(Press-News.org) Bladder cancer patients who have radical surgery at university hospitals can benefit from excellent local control of the disease, acceptable clinical outcomes and low death rates, according to research in the August issue of the urology journal BJUI.
Researchers studied 2,287 patients who had radical cystectomy surgery, where the bladder is removed, together with nearby tissue and organs as required. The surgery was performed at eight Canadian academic centres between 1998 and 2008.
The study found that there were three independent factors, apart from pathological stage at surgery, that influenced survival rates. Patients who smoked had lower survival rates, while patients who had pelvic lymphadenectomy - lymph nodes removed from the pelvic area - had higher survival rates, as did patients who received adjuvant chemotherapy, which aims to destroy microscopic cancer cells left after surgery.
However, the researchers found that neoadjuvant chemotherapy - which is often recommended prior to surgery to improve outcomes - tends to be under utilised for bladder cancer in Canada.
"Recent advances in combined radiation with chemotherapy have challenged the role of radical cystectomy (RC) with pelvic lymphadenectomy, which is used to treat muscle invasive and refractory non-muscle invasive bladder cancer" says co-author Dr Wassim Kassouf, from McGill University Health Centre, Quebec, Canada.
"These bladder-preservation strategies are potentially attractive in terms of health-related quality of life and cancer outcomes, but they only tend to work in highly selected patients.
"Advances in RC surgery have improved surgical care and techniques and reduced complications and mortality rates. The aim of our study was to evaluate a contemporary series of patients with bladder cancer to assess the clinical outcomes and identify any variables that affected their long-term health."
Key findings of the study included:
79% of the patients were male, the median age was 68 and the average follow-up of live patients was just over 29 months. 66% reported a family history of tobacco smoking.
More than three-quarters of the patients had high-grade tumours. Pathological specimen examination revealed no evidence of cancer in 7% of patients, muscle invasive disease in 73% and positive nodal involvement in 25%.
Adjuvant chemotherapy was offered to 19% of patients and neoadjuvant chemotherapy to just over 3%.
All patients had previously undergone transurethral resection of bladder tumours and the median time from this to RC surgery was 49 days. This is similar to waiting times reported in international studies conducted in Sweden (49 days), the USA (42 days) and Germany (54 days).
The 30, 60 and 90-day death rates were 1.3%, 2.6% and 3.2% respectively. Cancer returned in 33% of patients within a median of 10 months. Local recurrence rates were 6% in the overall group and 4% in the organ-confirmed node-negative group.
The five-year overall, recurrence-free and cancer-specific survival rates were 57%, 48% and 67% respectively.
Multivariate analysis showed that lower pathological stage, negative surgical margins, receipt of adjuvant chemotherapy, performance of pelvic lymphadenectomy and an absence of smoking were associated with prolonged disease-specific and overall survival.
"Our study shows that very good results can be achieved when RC is performed at academic centres within a universal healthcare system and that it remains an effective clinical option for treating patients with bladder cancer" says Dr Kassouf.
###
Notes to editors
Contemporary outcomes of 2287 patients with bladder cancer who were treated with radical cystectomy: a Canadian multicentre experience. Yafi et al. BJUI. 108, pp539-545. (August 2011). DOI: 10.1111/j.1464-410X.2010.09912.x
Established in 1929, BJUI is edited by Professor John Fitzpatrick from Mater Misericordiae University Hospital and University College Dublin, Ireland. It provides its international readership with invaluable practical information on all aspects of urology, including original and investigative articles and illustrated surgery. http://wileyonlinelibrary.com/journal/BJU
Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.
END
Researchers can now watch molecules move in living cells, literally millisecond by millisecond, thanks to a new microscope developed by scientists at the European Molecular Biology Laboratory (EMBL) in Heidelberg, Germany. Published online today in Nature Biotechnology, the new technique provides insights into processes that were so far invisible.
By combining light-sheet microscopy and single molecule spectroscopy, the new microscope can record the fluorescence of every pixel within view, and take snapshots at intervals of less than one millisecond. With it, scientists ...
Scientists at the University of Liverpool have found that male fruitflies experience a type of 'paranoia' in the presence of another male, which doubles the length of time they mate with a female, despite the female of the species only ever mating with one male.
Females in many species of animal have multiple mates and males have evolved particular reproductive characteristics to ensure their sperm are successful when in competition with the sperm of other males. Adaptations include physical traits that result in increased sperm count, as well as behavioural alterations ...
Calculating the surface area of Gran Canaria is no easy task for a 14-year-old. It's not simply a question of learning the right formula. Students have to develop a strategy that enables them to put mathematical theory into practice – working out the information that is important and applying the right geometric models and tools. Realizing that the island has an almost circular shape and so its surface area can be approximated using the area of a circle is not as straightforward as it sounds. Are schoolchildren capable of developing these kinds of solutions themselves or ...
In Anna Gudmundsdottir's laboratory at the University of Cincinnati, dedicated researchers endeavor to tame the extremely reactive chemicals known as radicals.
Highly reactive radicals are atoms, molecules or ions frantically trying to become something else. Their lifetimes are measured in fractions of seconds and typically occur in the middle of a chain of chemical reactions. They are also known as reactive intermediates. Much of Gudmundsdottir's work has focused on a family of radicals known as triplet nitrenes.
"Triplet nitrenes are reactive intermediates with high ...
A new study from the University of Haifa has found that walking around the ward during hospitalization significantly reduces the length of the older patient's stay. "Given the over-occupancy of many hospitals, this finding can be of great importance," the researchers stated.
Walking around the ward during hospitalization reduces the length of geriatric patients' stay in internal wards. This has been shown in a new study by Dr. Efrat Shadmi and Dr. Anna Zisberg of the University of Haifa's Department of Nursing, funded by the Israeli Science Foundation and published in ...
Nearly half of all women scientists and one-quarter of male scientists at the nation's top research universities said their career has kept them from having as many children as they had wanted, according to a new study by Rice University and Southern Methodist University (SMU).
The study, "Scientists Want More Children," was authored by sociologists Elaine Howard Ecklund of Rice and Anne Lincoln of SMU and appears in the current issue of the journal PLoS ONE.
For the past three years, Ecklund and Lincoln have been studying what junior and senior scientists in physics, ...
U.S. Department of Agriculture (USDA) scientists are using a technology known as "Fourier transform infrared-attenuated total reflection" (FTIR-ATR) spectroscopy to rapidly identify with 95 percent accuracy citrus plant leaves infected with the devastating disease known as citrus greening.
Scientists from the Agricultural Research Service (ARS) Subtropical Plant Pathology Research Unit in Fort Pierce, Fla., and the agency's Quality and Safety Assessment Research Unit in Athens, Ga., collaborated on the use of FTIR-ATR spectroscopy to identify citrus greening in plants. ...
OTTAWA – August 8, 2011 – There are increasing pressures for health care providers to make individual-level data readily available for research and policy making. But Canadians are more likely to allow the sharing of their personal data if they believe that their privacy is protected. A new report by Dr. Khaled El Emam, the Canada Research Chair in Electronic Health Information at the University of Ottawa and the Children's Hospital of Eastern Ontario Research Institute, suggests that Canadians can be uniquely identified from their date of birth, postal code, and gender. ...
A liquid does not have to be a disordered bunch of particles: A team of researchers at Vienna University of Technology (TU Vienna) and the University of Vienna has discovered intriguing structures formed by tiny particles floating in liquids. Under mechanical strain, particle clusters in liquids can spontaneously form strings and dramatically alter the properties of the liquid.
What is common to blood, ink and gruel? They are all liquids in which tiny particles are suspended – so called "colloids". In some of these liquids, the particles form groups (clusters), which ...
Hospitals vary markedly when it comes to the rate at which diagnostic coronary angiography or catheterization – an invasive procedure that allows doctors to see the vessels and arteries leading to the heart – actually finds obstructive coronary artery disease (CAD) in people without known heart disease.
In fact, while some U.S. hospitals report that 100 percent of patients undergoing this procedure were found to have CAD, others had rates as low as 23 percent, meaning the majority of patients selected for elective catheterization did not have blockages, according to ...
