Modified 5-Item Frailty Index Score as Prognostic Marker After Radical Cystectomy in Bladder Cancer.

INTRODUCTION: A modified 5-item frailty index was recently developed as a predictor of patient comorbidity-based mortality and morbidity. We evaluate the association between preoperative modified 5-item frailty index score and prognosis after radical cystectomy for bladder cancer. PATIENTS AND METHODS: In this multicenter retrospective study, we calculated modified 5-item frailty index scores of the 238 patients that underwent radical cystectomy for bladder cancer between March 2009, and March 2018. The patients were classified into high frailty index score (≥ 2) or low frailty index score (≤ 1) groups for comparison of overall and cancer-specific survival between them. To evaluate the prognostic impact of the preoperative frailty index, we also performed Cox proportional regression analyses for overall, and cancer-specific survival. RESULTS: Of 238 patients, 53 patients were classified into the high frailty index score group and 185 patients into the low frailty index score group. Overall, 70 patients died of bladder cancer (29%), and 21 patients died of other causes (9%). The patients with high frailty index score had significantly lower rate of overall survival than those with low frailty index score (P < .01). On the other hand, there was no significant difference in cancer-specific survival rate between the 2 groups (P = .07). Multivariable Cox proportional hazard analysis revealed that high modified 5-item frailty index score was independently associated with poor overall survival (P = .01), but not with poor cancer-specific survival (P = .15). CONCLUSION: High preoperative modified 5-item frailty index score could be a significant independent predictor of poor prognosis after radical cystectomy in patients with bladder cancer.

Usefulness of Preoperative High Systemic Immune-Inflammation Index as a Prognostic Biomarker in Patients Who Undergo Radical Cystectomy for Bladder Cancer: Multicenter Analysis.

Evidence of the prognostic value of pretreatment systemic immune-inflammation index (SII) after radical cystectomy (RC) for bladder cancer is limited. This study aims to assess the association between preoperative SII and prognosis after RC for bladder cancer. In this multicenter retrospective study, we calculated preoperative SII as well as the neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in 237 patients who underwent RC for bladder cancer between March 2009 and March 2018. Patients were classified into high SII and low SII groups by using the optimal cutoff value (438 × 109/L) based on receiver operating characteristic curve analysis for cancer-specific death. We compared cancer-specific survival (CSS) and overall survival (OS) between the two groups. To evaluate the prognostic impact of preoperative SII, we also performed Cox proportional regression analyses for CSS and OS. Of 237 patients, 127 patients were classified into the high SII group and 110 patients into the low SII group. During the follow-up period, 70 patients died of bladder cancer (30%) and 21 patients died from other causes (9%). Patients with high SII had significantly lower rates of CSS and OS than those with low SII (p < 0.01 and p < 0.01, respectively). Multivariable Cox proportional hazard analysis showed that high SII was independently associated with poor CSS (p = 0.01) and poor OS (p < 0.01). In conclusion, high SII could be an independent significant predictor of poor prognosis after RC in patients with bladder cancer.

Myosteatosis as a novel prognostic biomarker after radical cystectomy for bladder cancer.

This study aims to evaluate the influence of myosteatosis on survival of patients after radical cystectomy (RC) for bladder cancer. We retrospectively identified 230 patients who underwent RC for bladder cancer at our three institutions between 2009 and 2018. Digitized free-hand outlines of the left and right psoas muscles were made on axial non-contrast computed tomography images at level L3. To assess myosteatosis, average total psoas density (ATPD) in Hounsfield Units (HU) was also calculated as an average of bilateral psoas muscle density. We compared cancer-specific survival (CSS) between high ATPD and low ATPD groups and performed cox regression hazard analyses to identify the predictors of CSS. Median ATPD was 44 HU (quartile: 39-47 Hounsfield Units). Two-year CSS rate in overall patients was 76.6%. Patients with low ATPD (< 44 HU) had significantly lower CSS rate (P = 0.01) than patients with high ATPD (≥ 44 HU). According to multivariate analysis, significant independent predictors of poor CSS were: Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.03), decreasing ATPD (P = 0.03), non-urothelial carcinoma (P = 0.01), pT ≥ 3 (P < 0.01), and pN positive (P < 0.01). In conclusion, myosteatosis (low ATPD) could be a novel predictor of prognosis after RC for bladder cancer.

Naftopidil versus flopropione as medical expulsive therapy for distal ureteral stones: results of a randomized, multicenter, double-blind, controlled trial.

PURPOSE: A multicenter, double-blind, randomized, controlled trial was conducted to determine the efficacy of naftopidil as medical expulsive therapy (MET) for patients with distal ureteral stones. METHODS: Ninety-two patients presenting with a single distal ureteral stone ≤10 mm were randomly assigned to receive either naftopidil (75 mg of naftopidil once in the morning and placebo twice a day) or flopropione (80 mg three times a day). The primary end point was time to stone expulsion calculated by the Kaplan-Meier method. Secondary end points were the percentages of patients who required analgesics, hospital admission, and surgery, the number of working days lost to the disease, and treatment safety. RESULTS: Overall, three patients were excluded from the final analysis. No significant differences were noted in age, stone size, and stone side between the treatment arms. The median time to stone expulsion was 8 days [95 % confidence interval (CI), 3-16] for the naftopidil group, and this was significantly less than the 18 days (95 % CI, 11 to not reached) for the flopropione group (p = 0.03). On multivariate Cox regression analysis, the hazard of expulsion was 1.8-fold higher for the naftopidil group than for the flopropione group after adjustment for age, sex, stone side, and stone size. No significant differences were noted in the secondary end points. CONCLUSIONS: The administration of naftopidil significantly improved time to stone expulsion in patients with distal ureteral stones ≤10 mm. We believe that this is the first multicenter, double-blind, randomized, controlled trial demonstrating the efficacy of naftopidil for MET.

[Preoperative parameters, including percent of positive biopsy cores, in predicting pathological findings after radical prostatectomy].

OBJECTIVES: We investigated whether preoperative parameters predict pathological stage at radical prostatectomy for patients with clinically localized prostatic cancer. MATERIALS AND METHODS: We studied a total of 160 men with clinically localized prostatic cancer (less than or equal to clinical T2) who underwent radical rertropubic prostatectomy at Wakayama Medical University. Clinical Ts patients are not included in this study. Preoperative parameters include patient age, Body Mass Index, preoperative serum PSA value, biopsy Gleason score, clinical stage, the percent of positive biopsy cores (%PosBx) and the percent of positive biopsy cores on the dominant side (%DomPosBx). Univariate and multivariate analysis were performed to examine the prognostic significance of these preoperative parameters. Significant independent factors were combined to create a table to predict pathologically organ confined disease. RESULTS: Univariate analysis showed preoperative serum PSA value (p< 0.001), biopsy Gleason score (p =0.001), clinical stage (p = 0.026), %PosBx (p= 0.002) and %DomPosBx (p=0.003) were significantly related to the pathological stage. On multivariate analysis, serum PSA value (p< 0.01), biopsy Gleason score (p<0.05) and %DomPosBx (p<0.05) were significant independent predictors of pathological stage. CONCLUSION: We provide two model combinations using preoperative clinical factors, one is a combination of serum PSA and biopsy Gleason score and the other is a combination of serum PSA and %DomPosBx, which define a new preoperative model for predicting pathological organ confined prostatic cancer. These combinations are useful and provide important information for urologists to determine the appropriate treatment strategy for clinically localized prostatic cancer.

[Inflammatory pseudotumor of the prostate: a case report].

We report a rare case of inflammatory pseudotumor of the prostate. A 42-year-old man with a history of hematospermia and chronic prostatitis presented with difficulty in voiding. Cystoscopy demonstrated a large non-papillary tumor occupying the prostatic urethra along with two bladder stones. Magnetic resonance imaging (MRI) demonstrated a 7-cm prostatic mass protruding toward the bladder and the rectum. Transrectal biopsy of the prostate demonstrated a fibrous lesion containing inflammatory cells without evidence of malignancy. We performed transurethral resection of the prostatic lesion to release the bladder outlet obstruction, followed by cystolithotripsy. Histopathological examination of the surgical specimen demonstrated a benign fibromuscular lesion with spindle cell proliferation, leading to a diagnosis of inflammatory pseudotumor. Postoperatively, the patient voided normally without any signs of recurrence on follow-up at five months. Inflammatory pseudotumor is an unusual benign lesion of unknown etiology. Only 10 previous cases of the disease involving the prostate have been reported in English and Japanese literature. Prostatic involvement of inflammatory pseudotumor may show a presentation similar to malignant prostatic sarcoma. Thus, accurate identification of this benign process is important in order to avoid unnecessary radical surgery.