PURPOSE: To evaluate trends in oncologic characteristics and outcomes, as well as perioperative management, among patients undergoing radical cystectomy at Memorial Sloan Kettering from 1995 to 2015. MATERIALS AND METHODS: We retrospectively reviewed our institutional database to analyze changes in disease recurrence probability, cancer-specific and all-cause mortality, incidence of muscle-invasive bladder cancer, use of perioperative chemotherapy, rate of positive soft-tissue surgical margins, and lymph node yield. RESULTS: In 2,740 patients with non-metastatic urothelial carcinoma undergoing radical cystectomy from 1995 to 2015, the 5-year probability of disease recurrence decreased from a peak of 42% in 1997 to 34% in 2013 (p=0.045), while 5-year probability of cancer-specific mortality likewise declined from 36% in 1997 to 24% in 2013 (p=0.009). Incidence of non-muscle-invasive disease before radical cystectomy did not change, comprising 30%-35% of patients across the study period. Use of neoadjuvant chemotherapy rose significantly: 57% of patients with muscle-invasive bladder cancer from 2010 to 2015 received it. We observed a corresponding rise in complete pathologic response (pT0) at radical cystectomy, as well as decreasing positive soft-tissue surgical margins (10% to 2.5%) and rising lymph node yield (7 to 24) from 1995 to 2015. CONCLUSIONS: Over a 21-year period, outcomes after radical cystectomy at our institution improved significantly, as probability of recurrence and cancer-specific mortality decreased. Increasing utilization of neoadjuvant chemotherapy, rising pT0 rates, decreased positive soft-tissue surgical margins, and increasing lymph node yields likely contributed, suggesting that optimized surgical and perioperative care led to improved cancer outcomes in patients undergoing radical cystectomy.
PURPOSE: To evaluate trends in oncologic characteristics and outcomes, as well as perioperative management, among patients undergoing radical cystectomy at Memorial Sloan Kettering from 1995 to 2015. MATERIALS AND METHODS: We retrospectively reviewed our institutional database to analyze changes in disease recurrence probability, cancer-specific and all-cause mortality, incidence of muscle-invasive bladder cancer, use of perioperative chemotherapy, rate of positive soft-tissue surgical margins, and lymph node yield. RESULTS: In 2,740 patients with non-metastatic urothelial carcinoma undergoing radical cystectomy from 1995 to 2015, the 5-year probability of disease recurrence decreased from a peak of 42% in 1997 to 34% in 2013 (p=0.045), while 5-year probability of cancer-specific mortality likewise declined from 36% in 1997 to 24% in 2013 (p=0.009). Incidence of non-muscle-invasive disease before radical cystectomy did not change, comprising 30%-35% of patients across the study period. Use of neoadjuvant chemotherapy rose significantly: 57% of patients with muscle-invasive bladder cancer from 2010 to 2015 received it. We observed a corresponding rise in complete pathologic response (pT0) at radical cystectomy, as well as decreasing positive soft-tissue surgical margins (10% to 2.5%) and rising lymph node yield (7 to 24) from 1995 to 2015. CONCLUSIONS: Over a 21-year period, outcomes after radical cystectomy at our institution improved significantly, as probability of recurrence and cancer-specific mortality decreased. Increasing utilization of neoadjuvant chemotherapy, rising pT0 rates, decreased positive soft-tissue surgical margins, and increasing lymph node yields likely contributed, suggesting that optimized surgical and perioperative care led to improved cancer outcomes in patients undergoing radical cystectomy.
Authors: Nima Almassi; Karissa Whiting; Antoun Toubaji; Andrew T Lenis; Emmet J Jordan; Helen Won; Ashley M Regazzi; Ying-Bei Chen; Anuradha Gopalan; Sahussapont J Sirintrapun; Samson W Fine; Satish K Tickoo; Irina Ostrovnaya; Eugene J Pietzak; Eugene K Cha; Alvin C Goh; Timothy F Donahue; Harry W Herr; S Machele Donat; Guido Dalbagni; Bernard H Bochner; Min Yuen Teo; Samuel A Funt; Jonathan E Rosenberg; Victor E Reuter; Dean F Bajorin; David B Solit; Hikmat Al-Ahmadie; Gopa Iyer Journal: JCO Precis Oncol Date: 2022-06
Authors: Nima Almassi; Emily A Vertosick; Daniel D Sjoberg; Nathan C Wong; Chun Huang; Eugene J Pietzak; Eugene K Cha; Timothy F Donahue; Guido Dalbagni; Bernard H Bochner; Gopa Iyer; Jonathan E Rosenberg; Dean F Bajorin; Hikmat Al-Ahmadie; Alvin C Goh Journal: BJU Int Date: 2021-05-24 Impact factor: 5.969
Authors: Anirban P Mitra; Jie Cai; Gus Miranda; Sumeet Bhanvadia; David I Quinn; Anne K Schuckman; Hooman Djaladat; Siamak Daneshmand Journal: J Urol Date: 2021-11-08 Impact factor: 7.450