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    Impact of neoadjuvant chemotherapy on short-term complications and survival following radical cystectomy
    (SPRINGER, 2019) Milenkovic, Uros; Akand, Murat; Moris, Lisa; Demaegd, Liesbeth; Muilwijk, Tim; Bekhuis, Youri; Laenen, Annouschka; Cleynenbreugel, Ben Van; Everaerts, Wouter; Poppel, Hein Van; Dumez, Herlinde; Albersen, Maarten; Joniau, Steven
    Objectives To compare perioperative and short-term postoperative complication rates between patients receiving radical cystectomy (RC) after neoadjuvant chemotherapy (NAC) and patients undergoing RC alone. Secondary objectives were to compare overall survival (OS) and cancer-specific survival (CSS). Materials and methods Clinico-pathological data of all patients who received RC between 1996 and 2015 were retrospectively collected. Only patients with RC for muscle-invasive bladder cancer were included in the final analysis. Short-term (30-day) postoperative complications were assessed by registering the Clavien-Dindo classification (CDC) and dividing into sub-groups: low-grade (LGC) CDC 1-2 and high-grade (HGC) CDC 3-5. To compare populations with similar age, comorbidities and preoperative creatinine, we used a propensity score-adjusted statistical model. Pre- and perioperative predictors of short-term complications were identified using uni- and multivariable models. Survival was assessed using Kaplan-Meier analysis. Results A total of 491 patients undergoing RC were included, of whom 102 (20.8%) received NAC. After propensity score covariate adjustment, there was no significant difference in postoperative complications between patients undergoing NAC plus RC and RC alone with an overall complication rate of 69% and 66%, respectively. No significant differences in the 30-day HGC rates (11.76% and 11.83%, respectively) were observed. NAC plus RC patients had worse prognostic factors at baseline; nevertheless, after correction for group differences OS and CSS did not differ from RC only group (5-year OS 61.3% vs. 50.2%, and 5-year CSS 61.8% vs. 57.9% respectively, p > 0.05 for all). Conclusion In appropriately selected patients, exposure to NAC is not associated with increased short-term complications.
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    Prognostic score predicts overall survival following complete urinary tract extirpation
    (TAYLOR & FRANCIS LTD, 2020) Akand, Murat; Muilwijk, Tim; Van Der Aa, Frank; Gevaert, Thomas; Milenkovic, Uros; Moris, Lisa; Blyweert, Wim; Poppel, Hendrik Van; Albersen, Maarten; Joniau, Steven
    Purpose: To evaluate the oncological outcome and complications of patients treated with complete urinary tract extirpation (CUTE) in our department, and to identify prognostic factors for survival. Methods: Clinico-pathological data of patients treated with one-step or stepwise CUTE between 1999 and 2017 were collected retrospectively. Complications were classified according to the modified Clavien-Dindo classification (CDC) in the early (<= 30 days) and late (>30 days) follow-up. Log-rank test was used to assess independent predictors of overall survival (OS), cancer-specific survival (CSS) and recurrence-free survival (RFS). Results: Twenty-five patients (20 male) underwent CUTE (16 one-step) for BC + unilateral/bilateral UTUC. Minor (CDC 1-2) and major (CDC3-5) complications were observed in 72% and 40% of patients, respectively, in the early postoperative period (<= 30 days). Five (20%) patients died in the perioperative period (CDC 5) with a median OS of 52 days (range: 25-77). Median time to last follow-up or death was 30 months (range: 0-161). Median OS was 50 months (95% Confidence Interval [CI]: 22-118 months), while median CCS and RFS were not reached. The 5-year OS, CSS and RFS were 42.7%, 69.6% and 66.7%, respectively. A score for determining which patients would benefit from CUTE was arbitrarily developed, and showed that the patients with a score of 0-2 points (good prognosis) had a better OS than the patients with a poor prognosis (3-4 points) in the log-rank test. Conclusions: Because of lower OS rates, patients with ESRD or with a CUTE score of 3-4 points are probably not ideal candidates for CUTE.