Claudio Jeldres Lanzarotti

Publications (158) View all

• Article: Incidence, survival and mortality rates of stage-specific bladder cancer in United States: A trend analysis.

  Firas Abdollah, Giorgio Gandaglia, Rodolphe Thuret, Jan Schmitges, Zhe Tian, Claudio Jeldres, Niccolò Maria Passoni, Alberto Briganti, Shahrokh F Shariat, Paul Perrotte, Francesco Montorsi, Pierre I Karakiewicz, Maxine Sun
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  ABSTRACT: PURPOSE: To examine the overall and stage-specific age-adjusted incidence, 5-year survival and mortality rates of bladder cancer (BCa) in the United States, between 1973 and 2009. MATERIALS AND METHODS: A total of 148,315 BCa patients were identified in the Surveillance, Epidemiology and End Results database, between years 1973 and 2009. Incidence, mortality, and 5-year cancer-specific survival rates were calculated. Temporal trends were quantified using the estimated annual percentage change (EAPC) and linear regression models. All analyses were stratified according to disease stage, and further examined according to sex, race, and age groups. RESULTS: Incidence rate of BCa increased from 21.0 to 25.5/100,000 person-years between 1973 and 2009. Stage-specific analyses revealed an increase incidence for localized stage: 15.4-20.2 (EAPC: +0.5%, p<0.001) and distant stage: 0.5-0.8 (EAPC: +0.7%, p=0.001). Stage-specific 5-year survival rates increased for all stages, except for distant disease. No significant changes in mortality were recorded among localized (EAPC: -0.2%, p=0.1) and regional stage (EAPC: -0.1%, p=0.5). An increase in mortality rates was observed among distant stage (EAPC: +1.0%, p=0.005). Significant variations in incidence and mortality were recorded when estimates were stratified according to sex, race, and age groups. DISCUSSION: Albeit statistically significant, virtually all changes in incidence and mortality were minor, and hardly of any clinical importance. Little or no change in BCa cancer control outcomes has been achieved during the study period.
  Cancer epidemiology. 02/2013;
• Article: Effect of Nodal Metastases on Cancer-specific Mortality After Cytoreductive Nephrectomy.

  Quoc-Dien Trinh, Shyam Sukumar, Jan Schmitges, Marco Bianchi, Maxine Sun, Shahrokh F Shariat, Jesse D Sammon, Claudio Jeldres, Kevin C Zorn, Paul Perrotte, Markus Graefen, Craig G Rogers, James O Peabody, Mani Menon, Pierre I Karakiewicz
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  ABSTRACT: BACKGROUND: Relatively few reports have described the outcomes of patients with node-positive renal cell carcinoma (RCC) in the presence of distant metastases. We examined the outcomes of these patients in a large population-based cohort and examined the ability of standard risk factors to predict cancer-specific mortality (CSM). METHODS: Using the Surveillance, Epidemiology, and End Results database, 1415 RCC patients with distant metastases undergoing cytoreductive nephrectomy (CNT) were identified. Univariable and multivariable analyses addressed CSM to identify independent predictors of CSM. First, the effect of nodal disease on CSM and overall mortality (OM) was estimated in patients with metastatic disease (N0M1 vs. N1M1). Then, we examined the effect of the number of removed nodes and the number of positive nodes on CSM to quantify the effect on mortality, if any, of the increasing burden of nodal disease. RESULTS: Actuarial survival estimates demonstrated that for patients with nodal disease 40.2, 23.5 and 11.5 % of patients survived at 12, 24 and 60 months after nephrectomy. In Kaplan-Meier analyses, patients with N1M1 disease had a significantly worse CSM when compared to patients with N0M1 disease (log rank p < 0.001). In multivariable analyses, N1M1 had a 68 and 69 % increase in CSM and OM (vs. N0M1 disease) while, for every additional positive node, CSM and OM increased by 5.1 and 5.6 %. CONCLUSIONS: In patients undergoing CNT, the burden of nodal disease is an independent predictor of CSM, with an incremental effect of every additional positive node.
  Annals of Surgical Oncology 12/2012; · 4.17 Impact Factor
• Article: The effect of gender on nephrectomy perioperative outcomes: a national survey.

  Jesse Sammon, Quoc-Dien Trinh, Maxine Sun, Marco Bianchi, Jan Schmitges, Shahrokh F Shariat, Khurshid R Ghani, Shyam Sukumar, Claudio Jeldres, Alberto Briganti, Paul Perrotte, Craig G Rogers, James O Peabody, Francesco Montorsi, Mani Menon, Pierre I Karakiewicz
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  ABSTRACT: The effect of gender on complications after surgery is controversial. We examine the effect of gender on five short term nephrectomy outcomes. Within the Health Care Utilization Project, Nationwide Inpatient Sample (NIS) we focused on nephrectomies performed within the most contemporary years (1998-2007). We tested the rates of blood transfusions, extended length of stay, in-hospital mortality, as well as intraoperative and postoperative complications, stratified according to gender. Multivariable logistic regression analyses fitted with general estimation equations for clustering among hospitals further adjusted for confounding factors. Separate multivariable analyses were performed for open radical nephrectomy (ORN), open partial nephrectomy (OPN), laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN). Overall, 48172 nephrectomies were identified. Of those, female patients accounted 39.4% of cases (n = 18966). Female gender was associated with higher rates of blood transfusions (p < 0.001) and higher rates of prolonged length of stay (p < 0.001). Conversely, female gender was associated with lower rates of postoperative complications (p < 0.001) and in-hospital mortality (p = 0.015). In multivariable analyses, female patients had higher rates of blood transfusion (OR = 1.22, p < 0.001) but significantly lower rates of postoperative complications (OR = 0.81, p < 0.001) and in-hospital mortality. No statistically significant differences were recorded when accounting for intraoperative complications and length of stay beyond the median (all p > 0.05). Gender as a predictor of outcomes was most pronounced in OPN and LPN. Nephrectomies performed in female patients are associated with lower rates of postoperative complications and in-hospital mortality. Conversely, blood transfusions rates are higher in these patients. Gender disparities in perioperative outcomes are most pronounced after OPN.
  The Canadian Journal of Urology 08/2012; 19(4):6337-44. · 0.64 Impact Factor
• Article: Impact of academic affiliation on radical cystectomy outcomes in North America: A population-based study.

  Marco Bianchi, Quoc-Dien Trinh, Maxine Sun, Malek Meskawi, Jan Schmitges, Shahrokh F Shariat, Alberto Briganti, Zhe Tian, Claudio Jeldres, Shyam Sukumar, James O Peabody, Markus Graefen, Paul Perrotte, Mani Menon, Francesco Montorsi, Pierre I Karakiewicz
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  ABSTRACT: : The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to institutional academic status in patients undergoing radical cystectomy (RC). : Within the Health Care Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCI), hospital region, insurance status, annual hospital caseload (AHC), year of surgery and urinary diversion. : Overall, 12 262 patients underwent RC. Of those, 7892 (64.4%) were from academic institutions. Patients treated at academic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associated with fewer postoperative complications (28.8% vs. 32.9%, p < 0.001), shorter length of stay (54.0% vs. 56.2%, p = 0.02) and lower in-hospital mortality rates (2.1 vs. 3.0%, p = 0.002). In multivariable analyses, patients who underwent RC at an academic hospital were 12% less likely to succumb to postoperative complications (odds ratio=0.88, p = 0.003). : Even after adjusting for AHC, RCs performed at academic institutions are associated with better postoperative outcomes than RCs performed at non-academic institutions. From a public health prospective, performing RCs at academic institutions may help reduce costs associated with the management of complications and prolonged length of stay.
  Canadian Urological Association journal = Journal de l'Association des urologues du Canada 08/2012; 6(4):245-50. · 1.24 Impact Factor
• Article: Extranodal Extension Is a Powerful Prognostic Factor in Bladder Cancer Patients with Lymph Node Metastasis.

  Harun Fajkovic, Eugene K Cha, Claudio Jeldres, Brian D Robinson, Michael Rink, Evanguelos Xylinas, Thomas F Chromecki, Eckart Breinl, Robert S Svatek, Gerhard Donner, [......], Pierre I Karakiewicz, Bjoern G Volkmer, Giacomo Novara, Abdennabi Joual, Talia Faison, Guru Sonpavde, Siamak Daneshmand, Yair Lotan, Douglas S Scherr, Shahrokh F Shariat
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  ABSTRACT: BACKGROUND: Lymph node metastasis (LNM) is the most powerful pathologic predictor of disease recurrence after radical cystectomy (RC). However, the outcomes of patients with LNM are highly variable. OBJECTIVE: To assess the prognostic value of extranodal extension (ENE) and other lymph node (LN) parameters. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 748 patients with urothelial carcinoma of the bladder and LNM treated with RC and lymphadenectomy without neoadjuvant therapy at 10 European and North American centers (median follow-up: 27 mo). INTERVENTION: All subjects underwent RC and bilateral pelvic lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Each LNM was microscopically evaluated for the presence of ENE. The number of LNs removed, number of positive LNs, and LN density were recorded and calculated. Univariable and multivariable analyses addressed time to disease recurrence and cancer-specific mortality after RC. RESULTS AND LIMITATIONS: A total of 375 patients (50.1%) had ENE. The median number of LNs removed, number of positive LNs, and LN density were 15, 2, and 15, respectively. The rate of ENE increased with advancing pT stage (p<0.001). In multivariable Cox regression analyses that adjusted for the effects of established clinicopathologic features and LN parameters, ENE was associated with disease recurrence (hazard ratio [HR]: 1.89; 95% confidence interval [CI], 1.55-2.31; p<0.001) and cancer-specific mortality (HR: 1.90; 95% CI, 1.52-2.37; p<0.001). The addition of ENE to a multivariable model that included pT stage, tumor grade, age, gender, lymphovascular invasion, surgical margin status, LN density, number of LNs removed, number of positive LNs, and adjuvant chemotherapy improved predictive accuracy for disease recurrence and cancer-specific mortality from 70.3% to 77.8% (p<0.001) and from 71.8% to 77.8% (p=0.007), respectively. The main limitation of the study is its retrospective nature. CONCLUSIONS: ENE is an independent predictor of both cancer recurrence and cancer-specific mortality in RC patients with LNM. Knowledge of ENE status could help with patient counseling, clinical decision making regarding inclusion in clinical trials of adjuvant therapy, and tailored follow-up scheduling after RC.
  European urology 07/2012; · 7.67 Impact Factor