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Re: Impact of Statin Use on Oncologic Outcomes in Patients with Urothelial Carcinoma of the Bladder Treated with Radical Cystectomy
Letters to the Editor/Errata Re: Impact of Statin Use on Oncologic Outcomes in Patients with Urothelial Carcinoma of the Bladder Treated with Radical Cystectomy R. D. da Silva, E. Xylinas, L. Kluth, J. J. Crivelli, J. Chrystal, D. Chade, G. B. Guglielmetti, A. Pycha, Y. Lotan, P. I. Karakiewicz, M. Sun, H. Fajkovic, M. Zerbib, D. S. Scherr and S. F. Shariat J Urol 2013; 190: 487e492.
To the Editor: In a questionnaire based study of lifestyle factors the rate of statin use in patients older than 45 years was 13%.1 In another study the 1-year prevalence of statin use in patients 50 years or older was 13.9% in 1999 and 22.8% in 2008.2 However, the rate was detected to be quite high (42.7%) in the present study, even taking into consideration the increase in the rate of statin use since 1999.2 Negative surgical margins and removal of 10 or more lymph nodes provide a better overall survival.3 Average number of lymph nodes removed was adequate in the present study, although it is not mentioned whether limited or extended lymph node dissection was performed. While extent of lymph node dissection is significantly associated with survival after radical cystectomy,4 the number of lymph nodes in a particular anatomical template may differ individually. It is unclear whether all cases included in the present study were managed by open radical cystectomy. In laparoscopic radical cystectomy positive surgical margins may be increased compared to open surgery,5 which might have an impact on the outcomes. Respectfully, Ali Fuat Atmaca Department of Urology € rk Training and Research Hospital Ankara Atatu Yıldırım Beyazıt University School of Medicine Ankara, Turkey
Reply by Authors: Atmaca questions the high rate of patients treated with statins in our cohort (42.7%), which is higher than in the 2 cited surveys (13% to 23%).1,2 Statins, which are among the most commonly prescribed drugs worldwide, are cholesterol lowering agents used to manage and prevent cardiovascular diseases. As we and others have shown, patients with bladder cancer are more likely to harbor comorbidities at diagnosis and treatment (ie concurrent cardiovascular risk factors) compared to their healthy counterparts.6,7 This finding is mostly due to age at diagnosis of bladder cancer (60 to 65 years) and to risk factors for bladder cancer (eg smoking). Moreover, our rate of statin users is in line with previously published series, which revealed rates from 28% to 48% in the bladder cancer setting.811 Atmaca further highlights the importance of the quality of surgery when performing radical cystectomy (ie rates of positive soft tissue surgical margins and extent of lymphadenectomy). We fully agree that positive soft tissue surgical margins and lymph node involvement are, together with pathological stage, the most important prognostic factors in patients treated with radical cystectomy. In the current study we evaluated the impact of statin use on these outcomes. While there was an association with disease recurrence and cancer specific mortality in univariable analyses, this association did not remain after adjustment for the aforementioned factors.
0022-5347/14/1911-0273/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2013.07.099 Vol. 191, 273-274, January 2014 Printed in U.S.A.
www.jurology.com
j
273
274
LETTERS TO THE EDITOR/ERRATA
1. Thomsen RW, Nielsen RB, Nørgaard M et al: Lifestyle profile among statin users. Epidemiology 2013; 24: 619. 2. Geleedst-De Vooght M, Maitland-van der Zee AH, Schalekamp T et al: Statin prescribing in the elderly in The Netherlands: a pharmacy database time trend study. Drugs Aging 2010; 27: 589. 3. Herr HW, Faulkner JR, Grossman HB et al: Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol 2004; 22: 2781. 4. Gakis G, Efstathiou J, Lerner SP et al: ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2013; 63: 45. 5. Hautmann RE: The oncologic results of laparoscopic radical cystectomy are not (yet) equivalent to open cystectomy. Curr Opin Urol 2009; 19: 522.
6. Shariat SF, Sfakianos JP, Droller MJ et al: The effect of age and gender on bladder cancer: a critical review of the literature. BJU Int 2010; 105: 300. 7. Kluth LA, Xylinas E, Crivelli JJ et al: Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder. J Urol 2013; 190: 480. 8. Berglund RK, Savage CJ, Vora KC et al: An analysis of the effect of statin use on the efficacy of bacillus Calmette-Guerin treatment for transitional cell carcinoma of the bladder. J Urol 2008; 180: 1297. 9. Skolarus TA, Lee EW, Virgo KS et al: Intravesical bacille CalmetteGuerin therapy for non-muscle-invasive bladder cancer: effects of concurrent statin therapy. J Am Coll Surg 2009; 209: 248. 10. Crivelli JJ, Xylinas E, Kluth LA et al: Effect of statin use on outcomes of non-muscle-invasive bladder cancer. BJU Int 2013; 112: E4. 11. Xylinas E, Kluth LA, Crivelli JJ et al: Impact of statin use on oncologic outcomes of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. Eur Urol 2013; 63: 1134.
To the Editor: In a questionnaire based study of lifestyle factors the rate of statin use in patients older than 45 years was 13%.1 In another study the 1-year prevalence of statin use in patients 50 years or older was 13.9% in 1999 and 22.8% in 2008.2 However, the rate was detected to be quite high (42.7%) in the present study, even taking into consideration the increase in the rate of statin use since 1999.2 Negative surgical margins and removal of 10 or more lymph nodes provide a better overall survival.3 Average number of lymph nodes removed was adequate in the present study, although it is not mentioned whether limited or extended lymph node dissection was performed. While extent of lymph node dissection is significantly associated with survival after radical cystectomy,4 the number of lymph nodes in a particular anatomical template may differ individually. It is unclear whether all cases included in the present study were managed by open radical cystectomy. In laparoscopic radical cystectomy positive surgical margins may be increased compared to open surgery,5 which might have an impact on the outcomes. Respectfully, Ali Fuat Atmaca Department of Urology € rk Training and Research Hospital Ankara Atatu Yıldırım Beyazıt University School of Medicine Ankara, Turkey
Reply by Authors: Atmaca questions the high rate of patients treated with statins in our cohort (42.7%), which is higher than in the 2 cited surveys (13% to 23%).1,2 Statins, which are among the most commonly prescribed drugs worldwide, are cholesterol lowering agents used to manage and prevent cardiovascular diseases. As we and others have shown, patients with bladder cancer are more likely to harbor comorbidities at diagnosis and treatment (ie concurrent cardiovascular risk factors) compared to their healthy counterparts.6,7 This finding is mostly due to age at diagnosis of bladder cancer (60 to 65 years) and to risk factors for bladder cancer (eg smoking). Moreover, our rate of statin users is in line with previously published series, which revealed rates from 28% to 48% in the bladder cancer setting.811 Atmaca further highlights the importance of the quality of surgery when performing radical cystectomy (ie rates of positive soft tissue surgical margins and extent of lymphadenectomy). We fully agree that positive soft tissue surgical margins and lymph node involvement are, together with pathological stage, the most important prognostic factors in patients treated with radical cystectomy. In the current study we evaluated the impact of statin use on these outcomes. While there was an association with disease recurrence and cancer specific mortality in univariable analyses, this association did not remain after adjustment for the aforementioned factors.
0022-5347/14/1911-0273/0 THE JOURNAL OF UROLOGY® © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2013.07.099 Vol. 191, 273-274, January 2014 Printed in U.S.A.
www.jurology.com
j
273
274
LETTERS TO THE EDITOR/ERRATA
1. Thomsen RW, Nielsen RB, Nørgaard M et al: Lifestyle profile among statin users. Epidemiology 2013; 24: 619. 2. Geleedst-De Vooght M, Maitland-van der Zee AH, Schalekamp T et al: Statin prescribing in the elderly in The Netherlands: a pharmacy database time trend study. Drugs Aging 2010; 27: 589. 3. Herr HW, Faulkner JR, Grossman HB et al: Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol 2004; 22: 2781. 4. Gakis G, Efstathiou J, Lerner SP et al: ICUD-EAU International Consultation on Bladder Cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 2013; 63: 45. 5. Hautmann RE: The oncologic results of laparoscopic radical cystectomy are not (yet) equivalent to open cystectomy. Curr Opin Urol 2009; 19: 522.
6. Shariat SF, Sfakianos JP, Droller MJ et al: The effect of age and gender on bladder cancer: a critical review of the literature. BJU Int 2010; 105: 300. 7. Kluth LA, Xylinas E, Crivelli JJ et al: Obesity is associated with worse outcomes in patients with T1 high grade urothelial carcinoma of the bladder. J Urol 2013; 190: 480. 8. Berglund RK, Savage CJ, Vora KC et al: An analysis of the effect of statin use on the efficacy of bacillus Calmette-Guerin treatment for transitional cell carcinoma of the bladder. J Urol 2008; 180: 1297. 9. Skolarus TA, Lee EW, Virgo KS et al: Intravesical bacille CalmetteGuerin therapy for non-muscle-invasive bladder cancer: effects of concurrent statin therapy. J Am Coll Surg 2009; 209: 248. 10. Crivelli JJ, Xylinas E, Kluth LA et al: Effect of statin use on outcomes of non-muscle-invasive bladder cancer. BJU Int 2013; 112: E4. 11. Xylinas E, Kluth LA, Crivelli JJ et al: Impact of statin use on oncologic outcomes of patients with upper tract urothelial carcinoma treated with radical nephroureterectomy. Eur Urol 2013; 63: 1134.