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Holmberg, L., Skogmar, S., Garmo, H., Hagberg, O., Häggström, C., Gårdmark, T., . . . Liedberg, F. (2024). Cumulative incidence of and risk factors for BCG infection after adjuvant BCG instillations. BJU International
Open this publication in new window or tab >>Cumulative incidence of and risk factors for BCG infection after adjuvant BCG instillations
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2024 (English)In: BJU International, ISSN 1464-4096, E-ISSN 1464-410XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: To investigate the cumulative incidence proportion of disseminated or local Bacillus Calmette-Guérin (BCG) infections after adjuvant BCG instillations in patients with non-muscle-invasive bladder cancer (NMIBC).

PATIENTS AND METHODS: We analysed the timing and occurrence of BCG infections and absolute and relative risk in relation to patient characteristics available in the Swedish nationwide database 'BladderBaSe 2.0'. The cumulative incidence proportion of a BCG infection was indicated by a reported diagnosis of tuberculosis (TB) in the patient registry or filing a prescription for tuberculostatic drugs.

RESULTS: The cumulative incidence proportion was 1.1% at the 5-year follow-up in 5033 patients exposed to adjuvant BCG instillations. The incidence rate was highest during the first 2 years after start of BCG instillations. Women had a lower risk than men (hazard ratio 0.23, 95% confidence interval 0.07-0.74). Age and calendar time at diagnosis, comorbidity, tumour risk group, previous medication with corticosteroids, immunosuppressive drugs, or time between transurethral resection of the bladder tumour and commencing the adjuvant BCG instillation were not associated with risk.

CONCLUSIONS: These data further supports that the overall risk of a BCG infection after BCG-instillation treatment for NMIBC is low. The great majority of infections occur in the first 2 years, calling for an awareness of the diverse symptoms of BCG infection during this period. We provide evidence for male sex as a risk factor; however, the statistical precision is low and with a risk of selection bias, making it difficult to rule out the other suggested risk factors without further studies with different approaches.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
BCG instillations, cumulative incidence proportion, local or systemic BCG infections, non-muscle-invasive bladder cancer, risk factors
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-221629 (URN)10.1111/bju.16303 (DOI)38403809 (PubMedID)2-s2.0-85186546298 (Scopus ID)
Funder
Swedish Cancer Society, CAN 2022/1971Swedish Cancer Society, CAN 2023/2807Swedish Research Council, 2021-00859
Available from: 2024-02-29 Created: 2024-02-29 Last updated: 2024-03-13
Enlund, M., Hållberg, H., Berglund, A., Sherif, A., Enlund, A. & Bergkvist, L. (2024). Long-term survival after volatile or propofol general anesthesia for bladder cancer surgery: a retrospective national registry cohort study. Anesthesiology
Open this publication in new window or tab >>Long-term survival after volatile or propofol general anesthesia for bladder cancer surgery: a retrospective national registry cohort study
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2024 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Prospective interventional trials and retrospective observational analyses provide conflicting evidence regarding the relationship between propofol versus inhaled volatile general anesthesia and long-term survival after cancer surgery. In specific, bladder cancer surgery lacks prospective clinical trial evidence.

METHODS: Data on bladder cancer surgery performed under general anesthesia between 2014 and 2021 from The National Quality Registry for Urinary Tract and Bladder Cancer and the Swedish Perioperative Registry were record-linked. Overall survival was compared between patients receiving propofol or inhaled volatile for anesthesia maintenance. The minimum clinically important difference was defined as a five-percentage point difference in five-year survival.

RESULTS: Of 7,571 subjects, 4,519 (59.7%) received an inhaled volatile anesthetic and 3,052 (40.3%) received propofol for general anesthesia maintenance. The two groups were quite similar in most respects but differed in ASA physical status and tumor stage. Propensity score matching was used to address treatment bias. Survival did not differ during follow-up (median 45 months [interquartile range, 33 to 62]) in neither the full unmatched cohort, nor following 1:1 propensity score matching (3,052 matched pairs). The Kaplan-Meier adjusted five-year survival rates in the matched cohort were 898/3,052, 67.5% (65.7-69.3) for propofol and 852/3,052, 68.5% (66.7-70.4) for inhaled volatile general anesthesia, respectively (hazard ratio 1.05 [95% CI: 0.96 to 1.15], P = 0.332). A sensitivity analysis restricted to 1,766 propensity score matched pairs of patients who received only one general anesthetic during the study period did not demonstrate a difference in survival; Kaplan-Meier adjusted five-year-survival rates were 521/1,766, 67.1% (64.7-69.7) and 482/1,766, 68.9% (66.5-71.4) for propofol and inhaled volatile general anesthesia, respectively (hazard ratio 1.09 [95% CI: 0.97 to 1.23], P = 0.139).

CONCLUSIONS: Among patients undergoing bladder cancer surgery under general anesthesia, there was no statistically significant difference in long-term overall survival associated with the choice of propofol or an inhaled volatile maintenance.

Place, publisher, year, edition, pages
Wolters Kluwer, 2024
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-222332 (URN)10.1097/ALN.0000000000004969 (DOI)38466217 (PubMedID)
Available from: 2024-03-14 Created: 2024-03-14 Last updated: 2024-03-14
Wiberg, E., Vega, A., Eriksson, V., Banday, V. S., Svensson, J., Eriksson, E. K., . . . Sherif, A. (2023). A validation study of cT-categories in the Swedish national urinary bladder cancer register - Norrland University Hospital. Journal of Personalized Medicine, 13(7), Article ID 1163.
Open this publication in new window or tab >>A validation study of cT-categories in the Swedish national urinary bladder cancer register - Norrland University Hospital
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2023 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 13, no 7, article id 1163Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In Sweden, all patients with urinary bladder cancer (UBC) are recorded in the Swedish National Register for Urinary Bladder Cancer (SNRUBC). The purpose of this study was to validate the registered clinical tumour categories (cT-categories) in the SNRUBC for Norrland University Hospital, Sweden, from 2009 to 2020, inclusive.

METHODS: The medical records of all 295 patients who underwent radical cystectomy for the treatment of UBC were reviewed retrospectively. Possible factors impacting the cT-categories were identified. To optimise cT-classification, computed tomography urography of all patients with suspected tumour-associated hydronephrosis (TAH) or suspected tumour in bladder diverticulum (TIBD) were retrospectively reviewed by a radiologist. Discrepancy was tested with a logistic regression model.

RESULTS: cT-categories differed in 87 cases (29.5%). Adjusted logistic regression analysis found TIBD and TAH as significant predictors for incorrect registration; OR = 7.71 (p < 0.001), and OR = 17.7, (p < 0.001), respectively. In total, 48 patients (68.6%) with TAH and 12 patients (52.2%) with TIBD showed discrepancy regarding the cT-category. Incorrect registration was mostly observed during the years 2009-2012.

CONCLUSION: The study revealed substantial incorrect registration of cT-categories in SNRUBC. A major part of the misclassifications was related to TAH and TIBD. Registration of these variables in the SNRUBC might be considered to improve correct cT-classification.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
hydronephrosis, neoplasm staging, tumour in bladder diverticulum, urinary bladder neoplasm, validation study
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-212875 (URN)10.3390/jpm13071163 (DOI)001038517500001 ()37511776 (PubMedID)2-s2.0-85166304439 (Scopus ID)
Available from: 2023-08-14 Created: 2023-08-14 Last updated: 2023-09-26Bibliographically approved
Saudi, A., Banday, V. S., Zirakzadeh, A. A., Selinger, M., Forsberg, J., Holmbom, M., . . . Sherif, A. (2023). Immune-activated B cells are dominant in prostate cancer. Cancers, 15(3), Article ID 920.
Open this publication in new window or tab >>Immune-activated B cells are dominant in prostate cancer
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2023 (English)In: Cancers, ISSN 2072-6694, Vol. 15, no 3, article id 920Article in journal (Refereed) Published
Abstract [en]

B cells are multifaceted immune cells responding robustly during immune surveillance against tumor antigens by presentation to T cells and switched immunoglobulin production. However, B cells are unstudied in prostate cancer (PCa). We used flow cytometry to analyze B-cell subpopulations in peripheral blood and lymph nodes from intermediate-high risk PCa patients. B-cell subpopulations were related to clinicopathological factors. B-cell-receptor single-cell sequencing and VDJ analysis identified clonal B-cell expansion in blood and lymph nodes. Pathological staging was pT2 in 16%, pT3a in 48%, and pT3b in 36%. Lymph node metastases occurred in 5/25 patients (20%). Compared to healthy donors, the peripheral blood CD19+ B-cell compartment was significantly decreased in PCa patients and dominated by naïve B cells. The nodal B-cell compartment had significantly increased fractions of CD19+ B cells and switched memory B cells. Plasmablasts were observed in tumor-draining sentinel lymph nodes (SNs). VDJ analysis revealed clonal expansion in lymph nodes. Thus, activated B cells are increased in SNs from PCa patients. The increased fraction of switched memory cells and plasmablasts together with the presence of clonally expanded B cells indicate tumor-specific T-cell-dependent responses from B cells, supporting an important role for B cells in the protection against tumors.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
B cells, T cells, prostatic neoplasms, sentinel lymph node biopsy
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-204791 (URN)10.3390/cancers15030920 (DOI)000933775500001 ()36765877 (PubMedID)2-s2.0-85147818726 (Scopus ID)
Funder
Swedish Research Council, 2022-5-18The Kempe Foundations
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2024-02-01Bibliographically approved
Aas, K. & Sherif, A. (2023). Long-term patient follow-up should be routinely implemented in radiotherapy units to detect late adverse effects after cancer treatment. Scandinavian journal of urology, 58, 30-31
Open this publication in new window or tab >>Long-term patient follow-up should be routinely implemented in radiotherapy units to detect late adverse effects after cancer treatment
2023 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 58, p. 30-31Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Medical Journals Sweden, 2023
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-212869 (URN)10.2340/sju.v58.13470 (DOI)37551085 (PubMedID)2-s2.0-85166785492 (Scopus ID)
Note

Editorial comment to: Brändstedt et al. (2023). Urosymphyseal fistula after pelvic radiotherapy - an entity in patients with significant comorbidity requiring multidisciplinary management. Scandinavian Journal of Urology.

Available from: 2023-08-14 Created: 2023-08-14 Last updated: 2024-02-01Bibliographically approved
Kowald, S., Huge, Y., Tandiono, D., Ali, Z., Vazquez-Rodriguez, G., Erkstam, A., . . . Jensen, L. D. (2023). Novel zebrafish patient-derived tumor xenograft methodology for evaluating efficacy of immune-stimulating bcg therapy in urinary bladder cancer. Cells, 12(3), Article ID 508.
Open this publication in new window or tab >>Novel zebrafish patient-derived tumor xenograft methodology for evaluating efficacy of immune-stimulating bcg therapy in urinary bladder cancer
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2023 (English)In: Cells, E-ISSN 2073-4409, Vol. 12, no 3, article id 508Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Bacillus Calmette-Guérin (BCG) immunotherapy is the standard-of-care adjuvant therapy for non-muscle-invasive bladder cancer in patients at considerable risk of disease recurrence. Although its exact mechanism of action is unknown, BCG significantly reduces this risk in responding patients but is mainly associated with toxic side-effects in those facing treatment resistance. Methods that allow the identification of BCG responders are, therefore, urgently needed.

METHODS: Fluorescently labelled UM-UC-3 cells and dissociated patient tumor samples were used to establish zebrafish tumor xenograft (ZTX) models. Changes in the relative primary tumor size and cell dissemination to the tail were evaluated via fluorescence microscopy at three days post-implantation. The data were compared to the treatment outcomes of the corresponding patients. Toxicity was evaluated based on gross morphological evaluation of the treated zebrafish larvae.

RESULTS: BCG-induced toxicity was avoided by removing the water-soluble fraction of the BCG formulation prior to use. BCG treatment via co-injection with the tumor cells resulted in significant and dose-dependent primary tumor size regression. Heat-inactivation of BCG decreased this effect, while intravenous BCG injections were ineffective. ZTX models were successfully established for six of six patients based on TUR-B biopsies. In two of these models, significant tumor regression was observed, which, in both cases, corresponded to the treatment response in the patients.

CONCLUSIONS: The observed BCG-related anti-tumor effect indicates that ZTX models might predict the BCG response and thereby improve treatment planning. More experiments and clinical studies are needed, however, to elucidate the BCG mechanism and estimate the predictive value.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
BCG, PDX, cancer, immune-oncology, personalized medicine, xenograft, zebrafish
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-204792 (URN)10.3390/cells12030508 (DOI)000933763100001 ()36766850 (PubMedID)2-s2.0-85147820509 (Scopus ID)
Funder
Vinnova, 2020-04728EU, Horizon 2020, CRYSTAL3
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2024-02-01Bibliographically approved
Bergengren, O., Belozerov, A., Bill-Axelson, A., Garmo, H., Hagberg, O., Aljabery, F., . . . Liedberg, F. (2023). Short term outcomes after robot assisted and open cystectomy: A nation-wide population-based study. European Journal of Surgical Oncology, 49(4), 868-874
Open this publication in new window or tab >>Short term outcomes after robot assisted and open cystectomy: A nation-wide population-based study
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2023 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 49, no 4, p. 868-874Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for urinary bladder cancer in a large population.

MATERIALS AND METHODS: We included all patients without distant metastases who underwent either RARC or ORC with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days, and secondary outcomes within 90 days of surgery were reoperations, Clavien 3-5 complications, total days alive and out of hospital, and mortality. The analysis was carried out using multivariate regression models.

RESULTS: Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures were to a larger extent performed during later years, at high volume centers (47% vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC were more commonly readmitted (29% vs. 25%). In multivariable analysis RARC was associated with decreased risk of Clavien 3-5 complications (OR 0.58, 95% CI 0.47-0.72), reoperations (OR 0.53, 95% CI 0.39-0.71) and had more days alive and out of hospital (mean difference 3.7 days, 95% CI 2.4-5.0).

CONCLUSION: This study illustrates the "real-world" effects of a gradual and nation-wide introduction of RARC. Patients operated with RARC had fewer major complications and reoperations but were more frequently readmitted compared to ORC. The observed differences were largely due to more wound related complications among patients treated with ORC.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Morbidity, Mortality, Open, Radical cystectomy, Robot assisted, Urinary bladder cancer
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-204795 (URN)10.1016/j.ejso.2023.01.023 (DOI)000966150500001 ()36759262 (PubMedID)2-s2.0-85148710732 (Scopus ID)
Funder
Swedish Cancer Society, 2019/62Swedish Cancer Society, 2020/0709Swedish Research Council, 2021-00859Region Skåne
Available from: 2023-02-13 Created: 2023-02-13 Last updated: 2024-02-01Bibliographically approved
Schulz Hägersten, E., Ottosson, K., Pelander, S., Johansson, M., Huge, Y., Aljabery, F., . . . Sherif, A. (2023). The risk of thromboembolism in patients with muscle invasive bladder cancer before and after cystectomy depending on blood group and neoadjuvant chemotherapy: a multicentre retrospective cohort study. Journal of Personalized Medicine, 13(9), Article ID 1355.
Open this publication in new window or tab >>The risk of thromboembolism in patients with muscle invasive bladder cancer before and after cystectomy depending on blood group and neoadjuvant chemotherapy: a multicentre retrospective cohort study
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2023 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 13, no 9, article id 1355Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Previous studies have indicated that patients with muscle-invasive bladder cancer with non-O blood types have an increased risk of experiencing thromboembolic events (TEEs). This is finding is in relation to neoadjuvant-chemotherapy (NAC)-naïve patients.

AIM: to establish the risk of TEEs and any association with blood types among NAC patients as well as NAC-naïve patients.

METHODS: Cystectomized patients at four centres treated from 2009 to 2018 (n = 244) were analysed. The quantities of patients corresponding to each blood group were as follows: A-108 (44%); O-99 (41%); B-30 (12%); and AB-7 (3%). NAC patients (n = 167) and NAC-naïve NAC-eligible patients (n = 77) were assessed. In total, 54 women (22%) and 190 men (78%), with a median age of 69 years, were included in the study. The occurrence of any type of TEE from six months pre-cystectomy to 12-24 months after was analysed using logistic regression adjusted for NAC and confounders.

RESULTS: Sixty-six TEEs were detected in 21% of the patients (n = 52). Pulmonary embolus (n = 33) and deep venous thrombosis (n = 11) were the most common forms. No significant differences between blood types were found in the analysis, although B blood type had a nearly significant increased crude risk compared with O blood type, for which there was an OR of 2.48 (95% CI 0.98-6.36). Adjustment for NAC and covariates weakened the OR, which plummeted to 1.98 (95% CI 0.71-5.51).

CONCLUSIONS: No significant associations were found between blood types and TEE occurrences in this cohort including both NAC and NAC-naïve NAC-eligible patients.

Place, publisher, year, edition, pages
MDPI, 2023
Keywords
ABO blood group system, complications, cystectomy, neoadjuvant therapy, thromboembolism, urinary bladder neoplasms
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-214814 (URN)10.3390/jpm13091355 (DOI)001073713500001 ()37763123 (PubMedID)2-s2.0-85172903119 (Scopus ID)
Funder
Region Västerbotten, RV-848051
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2024-02-01Bibliographically approved
Asad, D., Styrke, J., Hagsheno, M., Johansson, M., Huge, Y., Svensson, J., . . . Sherif, A. (2022). A prospective multicenter study of visual response-evaluation by cystoscopy in patients undergoing neoadjuvant chemotherapy for muscle invasive urinary bladder cancer. Scandinavian journal of urology, 56(1), 20-26
Open this publication in new window or tab >>A prospective multicenter study of visual response-evaluation by cystoscopy in patients undergoing neoadjuvant chemotherapy for muscle invasive urinary bladder cancer
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2022 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 56, no 1, p. 20-26Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To evaluate a method of transurethral visual response-staging in patients with urothelial muscle-invasive urinary bladder cancer (MIBC), undergoing neoadjuvant chemotherapy (NAC) and radical cystectomy (RC).

METHODS: A prospective study at four Swedish cystectomy centers, cystoscopy was performed after final NAC-cycle for MIBC. Fifty-six participants underwent cystoscopy for visual staging of the tumor immediately pre-RC. Visual assessments were correlated to pathoanatomical outcomes post-RC.

RESULTS: Seventeen tumors were classified as complete response (CR), i.e. pT0. Twenty-five patients had residual MIBC and 14 had non-muscle invasive residual tumors (NMIBC). Of the 39 patients with residual tumor, 25 were correctly identified visually (64%). Eleven patients were pN+. The diagnostic accuracy of cystoscopy to correctly identify complete response or remaining tumor was 70% (CI = 56-81%) with a sensitivity of 64% (CI = 47-79%), specificity 82% (CI = 57-96%), PPV 89% (CI = 74-96%) and NPV 50% (CI =38-61%). Twenty-eight cystoscopy evaluations showed signs of residual tumors and 3/28 (11%) were false positive. In 4/14 patients assessed having residual NMIBC the estimates were correct, 8/14 had histopathological MIBC and 2/14 had CR. In 11/14 patients (79%), the suggested visual assessment of MIBC was correct, 2/14 had NMIBC and 1/14 had CR. Twenty-eight cystoscopies had negative findings, 14 were false negatives (50%), when cystoscopy falsely predicted pT0. Among them there were eight patients with pTa, pT1 or pTis and six MIBC-tumors. In 17 patients with histopathological pT0, 14 were correctly identified with cystoscopy (82%).

CONCLUSION: Cystoscopy after the final NAC-cycle cannot robustly differentiate between NAC-responders and non-responders. Visually, negative MIBC-status cannot be determined safely.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2022
Keywords
Cystectomy, neoadjuvant therapy, neoplasm staging, urinary bladder neoplasms
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-189869 (URN)10.1080/21681805.2021.2002402 (DOI)000721156100001 ()34806518 (PubMedID)2-s2.0-85119682221 (Scopus ID)
Funder
Region Västerbotten, RV-848051Cancerforskningsfonden i Norrland, 13-2000
Available from: 2021-11-23 Created: 2021-11-23 Last updated: 2023-09-26Bibliographically approved
Eriksson, V., Holmkvist, O., Huge, Y., Johansson, M., Alamdari, F., Svensson, J., . . . Sherif, A. (2022). A retrospective analysis of the de ritis ratio in muscle invasive bladder cancer, with focus on tumor response and long-term survival in patients receiving neoadjuvant chemotherapy and in chemo naïve cystectomy patients: a study of a clinical multicentre database. Journal of Personalized Medicine, 12(11), Article ID 1769.
Open this publication in new window or tab >>A retrospective analysis of the de ritis ratio in muscle invasive bladder cancer, with focus on tumor response and long-term survival in patients receiving neoadjuvant chemotherapy and in chemo naïve cystectomy patients: a study of a clinical multicentre database
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2022 (English)In: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 12, no 11, article id 1769Article in journal (Refereed) Published
Abstract [en]

Background: A high pre-treatment De Ritis ratio, the aspartate transaminase/alanine aminotransferase ratio, has been suggested to be of prognostic value for mortality in muscle-invasive bladder cancer (MIBC). Our purpose was to evaluate if a high ratio was associated with mortality and downstaging. Methods: A total of 347 Swedish patients with clinically staged T2-T4aN0M0, with administered neoadjuvant chemotherapy (NAC) or eligible for NAC and undergoing radical cystectomy (RC) 2009–2021, were retrospectively evaluated with a low ratio < 1.3 vs. high ratio > 1.3, by Log Rank test, Cox regression and Mann–Whitney U-test (MWU), SPSS 27. Results: Patients with a high ratio had a decrease of up to 3 years in disease-free survival (DFS), cancer-specific survival (CSS) and overall survival (OS) (p = 0.009, p = 0.004 and p = 0.009) and 5 years in CSS and OS (p = 0.019 and p = 0.046). A high ratio was associated with increased risk of mortality, highest in DFS (HR, 1.909; 95% CI, 1.265–2.880; p = 0.002). No significant relationship between downstaging and a high ratio existed (p = 0.564 MWU). Conclusion: A high pre-treatment De Ritis ratio is on a population level, associated with increased mortality post-RC in endpoints DFS, CSS and OS. Associations decrease over time and require further investigations to determine how strong the associations are as meaningful prognostic markers for long-term mortality in MIBC. The ratio is not suitable for downstaging-prediction.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
clinical decision rules, cystectomy, neoadjuvant therapy, prognosis, urinary bladder neoplasms
National Category
Urology and Nephrology Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-201225 (URN)10.3390/jpm12111769 (DOI)000882599300001 ()2-s2.0-85141776643 (Scopus ID)
Funder
Swedish Research Council, Bas-ALF/VLL RV-848051
Available from: 2022-12-05 Created: 2022-12-05 Last updated: 2023-09-26Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3675-3050

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