Kyohei Hakozaki1,2, Eiji Kikuchi1,3, Koichiro Ogihara1,4, Keisuke Shigeta1, Takayuki Abe5,6, Yasumasa Miyazaki7, Gou Kaneko8, Takahiro Maeda4, Shunsuke Yoshimine9, Kunimitsu Kanai2, Hiroki Ide10, Suguru Shirotake8, Masafumi Oyama8, Ryuichi Mizuno1, Mototsugu Oya1. 1. Department of Urology, Keio University School of Medicine, Tokyo, Japan. 2. Department of Urology, National Hospital Organization Saitama National Hospital, Saitama. 3. Department of Urology, St. Marianna University School of Medicine, Kanagawa. 4. Department of Urology, Kawasaki Municipal Hospital, Kanagawa. 5. Department of Clinical and Translational Research Center, Keio University School of Medicine, Tokyo. 6. Yokohama City University, School of Data Science, Kanagawa. 7. Department of Urology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa. 8. Department of Uro-Oncology, Saitama Medical University International Medical Center, Saitama. 9. Department of Urology, Saitama City Hospital, Saitama. 10. Department of Urology, Saiseikai Central Hospital, Tokyo.
Abstract
BACKGROUND: Prophylactic urethrectomy at the time of radical cystectomy is frequently recommended for patients with bladder cancer at a high risk of urethral recurrence without definitive evidence. The present study attempted to clarify the survival benefits of performing prophylactic urethrectomy. METHODS: We identified 214 male patients who were treated by radical cystectomy with an incontinent urinary diversion in our seven institutions between 2004 and 2017. We used propensity score matching and ultimately identified 114 patients, 57 of whom underwent prophylactic urethrectomy (prophylactic urethrectomy group) and 57 who did not (non-prophylactic urethrectomy group). RESULTS: No significant differences were observed in the 5-year overall survival rate between the prophylactic urethrectomy and non-prophylactic urethrectomy groups in the overall. However, the local recurrence rate was significantly lower in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.015). In the subgroup of 58 patients with multiple tumours and/or concomitant carcinoma in situ at the time of transurethral resection of bladder tumour, the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.021). A multivariate analysis revealed that performing prophylactic urethrectomy was the only independent predictor of the overall survival rate (P = 0.016). In those patients who were treated without neoadjuvant chemotherapy (n = 38), the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.007). CONCLUSIONS: Prophylactic urethrectomy at the time of radical cystectomy may have a survival benefit in patients with multiple tumours and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy.
BACKGROUND: Prophylactic urethrectomy at the time of radical cystectomy is frequently recommended for patients with bladder cancer at a high risk of urethral recurrence without definitive evidence. The present study attempted to clarify the survival benefits of performing prophylactic urethrectomy. METHODS: We identified 214 male patients who were treated by radical cystectomy with an incontinent urinary diversion in our seven institutions between 2004 and 2017. We used propensity score matching and ultimately identified 114 patients, 57 of whom underwent prophylactic urethrectomy (prophylactic urethrectomy group) and 57 who did not (non-prophylactic urethrectomy group). RESULTS: No significant differences were observed in the 5-year overall survival rate between the prophylactic urethrectomy and non-prophylactic urethrectomy groups in the overall. However, the local recurrence rate was significantly lower in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.015). In the subgroup of 58 patients with multiple tumours and/or concomitant carcinoma in situ at the time of transurethral resection of bladder tumour, the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.021). A multivariate analysis revealed that performing prophylactic urethrectomy was the only independent predictor of the overall survival rate (P = 0.016). In those patients who were treated without neoadjuvant chemotherapy (n = 38), the 5-year overall survival rate was significantly higher in the prophylactic urethrectomy group than in the non-prophylactic urethrectomy group (P = 0.007). CONCLUSIONS: Prophylactic urethrectomy at the time of radical cystectomy may have a survival benefit in patients with multiple tumours and/or concomitant carcinoma in situ, particularly those who do not receive neoadjuvant chemotherapy.
Authors: Ekaterina Laukhtina; Axelle Boehm; Benoit Peyronnet; Carlo Andrea Bravi; Jose Batista Da Costa; Francesco Soria; David D'Andrea; Pawel Rajwa; Fahad Quhal; Takafumi Yanagisawa; Frederik König; Hadi Mostafaei; Dmitry Enikeev; Alexandre Ingels; Gregory Verhoest; Frederiek D'Hondt; Alexandre Mottrie; Steven Joniau; Hendrik Van Poppel; Alexandre de la Taille; Karim Bensalah; Franck Bruyère; Shahrokh F Shariat; Benjamin Pradere Journal: World J Urol Date: 2022-05-20 Impact factor: 3.661
Authors: Daniela Fasanella; Michele Marchioni; Luigi Domanico; Claudia Franzini; Antonino Inferrera; Luigi Schips; Francesco Greco Journal: Life (Basel) Date: 2022-08-04