Penile cancer care in the Netherlands: increased incidence, centralisation, and improved survival.

OBJECTIVE: To evaluate penile squamous cell carcinoma (PSCC) incidence and centralisation trends in the Netherlands over the past three decades, as well as the effect of centralisation of PSCC care on survival. PATIENTS AND METHODS: In the Netherlands PSCC care is largely centralised in one national centre of expertise (Netherlands Cancer Institute [NCI], Amsterdam). For this study, the Netherlands Cancer Registry, an independent nationwide cancer registry, provided per-patient data on age, clinical and pathological tumour staging, follow-up, and vital status. Patients with treatment at the NCI were identified and compared to patients who were treated at all other centres. The age-standardised incidence rate was calculated with the European Standard Population. The probability of death due to PSCC was estimated using the relative survival. Multivariable Cox regression analysis was performed to evaluate predictors of survival. RESULTS: A total of 3160 patients were diagnosed with PSCC between 1990 and 2020, showing a rising incidence (P < 0.001). Annual caseload increased at the NCI (1% in 1990, 65% in 2020) and decreased at other (regional) centres (99% to 35%). Despite a relatively high percentage of patients with T2-4 (64%) and N+ (33%) at the NCI, the 5-year relative survival was higher (86%, 95% confidence interval [CI] 82-91%) compared to regional centres (76%, 95% CI 73-80%, P < 0.001). Patients with a pathological T2 tumour were treated with glans-sparing treatment more often at the reference centre than at the regional centres (16% vs 5.0%, P < 0.001). After adjusting for age, histological grading, T-stage, presence of lymph node involvement and year of diagnosis, treatment at regional centres remained a predictor for worse survival (hazard ratio 1.22, 95% CI 1.05-1.39; P = 0.006). CONCLUSION: The incidence of PSCC in the Netherlands has been gradually increasing over the past three decades, with a noticeable trend towards centralisation of PSCC care and improved relative survival rate.

Laparoscopic Radical Cystectomy in the Elderly - Results of a Single Center LRC only Series

ABSTRACT Objective: To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly ( (≥75 years) versus 51 younger (<75 years) patients. patients. Materials and Methods: Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry. Results: Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively. Conclusions: Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured.

Marcadores moleculares de respuesta terapéutica en cáncer vesical / Biomarkers for assessing therapeutic response in bladder cancer

Son necesarios marcadores fiables para evaluar la respuesta terapéutica en pacientes con cáncer vesical, para seleccionar la estrategia terapéutica más eficaz. Analizamos el papel de los biomarcadores prediciendo la respuesta del cáncer vesical no musculo invasivo a la inducción con BCG, y del cáncer vesical musculo invasivo no órgano confinado a la quimioterapia neoadyuvante. Se llevo a cabo una revisión crítica no estructurada de la literatura. Para evaluar el resultado de la terapia con BCG, la medición de los niveles de IL-2 parece ser el marcador más potente de todos los parámetros clínicos revisados. La medición de las interleuquinas IL-8 , IL 18 y de los niveles del ligando del factor de necrosis tumoral inductor de apoptosis parecen también prometedores. Los marcadores inmunohistoquímicos (es decir TP53, Ki 67 y Rb) muestran resultados contradictorios y parecen inadecuados. Los polimorfismos de genes necesitan estudios de más profundidad antes de poder determinar su relevancia clínica. Respecto a la evaluación y predicción de la respuesta del cáncer vesical musculo invasivo a la quimioterapia neoadyuvante, se ha estudiado un juego de marcadores potentes. Sin embargo, no hay evidencia concluyente disponible todavía sobre su valor adicional sobre las variables clinicopatológicas establecidas. Son necesarios ensayos prospectivos para validar el beneficio clínico de los marcadores moleculares para predecir la respuesta a BCG (cáncer vesical no musculo invasivo) y a quimioterapia neoadyuvante (músculo invasivo) antes de que los biomarcadores predictivos puedan llegar a ser parte de la práctica clínica (AU)

Reliable markers for assessing therapeutic response are needed to select the most effective treatment strategy for bladder cancer patients. We analyzed the role of biomarkers predicting response of non-muscle invasive bladder cancer (NMIBC) on BCG induction, and of non-organ confined muscle invasive bladder cancer (MIBC) on neoadjuvant chemotherapy. A critical, non-structured review of the literature was conducted. For assessing BCG therapy outcome, measurement of urinary IL-2 levels seems to be the most potent marker of all the clinical parameters reviewed. Measurements of urinary interleukins IL-8, IL-18, and tumour necrosis factor apoptosis-inducing ligand levels seem promising as well. Immunohistochemical markers (ie, TP53, Ki-67, and Rb) display contradictory results and seem unsuitable. Gene polymorphisms need to be studied more thoroughly before their clinical relevance can be determined. Regarding assessing and predicting response of MIBC to neoadjuvant chemotherapy, a set of potent markers has been studied. However, no conclusive evidence is yet available on their additional value over the established clinicopathological variables. Prospective trials are needed to validate the clinical benefit of molecular markers to predict response to BCG (NMIBC) and neoadjuvant chemotherapy (MIBC) before predictive biomarkers can become part of clinical practice (AU)