Urologic oncology
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To compare the oncologic outcomes and prognostic factors between metastatic upper tract urothelial carcinoma (UTUC) and UC of the bladder (UCB) after cisplatin-based chemotherapy. ⋯ Our study suggests discordant oncologic outcomes and prognostic factors between metastatic UTUC and UCB after cisplatin-based chemotherapy. A prospective study is warranted to validate our results.
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To describe lymph node counts in routine clinical practice and evaluate their association with outcomes to explore its utility as a quality indicator. ⋯ There is significant variation in use and quality of PLND at cystectomy in routine practice. Node counts are independently associated with long-term survival, and this association is persistent despite adjustment for provider-related variables. These results suggest that lymph node counts are a valid quality indicator of surgical care of muscle-invasive bladder cancer.
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Comparative Study
Validation of a frailty index in patients undergoing curative surgery for urologic malignancy and comparison with other risk stratification tools.
To retrospectively validate and compare a modified frailty index predicting adverse outcomes and other risk stratification tools among patients undergoing urologic oncological surgeries. ⋯ Existing risk stratification tools may be improved by incorporating variables in our 15-point modified frailty index as well as other factors such as walking speed, exhaustion, and sarcopenia to fully assess frailty. This is relevant in diseases such as kidney and prostate cancer, where surveillance and other nonsurgical interventions exist as alternatives to a potentially complicated surgery. In these scenarios, our modified frailty index augmented by the American Society of Anesthesiologists Risk Class may help inform which patients have increased surgical complications that may outweigh the benefit of surgery although this index needs prospective validation.
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Yes-associated protein 1 (YAP1) and long noncoding RNA H19 act as potent oncogenes in many human cancers, but little is known about their roles in bladder cancer or their relationship with each other. ⋯ Our results emphasize the importance of YAP1 and H19 in bladder cancer progression and indicate that H19, at least in part, is induced by YAP1 overexpression.
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To examine the Centers for Medicare and Medicaid Services, which since 2008 has identified and not reimbursed 10 common postoperative complications deemed "never events" or hospital-acquired conditions (HACs). Prostate cancer, the most frequent cancer among U.S. men, is most often treated with radical prostatectomy (RP). Therefore, its complications in total may represent significant costs to hospitals and providers if not reimbursed. We evaluated the potential effect of these unreimbursed HACs following RP on clinical outcomes and costs. ⋯ In a robust sample of patients who underwent RP in the United States, HACs were very uncommon and contributed approximately $1 million in additional expenditures. As the U.S. government continues to expand quality improvement programs and develop incentives to avoid complications, efforts to monitor unnecessary complications should continue as well.