Dural metastases from disseminated prostate cancer clinically mimicking a benign reactive condition of the dura: case report and review of the literature.

Dural spread from prostate cancer (PC) is exceedingly uncommon. We report on a 62-year-old man suffering from disseminated PC with osseous metastases who presented with a parietal skull metastasis along with a circumscribed nodular thickening of the adjacent dura. Magnetic resonance imaging findings suggested a benign reactive condition of the dura which, however, histologically turned out to be a dural metastasis. Therefore, the present case report stresses the notion that very rarely, disseminated PC might present with clinically unsuspected dural metastases radiologically mimicking a benign condition.

Digital image analysis of mean AgNOR area objectively discriminates between reactive plasmacytosis and multiple myeloma in cytologic smears from bone marrow aspirates.

OBJECTIVE: To differentiate between reactive plasmacytosis (RP) and multiple myeloma (MM) in bone marrow aspirates by assessment of silver-stainable nucleolar organizer regions (AgNORs). METHODS: Archival cytologic smears (n = 69) from bone marrow aspirates were retrospectively investigated. Twenty cases had RP and 49 cases MM (24 low-grade, 22 intermediate-grade and 3 high-grade MM). Diagnoses were confirmed by evaluation of the corresponding bone marrow trephine biopsies. Cytologic smears were subjected to AgNOR staining using a standardized silver-staining protocol and assessed by two independent clinical histopathologists using digital image analysis. AgNOR count and area were analyzed in 100 plasma cell nuclei per sample. RESULTS: The mean AgNOR area was found to be significantly (p < 0.001) higher in low-grade MM (mean: 23.4 microm(2); range: 19.2-26.7 microm(2)) than in RP cases (mean: 6.2 microm(2); range: 3.8-8.4 microm(2)). In contrast, mean AgNOR count failed to disclose significant differences between low-grade MM (mean: 5.36; range: 1-7) and RP (mean: 3.68; range: 1-6). CONCLUSION: Digital image analysis of the mean AgNOR area might be used as a diagnostically useful adjunct to aid objectively in the challenging differentiation between RP and MM in bone marrow aspirates.

Do different disorders in cell cycle regulation account for different biological behavior of urothelial and sinonasal inverted papillomas?

OBJECTIVE: It was the aim of this study to assess the expression of selected cell cycle regulation genes in urothelial and sinonasal inverted papillomas (IP). METHODS: Archived surgically resected specimens from 18 urothelial and 19 sinonasal IP were studied immunohistochemically for p16, p53, cyclin D1 and Ki67. Staining results were semiquantified and compared between IP and adjacent control mucosa (CM). RESULTS: p53 expression did not differ between sinonasal and urothelial IP. Although there was a trend of higher p53 expression in IP compared with the adjacent CM in sinonasal and urothelial specimens, this trend failed to be statistically significant. p16 expression was significantly higher in urothelial IP and CM in comparison with their sinonasal counterparts, but did not differ significantly between IP and its adjacent CM either in urothelial or sinonasal specimens. There were no significant differences in the mean scores for cyclin D1 or Ki67. CONCLUSION: The changes in p53 expression seen in both types of IP compared with adjacent CM suggest that sinonasal and urothelial IP may share some common ground in terms of their evolution. Although p16 appears not to be directly involved in the development of sinonasal or urothelial IP, the differing recurrence patterns of sinonasal versus urothelial IP may be attributable in part to different p16 expression.

Visual estimation of the tumor volume in prostate cancer: a useful means for predicting biochemical-free survival after radical prostatectomy?

Absolute and relative (ratio absolute tumor volume to gland volume) tumor volumes were visually estimated in 528 prostatectomy specimens. Surveying a mean post-surgical follow-up of 49 months, both parameters were analyzed regarding their aptitude for prognostication. We found relative tumor volumes exceeding 25% to independently predict biochemical recurrence reflected by post-surgical prostate-specific antigen progression, which was also determined to be increased to 28% when absolute tumor volumes exceeded 10 cm(3). However, this cutoff failed to be an independent prognosticator. Because the visual estimation of both parameters can easily be performed, they are felt to be formidable candidates for deriving prognostic information during routine procedures.

[High-dose chemotherapy with transplantation of autologous stem cells in advanced germ-cell poor-risk testicular tumors].

Testicular tumors illustrate curable cancer, but 25% patients are resistant to standard therapy. High-dose chemotherapy (HDC) is promising therapy for germ-cell tumors with poor prognosis. HDC and transplantation of autologous stem cells were performed in 13 patients with germ-cell testicular tumors (GTT). In 6 patients of group 1 HDC was first-line treatment in poor prognosis, in 7 patients (group 2) it was a salvage treatment after recurrences. Patients of group 1 had longer mean survival than those of group 2 (31.3 and 11 months, respectively; p = 0.136). Two patients died of HDC complications. Neurological, hematological and other complications occurred. In spite of 50-90% remission after HDC, multicenter prospective randomized trials will give final conclusion on effectiveness of HDC which must be performed in special clinics having many specialists in their staff (urologists, oncologists, chemotherapists, etc.).

[Coincidence of testicular germ cell tumor and sarcoidosis: A diagnostic challenge]. / Testikulärer Keimzelltumor und Sarkoidose: Eine diagnostische Herausforderung.

Several case reports and small case series have described a total of 66 patients with sarcoidosis and testicular cancer so far. This report describes three additional cases. We highlight the association of sarcoidosis and testicular cancer and comment on the potential impact of this connection on the interpretation of the radiological and pathological findings in suspected cancer relapse. Sarcoidosis, a condition that can be combined with testicular cancer, should always be considered in the differential diagnosis.

Is it possible to provide a prognosis after radical prostatectomy for prostate cancer by means of a PSA regression model?

BACKGROUND: For over 15 years, studies have been done to evaluate the elimination kinetics of the prostate-specific antigen (PSA) after radical prostatectomy. Even though evaluation of PSA regression in the two-compartment model has become established, no clear data are currently available as to whether a statement can be made with regard to tumor prognosis from a computation of the PSA half-life (PSA-HL). This study focuses on the determination of the PSA-HL in the two-compartment model and on its correlation with the biochemical recurrence-free survival. In addition, a computer program is being developed to simplify the determination of PSA-HL. MATERIAL AND METHODS: Seventy-seven prospective patients were examined who subsequently had a radical prostatectomy at our facility without neoadjuvant or adjuvant hormone deprivation. In addition to preoperative measurement of the PSA value (dO), PSA determinations were carried out postoperatively on days 5, 10 and 60, and at four-monthly intervals thereafter (mean follow-up: 16 months). By means of the computer program developed for this purpose, CTK.TumW, the PSA half-lives for the first (d0-d5, PSA-HL1) and second (d5-d10, PSA-HL2) compartments were subsequently determined and their effect on biochemical recurrence-free survival was assessed. RESULTS: PSA-HL1 and PSA-HL2 were 1.89 (+/- 0.03) and 3.39 (+/- 0.14) days, respectively. Whilst PSA-HL1 did not permit any prognostic statement, the median PSA-HL in the second compartment between patients with and without disease progression differed significantly (4.44 versus 3.12 days; p < 0.001). Discrimination analysis produced a cutoff of 3.8 days for the second compartment; patients with a PSA-HL2 > or = 3.8 days had a significantly worse biochemical recurrence-free survival after 18 months than the other patients (27% versus 93%; p < 0.001). CONCLUSION: The PSA regression kinetics after radical prostatectomy follows a two-compartment model in which the prognostic value of the PSA-HL1 is limited. When a cutoff of 3.8 days is used, evaluation of the PSA-HL in compartment 2 (d5-10) appears to permit a prognostic statement. Due to the limited postsurgical follow-up, the disease process was only assessed as biochemical recurrence-free survival, and a longer follow-up will be necessary to generate data on progression-free survival.

Mycobacterial spindle cell pseudotumor (MSP) of the nasal septum clinically mimicking Kaposi's sarcoma: case report.

Mycobacterial spindle cell pseudotumor (MSP) is a rare benign lesion characterised by local proliferation of spindle--shaped histiocytes containing acid--fast atypical mycobacteria, clinically resembling Kaposi's sarcoma. Most cases of MSP reported so far affected immunodeficient patients or patients receiving immunosuppressive medication. We report a case of MSP affecting the nasal septum of a 76-year-old man, a location that has not been published so far concerning the manifestation of MSP. In conclusion, our case report points toward MSP as a very rare pseudomalignant lesion that should be included into deliberations concerning the differential diagnosis of circumscribed expansile nodular proliferations of the nasal septum clinically mimicking Kaposis's sarcoma or other mesenchymal neoplasms.

CD44s-targeted treatment with monoclonal antibody blocks intracerebral invasion and growth of 9L gliosarcoma.

Glioma invasiveness is a complex process involving recognition and attachment of tumor cells to particular extracellular matrix (ECM) molecules prior to migrating into proteolytically modified matrix and inducing angiogenesis. CD44 is a group of transmembrane adhesion molecules found on a wide variety of cells including gliomas that has been suggested as the principal mediator of migration/invasion. The aim of the present study was to demonstrate whether antibody specific for the standard form of CD44 (CD44s, 85-90 kDa) might prevent invasion, thus blocking growth of the 9L gliosarcoma in vivo. High expression of CD44s on the surface of 9L cells and brain tumors was demonstrated by immunochemistry. Fluorescence-activated cell sorting (FACS) demonstrated binding saturation of anti-CD44s monoclonal antibody (mAb) to the receptor at 1 microg/5 x 10(5) cells. Blocking of CD44s in vitro resulted in a dose-dependent progressive, up to 95%+/-2.5% detachment of 9L cells from ECM-coated culture surfaces. Blocking of CD44s in vivo resulted in significantly reduced 9L brain tumors (2.5%+/-0.4%)--measured as the quotient: tumor surface (mm2)/brain surface (mm2) x 100--as compared to untreated (16.1%+/-2.2%) or sham-treated rats (16%+/-3.7% to 16.1%+/-3%). We conclude that CD44s-targeted treatment with specific mAb may be an effective means for preventing glioma progression.

A rare course of Whipple's disease with atypical cardiac manifestation.

Whipple's disease (WD) is a rare disorder caused by the gram-positive actinomycete Tropheryma whippelii (1). An oral route of acquisition is presumed (2). WD is a chronic systemic infection morphologically characterized by foamy PAS-positive macrophages. This case report depicts the diagnosis and clinical management of a woman who presented with atypical cardial manifestations of WD and died from severe cardiac impairment by Tropheryma whippelii which was confirmed by polymerase chain reaction. Histological assessment of myocardial specimens obtained at autopsy showed PAS-positive macrophages accumulating within foci of interstitial myocardial fibrosis. Immunohistochemical staining demonstrated myocarditis with lymphocytes and neutrophilic granulocytes, which has not been reported so far in the course of WD.

Disruption of intracerebral progression of C6 rat glioblastoma by in vivo treatment with anti-CD44 monoclonal antibody.

OBJECT: Glioblastoma multiforme (GBM) invasiveness is a complex process that involves recognition and attachment of GBM cells to particular extracellular matrix (ECM) molecules before migrating into proteolytically modified matrix and inducing angiogenesis. The CD44 molecule, which is a transmembrane adhesion molecule found on a wide variety of cells including GBM, has been suggested as the principal mediator of migration and invasion. The aim of the present study was to demonstrate whether an antibody specific to the standard form of CD44 (CD44s, 85-90 kD) might prevent invasion and thus disrupt progression of C6 GBM in vivo. METHODS: Immunostaining demonstrated homogeneous expression of CD44s on the surface of C6 GBM cells and tumors. Flow cytometric analysis demonstrated binding saturation of anti-CD44s monoclonal antibody (mAb) to the receptor at 1 microg/5 x 10(5) cells. Blocking of CD44s in vitro resulted in a dose-dependent progressive (up to 94+/-2.7%; mean +/- standard deviation [SD]) detachment of C6 cells from ECM-coated culture. Blocking of CD44s in vivo resulted in significantly reduced C6 brain tumors (3.6+/-0.4% [SD])--measured as the quotient: tumor surface (mm2)/brain surface (mm2) x 100--compared with untreated (19.9+/-0.9%) or sham-treated (19.2+/-1.1 to 19.3+/-2.5% [SD]) rats. Disruption of C6 GBM progression correlated with an improved food intake; treated rats were significantly less cachectic (166.6+/-16.4 g [SD]) than those that were untreated (83+/-2.7 g [SD]) or sham-treated (83.4+/-1.1 to 83+/-2.2 g [SD]) rats. CONCLUSIONS: The authors conclude that CD44s-targeted treatment with specific mAb may represent an effective means for preventing progression of highly invasive GBMs.

[Renal cell carcinoma. Comparative analysis of the prognostic significance of the WHO-classification and the Störkel's prognostic score]. / Das Nierenzellkarzinom. Vergleichende Analyse der prognostischen Bedeutung der WHO-Klassifikation und des Prognosescores nach Störkel.

Due to the increasing epidemiological importance of renal cell carcinoma (RCC) in the past, several studies have been undertaken to evaluate a variety of parameters in view of their aptitude for reliably predicting individual prognosis. Currently, staging according to the TNM classification and pathohistological nuclear grading of the tumor is most widely used for determining prognosis. In the latest edition of the TNM system, a subdivision of the stage pT1 into the stages pT1a and pT1b has been established. Analyzing a total of 129 patients with a postoperative follow-up period of 60 months after radical nephrectomy, we investigated the TNM classification in regard to its prognostic potential with emphasis on the new subdivision of the stage pT1. Furthermore, the results were compared to Störkel's prognostic score, which was first described in 1990 as a useful tool for predicting individual prognosis in patients with RCC. In conclusion, our study demonstrates that subdivision of the stage pT1 into the stages pT1a and pT1b did not result in any improvement concerning the aptitude of the TNM classification to predict individual prognosis. In comparison, Störkel's prognostic score has statistically proven to be superior to the TNM classification in regard to its prognostic potential. According to our experience, determination of Störkel's prognostic score can be easily performed by the pathologist without much expense in the course of daily routine diagnostic procedures. Therefore, we strongly recommend Störkel's prognostic score as the parameter of choice to reliably predict individual prognosis of patients suffering from RCC.

[Superior vena cava syndrome with bilateral jugular and subclavian vein thrombosis. Paraneoplastic manifestion of renal cell carcinoma]. / V. -cava-superior-Syndrom mit beidseitiger Jugularis- und SubklaviavenenthromboseParaneoplastische Manifestation eines Nierenzellkarzinoms.

At present thrombosis of the superior vena cava is an uncommon event that is now more frequently associated with diagnostic or therapeutic catheterization. If an apparent spontaneous thrombosis occurs, malignancy should be considered in the differential diagnosis. One case of clinically symptomatic thrombosis of the internal jugular, subclavian, and superior vena cava is presented. We detected an asymptomatic left renal cell carcinoma in a 54-year-old patient and nephrectomy was performed. Increased blood coagulability as part of a paraneoplastic syndrome was considered to be the possible etiology. In patients with otherwise unexplained superior vena cava thrombosis, examination not only of the head and neck but also of the abdomen, retroperitoneum, and pelvis should be pursued. A review of the literature pertinent to this rare case is provided.

[Locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord]. / Das lokal rezidivierende maligne fibröse Histiozytom der Niere oder des Samenstrangs.

OBJECTIVE: In this study, 26 patients with locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord after initial R0 resection were reviewed with regard to therapeutic options and prognosis. PATIENTS AND METHODS: Based on a literature query in the PubMed database, we identified 24 cases with locally recurrent malignant fibrous histiocytoma of the kidney and spermatic cord after initial R0 resection. Two of our own patients were included and afterwards the entire patient group was analyzed with regard to the time period of the first local recurrence and the overall survival rate. RESULTS: The average patient age was 58 years; in 17 cases (65%) the left side was affected. After primary therapy the 5-year survival rate was 25%; adjuvant therapy did not achieve any significant improvement in survival time ( p=0.259). The local recurrence was on average diagnosed after 13 months (with a median of 12 months). The prognosis of malignant fibrous histiocytoma after detection of the local recurrence was extraordinary poor, only 4 of 26 patients survived for longer than 3 years. The 1-, 2- and 5-year survival rates then were 34%, 28%, and 14%, respectively. The mean survival time was 31 months with a median survival of 9 months. Patients with a locally recurrent malignant fibrous histiocytoma of the spermatic cord showed a significant better survival prognosis than patients with a local recurrence of a renal malignant fibrous histiocytoma ( p=0.04). CONCLUSION: Malignant fibrous histiocytoma of the genitourinary tract are rare tumors with a high rate of local recurrence. If there are no distant metastases a R0 resection can result in a curative objective. Nevertheless, the prognosis of this disease is poor. Even early detection of local therapy failure and promptly initiated aggressive salvage therapy may offer the chance of long-term survival only in selected cases. Lifelong follow-up is necessary for patients with a malignant fibrous histiocytoma of the kidney or spermatic cord.

[Liposarcoma of the spermatic cord--report of one new case and review of the literature]. / Liposarkom des Samenstrangs--Darstellung eines Falls.

Liposarcoma of the spermatic cord is a rare entity. Although most liposarcomas of the spermatic cord are well-differentiated, the propensity for local recurrence is high. Preferential treatment of spermatic cord liposarcoma is radical orchiectomy with high ligation of the cord. Radiation therapy is recommended in addition to surgery in cases with evidence of more aggressive tumour behavior (i.e., high-grade tumour, lymphatic invasion, inadequate margin, or recurrence). A 39-year-old-male presented with a 4-year history of a mass in the left scrotum. Radical orchiectomy was performed. Pathological analysis demonstrated a well-differentiated liposarcoma with tumour detection in the surgical margin. In view of the incomplete surgical removal of the tumour a retroperitoneal reoperation of the testicular vessels and vas deferent with R0-resection was conducted. Without any postoperative adjuvant therapy in evidence of recurrence or metastasis was noted during the 12-month follow-up period. The current literature on management of malignant tumours of the spermatic cord is reviewed. Paratesticular liposarcomas are most commonly well-differentiated and lipoma-like and have a prolonged clinical course. Radical orchiectomy with wide local excision of the mass is the recommended therapy, while adjuvant radiotherapy may be considered in high-grade tumours and in recurrent liposarcomas. Retroperitoneal lymphadenectomy does not offer any additional therapeutic benefit, and the role of chemotherapy is not well defined. Regardless of initial therapy, the risk of local recurrence always necessitates long-term followup.

[An unusual complication of extracorporeal shock wave lithotripsy: rupture of the kidney with consecutive nephrectomy]. / Eine seltene Komplikation der Extrakorporalen Stosswellenlithotripsie: Nierenruptur mit nachfolgender Nephrektomie.

INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) plays a major role in the treatment of urolithiasis. It has a high success rate, and spectrum and incidence of treatment-related morbidity are low. CASE REPORT: A 66-year-old male patient underwent ESWL treatment for an 8 mm medium-sized stone in the left kidney. During the subsequent post-interventional phase he experienced persistent flank pain, macrohematuria and protracted hemodynamic instability. An acute CT scan displayed a massive kidney rupture. Emergency lumbar exploration of the left kidney revealed multiple lacerations in the renal parenchyma and a nephrectomy was carried out. CONCLUSION: This is the second internationally reported case study in which nephrectomy was necessitated after ESWL treatment due to multiple ruptures of the kidney. In view of the increasing use of ESWL in outpatient care, it is important that this potential complication is recognized and its clinical aspects appropriately assessed. The conclusion of the report comprises a concise review of the most severe complications in the immediate period after ESWL.

[Sialadenoma papilliferum--a rare benign endobronchial tumor]. / Sialadenoma papilliferum--ein seltener benigner endobronchialer Tumor.

UNLABELLED: HISTORY AND PRESENTATION AT ADMISSION: An 82-year-old male patient presented with a 3 week history of exercise-induced dyspnea, productive cough and left sided chest pain. INVESTIGATIONS: Computertomography of the chest revealed an occluding endobronchial tumor in the left main bronchus with enlarged mediastinal lymph nodes, mediastinal shift and post-stenotic peribronchitis. TREATMENT AND COURSE: The tumor was removed completely with an optical forceps in rigid bronchoscopy. Histologically an endobronchial sialadenoma papilliferum was diagnosed. CONCLUSIONS: Benign tumors of the lower airways are rare. They cannot be distinguished reliably from malignant tumors by their endoscopic and radiologic appearance. Sialadenoma papilliferum is an extremely rare benign salivary gland tumor which is characterized by coexisting glandular and (pseudo) papillar formations. It occurs mainly in the oral cavity. The relapse rate is 10-15%. In single cases a malignant transformation may appear.

Calcineurin inhibitor-free immunosuppression using everolimus (Certican) after heart transplantation: 2 years' follow-up from the University Hospital Münster.

BACKGROUND: Everolimus is a proliferation-signal inhibitor which was introduced for heart transplant recipients in 2004. To date, there are only sparse data about long-term calcineurin inhibitor (CNI)-free immunosuppression using everolimus. METHODS: After heart transplantation, patients receiving everolimus were consecutively enrolled. Reasons for switching to everolimus were side effects of CNI immunosuppression, such as deterioration of kidney function and recurrent rejection episodes. All 60 patients underwent standardized switching protocols, 42 patients completed 24-month follow-up. Blood was sampled for lipid status, renal function, routine controls, and levels of immunosuppressive agents. On days 0, 14, and 28, and then every 3 months, echocardiography and physical examination were performed. RESULTS: After switching to everolimus, most patients recovered from the side effects. Renal function improved significantly after 24 months (creatinine, 2.1 ± 0.6 vs 1.8 ± 1 mg/dL; P < .001; creatinine clearance, 41.8 ± 22 vs 48.6 ± 21.8 mL/min; P < .001). Median blood pressure increased from 120.0/75.0 mm Hg at baseline to 123.8/80.0 mm Hg at month 24 (P values .008 and .003 for systolic and diastolic pressures, respectively). Tremor, peripheral edema, hirsutism, and gingival hyperplasia markedly improved. Levels of interleukin-6 were stable between baseline and 24-month levels. Temporary adverse events occurred in 8 patients [13.3%: interstitial pneumonia (n = 2), skin disorders (n = 2); reactivated hepatitis B (n = 1), and fever of unknown origin (n = 3)]. CONCLUSION: CNI-free immunosuppression using everolimus is safe, with excellent efficacy in maintenance of heart transplant recipients. Arterial hypertension and renal function significantly improved. CNI-induced side effects, such as tremor, peripheral edema, hirsutism, and gingival hyperplasia, markedly improved in most patients.

[Validation of pre-cystectomy nomograms for the prediction of locally advanced urothelial bladder cancer in a multicentre study: are we able to adequately predict locally advanced tumour stages before surgery?]. / Validierung von Präzystektomienomogrammen zur Vorhersage lokal fortgeschrittener Harnblasenkarzinome in einer multizentrischen Studie : Können wir lokal fortgeschrittene Tumorstadien präoperativ ausreichend sicher vorhersagen?

OBJECTIVE: Pre-cystectomy nomograms with a high predictive ability for locally advanced urothelial carcinomas of the bladder would enhance individual treatment tailoring and patient counselling. To date, there are two currently not externally validated nomograms for prediction of the tumour stages pT3-4 or lymph node involvement. MATERIALS AND METHODS: Data from a German multicentre cystectomy series comprising 2,477 patients with urothelial carcinoma of the bladder were applied for the validation of two US nomograms, which were originally based on the data of 726 patients (nomogram 1: prediction of pT3-4 tumours, nomogram 2: prediction of lymph node involvement). Multivariate regression models assessed the value of clinical parameters integrated in both nomograms, i.e. age, gender, cT stage, TURB grade and associated Tis. Discriminative abilities of both nomograms were assessed by ROC analyses; calibration facilitated a comparison of the predicted probability and the actual incidence of locally advanced tumour stages. RESULTS: Of the patients, 44.5 and 25.8% demonstrated tumour stages pT3-4 and pN+, respectively. If only one case of a previously not known locally advanced carcinoma (pT3-4 and/or pN+) is considered as a staging error, the rate of understaging was 48.9% (n=1211). The predictive accuracies of the validated nomograms were 67.5 and 54.5%, respectively. The mean probabilities of pT3-4 tumours and lymph node involvement predicted by application of these nomograms were 36.7% (actual frequency 44.5%) and 20.2% (actual frequency 25.8%), respectively. Both nomograms underestimated the real incidence of locally advanced tumours. CONCLUSIONS: The present study demonstrates that prediction of locally advanced urothelial carcinomas of the bladder by both validated nomograms is not conferrable to patients of the present German cystectomy series. Hence, there is still a need for statistical models with enhanced predictive accuracy.

[Influence of older age on survival after radical cystectomy due to urothelial carcinoma of the bladder: survival analysis of a German multi-centre study after curative treatment of urothelial carcinoma of the bladder]. / Einfluss des Alters auf das karzinomspezifische Überleben nach radikaler Zystektomie : Überlebensanalyse aus einer deutschen Multicenterstudie nach kurativer Therapie eines Urothelkarzinoms der Harnblase.

BACKGROUND: The therapeutic gold standard of muscle-invasive tumour stages is radical cystectomy (RC), but there are still conflicting reports about associated morbidity and mortality and the oncologic benefit of RC in elderly patients. The aim of the present study was the comparison of overall (OS) and cancer-specific survival (CSS) in patients <75 and >75 years of age (median follow-up was 42 months). PATIENTS AND METHODS: Clinical and histopathological data of 2,483 patients with urothelial carcinoma and consecutive RC were collated. The study group was dichotomized by the age of 75 years at RC. Statistical analyses comprising an assessment of postoperative mortality within 90 days, OS and CSS were assessed. Multivariate logistic regression and survival analyses were performed. RESULTS: The 402 patients (16.2%) with an age of ≥75 years at RC showed a significantly higher local tumour stage (pT3/4 and/or pN+) (58 vs 51%; p=0.01), higher tumour grade (73 vs 65%; p=0.003) and higher rates of upstaging in the RC specimen (55 vs 48%; p=0.032). Elderly patients received significantly less often adjuvant chemotherapy (8 vs 15%; p<0.001). The 90-day mortality was significantly higher in patients ≥75 years (6.2 vs 3.7%; p=0.026). When adjusted for different variables (gender, tumour stage, adjuvant chemotherapy, time period of RC), only in male patients and locally advanced tumour stages was an association with 90-day mortality noticed. The multivariate analysis showed that patients ≥75 years of age have a significantly worse OS (HR=1.42; p<0.001) and CSS (HR=1.27; p=0.018). CONCLUSIONS: An age of ≥75 years at RC is associated with a worse outcome. Prospective analyses including an assessment of the role of comorbidity and possibly age-dependent tumour biology are warranted.