Muscle invasive bladder cancer at the time of COVID-19: a retrospective monocentric study

LETTER TO THE EDITOR

Giuseppe Romeo 1, Luigi De Luca 2, Francesco Trama 3, Marco Fabiano 1, Maurizio Fedelini 1 , Clemente Meccariello 1, Nunzio Alberto Langella 1, Francesco Bottone 1, Luigi Cirillo 2, Giovanni Maria Fusco 2 , Luigi Napolitano 2, Biagio Barone 2, Riccardo Giannella 1, Luigi Pucci 1, Paolo Fedelini 1

1 AORN “A. Cardarelli”, Napoli; 2 Department of Neuroscience and Reproductive and Odontostomatological Sciences of University of Naples "Federico II", Naples, Italy; 3 Uroginecology and Andrology Clinic University of Perugia.

To the Editor,

The suspension of most elective surgeries during the COVID-19 pandemic has led to an extension of the waiting list for urological surgery (1). The purpose of this study is to evaluate the impact of the COVID-19 pandemic on the bladder cancer in large hospitals.

A retrospective study was designed. Radical Cystectomy (RC) between December 2019 and March 2020 were analyzed (group A). In addition, we analyzed patients who performed RC between December 2018 and March 2019 in the pre - covid era (group B). Medical records of our single-center bladder cancer database, including demographic and histopathologic data were collected. All surgical procedures were performed by a single expert equipe, and a single anatomic pathologist was recruited for histologic diagnosis. We excluded: patients in whom the muscle tunic was not present on final histological examination, patients in whom demographic and clinical data were not collected or patients with a previous diagnosis of bladder cancer. Tumor Nodal Metastasis (TNM) 7th edition classification was used for pathological staging and WHO 2016 classification for histological grading.

Thirty-six patients were enrolled. Group A consisted of 13 subjects while group B consisted of 23 subjects. The two groups did not differ statistically in age (71±8.3 Vs 69±7.8) and BMI (22.1±5.9 Vs 21.7±6.7) (p=0.532). Analysis of the histologic study of the pieces indicated that there was a statically significant increase in diagnosis of pT3a stage in group A compared with group B (p=0.045). There were no statically significant differences in pT2b stage (p=0.762). In addition, there was a statically significant increase of T4 diagnosis in group A compared Group B (p=0.037). There were no statistically significant differences in length of hospitalization (p=0.667), peri-operative complications (p=0.091), and bleeding (p=0.058) in the two groups). There was a statistically significant difference regarding the urinary diversion. In fact, there was a higher incidence of ureterocutaneostomy diversion in group A (74% Vs 47%) than in group B (p=0.021)(Table 1).

Table 1. Perioperative outcomes.

Group A (n=13) Group B (n=23) p

pT2b 30.7% 34.8% 0.762

pT3

38.4% 30.4% 0.045 pT4 30.8% 17.4% 0.037 Time of hospitalization 10±4 8±7 0.667 Hemotransfusion 49% 54% 0.058 Peri-operative complications 24% 32% 0.091 UCS diversion 74% 47% 0.021

Our findings report that patients who underwent RC during the pandemic had a more advanced disease stage than subjects who underwent RC in the pre-pandemic period. This is probably due to the delays to treatment of patients awaiting urologic surgery during COVID-19 pandemic (2, 3).

Further studies, with higher number of cases are needed to assess a more accurate correlation between disease stage and time to surgery in COVID-19 pandemic years.

REFERENCES

1. Creta M, Sagnelli C, Celentano G, et al. SARS-CoV-2 infection affects the lower urinary tract and male genital system: A systematic review. J Med Virol. 2021; 93(5):3133-3142. 2. Leow JJ, Tan WS, Tan WP, et al. A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond. Front Surg. 2022; 9:879774. 3. Esperto F, Pang KH, Albisinni S, et al. Bladder Cancer at the time of COVID-19 Outbreak. Int Braz J Urol. 2020; 46(suppl.1):62-68.

CORRESPONDENCE Giovanni Maria Fusco Department of Neuroscience and Reproductive and Odontostomatological Sciences of University of Naples "Federico II", 80131 Naples, Italy e-mail: giom.fusco@gmail.com Phone: +39 0817462611