Assessing the Impact of Time to Cystectomy for Variant Histology of Urothelial Bladder Cancer
To determine if the timing of radical cystectomy for variant histology of urothelial carcinoma has an impact on survival. Variant histology has been associated with aberrant behavior compared to pure urothelial carcinoma, however the timing of surgery for these patients has not been studied. We iden...
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| Veröffentlicht in: | Urology (Ridgewood, N.J.) N.J.), 2019-11, Vol.133, p.157-163 |
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| creator | Lin-Brande, Michael Pearce, Shane M. Ashrafi, Akbar N. Nazemi, Azadeh Burg, Madeleine L. Ghodoussipour, Saum Miranda, Gus Djaladat, Hooman Schuckman, Anne Daneshmand, Siamak |
| description | To determine if the timing of radical cystectomy for variant histology of urothelial carcinoma has an impact on survival. Variant histology has been associated with aberrant behavior compared to pure urothelial carcinoma, however the timing of surgery for these patients has not been studied.
We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical cystectomy without perioperative intravesical and/or systemic therapy from 2003 to 2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant histology. The time from diagnosis to radical cystectomy was analyzed as a continuous variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic outcomes.
Patients with variant histology, when compared to those with pure urothelial carcinoma, were more likely to present with extravesical disease (P |
| doi_str_mv | 10.1016/j.urology.2019.07.034 |
| format | Article |
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We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical cystectomy without perioperative intravesical and/or systemic therapy from 2003 to 2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant histology. The time from diagnosis to radical cystectomy was analyzed as a continuous variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic outcomes.
Patients with variant histology, when compared to those with pure urothelial carcinoma, were more likely to present with extravesical disease (P <.01), be upstaged (P <.01), have lymphovascular invasion (P <.01) and have lymph node metastasis at radical cystectomy (P = .02). The median days to radical cystectomy did not differ between pure urothelial and variant histology. On multivariable analysis controlling for age, comorbidities, tumor stage, lymph node status, lymphovascular invasion, and surgical margins, every month in delay was associated with a worse overall survival for variants (HR = 1.36, P = .003). At an 8-week delay or longer, those with variant histology had a statistically worse survival (P = .03).
For patients with variant histology, delays in surgery were associated with an increased risk of death.</description><identifier>ISSN: 0090-4295</identifier><identifier>EISSN: 1527-9995</identifier><identifier>DOI: 10.1016/j.urology.2019.07.034</identifier><identifier>PMID: 31421144</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Carcinoma, Transitional Cell - mortality ; Carcinoma, Transitional Cell - pathology ; Carcinoma, Transitional Cell - surgery ; Cystectomy - methods ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Time-to-Treatment - statistics & numerical data ; Urinary Bladder Neoplasms - mortality ; Urinary Bladder Neoplasms - pathology ; Urinary Bladder Neoplasms - surgery</subject><ispartof>Urology (Ridgewood, N.J.), 2019-11, Vol.133, p.157-163</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-4abf2e2d1654babf9a49c9814d2d2df7185ff69c9c2b3c66749e65564baf132e3</citedby><cites>FETCH-LOGICAL-c365t-4abf2e2d1654babf9a49c9814d2d2df7185ff69c9c2b3c66749e65564baf132e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.urology.2019.07.034$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31421144$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lin-Brande, Michael</creatorcontrib><creatorcontrib>Pearce, Shane M.</creatorcontrib><creatorcontrib>Ashrafi, Akbar N.</creatorcontrib><creatorcontrib>Nazemi, Azadeh</creatorcontrib><creatorcontrib>Burg, Madeleine L.</creatorcontrib><creatorcontrib>Ghodoussipour, Saum</creatorcontrib><creatorcontrib>Miranda, Gus</creatorcontrib><creatorcontrib>Djaladat, Hooman</creatorcontrib><creatorcontrib>Schuckman, Anne</creatorcontrib><creatorcontrib>Daneshmand, Siamak</creatorcontrib><title>Assessing the Impact of Time to Cystectomy for Variant Histology of Urothelial Bladder Cancer</title><title>Urology (Ridgewood, N.J.)</title><addtitle>Urology</addtitle><description>To determine if the timing of radical cystectomy for variant histology of urothelial carcinoma has an impact on survival. Variant histology has been associated with aberrant behavior compared to pure urothelial carcinoma, however the timing of surgery for these patients has not been studied.
We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical cystectomy without perioperative intravesical and/or systemic therapy from 2003 to 2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant histology. The time from diagnosis to radical cystectomy was analyzed as a continuous variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic outcomes.
Patients with variant histology, when compared to those with pure urothelial carcinoma, were more likely to present with extravesical disease (P <.01), be upstaged (P <.01), have lymphovascular invasion (P <.01) and have lymph node metastasis at radical cystectomy (P = .02). The median days to radical cystectomy did not differ between pure urothelial and variant histology. On multivariable analysis controlling for age, comorbidities, tumor stage, lymph node status, lymphovascular invasion, and surgical margins, every month in delay was associated with a worse overall survival for variants (HR = 1.36, P = .003). At an 8-week delay or longer, those with variant histology had a statistically worse survival (P = .03).
For patients with variant histology, delays in surgery were associated with an increased risk of death.</description><subject>Aged</subject><subject>Carcinoma, Transitional Cell - mortality</subject><subject>Carcinoma, Transitional Cell - pathology</subject><subject>Carcinoma, Transitional Cell - surgery</subject><subject>Cystectomy - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Survival Rate</subject><subject>Time-to-Treatment - statistics & numerical data</subject><subject>Urinary Bladder Neoplasms - mortality</subject><subject>Urinary Bladder Neoplasms - pathology</subject><subject>Urinary Bladder Neoplasms - surgery</subject><issn>0090-4295</issn><issn>1527-9995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkE1PAyEURYnRaP34CRqWbmYEBhhZGW38Spq4UXeGUOahNDOlAjXpv5fa6tawgLycy807CJ1SUlNC5cWsXsbQh_dVzQhVNWlr0vAdNKKCtZVSSuyiESGKVJwpcYAOU5oRQqSU7T46aChnlHI-Qm_XKUFKfv6O8wfgx2FhbMbB4Wc_AM4Bj1cpg81hWGEXIn410Zt5xg8-5Z_6NfsSQwn33vT4pjddBxGPzdxCPEZ7zvQJTrb3EXq5u30eP1STp_vH8fWkso0UueJm6hiwjkrBp-WtDFdWXVLesXJcSy-Fc7KMLJs2tqzAFUghZIEdbRg0R-h88-8ihs8lpKwHnyz0vZlDWCbNWCuYVIrSgooNamNIKYLTi-gHE1eaEr02q2d6a1avzWrS6mK25M62FcvpAN1f6ldlAa42AJRFvzxEnayHYqHzsQjUXfD_VHwDYzONrw</recordid><startdate>201911</startdate><enddate>201911</enddate><creator>Lin-Brande, Michael</creator><creator>Pearce, Shane M.</creator><creator>Ashrafi, Akbar N.</creator><creator>Nazemi, Azadeh</creator><creator>Burg, Madeleine L.</creator><creator>Ghodoussipour, Saum</creator><creator>Miranda, Gus</creator><creator>Djaladat, Hooman</creator><creator>Schuckman, Anne</creator><creator>Daneshmand, Siamak</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201911</creationdate><title>Assessing the Impact of Time to Cystectomy for Variant Histology of Urothelial Bladder Cancer</title><author>Lin-Brande, Michael ; Pearce, Shane M. ; Ashrafi, Akbar N. ; Nazemi, Azadeh ; Burg, Madeleine L. ; Ghodoussipour, Saum ; Miranda, Gus ; Djaladat, Hooman ; Schuckman, Anne ; Daneshmand, Siamak</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-4abf2e2d1654babf9a49c9814d2d2df7185ff69c9c2b3c66749e65564baf132e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Carcinoma, Transitional Cell - mortality</topic><topic>Carcinoma, Transitional Cell - pathology</topic><topic>Carcinoma, Transitional Cell - surgery</topic><topic>Cystectomy - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Survival Rate</topic><topic>Time-to-Treatment - statistics & numerical data</topic><topic>Urinary Bladder Neoplasms - mortality</topic><topic>Urinary Bladder Neoplasms - pathology</topic><topic>Urinary Bladder Neoplasms - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lin-Brande, Michael</creatorcontrib><creatorcontrib>Pearce, Shane M.</creatorcontrib><creatorcontrib>Ashrafi, Akbar N.</creatorcontrib><creatorcontrib>Nazemi, Azadeh</creatorcontrib><creatorcontrib>Burg, Madeleine L.</creatorcontrib><creatorcontrib>Ghodoussipour, Saum</creatorcontrib><creatorcontrib>Miranda, Gus</creatorcontrib><creatorcontrib>Djaladat, Hooman</creatorcontrib><creatorcontrib>Schuckman, Anne</creatorcontrib><creatorcontrib>Daneshmand, Siamak</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Urology (Ridgewood, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin-Brande, Michael</au><au>Pearce, Shane M.</au><au>Ashrafi, Akbar N.</au><au>Nazemi, Azadeh</au><au>Burg, Madeleine L.</au><au>Ghodoussipour, Saum</au><au>Miranda, Gus</au><au>Djaladat, Hooman</au><au>Schuckman, Anne</au><au>Daneshmand, Siamak</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessing the Impact of Time to Cystectomy for Variant Histology of Urothelial Bladder Cancer</atitle><jtitle>Urology (Ridgewood, N.J.)</jtitle><addtitle>Urology</addtitle><date>2019-11</date><risdate>2019</risdate><volume>133</volume><spage>157</spage><epage>163</epage><pages>157-163</pages><issn>0090-4295</issn><eissn>1527-9995</eissn><abstract>To determine if the timing of radical cystectomy for variant histology of urothelial carcinoma has an impact on survival. Variant histology has been associated with aberrant behavior compared to pure urothelial carcinoma, however the timing of surgery for these patients has not been studied.
We identified 363 patients with cT2-T4N0M0 urothelial carcinoma who underwent radical cystectomy without perioperative intravesical and/or systemic therapy from 2003 to 2014. Clinicopathologic data were compared between pure urothelial carcinoma and variant histology. The time from diagnosis to radical cystectomy was analyzed as a continuous variable and dichotomized at 4-, 8-, and 12-weeks to determine impact on oncologic outcomes.
Patients with variant histology, when compared to those with pure urothelial carcinoma, were more likely to present with extravesical disease (P <.01), be upstaged (P <.01), have lymphovascular invasion (P <.01) and have lymph node metastasis at radical cystectomy (P = .02). The median days to radical cystectomy did not differ between pure urothelial and variant histology. On multivariable analysis controlling for age, comorbidities, tumor stage, lymph node status, lymphovascular invasion, and surgical margins, every month in delay was associated with a worse overall survival for variants (HR = 1.36, P = .003). At an 8-week delay or longer, those with variant histology had a statistically worse survival (P = .03).
For patients with variant histology, delays in surgery were associated with an increased risk of death.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>31421144</pmid><doi>10.1016/j.urology.2019.07.034</doi><tpages>7</tpages></addata></record> |
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| subjects | Aged Carcinoma, Transitional Cell - mortality Carcinoma, Transitional Cell - pathology Carcinoma, Transitional Cell - surgery Cystectomy - methods Female Humans Male Middle Aged Retrospective Studies Survival Rate Time-to-Treatment - statistics & numerical data Urinary Bladder Neoplasms - mortality Urinary Bladder Neoplasms - pathology Urinary Bladder Neoplasms - surgery |
| title | Assessing the Impact of Time to Cystectomy for Variant Histology of Urothelial Bladder Cancer |
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