, Marco, Abdollah, Firas, Di Trapani, Ettore, Moschini, Marco, Gallina, Andrea, Salonia, Andrea, Briganti, Alberto, Montorsi, Francesco, and Bertini, Roberto
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RENAL cell carcinoma ,LYMPH nodes ,NEPHRECTOMY ,METASTASIS ,TUMORS - Abstract
Objective To test whether the number of lymph nodes removed affects cancer-specific survival ( CSS) or metastatic progression-free survival ( MPFS) in different renal cell carcinoma ( RCC) scenarios., Methods We used Cox regression analyses to analyse the effect of the number of lymph nodes removed on CSS and MPFS in 1983 patients with RCC treated with nephrectomy., To adjust for possible clinical and surgical selection bias, analyses were further adjusted for number of positive nodes, presence of metastases, age, performance status, T stage, tumour size and grade., Results The prevalence of lymph node invasion was 6.1%. The mean follow-up period was 83.3 months., Multivariable analyses showed that the number of nodes removed had an independent, protective effect on CSS in patients with pT2a- pT2b or pT3c- pT4 RCC (hazard ratio [ HR] 0.91, P = 0.008 and HR 0.89, P < 0.001, respectively), in patients with bulky tumours (tumour size >10 cm, HR 0.97, P = 0.03) or when sarcomatoid features were found ( HR 0.81, P = 0.006)., The removal of each additional lymph node was associated with a 3-19% increase in CSS., When considering MPFS as an endpoint, the number of nodes removed had an independent, protective effect in the same patient categories., Conclusions When clinically indicated, the number of nodes removed affects CSS and MPFS in specific sub-categories of patients with RCC. [ABSTRACT FROM AUTHOR]
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- 2014
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17. Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes.
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Moschini, Marco, Zamboni, Stefania, Soria, Francesco, Mathieu, Romain, Xylinas, Evanguelos, Tan, Wei Shen, Kelly, John D, Simone, Giuseppe, Meraney, Anoop, Krishna, Suprita, Konety, Badrinath, Mattei, Agostino, Baumeister, Philipp, Mordasini, Livio, Montorsi, Francesco, Briganti, Alberto, Gallina, Andrea, Stabile, Armando, Sanchez-Salas, Rafael, and Cathelineau, Xavier
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PROPENSITY score matching , *LYMPHADENECTOMY , *CYSTECTOMY , *SURVIVAL analysis (Biometry) , *CANCER relapse , *CANCER-related mortality , *OPERATIVE surgery - Abstract
Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available. [ABSTRACT FROM AUTHOR]
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- 2019
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18. Lymphadenectomy for Upper Tract Urothelial Carcinoma: A Systematic Review.
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Duquesne, Igor, Ouzaid, Idir, Loriot, Yohann, Moschini, Marco, and Xylinas, Evanguelos
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TRANSITIONAL cell carcinoma ,LYMPHADENECTOMY ,META-analysis ,URINARY organs ,TUMOR surgery ,URINARY catheterization - Abstract
Background: The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. Objective: To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication. Data Synthesis: The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease. Conclusion: An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit. [ABSTRACT FROM AUTHOR]
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- 2019
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19. First-line immune-checkpoint inhibitor combination therapy for chemotherapy-eligible patients with metastatic urothelial carcinoma: A systematic review and meta-analysis.
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Mori, Keiichiro, Pradere, Benjamin, Moschini, Marco, Mostafaei, Hadi, Laukhtina, Ekaterina, Schuettfort, Victor M., Sari Motlagh, Reza, Soria, Francesco, Teoh, Jeremy Y.C., Egawa, Shin, Powles, Thomas, and Shariat, Shahrokh F.
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SURVIVAL , *IMMUNE checkpoint inhibitors , *COMBINATION drug therapy , *META-analysis , *CONFIDENCE intervals , *CANCER chemotherapy , *SYSTEMATIC reviews , *METASTASIS , *CANCER patients , *URINARY organs , *DESCRIPTIVE statistics , *ADVERSE health care events , *MEMBRANE proteins , *IMMUNOTHERAPY , *THERAPEUTICS - Abstract
Platinum-based combination chemotherapy is the standard treatment for patients with chemotherapy-eligible metastatic urothelial carcinoma (mUC). Immune-checkpoint inhibitors (ICIs) are currently assessed in this setting. This review aimed to assess the role of ICIs alone or in combination as first-line treatment in chemotherapy-eligible patients with mUC. Multiple databases were searched for articles published until November 2020. Studies were deemed eligible if they compared overall survival (OS), progression-free survival (PFS), objective response rates (ORRs), complete response rates (CRRs), durations of response (DORs) and adverse events (AEs) in chemotherapy-eligible patients with mUC. Three studies met our eligibility criteria. ICI combination therapy was associated with significantly better OS and PFS, higher CRR and longer DOR than chemotherapy alone (hazard ratio [HR]: 0.85, 95% confidence interval [CI]: 0.76–0.94, P = 0.002; HR: 0.80, 95% CI: 0.71–0.90, P = 0.0002; odds ratio [OR]: 1.48, 95% CI: 1.12–1.96, P = 0.006; and mean difference: 1.39, 95% CI: 0.31–2.46, P = 0.01, respectively). ICI-chemotherapy combination therapy was also associated with significantly better OS and PFS, higher ORR and CRR and longer DOR than chemotherapy alone. Although OS and PFS benefits of ICI combination therapy were larger in patients with high expression of programmed death-ligand 1 (PD-L1), PD-L1 low expression patients also had a benefit; HR for OS (high PD-L1: HR 0.79 versus low PD-L1: HR 0.89) and PFS (high PD-L1: HR 0.74 versus low PD-L1: HR 0.82). ICI monotherapy was not associated with better oncological outcomes but was associated with better safety outcomes than chemotherapy alone. Our analysis indicates a superior oncologic benefit to first-line ICI combination therapies in patients with chemotherapy-eligible mUC over standard chemotherapy. In contrast, ICI monotherapy was associated with favorable safety outcomes compared with chemotherapy but failed to show its superiority over chemotherapy in oncological benefits. PD-L1 status alone cannot help guide treatment decision-making. However, caution should be exercised in interpreting the conclusions drawn from this study, given that there is the heterogeneity of the population of interest, risk of bias and the nature of the studies evaluated whose data remain immature or unpublished. • ICIs are currently assessed for patients with chemotherapy-eligible mUC. • ICIs used in combination are superior to chemotherapy in oncological benefits. • ICI monotherapy efficacy is not superior to that of chemotherapy alone. • PD-L1 alone is not a sufficiently robust, reliable and reproducible biomarker. • The analyses include the heterogeneity of the population and risk of bias. [ABSTRACT FROM AUTHOR]
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- 2021
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20. The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes.
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Moschini, Marco, Shariat, Shahrokh F., Abufaraj, Mohammad, Soria, Francesco, Klatte, Tobias, Croce, Giovanni La, Mattei, Agostino, Damiano, Rocco, Salonia, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, and Gallina, Andrea
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BLADDER cancer treatment , *CYSTECTOMY , *CANCER relapse , *DISEASE incidence , *REGRESSION analysis , *FOLLOW-up studies (Medicine) , *SURGICAL excision , *LONGITUDINAL method , *LYMPH node surgery , *PROGNOSIS , *SURVIVAL , *RETROSPECTIVE studies , *CARCINOMA in situ , *DIAGNOSIS ,BLADDER tumors - Abstract
Introduction: To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates.Methods: The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality-free rates in the overall population and in pT0-pT2 and pT3-pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence.Results: The presence of CIS was reported in 277 (24.6%) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3-pT4 patients (all P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0-pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01-3.29; P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0-pT2 patients (HR = 2.99; CI: 1.05-8.53; P = 0.04), pT3-pT4 patients (HR = 10.29; CI: 1.40-75.75; P = 0.02), and in the overall population (HR = 4.47; CI: 1.81-11.07; P = 0.001).Conclusion: An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature. [ABSTRACT FROM AUTHOR]- Published
- 2017
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21. The effect of HER2 status on oncological outcomes of patients with invasive bladder cancer.
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Soria, Francesco, Moschini, Marco, Haitel, Andrea, Wirth, Gregory J., Gust, Kilian M., Briganti, Alberto, Rouprêt, Morgan, Klatte, Tobias, Hassler, Melanie R., Karakiewicz, Pierre I., and Shariat, Shahrokh F.
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BLADDER cancer , *GENETIC overexpression , *HER2 protein , *CYSTECTOMY , *IMMUNOHISTOCHEMISTRY , *ANTINEOPLASTIC agents , *PROTEIN analysis , *CANCER relapse , *CANCER invasiveness , *CELL receptors , *COMBINED modality therapy , *COMPARATIVE studies , *GENES , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PROTEINS , *RESEARCH , *EVALUATION research , *TREATMENT effectiveness , *RETROSPECTIVE studies , *TRANSITIONAL cell carcinoma , *KAPLAN-Meier estimator , *TUMOR treatment , *THERAPEUTICS ,BLADDER tumors - Abstract
Purpose: The aim of this study was to evaluate the overexpression of human epidermal growth factor receptor 2 (HER2) in patients with bladder cancer (BCa) and to assess its association with oncological outcomes.Methods: This retrospective single-center study included 354 patients with BCa treated with radical cystectomy (RC). HER2 status was assessed with immunohistochemistry and scored according to HercepTest. Conditional survival and competing risk regression were performed to assess the association between HER2 expression and survival outcomes.Results: HER2 was overexpressed in 36% of patients. HER2 overexpression was associated with features of tumor aggressiveness such as lymph-node metastases (P = 0.002). At a median follow-up of 123 months (interquartile range: 79-180), 160 patients (45%) experienced disease recurrence, 263 patients (74%) died and 157 (44%) died of cancer. On multivariable analyses, HER2 overexpression was not significantly associated with any oncological outcomes. Adding HER2 status to a model for the prediction of survival outcomes did not change the accuracy of the model for any of the outcomes. Interestingly, HER2 status significantly affected late disease recurrence (P = 0.05 for conditional survival at 24 months).Conclusions: More than one third of RC patients overexpress HER2 in their tumors. HER2 overexpression was associated with features of biological and clinical aggressiveness. HER2 did not add prognostic significance to the standard established predictors of survival outcomes after RC. However, due to the high overexpression rate, it could represent a target for therapy in select advanced BCa tumors. [ABSTRACT FROM AUTHOR]- Published
- 2016
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22. Caveolin-1 as prognostic factor of disease recurrence and survival in patients treated with radical cystectomy for bladder cancer.
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Soria, Francesco, Lucca, Ilaria, Moschini, Marco, Mathieu, Romain, Rouprêt, Morgan, Karakiewicz, Pierre I., Briganti, Alberto, Rink, Michael, Gust, Kilian M., Hassler, Melanie R., Foerster, Beat, Abufarraj, Mohammad, Haitel, Andrea, Klatte, Tobias, and Shariat, Shahrokh F.
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BLADDER cancer treatment , *BLADDER cancer , *CAVEOLINS , *CANCER relapse , *SURVIVAL analysis (Biometry) , *PROGNOSIS , *CARRIER proteins , *DISEASE relapse , *TREATMENT effectiveness , *CYSTECTOMY ,BLADDER tumors - Abstract
Purpose: Overexpression of Caveolin-1 has been associated with cancer growth, migration, and metastases in several malignancies, but only few data are available on its role in bladder cancer (BCa). The aim of this study is to validate Caveolin-1 as a prognosticator of recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) in a large cohort of patients treated with radical cystectomy (RC) for BCa.Methods: Caveolin-1 expression was evaluated by immunochemistry on a tissue microarray from 424 patients treated with RC for UCB at a single institution. Caveolin-1 was considered overexpressed when at least 50% of the tumor cells stained positively. Univariable and multivariable Cox proportional hazards regression models were used to assess the association of Caveolin-1 expression with RFS, OS, and CSS.Results: Overexpression of Caveolin-1 was observed in 116 (27.4%) patients and was associated with lymph node metastasis (P = 0.003). Median follow-up for patients alive at last follow-up was 129 months (interquartile range [IQR]: 82-178). Patients with overexpression of Caveolin-1 had significant worse RFS, OS, and CSS compared to those with normal expression (log-rank test, P = 0.008, P = 0.001, and P = 0.005, respectively). At multivariable analyses that adjusted for the effects of standard clinicopathologic features, Caveolin-1 remained associated with OS (hazard ratio = 1.47, P = 0.002) and CSS (hazard ratio = 1.42, P = 0.03). Conversely, no association with RFS was found (P = 0.1). Addition of Caveolin-1 in a model for prediction of survival did not improve the accuracy of the prognostic model. Actually, C-index did not differ among models with or without Caveolin-1 (0.72 for a model predicting RFS, 0.65 for OS, and 0.71 for CSS).Conclusions: Caveolin-1 is overexpressed in one-third of patients with BCa treated with RC. Overexpression of Caveolin-1 is significantly associated with OS and CSS, but not with RFS, in patients with BCa treated with RC. However, it is not clinically useful as it does not improve upon the predictive accuracy of survival achieved by pathologic variables alone. [ABSTRACT FROM AUTHOR]- Published
- 2017
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23. Oncologic outcomes of patients treated with kidney-sparing surgery or radical nephroureterectomy for upper urinary tract urothelial cancer: a population-based study.
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Ślusarczyk, Aleksander, Zapała, Piotr, Zapała, Łukasz, Rajwa, Paweł, Moschini, Marco, Laukhtina, Ekaterina, and Radziszewski, Piotr
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TRANSITIONAL cell carcinoma , *URINARY organs , *LYMPHADENECTOMY , *PROPENSITY score matching , *SURGICAL excision , *KIDNEY tumors - Abstract
• Oncologic outcomes following radical nephroureterectomy and segmental ureterectomy (SU) for advanced upper urinary tract urothelial cancer remain poor. • SU is a viable option even in patients with muscle-invasive upper urinary tract urothelial cancer. • Our population-based study suggests that SU provides noninferior cancer-specific survival compared to radical nephroureterectomy. Although kidney-sparing surgery (KSS) is a nonminor option for low-risk upper urinary tract urothelial cancer (UTUC), its oncological benefits in high-risk UTUC remain unclear when compared to radical nephroureterectomy (RNU). This study aimed to compare the oncological outcomes of RNU and KSS in patients with UTUC. We searched the SEER database for patients treated for primary non-metastatic UTUC with either RNU or a kidney-sparing approach (segmental ureterectomy (SU) or local tumor excision (LTE)) between 2004 and 2018. The study included 6,659 patients with primary non-metastatic UTUC treated with surgery; 2,888 (43.4%) and 3,771 (56.6%) patients presented with ureteral and renal pelvicalyceal tumors, respectively. Finally, 5,479 (82.3%) patients underwent RNU, 799 (12.0%) were treated with SU, and 381 (5.7%) patients received LTE. For confounder control, propensity score matching (PSM) of patients treated with SU and RNU was performed to adjust for T stage, grade, age, gender, tumor size, and lymphadenectomy performance. PSM analysis included 694 patients treated with RNU and 694 individuals who underwent SU. In multivariable Cox regression and Kaplan-Meier analyses, we found no difference in either CSS or OS between RNU and SU, even in the subgroup of high-grade and/or muscle-invasive UTUC including pT3-T4 tumors (all p > 0.05). In this population-based study, SU provides equivalent CSS and OS compared to RNU, even in high-risk and locally advanced ureteral cancer. Due to the unavoidable risk of selection bias, further prospective studies are expected to overcome the limitations of this study and support the wider implementation of KSS. [ABSTRACT FROM AUTHOR]
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- 2024
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24. Prognostic role of N-cadherin expression in patients with non-muscle-invasive bladder cancer.
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Abufaraj, Mohammad, Shariat, Shahrokh F., Haitel, Andrea, Moschini, Marco, Foerster, Beat, Chłosta, Piotr, Gust, Kilian, Babjuk, Marek, Briganti, Alberto, Karakiewicz, Pierre I., and Albrecht, Walter
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CADHERINS , *BLADDER cancer patients , *TRANSURETHRAL prostatectomy , *IMMUNOHISTOCHEMISTRY , *CANCER invasiveness - Abstract
Purpose: To assess the role of N-cadherin as a prognostic biomarker in patients with non-muscle-invasive bladder cancer (NMIBC) treated with transurethral resection with or without adjuvant intravesical therapy.Patients and Methods: Immunohistochemistry using monoclonal mouse antibody was used to evaluate the expression status of N-cadherin in 827 patients with NMIBC. N-cadherin was considered positive if any immunoreactivity with membranous staining was detected. Multivariable Cox regression models were performed to evaluate the prognostic effect of N-cadherin on survival outcomes.Results: N-cadherin expression was observed in 333 patients (40.3%); it was associated with pT1 stage and high tumor grade (both were P<0.001). Median follow-up was 55 months (interquartile range: 18-106). On multivariable Cox regression analyses that adjusted for the effect of the standard clinicopathologic features, N-cadherin expression remained associated with recurrence-free survival (P = 0.007) but not progression-free survival (P = 0.3), cancer-specific survival (P = 0.2), or overall survival (P = 0.9). Adding N-cadherin to a model for prediction of disease recurrence modestly improved its discrimination from 72.8% to 73.4%.Conclusion: N-cadherin is expressed in approximately 2/5 patients with NMIBC. Its expression is associated with adverse pathological features and higher risk of disease recurrence but not progression. N-cadherin could be incorporated in predictive tools to assist in recurrence prediction helping thereby in patient selection regarding adjuvant therapies and follow-up planning. [ABSTRACT FROM AUTHOR]- Published
- 2017
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25. Prognostic Role of N-cadherin Expression in Patients With Invasive Bladder Cancer
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Alberto Briganti, Morgan Rouprêt, Shahrokh F. Shariat, David D'Andrea, Kilian M. Gust, Pierre I. Karakiewicz, Mehmet Özsoy, Beat Foerster, Andrea Haitel, Marco Moschini, Mohammad Abufaraj, Abufaraj, Mohammad, Haitel, Andrea, Moschini, Marco, Gust, Kilian, Foerster, Beat, Özsoy, Mehmet, D'Andrea, David, Karakiewicz, Pierre I., Rouprêt, Morgan, Briganti, Alberto, and Shariat, Shahrokh F.
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Oncology ,medicine.medical_specialty ,Survival ,Prognosi ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Lymph node ,Muscle-invasive BCa ,Tissue microarray ,Bladder cancer ,Cadherin ,business.industry ,Proportional hazards model ,medicine.disease ,Radical cystectomy ,Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Monoclonal ,Prediction ,business - Abstract
Background: We assessed the role of N-cadherin as a prognostic biomarker in patients with invasive bladder cancer (BCa) who had undergone radical cystectomy (RC). Patients and Methods: The present retrospective single-center study included 433 BCa patients who had undergone RC and bilateral lymph node dissection. Formalin-fixed paraffin tissue microarrays were stained with an anti-N-cadherin monoclonal mouse antibody. N-cadherin expression was considered positive if any immunoreactivity was detected. Multivariable Cox regression models were created to evaluate the prognostic effect of N-cadherin on survival. Results: N-cadherin expression was observed in 189 patients (43.7%). It was associated with advanced pathologic stage (P = .001) and lymph node metastasis (P < .001). During a median follow-up period of 10.6 years, N-cadherin expression was associated with worse recurrence-free survival, overall survival, and cancer-specific survival (P < .001, P = .001, and P < .001, respectively). On multivariable analysis adjusted for the effects of standard clinicopathologic features, N-cadherin expression retained its association with worse recurrence-free survival (hazard ratio, 1.41; 95% confidence interval, 1.02-1.92; P = .032) but not cancer-specific survival (P = .07) and overall survival (P = .3). Conclusion: N-cadherin was expressed in approximately 40% of patients with invasive BCa. Its expression was associated with features of biologically and pathologically adverse disease and worse recurrence-free survival. N-cadherin could be a part of a marker panel to help clinical decision-making and therapy for BCa.
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- 2018
26. Surgical treatment for clinical node-positive bladder cancer patients treated with radical cystectomy without neoadjuvant chemotherapy
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Renzo Colombo, Andrea Gallina, Alberto Briganti, Andrea Salonia, Julian Cornelius, Paolo Dell'Oglio, Emanuele Zaffuto, Marco Moschini, Shahrokh F. Shariat, Francesco Montorsi, Agostino Mattei, Moschini, Marco, Mattei, Agostino, Cornelius, Julian, Shariat, Shahrokh F., Dell’Oglio, Paolo, Zaffuto, Emanuele, Salonia, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, and Gallina, Andrea
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Male ,Nephrology ,Clinical metastase ,medicine.medical_specialty ,Survival ,Urology ,medicine.medical_treatment ,Urinary Bladder ,Metastase ,030232 urology & nephrology ,Kaplan-Meier Estimate ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Lymph node ,Aged ,Neoplasm Staging ,Carcinoma, Transitional Cell ,Chemotherapy ,Bladder cancer ,Proportional hazards model ,business.industry ,Hazard ratio ,Multimodal therapy ,Middle Aged ,medicine.disease ,Radical cystectomy ,Treatment Outcome ,medicine.anatomical_structure ,Urinary Bladder Neoplasms ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Lymph Nodes ,business ,Clinical node positive - Abstract
Objective: Growing literature supports good survival expectancies in bladder cancer (BCa) patients affected by clinical node metastases (cN+) treated with multimodal therapy. We evaluated the role of adjuvant chemotherapy in cN+BCa patients treated with radical cystectomy (RC) and pelvic lymph node dissection (PLND) without neoadjuvant chemotherapy (NAC). Methods: We evaluated a total of 192 patients with BCa and cN+. All patients were treated with RC and PLND without NAC between 2001 and 2013. KaplanâMeier analyses and Cox regression analyses were used to assess the impact of adjuvant chemotherapy (ACT) on recurrence, cancer-specific mortality (CSM) and overall mortality (OM) after surgery. Results: Overall, 99 patients (51.6%) were found without node metastases at RC, while 18 (9.4%), 58 (30.2%) and 17 (8.9%) patients were found pN1, pN2 and pN3, respectively. With a median follow-up of 48 months, in cN+ patients we recorded 5-year recurrence, CSM and OM of 55, 53 and 51%, respectively. Overall, 36 (18.8%) patients were treated with adjuvant chemotherapy. At univariable analyses, ACT was associated with improved overall survival [Hazard ratio (HR): 0.42, confidence interval (CI) 0.20â0.86, p = 0.02) in pN+ subgroup only. These results were confirmed at multivariable analyses, where ACT was associated with improved CSS (HR: 0.45, CI 0.21â0.89, p = 0.03) and OS (HR: 0.37, CI 0.17â0.81, p = 0.01). Conclusions: We report good survival outcomes in cN+ patients treated with RC. The use of ACT after surgery increases survival expectancies, especially in those patients with pathological node disease. Our data need to be further evaluated in prospective setting.
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- 2018
27. Caveolin-1 as prognostic factor of disease recurrence and survival in patients treated with radical cystectomy for bladder cancer
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Marco Moschini, Francesco Soria, Mohammad Abufarraj, Alberto Briganti, Romain Mathieu, Michael Rink, Kilian M. Gust, Shahrokh F. Shariat, Andrea Haitel, Pierre I. Karakiewicz, Tobias Klatte, Ilaria Lucca, Beat Foerster, Morgan Rouprêt, Melanie R. Hassler, Soria, Francesco, Lucca, Ilaria, Moschini, Marco, Mathieu, Romain, Rouprêt, Morgan, Karakiewicz, Pierre I., Briganti, Alberto, Rink, Michael, Gust, Kilian M., Hassler, Melanie R., Foerster, Beat, Abufarraj, Mohammad, Haitel, Andrea, Klatte, Tobia, and Shariat, Shahrokh F.
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Male ,Oncology ,medicine.medical_specialty ,Pathology ,Survival ,Prognosi ,Urology ,medicine.medical_treatment ,Caveolin 1 ,030232 urology & nephrology ,Disease ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,Caveolin-1 ,Recurrence ,Interquartile range ,Internal medicine ,medicine ,Humans ,Biological marker ,Bladder cancer ,Prognosis ,Aged ,Female ,Middle Aged ,Treatment Outcome ,Urinary Bladder Neoplasms ,Tissue microarray ,business.industry ,Hazard ratio ,Cancer ,medicine.disease ,030220 oncology & carcinogenesis ,business - Abstract
Purpose Overexpression of Caveolin-1 has been associated with cancer growth, migration, and metastases in several malignancies, but only few data are available on its role in bladder cancer (BCa). The aim of this study is to validate Caveolin-1 as a prognosticator of recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) in a large cohort of patients treated with radical cystectomy (RC) for BCa. Methods Caveolin-1 expression was evaluated by immunochemistry on a tissue microarray from 424 patients treated with RC for UCB at a single institution. Caveolin-1 was considered overexpressed when at least 50% of the tumor cells stained positively. Univariable and multivariable Cox proportional hazards regression models were used to assess the association of Caveolin-1 expression with RFS, OS, and CSS. Results Overexpression of Caveolin-1 was observed in 116 (27.4%) patients and was associated with lymph node metastasis ( P = 0.003). Median follow-up for patients alive at last follow-up was 129 months (interquartile range [IQR]: 82–178). Patients with overexpression of Caveolin-1 had significant worse RFS, OS, and CSS compared to those with normal expression (log-rank test, P = 0.008, P = 0.001, and P = 0.005, respectively). At multivariable analyses that adjusted for the effects of standard clinicopathologic features, Caveolin-1 remained associated with OS (hazard ratio = 1.47, P = 0.002) and CSS (hazard ratio = 1.42, P = 0.03). Conversely, no association with RFS was found ( P = 0.1). Addition of Caveolin-1 in a model for prediction of survival did not improve the accuracy of the prognostic model. Actually, C-index did not differ among models with or without Caveolin-1 (0.72 for a model predicting RFS, 0.65 for OS, and 0.71 for CSS). Conclusions Caveolin-1 is overexpressed in one-third of patients with BCa treated with RC. Overexpression of Caveolin-1 is significantly associated with OS and CSS, but not with RFS, in patients with BCa treated with RC. However, it is not clinically useful as it does not improve upon the predictive accuracy of survival achieved by pathologic variables alone.
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- 2017
28. Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes
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Alberto Briganti, Anthony Koupparis, Armando Stabile, Stefania Zamboni, Andrea Necchi, Francesco Montorsi, Badrinath R. Konety, Prasanna Sooriakumaran, Stephen A. Boorjian, John D. Kelly, Xavier Cathelineau, Pierre I. Karakiewicz, Douglas S. Scherr, Wei Shen Tan, Livio Mordasini, Wassim Kassouf, Michael Rink, Andrea Gallina, Romain Mathieu, Guillaume Ploussard, Anoop Meraney, Francesco Soria, Morgan Rouprêt, Yair Lotan, Philipp Baumeister, Rafael Sanchez-Salas, Suprita Krishna, Marco Moschini, Giuseppe Simone, Evanguelos Xylinas, Shahrokh F. Shariat, Agostino Mattei, Moschini, Marco, Zamboni, Stefania, Soria, Francesco, Mathieu, Romain, Xylinas, Evanguelo, Tan, Wei Shen, Kelly, John D, Simone, Giuseppe, Meraney, Anoop, Krishna, Suprita, Konety, Badrinath, Mattei, Agostino, Baumeister, Philipp, Mordasini, Livio, Montorsi, Francesco, Briganti, Alberto, Gallina, Andrea, Stabile, Armando, Sanchez-Salas, Rafael, Cathelineau, Xavier, Rink, Michael, Necchi, Andrea, Karakiewicz, Pierre I, Rouprêt, Morgan, Koupparis, Anthony, Kassouf, Wassim, Scherr, Douglas S, Ploussard, Guillaume, Boorjian, Stephen A, Lotan, Yair, Sooriakumaran, Prasanna, and Shariat, Shahrokh F
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Matching (statistics) ,medicine.medical_specialty ,Robotic assisted ,medicine.medical_treatment ,Population ,030232 urology & nephrology ,Urology ,lcsh:Medicine ,survival ,Article ,Cystectomy ,03 medical and health sciences ,0302 clinical medicine ,open ,medicine ,education ,radical cystectomy ,propensity score ,education.field_of_study ,Bladder cancer ,robotic-assisted ,Proportional hazards model ,business.industry ,lcsh:R ,General Medicine ,bladder cancer ,medicine.disease ,030220 oncology & carcinogenesis ,Propensity score matching ,Cohort ,business - Abstract
Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values >, 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values >, 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.
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- 2019
29. Radical Cystectomy in Pathological T4a and T4b Bladder Cancer Patients: Is There Any Space for Sub Stratification?
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Massimo Freschi, Emanuele Zaffuto, Shahrokh F. Shariat, Stefania Zamboni, Agostino Mattei, Andrea Gallina, Julian Cornelius, Carlo Di Bona, Renzo Colombo, Alberto Briganti, Andrea Salonia, Marco Moschini, Ospedale San Raffaele, Philipp Baumeister, Francesco Montorsi, Moschini, Marco, Zamboni, Stefania, Mattei, Agostino, Baumeister, Philipp, Di Bona, Carlo, Cornelius, Julian, Shariat, Shahrokh F., Freschi, Massimo, Zaffuto, Emanuele, Salonia, Andrea, Montorsi, Francesco, Briganti, Alberto, Colombo, Renzo, and Gallina, Andrea
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Male ,medicine.medical_specialty ,Vaginal Neoplasms ,pT4 ,Survival ,medicine.medical_treatment ,Urology ,Urinary Bladder ,030232 urology & nephrology ,Uterus ,Cystectomy ,Abdominal wall ,03 medical and health sciences ,0302 clinical medicine ,Prostate ,Prevalence ,medicine ,Humans ,Neoplasm Invasiveness ,Prospective Studies ,Aged ,Neoplasm Staging ,Pelvic Neoplasms ,Proportional Hazards Models ,Carcinoma, Transitional Cell ,Bladder cancer ,Proportional hazards model ,business.industry ,Hazard ratio ,Prostatic Neoplasms ,Middle Aged ,medicine.disease ,Radical cystectomy ,Treatment Outcome ,medicine.anatomical_structure ,Urinary Bladder Neoplasms ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Uterine Neoplasms ,Vagina ,Lymph Node Excision ,Female ,Locally advanced ,Neoplasm Recurrence, Local ,business ,Follow-Up Studies - Abstract
Introduction: According to TNM staging, pathological T4ab are comprehensive of the invasion of prostate, seminal vesicles, uterus or vagina and pelvic or abdominal wall. However, few data are available on the perioperative and oncological outcomes of specific organ invasion. Materials and Methods: A total of 917 consecutive bladder cancer (BCa) patients treated with radical cystectomy (RC) at a single institution between 1990 and 2015 were studies. Cox regression analyses were used to stratify pT4ab according to the site of invasion and survival. Results: Overall, 176 (19.2%) and 40 (4.4%) patients harbored pT4a or pT4b disease. Specifically, 84 (9.2%) patients reported prostate and/or SVI invasion, 62 (6.8%) prostate only, 16 (1.7%) uterus, 14 (1.5%) vaginal, 24 (2.6%) pelvic wall, and 16 (1.7%) abdominal wall invasion. The median follow-up in pT4 patients was 48 months. The 1-year cancer-specific mortality (CSM) rates were 71, 65, 24, 50, 50, and 72%, for vaginal, uterus, prostate only, prostate and/or seminal vesicles, pelvic wall, and abdominal wall invasions, respectively. At multivariable Cox regression, the invasion of prostate only (hazard ratio [HR] 3.53), prostate and/or SVI (HR 4.98), uterus (HR 7.16), vagina (HR 6.12), pelvic (HR 11.81), abdominal (8.36) were associated with adverse CSM. Conclusions: Our study described the differences in survival related to invasion site in pT4 patients, confirming poor survival expectancies in this subgroup. Patients with prostate invasion only seem to be associated with better survival than those affected by concomitant invasion of seminal vesicles. Uterus and vaginal invasions were associated with poor survival outcomes. Patients Summary: In this study, we looked at the outcome of locally advanced invasive BCa (stage pT4) in patients treated with RC at a tertiary referral hospital. We analyzed the differences in survival related to the specific organ invasion. We confirmed poor survival in this subgroup of patients. Only patients who had prostate invasion only seem to have a better survival.
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- 2019
30. The effect of androgen deprivation treatment on subsequent risk of bladder cancer diagnosis in male patients treated for prostate cancer
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Alberto Briganti, Francesco Montorsi, Nicola Fossati, Pierre I. Karakiewicz, Emanuele Zaffuto, Shahrokh F. Shariat, Giorgio Gandaglia, Agostino Mattei, Marco Moschini, Moschini, Marco, Zaffuto, Emanuele, Karakiewicz, Pierre, Mattei, Agostino, Gandaglia, Giorgio, Fossati, Nicola, Montorsi, Francesco, Briganti, Alberto, and Shariat, Shahrokh F.
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Oncology ,Nephrology ,Male ,medicine.medical_specialty ,Survival ,medicine.drug_class ,Urology ,Metastase ,030232 urology & nephrology ,ADT ,Risk Assessment ,Androgen deprivation therapy ,Androgen deprivation treatment ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,skin and connective tissue diseases ,Differential impact ,Aged ,Retrospective Studies ,Bladder cancer ,business.industry ,Incidence ,Prostatic Neoplasms ,Androgen Antagonists ,Neoplasms, Second Primary ,medicine.disease ,Androgen ,Urinary Bladder Neoplasms ,Male patient ,030220 oncology & carcinogenesis ,business - Abstract
Introduction: Bladder cancer (BCa) is three-to-four times more common in men than in women. To explain this gender gap, several theories have been proposed, including the impact of androgen hormones. The aim of this study was to investigate the differential impact of androgen deprivation therapy (ADT) on subsequent risk of developing BCa in men with prostate cancer (PCa). Methods: A total of 196,914 patients diagnosed with histologically confirmed localized PCa between 2000 and 2009 were identified in the SEER-Medicare insurance program-linked database. Competing-risk regression analyses were performed to assess the risk of developing BCa adjusting for the risk of all-cause mortality. Univariable and multivariable competing-risk regression analyses were performed to test the effect of ADT on BCa incidence for each PCa treatment modality. Results: Of the 196,914 individuals included in the study, 68,421 (34.7%) received ADT. Median (IQR) follow-up was 59 (29–95) months. Overall, a total of 2495 (1.3%) individuals developed BCa during follow-up. After stratification according to ADT, the 10-year cumulative incidence rate was 1.75% (95% CI 1.65–1.85). In the untreated group, the 10-year cumulative incidence rate was 1.99% (95% CI 1.83–2.15). In multivariable competing-risk regression, the use of ADT was not associated with BCa, after accounting for the risk of dying from any cause (p = 0.1). Conclusion: We failed to identify any impact of ADT on the risk of developing a subsequent BCa even after stratifying according to the type of treatment. Further studies are required to explain the gender gap in BCa incidence and outcomes.
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- 2018
31. External beam radiotherapy with or without androgen deprivation therapy in elderly patients with high metastatic risk prostate cancer
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Paolo Dell'Oglio, Umberto Capitanio, Marco Moschini, Zhe Tian, Giorgio Gandaglia, Fred Saad, Vincent Trudeau, Sami-Ramzi Leyh-Bannurah, Alberto Briganti, Francesco Montorsi, Markus Graefen, Marco Bandini, Pierre I. Karakiewicz, Nicola Fossati, Alessandro Larcher, Dell'Oglio, Paolo, Bandini, Marco, Leyh-Bannurah, Sami-Ramzi, Tian, Zhe, Trudeau, Vincent, Larcher, Alessandro, Fossati, Nicola, Moschini, Marco, Gandaglia, Giorgio, Capitanio, Umberto, Briganti, Alberto, Graefen, Marku, Montorsi, Francesco, Saad, Fred, and Karakiewicz, Pierre I
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Oncology ,Male ,medicine.medical_specialty ,Survival ,Cost ,Urology ,medicine.medical_treatment ,030232 urology & nephrology ,Adenocarcinoma ,law.invention ,Androgen deprivation therapy ,03 medical and health sciences ,Prostate cancer ,0302 clinical medicine ,Randomized controlled trial ,law ,Risk Factors ,Internal medicine ,medicine ,Surveillance, Epidemiology, and End Results ,Humans ,High metastatic risk ,External beam radiotherapy ,RT with ADT ,Aged, 80 and over ,business.industry ,Confounding ,Prostatic Neoplasms ,Androgen Antagonists ,Radiotherapy Dosage ,Chemoradiotherapy ,medicine.disease ,Prognosis ,Comorbidity ,Radiation therapy ,Survival Rate ,030220 oncology & carcinogenesis ,Female ,business ,Elderly patient ,Follow-Up Studies - Abstract
Objective Several randomized controlled trials have documented significant overall survival benefit in high metastatic risk prostate cancer (PCa) patients treated with combination of androgen deprivation therapy (ADT) at radiotherapy (RT) relative to RT alone. Unfortunately, elderly patients are either not included or are underrepresented in these trials. In consequence, the survival benefit of combination of ADT at RT in the elderly warrants detailed reassessment, including its cost. Methods Between 1991 and 2009 within the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 3,692 patients aged 80 years or more with clinical T1–T2 PCa and WHO histological grade 3, or clinical T3–T4 PCa and any histological grade, treated with or without combination of ADT at RT. Competing risks analyses focused on cancer-specific mortality (CSM) and other-cause mortality, after accounting for confounders. All analyses were repeated in patients with no comorbidity and in most contemporary patients, treated between 2001 and 2009. Finally, we assessed median annual cost according to use of combination of ADT at RT, after adjusting for patient and tumor characteristics. Results In competing-risks multivariable analyses, no statistically significant difference was observed in CSM and other-cause mortality between patients treated with or without combination of ADT at RT. Same results were recorded in subgroup analyses of patients with no comorbidity and in most contemporary patients. The median annual costs of $36,140 and of $47,510 were recorded, respectively in patients treated without and with ADT at RT. Conclusion Our findings failed to confirm that combination of ADT at RT reduces CSM rates in high metastatic risk PCa patients aged 80 years or more. Moreover, combination of ADT at RT resulted in a significant cost increase, relative to RT alone.
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- 2017
32. Prognostic role of N-cadherin expression in patients with non-muscle-invasive bladder cancer
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Marek Babjuk, Beat Foerster, Pierre I. Karakiewicz, Alberto Briganti, Piotr Chlosta, Walter Albrecht, Marco Moschini, Shahrokh F. Shariat, Kilian M. Gust, Andrea Haitel, Mohammad Abufaraj, Abufaraj, Mohammad, Shariat, Shahrokh F., Haitel, Andrea, Moschini, Marco, Foerster, Beat, Chłosta, Piotr, Gust, Kilian, Babjuk, Marek, Briganti, Alberto, Karakiewicz, Pierre I., and Albrecht, Walter
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Male ,Oncology ,Survival ,medicine.medical_treatment ,030232 urology & nephrology ,Disease ,0302 clinical medicine ,Recurrence ,Retrospective Studie ,Medicine ,Stage (cooking) ,Progression ,Middle Aged ,Cadherins ,Survival Rate ,030220 oncology & carcinogenesis ,Urinary Bladder Neoplasm ,Monoclonal ,Disease Progression ,Immunohistochemistry ,Female ,Adjuvant ,Human ,Urothelial tumor ,medicine.medical_specialty ,Prognosi ,Urology ,Disease-Free Survival ,Follow-Up Studie ,03 medical and health sciences ,Internal medicine ,Nonâmuscle-invasive bladder cancer ,Biomarkers, Tumor ,Humans ,Neoplasm Invasiveness ,Pathological ,N-cadherin ,Aged ,Neoplasm Staging ,Retrospective Studies ,Neoplasm Invasivene ,Bladder cancer ,business.industry ,Proportional hazards model ,Transurethral resection ,medicine.disease ,Urinary Bladder Neoplasms ,Cadherin ,Neoplasm Grading ,Neoplasm Recurrence, Local ,Prediction ,business ,Follow-Up Studies - Abstract
Purpose To assess the role of N-cadherin as a prognostic biomarker in patients with nonâmuscle-invasive bladder cancer (NMIBC) treated with transurethral resection with or without adjuvant intravesical therapy. Patients and methods Immunohistochemistry using monoclonal mouse antibody was used to evaluate the expression status of N-cadherin in 827 patients with NMIBC. N-cadherin was considered positive if any immunoreactivity with membranous staining was detected. Multivariable Cox regression models were performed to evaluate the prognostic effect of N-cadherin on survival outcomes. Results N-cadherin expression was observed in 333 patients (40.3%); it was associated with pT1 stage and high tumor grade (both were P
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- 2017
33. Preoperative anemia is associated with disease recurrence and progression in patients with non–muscle-invasive bladder cancer
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Romain Mathieu, Alberto Briganti, Paolo Gontero, Mohammad Abufaraj, Francesco Soria, Mehmet Özsoy, Kilian M. Gust, Morgan Rouprêt, Pierre I. Karakiewicz, Marco Moschini, Grégory Johann Wirth, Beat Foerster, Shahrokh F. Shariat, Soria, Francesco, Moschini, Marco, Abufaraj, Mohammad, Wirth, Gregory J., Foerster, Beat, Gust, Kilian M., Özsoy, Mehmet, Briganti, Alberto, Gontero, Paolo, Mathieu, Romain, Rouprêt, Morgan, Karakiewicz, Pierre I., and Shariat, Shahrokh F.
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Male ,Survival ,medicine.medical_treatment ,030232 urology & nephrology ,Disease ,0302 clinical medicine ,Interquartile range ,Recurrence ,ddc:617 ,Progression ,Muscles ,Anemia ,Middle Aged ,Prognosis ,Administration, Intravesical ,Oncology ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Cohort ,Preoperative Period ,Disease Progression ,Non–muscle-invasive bladder cancer ,Preoperative anemia ,Urology ,Female ,Adjuvant ,medicine.medical_specialty ,Urinary Bladder ,Cystectomy ,Disease-Free Survival ,03 medical and health sciences ,medicine ,Nonâmuscle-invasive bladder cancer ,Humans ,Aged ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Bladder cancer ,Proportional hazards model ,business.industry ,Retrospective cohort study ,medicine.disease ,Surgery ,Institutional repository ,Urinary Bladder Neoplasms ,Neoplasm Grading ,Neoplasm Recurrence, Local ,business - Abstract
Purpose To evaluate the effect of preoperative anemia (PA) on oncological outcomes in a multicenter cohort of patients with non–muscle-invasive bladder cancer (NMIBC) treated with transurethral resection of the bladder (TURB) and adjuvant intravesical therapies. We hypothesize that PA represents a marker of disease aggressiveness and could be used to improve the discrimination of prognostic tools for the prediction of disease recurrence and progression. Methods This multicenter retrospective study included 1,117 patients from 4 different centers. The presence of PA was assessed according to the World Health Organization classification as a preoperative hemoglobin level of≤13 g/dl in men and≤12 g/dl in women. PA evaluation was done at each institution, generally 1 to 3 days before surgery. Multivariable Cox regression models were performed to evaluate the prognostic effect of PA on survival outcomes. Results Overall, 381 (34%) patients with NMIBC treated with TURB, had PA. Median follow-up for patients alive at last follow-up was 62.7 months (interquartile range: 25–110.7). On multivariable Cox regression analyses that accounted for the effect of standard clinicopathologic prognosticators, PA was independently associated with recurrence-free survival ( P = 0.045) and progression-free survival ( P = 0.01). Adding PA to a model for the prediction of disease recurrence and progression improved the discrimination of the prognostic models marginally from 69.8% to 70.3% and from 71.6% to 73.1%, respectively. Conclusions PA was found in more than one-third of patients with NMIBC treated with TURB. PA was associated with poor oncological outcomes and was an independent predictor of intravesical disease recurrence and progression. However, the additional prognostic information provided by PA remains limited.
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- 2017
34. The effect of HER2 status on oncological outcomes of patients with invasive bladder cancer
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Melanie R. Hassler, Kilian M. Gust, Alberto Briganti, Marco Moschini, Shahrokh F. Shariat, Morgan Rouprêt, Grégory Johann Wirth, Francesco Soria, Tobias Klatte, Andrea Haitel, Pierre I. Karakiewicz, Soria, Francesco, Moschini, Marco, Haitel, Andrea, Wirth, Gregory J., Gust, Kilian M., Briganti, Alberto, Rouprêt, Morgan, Klatte, Tobia, Hassler, Melanie R., Karakiewicz, Pierre I., and Shariat, Shahrokh F.
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Male ,Oncology ,Survival ,Receptor, ErbB-2 ,medicine.medical_treatment ,030232 urology & nephrology ,Kaplan-Meier Estimate ,Disease ,Target therapy ,Antineoplastic Agent ,ErbB-2 ,0302 clinical medicine ,Retrospective Studie ,Interquartile range ,Recurrence ,skin and connective tissue diseases ,Adjuvant ,integumentary system ,ddc:617 ,Bladder cancer ,Middle Aged ,Prognosis ,Combined Modality Therapy ,Neoplasm Proteins ,Gene Expression Regulation, Neoplastic ,Treatment Outcome ,Local ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Urinary Bladder Neoplasm ,Immunohistochemistry ,Female ,Receptor ,Human ,medicine.medical_specialty ,Prognosi ,Urology ,Antineoplastic Agents ,Cystectomy ,HercepTest ,Follow-Up Studie ,Neoplasm Protein ,03 medical and health sciences ,Internal medicine ,HER2 ,medicine ,Chemotherapy ,Humans ,Neoplasm Invasiveness ,Retrospective Studies ,Aged ,Neoplasm Invasivene ,Gynecology ,Neoplastic ,Carcinoma, Transitional Cell ,business.industry ,Carcinoma ,Cancer ,Retrospective cohort study ,Genes, erbB-2 ,medicine.disease ,Follow-Up Studies ,Neoplasm Recurrence, Local ,Urinary Bladder Neoplasms ,Neoplasm Recurrence ,Gene Expression Regulation ,Genes ,Transitional Cell ,business - Abstract
Purpose The aim of this study was to evaluate the overexpression of human epidermal growth factor receptor 2 (HER2) in patients with bladder cancer (BCa) and to assess its association with oncological outcomes. Methods This retrospective single-center study included 354 patients with BCa treated with radical cystectomy (RC). HER2 status was assessed with immunohistochemistry and scored according to HercepTest. Conditional survival and competing risk regression were performed to assess the association between HER2 expression and survival outcomes. Results HER2 was overexpressed in 36% of patients. HER2 overexpression was associated with features of tumor aggressiveness such as lymph-node metastases ( P = 0.002). At a median follow-up of 123 months (interquartile range: 79–180), 160 patients (45%) experienced disease recurrence, 263 patients (74%) died and 157 (44%) died of cancer. On multivariable analyses, HER2 overexpression was not significantly associated with any oncological outcomes. Adding HER2 status to a model for the prediction of survival outcomes did not change the accuracy of the model for any of the outcomes. Interestingly, HER2 status significantly affected late disease recurrence ( P = 0.05 for conditional survival at 24 months). Conclusions More than one third of RC patients overexpress HER2 in their tumors. HER2 overexpression was associated with features of biological and clinical aggressiveness. HER2 did not add prognostic significance to the standard established predictors of survival outcomes after RC. However, due to the high overexpression rate, it could represent a target for therapy in select advanced BCa tumors.
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- 2016
35. External beam radiotherapy with or without androgen deprivation therapy in elderly patients with high metastatic risk prostate cancer.
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Dell’Oglio, Paolo, Bandini, Marco, Leyh-Bannurah, Sami-Ramzi, Tian, Zhe, Trudeau, Vincent, Larcher, Alessandro, Fossati, Nicola, Moschini, Marco, Gandaglia, Giorgio, Capitanio, Umberto, Briganti, Alberto, Graefen, Markus, Montorsi, Francesco, Saad, Fred, Karakiewicz, Pierre I., and Dell'Oglio, Paolo
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- *
PROSTATE cancer treatment , *HEALTH outcome assessment , *DISEASE progression , *ANDROGENS , *OLDER patients , *CANCER treatment , *PROSTATE tumors treatment , *ADENOCARCINOMA , *ANTIANDROGENS , *COMPARATIVE studies , *LONGITUDINAL method , *RESEARCH methodology , *MEDICAL cooperation , *PROGNOSIS , *PROSTATE tumors , *RADIATION doses , *RESEARCH , *SURVIVAL , *EVALUATION research , *ECONOMICS , *THERAPEUTICS ,RISK of metastasis - Abstract
Objective: Several randomized controlled trials have documented significant overall survival benefit in high metastatic risk prostate cancer (PCa) patients treated with combination of androgen deprivation therapy (ADT) at radiotherapy (RT) relative to RT alone. Unfortunately, elderly patients are either not included or are underrepresented in these trials. In consequence, the survival benefit of combination of ADT at RT in the elderly warrants detailed reassessment, including its cost.Methods: Between 1991 and 2009 within the Surveillance Epidemiology and End Results (SEER)-Medicare-linked database, we identified 3,692 patients aged 80 years or more with clinical T1-T2 PCa and WHO histological grade 3, or clinical T3-T4 PCa and any histological grade, treated with or without combination of ADT at RT. Competing risks analyses focused on cancer-specific mortality (CSM) and other-cause mortality, after accounting for confounders. All analyses were repeated in patients with no comorbidity and in most contemporary patients, treated between 2001 and 2009. Finally, we assessed median annual cost according to use of combination of ADT at RT, after adjusting for patient and tumor characteristics.Results: In competing-risks multivariable analyses, no statistically significant difference was observed in CSM and other-cause mortality between patients treated with or without combination of ADT at RT. Same results were recorded in subgroup analyses of patients with no comorbidity and in most contemporary patients. The median annual costs of $36,140 and of $47,510 were recorded, respectively in patients treated without and with ADT at RT.Conclusion: Our findings failed to confirm that combination of ADT at RT reduces CSM rates in high metastatic risk PCa patients aged 80 years or more. Moreover, combination of ADT at RT resulted in a significant cost increase, relative to RT alone. [ABSTRACT FROM AUTHOR]- Published
- 2018
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36. Evaluating the effect of time from prostate cancer diagnosis to radical prostatectomy on cancer control: Can surgery be postponed safely?
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Fossati, Nicola, Rossi, Martina Sofia, Cucchiara, Vito, Gandaglia, Giorgio, Dell’Oglio, Paolo, Moschini, Marco, Suardi, Nazareno, Dehò, Federico, Montorsi, Francesco, Schiavina, Riccardo, Mottrie, Alexandre, Briganti, Alberto, and Dell'Oglio, Paolo
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PROSTATE cancer , *DIAGNOSIS , *PROSTATE cancer treatment , *PROSTATECTOMY , *CANCER relapse , *TREATMENT delay (Medicine) , *NONPARAMETRIC statistics , *LONGITUDINAL method , *MEDICAL care , *PATIENTS , *PROGNOSIS , *PROSTATE tumors , *SURVIVAL , *PREVENTION - Abstract
Objective: To test the prognostic role of treatment delay in patients affected by prostate cancer (PCa).Materials and Methods: The study included 2,653 patients treated with radical prostatectomy (RP) at a single institution between 2006 and 2011. The evaluated outcomes were biochemical recurrence (BCR) and clinical recurrence (CR). Multivariable Cox regression analysis was used to test the association between time from diagnosis to RP and oncological outcomes. Nonparametric curve fitting methods were used to graphically explore the relationship between time from diagnosis to RP and oncological outcomes. Sensitivity analyses were repeated in the subgroups of low-, intermediate-, and high-risk patients.Results: At median follow-up of 56 months (interquartile range: 26, 92), 283 patients experienced BCR, and 84 patients developed CR. Median time from PCa diagnosis to surgery was 2.8 months (interquartile range: 1.6, 4.7). At multivariable Cox regression analysis, time from biopsy to RP was significantly associated with an increased risk of BCR (hazard ratio = 1.02, P = 0.0005) and CR (hazard ratio = 1.03, P = 0.0002). Using Nonparametric curve fitting methods, a significant increased risk of BCR and CR after approximately 18 months was observed. However, when sensitivity analyses were repeated according to risk groups, this effect was maintained in high-risk patients only, and such time interval was reduced to 12 months.Conclusions: Despite the overall trend on higher rate of cancer relapse after RP, the effect of treatment delay from biopsy to RP was significantly evident in high-risk patients only. Even in high-risk patients surgical treatment can be postponed safely, but not beyond the 12-month landmark. [ABSTRACT FROM AUTHOR]- Published
- 2017
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37. Prognostic role of expression of N-cadherin in patients with upper tract urothelial carcinoma: a multi-institutional study
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Romain Mathieu, Morgan Rouprêt, Mehmet Özsoy, Vitaly Margulis, Jose A. Karam, Francesco Soria, Mohammad Abufaraj, Alberto Briganti, Andrea Haitel, Marco Moschini, Christopher G. Wood, Shahrokh F. Shariat, Kilian M. Gust, Karim Bensalah, Abufaraj, Mohammad, Moschini, Marco, Soria, Francesco, Gust, Kilian, Özsoy, Mehmet, Mathieu, Romain, Rouprêt, Morgan, Margulis, Vitaly, Karam, Jose A., Wood, Christopher G., Briganti, Alberto, Bensalah, Karim, Haitel, Andrea, and Shariat, Shahrokh F.
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Male ,Nephrology ,Oncology ,Survival ,030232 urology & nephrology ,UTUC prognosi ,Kaplan-Meier Estimate ,Kidney ,Nephroureterectomy ,0302 clinical medicine ,Lymph node ,Tumor ,Cadherins ,Prognosis ,Immunohistochemistry ,Kidney Neoplasms ,N-Cadherin ,Prediction ,Upper tract urothelial carcinoma ,Urothelial carcinoma ,UTUC prognosis ,Aged ,Biomarkers, Tumor ,Female ,Humans ,Neoplasm Staging ,Predictive Value of Tests ,Ureter ,Urothelium ,Carcinoma ,Ureteral Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Predictive value of tests ,Cohort ,Original Article ,medicine.medical_specialty ,Urology ,03 medical and health sciences ,Internal medicine ,medicine ,Ureteral neoplasm ,business.industry ,Proportional hazards model ,medicine.disease ,business ,Biomarkers - Abstract
Purpose To assess the role of N-cadherin as prognostic biomarker in patients with upper tract urothelial carcinoma (UTUC) in a large multi-institutional cohort of patients. Patients and methods Immunohistochemistry was used to evaluate the status of N-cadherin expression in 678 patients with unilateral sporadic UTUC treated with radical nephroureterectomy. N-cadherin was considered positive if any immunoreactivity with membranous staining was detected. The Kaplan–Meier method was used to estimate recurrence-free survival, overall survival and cancer-specific survival. Disease recurrence, overall mortality and cancer-specific mortality probabilities were tested in Cox regression models. Results Expression of N-cadherin was observed in 292 (43.1%) of patients, and it was associated with advanced tumour stage (p
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