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No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy : a nation-wide register-based study

Jerlström, Tomas ; Chen, Ruoqing ; Liedberg, Fredrik LU ; Andrén, Ove ; Ströck, Viveka ; Aljabery, Firas A.S. ; Hosseini, Abolfazl ; Sherif, Amir ; Malmström, Per Uno and Ullén, Anders , et al. (2020) In World Journal of Urology 38(2). p.381-388
Abstract

Purpose: Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking. Methods: We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death... (More)

Purpose: Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking. Methods: We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not. Results: Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82–1.39) or mortality (OR 0.75 95% CI 0.36–1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30–0.81). Conclusion: This nation-wide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.

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organization
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Contribution to journal
publication status
published
subject
keywords
Bladder cancer, Induction chemotherapy, Neoadjuvant chemotherapy, Postoperative complications, Radical cystectomy
in
World Journal of Urology
volume
38
issue
2
pages
8 pages
publisher
Springer
external identifiers
  • pmid:31020424
  • scopus:85064805869
ISSN
0724-4983
DOI
10.1007/s00345-019-02770-2
language
English
LU publication?
yes
id
c093eae8-ea18-41ee-a7bd-fa19bc935f0d
date added to LUP
2019-05-08 14:15:53
date last changed
2021-04-06 02:52:29
@article{c093eae8-ea18-41ee-a7bd-fa19bc935f0d,
  abstract     = {<p>Purpose: Preoperative chemotherapy is underused in conjunction with radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC) due to concerns for complications and delay of surgery. Prospective data on short-term complications from population-based settings with frequent use of preoperative chemotherapy and standardised reporting of complications is lacking. Methods: We identified 1,340 patients who underwent RC between 2011 and 2015 in Sweden due to MIBC according to the Swedish Cystectomy Register. These individuals were followed through linkages to several national registers. Propensity score adjusted logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for complications and death within 90 days of surgery, comparing patients receiving preoperative chemotherapy or not. Results: Minimum two cycles of preoperative chemotherapy were given to 519 (39%) of the patients, who on average tended to be younger, have higher education, better physical status, and more advanced bladder cancer than patients not receiving chemotherapy. After adjusting for these and other parameters, there was no association between treatment with preoperative chemotherapy and short-term complications (OR 1.06 95% CI 0.82–1.39) or mortality (OR 0.75 95% CI 0.36–1.55). We observed a risk reduction for gastrointestinal complications among patients who received preoperative chemotherapy compared with those who did not (OR 0.49 95% CI 0.30–0.81). Conclusion: This nation-wide population-based observational study does not suggest that preoperative chemotherapy, in a setting with high utilisation of such treatment, is associated with an increased risk of short-term complications in MIBC patients treated with radical cystectomy.</p>},
  author       = {Jerlström, Tomas and Chen, Ruoqing and Liedberg, Fredrik and Andrén, Ove and Ströck, Viveka and Aljabery, Firas A.S. and Hosseini, Abolfazl and Sherif, Amir and Malmström, Per Uno and Ullén, Anders and Gårdmark, Truls and Fall, Katja},
  issn         = {0724-4983},
  language     = {eng},
  number       = {2},
  pages        = {381--388},
  publisher    = {Springer},
  series       = {World Journal of Urology},
  title        = {No increased risk of short-term complications after radical cystectomy for muscle-invasive bladder cancer among patients treated with preoperative chemotherapy : a nation-wide register-based study},
  url          = {http://dx.doi.org/10.1007/s00345-019-02770-2},
  doi          = {10.1007/s00345-019-02770-2},
  volume       = {38},
  year         = {2020},
}