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Hamano, Itsuto ; Hatakeyama, Shingo ; Iwamura, Hiromichi ; Fujita, Naoki ; Fukushi, Ken ; Narita, Takuma ; Hagiwara, kazuhisa ; Kusaka, Ayumu ; Hosogoe, Shogo ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Kawaguchi, Toshiaki ; Ohyama, Chikara
概要:
Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy. Methods: A total of 581 patients who underwent radical
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cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram. Results: Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively). Conclusions: Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.
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Kusaka, Ayumu ; Hatakeyama, Shingo ; Hosogoe, Shogo ; Hamano, Itsuto ; Iwamura, Hiromichi ; Fujita, Naoki ; Fukushi, Ken ; Narita, Takuma ; Hagiwara, kazuhisa ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Kawaguchi, Toshiaki ; Ohyama, Chikara
概要:
Background: The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost
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effectiveness after radical cystectomy. Results: Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal-and high-risk patients, but the medical expense was high, especially in normal-risk (<= pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol. Materials and Methods: We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-and high-risk groups by a pathology-based protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared. Conclusions: Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.
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Kodama, Hirotake ; Hatakeyama, Shingo ; Fujita, Naoki ; Iwamura, Hiromichi ; Anan, Go ; Fukushi, Ken ; Narita, Takuma ; Tanaka, Toshikazu ; Kubota, Yuka ; Horiguchi, Hirotaka ; Momota, Masaki ; Kido, Koichi ; Matsumoto, Teppei ; Soma, Osamu ; Hamano, Itsuto ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Sasaki, Atsushi ; Kawaguchi, Toshiaki ; Sato, Makoto ; Ohyama, Chikara
概要:
Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes in patients with upper tract urothelial carcinoma who underwent radical nephroureterectomy. Methods: A total of 426 patients who
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underwent radical nephroureterectomy at five medical centers between February 1995 and February 2017 were retrospectively examined. Oncological outcomes, including intravesical recurrence-free, visceral recurrence-free, cancer-specific, and overall survival rates (intravesical RFS, visceral RFS, CSS, and OS, respectively) stratified by preoperative CKD status (CKD vs. non-CKD) were investigated. Cox proportional hazards regression analysis was performed using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and a prognostic factor-based risk stratification nomogram was developed. Results: Of the 426 patients, 250 (59%) were diagnosed with CKD before radical nephroureterectomy. Before the background adjustment, intravesical RFS, visceral RFS, CSS, and OS after radical nephroureterectomy were significantly shorter in the CKD group than in the non-CKD group. Background-adjusted IPTW analysis demonstrated that preoperative CKD was significantly associated with poor visceral RFS, CSS, and OS after radical nephroureterectomy. Intravesical RFS was not significantly associated with preoperative CKD. The nomogram for predicting 5-year visceral RFS and CSS probability demonstrated a significant correlation with actual visceral RFS and CSS (c-index = 0.85 and 0.83, respectively). Conclusions: Upper tract urothelial carcinoma patients with preoperative CKD had a significantly lower survival probability than those without CKD.
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Anan, Go ; Hatakeyama, Shingo ; Fujita, Naoki ; Iwamura, Hiromichi ; Tanaka, Toshikazu ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Kawaguchi, Toshiaki ; Sato, Makoto ; Ohyama, Chikara
概要:
Objective: Despite benefits of neoadjuvant chemotherapy (NAC), the adoption of guideline recommendations for NAC use in patients with muscle-invasive bladder cancer (MIBC) has been slow. We aimed to evaluate temporal trends in NAC use and
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oncological outcomes in a representative cohort of patients with MIBC. Methods: We included 532 patients from 4 hospitals who underwent radical cystectomy (RC) for >= cT2 MIBC in 1996-2017. We retrospectively evaluated temporal changes in NAC use and progression-free and overall survival. Candidates for NAC were administered with either cisplatin- or carboplatin-based regimens. The impact of NAC on oncological outcomes was examined using multivariate Cox regression analysis with inverse probability of treatment weighting (IPTW) models. Results: Of 532 patients, 336 underwent NAC followed by RC (NAC group) and 196 underwent RC alone (Ctrl group). NAC use significantly increased from 10% (1996-2004) to 83% (2005-2016). The number of patients administered with cisplatin- and carboplatin-based regimens was 43 and 280, respectively. Oncological outcomes in the NAC group were significantly improved compared to those in the Ctrl group. Multivariable analysis with IPTW models revealed that NAC significantly improved oncological outcomes in patients with MIBC. A nomogram for 5-year overall survival predicted 16% improvement in patients undergoing NAC. Conclusions: NAC use for MIBC increased after 2005. Platinum-based NAC for MIBC potentially improves oncological outcomes.
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Kubota, Yuka ; Hatakeyama, Shingo ; Tanaka, Toshikazu ; Fujita, Naoki ; Iwamura, Hiromichi ; Mikami, Jotaro ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Sasaki, Atsushi ; Kawaguchi, Toshiaki ; Ohyama, Chikara
概要:
Objective: The clinical impact of neoadjuvant chemotherapy (NAC) on oncological outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC) remains unclear. We investigated the oncological outcomes of
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platinum-based NAC for locally advanced UTUC. Results: Of 234 patients, 101 received NAC (NAC group) and 133 did not (Control [Ctrl] group). The regimens in the NAC group included gemcitabine and carboplatin (75%), and gemcitabine and cisplatin (21%). Pathological downstagings of the primary tumor and lymphovascular invasion were significantly improved in the NAC than in the Ctrl groups. NAC for locally advanced UTUC significantly prolonged recurrence-free and cancer-specific survival. Multivariate Cox regression analysis using an inverse probability of treatment weighted (IPTW) method showed that NAC was selected as an independent predictor for prolonged recurrence-free and cancer-specific survival. However, the influence of NAC on overall survival was not statistically significant. Materials and Methods: A total of 426 patients who underwent radical nephroureterectomy at five medical centers between January 1995 and April 2017 were examined retrospectively. Of the 426 patients, 234 were treated for a highrisk disease (stages cT3-4 or locally advanced [cN+] disease) with or without NAC. NAC regimens were selected based on eligibility of cisplatin. We retrospectively evaluated post-therapy pathological downstaging, lymphovascular invasion, and prognosis stratified by NAC use. Multivariate Cox regression analysis was performed for independent factors for prognosis. Conclusions: Platinum-based NAC for locally advanced UTUC potentially improves oncological outcomes. Further prospective studies are needed to clarify the clinical benefit of NAC for locally advanced UTUC.
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