Partial Cystectomy With Pelvic Lymph Node Dissection for Patients With Nonmetastatic Stage pT2-T3 Urothelial Carcinoma of Urinary Bladder: Temporal Trends and Survival Outcomes.

INTRODUCTION: We investigated the effect of partial cystectomy (PC) on cancer-specific mortality (CSM) and other-cause mortality (OCM) and the effect of pelvic lymph node dissection (PLND) during PC on CSM. MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2004-2015), 11,429 cases of nonmetastatic stage pT2-T3 urothelial carcinoma of the urinary bladder treated with either PC or radical cystectomy (RC) were identified. All comparisons between PC and RC relied on propensity score (PS; ratio, 1:1) adjusted univariable and multivariable logistic and competing risks regression models. In contrast, all comparisons between PLND and no PLND at PC relied on inverse probability of treatment weighting-adjusted univariable and multivariable Cox regression models. RESULTS: Within the SEER database, PC had been performed in 979 patients (8.6%). The PC annual rates decreased from 11.0% to 6.8% during the study period (P < .001). In PS-adjusted multivariable analyses focusing on CSM and OCM, no statistically significant difference between the PC and RC groups (P = .2 and P = .3, respectively). The annual PLND rates with PC (50.3%) did not vary over time (P = .3). In the overall cohort and the PC subgroup, PLND was associated with a lower CSM rate (hazard ratio, 0.56; P < .001; and hazard ratio, 0.57; P < .001, respectively). CONCLUSIONS: A small proportion of patients with stage pT2-T3 urothelial carcinoma of the urinary bladder were candidates for PC. In the PS-adjusted multivariable analyses, no statistically significant differences were found in CSM or OCM between the PC and RC groups. Within the PC group, PLND had been omitted 50% of the time despite its association with lower CSM.

Impact of Tumor Size on Cancer-Specific Mortality Rate After Local Tumor Ablation in T1a Renal-Cell Carcinoma.

Introduction: Institutional studies suggested that tumor size (TS) might be an independent predictor of recurrence after local tumor ablation (LTA). However, limited data exist to ascertain whether a larger TS may also predispose to a worse cancer-specific mortality (CSM) rate. Materials and Methods: Patients treated with LTA for T1a nonmetastatic renal-cell carcinoma were identified within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Estimated annual percentage change (EAPC) methodology, cumulative incidence plots, and multivariable competing risk regression (CRR) models before and after the 1:1 ratio propensity score (PS) adjustment were used to compare LTA for TS ≤30 mm vs TS >30 mm. A comparison of cryosurgery vs thermal ablation according to TS was also performed. Results: Of 3946 LTA patients, 2974 (75.3%) patients harbored TS ≤30 mm vs 972 (24.7%) harbored TS >30 mm. The latter was significantly older (median age 67 years vs 71 years, p < 0.001), compared with TS ≤30 mm. No differences were recorded in annual rates over time. In unmatched CRR models, after adjustment for other-cause mortality (OCM) rate, LTA for TS >30 mm showed a worse 5-year CSM rate (hazard ratio [HR] 2.3, p < 0.001), relative to TS ≤30 mm. In PS- and OCM rate-adjusted CRR models, LTA for TS >30 mm still showed a worse 5-year CSM rate (HR 2.86, p < 0.001), relative to TS ≤30 mm. Thermal ablation was associated with a higher 5-year CSM rate, compared with cryosurgery (7.6% vs 3.9%, p = 0.02), but only when TS was >30 mm. Conclusions: TS >30 mm is an independent predictor of higher 5-year CSM rates in patients treated with LTA, even after adjustment for OCM rate. In consequence, when LTA is considered, it ideally should be performed for TS ≤30 mm.

Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer.

BACKGROUND: Advanced prostate cancer may cause significant local complications which affect quality of life, including bladder outlet obstruction and hematuria. We performed a detailed review of our outcomes of palliative transurethral resection of the prostate (pTURP) in the era of taxane chemotherapy and potent androgen receptor antagonists at our tertiary-care institution. METHODS: Using hospital coding data, we identified patients with a diagnosis of prostate cancer who underwent a TURP at Hotel-Dieu Hospital in Quebec City between 2006 and 2016 for detailed chart review. Co-morbidities were classified using the Charlson comorbidity index (CCI). Cox regression analyses assessed predictors of perioperative mortality and morbidity. RESULTS: Of 137 patients identified, 58 were included in our study. Median age was 68 years; 27 (47%) men had castration-resistant prostate cancer and 28 (48%) were metastatic at time of pTURP. Mean follow-up from the first pTURP was 2.2 years, with an estimated 5-year overall survival of 16.3% (95% CI: 6.5%-29.8%). Castration-resistant prostate cancer, CCI ≥5, and age predicted poorer survival. Primary indication for pTURP was bladder outlet obstruction (69%) or hematuria (22%). Postoperative Clavien 0, 1, 2, 3, 4, 5 complications occurred in 20 (34%), 16 (28%), 18 (31%), 3 (5%), 0, and 1 (2%) patients, respectively. Overall, 17 (27%) men underwent ≥1 redo pTURPs and 16 (28%) eventually had an indwelling catheter. Nephrostomy tubes or ureteral stents in place before pTURP remained indefinitely in all cases. CONCLUSIONS: We conclude palliative TURP remains an important surgical option to relieve bladder outlet obstruction in patients with locally advanced prostate cancer, but is ineffective to relieve ureteral obstruction.