Nationwide analysis of survival after radical cystectomy for bladder cancer in Finland.

BACKGROUND: Population-based survival results after radical cystectomy (RC) are limited. Our objective was to report short and long-term survival results after RC for bladder cancer from Finland in a population-based setting. MATERIALS AND METHODS: The Finnish National Cystectomy Database containing retrospectively collected essential RC data covering the years 2005-2017 was combined with the survival data from the Finnish Cancer Registry. Kaplan-Meier plots were used to estimate survival and the survival graphs were illustrated according to the final pathological staging. Centers were divided according to operational volume, and the results were then compared using Pearsons's Chi-squared test. RESULTS: A total of 2047 patients were included in the study. 30-, and 90-day mortality was 1.3%, and 3.8%, respectively. The OS of the entire RC population at 5- and 10 years was 66% and 55%, and CSS was 74% and 72%, respectively. Center volume did not significantly associate with surgical mortality or long-term survival. The 5- and 10-year OS according to pT-category was 87% and 74% for pT0, 85% and 69% for pTa-pTis-pT1, 70% and 58% for pT2, 50% and 42% for pT3 and 41% and 30% for pT4. The corresponding 5- and 10-year CSS rates were 96% and 93% for pT0, 91% and 90% for pTa-pTis-pT1, 78% and 75% for pT2, 56% and 55% for pT3 and 47% and 44% for pT4. The 5- and 10-year OS rates in patients with no lymph node metastases (pN-) were 74% and 62%, and CSS 82% and 80%, respectively. If lymph nodes were positive (pN+), the corresponding OS rates were 44% and 34% and CSS 49% and 48%, respectively. CONCLUSION: RC survival results have improved in contemporary series and are associated with the pTNM-status. The nationwide results from Finland demonstrate outcome comparable to high volume single-center series.

Visual MRI T-category versus VI-RADS evaluation from multiparametric MRI in the detection of muscle-invasion in patients with suspected bladder cancer: single centre registered clinical trial (MIB-trial).

BACKGROUND: Multiparametric Magnetic Resonance Imaging (mpMRI) has been proposed to add value in the diagnostic pathway of bladder cancer (BC). We wanted to evaluate the performance of mpMRI for muscle-invasion detection in BC patients using a subjective MRI visual T-category and the Vesical Imaging-Reporting and Data System (VI-RADS) score. METHODS: This single centre clinical trial included 45 patients with suspected BC (ClinicalTrials.gov Identifier: NCT02662166). All patients had mpMRI prior to transurethral resection of bladder tumour (TUR-BT). The imaging was correlated to histopathological findings. Two individual radiologists evaluated all the mpMRI images. A binary cut-off point for the detection of muscle-invasion in the MRI visual T-category was defined between T1 and T2 and the VI-RADS cut-off score was 3. Cohen's Kappa values were used to evaluate the agreement between the two radiologists. Sensitivity, Specificity, Area Under Receiver Operator Characteristics Curve (AUC), Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated to evaluate the performance of both radiologists separately. RESULTS: AUC values for reader A and B using the MRI visual T-category were 0.76 and 0.56, while the corresponding values for VI-RADS were 0.63 and 0.57, respectively. There was no statistically significant difference between the radiologists nor the reporting systems (p > .05) in the detection of muscle-invasion. The inter-reader agreement was substantial (0.61-0.80). CONCLUSION: Both the subjective MRI visual T-category and VI-RADS score had only a low to moderate accuracy for the detection of muscle-invasion in BC with no statistically significant difference between the reporting systems.

ANO7 rs77559646 Is Associated With First-line Docetaxel Treatment Response in Metastatic Castration-resistant Prostate Cancer.

BACKGROUND: Identification of genetic prognostic biomarkers, such as germline variants, are urgently needed to choose optimal treatment for metastatic castration-resistant prostate cancer (mCRPC). PATIENTS AND METHODS: The prognostic value of anoctamin 7 (ANO7) rs77559646 on docetaxel response was tested in a prospective PROSTY randomized trial and a retrospective Auria Biobank set. The variant rs77559646 was genotyped and its association with progression-free survival (PFS) and overall survival (OS) was tested. RESULTS: In comparison with the non-carriers, the variant carriers had longer PFS (p=0.005) and OS (p=0.003) in the PROSTY cohort. In the retrospective cohort, there was a borderline association with PFS (p=0.09), but not in OS (p=0.9). In both cohorts, Cox regression multivariate models revealed that rs77559646 was an independent prognostic factor for favourable PFS. CONCLUSION: The rs77559646 was shown to be a prognostic germline biomarker for better response to docetaxel treatments. To our knowledge, this is the first time that a non-coding germline variant has been associated with chemotherapy of mCRPC.