Decrease in skeletal muscle index one year after radical cystectomy as a prognostic indicator in patients with urothelial bladder cancer

ABSTRACT Purpose The present study aimed to determine whether sarcopenia after radical cystectomy (RC) could predict overall survival (OS) in patients with urothelial bladder cancer (UBC). Materials and Methods The lumbar skeletal muscle index (SMI) of 80 patients was measured before and 1 year after RC. The prognostic significance of sarcopenia and SMI decrease after RC were evaluated using Kaplan-Meier analysis and a multivariable Cox regression model. Results Of 80 patients, 26 (32.5%) experienced sarcopenia before RC, whereas 40 (50.0%) experienced sarcopenia after RC. The median SMI change was -2.2 cm2/m2. Patients with sarcopenia after RC had a higher pathological T stage and tumor grade than patients without sarcopenia. Furthermore, the overall mortality rate was significantly higher in patients with sarcopenia than in those without sarcopenia 1 year after RC. The median follow-up time was 46.2 months, during which 22 patients died. Kaplan-Meier estimates showed a significant difference in OS rates based on sarcopenia (P=0.012) and SMI decrease (P=0.025). Multivariable Cox regression analysis showed that SMI decrease (≥2.2 cm2/m2) was an independent predictor of OS (hazard ratio: 2.68, confidence interval: 1.007-7.719, P = 0.048). Conclusions The decrease in SMI after surgery might be a negative prognostic factor for OS in patients who underwent RC to treat UBC.

Bladder Tumors in Benin City : a 15 Year Histopathological Study

A 15 year (1988 - 2002) retrospective study was undertaken to determine the frequency and histological pattern of bladder neoplasms seen in the University of Benin Teaching Hospital; Benin City; Nigeria. Forty-five cases were diagnosed. Males predominated constituting 35 (77.8) cases; giving a M:F ratio of 3.5:1 with ages ranging from 1.5 - 75 years. Malignant neoplasms (40 cases) accounted for 88.9 of the bladder tumours and 1.85 of all malignant neoplasms seen during the study period. Contrary to most reports; the malignant neoplasms were predominantly transitional cell carcinoma constituting 27(67.2) cases; with peak in the 7th and 8th decades; mean age of 61 years (SD + 13.3) and an age range of 33 - 75 years. Squamous cell carcinoma (SqCC) was relatively rare accounting for 15 malignant tumours. SqCC patients had a lower mean age 42 years (SD + 27.5) with ages ranging from 11 - 64 years. None of the SqCC cases showed evidence of schistosoma ova. Rhabdomyosarcoma; fibrosarcoma; non Hodgkin's lymphoma and metastatic tumours constituted 7.5; 2.5; 2.5 and 5 of the malignant tumours respectively. The benign tumours were all squamous papillomas comprising 5(11.1) cases. Haematuria screening for individuals in high risk occupation; and provision of pipe borne water were recommended

Reporte de caso que ilustra la posición en contra de la preservación de la vejiga en el ca invasor de vejiga de células transicionales / Report of case that illustrates the position against the preservation of bladder in ca invading of bladder of transitional cell

El tratamiento del cáncer de vejiga de CT invasor es controversial y se reportan excelentes sobrevivas con protocolos conservadores con tratamiento a base de RTU s, combinadas con radioterapia y quimioterapia. Sin embargo hay casos como el que se reporta aquí en que, a pesar de no tener enfermedad local residual tienen enfermedad sistémica que no pueden ser salvados con cirugía radical tardía.

Comportamiento clínico del carcinoma vesical acompañado de producción ectópica de gonadotropina coriónica / Clinical behavior of bladder carcinoma associated with ectopic productions of chorionic gonadotropin

De marzo a septiembre de 1992 se estudiaron 25 pacientes portadores de cáncer vesical de células transicionales, a los cuales se les determinó hormona gonadotropina coriónica en las muestras de patología con técnica de inmunoperoxidasa indirecta. La edad promedio fue de 62 años (24 a 89); 21 eran varones y cuatro mujeres (proporción 5:1). Fumaban 80 por ciento, había hematuria en 76 por ciento y manifestaban síntomas irritativos urinarios bajos 28 por ciento. Del total 21 tenían carcinomas de etapa A y cuatro de etapa B. El promedio de seguimiento fue de 35 meses. De las 25 muestras analizadas, seis (24 por ciento) fueron positivas a la hormona gonadotropina coriónica: la positividad era leve en dos, moderada en dos e intensas en otras dos. Se observó grado de diferenciación III de Ash en 66 por ciento de los casos positivos y en 10 por ciento de los negativos. Seconcluye que la expresión ectópica de la hormona gonadotropina coriónica por tumores vesicales es un factor de mal pronóstico que indica mayor desdiferenciación celular

Tumour necrosis factor production in patients with carcinoma of the bladder associated with bilharziasis

Tumour necrosis factor [TNF] is produced by activated macrophages in response to the presence of a malignant tumour. In this study we evaluated the level of TNF in patients bearing carcinoma of the bladder with bilharziasis in comparison either to similar patients who underwent surgical procedures or even normal individuals. Twenty three patients eight of whome were bearing cancer bladder associated with bilharziasis. The remaining fifteen patients had a surgical intervention for removal of their cancer bladder. They underwent either total cystectomy with urine diversion [11 cases] or transurethral resection with or without intravesical therapy [4 cases]. The TNF level in the urine and serum of the 23 patients was assayed. The TNF level in urine and serum of 11 normal individuals [control] was also measured. The mean value of TNF level in the urine and serum of patients who underwent different surgical procedures [10.78 pg/ml. and 16. 2pg/ml] was higher when compared to the normal control [4.68 pg/ml and 12.77 pg/ml]. Also the mean value of the TNF level in the urine of the same group of patients was higher than the group of patients who had cancer bladder associated with bilharziasis before treatment [6.814 pg/ml]. Yet, there was a slight decrease in the mean value of the TNF level in the serum of the postoperative group when compared to the preoperative [17.375 pg/ml] although it was statistically insignificant. At the same time it was found that patients with carcinoma of the bladder associated with bilharziasis had a significantly higher TNF level in serum and urine [P<0.01 and P<0.05] when compared to normal individuals. Our conclusion was that TNF level assay in the urine and serum of patients bearing cancer bladder associated with bilhariziasis after being surgically treated is of an insignificant value since there are many factors to interplay [metabolic, metastasize, recurrence intravesical therapy. Also it is possible to take the TNF level whether in urine or serum of patients having cancer bladder associated with bilharziasis before treatment as an indication to the existance of the malignant tumour