- Email: [email protected]
MP04-16 PERIOPERATIVE AND LONG TERM OUTCOMES AFTER RADICAL CYSTECTOMY IN HEMODIALYSIS PATIENTS
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THE JOURNAL OF UROLOGYâ
difference in delay to RC except women with Stage IV disease were less likely to have delay to RC than men (RR 0.67, 95% CI ¼ 0.62-0.95, p¼0.017). Using propensity score matching, women had improved overall (Hazard Ratio (HR) 0.85, CI 0.82-0.88, p < 0.001), but worse cancer-specific survival (HR 1.08, CI 1.02-1.15, p ¼ 0.008) than men, respectively. CONCLUSIONS: Gender differences persist with women significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse cancer-specific survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women.
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
to varying degrees. The SMI was the strongest predictor of readmission and postoperative complications in patients undergoing cystectomy. Evaluation of patients preoperatively can be used to better counsel patients about postoperative complication risk.
Source of Funding: This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a by a Clinical and Translational Science Award Mentored Career Development (KL2) Award (KL2TR001441) from the National Center for Advancing Translational Sciences, National Institutes of Health, Comparative Effectiveness Research on Cancer in Texas (CERCIT) (RP140020) and the National Cancer Institute (NCI) (K05 CA134923) (SBW) and in part by the fellowship from University of Texas MD Anderson Cancer Center’s Halliburton Employees Foundation (JH).
MP04-15 THE PREVALENCE AND IMPACT OF PREOPERERATIVE FRAILTY: A PROSPECTIVE STUDY OF PATIENTS UNDERGOING CYSTECTOMY
Source of Funding: American Cancer Society Seed Grant.
Conrad Tobert*, Nathan Brooks, Lewis Thomas, Chermaine Hung, Sarah Bell, Kenneth Nepple, Iowa City, IA INTRODUCTION AND OBJECTIVES: Perioperative morbidity is common amongst patients undergoing radical cystectomy. Frailty (decreased functional reserve) measurement has been proposed to identify at-risk patients, but there has been limited comparative prospective analysis of different frailty measures. METHODS: 98 cystectomy patients at our institution from January 2015 to September 2016 were prospectively evaluated preoperatively, using the protocols for the four frailty indices: Duke Activity Status Index (DASI), Edmonton Frailty Index (EFI), Fried Frailty Index (FFI) and Schonberg Mortality Index (SMI) by a urology resident. Consensus Statement malnutrition assessment was performed by a dietitian. We examined the relationship between frailty, patient characteristics (age, neoadjuvant chemotherapy, malnutrition), and outcomes (length of stay 30-day readmission, 30-day Clavien grade > 2) were examined. RESULTS: Median DASI was 39.4 (IQR: 26.9, 58.2), median EFI was 3 (IQR: 2, 4.2), median FFI was 2 (IQR: 1, 3), and median SMI was 12 (IQR: 9.7, 15). The median age of cystectomy patients was 71 years (IQR: 62, 77). 66 of 98 (67.3%) patients underwent neoadjuvant chemotherapy while preoperative malnutrition was present in 32 of 98 (32.6%) patients. With respect to outcomes: median length of stay was 7 days (IQR: 5, 8), 30-day readmission rate was 25.8%, and the 30-day complication rate was 41.8%. The associations of variables with the four frailty indices are displayed in Table 1. Increased age was significantly associated with all four indices. Neoadjuvant chemotherapy was only associated with the FFI (p¼0.04). The presence of malnutrition was associated with the EFI (p¼0.02), FFI (p<0.01), and SMI (p¼0.04). The SMI was only index related to postoperative outcomes, as increased SMI was associated with both 30-day complications (p¼0.04) and 30-day readmission (p<0.01). CONCLUSIONS: Different frailty indices appear to measure different aspects of functional status. In this prospective evaluation, frailty was associated with age, malnutrition, and complications
MP04-16 PERIOPERATIVE AND LONG TERM OUTCOMES AFTER RADICAL CYSTECTOMY IN HEMODIALYSIS PATIENTS Scott Johnson*, Zachary Smith, Joseph Rodriguez III, Gary Steinberg, Chicago, IL INTRODUCTION AND OBJECTIVES: End stage renal disease patients on hemodialysis (HD) have in increased risk of developing bladder cancer, which is more likely to present in an advanced stage. These patients also have significant risk of non-cancer related morbidity and mortality, especially from cardiovascular disease. Radical cystectomy (RC) is the standard of care for non-metastatic muscle invasive bladder cancer, but is associated with significant morbidity. Despite this high risk scenario, very little is known regarding outcomes in HD patients following RC. METHODS: The US Renal Disease System database was used for this study, which is a prospective database which includes every HD patient in the United States. A retrospective review of all HD dependent patients who underwent radical RC for bladder cancer between 1989-2013 was performed. Competing risks analysis was used to estimate overall and disease specific survival. Cox regression was used to identify predictors of death. RESULTS: During the 25-year study period, a total of 1594 patients were identified for analysis, of whom 76.1% were male. The mean age was 70.4 9.8 years. Mean length of stay was 16.2 14.8. Concurrent nephrectomy was undertaken in 33.1% of patients. The 30-day mortality rate was 5.9%. Overall 1, 3, and 5-year survival was 58.4%, 31.4%, and 19.6% respectively. Bladder cancer specific survival at 1, 3, and 5 years was 89.3%, 82.3%, and 80.0% respectively. Predictors of overall mortality were age (HR, 1.03; 95%CI, 1.02-1.03), history of congestive heart failure (CHF) (HR, 1.19; 95%CI, 1.03-1.38), history of diabetes (HR, 1.22; 95%CI, 1.04-1.42), concurrent nephrectomy (HR, 1.09; 95%CI, 1.03-1.14), and female sex (HR, 1.15; 95%CI, 1.01-1.33). Amount of time on HD prior to RC was not predictive of mortality.
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
CONCLUSIONS: This represents the largest study to date evaluating outcomes following RC in HD patients. RC is associated with significant morbidity and less than 20% of patients survive 5 years. Older patients, female patients, and those with a history of CHF or diabetes are at an increased risk of mortality. Source of Funding: none
MP04-17 BLOOD-BASED BIOMARKERS AS PREDICTORS OF ONCOLOGIC OUTCOMES FOR NON-MUSCLE-INVASIVE UROTHELIAL BLADDER CARCINOMA Daher Chade*, Andre Machado, Ricardo Waksman, Guilherme Garcia, Paulo Esteves, Sanarelly Adonias, Flavio Areas, Luis Botelho, Mauricio Cordeiro, Claudio Murta, Leopoldo Ribeiro-Filho, Alvaro Sarkis, Sao Paulo, Brazil; Shahrokh Shariat, Vienna, Austria; Diogo Bastos, Carlos Dzik, Miguel Srougi, William Nahas, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: Our group has previously demonstrated that blood-based tumor markers can be useful clinical outcome predictors for non-muscle invasive urothelial carcinoma of the bladder (UCB) Our aim in this study is to further evaluate the predictive value of CEA, CA 19-9 and CA 125 on disease recurrence and progression. METHODS: We prospectively included 328 consecutive patients between February 2008 and August 2014 to measure preoperative serum levels of CEA, CA 19-9 and CA 125 before first transurethral resection of the bladder (TUR). Institutional Ethical Committee approval was obtained prior to this study. Patients diagnosed with pT2 UBC were excluded (42), leaving 286 patients for analysis of recurrence or progression. After first TUR, patients were followed with routine cystoscopy, cytology and ultrasound every 6 months. All patients with non-muscle invasive (NMI) bladder cancer with high-grade disease, previous recurrence, carcinoma in situ (CIS) or T1 received induction and maintenance intravesical BCG. RESULTS: We found that CEA and CA 19-9 levels were significantly higher in patients who had either tumor recurrence and/or progression compared to those who had no UBC recurrence during follow-up (p¼0.02; p¼0.03). As we had found previously, however, CA 125 levels did not differ between the two groups (p¼0.42). Overall, mean CEA level was 2.1 (0.2-12.8), CA 19-9 was 17.1 (0.4-189.9) and CA 125 was 12.5 (1.2-103.9). In patients who presented tumor recurrence and/or progression, mean CEA was 5.5, mean CA 19-9 was 21.0 and CA 125 was 13.8, while in the non-recurring group, mean CEA was 3.1, mean CA 19-9 was 11.1 and CA 125 was 11.3. Mean follow-up was 4.9 years. Patients were 70.3% males (201); 63.3% (181) of patients had pTa at first TUR. Concomitant carcinoma in situ was present in 25 cases (8.7%). CONCLUSIONS: Biomarkers utilized in routine follow-up of other malignancies, such as CEA and CA 19-9, can also be included in UCB management, since it proved able to distinguish a higher risk group of patients that could be managed accordingly. Future studies may add these blood-based tumor markers to a predictive model and validated in a larger cohort. Although CA 125 was not significantly associated with oncologic outcome, further studies are required before excluding this potential biomarker in UBC.
e35
MP04-18 SMOKING INTENSITY AS A PREDICTOR OF SURVIVAL IN BLADDER CANCER PATIENTS: RESULTS FROM A POPULATION-BASED FLORIDA CANCER REGISTRY (1981-2009) vio*, Tulay Koru-Sengul, Diana M Lopategui, Feng Miao, Luís Felipe Sa Nachiketh Soodana Prakash, Bruno Nahar, Vivek Venkatramani, Sanjaya Swain, Sanoj Punnen, Dipen J Parekh, Chad Ritch, Mark L. Gonzalgo, Miami, FL INTRODUCTION AND OBJECTIVES: There is limited information regarding the association between smoking intensity and survival trends among patients with bladder cancer (BC). We examined demographic and survival trends for patients diagnosed with BC stratified by smoking intensity. METHODS: The Florida Cancer Data System (FCDS) linked with US census data was used to identify all smoking adult patients ¼18 years residing in Florida diagnosed with BC between 1981 and 2009. Median and 5-year overall survival rates were compared between patients that smoked <1, 1-2, and >2 packs of cigarettes per day (PPD). A multivariable Cox regression model was used to determine the adjusted hazard ratio (AHR) along with 95% confidence interval (95% CI) for mortality after adjustment for age at diagnosis, sex, race, ethnicity, socioeconomic status (SES), marital status, regional lymph node positvity, treatment, grade, and stage of BC. RESULTS: Of the 14,077 smoking BC patients, 25%, 63%, and 12% smoked <1, 1-2, and >2 PPD, respectively. The majority of patients were males (74%), Whites (96%), living in an urban area (94%), and with a middle-high/highest SES (53%). The majority of them had localized BC (73%). Median overall survival and 5-year survival rates for the entire cohort were 4.0 years and 43.7% (95%CI: 42.7-44.7), respectively. Median overall survival for patients smoking <1, 1-2, and >2 PPD was 4.2 years, 3.9 years, and 4.1 years, respectively. The 5-year survival rates for patients smoking <1, 1-2, and >2 PPD were 45.1% (43.1-47.1), 43.1% (41.8-44.3), and 43.6% (40.9-46.3), respectively. Patients smoking 1-2 PPD ([HR] 1.11; 95% CI 1.06-1.16, p<0.001) and >2 PPD ([1.08] 1.00-1.16, p¼0.042] were significantly more likely to have a higher risk of mortality compared to patients that smoked <1 PPD on multivariate analysis. CONCLUSIONS: Higher smoking intensity is associated with an increased risk of mortality among patients with BC. These data highlight the importance of smoking cessation for BC patients and underscore the need for patient education regarding the dangers of smoking. Smoking cessation efforts should be targeted to this population since even a small reduction in the amount of smoking may still have potential survival benefit. Source of Funding: None
MP04-19 PROGNOSTIC IMPACT OF SERUM CYFRA 21-1 AMONG CLASSIC TUMOR MARKERS IN PATIENTS WITH NONMETASTATIC BUT POTENTIALLY LETHAL BLADDER CANCER Akihiro Yano*, Kojiro Tachibana, Shunsuke Hiranuma, Hironori Sugiyama, Makoto Kagawa, Hideki Takeshita, Yohei Okada, Makoto Morozumi, Satoru Kawakami, Kawagoe, Japan
Source of Funding: none INTRODUCTION AND OBJECTIVES: No serum prognosticator has been established in patients with potentially lethal bladder cancer. The aim of this study is to evaluate the prognostic impact of serum
THE JOURNAL OF UROLOGYâ
difference in delay to RC except women with Stage IV disease were less likely to have delay to RC than men (RR 0.67, 95% CI ¼ 0.62-0.95, p¼0.017). Using propensity score matching, women had improved overall (Hazard Ratio (HR) 0.85, CI 0.82-0.88, p < 0.001), but worse cancer-specific survival (HR 1.08, CI 1.02-1.15, p ¼ 0.008) than men, respectively. CONCLUSIONS: Gender differences persist with women significantly more likely to undergo RC independent of clinical stage. However, women have significantly worse cancer-specific survival than men. Delay from diagnosis to surgery did not account for this decreased survival among women.
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
to varying degrees. The SMI was the strongest predictor of readmission and postoperative complications in patients undergoing cystectomy. Evaluation of patients preoperatively can be used to better counsel patients about postoperative complication risk.
Source of Funding: This study was conducted with the support of the Institute for Translational Sciences at the University of Texas Medical Branch, supported in part by a by a Clinical and Translational Science Award Mentored Career Development (KL2) Award (KL2TR001441) from the National Center for Advancing Translational Sciences, National Institutes of Health, Comparative Effectiveness Research on Cancer in Texas (CERCIT) (RP140020) and the National Cancer Institute (NCI) (K05 CA134923) (SBW) and in part by the fellowship from University of Texas MD Anderson Cancer Center’s Halliburton Employees Foundation (JH).
MP04-15 THE PREVALENCE AND IMPACT OF PREOPERERATIVE FRAILTY: A PROSPECTIVE STUDY OF PATIENTS UNDERGOING CYSTECTOMY
Source of Funding: American Cancer Society Seed Grant.
Conrad Tobert*, Nathan Brooks, Lewis Thomas, Chermaine Hung, Sarah Bell, Kenneth Nepple, Iowa City, IA INTRODUCTION AND OBJECTIVES: Perioperative morbidity is common amongst patients undergoing radical cystectomy. Frailty (decreased functional reserve) measurement has been proposed to identify at-risk patients, but there has been limited comparative prospective analysis of different frailty measures. METHODS: 98 cystectomy patients at our institution from January 2015 to September 2016 were prospectively evaluated preoperatively, using the protocols for the four frailty indices: Duke Activity Status Index (DASI), Edmonton Frailty Index (EFI), Fried Frailty Index (FFI) and Schonberg Mortality Index (SMI) by a urology resident. Consensus Statement malnutrition assessment was performed by a dietitian. We examined the relationship between frailty, patient characteristics (age, neoadjuvant chemotherapy, malnutrition), and outcomes (length of stay 30-day readmission, 30-day Clavien grade > 2) were examined. RESULTS: Median DASI was 39.4 (IQR: 26.9, 58.2), median EFI was 3 (IQR: 2, 4.2), median FFI was 2 (IQR: 1, 3), and median SMI was 12 (IQR: 9.7, 15). The median age of cystectomy patients was 71 years (IQR: 62, 77). 66 of 98 (67.3%) patients underwent neoadjuvant chemotherapy while preoperative malnutrition was present in 32 of 98 (32.6%) patients. With respect to outcomes: median length of stay was 7 days (IQR: 5, 8), 30-day readmission rate was 25.8%, and the 30-day complication rate was 41.8%. The associations of variables with the four frailty indices are displayed in Table 1. Increased age was significantly associated with all four indices. Neoadjuvant chemotherapy was only associated with the FFI (p¼0.04). The presence of malnutrition was associated with the EFI (p¼0.02), FFI (p<0.01), and SMI (p¼0.04). The SMI was only index related to postoperative outcomes, as increased SMI was associated with both 30-day complications (p¼0.04) and 30-day readmission (p<0.01). CONCLUSIONS: Different frailty indices appear to measure different aspects of functional status. In this prospective evaluation, frailty was associated with age, malnutrition, and complications
MP04-16 PERIOPERATIVE AND LONG TERM OUTCOMES AFTER RADICAL CYSTECTOMY IN HEMODIALYSIS PATIENTS Scott Johnson*, Zachary Smith, Joseph Rodriguez III, Gary Steinberg, Chicago, IL INTRODUCTION AND OBJECTIVES: End stage renal disease patients on hemodialysis (HD) have in increased risk of developing bladder cancer, which is more likely to present in an advanced stage. These patients also have significant risk of non-cancer related morbidity and mortality, especially from cardiovascular disease. Radical cystectomy (RC) is the standard of care for non-metastatic muscle invasive bladder cancer, but is associated with significant morbidity. Despite this high risk scenario, very little is known regarding outcomes in HD patients following RC. METHODS: The US Renal Disease System database was used for this study, which is a prospective database which includes every HD patient in the United States. A retrospective review of all HD dependent patients who underwent radical RC for bladder cancer between 1989-2013 was performed. Competing risks analysis was used to estimate overall and disease specific survival. Cox regression was used to identify predictors of death. RESULTS: During the 25-year study period, a total of 1594 patients were identified for analysis, of whom 76.1% were male. The mean age was 70.4 9.8 years. Mean length of stay was 16.2 14.8. Concurrent nephrectomy was undertaken in 33.1% of patients. The 30-day mortality rate was 5.9%. Overall 1, 3, and 5-year survival was 58.4%, 31.4%, and 19.6% respectively. Bladder cancer specific survival at 1, 3, and 5 years was 89.3%, 82.3%, and 80.0% respectively. Predictors of overall mortality were age (HR, 1.03; 95%CI, 1.02-1.03), history of congestive heart failure (CHF) (HR, 1.19; 95%CI, 1.03-1.38), history of diabetes (HR, 1.22; 95%CI, 1.04-1.42), concurrent nephrectomy (HR, 1.09; 95%CI, 1.03-1.14), and female sex (HR, 1.15; 95%CI, 1.01-1.33). Amount of time on HD prior to RC was not predictive of mortality.
THE JOURNAL OF UROLOGYâ
Vol. 197, No. 4S, Supplement, Friday, May 12, 2017
CONCLUSIONS: This represents the largest study to date evaluating outcomes following RC in HD patients. RC is associated with significant morbidity and less than 20% of patients survive 5 years. Older patients, female patients, and those with a history of CHF or diabetes are at an increased risk of mortality. Source of Funding: none
MP04-17 BLOOD-BASED BIOMARKERS AS PREDICTORS OF ONCOLOGIC OUTCOMES FOR NON-MUSCLE-INVASIVE UROTHELIAL BLADDER CARCINOMA Daher Chade*, Andre Machado, Ricardo Waksman, Guilherme Garcia, Paulo Esteves, Sanarelly Adonias, Flavio Areas, Luis Botelho, Mauricio Cordeiro, Claudio Murta, Leopoldo Ribeiro-Filho, Alvaro Sarkis, Sao Paulo, Brazil; Shahrokh Shariat, Vienna, Austria; Diogo Bastos, Carlos Dzik, Miguel Srougi, William Nahas, Sao Paulo, Brazil INTRODUCTION AND OBJECTIVES: Our group has previously demonstrated that blood-based tumor markers can be useful clinical outcome predictors for non-muscle invasive urothelial carcinoma of the bladder (UCB) Our aim in this study is to further evaluate the predictive value of CEA, CA 19-9 and CA 125 on disease recurrence and progression. METHODS: We prospectively included 328 consecutive patients between February 2008 and August 2014 to measure preoperative serum levels of CEA, CA 19-9 and CA 125 before first transurethral resection of the bladder (TUR). Institutional Ethical Committee approval was obtained prior to this study. Patients diagnosed with pT2 UBC were excluded (42), leaving 286 patients for analysis of recurrence or progression. After first TUR, patients were followed with routine cystoscopy, cytology and ultrasound every 6 months. All patients with non-muscle invasive (NMI) bladder cancer with high-grade disease, previous recurrence, carcinoma in situ (CIS) or T1 received induction and maintenance intravesical BCG. RESULTS: We found that CEA and CA 19-9 levels were significantly higher in patients who had either tumor recurrence and/or progression compared to those who had no UBC recurrence during follow-up (p¼0.02; p¼0.03). As we had found previously, however, CA 125 levels did not differ between the two groups (p¼0.42). Overall, mean CEA level was 2.1 (0.2-12.8), CA 19-9 was 17.1 (0.4-189.9) and CA 125 was 12.5 (1.2-103.9). In patients who presented tumor recurrence and/or progression, mean CEA was 5.5, mean CA 19-9 was 21.0 and CA 125 was 13.8, while in the non-recurring group, mean CEA was 3.1, mean CA 19-9 was 11.1 and CA 125 was 11.3. Mean follow-up was 4.9 years. Patients were 70.3% males (201); 63.3% (181) of patients had pTa at first TUR. Concomitant carcinoma in situ was present in 25 cases (8.7%). CONCLUSIONS: Biomarkers utilized in routine follow-up of other malignancies, such as CEA and CA 19-9, can also be included in UCB management, since it proved able to distinguish a higher risk group of patients that could be managed accordingly. Future studies may add these blood-based tumor markers to a predictive model and validated in a larger cohort. Although CA 125 was not significantly associated with oncologic outcome, further studies are required before excluding this potential biomarker in UBC.
e35
MP04-18 SMOKING INTENSITY AS A PREDICTOR OF SURVIVAL IN BLADDER CANCER PATIENTS: RESULTS FROM A POPULATION-BASED FLORIDA CANCER REGISTRY (1981-2009) vio*, Tulay Koru-Sengul, Diana M Lopategui, Feng Miao, Luís Felipe Sa Nachiketh Soodana Prakash, Bruno Nahar, Vivek Venkatramani, Sanjaya Swain, Sanoj Punnen, Dipen J Parekh, Chad Ritch, Mark L. Gonzalgo, Miami, FL INTRODUCTION AND OBJECTIVES: There is limited information regarding the association between smoking intensity and survival trends among patients with bladder cancer (BC). We examined demographic and survival trends for patients diagnosed with BC stratified by smoking intensity. METHODS: The Florida Cancer Data System (FCDS) linked with US census data was used to identify all smoking adult patients ¼18 years residing in Florida diagnosed with BC between 1981 and 2009. Median and 5-year overall survival rates were compared between patients that smoked <1, 1-2, and >2 packs of cigarettes per day (PPD). A multivariable Cox regression model was used to determine the adjusted hazard ratio (AHR) along with 95% confidence interval (95% CI) for mortality after adjustment for age at diagnosis, sex, race, ethnicity, socioeconomic status (SES), marital status, regional lymph node positvity, treatment, grade, and stage of BC. RESULTS: Of the 14,077 smoking BC patients, 25%, 63%, and 12% smoked <1, 1-2, and >2 PPD, respectively. The majority of patients were males (74%), Whites (96%), living in an urban area (94%), and with a middle-high/highest SES (53%). The majority of them had localized BC (73%). Median overall survival and 5-year survival rates for the entire cohort were 4.0 years and 43.7% (95%CI: 42.7-44.7), respectively. Median overall survival for patients smoking <1, 1-2, and >2 PPD was 4.2 years, 3.9 years, and 4.1 years, respectively. The 5-year survival rates for patients smoking <1, 1-2, and >2 PPD were 45.1% (43.1-47.1), 43.1% (41.8-44.3), and 43.6% (40.9-46.3), respectively. Patients smoking 1-2 PPD ([HR] 1.11; 95% CI 1.06-1.16, p<0.001) and >2 PPD ([1.08] 1.00-1.16, p¼0.042] were significantly more likely to have a higher risk of mortality compared to patients that smoked <1 PPD on multivariate analysis. CONCLUSIONS: Higher smoking intensity is associated with an increased risk of mortality among patients with BC. These data highlight the importance of smoking cessation for BC patients and underscore the need for patient education regarding the dangers of smoking. Smoking cessation efforts should be targeted to this population since even a small reduction in the amount of smoking may still have potential survival benefit. Source of Funding: None
MP04-19 PROGNOSTIC IMPACT OF SERUM CYFRA 21-1 AMONG CLASSIC TUMOR MARKERS IN PATIENTS WITH NONMETASTATIC BUT POTENTIALLY LETHAL BLADDER CANCER Akihiro Yano*, Kojiro Tachibana, Shunsuke Hiranuma, Hironori Sugiyama, Makoto Kagawa, Hideki Takeshita, Yohei Okada, Makoto Morozumi, Satoru Kawakami, Kawagoe, Japan
Source of Funding: none INTRODUCTION AND OBJECTIVES: No serum prognosticator has been established in patients with potentially lethal bladder cancer. The aim of this study is to evaluate the prognostic impact of serum