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  • 1.
    Aljabery, Firas
    et al.
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Liedberg, Fredrik
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden.
    Häggström, Christel
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Department of Biobank Research, Umeå University, Umeå, Sweden.
    Ströck, Viveka
    Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hosseini, Abolfazl
    Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Jerlström, Tomas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Urology.
    Malmström, Per-Uno
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Holmberg, Lars
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; School of Medicine, King´s College London, London, UK.
    Hagberg, Oskar
    Department of Translational Medicine, Lund University, Malmö, Sweden.
    Jahnson, Staffan
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Management and outcome of muscle-invasive bladder cancer with clinical lymph node metastases. A nationwide population-based study in the bladder cancer data base Sweden (BladderBaSe)2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the clinical management and outcome of patients with muscle-invasive bladder cancer with clinical lymph node involvement, using longitudinal nationwide population-based data.

    Methods: In the Bladder Cancer Data Base Sweden (BladderBaSe), treatment and survival in patients with urinary bladder cancer clinical stage T2-T4 N + M0 diagnosed between 1997 and 2014 was investigated. Patients´ characteristics were studied in relation to TNM classification, curative or palliative treatment, cancer-specific (CSS) and overall survival (OS). Age at diagnosis was categorised as ≤60, 61-70, 71-80 and >80 years, and time periods were stratified as follows: 1997-2001, 2002-2005, 2006-2010 and 2011-2014.

    Results: There were 786 patients (72% males) with a median age of 71 years (interquartile range = 64-79 years). The proportion of patients with high comorbidity increased over time. Despite similar low comorbidity, curative treatment was given to 44% and to 70% of those in older (>70 years) and younger age groups, respectively. Curative treatment decreased over time, but chemotherapy and cystectomy increased to 25% during the last time period. Patients with curative treatment had better survival compared to those with palliative treatment, both regarding CSS and OS in the whole cohort and in all age groups.

    Conclusions: The low proportion of older patients undergoing treatment with curative intent, despite no or limited comorbidity, indicates missed chances of treatment with curative intent. The reasons for an overall decrease in curative treatment over time need to be analysed and the challenge of coping with an increasing proportion of node-positive patients with clinically significant comorbidity needs to be met.

  • 2.
    Böös, Malin
    et al.
    aDepartment of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden.
    Jerlström, Tomas
    Örebro University, School of Medical Sciences. Department of Urology.
    Beckman, Eva
    Department of Urology, Uppsala University Hospital, Uppsala, Sweden.
    Bläckberg, Mats
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden.
    Brändstedt, Johan
    Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Kollberg, Petter
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Löfgren, Annica
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Malmström, Per-Uno
    Department of Urology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sahlén, Göran
    Department of Urology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sörenby, Anne
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Vikerfors, Anders
    Örebro University, School of Medical Sciences. Department of Urology.
    Åkesson, Anna
    Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.
    Liedberg, Fredrik
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomyManuscript (preprint) (Other academic)
  • 3.
    Böös, Malin
    et al.
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden.
    Jerlström, Tomas
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Urology.
    Beckman, Eva
    Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Bläckberg, Mats
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden.
    Brändstedt, Johan
    Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Kollberg, Petter
    Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Löfgren, Annica
    Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Malmström, Per-Uno
    Department of Urology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sahlén, Göran
    Department of Urology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Sörenby, Anne
    Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Vikerfors, Anders
    Örebro University, School of Medical Sciences. Department of Urology.
    Åkesson, Anna
    Clinical Studies Sweden, Skåne University Hospital, Lund, Sweden.
    Liedberg, Fredrik
    Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Urology, Skåne University Hospital, Malmö, Sweden.
    Who should record surgical complications?: Results from a third-party assessment of complications after radical cystectomy2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813Article in journal (Refereed)
    Abstract [en]

    Objective: In Sweden complications after radical cystectomy have been reported to the nationwide population-based Swedish Cystectomy Registry since 2011. Here, validation of the reporting was assessed in two healthcare regions.

    Materials and methods: Complications were ascertained from patient records by a third party not involved in the care delivered to 429 randomly selected patients from 949 who had undergone radical cystectomy since 2011 in four hospitals. Without knowledge of the outcome in the primary registration, post-operative complications within 90 days post-operatively were assessed by an independent review of patient charts, and the results were compared with the primary reports in the Swedish Cystectomy Registry.

    Results: The third-party assessment identified post-operative complications in 310 patients (72%). Low-grade complications (Clavien-Dindo I-II) were noted in 110 (26%) of the patients in the primary registration, but increased to 182 (42%) in the validation (p < 0.00001). High-grade complications (Clavien-Dindo III-V) were reported in 113 (26%) patients in the primary registration, but in 128 (30%) of the patients in the validation (p = 0.02). According to the third-party assessment, 18 patients (4%) had Clavien-Dindo grade IV complications and 12 (3%) died within 90 days of surgery (Clavien-Dindo grade V); corresponding values in the primary registration were 15 (3%) and 9 (2%), respectively. The readmission rate within 90 days increased from 27 to 32% in the validation (p < 0.00001).

    Conclusions: Compared with registry data, third-party assessment revealed more complications and readmissions after radical cystectomy. Hence such evaluation may improve the validity of reported complication data.

  • 4.
    Carlsson, Jessica
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Vikerfors, Anders
    Örebro University, School of Medical Sciences.
    Frey, Janusz
    Jerlström, Tomas
    Örebro University, School of Medical Sciences.
    Davidsson, Sabina
    Is soluble PD-L1 a potential biomarker for urothelial bladder cancer?2019Conference paper (Refereed)
  • 5.
    Jerlström, Tomas
    Örebro University, School of Medical Sciences.
    Clinical aspects of cystectomy and urinary diversion2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to explore different aspects of treatment of advanced urinary bladder cancer with radical cystectomy, pelvic lymph node dissection, and urinary diversion. Surgery that carry a high risk of complications as well as mortality. Aside from complications and risk of recurrance, patients have to cope with lifelong postoperative changes of body function, including sexual function, and body image, all affecting quality of life (QoL). The thesis comprises four papers. In the first paper, we compared functional outcome and QoL following two types of ileal orthotopic neobladder substitution. The results suggest that the S-shaped substitute entails better functional results than the U-shaped substitute, with better continence, especially at night. There was no difference in QoL. The second paper reports results from the first year of registration in the nation-wide Swedish Cystectomy Register. Analysis of risk factors for complications showed that high age and prolonged operation are associated with increased risk of short-term complications. The third paper investigated whether preoperative chemotherapy in patients with muscle-invasive bladder cancer (MIBC) affects the risk of shortterm complications after radical cystectomy, using data from the Cystectomy Register covering 1340 patients of whom 39 percent received preoperativevchemotherapy. We found no such increase in risk. In the fourth paper, we analysed the results of a validation study of the Cystectomy Register. The validation showed 17 percent more low grade complications, three percent more high grade complications, and five percent more readmissions, within 90 days of surgery. Hence, a third-party validation may improve the validity of the register

    List of papers
    1. Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
    Open this publication in new window or tab >>Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder
    2010 (English)In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 4, p. 197-203Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE: To compare the functional outcome of two types of orthotopic bladder substitution, the S-shaped and the U-shaped neobladder, with respect to leakage, functional capacity and quality of life.

    MATERIAL AND METHODS: Between 1999 and 2007, 45 male patients with urinary bladder cancer were treated with cystectomy and orthotopic bladder substitution; 23 with the S-shaped bladder ad modum Schreiter and 22 with the U-shaped bladder ad modum Studer. Patients were followed up by a urologist and a specialized nurse (urotherapist) at 1, 3 and 6 months. At each visit the patient completed a voiding chart, a weighted pad test and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Differences between the groups in functional outcome and quality of life variables were analysed by Student's t test using SPSS software.

    RESULTS: Mean maximum bladder capacity increased over time. At 6 months, the S-bladder had a larger capacity than the U-bladder (525 ml vs 423 ml). Patients with an S-bladder had less urine leakage at all follow-ups, although this was statistically significant only at 6 months regarding day-time incontinence and at all visits regarding night-time incontinence. The mean urine leakage at 6 months was 7 g (day) and 30 g (night) in the S-bladder group and 50 g (day) and 250 g (night) in the U-bladder group. However, quality of life did not differ between the groups.

    CONCLUSION: The S-bladder had better bladder capacity and less leakage than the U-bladder, but these differences did not translate into differences in quality of life. The results should be confirmed in larger prospective studies.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2010
    Keywords
    Functional outcome, neobladder, orthotopic bladder substitution, quality of life, urinary leakage
    National Category
    Urology and Nephrology Nursing
    Research subject
    Medicine; Nursing Science
    Identifiers
    urn:nbn:se:oru:diva-35176 (URN)10.3109/00365591003727577 (DOI)000282143600001 ()20367221 (PubMedID)2-s2.0-77955538348 (Scopus ID)
    Available from: 2014-05-27 Created: 2014-05-27 Last updated: 2019-04-09Bibliographically approved
    2. Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
    Open this publication in new window or tab >>Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database
    Show others...
    2014 (English)In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, no 4, p. 334-340Article in journal (Refereed) Published
    Abstract [en]

    Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.

    Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.

    Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.

    Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2014
    Keywords
    Bladder carcinoma, complications, radical cystectomy
    National Category
    Urology and Nephrology
    Identifiers
    urn:nbn:se:oru:diva-56495 (URN)10.3109/21681805.2014.909883 (DOI)000340072700001 ()24844275 (PubMedID)2-s2.0-84904320467 (Scopus ID)
    Available from: 2017-03-16 Created: 2017-03-16 Last updated: 2019-04-01Bibliographically approved
    3. No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
    Open this publication in new window or tab >>No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based study
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-73417 (URN)
    Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
    4. Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
    Open this publication in new window or tab >>Who should record surgical complications? Results from a third-party assessment of complications after radical cystectomy
    Show others...
    (English)Manuscript (preprint) (Other academic)
    National Category
    Surgery
    Identifiers
    urn:nbn:se:oru:diva-73418 (URN)
    Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
  • 6.
    Jerlström, Tomas
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Andersson, Gunnel
    Örebro University Hospital, Örebro, Sweden.
    Carringer, Malcolm
    Örebro University Hospital, Örebro, Sweden.
    Functional outcome of orthotopic bladder substitution: a comparison between the S-shaped and U-shaped neobladder2010In: Scandinavian Journal of Urology and Nephrology, ISSN 0036-5599, E-ISSN 1651-2065, Vol. 44, no 4, p. 197-203Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare the functional outcome of two types of orthotopic bladder substitution, the S-shaped and the U-shaped neobladder, with respect to leakage, functional capacity and quality of life.

    MATERIAL AND METHODS: Between 1999 and 2007, 45 male patients with urinary bladder cancer were treated with cystectomy and orthotopic bladder substitution; 23 with the S-shaped bladder ad modum Schreiter and 22 with the U-shaped bladder ad modum Studer. Patients were followed up by a urologist and a specialized nurse (urotherapist) at 1, 3 and 6 months. At each visit the patient completed a voiding chart, a weighted pad test and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Differences between the groups in functional outcome and quality of life variables were analysed by Student's t test using SPSS software.

    RESULTS: Mean maximum bladder capacity increased over time. At 6 months, the S-bladder had a larger capacity than the U-bladder (525 ml vs 423 ml). Patients with an S-bladder had less urine leakage at all follow-ups, although this was statistically significant only at 6 months regarding day-time incontinence and at all visits regarding night-time incontinence. The mean urine leakage at 6 months was 7 g (day) and 30 g (night) in the S-bladder group and 50 g (day) and 250 g (night) in the U-bladder group. However, quality of life did not differ between the groups.

    CONCLUSION: The S-bladder had better bladder capacity and less leakage than the U-bladder, but these differences did not translate into differences in quality of life. The results should be confirmed in larger prospective studies.

  • 7.
    Jerlström, Tomas
    et al.
    Department of Urology, University Hospital, Örebro, Sweden.
    Gardmark, Truls
    Dept Surg & Urol, Danderyd Hosp, Danderyd, Sweden.
    Carringer, Malcolm
    Örebro University Hospital. Department of Urology, Örebro University Hospital, Örebro, Sweden.
    Holmang, Sten
    Dept Urol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Liedberg, Fredrik
    Dept Urol, Skåne Univ Hosp, Malmö, Sweden.
    Hosseini, Abolfazl
    Dept Mol Med & Surg, Urol Sect, Karolinska Inst, Stockholm, Sweden.
    Malmström, Per-Uno
    Dept Surg Sci, Uppsala Univ, Uppsala, Sweden.
    Ljungberg, Börje
    Dept Surg & Perioperat Sci Urol & Androl, Norrlands Univ Hosp, Umeå, Sweden.
    Hagberg, Oskar
    Reg Canc Ctr South, Lund, Sweden.
    Jahnson, Staffan
    Dept Clin & Expt Med, Div Urol, Linköping Univ Hosp, Linköping, Sweden.
    Urinary bladder cancer treated with radical cystectomy: Perioperative parameters and early complications prospectively registered in a national population-based database2014In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 48, no 4, p. 334-340Article in journal (Refereed)
    Abstract [en]

    Objective: Cystectomy combined with pelvic lymph-node dissection and urinary diversion entails high morbidity and mortality. Improvements are needed, and a first step is to collect information on the current situation. In 2011, this group took the initiative to start a population-based database in Sweden (population 9.5 million in 2011) with prospective registration of patients and complications until 90 days after cystectomy. This article reports findings from the first year of registration.

    Material and methods: Participation was voluntary, and data were reported by local urologists or research nurses. Perioperative parameters and early complications classified according to the modified Clavien system were registered, and selected variables of possible importance for complications were analysed by univariate and multivariate logistic regression.

    Results: During 2011, 285 (65%) of 435 cystectomies performed in Sweden were registered in the database, the majority reported by the seven academic centres. Median blood loss was 1000 ml, operating time 318 min, and length of hospital stay 15 days. Any complications were registered for 103 patients (36%). Clavien grades 1-2 and 3-5 were noted in 19% and 15%, respectively. Thirty-seven patients (13%) were reoperated on at least once. In logistic regression analysis elevated risk of complications was significantly associated with operating time exceeding 318 min in both univariate and multivariate analysis, and with age 76-89 years only in multivariate analysis.

    Conclusions: It was feasible to start a national population-based registry of radical cystectomies for bladder cancer. The evaluation of the first year shows an increased risk of complications in patients with longer operating time and higher age. The results agree with some previously published series but should be interpreted with caution considering the relatively low coverage, which is expected to be higher in the future.

  • 8.
    Jerlström, Tomas
    et al.
    Örebro University, School of Medical Sciences. Department of Urology.
    Ruoqing, Chen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Liedberg, Fredrik
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden.
    Andrén, Ove
    Örebro University, School of Medical Sciences. Department of Urology.
    Ströck, Viveka
    Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden; Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg, Sweden.
    Aljabery, Firas A. S.
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Hosseini, Abolfazl
    Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Malmström, Per-Uno
    Department of Urology, Institute of Surgical Sciences, Uppsala, Sweden.
    Ullén, Anders
    PO Bäckencancer, Theme Cancer, Karolinska University Hospital and Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences. Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    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 study2019In: World journal of urology, ISSN 0724-4983, E-ISSN 1433-8726Article in journal (Refereed)
    Abstract [en]

    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.

  • 9.
    Jerlström, Tomas
    et al.
    Örebro University, School of Medical Sciences. Department of Urology.
    Ruoqing, Chen
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Liedberg, Fredrik
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden.
    Ströck, Viveka
    Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Academy, institute of Clinical Sciences, Gothenburg, Sweden.
    Aljabery, Firas A.S.
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Hosseini, Abolfazl
    Section of Urology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Malmström, Per-Uno
    1Department of Urology, Institute of surgical Sciences, Uppsala, Sweden.
    Ullén, Anders
    PO Bäckencancer, Theme Cancer, Karolinska University Hospita, Solna, Sweden; Department of Oncology-Pathology, Karolinska Institutet, Solna, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    No increased risk of short-term complications after radical cystectomy for muscle invasive bladder cancer among patients treated with preoperative chemotherapy: a nationwide register-based studyManuscript (preprint) (Other academic)
  • 10.
    Liedberg, Fredrik
    et al.
    Skåne University Hospital, Lund University, Malmö, Sweden.
    Hagberg, Oskar
    Regional Cancer Centre South, Region Skåne, Lund, Sweden.
    Aljabery, Firas
    Linköping University, Linköping, Sweden.
    Gårdmark, Truls
    Karolinska Institute, Stockholm, Sweden.
    Hosseini, Abolfazl
    Karolinska University Hospital, Stockholm, Sweden.
    Jahnson, Staffan
    Linköping University, Linköping, Sweden.
    Jancke, Georg
    Lund University, Malmö, Sweden.
    Jerlström, Tomas
    Örebro University, School of Medical Sciences.
    Malmström, Per-Uno
    Uppsala University, Uppsala, Sweden.
    Sherif, Amir
    Umeå University, Umeå, Sweden.
    Ströck, Viveka
    Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
    Haggström, Christel
    Umeå University, Umeå, Sweden; Uppsala University, Uppsala, Sweden.
    Holmberg, Lars
    Uppsala University, Uppsala, Sweden; Kings College, London, United Kingdom.
    Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care in Sweden: a nationwide population-based study2019In: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 53, no Suppl. 221, p. 20-20Article in journal (Other academic)
    Abstract [en]

    Objective: To investigate the association between hospital volume on overall survival (OS), cancer-specific survival (CSS), and quality of care defined as use of extended lymphadenectomy, continent reconstruction, neoadjuvant chemotherapy and treatment delay less than 3 months.

    Materials and Methods: We used Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent radical cystectomy for primary invasive bladder cancer stage T1T3 in Sweden 19972014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level and neoadjuvant chemotherapy. PSMAV was either categorised in tertiles, dichotomised (at 25 or more cystectomies annually), or used as a continuous variable for every increase of 10 cystectomies annually.

    Results: PSMAV in the highest tertile (25 or more cystectomies annually) was associated with improved overall survival (HR 0.87, 95% CI 0.751.0), with a similar trend for cancer-specific survival (HR 0.87, 95% CI 0.731.04). With PSMAV as a continuous variable, overall survival was improved for every increase of 10 cystectomies annually (HR 0.95, 95% CI 0.900.99). Moreover, higher PSMAV was associated with increased use of extended lymphadenectomy, continent reconstruction and neoadjuvant chemotherapy, but also more frequently with a treatment delay of more than 3 months after diagnosis.

    Conclusions: The current study supports centralisation of radical cystectomy for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

  • 11.
    Liedberg, Fredrik
    et al.
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
    Hagberg, Oskar
    Regional Cancer Centre South, Region Skåne, Lund, Sweden.
    Aljabery, Firas
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Gårdmark, Truls
    Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
    Hosseini, Abolfazl
    Department of Urology, Karolinska University Hospital, Stockholm, Sweden.
    Jahnson, Staffan
    Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden.
    Jancke, Georg
    Department of Urology, Skåne University Hospital, Malmö, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
    Jerlström, Tomas
    Örebro University, School of Medical Sciences. Department of Urology.
    Malmström, Per-Uno
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Sherif, Amir
    Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.
    Ströck, Viveka
    Department of Urology, Sahlgrenska University Hospital and, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Häggström, Christel
    Department of Biobank Research, Umeå University, Umeå, and Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Holmberg, Lars
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; School of Medicine, King's College, London, UK.
    Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study2019In: BJU International, ISSN 1464-4096, E-ISSN 1464-410X, Vol. 124, no 3, p. 449-456Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the association between hospital volume on overall survival (OS), cancer-specific survival (CSS), and quality of care defined as use of extended lymphadenectomy, continent reconstruction, neoadjuvant chemotherapy and treatment delay less than 3 months.

    MATERIALS AND METHODS: We used Bladder Cancer Data Base Sweden (BladderBaSe) to study survival and indicators of perioperative quality of care in all 3172 patients who underwent radical cystectomy for primary invasive bladder cancer stage T1-T3 in Sweden 1997-2014. The period-specific mean annual hospital volume (PSMAV) during the 3 years preceding surgery was applied as an exposure and analysed using univariate and multivariate mixed models, adjusting for tumour and nodal stage, age, gender, comorbidity, educational level and neoadjuvant chemotherapy. PSMAV was either categorised in tertiles, dichotomised (at 25 or more cystectomies annually), or used as a continuous variable for every increase of 10 cystectomies annually.

    RESULTS: PSMAV in the highest tertile (25 or more cystectomies annually) was associated with improved overall survival (HR 0.87, 95% CI 0.75-1.0), whereas corresponding HR for cancer-specific survival was 0.87 (95% CI 0.73-1.04). With PSMAV as a continuous variable, overall survival was improved for every increase of 10 cystectomies annually (HR 0.95, 95% CI 0.90-0.99). Moreover, higher PSMAV was associated with increased use of extended lymphadenectomy, continent reconstruction and neoadjuvant chemotherapy, but also more frequently with a treatment delay of more than 3 months after diagnosis.

    CONCLUSIONS: The current study supports centralisation of radical cystectomy for bladder cancer, but also underpins the need for monitoring treatment delays associated with referral.

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