PMID- 35114679
OWN - NLM
STAT- MEDLINE
DCOM- 20220804
LR  - 20220804
IS  - 1423-0399 (Electronic)
IS  - 0042-1138 (Linking)
VI  - 106
IP  - 8
DP  - 2022
TI  - Clinical Implication of Borderline CT-Morphological Metastatic Spread in Bladder 
      Cancer: What You See Is Not Always What You Got.
PG  - 806-815
LID - 10.1159/000521857 [doi]
AB  - INTRODUCTION: Palliative radical cystectomy (pRC) may be offered to selected 
      bladder cancer (BC) patients with grievous local symptoms. However, there is only 
      scarce information on perioperative complications and prognosis, especially in 
      the case of metastatic spread. We intended to analyze morbidity and oncological 
      outcome in this patient subgroup. MATERIALS: Patients undergoing pRC because of 
      BC with radiologic evidence of metastases were included in this retrospective 
      study. Perioperative adverse events (AEs) were graded by the Clavien-Dindo 
      Classification system. All patients underwent CT-based surveillance, and 
      questionnaires were sent for survival follow-up in predefined intervals. 
      Oncological outcome and predictive markers were assessed in univariate and 
      multivariate analyses, using log-rank tests and Cox-regression analyses. RESULTS: 
      Between 2004 and 2016, 77 patients were identified. Median age at surgery was 70 
      years (IQR 66-77) and the median follow-up time was 12 months (IQR 4-44). 
      Preoperative staging revealed pulmonary, hepatic, bone, peritoneal, and various 
      other metastasis in 46/77 (60%), 14/77 (18%), 11/77 (14%), 5/77 (7%), and 11/77 
      (14%) cases, respectively. Most frequently observed symptoms at the time of pRC 
      were severe gross hematuria (n = 41) and intense pain (n = 11). Most AEs were of 
      minor grade (83%). The median length of stay was 20 days. Median CSS was 13 
      months with a 5-year CSS of 34%. Intriguingly and unsuspectedly, preoperatively 
      suspicious lung lesions were confirmed during surveillance only in 33%, 
      respectively. In multivariate analysis, intraoperative blood transfusions (HR = 
      2.25, 95% CI: 1.09-4.63, p = 0.028) were significantly associated with decreased 
      CSS. The best outcome was observed in patients with only subpleural metastases 
      (CSS 80 months, p = 0.039) and normal CRP- and Hb values. CONCLUSION: pRC can be 
      performed with acceptable perioperative morbidity and mortality. Pulmonary 
      lesions seem to have a risk of false-positive results and should be biopsied in 
      all uncertain cases. Localization of lung metastases together with preoperative 
      CRP- and Hb levels seem to play a prognostic role.
CI  - (c) 2022 S. Karger AG, Basel.
FAU - Weinhold, Philipp
AU  - Weinhold P
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Jokisch, Friedrich
AU  - Jokisch F
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Schulz, Gerald Bastian
AU  - Schulz GB
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Buchner, Alexander
AU  - Buchner A
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Kazmierczak, Philipp Maximilian
AU  - Kazmierczak PM
AD  - Department of Radiology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Kretschmer, Alexander
AU  - Kretschmer A
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Schlenker, Boris
AU  - Schlenker B
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Karl, Alexander
AU  - Karl A
AD  - Department of Urology, Barmherzige Bruder Hospital, Munich, Germany.
FAU - Stief, Christian G
AU  - Stief CG
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
FAU - Grimm, Tobias
AU  - Grimm T
AD  - Department of Urology, Ludwig-Maximilians-University, Munich, Germany.
LA  - eng
PT  - Journal Article
DEP - 20220203
PL  - Switzerland
TA  - Urol Int
JT  - Urologia internationalis
JID - 0417373
SB  - IM
MH  - *Carcinoma, Transitional Cell/surgery
MH  - Cystectomy/methods
MH  - Humans
MH  - Prognosis
MH  - Retrospective Studies
MH  - Tomography, X-Ray Computed
MH  - *Urinary Bladder Neoplasms/diagnostic imaging/surgery
OTO - NOTNLM
OT  - Bladder cancer
OT  - Computed tomography
OT  - Metastasis
OT  - Radical cystectomy
OT  - Staging
OT  - Uro-oncology
OT  - Urothelial carcinoma
EDAT- 2022/02/04 06:00
MHDA- 2022/08/05 06:00
CRDT- 2022/02/03 20:20
PHST- 2021/05/26 00:00 [received]
PHST- 2021/12/17 00:00 [accepted]
PHST- 2022/02/04 06:00 [pubmed]
PHST- 2022/08/05 06:00 [medline]
PHST- 2022/02/03 20:20 [entrez]
AID - 000521857 [pii]
AID - 10.1159/000521857 [doi]
PST - ppublish
SO  - Urol Int. 2022;106(8):806-815. doi: 10.1159/000521857. Epub 2022 Feb 3.