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MINERVA UROLOGICA E NEFROLOGICA

Rivista di Nefrologia e Urologia


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Minerva Urologica e Nefrologica 2018 Mar 28

DOI: 10.23736/S0393-2249.18.02995-8

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Prognostic role of delay before radical cystectomy: retrospective analysis of a single-centre cohort with 376 patients

Alessandro ANTONELLI, Stefania ZAMBONI , Carlotta PALUMBO, Sandra BELOTTI, Marco LATTARULO, Maria FURLAN, Maria C. MARCONI, Luca CRISTINELLI, Claudio SIMEONE

Department of Urology, ASST Spedali Civili Hospital of Brescia, University of Brescia, Brescia, Italy


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BACKGROUND: According to International Guidelines radical cystectomy (RC) should not be delayed over 90 days to prevent the risk of intercurrent progression and worse survival. Nevertheless, such a recommendation relies on a few retrospective studies reaching non univocal conclusions. Aim of the present study is to investigate if the latency between diagnosis and cystectomy (LDC) is related to prognosis after RC.
METHODS: Retrospective analysis of database collecting complete information on patients undergone RC at single institution since 2004. The cases with a LDC <15 or > 360 days or submitted to neo-adjuvant chemotherapy or with distant metastasis were excluded. Uni- and multivariate analyses assessed the relationship between LDC upstaging, progression-free and overall survival.
RESULTS: The data of 376 patients were analyzed; mean/median LDC was 83/76 days and 124 patients (33%) had LDC>90 days. LDC was shorter in younger patients with first diagnosis of more advanced BC at clinical staging; accordingly, patients with LDC<90 days had more advanced disease also at final pathology. Prevalence of pathological upstaging was 37%; in case of upstaging LDC was 75 days vs 72 days (p=0.4629). Multivariable regression models adjusted for pathological local and lymphnodal stage showed that LDC, continuous or dichotomized at 30/60/90/120/180/240 days was not related to progression-free or overall survival. The retrospective design of study is the main limitation of the study.
CONCLUSIONS: In our experience nor the risk of upstaging, neither survival after RC were related to LDC. Even if this results should not discourage any effort to perform surgery expeditiously, the window of opportunity for RC might not be delimited by a predetermined threshold.


KEY WORDS: Bladder cancer, Radical Cystectomy, Prognostic factor, Treatment delay, Survival

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Publication History

Article first published online: March 28, 2018
Manuscript accepted: March 12, 2018
Manuscript revised: January 15, 2018
Manuscript received: June 28, 2017

Per citare questo articolo

Antonelli A, Zamboni S, Palumbo C, Belotti S, Lattarulo M, Furlan M, et al. Prognostic role of delay before radical cystectomy: retrospective analysis of a single-centre cohort with 376 patients. Minerva Urol Nefrol 2018 Mar 28. DOI: 10.23736/S0393-2249.18.02995-8

Corresponding author e-mail

stefania.zamboni@libero.it