Objective We aimed to evaluate the effect of body mass index (BMI) on oncological and surgical outcomes in patients who underwent radical cystectomy (RC) for bladder cancer (BC). Materials and Methods We retrospectively assessed data from patients who underwent RC with pelvic lymphadenectomy and urinary diversion for BC recorded in the bladder cancer database of the Urooncology Association, Turkey, between 2007 and 2019. Patients were stratified into three groups according to the BMI cut-off values recommended by the WHO; Group 1 (normal weight, <25 kg/m2), Group 2 (overweight, 25.0-29.9 kg/m2) and Group 3 (obese, ≥30 kg/m2). Results In all, 494 patients were included, of them 429 (86.8%) were men and 65 (13.2%) were women. The median follow-up was 24 months (12-132 months). At the time of surgery, the number of patients in groups 1, 2 and 3 were 202 (40.9%), 215 (43.5%) and 77 (15.6%), respectively. The mean operation time and time to postoperative oral feeding were longer and major complications were statistically higher in Group 3 compared to Groups 1 and 2 (P = .019, P < .001 and P = .025, respectively). Although the mean overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) was shorter in cases with BMI ≥ 30 kg/m2 compared with other BMI groups, differences were not statistically significant (P = .532, P = .309, P = .751 and P = .213, respectively). Conclusion Our study showed that although major complications are more common in obese patients, the increase in BMI does not reveal a significant negative effect on OS, CSS, RFS and MFS.

Lymphadenectomy

10.1111/ijcp.13750

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Grade Heterogeneity in High-Grade Urothelial Carcinomas: Does It Have an Impact on the Survival of Patients With Intermediate/High-Risk Nonmuscle-Invasive Bladder Cancer Who Received Adequate Adjuvant Bacillus Calmette-Guérin Therapy?

The Journal of Urology (2024)

Murat Can Karaburun Ezgi Dicle Serbes Çağrı Akpınar Khaled Obaid Çağatay Göğüş

No AccessJournal of UrologyAdult Urology1 May 2024Grade Heterogeneity in High-Grade Urothelial Carcinomas: Does It Have an Impact on the Survival of Patients With Intermediate/High-Risk Nonmuscle-Invasive Bladder Cancer Who Received Adequate Adjuvant Bacillus Calmette-Guérin Therapy? Murat Can Karaburun, Ezgi Dicle Kuz, Çağrı Akpınar, Khaled Obaid, Cagatay Göğüş, Saba Kiremitci, Duygu Enneli, Sümer Baltacı, and Evren Süer Murat Can KaraburunMurat Can Karaburun Corresponding Author: Murat Can Karaburun, MD, Ankara Üniversitesi Tıp Fakültesi, İbni Sina Hastanesi Üroloji Kliniği, 06230, Altındağ, Ankara , Turkey ([email protected]) https://orcid.org/0000-0001-6917-9051 , Ezgi Dicle KuzEzgi Dicle Kuz , Çağrı AkpınarÇağrı Akpınar , Khaled ObaidKhaled Obaid , Cagatay GöğüşCagatay Göğüş , Saba KiremitciSaba Kiremitci , Duygu EnneliDuygu Enneli , Sümer BaltacıSümer Baltacı , and Evren SüerEvren Süer View All Author Informationhttps://doi.org/10.1097/JU.0000000000003990AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail Abstract Purpose: We aimed to compare recurrence-free survival (RFS) and progression-free survival (PFS) of the patients with pure high-grade (HG) vs mixed-grade (MG) nonmuscle-invasive bladder cancer who received adequate bacillus Calmette-Guérin therapy. Material and Methods: We conducted a retrospective cohort analysis using data from an institutional database. The study included patients diagnosed with HG nonmuscle-invasive bladder cancer at the initial transurethral resection specimen between 2010 and 2020. The initial transurethral resection specimens of all patients were reevaluated by a dedicated uropathologist. The percentage of low-grade tumor areas accompanying HG areas was determined for each case. Time-to-event analysis was performed using the Kaplan-Meier method. RFS and PFS rates were compared between groups. Results: Of the 203 patients enrolled in the study, 69 (34%) had MG tumors. Recurrence was observed in 41 out of 134 patients (30.6%) in the HG group and in 19 out of 69 patients (27.5%) in the MG group. The 36-month RFS rates were 69% (CI: 62-77) and 72% (CI: 62-83) for the HG–urothelial carcinoma (UC) and MG-UC groups, respectively. The RFS rates were similar between groups (log-rank, P = .58). Progression was observed in 22 out of 134 patients (16.4%) in the HG group and in 4 out of 69 patients (5.8%) in the MG group. The 36-month PFS rates were 84% (CI: 77-90) and 94% (CI: 89-100) for the HG-UC and MG-UC groups, respectively. The pure HG-UC group had a worse PFS than the MG-UC group (log-rank, P = .042). Multivariate analysis demonstrated that age and tumor grade were significant risk factors for the development of progression. Conclusions: The indication of MG-UC category separately from pure HG carcinomas in the pathology report seems to be an important issue that can guide patient management. In this way, both more accurate risk classification and more accurate patient counseling can be performed. More importantly, the treatment plan can be made more accurately. For more precise conclusions, our results should be supported by prospective studies with larger sample size. REFERENCES 1. . What's new in WHO fifth edition—urinary tract. Histopathology.2022; 81(4):439-446. doi: 10.1111/his.14764 Crossref, Medline, Google Scholar 2. . European Association of Urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol.2022; 81(1):75-94. doi: 10.1016/j.eururo.2021.08.010 Crossref, Medline, Google Scholar 3. . Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials. Eur Urol.2006; 49(3):466-477. doi: 10.1016/j.eururo.2005.12.031 Crossref, Medline, Google Scholar 4. . The effect of tumor grade heterogeneity on recurrence in non-muscle invasive bladder cancer. Urol Oncol.2022; 40(2):60.e11-60.e16. doi: 10.1016/j.urolonc.2021.07.003 Crossref, Medline, Google Scholar 5. . Significance of a minor high-grade component in a low-grade noninvasive papillary urothelial carcinoma of bladder. Hum Pathol.2016; 47(1):20-25. doi: 10.1016/j.humpath.2015.09.007 Crossref, Medline, Google Scholar 6. . Mixed low- and high-grade non-muscle-invasive bladder cancer: a histological subtype with favorable outcome. World J Urol.2015; 33(6):847-852. doi: 10.1007/s00345-014-1383-5 Crossref, Medline, Google Scholar 7. . Mixed high and low grade bladder tumors—are they clinically high or low grade?. J Urol.2014; 191(6):1693-1696. doi: 10.1016/j.juro.2013.11.056 Link, Google Scholar 8. . Cancer heterogeneity and its biologic implications in the grading of urothelial carcinoma. Cancer.2000; 88(7):1663-1670. doi: 10.1002/(sici)1097-0142(20000401)88:7<1663::aid-cncr21>3.0.co;2-8 Crossref, Medline, Google Scholar 9. . Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol.2000; 163(4):1124-1129. doi: 10.1016/s0022-5347(05)67707-5 Link, Google Scholar 10. . Definitions, end points, and clinical trial designs for non-muscle-invasive bladder cancer: recommendations from the International Bladder Cancer Group. J Clin Oncol.2016; 34(16):1935-1944. doi: 10.1200/JCO.2015.64.4070 Crossref, Medline, Google Scholar 11. . Tumor grade heterogeneity in urothelial bladder carcinoma—proposal of a system using combined numbers. Scand J Urol Nephrol.2001; 35(4):275-279. doi: 10.1080/003655901750425837 Crossref, Medline, Google Scholar 12. . The World Health Organization/International Society of Urological pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol.1998; 22(12):1435-1448. doi: 10.1097/00000478-199812000-00001 Crossref, Medline, Google Scholar 13. . Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. WHO Classification of Tumours, 3rd edition, volume 7. IARC Press; 2004. Google Scholar 14. . European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) incorporating the WHO 2004/2016 and WHO 1973 classification systems for grade: an update from the EAU NMIBC guidelines panel. Eur Urol.2021; 79(4):480-488. doi: 10.1016/j.eururo.2020.12.033 Crossref, Medline, Google Scholar 15. . The origins of urothelial carcinoma. Expert Rev Anticancer Ther.2010; 10(6):865-880. doi. 10.1586/era.10.73 Crossref, Medline, Google Scholar 16. . Analysis of papillary urothelial carcinomas of the bladder with grade heterogeneity: supportive evidence for an early role of CDKN2A deletions in the FGFR3 pathway. Histopathology.2017; 70(2):281-289. doi: 10.1111/his.13063 Crossref, Medline, Google Scholar 17. . Side effects of bacillus Calmette-Guérin (BCG) in the treatment of intermediate- and high-risk Ta, T1 papillary carcinoma of the bladder: results of the EORTC genito-urinary cancers group randomised phase 3 study comparing one-third dose with full dose and 1 year with 3 years of maintenance BCG. Eur Urol.2014; 65(1):69-76. doi: 10.1016/j.eururo.2013.07.021 Crossref, Medline, Google Scholar Funding/Support: None. Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. İ05-299-22). Author Contributions: Conception and design: Karaburun, Göğüş, Baltacı, Süer. Data analysis and interpretation: Karaburun, Kuz, Akpınar, Obaid, Kiremitci, Enneli, Baltacı, Süer. Data acquisition: Karaburun, Kuz, Obaid, Enneli, Baltacı. Drafting the manuscript: Karaburun, Akpınar, Obaid, Enneli, Baltacı. Critical revision of the manuscript for scientific and factual content: Karaburun, Kuz, Göğüş, Kiremitci, Enneli, Baltacı, Süer. Statistical analysis: Karaburun, Kuz, Akpınar, Obaid. Supervision: Karaburun, Göğüş, Kiremitci, Enneli, Baltacı, Süer. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsnonmuscle-invasive bladder cancergrade heterogeneitybladder cancerbacillus Calmette-GuérinsurvivalMetrics Author Information Murat Can Karaburun Corresponding Author: Murat Can Karaburun, MD, Ankara Üniversitesi Tıp Fakültesi, İbni Sina Hastanesi Üroloji Kliniği, 06230, Altındağ, Ankara , Turkey ([email protected]) More articles by this author Ezgi Dicle Kuz More articles by this author Çağrı Akpınar More articles by this author Khaled Obaid More articles by this author Cagatay Göğüş More articles by this author Saba Kiremitci More articles by this author Duygu Enneli More articles by this author Sümer Baltacı More articles by this author Evren Süer More articles by this author Expand All Funding/Support: None. Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose. Ethics Statement: This study received Institutional Review Board approval (IRB No. İ05-299-22). Author Contributions: Conception and design: Karaburun, Göğüş, Baltacı, Süer. Data analysis and interpretation: Karaburun, Kuz, Akpınar, Obaid, Kiremitci, Enneli, Baltacı, Süer. Data acquisition: Karaburun, Kuz, Obaid, Enneli, Baltacı. Drafting the manuscript: Karaburun, Akpınar, Obaid, Enneli, Baltacı. Critical revision of the manuscript for scientific and factual content: Karaburun, Kuz, Göğüş, Kiremitci, Enneli, Baltacı, Süer. Statistical analysis: Karaburun, Kuz, Akpınar, Obaid. Supervision: Karaburun, Göğüş, Kiremitci, Enneli, Baltacı, Süer. Advertisement PDF downloadLoading ...

Urothelial cancer

Bacillus (shape)

10.1097/ju.0000000000003990

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Value of selective upper tract cytology for recognition of upper tract tumors after treatment of superficial bladder cancer

International Journal of Urology (2003)

Çağatay Göğüş Sümer Baltacı Savaş Şahinli Kadir Türkölmez Yaşar Bedük

The value of selective upper urinary tract (UT) cytology in patients who are asymptomatic and tumor free at control cystoscopy after being treated for superficial bladder carcinoma has not been studied. The present study was performed to evaluate the value of selective UT cytology in patients who are tumor free at control cystoscopy after being treated for superficial bladder cancer.Forty-seven consecutive patients who had undergone definitive surgical treatment for superficial bladder cancer at least 24 months prior and were tumor free at control cystoscopy were evaluated with bladder wash for cytology as well as selective UT urine cytology by catheterization of both ureteral orifices. Of the 47 patients, disease was stage Ta in 30 (63.8%), T1 in 15 (31.9%) and Ta/Tcis in 2 (4.3%). Primary tumor was unifocal in 24 (51.1%) and multifocal in 23 (48.9%) patients. The time elapsed from the initial diagnosis to the last evaluation ranged from 2 to 21 years (mean 5.39).UT cytology was positive in 2 cases. Although, excretory urography (IVP) revealed mild pelvicalicectasis in 1 of these 2 patients, ureterorenoscopy (URS) revealed no abnormality. In the other patient with normal IVP and retrograde pyelography (RGP), URS revealed a ureteral tumor 5 mm in diameter. Although the UT cytology was normal in the remaining 45 patients, IVP revealed right hydronephrosis in 1 patient and URS revealed multiple ureteral tumors.Given the normal appearance of the UT, it is highly unlikely that these patients have tumor in the UT. Thus, during the follow-up of patients with superficial bladder cancer, it is not useful to perform UT select cytology in the absence of any identifiable filling defects in the upper urinary tract.

Urine cytology

Upper urinary tract

10.1046/j.1442-2042.2003.00611.x

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Significance of the interval between first and second transurethral resection on recurrence and progression rates in patients with high-risk non-muscle-invasive bladder cancer treated with maintenance intravesical Bacillus Calmette-Guérin

BJU International (2015)

Sümer Baltacı Murat Bozlu Asıf Yıldırım Mehmet İlker Gökçe İlker Tınay

To evaluate the effect of the interval between the initial and second transurethral resection (TUR) on the outcome of patients with high-risk non-muscle-invasive bladder cancer (NMIBC) treated with maintenance intravesical Bacillus Calmette-Guérin (BCG) therapy.We reviewed the data of patients from 10 centres treated for high-risk NMIBC between 2005 and 2012. Patients without a diagnosis of muscle-invasive cancer on second TUR performed ≤90 days after a complete first TUR, and received at least 1 year of maintenance BCG were included in this study. The interval between first and second TUR in addition to other parameters were recorded. Multivariate logistic regression analysis was used to identify predictors of recurrence and progression.In all, 242 patients were included. The mean (sd, range) follow-up was 29.4 (22.2, 12-96) months. The 3-year recurrence- and progression-free survival rates of patients who underwent second TUR between 14 and 42 days and 43-90 days were 73.6% vs 46.2% (P < 0.001) and 89.1% vs 79.1% (P = 0.006), respectively. On multivariate analysis, the interval to second TUR was found to be a predictor of both recurrence [odds ratio (OR) 3.598, 95% confidence interval (CI) 1.885-8.137; P = 0.001] and progression (OR 2.144, 95% CI 1.447-5.137; P = 0.003).The interval between first and second TUR should be ≤42 days in order to attain lower recurrence and progression rates. To our knowledge, this is the first study demonstrating the effect of the interval between first and second TUR on patient outcomes.

Tumor progression

10.1111/bju.13102

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MULTICENTER EVALUATION OF A QUESTIONNAIRE-BASED SCREENING TOOL IN UROTHELIAL CARCINOMA OF THE BLADDER

The Journal of Urology (2008)

Levent Türkeri Polat Türker Bülent Günlüsoy Asıf Yıldırım Güven Aslan

You have accessJournal of Urology1 Apr 2008MULTICENTER EVALUATION OF A QUESTIONNAIRE-BASED SCREENING TOOL IN UROTHELIAL CARCINOMA OF THE BLADDER Levent Turkeri, Polat Turker, Bulent Gunlusoy, Asif Yildirim, Guven Aslan, Aydin Mungan, Sumer Baltaci, Mustafa Kaplan, Hayrettin Sahin, Murat Bozlu, and Gerson Ludecke Levent TurkeriLevent Turkeri More articles by this author , Polat TurkerPolat Turker More articles by this author , Bulent GunlusoyBulent Gunlusoy More articles by this author , Asif YildirimAsif Yildirim More articles by this author , Guven AslanGuven Aslan More articles by this author , Aydin MunganAydin Mungan More articles by this author , Sumer BaltaciSumer Baltaci More articles by this author , Mustafa KaplanMustafa Kaplan More articles by this author , Hayrettin SahinHayrettin Sahin More articles by this author , Murat BozluMurat Bozlu More articles by this author , and Gerson LudeckeGerson Ludecke More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(08)60939-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "MULTICENTER EVALUATION OF A QUESTIONNAIRE-BASED SCREENING TOOL IN UROTHELIAL CARCINOMA OF THE BLADDER." The Journal of Urology, 179(4S), p. 321 © 2008 by American Urological AssociationFiguresReferencesRelatedDetails Volume 179Issue 4SApril 2008Page: 321 Advertisement Copyright & Permissions© 2008 by American Urological AssociationMetricsAuthor Information Levent Turkeri More articles by this author Polat Turker More articles by this author Bulent Gunlusoy More articles by this author Asif Yildirim More articles by this author Guven Aslan More articles by this author Aydin Mungan More articles by this author Sumer Baltaci More articles by this author Mustafa Kaplan More articles by this author Hayrettin Sahin More articles by this author Murat Bozlu More articles by this author Gerson Ludecke More articles by this author Expand All Advertisement PDF DownloadLoading ...

10.1016/s0022-5347(08)60939-8

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Extracorporeal Shockwave Lithotripsy in Anomalous Kidneys

Journal of Endourology (1994)

Sümer Baltacı Kemal Sarıca Erol Özdi̇ler Çetin Dinçel Sadettin Küpeli

Traditionally, stones in anomalous kidneys have been removed by open or percutaneous surgery. Extracorporeal Shockwave lithotripsy (SWL) with the Dornier MPL 9000 lithotripter was performed in seven patients with horseshoe kidneys, four with pelvic ectopic kidneys, and six with malrotated kidneys. Twelve patients (71%) needed repeated treatments. A total of 11 patients (65%) in all the groups were stone free, and four patients had asymptomatic residual fragments no more than 5 mm in diameter. In the remaining two patients, no sign of stone disintegration was observed, and they underwent open surgery. Extracorporeal lithotripsy is the treatment of choice for stones in horseshoe or malrotated kidneys but is not useful for stones in most pelvic kidneys.

Extracorporeal shockwave lithotripsy

Horseshoe kidney

Extracorporeal

Open surgery

Pelvic kidney

Ectopic kidney

10.1089/end.1994.8.179

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Citations (20)

Use of Percent Free Prostate-Specific Antigen Density to Improve the Specificity for Detecting Prostate Cancer in Patients with Normal Rectal Examinations and Intermediate Prostate-Specific Antigen Levels

Urologia Internationalis (2003)

Sümer Baltacı Hakan Aksoy Kadir Türkölmez Atilla Halil Elhan Eriz Özden

As prostatic volume influences percent free prostate-specific antigen (PSA) in patients with prostate cancer, we evaluated whether percent free PSA density, which relates the serum percent free PSA to the volume of the prostate determined by transrectal ultrasound, could increase the specificity of cancer detection in men with normal digital rectal examinations and intermediate PSA levels.We prospectively evaluated 105 consecutive men with normal digital rectal examinations and serum PSA levels of 4.1-10.0 ng/ml. All patients underwent at least sextant prostate biopsies to establish the diagnosis. For detection of total and free PSA we used an Immulite free and total PSA assay. We compared PSA density, percent free PSA and percent free PSA density for their utility in cancer detection.Overall, 20 of 105 patients (19%) had prostate cancer. The area under the curve (AUC) for percent free PSA density was 0.771, not significantly higher than the AUC of 0.75 for PSA density (p = 0.778), but significantly higher than the AUC of 0.604 for percent free PSA (p = 0.021). Of these three parameters, percent free PSA density yielded the highest specificity percentage (54.1%) at 95% sensitivity.Percent free PSA density is more specific than percent free PSA in distinguishing benign from malignant disease in men with a normal digital rectal examination and an intermediate PSA level. Further study is necessary to discover whether percent free PSA density is superior to percent free PSA or PSA density.

Rectal examination

10.1159/000067700

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Treatment of Primary Tumor in Oligometastatic Prostate Cancer: An Observational Study of the Turkish Urooncology Association Prostate Diseases Working Group

Bulletin of Urooncology (2023)

Murat Yavuz Koparal Tevfik Sözen Güven Aslan Sümer Baltacı Oğuzcan Erbatu

Objective: To report the clinical results of patients who had metastatic prostate cancer (PC) at admission and underwent standard androgen deprivation therapy with radiotherapy (RT) and radical prostatectomy (RP) for the primary tumor. Materials and Methods:This study used the PC database from the Turkish Urooncology Association, to which participating institutions submit online data.The following clinical, radiological, and pathological findings were retrieved from the database: age, total prostate-specific antigen, clinical TNM stage, number of metastases, International Society of Urological Pathology grade group of biopsy, time to castration-resistant disease, type of local treatment, type of staging method, status of survival, type of systemic treatment, and follow-up time. Results:The median follow-up of the 18 included patients was 59.1 (19.9-180) months.RP and extended lymphadenectomy were performed in 12 patients.RT was performed in 6 patients.The median number of metastases was 2 (1-4) and 3 (1-4) in the RP and RT groups, respectively.In the RP group, 3 of 12 patients developed castration-resistant prostate cancer (CRPC) during the follow-up period.In the RT group, 2 of 6 patients developed CRPC in the follow-up period.The time to CRPC was 48.4 and 43.3 months, respectively.Conclusion: While primary tumor-directed RT is effective in selected patients, the results of prospective randomized controlled studies are required to demonstrate the effectiveness of RP.

10.4274/uob.galenos.2023.2023.1.4

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