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Häggström, ChristelORCID iD iconorcid.org/0000-0001-6808-4405
Publications (10 of 98) Show all publications
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
Molin, J., Domellöf, M., Häggström, C., Vanky, E., Zamir, I., Östlund, E. & Bixo, M. (2024). Neonatal outcome following metformin-treated gestational diabetes mellitus: a population-based cohort study. Acta Obstetricia et Gynecologica Scandinavica
Open this publication in new window or tab >>Neonatal outcome following metformin-treated gestational diabetes mellitus: a population-based cohort study
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2024 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412Article in journal (Refereed) Epub ahead of print
Abstract [en]

Introduction: Neonatal hypoglycemia is a common complication associated with gestational diabetes and therefore relevant to consider in evaluations of maternal treatment. We aimed to investigate the risk of neonatal hypoglycemia in offspring exposed to metformin treatment alone (MT) or combined with insulin (MIT) in comparison with nutrition therapy alone (NT), and insulin treatment alone (IT). In addition, we investigated MT in comparison with MIT. Secondary outcomes included neonatal anthropometrics, respiratory morbidity, hyperbilirubinemia, 5-min Apgar score, and preterm birth.

Material and methods: This Swedish population-based cohort included 16 181 women diagnosed with gestational diabetes, and their singleton offspring born in 2019–2021. We estimated risk as adjusted odds ratio (aOR) with 95% confidence interval (CI), using individual-level, linkage register-data in multivariable logistic regression models.

Results: In the main analysis, MT was associated with a lower risk of neonatal hypoglycemia versus NT (aOR 0.85, 95% CI: 0.74–0.96), versus MIT (0.74 [0.64–0.87]), and versus IT (0.47 [0.40–0.55]), whereas MIT was associated with a similar risk of neonatal hypoglycemia versus NT (1.14 [0.99–1.30]) and with lower risk versus IT (0.63 [0.53–0.75]). However, supplemental feeding rates were lower for NT versus pharmacological treatments (p < 0.001). In post hoc subgroup analyses including only exclusively breastfed offspring, the risk of neonatal hypoglycemia was modified and similar among MT and NT, and higher in MIT versus NT. Insulin exposure, alone or combined with metformin, was associated with increased risk of being large for gestational age. Compared with NT, exposure to any pharmacological treatment was associated with significantly lower risk of 5-min Apgar score < 4. All other secondary outcomes were comparable among the treatment categories.

Conclusions: The risk of neonatal hypoglycemia appears to be comparable among offspring exposed to single metformin treatment and nutrition therapy alone, and the lower risk that we observed in favor of metformin is probably explained by a difference in supplemental feeding practices rather than metformin per se. By contrast, the lower risk favoring metformin exposure over insulin exposure was not explained by supplemental feeding. However, further investigations are required to determine whether the difference is an effect of metformin per se or mediated by other external factors.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
gestational diabetes mellitus, metformin, neonatal hypoglycemia, neonatal outcome, population-based, register-based
National Category
Obstetrics, Gynecology and Reproductive Medicine Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-220881 (URN)10.1111/aogs.14787 (DOI)001153803000001 ()38288656 (PubMedID)2-s2.0-85183895565 (Scopus ID)
Funder
Region Västerbotten, C-ALF 7004352Umeå University, 310426017
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-02-15
Fritz, J., Jochems, S. H. J., Bjørge, T., Wood, A. M., Häggström, C., Ulmer, H., . . . Stocks, T. (2023). Body mass index, triglyceride-glucose index, and prostate cancer death: a mediation analysis in eight European cohorts. British Journal of Cancer
Open this publication in new window or tab >>Body mass index, triglyceride-glucose index, and prostate cancer death: a mediation analysis in eight European cohorts
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2023 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Insulin resistance is a hypothesised biological mechanism linking obesity with prostate cancer (PCa) death. Data in support of this hypothesis is limited.

Methods: We included 259,884 men from eight European cohorts, with 11,760 incident PCa’s and 1784 PCa deaths during follow-up. We used the triglyceride-glucose (TyG) index as indicator of insulin resistance. We analysed PCa cases with follow-up from PCa diagnosis, and the full cohort with follow-up from the baseline cancer-free state, thus incorporating both PCa incidence and death. We calculated hazard ratios (HR) and the proportion of the total effect of body mass index (BMI) on PCa death mediated through TyG index.

Results: In the PCa-case-only analysis, baseline TyG index was positively associated with PCa death (HR per 1-standard deviation: 1.11, 95% confidence interval (CI); 1.01–1.22), and mediated a substantial proportion of the baseline BMI effect on PCa death (HRtotal effect per 5-kg/m2 BMI: 1.24; 1.14–1.35, of which 28%; 4%–52%, mediated). In contrast, in the full cohort, the TyG index was not associated with PCa death (HR: 1.03; 0.94-1.13), hence did not substantially mediate the effect of BMI on PCa death.

Conclusions: Insulin resistance could be an important pathway through which obesity accelerates PCa progression to death.

Place, publisher, year, edition, pages
Nature Publishing Group, 2023
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-218306 (URN)10.1038/s41416-023-02526-1 (DOI)2-s2.0-85179305097 (Scopus ID)
Funder
World Cancer Research Fund InternationalSwedish Cancer Society, 20 1033 PjFSwedish Cancer Society, CAN 2017/1019Swedish Research Council, 2018-02825ProstatacancerförbundetThe Crafoord Foundation, 20200546
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2023-12-21
Häggström, C., Rowley, M., Liedberg, F., Coolen, A. C. C. & Holmberg, L. (2023). Latent heterogeneity of muscle-invasive bladder cancer in patient characteristics and survival: a population-based nation-wide study in the Bladder Cancer Data Base Sweden (BladderBaSe). Cancer Medicine, 12(12), 13856-13864
Open this publication in new window or tab >>Latent heterogeneity of muscle-invasive bladder cancer in patient characteristics and survival: a population-based nation-wide study in the Bladder Cancer Data Base Sweden (BladderBaSe)
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2023 (English)In: Cancer Medicine, E-ISSN 2045-7634, Vol. 12, no 12, p. 13856-13864Article in journal (Refereed) Published
Abstract [en]

Background: Patients with muscle-invasive bladder cancer (MIBC) constitute a heterogenous group in terms of patient and tumour characteristics (‘case-mix’) and prognosis. The aim of the current study was to investigate whether differences in survival could be used to separate MIBC patients into separate classes using a recently developed latent class regression method for survival analysis with competing risks.

Methods: We selected all participants diagnosed with MIBC in the Bladder Cancer Data Base Sweden (BladderBase) and analysed inter-patient heterogeneity in risk of death from bladder cancer and other causes.

Results: Using data from 9653 MIBC patients, we detected heterogeneity with six distinct latent classes in the studied population. The largest, and most frail class included 50% of the study population and was characterised by a somewhat larger proportion of women, higher age at diagnosis, more advanced disease and lower probability of curative treatment. Despite this, patients in this class treated with curative intent by radical cystectomy or radiotherapy had a lower association to risk of death. The second largest class included 23% and was substantially less frail as compared to the largest class. The third and fourth class included each around 9%–10%, whereas the fifth and sixth class included each 3%–4% of the population.

Conclusions: Results from the current study are compatible with previous research and the method can be used to adjust comparisons in prognosis between MIBC populations for influential differences in the distribution of sub-classes.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
bladder cancer, competing risks, latent class, survival analysis
National Category
Cancer and Oncology Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-207880 (URN)10.1002/cam4.5981 (DOI)000977301300001 ()37096787 (PubMedID)2-s2.0-85153616725 (Scopus ID)
Funder
Swedish Cancer Society, CAN 2013/472Swedish Cancer Society, CAN 2017/278
Available from: 2023-05-08 Created: 2023-05-08 Last updated: 2024-01-17Bibliographically approved
Sun, M., Fritz, J., Häggström, C., Bjørge, T., Nagel, G., Manjer, J., . . . Stocks, T. (2023). Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study. Journal of the National Cancer Institute, 115(4), 456-467
Open this publication in new window or tab >>Metabolically (un)healthy obesity and risk of obesity-related cancers: a pooled study
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2023 (English)In: Journal of the National Cancer Institute, ISSN 0027-8874, E-ISSN 1460-2105, Vol. 115, no 4, p. 456-467Article in journal (Refereed) Published
Abstract [en]

Background: Studies of obesity with or without metabolic aberrations, commonly termed metabolically unhealthy or healthy obesity, in relation to cancer risk are scarce.

Methods: We investigated body mass index (normal weight, overweight, obesity) jointly and in interaction with metabolic health status in relation to obesity-related cancer risk (n = 23630) among 797193 European individuals. A metabolic score comprising mid-blood pressure, plasma glucose, and triglycerides was used to define metabolically healthy and unhealthy status. Hazard ratios (HRs) and multiplicative interactions were assessed using Cox regression, and additive interactions were assessed using the relative excess risk for interaction. All statistical tests were 2-sided.

Results: Metabolically unhealthy obesity, with a baseline prevalence of 7%, was, compared with metabolically healthy normal weight, associated with an increased relative risk of any obesity-related cancer and of colon, rectal, pancreas, endometrial, liver, gallbladder, and renal cell cancer (P <. 05), with the highest risk estimates for endometrial, liver, and renal cell cancer (HR = 2.55-3.00). Metabolically healthy obesity showed a higher relative risk for any obesity-related cancer and colon (in men), endometrial, renal cell, liver, and gallbladder cancer, though the risk relationships were weaker. There were no multiplicative interactions, but there were additive, positive interactions between body mass index and metabolic health status on obesity-related and rectal cancer among men and on endometrial cancer (P <. 05).

Conclusions: This study highlights that the type of metabolic obesity phenotype is important when assessing obesity-related cancer risk. In general, metabolic aberrations further increased the obesity-induced cancer risk, suggesting that obesity and metabolic aberrations are useful targets for prevention.

Place, publisher, year, edition, pages
Oxford University Press, 2023
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-211797 (URN)10.1093/jnci/djad008 (DOI)000941199500001 ()36647199 (PubMedID)2-s2.0-85150040100 (Scopus ID)
Funder
Swedish Cancer Society, CAN 2017/1019
Available from: 2023-07-12 Created: 2023-07-12 Last updated: 2023-07-12Bibliographically approved
Jonsson, S., Jonsson, H., Lundin, E., Häggström, C. & Idahl, A. (2023). Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden. American Journal of Obstetrics and Gynecology, 230(1), 75.e1-75.e15
Open this publication in new window or tab >>Pelvic inflammatory disease and risk of epithelial ovarian cancer: a national population-based case-control study in Sweden
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2023 (English)In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 230, no 1, p. 75.e1-75.e15Article in journal (Refereed) Published
Abstract [en]

Background: Epithelial ovarian cancer is an insidious disease, and women are often diagnosed when the disease is beyond curative treatment. Accordingly, identifying modifiable risk factors is of paramount importance. Inflammation predisposes an individual to cancer in various organs, but whether pelvic inflammatory disease is associated with an increased risk of epithelial ovarian cancer has not been fully determined.

Objective: This study aimed to investigate a possible association between clinically verified pelvic inflammatory disease and the risk of epithelial ovarian cancer.

Study Design: In this national population-based case-control study, all women in Sweden diagnosed with epithelial ovarian cancer between 1999 and 2020 and 10 controls for each were identified, matched for age and residential district. Using several Swedish nationwide registers, data on previous pelvic inflammatory disease and potential confounding factors (age, parity, educational level, and previous gynecologic surgery) were retrieved. Adjusted odds ratios and 95% confidence intervals were estimated using conditional logistic regression. Histotype-specific analyses were performed for the subgroup of women diagnosed with epithelial ovarian cancer between 2015 and 2020. Moreover, hormonal contraceptives and menopausal hormone therapy were adjusted in addition to the aforementioned confounders.

Results: This study included 15,072 women with epithelial ovarian cancer and 141,322 controls. Most women (9102 [60.4%]) had serous carcinoma. In a subgroup of cases diagnosed between 2015 and 2020, high-grade serous carcinoma (2319 [60.0%]) was identified. A total of 168 cases (1.1%) and 1270 controls (0.9%) were diagnosed with pelvic inflammatory disease. Previous pelvic inflammatory disease was associated with an increased risk of epithelial ovarian cancer (adjusted odds ratio, 1.39; 95% confidence interval, 1.17–1.66) and serous carcinoma (adjusted odds ratio, 1.46; 95% confidence interval, 1.18–1.80) for the entire study population. For the subgroup of women diagnosed in 2015–2020, pelvic inflammatory disease was associated with high-grade serous carcinoma (adjusted odds ratio, 1.43; 95% confidence interval, 1.01–2.04). The odds ratios of the other histotypes were as follows: endometrioid (adjusted odds ratio, 0.13; 95% confidence interval, 0.02–1.06), mucinous (adjusted odds ratio, 1.55; 95% confidence interval, 0.56–4.29), and clear cell carcinoma (adjusted odds ratio, 2.30; 95% confidence interval, 0.90–5.86). A dose-response relationship was observed between the number of pelvic inflammatory disease episodes and the risk of epithelial ovarian cancer (Ptrend<.001).

Conclusion: A history of pelvic inflammatory disease is associated with an increased risk of epithelial ovarian cancer and a dose-response relationship is evident. Histotype-specific analyses show an association with increased risk of serous epithelial ovarian cancer and high-grade serous carcinoma and potentially also with clear cell carcinoma, but there is no significant association with other histotypes. Infection and inflammation of the upper reproductive tract might have serious long-term consequences, including epithelial ovarian cancer.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
epithelial ovarian cancer, high-grade serous carcinoma, ovarian cancer, pelvic inflammatory disease, population-based case-control study
National Category
Obstetrics, Gynecology and Reproductive Medicine Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-216205 (URN)10.1016/j.ajog.2023.09.094 (DOI)37778677 (PubMedID)2-s2.0-85175294490 (Scopus ID)
Available from: 2023-11-06 Created: 2023-11-06 Last updated: 2024-01-05Bibliographically approved
Jochems, S. H. J., Fritz, J., Häggström, C., Stattin, P. & Stocks, T. (2023). Prediagnostic markers of insulin resistance and prostate cancer risk and death: a pooled study. Cancer Medicine, 12(12), 13732-13744
Open this publication in new window or tab >>Prediagnostic markers of insulin resistance and prostate cancer risk and death: a pooled study
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2023 (English)In: Cancer Medicine, E-ISSN 2045-7634, Vol. 12, no 12, p. 13732-13744Article in journal (Refereed) Published
Abstract [en]

Background: Insulin resistance has been shown to be related to a higher risk of several cancers, but the association with prostate cancer (PCa) has been inconsistent.

Methods: We investigated prediagnostic markers of insulin resistance in men in four cohorts in Sweden, in relation to PCa risk (total, non-aggressive and aggressive) and PCa death using multivariable-adjusted Cox regression. The number of men, PCa cases and PCa deaths was up to 66,668, 3940 and 473 for plasma glucose and the triglyceride-glucose (TyG) index, and up to 3898, 586 and 102 for plasma insulin, glycated haemoglobin (HbA1c) and leptin.

Results: Higher HbA1c was related to a lower risk of non-aggressive PCa but no significant associations were found for insulin resistance markers with the risk of aggressive or total PCa. In PCa cases, higher glucose and TyG index were related to a higher risk of PCa death (hazard ratio [HR] per higher standard deviation, 1.22, 95% CI 1.00–1.49 and 1.24, 95% CI 1.00–1.55), which further increased when restricting the analyses to glucose and TyG index measures taken <10 years before the PCa diagnosis (HR, 1.70, 95% CI 1.09–2.70 and 1.66, 95% CI 1.12–2.51). No associations were observed for other markers in relation to PCa death.

Conclusions: The results of this study showed no associations of insulin resistance markers with the risk of clinically relevant PCa, but higher glucose and TyG index were associated with poorer survival from PCa. The lack of association for other insulin resistance markers may be due to their smaller sample size.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
insulin resistance, prospective studies, prostatic neoplasms
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-208261 (URN)10.1002/cam4.6004 (DOI)000979235300001 ()37102250 (PubMedID)2-s2.0-85156191845 (Scopus ID)
Funder
Swedish Cancer Society, 2017/475Swedish Cancer Society, 2017/1019Swedish Cancer Society, 201,033 PjFSwedish Research Council, 2018-02825Swedish Research Council, 2017‐00650The Crafoord Foundation, 20200546Prostatacancerförbundet
Available from: 2023-05-22 Created: 2023-05-22 Last updated: 2024-01-17Bibliographically approved
Lu, S. S., Rutegård, M., Ahmed, M., Häggström, C., Gylfe, Å., Harlid, S. & van Guelpen, B. (2023). Prediagnostic prescription antibiotics use and survival in patients with colorectal cancer: a swedish national register-based study. Cancer Epidemiology, Biomarkers and Prevention, 32(10), 1391-1401
Open this publication in new window or tab >>Prediagnostic prescription antibiotics use and survival in patients with colorectal cancer: a swedish national register-based study
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2023 (English)In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 32, no 10, p. 1391-1401Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Antibiotics use is associated with higher colorectal cancer risk, but little is known regarding any potential effects on survival.

METHODS: We conducted a nationwide cohort study, using complete-population data from Swedish national registers between 2005 and 2020, to investigate prediagnostic prescription antibiotics use in relation to survival in colorectal cancer patients.

RESULTS: We identified 36,061 stage I-III and 11,242 stage IV colorectal cancer cases diagnosed between 2010 and 2019. For stage I-III, any antibiotics use (binary yes/no variable) was not associated with overall or cancer-specific survival. Compared with no use, moderate antibiotics use (total 11-60 days) was associated with slightly better cancer-specific survival [adjusted HR (aHR) = 0.93; 95% confidence interval (CI), 0.86-0.99)], whereas very high use (>180 days) was associated with worse survival [overall survival (OS) aHR = 1.42; 95% CI, 1.26-1.60, cancer-specific survival aHR = 1.31; 95% CI, 1.10-1.55]. In analyses by different antibiotic types, although not statistically significant, worse survival outcomes were generally observed across several antibiotics, particularly macrolides and/or lincosamides. In stage IV colorectal cancer, inverse relationships between antibiotics use and survival were noted.

CONCLUSIONS: Overall, our findings do not support any substantial detrimental effects of prediagnostic prescription antibiotics use on cancer-specific survival after colorectal cancer diagnosis, with the possible exception of very high use in stage I-III colorectal cancer. Further investigation is warranted to confirm and understand these results.

IMPACT: Although the study findings require confirmation, physicians probably do not need to factor in prediagnostic prescription antibiotics use in prognosticating patients with colorectal cancer.

Place, publisher, year, edition, pages
American Association For Cancer Research (AACR), 2023
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-215390 (URN)10.1158/1055-9965.EPI-23-0340 (DOI)37490284 (PubMedID)2-s2.0-85173563887 (Scopus ID)
Funder
Cancerforskningsfonden i Norrland, LP17–2154Cancerforskningsfonden i Norrland, LP21-2275Region Västerbotten, RV-932777
Available from: 2023-10-27 Created: 2023-10-27 Last updated: 2024-02-20Bibliographically approved
Liedberg, F., Hagberg, O., Häggström, C., Aljabery, F., Gårdmark, T., Hosseini, A., . . . Bobjer, J. (2023). Preoperative upper tract invasive diagnostic modalities are associated with intravesical recurrence following surgery for upper tract urothelial carcinoma: A population-based study. PLOS ONE, 18(2 February), Article ID e0281304.
Open this publication in new window or tab >>Preoperative upper tract invasive diagnostic modalities are associated with intravesical recurrence following surgery for upper tract urothelial carcinoma: A population-based study
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 2 February, article id e0281304Article in journal (Refereed) Published
Abstract [en]

Background: Intravesical recurrence (IVR) after surgery for upper tract urothelial carcinoma (UTUC) is a clinical problem. We investigated if preoperative invasive diagnostic modalities (IDM) such as antegrade/retrograde uretero-pyelography and/or selective urine cytology/barbotage, and URS with or without concomitant biopsy are associated with IVR after radical surgery for UTUC. Risk of death from urothelial cancer and all causes was investigated as secondary outcomes.

Methods: We investigated a population-based cohort of 1038 consecutive patients subjected to radical surgery for UTUC 2015–2019 in Sweden, using the Bladder Cancer Data Base Sweden (BladderBaSe 2.0), comprising all patients in the Swedish National Registry of Urinary Bladder Cancer. Risk estimates of IVR, death from urothelial cancer, and all causes was assessed using multivariable Cox regression models.

Results: The study included 536 cases with and 502 without preoperative IDM. IDM was associated with increased risk of IVR (HR 1.24, 95% CI 1.03–1.52) and risk of urothelial cancer death (HR 1.56, CI 1.12–2.18), compared to no IDM after a median follow-up of 1.3 yrs. Stratified analysis for tumor location showed that IDM was associated with risk of IVR in ureteric cancer (HR 1.66, 95% CI 1.21–2.28) but not in renal pelvic cancer (HR 1.07, 95% CI 0.81–1.41). Limitations included the observational setting and the lack of variables such as tumour grade, multifocality and preoperative hydronephrosis.

Conclusions: Worse outcomes for patients subjected to preoperative IDM highlight the need for carefully considering diagnostic decisions for UTUC patients, specifically in tumours located in the ureter.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-204744 (URN)10.1371/journal.pone.0281304 (DOI)000974706800001 ()36730353 (PubMedID)2-s2.0-85147318490 (Scopus ID)
Funder
Swedish Cancer Society, 2019/62Swedish Cancer Society, 2020/0709Swedish Research Council, 2021-00859Gyllenstiernska Krapperup FoundationStiftelsen Sigurd och Elsa Goljes minneFamiljen Bergqvists InsamlingsstiftelseRegion SkåneStiftelsen Gösta Jönssons forskningsfond
Available from: 2023-02-21 Created: 2023-02-21 Last updated: 2023-09-05Bibliographically 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
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6808-4405

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