We identify clinicopathological variables predicting overall survival in patients with recurrent bladder urothelial carcinoma after radical cystectomy. We retrospectively collected data on 114 patients treated with radical cystectomy for bladder urothelial carcinoma who subsequently had remote metastasis and/or local recurrence. The Kaplan-Meier method with the log rank test and multivariate Cox regression models were used to address overall survival after recurrence. During followup 99 of the 114 patients died. Median survival in the 114 patients was 11.2 months. One and 3-year overall survival rates were 48.0% and 12.1%, respectively. On multivariate analysis independent predictors of poorer overall survival included less than 1 year to recurrence, symptoms at recurrence, 2 or more metastatic organs at recurrence, high serum C-reactive protein, high lactate dehydrogenase, no post-recurrence platinum based chemotherapy and no metastasectomy. Based on the 4 variables (time to recurrence, symptoms, number of metastatic organs and C-reactive protein), we constructed a risk model predicting post-recurrence overall survival that classified patients into 3 groups with significantly different overall survival (p <0.0001). Our data confirm that recurrent urothelial carcinoma after radical cystectomy is a highly aggressive, lethal disease. Seven clinicopathological factors were identified that predicted post-recurrence overall survival. Our risk model based on the 4 variables could be useful to provide relevant prognostic information to patients and physicians, and better stratify patients in clinical trials.

Objectives: To evaluate the prognostic significance of the pretreatment neutrophil‐to‐lymphocyte ratio in patients with metastatic urothelial carcinoma who underwent salvage chemotherapy.Methods: We reviewed 200 metastatic urothelial carcinoma patients who received salvage chemotherapy at our five affiliate institutions between 2003 and 2011. The associations of pretreatment clinicopathological factors, including neutrophil‐to‐lymphocyte ratio, with cancer‐specific survival and overall survival from the start of chemotherapy were assessed. Cox proportional hazards model was used for multivariate analysis.Results: A total of 15 cases with missing data were excluded. Among the remaining 185 patients, 157 died during follow up, with a median survival of 13.0 months. Multivariate analysis showed that the pretreatment neutrophil‐to‐lymphocyte ratio ≥3, Eastern Cooperative Oncology Group performance status ≥2 and liver metastasis were independent poor prognostic factors, both for cancer‐specific survival and overall survival. A prognostic model predicting overall survival was constructed based on the number of these three variables (0, 1 and ≥ 2). The classified patients showed significantly different overall survival (each P < 0.0001, log–rank test), with Harrell's concordance index as high as 0.81.Conclusions: Pretreatment neutrophil‐to‐lymphocyte ratio elevation was an independent poor prognostic factor for metastatic urothelial carcinoma undergoing salvage chemotherapy. Our newly constructed prognostic model including the pretreatment neutrophil‐to‐lymphocyte ratio proved to be an excellent discriminator of overall survival.

In this study we used nationwide population based data to compare perioperative outcomes, including severe bladder injury, between monopolar and bipolar transurethral resection of bladder tumors. Data of patients with clinical T2 or less bladder cancer who underwent monopolar or bipolar transurethral bladder tumor resection were collected from 788 hospitals in the Japanese Diagnosis Procedure Combination database 2007-2012. One-to-one propensity score matching was performed. End points assessed were severe bladder injury requiring placement of a drainage tube or repair surgery within 3 postoperative days, hemostasis procedures consisting of clot removal or transurethral coagulation within 3 postoperative days, transfusion, other complications, anesthesia duration, postoperative length of stay and total costs. Multivariate analyses compared outcomes of bipolar and monopolar transurethral bladder tumor resection with gender, age, Charlson comorbidity index, clinical stage, hospital volume and hospital academic status as covariates. A total of 8,188 pairs were generated. Compared with monopolar transurethral bladder tumor resection, bipolar resection was associated with a significantly lower incidence of severe bladder injury (0.3% vs 0.6%, OR 0.57), other complications (4.6% vs 5.8%, OR 0.78), slightly shorter postoperative stay (mean 6.4 vs 6.7 days, difference -3.3%) and slightly lower total costs (mean $4,628 vs $4,727; difference -1.1%, all p <0.05). There were no differences in postoperative hemostasis procedures, transfusion and anesthesia duration. Bipolar transurethral bladder tumor resection was associated with a substantially lower incidence of several perioperative complications including severe bladder injury. The findings support the benefit of bipolar transurethral bladder tumor resection over monopolar resection in real-world clinical practice.

Robot-assisted radical prostatectomy (RARP) has now become a gold standard approach in radical prostatectomy. The aim of this study was to investigate incidence and risk factors of inguinal hernia (IH) after RARP. This study included 307 consecutive men who underwent RARP for the treatment of prostate cancer from January 2011 to August 2015. The incidence of IH after RARP was investigated. Clinical and pathological factors were also investigated to assess relationship with development of postoperative IH. Median follow-ups were 380 days, and median age of patients was 67 years. Incidence of IH was 11.3, 14.0, and 15.4% at 1, 2, and 3 years after RARP, respectively. Postoperative IH occurrence was significantly associated with low surgeon experience and postoperative incontinence at 3 or 6 months after surgery (P = 0.019, P = 0.002, and P = 0.016, respectively). Most of the IH occurred within the first 2 years with a rate of 14%. Incidence of IH after RARP was significantly associated with surgical experience and incontinence outcomes.

Sunitinib, a tyrosine kinase inhibitor currently in use for the treatment of metastatic renal cell carcinoma (mRCC), has been reported to modulate immunosuppressive cells such as myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) in addition to exerting anti-angiogenic effects. We conducted a clinical trial of dendritic cell (DC)-based immunotherapy together with sunitinib in mRCC patients in an effort to enhance immunotherapeutic efficacy by inhibiting immunosuppressive cells.