Document Type : Original Article(s)
Authors
- Nastaran Mahmoudnejad 1
- Mohammad Hamidi Madani 1
- Parham Montazeri 1
- Kimia Vakili 1
- Mohammad Nasri 1
- Sajjad Imen 2
- Navid Masoumi 3
1 Urology and Nephrology Research Center, Research Institute for Urology and Nephrology, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Clinical Research Development Center of Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Urology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Background: The preservation of reproductive organs in females with muscle-invasive bladder cancer (MIBC) might improve reproductive and sexual function. This study aimed to identify potential clinical risk factors for reproductive organ involvement (ROI) using preoperative data from transurethral resection of tumor (TURT) reports and imaging findings.
Methods: This retrospective analysis was conducted on 143 women with bladder cancer who underwent radical cystectomy (RC) at Modarres and Labafinejad Medical Centers in Tehran, Iran, between 2010 and 2019. Demographic, clinical, and pathological data, along with follow-up reports, were collected from medical records and analyzed.
Results: The mean age of the participants was 69.17±10.62 years, with an ROI rate of 16.8%. The vagina was the predominantly involved organ. Significant independent risk factors for ROI included clinical T stage (P=0.042), bladder neck or trigonal location of the tumor (P<0.001), tumor size> 5 cm (P=0.002), presence of carcinoma in situ (CIS) (P=0.014), lymphovascular invasion in TURT reports (P=0.002), and preoperative hydronephrosis in imaging (P<0.001). Patients with ROI demonstrated significantly lower 5-year survival rates than those without ROI, with overall survival rate of 20.8% versus 63.9% and cancer-specific survival rate of 19% versus 64.8%, respectively.
Conclusion: This study represented a comprehensive analysis of preoperative TURT and imaging predictors of ROI. Clinical T stage, tumor location, maximum tumor size, concomitant CIS, presence of lymphovascular invasion, and hydronephrosis were identified as significant preoperative clinical factors associated with ROI. These findings might help guide surgical planning for organ preservation in female MIBC patients.
Highlights
Nastaran Mahmoudnejad (Google Scholar)
Navid Masoumi (Google Scholar)
Keywords
- Xu N, Yao Z, Shang G, Ye D, Wang H, Zhang H, et al. Integrated proteogenomic characterization of urothelial carcinoma of the bladder. J Hematol Oncol. 2022;15:76. doi: 10.1186/s13045-022-01291-7. PubMed PMID: 35659036; PubMed Central PMCID: PMCPMC9164575.
- Wang YC, Ku WC, Liu CY, Cheng YC, Chien CC, Chang KW, et al. Supplementation of Probiotic Butyricicoccus pullicaecorum Mediates Anticancer Effect on Bladder Urothelial Cells by Regulating Butyrate-Responsive Molecular Signatures. Diagnostics (Basel). 2021;11. doi: 10.3390/diagnostics11122270. PubMed PMID: 34943506; PubMed Central PMCID: PMCPMC8700285.
- Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7-30. doi: 10.3322/caac.21590. PubMed PMID: 31912902.
- de la Calle CM, Patel SH, Kates M. Contemporary Rates of Gynecologic Organ Involvement in Females with Muscle Invasive Bladder Cancer: A Retrospective Review of Women Undergoing Radical Cystectomy following Neoadjuvant Chemotherapy. Letter. J Urol. 2022;207:476-7. doi: 10.1097/JU.0000000000002306. PubMed PMID: 34694151.
- Holzbeierlein J, Bixler BR, Buckley DI, Chang SS, Holmes RS, James AC, et al. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer: AUA/ASCO/SUO Guideline (2017; Amended 2020, 2024). J Urol. 2024;212:3-10. doi: 10.1097/JU.0000000000003981. PubMed PMID: 38661067.
- Martin R, Renouf T, Rigby J, Hafeez S, Thurairaja R, Kumar P, et al. Female sexual function in bladder cancer: A review of the evidence. BJUI Compass. 2023;4:5-23. doi: 10.1002/bco2.186. PubMed PMID: 36569507; PubMed Central PMCID: PMCPMC9766865.
- Taylor BL, Matrai CE, Smith AL, Ayangbesan A, Xia L, Golombos DM, et al. Gynecologic Organ Involvement During Radical Cystectomy for Bladder Cancer: Is It Time to Routinely Spare the Ovaries? Clin Genitourin Cancer. 2019;17:e209-e15. doi: 10.1016/j.clgc.2018.10.009. PubMed PMID: 30470630.
- Park JS, Yuk HD, Jeong CW, Kwak C, Kim HH, Ku JH. Comparison of functional and oncological outcomes between uterus-sparing radical cystectomy and standard radical cystectomy in females: A retrospective study. Investig Clin Urol. 2022;63:612-22. doi: 10.4111/icu.20220220. PubMed PMID: 36347550; PubMed Central PMCID: PMCPMC9643730.
- Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017;67:93-9. doi: 10.3322/caac.21388. PubMed PMID: 28094848.
- Djaladat H, Bruins HM, Miranda G, Cai J, Skinner EC, Daneshmand S. Reproductive organ involvement in female patients undergoing radical cystectomy for urothelial bladder cancer. J Urol. 2012;188:2134-8. doi: 10.1016/j.juro.2012.08.024. PubMed PMID: 23083874.
- Chen ME, Pisters LL, Malpica A, Pettaway CA, Dinney CP. Risk of urethral, vaginal and cervical involvement in patients undergoing radical cystectomy for bladder cancer: results of a contemporary cystectomy series from M. D. Anderson Cancer Center. J Urol. 1997;157:2120-3. PubMed PMID: 9146596.
- Bree KK, Hensley PJ, Westerman ME, Kokorovic A, Nogueras-Gonzalez GM, Dinney CP, et al. Contemporary Rates of Gynecologic Organ Involvement in Females with Muscle Invasive Bladder Cancer: A Retrospective Review of Women Undergoing Radical Cystectomy following Neoadjuvant Chemotherapy. J Urol. 2021;206:577-85. doi: 10.1097/JU.0000000000001784. PubMed PMID: 33872050.
- Whittum M, Hussein AA, Ahmed YE, Khan H, Krasowski C, Huben NB, et al. Gynecological organ involvement at robot-assisted radical cystectomy in females: Is anterior exenteration necessary? Can Urol Assoc J. 2018;12:E398-E402. doi: 10.5489/cuaj.5086. PubMed PMID: 29787373; PubMed Central PMCID: PMCPMC6143501.
- Avulova S, Benidir T, Cheville JC, Packiam VT, Shah P, Frank I, et al. Prevalence, Predictors, and Oncologic Outcomes of Pelvic Organ Involvement in Women Undergoing Radical Cystectomy. Arch Pathol Lab Med. 2023;147:202-7. doi: 10.5858/arpa.2021-0409-OA. PubMed PMID: 35700531.
- Choi SY, Yoo S, Han JH, Jeong IG, Hong B, Hong JH, et al. Predictors of female genital organ involvement in radical cystectomy for urothelial carcinoma of the bladder: A single-center retrospective analysis of 112 female patients. Int J Surg. 2017;47:101-6. doi: 10.1016/j.ijsu.2017.09.059. PubMed PMID: 28964932.
- Gregg JR, Emeruwa C, Wong J, Barocas DA, Chang SS, Clark PE, et al. Oncologic Outcomes after Anterior Exenteration for Muscle Invasive Bladder Cancer in Women. J Urol. 2016;196:1030-5. doi: 10.1016/j.juro.2016.04.090. PubMed PMID: 27164514.
- Alfred Witjes J, Max Bruins H, Carrion A, Cathomas R, Comperat E, Efstathiou JA, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol. 2024;85:17-31. doi: 10.1016/j.eururo.2023.08.016. PubMed PMID: 37858453.
- Varkarakis IM, Pinggera G, Antoniou N, Constantinides K, Chrisofos M, Deliveliotis C. Pathological review of internal genitalia after anterior exenteration for bladder cancer in women. Evaluating risk factors for female organ involvement. Int Urol Nephrol. 2007;39:1015-21. doi: 10.1007/s11255-006-9158-6. PubMed PMID: 17333520.
)