Antti P Salminen1, Ilmari Koskinen2, Ileana Montoya Perez3, Saija Hurme4, Teemu J Murtola5, Markku H Vaarala6, Timo K Nykopp7, Marjo Seppänen8, Taina Isotalo9, Timo Marttila10, Lasse Levomäki11, Sebastian Becker12, Mikael Anttinen13, Tapani Liukkonen13, Matti Säily14, Dimitri Pogodin-Hannolainen15, Jouko Viitanen16, Christian Palmberg17, Juhani Ottelin18, Jukka Sairanen2, Otto O Ettala19, Peter J Boström19. 1. Department of Urology, University of Turku and Turku University Hospital, Turku, Finland. Electronic address: antti.salminen@tyks.fi. 2. Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 3. Department of Information Technology, University of Turku, Turku, Finland. 4. Department of Biostatistics, University of Turku, Turku, Finland. 5. Department of Urology, University of Tampere and Tampere University Hospital, Tampere, Finland. 6. Department of Urology, University of Oulu and Oulu University Hospital, Oulu, Finland. 7. Department of Urology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland. 8. Department of Surgery, Division of Urology, Central Hospital of Pori, Pori, Finland. 9. Department of Surgery, Division of Urology, Central Hospital of Lahti, Lahti, Finland. 10. Department of Surgery, Division of Urology, Central Hospital of Seinäjoki, Seinäjoki, Finland. 11. Department of Surgery, Division of Urology, Central Hospital of Jyväskylä, Jyväskylä, Finland. 12. Department of Surgery, Division of Urology, Central Hospital of Lappeenranta, Lappeenranta, Finland. 13. Department of Surgery, Division of Urology, Central Hospital of Mikkeli, Mikkeli, Finland. 14. Department of Surgery, Division of Urology, Central Hospital of Rovaniemi, Rovaniemi, Finland. 15. Department of Surgery, Division of Urology, Central Hospital of Hämeenlinna, Hämeenlinna, Finland. 16. Department of Surgery, Division of Urology, Central Hospital of Joensuu, Joensuu, Finland. 17. Department of Surgery, Division of Urology, Central Hospital of Vaasa, Vaasa, Finland. 18. Department of Surgery, Division of Urology, Central Hospital of Kemi, Kemi, Finland. 19. Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.
Abstract
BACKGROUND: Neoadjuvant chemotherapy (NAC) is underutilized in the treatment of bladder cancer (BC). OBJECTIVE: To investigate the effect of NAC on the risk of surgical complications for radical cystectomy (RC) in a population-based setting. DESIGN, SETTING, AND PARTICIPANTS: All radical cystectomies performed in Finland during 2005-2014 were included in the study. Data were collected retrospectively using a web-based data collection platform. Complications were recorded for 90 d using the Clavien classification. Patients treated with NAC were compared to patients receiving RC alone using three cohorts and approaches: the entire cohort, a neoadjuvant period cohort, and a matched cohort. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: For all three cohorts, odds ratios (ORs) were estimated using simple binary logistic regression. In addition, a multivariable stratified logistic model with propensity score was used. For the matched cohort analysis, both univariate and adjusted analyses were carried out. RESULTS AND LIMITATIONS: During 2005-2014, 1427 RCs were performed in Finland, of which 1385 were included in the analyses. NAC was introduced in 2008, and 231 patients (16%) were assigned to NAC and 214 (15%) received two or more cycles of chemotherapy. Within 90 d, 61% of patients experienced complications and mortality was 4% (1.9% in the NAC group, and 4.4% in the RC-alone group). In simple binary logistic regression, NAC patients had significantly fewer complications, but this was not observed in multivariable or propensity score analyses. In the matched cohort analyses, no differences in complication rates could be observed. None of the analyses demonstrated higher complication rates in the NAC group. CONCLUSIONS: Our retrospective study reports on nationwide use of NAC for BC and demonstrates that NAC does not increase RC morbidity. PATIENT SUMMARY: Chemotherapy given before radical surgery does not increase severe postoperative complications in the treatment of bladder cancer.
BACKGROUND: Neoadjuvant chemotherapy (NAC) is underutilized in the treatment of bladder cancer (BC). OBJECTIVE: To investigate the effect of NAC on the risk of surgical complications for radical cystectomy (RC) in a population-based setting. DESIGN, SETTING, AND PARTICIPANTS: All radical cystectomies performed in Finland during 2005-2014 were included in the study. Data were collected retrospectively using a web-based data collection platform. Complications were recorded for 90 d using the Clavien classification. Patients treated with NAC were compared to patients receiving RC alone using three cohorts and approaches: the entire cohort, a neoadjuvant period cohort, and a matched cohort. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: For all three cohorts, odds ratios (ORs) were estimated using simple binary logistic regression. In addition, a multivariable stratified logistic model with propensity score was used. For the matched cohort analysis, both univariate and adjusted analyses were carried out. RESULTS AND LIMITATIONS: During 2005-2014, 1427 RCs were performed in Finland, of which 1385 were included in the analyses. NAC was introduced in 2008, and 231 patients (16%) were assigned to NAC and 214 (15%) received two or more cycles of chemotherapy. Within 90 d, 61% of patients experienced complications and mortality was 4% (1.9% in the NAC group, and 4.4% in the RC-alone group). In simple binary logistic regression, NACpatients had significantly fewer complications, but this was not observed in multivariable or propensity score analyses. In the matched cohort analyses, no differences in complication rates could be observed. None of the analyses demonstrated higher complication rates in the NAC group. CONCLUSIONS: Our retrospective study reports on nationwide use of NAC for BC and demonstrates that NAC does not increase RC morbidity. PATIENT SUMMARY: Chemotherapy given before radical surgery does not increase severe postoperative complications in the treatment of bladder cancer.
Authors: Sophia Liff Maibom; Ulla Nordström Joensen; Alicia Martin Poulsen; Henrik Kehlet; Klaus Brasso; Martin Andreas Røder Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692
Authors: Elisa Mäkäräinen-Uhlbäck; Jaana Vironen; Markku Vaarala; Pia Nordström; Anu Välikoski; Jyrki Kössi; Ville Falenius; Aristotelis Kechagias; Anne Mattila; Pasi Ohtonen; Tom Scheinin; Tero Rautio Journal: BMC Surg Date: 2021-05-03 Impact factor: 2.102
Authors: Benedikt Hoeh; Rocco Simone Flammia; Lukas Hohenhorst; Gabriele Sorce; Francesco Chierigo; Andrea Panunzio; Zhe Tian; Fred Saad; Michele Gallucci; Alberto Briganti; Carlo Terrone; Shahrokh F Shariat; Markus Graefen; Derya Tilki; Alessandro Antonelli; Luis A Kluth; Philipp Mandel; Felix K H Chun; Pierre I Karakiewicz Journal: Cancers (Basel) Date: 2022-02-26 Impact factor: 6.639