Age related trends in the utilization of neoadjuvant chemotherapy for muscle invasive bladder cancer.

PURPOSE: The current standard of care for muscle invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC). Previous research has shown under-utilization of NAC for treatment of MIBC, especially among the elderly. Our aim was to stratify NAC use by decade of life and analyze trends in use over time along with recording pathologic downstaging and perioperative outcomes. MATERIALS AND METHODS: The National Cancer Database was queried for patients with cT2-4NanyM0 MIBC treated with RC from 2010 to 2016 with urothelial carcinoma. Nineteen thousand nine hundred fifty seven patients met criteria for analysis. We retrospectively analyzed trends in use of NAC, readmission rate, mortality rate, and pathologic downstaging with NAC all stratified by decade of life. RESULTS: Of the 19,957 patients treated with RC for MIBC, only 30.9% underwent NAC. There was a statistically significant increase in NAC use across all age groups from 2010 to 2016. Receipt of NAC was associated with decreased age on univariate analysis (P < 0.001) and on logistic regression (OR: 0.617 for age 70-79, OR: 0.221 for age ≥80 vs. age <60; P < 0.001). Patients receiving NAC were more likely to exhibit pathologic downstaging at time of RC (OR: 3.907; P < 0.001), and this trend held for each age group examined. Among patients receiving NAC, the risk of 30 and 90-day mortality was associated with increasing age; however, age was not associated with 30-day readmission for those receiving NAC. CONCLUSION: Rates of NAC use prior to RC have increased among all age groups with the lowest utilization rate among the elderly. NAC use was associated with greater pathologic downstaging in all age groups. These data show a promising trend in the uptake of the gold standard for treatment of MIBC; however, the underlying etiology of differing rates of NAC utilization remains to be determined.

The clinical impact of ureteroscopy for upper tract urothelial carcinoma: A multicenter study.

BACKGROUND: With the development of kidney-sparing surgery and neoadjuvant chemotherapy, ureteroscopic biopsy (URSBx) has become important for the management of upper tract urothelial carcinoma (UTUC). METHODS: We retrospectively analyzed data from 744 patients with UTUC who underwent radical nephroureterectomy (RNU), stratified into no ureteroscopy (URS), URS alone, and URSBx groups. Intravesical recurrence-free survival (IVRFS) was examined using the Kaplan-Meier method. We conducted Cox regression analyses to identify risk factors for IVR. We investigated differences between clinical and pathological staging to assess the ability to predict the pathological tumor stage and grade of RNU specimens. RESULTS: Kaplan-Meier curves and multivariate Cox regression revealed significantly more IVR and inferior IVRFS in patients who underwent URS and URSBx. Superficial, but not invasive, bladder cancer recurrence was more frequent in the URS and URSBx groups than in the no URS group. Clinical and pathological staging agreed for 55 (32.4%) patients. Downstaging occurred for 48 (28.2%) patients and clinical understaging occurred for 67 (39.4%) patients. Upstaging to muscle-invasive disease occurred for 39 (35.8%) of 109 patients with ≤cT1 disease. Clinical and pathological grading were similar for 72 (42.3%) patients. Downgrading occurred for 5 (2.9%) patients, and clinical undergrading occurred for 93 (54.7%) patients. CONCLUSION: URS and URSBx instrumentation will be risk factors for superficial, but not invasive, bladder cancer recurrence. Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred for a large proportion of patients with UTUC who underwent RNU. These data emphasize the challenges involved in accurate UTUC staging and grading.

Priapismo maligno secundario a cáncer de vejiga / Malignant priapism and secondary bladder cancer

OBJETIVO: Presentamos un caso infrecuente de priapismo maligno secundario a carcinoma de celulas transicionales de la vejiga.MÉTODOS: El paciente portador de un cancer vesical (pT4G3) presenta una tumefacción dolorosa peneana. Realizamos biopsia de los cuerpos cavernosos.RESULTADOS: El informe de la anatomía patológica muestra metástasis peneana de carcinoma de células de transición.CONCLUSIONES: El priapismo secundario a metástasis peneana por carcinoma transicional es infrecuente y se asocia a un mal pronóstico debido a que su presencia indica diseminación metastática multiorgánica(AU)

OBJECTIVE: We report a rare case of malig-nant priapism secondary to transitional cell carcinoma.METHODS: The patient with bladder cancer (pT4G3) pre-sented with painful penile erection. Corpora cavernosa biopsy was done.RESULTS: The pathologic diagnosis was penile metastasis of transitional cell carcinoma.CONCLUSIONS: Priapism secondary to penile metastasis of transitional cell carcinoma is rare and indicates advanced disease with a poor prognosis(AU)

Urotelioma vesical en paciente de 12 años / Transitional cell tumor in a 12-year-old patient

Los papilomas de células transicionales son tumores de origen epitelial, y forman las neoplasias del tracto urinario más frecuentes en los adultos, sin embargo su incidencia en la infancia es muy baja. La localización más común en ambos grupos es la vesical, a menudo en la proximidad de los orificios ureterales. La clínica posible es muy variable, siendo la más frecuente la hematuria macroscópica. Histológicamente son de bajo grado de malignidad, y la escisión radical es considerada curativa; sin embargo, la tasa de recurrencia en la literatura especializada es alta, y existe la posibilidad de un tipo tumoral más agresivo. Presentamos el caso de una niña de 12 años de edad que presenta esta rara lesión cercana al orificio ureteral derecho y se revisa la etiopatogenia, diagnóstico, tratamiento y evolución de esta entidad

Transitional cell papillomas, which are tumors of epithelial origin, are the most common urinary tract neoplasm in adults but are extremely rare in children. In both groups the main location is the bladder, often around one of the ureteric orifices. Symptoms vary widely but the most frequent is gross hematuria. Transitional cell papillomas are histologically low-grade tumors and total excision is considered curative. However the rate of recurrence in the literature is high, and there is a potential for a more aggressive type of tumor. We report the case of a 12-year-old girl who presented with a transitional cell papilloma near the right ureteric orifice and describe the etiopathogenesis, diagnosis, treatment and outcome of this entity

Carcinoma plasmocitoide de células transicionales de la vejiga urinaria / Plasmacytoid transitional cell carcinoma of the urinary bladder: A case report and review of the literature

Presentamos el caso de un varón de 63 años con una variante plasmocitoide de carcinoma de células transicionales de vejiga urinaria. Debutó clínicamente con disuria y hematuria. En la cistoscopia se observó una lesión ulcerada en la pared de la vejiga que se biopsió. Tras el diagnóstico se realizó una cistectomía. El estudio histopatológico mostró un crecimiento difuso de células tumorales que asemejaban células plasmáticas. El diagnóstico diferencial se estableció entre un linfoma, melanoma y plasmocitoma. Las células neoplásicas mostraron inmunorreactividad frente a citoqueratinas, siendo negativo el estudio frente a S100 y marcadores de células linfoides y plasmáticas. En la literatura únicamente se recogen dos casos de esta variante tumoral, con datos clínicos y morfológicos semejantes a los que presentamos. La confirmación de la naturaleza epitelial de las células neoplásicas es la clave para el diagnóstico (AU)