Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference. Setting: Online Delphi survey and consensus conference. Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. Outcome measurements and statistical analysis: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as 70% agreement and 15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). Results and limitations: Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease. Conclusions: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach. Patient summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available.
These consensus statements were developed by the European Association of Urology (EAU) and the European Society for Medical Oncology (ESMO) and are published simultaneously in European Urology and Annals of Oncology. Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts before voting during a consensus conference. Setting: Online Delphi survey and consensus conference. Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management.
BACKGROUND Surgical blood loss is usually estimated by different formulae in studies of strategies aimed at reducing perioperative bleeding. This study assessed and compared the agreement of the main blood loss estimation formulae using a direct measurement of blood loss as the reference method. STUDY DESIGN AND METHODS Eighty consecutive patients undergoing urologic laparoscopic surgery were studied. Only optimal conditions for the direct measurement of surgical blood loss were considered. Surgical blood loss was estimated by six formulae at four different postoperative time points. The agreement of the formulae was evaluated by the Concordance correlation coefficient (CCC) and Bland–Altman analyses. An analysis of the agreement's variability regarding different magnitudes of blood loss was also performed. RESULTS Directly measured blood loss ranged from 200 to 2200 mL. The formulae studied showed poor agreement with the direct measurement of blood loss; 95% limits of agreement widely exceeded the criterion of ±560 mL. Significant biases were found, which for most of the formulae led to an overestimation of blood loss. For all formulae, agreement remained constant regardless of the amount of blood loss, with limits between −40 and +120% approximately. Among the formulae, the best agreement was achieved by López‐Picado's formula at 48 hours (CCC: 0.577), with a bias of +283 mL and 95% limits of agreement between −477 and +1043 mL. CONCLUSION Formulae currently used to estimate surgical blood loss differ substantially from direct measurements; therefore, they may not be reliable methods of blood loss quantification in the surgical setting.
Summary Objectives To analyse whether the histological subtype of renal cell carcinoma (RCC) impacts survival post-surgical resection in contemporary patients, and if so, whether prognostic significance differs according to type of surgical resection or tumour stage. Materials and methods From 2006 to 2014, 2237 patients underwent surgical resection (25% radical nephrectomy [RN], 75% partial nephrectomy [PN]) for non-metastatic RCC at a tertiary referral centre. Estimated survival function curves and Cox regression models evaluated impact of histological subtype on recurrence-free survival (RFS) and overall survival (OS). Interaction analyses tested whether the impact of histological subtype depends on type of surgical resection or tumour stage. Results Patients with RCC stage T2 or lower, and those with low-grade conventional clear cell, papillary or chromophobe RCC of any stage had 5-yr RFS probabilities > 90%. Patients with clear cell papillary RCC stage T3 or greater had predicted 5-yr RFS of 81%. However, 5-yr OS probabilities were >94% for clear cell papillary RCC of any stage. High-grade conventional clear cell and papillary RCC stage T2 or lower, low-grade conventional clear cell and chromophobe RCC of any stage conferred 5-yr OS probabilities of > 93%. Unclassified RCC demonstrated the lowest OS probabilities at any stage. In multivariable analyses, histological subtype impacted RFS (p<0.0001) and OS (p=0.026) following surgical resection, with no differences in this association for RN versus PN (RFS p=0.2, OS p=0.4), and across pathologic stages (RFS p=0.1, OS p=0.3). Compared to low-grade conventional clear cell RCC, chromophobe (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.30, 1.75) and papillary RCC (HR 0.30, 95% CI 0.09, 0.97) conferred lower risk of recurrence. Chromophobe (HR 0.67, 95% CI 0.30, 1.52) and clear cell papillary RCC (HR 0.91, 95% CI 0.12, 6.78) conferred the lowest risk of all-cause mortality. Conclusions In the era of PN for RCC, histological subtype remained a significant predictor of survival, regardless of type of surgical resection or tumour stage.
INTRODUCTION It is worth distinguishing between the two strategies of expectant management for PCa. WW entails administering non-curative androgen deprivation therapy to patients upon development of symptomatic progression, whereas AS entails delivering curative treatment upon signs of disease progression. The objectives of the two management strategies and the patients enrolled in either are different. AIM To review the role of AS as a management strategy for patients with low-risk PCa and review the benefits and pitfalls of AS. METHODS We performed a systematic review of AS for PCa in the literature using the National Center for Biotechnology Information's electronic database PubMed. We conducted a search in English using the terms: active surveillance, prostate cancer, watchful waiting, and conservative management. Selected studies were required to have a comprehensive description of the demographic and disease characteristics of the patients at the time of diagnosis, inclusion criteria for surveillance, and a protocol for the patients’ follow-up. Review articles were included but not multiple papers from the same datasets. CONCLUSIONS AS appears to reduce overtreatment in patients with low-risk PCa without compromising cancer-specific survival at 10 years. Therefore AS is an option for select patients who want to avoid the side effects inherent to the different types of immediate treatment. However, inclusion criteria for AS and the most appropriate method of monitoring patients on AS have not yet been standardized.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.