Optimal Number of Cycles of First-line Platinum-based Chemotherapy for Metastatic Urothelial Carcinoma.

BACKGROUND/AIM: In recent years, switch maintenance after platinum-based chemotherapy has been a standard of care. However, the appropriate number of systemic chemotherapy cycles against advanced-stage urothelial carcinoma (UC) remains unclear. This study assessed the survival outcomes of first-line platinum-based chemotherapy according to treatment cycles in patients with metastatic disease. PATIENTS AND METHODS: We retrospectively evaluated patients with metastatic bladder and upper urinary tract cancer who received platinum-based combination therapy. Overall survival (OS) was evaluated using the Kaplan-Meier method and the log-rank test. RESULTS: Of 179 patients, 47 (26.3%) were women, and 73 (40.8%) had upper urinary tract cancer. Furthermore, 47 (26.3%) who were not eligible for cisplatin received carboplatin. The median number of treatment cycles was 3 (range=1-14 cycles). The rates of progressive disease within two cycles, from two to four cycles, and from four to six cycles were 18.4%, 19.2%, and 30.6%, respectively. The median OS of patients with 2, 3, 4, 5-6, and ≥7 treatment cycles were 8.6, 14.3, 21.3, 24.4, and 26.1 months, respectively. The OS did not significantly differ between patients receiving four treatment cycles and those receiving ≥5 treatment cycles. In patients with disease control (complete or partial response or stable disease) receiving ≥4 treatment cycles, there was no significant difference in terms of OS between patients receiving four cycles and those receiving six cycles. CONCLUSION: Four cycles of first-line platinum-based chemotherapy can be effective in patients with metastatic UC.

Efficacy of Platinum-based Chemotherapy in Patients With Metastatic Urothelial Carcinoma With Variant Histology.

BACKGROUND/AIM: Variant urothelial carcinoma (VUC, defined herein as urothelial carcinoma with any histological variant) is frequently observed at an advanced stage. However, the efficacy of systemic chemotherapy against VUC in metastatic disease has rarely been reported. This study assessed the therapeutic response and survival outcomes of platinum-based chemotherapy as first-line treatment in patients with metastatic VUC. PATIENTS AND METHODS: We retrospectively analyzed consecutive patients with metastatic bladder and upper urinary tract cancer who received gemcitabine plus cisplatin (or carboplatin) at the University of Occupational and Environmental Health Hospital between November 2008 and November 2022. Progression-free survival and overall survival were evaluated using the Kaplan-Meier method and Cox proportional hazard models. RESULTS: Out of 131 patients recorded, 86 (65.6%) had pure urothelial carcinoma (PUC) and 45 (34.4%) had VUC. The most common variant element was squamous differentiation (44.4%). Compared to those with PUC, patients with VUC showed a comparable objective response rate (33.3% vs. 41.9%, p=0.451) and disease control rate (64.5% vs. 75.6%, p=0.221). They also had poorer progression-free survival (median=4.9 months vs. 7.9 months, p=0.014) and overall survival (median=10.9 months vs. 18.2 months, p=0.037) than those with PUC. On multivariate analysis, VUC was an independent predictor of progression (hazard ratio=1.79; 95% confidence interval=1.19-2.69; p=0.005) and mortality (hazard ratio=1.64; 95% confidence interval=1.08-2.48; p=0.020). CONCLUSION: Although the response of metastatic VUC to platinum-based chemotherapy was not inferior to that of PUC, VUC had progressed faster than PUC. VUC was significantly associated with a poor prognosis after platinum-based chemotherapy as first-line treatment.

[Clinical Statistics From 2017 to 2019 in the Department of Urology, Hospital of the University of the Occupational and Environmental Health, Japan].

We introduced the da Vinci Xi surgical system (Intuitive Surgical G.K. CA) in January 2018, and here we report clinical statistics on outpatients, inpatients, and surgical procedures for the 3-year period from January 2017 to December 2019. The number of new outpatients since 2017 has remained almost unchanged at 1,406, 1,530, and 1,494 per year. There was an increasing trend in the number of inpatients, from 862 to 1,021 to 1,239. The main diseases of the inpatients over the 3-year period were bladder cancer in 676 (21.7%), renal cancer in 374 (12.0%), prostate cancer in 268 (8.6%), and urolithiasis in 263 (8.4%). The total number of surgeries in the three years was 1,931. The numbers of transurethral surgeries and laparoscopic surgeries, including robotic surgeries, were 1,063 (55.0%) and 396 (20.5%), respectively. The numbers of inpatients and surgery have been increasing year by year. Medical resources are limited and need to be distributed more efficiently.

Stretching versus transitory icing: which is the more effective treatment for attenuating muscle fatigue after repeated manual labor?

PURPOSE: Effective recovery from muscle fatigue, especially during rest intervals between periods of high-intensity activity, is important to ensure optimal subsequent performance. Stretching and icing are two types of treatment used for muscle recovery in such situations. However, their effectiveness remains unclear because of a lack of adequate evidence and/or discrepant results of previous studies. We performed a study to elucidate the effects of stretching and icing on muscle fatigue in subjects performing alternating muscle contraction and rest. METHODS: Sixteen healthy male subjects aged 21-27 years were evaluated. Each subject performed repeated isometric muscle contraction exercises that involved lifting and holding a dumbbell to induce muscle fatigue. Four treatments were performed during the rest periods between isometric muscle contraction: static stretching, ballistic stretching, no stretching, or icing. Electromyography and relative muscle oxygen saturation measurements were performed during the exercises. Muscle fatigue was indirectly estimated by the decline in the median frequency of the electromyographic signal. RESULTS: Stretching between alternate isometric muscle contraction exercises resulted in a significantly lower median frequency of the electromyographic signal than did no stretching. There was no significant difference in the change in the median frequency between static and ballistic stretching. Conversely, icing between alternate exercises did not decrease the median frequency. CONCLUSIONS: Stretching, whether static or ballistic, is not beneficial for recovery from muscle fatigue and may actually inhibit recovery. Icing may more effectively induce such recovery and thus may be a better choice between the two treatment techniques.