Nonmuscle invasive (NMI) urothelial cancer (UC) is associated with varied biological potential. It is characterized by frequent recurrence and progression, which thus worsens the oncological outcome. Nearly three-quarters of NMI UCs recur within 5 years, whereas half can progress during follow-up. Progression is particularly seen in T1 and carcinoma in situ (CIS). Undoubtedly, NMI UC is one of the most expensive cancers to manage. The European Organisation for Research and Treatment of Cancer (EORTC) risk calculator is a commonly used tool for assessing the recurrence and progression potential of a newly diagnosed cancer. The parameters used in the assessment are tumor size and number, pathological stage and grade of the cancer, presence of CIS, and prior recurrence rate. The main advantages of the EORTC tool are its ease of use and the lack of need to run expensive molecular tests. However, reproducibility of pathologic stage and grade is modest, which is a concern to clinicians. Molecular markers have potential for predicting the clinical outcome of NMI UC, given that clinico-pathologic variables are not sufficient for prediction of prognosis in an individual. Significant work has been done in the past 2 decades in understanding the molecular biology of bladder cancer; however, the translational value of this knowledge remains poor. The role for molecular markers in predicting recurrence seems limited because multifocal disease and incomplete treatment are probably more important for recurrence than the molecular features of a resected tumor. Urinary markers have very limited value in prognostication of bladder cancer and are used (mainly as an adjunct to cytology) for detection and surveillance of urothelial cell cancer recurrence. Prediction of progression with molecular markers holds considerable promise. Nevertheless, the contemporary value of molecular markers over clinico-pathologic indexes is limited.
Age Factors ; Biomarkers, Tumor/*metabolism ; Carcinoma, Transitional Cell/*diagnosis/pathology/surgery ; Disease Progression ; Humans ; Prognosis ; Recurrence ; Risk Assessment/methods ; Urinary Bladder Neoplasms/*diagnosis/pathology/surgery

PURPOSE: It is well established that muscle-invasive urothelial carcinoma (UC) has a marked propensity for divergent differentiation, a fact that has significant diagnostic, prognostic, and therapeutic implications. This work is designed to assess the impact of different histopathologic variants of bladder cancer on morbidity and mortality in patients undergoing radical cystectomy (RC) as compared to the impact in patients with conventional UC. MATERIALS AND METHODS: We reviewed records of 201 patients treated with RC and pelvic lymph node dissections. Demographics as well as clinico-pathologic parameters, including histopathological variant, tumor stage, and nodal status, were reviewed. Multivariate analyses were used to evaluate these parameters for overall survival (OS). Kaplan-Meier curves for overall and cancer-specific survival were plotted. RESULTS: The majority of patients were male (84%), and the mean age was 61+/-13.1 years (range, 27-87 years). The mean follow-up was 67 months (range, 6-132 months). A histological variant of UC tumor was found in 19 patients (11%). The OS was 55%, and the cancer-specific survival was 35%. The histopathologic variance showed significant impact on morbidity and mortality (p=0.02 and p=0.05, respectively). Patients with divergent histopathology of bladder tumor have poorer survival than do those with UC in a multivariate analysis. CONCLUSIONS: The pathologic stages at RC and lymph node involvement are predictors for OS. Because of its aggressive nature, histopathologic variance is an independent risk factor determining the outcome in terms of both morbidity and mortality.
Cystectomy* ; Demography ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Lymph Nodes ; Male ; Mortality ; Multivariate Analysis ; Neoplasms, Glandular and Epithelial ; Risk Factors ; Urinary Bladder Neoplasms

PURPOSE: To compare the stone clearance rate, efficiency quotient (EQ), and early complications of shock wave lithotripsy (SWL) and percutaneous nephrolithotomy (PCNL) for solitary lower-pole renal stones measuring 15 to 20 mm. MATERIALS AND METHODS: This was a retrospective matched-pair analysis of 142 patients (78 in the SWL and 64 in the PCNL group). Preoperative imaging was done by use of noncontrast computed tomography (CT kidney, ureter, and bladder [KUB]), intravenous urogram, or plain X-ray and ultrasound KUB to assess the largest dimension of the stones. Only patients with radiopaque stones were included. The stone-free rates were assessed with plain X-ray and ultrasound at 4 weeks. Data were analyzed by use of SPSS ver. 19. RESULTS: The patients' demographic profiles (age, body mass index) and the stone sizes were comparable in the two groups. The mean stone size was 17.4+/-2.12 in the PCNL group compared with 17.67+/-2.04 in the SWL group (p=0.45). At 4 weeks, 83% of patients undergoing PCNL were stone-free compared with 51% in the SWL group (p<0.001). The EQ for the PCNL group was 76% compared with 44% for the SWL group (p<0.001). Ancillary procedures were required by 9% of patients in the PCNL group compared with 15% in the SWL group. The complication rate was 19% in both groups. The SWL complications were minor. CONCLUSIONS: Stone clearance from the lower pole of solitary stones sized 15 to 20 mm at the greatest diameter following SWL is poorer. These calculi can be better managed with percutaneous surgery owing to its higher efficacy and acceptably low morbidity.
Calculi ; Humans ; Kidney ; Kidney Calculi ; Lithotripsy ; Matched-Pair Analysis ; Nephrostomy, Percutaneous ; Retrospective Studies ; Shock ; Ureter ; Urinary Bladder