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Cumberbatch MGK, Foerster B, Catto JWF, Kamat AM, Kassouf W, Jubber I, Shariat SF, Sylvester RJ, Gontero P. Repeat Transurethral Resection in Non-muscle-invasive Bladder Cancer: A Systematic Review. Eur Urol 2018. [PMID: 29523366 DOI: 10.1016/j.eururo.2018.02.014] [Citation(s) in RCA: 186] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
CONTEXT Initial treatment for most bladder cancers (BCs) involves transurethral resection (TUR) or tumours. Often more cancer is found after the initial treatment in around half of patients, requiring a second resection. Repeat transurethral resection (reTUR) is recommended for high-risk, non-muscle-invasive bladder cancer (NMIBC) to remove any residual disease and improve cancer outcomes. OBJECTIVE To systematically review the practice and therapeutic benefit of an early reTUR for high-risk NMIBC. EVIDENCE ACQUISITION A systematic review of original articles was performed using PubMed/Medline and Web of Science databases in December 2016 (initial) and October 2017 (final). We searched the references of included papers. EVIDENCE SYNTHESIS We screened 15 209 manuscripts and selected 31 detailing 8409 persons with high-grade Ta and T1BC for inclusion. Detrusor muscle was found at initial TUR histology in 30-100% of cases. Residual tumour at reTUR was found in 17-67% of patients following Ta and in 20-71% following T1 cancer. Most residual tumours (36-86%) were found at the original resection site. Upstaging occurred in 0-8% (Ta to ≥T1) and 0-32% (T1 to ≥T2) of cases. Conflicting data report the impact of reTUR on subsequent recurrence and cancer-specific mortality. Recurrence for Ta was 16% in the reTUR group versus 58% in the non-reTUR group. For T1, recurrence ranged from 18% to 56%, but no clear trend was identified between reTUR and control. No clear relationship between reTUR and progression was found for Ta, although for T1 rates were higher in the non-reTUR group in series with control populations (5/6 studies). Overall mortality was slightly reduced in the reTUR group in two studies with controls (22-30% vs 26-36% [no reTUR]). CONCLUSIONS Residual tumour is common after TUR for high-risk NMIBC. The reTUR helps in the diagnosis of this residual cancer and may improve outcomes for cancers initially staged as T1. PATIENT SUMMARY Some bladder cancers (BCs) are aggressive but confined to the bladder surface. Initial treatment includes endoscopic resection. More cancer is found after the initial treatment in approximately half of patients. In the aggressive but confined group of BC, a second resection, a few weeks after the first, may help find this residual cancer and improve outcomes, although the evidence quality for this is weak.
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Affiliation(s)
| | - Beat Foerster
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wassim Kassouf
- Division of Urology, McGill University Health Center, Montreal, Canada
| | - Ibrahim Jubber
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
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Alharbi H, Alkhateeb S, Murshid E, Alotaibi M, Abusamra A, Rabah D, Almansour M, Alghamdi A, Aljubran A, Eltigani A, Alkushi H, Ahmed I, Alsharm A, Bazarbashi S. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for urothelial cell carcinoma of the urinary bladder 2017. Urol Ann 2018; 10:133-137. [PMID: 29719322 PMCID: PMC5907319 DOI: 10.4103/ua.ua_176_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation and medical/surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The guidelines are presented with their accompanying supporting evidence level, which is based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.
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Affiliation(s)
- Hulayel Alharbi
- Department of Medical Oncology, King Fahed Specialist Hospital, Dammam, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amin Eltigani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hussein Alkushi
- Department of Pathology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Imran Ahmed
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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53
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Yang WJ. Second Transurethral Resection of Bladder Cancer. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00018-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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54
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Radical Cystectomy (RC) with Urinary Diversion. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tae BS, Jeong CW, Kwak C, Kim HH, Moon KC, Ku JH. Pathology in repeated transurethral resection of a bladder tumor as a risk factor for prognosis of high-risk non-muscle-invasive bladder cancer. PLoS One 2017; 12:e0189354. [PMID: 29244843 PMCID: PMC5731735 DOI: 10.1371/journal.pone.0189354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/27/2017] [Indexed: 11/19/2022] Open
Abstract
The prognostic value of repeat transurethral resection of bladder tumor (TURBT) in patients with diagnosed high-risk, non-muscle-invasive bladder cancer (NMIBC) was investigated. We retrospectively reviewed the medical records of patients treated from October 2004 to December 2013 at Seoul National University who underwent repeated TURBT within 2–6 weeks after an initial resection. The study enrolled patients who had been diagnosed with NMIBC at both the initial and repeat TURBT; patients with muscle-invasive tumors on repeat TURBT were excluded. We used stepwise multivariate Cox regression models stratified by study to assess the independent effects of the predictive factors and estimated hazard ratios (HRs) from the Cox models. We investigated a total of 198 patients who were diagnosed with high-risk NMIBC. In logistic regression analyses, number of bladder tumors (2–7: OR, 2.319; 8≤: OR, 3.353; p<0.05), initially high tumor grade (OR, 2.435; p = 0.040), and presence of carcinoma in situ lesion (OR, 3.639; p = 0.017) correlated with residual tumor in the repeated-TURBT specimen. T1 stage in repeated-TURBT significantly correlated with recurrence (HR, 1.837; p = 0.010) and progression (HR, 2.806; p = 0.029) in multivariate analysis. The high grades of tumors in repeated-TURBT also significantly correlated with progression but not recurrence in the multivariate analysis (HR 2.152; p = 0.008). In this study, the pathologic findings in repeated-TURBT correlated with recurrence and progression in high-risk NMIBC. Repeated-TURBT is valuable because it can predict the recurrence and progression of high-risk NMIBC in addition to obtaining accurate pathologic findings.
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Affiliation(s)
- Bum Sik Tae
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
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Nguyen VP, Oh J, Park S, Wook Kang H. Feasibility of photoacoustic evaluations on dual-thermal treatment of ex vivo bladder tumors. JOURNAL OF BIOPHOTONICS 2017; 10:577-588. [PMID: 27136046 DOI: 10.1002/jbio.201600045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/22/2016] [Accepted: 04/08/2016] [Indexed: 06/05/2023]
Abstract
A variety of thermal therapeutic methods have been investigated to treat bladder tumors but often cause bowel injury and bladder wall perforation due to high treatment dosage and limited clinical margins. The objective of the current study is to develop a dual-thermal modality to deeply coagulate the bladder tumors at low thermal dosage and to evaluate therapeutic outcomes with high contrast photoacoustic imaging (PAI). High intensity focused ultrasound (HIFU) is combined with 532 nm laser light to enhance therapeutic depth during thermal treatments on artificial tumor-injected bladder tissue ex vivo. PAI is employed to identify the margins of the tumors pre- and post-treatments. The dual-thermal modality achieves 3- and 1.8-fold higher transient temperature changes and 2.2- and 1.5-fold deeper tissue denaturation than laser and HIFU, respectively. PAI vividly identifies the position of the injected tumor and entails approximately 7.9 times higher image contrast from the coagulated tumor as that from the untreated tumor. Spectroscopic analysis exhibits that both 740 nm and 760 nm attains the maximum photoacoustic amplitudes from the treated areas. The proposed PAI-guided dual-thermal treatments (laser and HIFU) treatments can be a feasible therapeutic modality to treat bladder tumors in a controlled and efficient manner.
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Affiliation(s)
- Van Phuc Nguyen
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, 608-737, South Korea
| | - Junghwan Oh
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, 608-737, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK 21 Plus), Pukyong National University, Busan, 608-737, South Korea
| | - Suhyun Park
- Samsung Advanced Institute of Technology, Samsung Electronics, Suwon, 443-803, South Korea
| | - Hyun Wook Kang
- Interdisciplinary Program of Biomedical Mechanical & Electrical Engineering, Pukyong National University, Busan, 608-737, South Korea
- Department of Biomedical Engineering and Center for Marine-Integrated Biomedical Technology (BK 21 Plus), Pukyong National University, Busan, 608-737, South Korea
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Nonmuscle-invasive bladder cancer: what's changing and what has changed. Urologia 2017; 84:1-8. [PMID: 28165132 DOI: 10.5301/uro.5000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Nonmuscle-invasive bladder cancer (NMIBC) is a challenging disease to manage primarily due to its varied clinical course. The management of NMIBC has witnessed a widespread change with respect to its diagnosis and treatment. Although transurethral resection (TUR) and adjuvant bacillus Calmette-Guerin (BCG) stills remain the cornerstone, newer protocols has come into vogue to achieve optimal care. On the basis of a literature review, we aimed to establish 'what changes has already occurred and what is expected in the future' in NMIBC. METHODS A Medline search was performed to identify the published literature with respect to diagnosis, treatment and future perspectives on NMIBC. Particular emphasis was directed to determinants such as the quality of TUR and the newer modifications, Re-TUR, current status of newer macroscopic and microscopic imaging, role of urinary biomarkers, clinical, histologic and molecular predictors of high-risk disease, administration of intravesical agents, salvage therapy in BCG recurrence and the current best practice guidelines were analyzed. RESULTS AND CONCLUSIONS Optimal TUR, restaging in select group, incorporation of newer endoscopic imaging and judicious administration of intravesical chemo-immunotherapeutic agents can contribute to better patient care. Although there is a plethora of urinary markers, there is insufficient evidence for their use in isolation. The future probably lies in identification of genetic markers to determine disease recurrence, nonresponders to standard treatment and early institution of alternative/targeted therapy.
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Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease. Kaohsiung J Med Sci 2017; 33:86-90. [DOI: 10.1016/j.kjms.2016.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/26/2016] [Accepted: 11/01/2016] [Indexed: 11/20/2022] Open
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Preliminary Development of a Continuum Dual-Arm Surgical Robotic System for Transurethral Procedures. INTELLIGENT ROBOTICS AND APPLICATIONS 2017. [DOI: 10.1007/978-3-319-65292-4_27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Clinical outcomes of second transurethral resection in non-muscle invasive high-grade bladder cancer: a retrospective, multi-institutional, collaborative study. Int J Clin Oncol 2016; 22:353-358. [DOI: 10.1007/s10147-016-1048-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/30/2016] [Indexed: 11/25/2022]
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Ching D, Anastasiadis E, Patel P, Sahu M, Sandhu S. A culture of open reporting results in improved quality of bladder tumour resections: a closed loop audit. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415816642695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Bladder cancer is the commonest cancer of the urinary tract. Transurethral Resection of Bladder Tumour (TURBT) is the gold standard for diagnosis and treatment of non-muscle invasive bladder cancer. The absence of muscle in a TURBT specimen is associated with a significantly higher risk of residual disease, early recurrence and tumour under staging. Materials and methods: TURBT and bladder biopsy specimens were examined before and after the introduction of an open reporting system as a quality improvement exercise. All specimens from the 4th quarter (between 2010 and 2014) were examined to determine the effect of open reporting on our inadequate resection rates. Results: A total of 244 cases were performed under the care of 5 consultant urologists. Analysis revealed a significant improvement in quality of both T1 and Ta resections (p=0.04*; p=0.02*) after the introduction of open reporting. The total number of TURBT cases increased per year, however the percentage of inadequate resections has significantly decreased (p=0.02*). Conclusion: Individual reporting provided surgeons with direct, personal and timely feedback on their performance. It did not negatively impact on trainee participation, but led to improved training outcomes. We have demonstrated that our simple intervention has improved quality of patient care.
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Affiliation(s)
- Daniel Ching
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
| | | | - Pareeta Patel
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
| | - Mahua Sahu
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
| | - Sarb Sandhu
- Department of Urology, Kingston Hospital NHS Foundation Trust, UK
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Türk H, Ün S, İşoğlu C, Karabıçak M, Ergani B, Yoldaş M, Tarhan H, Zorlu F. Factors that predict residual tumors in re-TUR patients. AFRICAN JOURNAL OF UROLOGY 2016. [DOI: 10.1016/j.afju.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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64
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Qie Y, Hu H, Tian D, Zhang Y, Xie L, Xu Y, Wu C. The value of extensive transurethral resection in the diagnosis and treatment of nonmuscle invasive bladder cancer with respect to recurrence at the first follow-up cystoscopy. Onco Targets Ther 2016; 9:2019-25. [PMID: 27103828 PMCID: PMC4827415 DOI: 10.2147/ott.s103703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the value of extensive transurethral resection (TUR) in the diagnosis and treatment of nonmuscle invasive bladder cancer (NMIBC) and its further impact on the recurrence rate at the first follow-up cystoscopy (RR-FFC). PATIENTS AND METHODS A retrospective review of consecutive series of 523 patients with NMIBCs who underwent TUR from June 2009 to July 2015 at the Second Hospital of Tianjin Medical University was conducted. Extensive TURs were performed by taking additional tumor base and marginal specimens for 317 patients (group 1). Extensive TURs were not done in the other 206 patients (group 2). Urine cytology and follow-up cystoscopy were performed at 3 months after the initial TUR. The positive findings of additional specimens were noted and it was found whether or not the diagnosis and treatment plan had changed in group 1. Also, a comparison was made of the RR-FFC between group 1 and 2. RESULTS There were 51/317 (16.1%) patients whose additional specimens revealed pathological findings such as Ta, T1, and carcinoma in situ diseases. Of these positive findings, 6/51 (11.8%) were Ta stage, 16/51 (31.4%) were T1 stage, 18/51 (35.3%) were T2 stage, and 11/51 (21.5%) were carcinoma in situ. Due to the positive findings, 29/317 (9.1%) patients had their final diagnosis changed and 45/317 (14.2%) had their post-TUR treatment plans adjusted. The RR-FFC of group 1 and 2 were 4.7% (14/297) and 13.1% (27/206), respectively (P=0.001). CONCLUSION Routine extensive TUR is helpful for the pathological diagnosis and the post-TUR treatment of NMIBC. Furthermore, it can significantly reduce the RR-FFC of NMIBC, especially in patients with T1 stage or high-grade disease.
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Affiliation(s)
- Yunkai Qie
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
| | - Hailong Hu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
| | - Dawei Tian
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
| | - Yu Zhang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
| | - Linguo Xie
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
| | - Yong Xu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
| | - Changli Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin, People’s Republic of China
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Alkhateeb S, Al-Mansour M, Alotaibi M, Saadeddin A, Abusamra A, Rabah D, Murshid E, Alsharm A, Ahmad I, Kushi H, Alghamdi A, Alghamdi K, Bazarbashi S. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for urothelial cell carcinoma of the urinary bladder. Urol Ann 2016; 8:131-5. [PMID: 27141179 PMCID: PMC4839226 DOI: 10.4103/0974-7796.176873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation, medical, and surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system 7(th) edition. The guidelines are presented with supporting evidence level, they are based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health care policy makers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.
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Affiliation(s)
- Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Sultan Alkhateeb, Department of Surgery, Division of Urology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, P.O. Box: 22490 (1446), Riyadh 11426, Saudi Arabia. E-mail:
| | - Mubarak Al-Mansour
- Department of Oncology, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Medical Military City, Jeddah, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hussain Kushi
- Department of Radiation Oncology, Princess Norah Oncology Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Medical Military Center, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Department of Surgery, Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Department of Oncology, Section of Medical Oncology, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Gotto GT, Shea-Budgell MA, Dean Ruether J. Low compliance with guidelines for re-staging in high-grade T1 bladder cancer and the potential impact on patient outcomes in the province of Alberta. Can Urol Assoc J 2016; 10:33-8. [PMID: 26977204 DOI: 10.5489/cuaj.3143] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite high-level evidence of benefit, early repeat resection (ERR) among high-grade T1 bladder cancer (HGT1-BC) patients remains low in several non-Canadian jurisdictions and rates in Canada are largely unreported. We evaluated rates of ERR and trends over time in Alberta. We also examined factors associated with uptake of ERR. METHODS We conducted a retrospective review of data from all patients diagnosed with HGT1-BC from 2007 through 2011. Patients were identified from the Alberta Cancer Registry. Patients with a non-urothelial carcinoma of the bladder and those with invasion into the prostate or metastatic disease were excluded. We collected demographic and clinicopathologic information from patients' electronic medical records. RESULTS A total of 600 patients diagnosed with HGT1-BC were included. Overall, 167 patients (27.8%) received an ERR; however, the rate increased in a non-linear fashion from 27.4% in 2007 to 37.8% in 2011. Factors associated with ERR included age <80 years (p=0.021) and centre at which the initial transurethral resection of bladder tumour (TURBT) was performed (p=0.013). Median overall survival (OS) was not reached, but five-year OS was 72.7% (95% CI 68.9, 76.5) for those who received an ERR and 55.3% (95% CI 52.5, 58.1) for those who did not. CONCLUSIONS Use of ERR in patients with HGT1-BC is improving over time. Regional variation in practice suggests the need for implementation strategies (i.e., provincial clinical care pathways) to standardize practice and set indicators for future measurement and reporting. Targeted interventions would require further investigation around the reasons for variation in practice.
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Affiliation(s)
- Geoffrey T Gotto
- Department of Surgery, Cumming School of Medicine, University of Calgary, Southern Alberta Institute of Urology, Calgary, AB, Canada
| | - Melissa A Shea-Budgell
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada;; Cancer Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - J Dean Ruether
- Department of Oncology, Cumming School of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, AB, Canada
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Can immediate second resection be an alternative to standardized second transurethral resection of bladder tumors? Kaohsiung J Med Sci 2016; 32:147-51. [DOI: 10.1016/j.kjms.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/01/2016] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
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Iida K, Naiki T, Kawai N, Etani T, Ando R, Ikegami Y, Okamura T, Kubota H, Okada A, Kohri K, Yasui T. Bacillus Calmette-Guerin therapy after the second transurethral resection significantly decreases recurrence in patients with new onset high-grade T1 bladder cancer. BMC Urol 2016; 16:8. [PMID: 26920373 PMCID: PMC4769574 DOI: 10.1186/s12894-016-0126-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/23/2016] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to assess the efficacy of Bacillus Calmette-Guerin (BCG) therapy after a second transurethral resection (TUR) in new onset high-grade T1 bladder cancer. Methods From January 2008 to September 2013, 207 patients with new onset high-grade T1 bladder cancer after an initial TUR were treated at our university and at affiliated hospitals. Residual cancer rate, intravesical recurrence-free survival (RFS), and risk factors for intravesical recurrence were analyzed. Results Among a total of 207 patients, 42 patients were treated with BCG therapy following a second TUR (group 1), 23 were treated with second TUR alone (group 2), 72 were treated with BCG alone (group 3), and 70 were treated without a second TUR or BCG. The median patients’ age was 72.0 years, and the median follow-up period was 33.5 months. The second TUR revealed that 34 patients (52 %) had residual cancer. Between groups 1 and 2 and groups 1 and 3, the differences in RFS were statistically significant (p = 0.002 and 0.045, respectively). In addition, BCG therapy was the most significant factor to predict RFS after the second TUR. Among the 31 patients whose pathology of the second TUR was pT0, only 1 of 12 patients (8 %) in group 1 and 11 of 19 patients (58 %) in group 2 had a recurrence. Conclusions BCG instillation following a second TUR decreases intravesical recurrence, even if the pathology of the second TUR is pT0.
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Affiliation(s)
- Keitaro Iida
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Taku Naiki
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan. .,Department of Urology, Daido Hospital, Aichi, Japan.
| | - Noriyasu Kawai
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Toshiki Etani
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Ryosuke Ando
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Yosuke Ikegami
- Department of Urology, Nagoya City East Medical Center, Aichi, Japan.
| | | | - Hiroki Kubota
- Department of Urology, Kainan Hospital, Aichi, Japan.
| | - Atsushi Okada
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Kenjiro Kohri
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
| | - Takahiro Yasui
- Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, 467-8601, Nagoya, Japan.
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Kassouf W, Aprikian A, Black P, Kulkarni G, Izawa J, Eapen L, Fairey A, So A, North S, Rendon R, Sridhar SS, Alam T, Brimo F, Blais N, Booth C, Chin J, Chung P, Drachenberg D, Fradet Y, Jewett M, Moore R, Morash C, Shayegan B, Gotto G, Fleshner N, Saad F, Siemens DR. Recommendations for the improvement of bladder cancer quality of care in Canada: A consensus document reviewed and endorsed by Bladder Cancer Canada (BCC), Canadian Urologic Oncology Group (CUOG), and Canadian Urological Association (CUA), December 2015. Can Urol Assoc J 2016; 10:E46-80. [PMID: 26977213 DOI: 10.5489/cuaj.3583] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This initiative was undertaken in response to concerns regarding the variation in management and in outcomes of patients with bladder cancer throughout centres and geographical areas in Canada. Population-based data have also revealed that real-life survival is lower than expected based on data from clinical trials and/or academic centres. To address these perceived shortcomings and attempt to streamline and unify treatment approaches to bladder cancer in Canada, a multidisciplinary panel of expert clinicians was convened last fall for a two-day working group consensus meeting. The panelists included urologic oncologists, medical oncologists, radiation oncologists, patient representatives, a genitourinary pathologist, and an enterostomal therapy nurse. The following recommendations and summaries of supporting evidence represent the results of the presentations, debates, and discussions. Methodology
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Affiliation(s)
- Wassim Kassouf
- Department of urology, McGill University Health Centre, Montreal, QC, Canada
| | - Armen Aprikian
- Department of urology, McGill University Health Centre, Montreal, QC, Canada
| | - Peter Black
- Department of urology, University of British Columbia, Vancouver, BC, Canada
| | - Girish Kulkarni
- Department of surgery (urology) and surgical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jonathan Izawa
- Division of urology, Western University, London, ON, Canada
| | - Libni Eapen
- Division of radiation oncology, University of Ottawa, Ottawa, ON, Canada
| | - Adrian Fairey
- Division of urology, University of Alberta, Edmonton, AB, Canada
| | - Alan So
- Department of urology, University of British Columbia, Vancouver, BC, Canada
| | - Scott North
- Medical oncology, University of Alberta, Edmonton, AB, Canada
| | - Ricardo Rendon
- Division of urology, Dalhousie University, Halifax, NS, Canada
| | - Srikala S Sridhar
- Medical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Tarik Alam
- School of nursing, Dawson College, Montreal, QC, Canada
| | - Fadi Brimo
- Pathology, McGill University Health Centre, Montreal, QC, Canada
| | - Normand Blais
- Division of medical oncology, University of Montreal, Montreal, QC, Canada
| | - Chris Booth
- Departments of oncology, Queen's University, Kingston, ON, Canada
| | - Joseph Chin
- Division of urology, Western University, London, ON, Canada
| | - Peter Chung
- Radiation oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Yves Fradet
- Division of urology, Laval University, Quebec City, QC, Canada
| | - Michael Jewett
- Department of surgery (urology) and surgical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ron Moore
- Division of urology, University of Alberta, Edmonton, AB, Canada
| | - Chris Morash
- Urology, University of Ottawa, Ottawa, ON, Canada
| | - Bobby Shayegan
- Division of urology, McMaster University, Hamilton, ON, Canada
| | - Geoffrey Gotto
- Division of urology, University of Calgary, Calgary, AB, Canada
| | - Neil Fleshner
- Department of surgery (urology) and surgical oncology, Princess Margaret Cancer Centre and the University Health Network, University of Toronto, Toronto, ON, Canada
| | - Fred Saad
- Urology, University of Montreal, Montreal, QC, Canada
| | - D Robert Siemens
- Departments of oncology, Queen's University, Kingston, ON, Canada;; Urology, Queen's University, Kingston, ON, Canada
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Power NE, Izawa J. Comparison of Guidelines on Non-Muscle Invasive Bladder Cancer (EAU, CUA, AUA, NCCN, NICE). Bladder Cancer 2016; 2:27-36. [PMID: 27376122 PMCID: PMC4927900 DOI: 10.3233/blc-150034] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Non-muscle invasive bladder cancer (NMIBC) represents a considerably diverse patient group and the management of this complex disease is debatable. A number of panels from Europe and North America have convened on the topic and recently released guideline documents. Objective: The purpose was to compare and contrast the NMIBC guideline recommendations from the EAU (Europe), CUA (Canada), NCCN (United States), AUA (United States), and NICE (United Kingdom). Methods: All unabridged guideline documents were reviewed by the authors and comparisons were completed according to major topics in NMIBC. Results: Despite a paucity of high level evidence regarding the majority of management topics in NMIBC, there was general agreement among the various guideline panels. Differences mainly centered on the categories of evidence synthesized and grades of recommendations. Each document offers a unique presentation of the available literature and guideline recommendation. Conclusions: The guidelines for NMIBC from the EAU, CUA, AUA, NCCN, and NICE provide considerable consensus regarding the management of this often difficult disease. Clinicians are encouraged to familiarize themselves with all of the guidelines in order to determine which style of presentation would be most useful to their current practice.
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Affiliation(s)
- Nicholas E Power
- Department of Surgery & Oncology, Divisions of Urology and Surgical Oncology, Western University , London, ON, Canada
| | - Jonathan Izawa
- Department of Surgery & Oncology, Divisions of Urology and Surgical Oncology, Western University , London, ON, Canada
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71
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Rose JB, Armstrong S, Hermann GG, Kjellberg J, Malmström PU. Budget impact of incorporating one instillation of hexaminolevulinate hydrochloride blue-light cytoscopy in transurethral bladder tumour resection for patients with non-muscle-invasive bladder cancer in Sweden. BJU Int 2015; 117:E102-13. [DOI: 10.1111/bju.13261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | | | - Gregers G. Hermann
- Department of Urology; University Hospital of Copenhagen; Frederiksberg Hospital; Copenhagen Denmark
| | - Jakob Kjellberg
- Danish Institute for Local and Regional Government Research (KORA); Copenhagen Denmark
| | - Per-Uno Malmström
- Department of Surgical Sciences; Uppsala University; Akademiska Sjukhuset; Uppsala Sweden
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72
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Gendy R, Delprado W, Brenner P, Brooks A, Coombes G, Cozzi P, Nash P, Patel MI. Repeat transurethral resection for non-muscle-invasive bladder cancer: a contemporary series. BJU Int 2015; 117 Suppl 4:54-9. [DOI: 10.1111/bju.13265] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Rasha Gendy
- Department of Urology; St George Hospital; Sydney NSW Australia
| | - Warick Delprado
- Douglas Hanley Moir Pathology Laboratory; Sydney NSW Australia
| | - Phillip Brenner
- Department of Urology; St Vincent's Hospital; Sydney NSW Australia
| | - Andrew Brooks
- Department of Urology; Westmead Hospital and Discipline of Surgery; University of Sydney; Sydney NSW Australia
| | - Graham Coombes
- Department of Urology; Concord Hospital; Sydney NSW Australia
| | - Paul Cozzi
- Department of Urology; St George Hospital; Sydney NSW Australia
| | - Peter Nash
- Department of Urology; St George Hospital; Sydney NSW Australia
| | - Manish I. Patel
- Department of Urology; Westmead Hospital and Discipline of Surgery; University of Sydney; Sydney NSW Australia
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El-Barky E, Sebaey A, Eltabey M, Aboutaleb A, Hussein S, Kehinde EO. The importance of second-look transurethral resection for superficial bladder cancer. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415814560189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: The objective of this article is to evaluate the importance of a second-look transurethral resection of bladder tumour (TURBT) in patients with newly diagnosed superficial bladder cancer and its impact on subsequent treatment plan. Methods: We carried out a prospective study on 100 consecutive patients with newly diagnosed superficial bladder cancer in whom a second-look TURBT was performed two to six weeks after initial resection. We assessed the incidence of residual tumours, sufficiency of initial pathological staging and grading. We also assessed the need for re-staging and grading after the second-look TURBT. Results: Forty-five out of 75 patients (60%) who underwent second-look TURBT had no tumours, 18 (24%) had visible residual tumours and 12 (16%) had microscopic residual tumours. Of the 30 (40%) patients with residual tumours, five had pTa, three had carcinoma in situ (CIS), 12 had pT1, and 10 had pT2 disease. Upstaging and change of treatment plan as a result of the second-look TURBT were necessary in 18/75 (24%) cases, of which 10 cases (13%) underwent radical cystectomy for muscle-invasive tumours. Conclusions: A second cystoscopy with or without TURBT is recommended two to six weeks after initial resection of stage Ta and T1 bladder tumours in patients with high-grade transitional carcinoma of the bladder or in patients with multiple tumours. Second-look cystoscopy in this category of patients may reveal the need for early change of treatment plan in about 25% of patients.
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Affiliation(s)
- Ehab El-Barky
- Urology Department, Banha Faculty of Medicine, Banha University, Egypt
| | - Ahmed Sebaey
- Urology Department, Banha Faculty of Medicine, Banha University, Egypt
| | - Magdy Eltabey
- Urology Department, Banha Faculty of Medicine, Banha University, Egypt
| | - Ahmed Aboutaleb
- Urology Department, Banha Faculty of Medicine, Banha University, Egypt
| | - Sundus Hussein
- Department of Pathology, Mubarak Al-Kabeer Teaching Hospital, Kuwait
| | - Elijah O Kehinde
- Department of Surgery (Division of Urology), Faculty of Medicine, Kuwait University, Kuwait
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74
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Kassouf W, Traboulsi SL, Kulkarni GS, Breau RH, Zlotta A, Fairey A, So A, Lacombe L, Rendon R, Aprikian AG, Siemens DR, Izawa JI, Black P. CUA guidelines on the management of non-muscle invasive bladder cancer. Can Urol Assoc J 2015; 9:E690-704. [PMID: 26664503 PMCID: PMC4662433 DOI: 10.5489/cuaj.3320] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | | | | | | | - Andrew Fairey
- Division of Urology, University of Alberta, Edmonton, AB
| | - Alan So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | | | | | | | | | | | - Peter Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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75
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Oncological outcomes of a single but extensive transurethral resection followed by appropriate intra-vesical instillation therapy for newly diagnosed non-muscle-invasive bladder cancer. Int Urol Nephrol 2015; 47:1509-14. [DOI: 10.1007/s11255-015-1048-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
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Pagano MJ, Badalato G, McKiernan JM. Optimal treatment of non-muscle invasive urothelial carcinoma including perioperative management revisited. Curr Urol Rep 2015; 15:450. [PMID: 25234184 DOI: 10.1007/s11934-014-0450-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Non-muscle invasive urothelial carcinoma is a heterogeneous disease that requires the practicing urologist to implement a variety of surgical and non-surgical treatment strategies. The disease course can range from recurrent low grade papillary disease to aggressive disease concerning for progression from initial presentation. Depending on the particular patient and goals of care, treatments similarly span the range from minimally invasive fulgurations to immediate radical cystectomy. For most patients some form of intravesical therapy will bridge the gap between transurethral resections (TUR) and radical surgery. Recent advances in the field continue to emphasize the importance of quality TUR and its strong impact on outcomes. In addition, continued research to optimize intravesical therapies has provided more information about how, when, and in whom these agents should be utilized to enhance their efficacy. This review covers the current state of NMIBC and the standards of care for the management of this disease.
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Affiliation(s)
- Matthew J Pagano
- Department of Urology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave., 11th Floor, New York, NY, 10032, USA,
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Maintenance Therapy with 3-monthly Bacillus Calmette-Guérin for 3 Years is Not Superior to Standard Induction Therapy in High-risk Non-muscle-invasive Urothelial Bladder Carcinoma: Final Results of Randomised CUETO Study 98013. Eur Urol 2015; 68:256-62. [PMID: 25794457 DOI: 10.1016/j.eururo.2015.02.040] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 02/27/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bacillus Calmette-Guérin (BCG) maintenance therapy for 3 yr following BCG induction can reduce the progression of urothelial bladder carcinoma versus BCG induction alone, but is associated with high toxicity. OBJECTIVE To investigate whether a modified 3-yr BCG maintenance regimen following induction therapy is more effective than standard BCG induction therapy alone and exhibits a low toxicity profile. DESIGN, SETTING, AND PARTICIPANTS Patients from the outpatient clinics of the participating centres with high-risk non-muscle-invasive bladder carcinoma (NMIBC) were randomised between October 1999 and April 2007. INTERVENTION Participants received BCG induction once-weekly for 6 wk (no maintenance arm) or BCG induction followed by one BCG instillation every 3 mo for 3 yr (maintenance arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary endpoints were disease-free interval (DFI) and time to progression (TTP). Secondary endpoints included survival duration and toxicity. Differences between treatment arms were tested using Student's t test and χ(2) and log-rank tests. RESULTS AND LIMITATIONS A total of 397 patients were randomised, 195 to the no-maintenance and 202 to the maintenance arm. A median time to recurrence was not reached in either treatment arm. DFI was similar between the arms (hazard ration [HR] 0.83; 95% CI 0.61-1.13; p=0.2) with disease relapse at 5 yr of 33.5% and 38.5%, respectively. TTP was also similar between the treatment arms (HR 0.79; 95% CI 0.50-1.26; p=0.3), with a progression rate at 5 yr of 16% and 19.5%, respectively. There were no significant differences between the treatment groups for overall survival and cancer-specific survival at 5 yr. Twenty and five patients in the maintenance and no-maintenance arms, respectively, stopped treatment because of toxicity. The most common local side effects were frequency (65% of patients), dysuria (63%), and haematuria (43%); the most frequent systemic side effects were general malaise (7.2%) and fever (34%). CONCLUSIONS In NMIBC patients treated with maintenance therapy comprising a single BCG instillation every 3 mo for 3 yr following standard induction BCG, we did not observe a decrease in recurrence and progression rates versus induction therapy alone. PATIENT SUMMARY Patients who undergo surgery to remove bladder cancer are usually treated with bacillus Calmette-Guérin (BCG) for 6 wk if there is a high risk of disease recurrence. Extending BCG therapy by 3 yr can further minimise disease recurrence and progression, but is associated with more side effects. We report that a modified 3-yr BCG treatment regimen showed low toxicity, but seemed to be no more effective than 6-wk treatment. TRIAL REGISTRATION CUETO 98013.
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78
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Han KS, You D, Jeong IG, Kwon T, Hong B, Hong JH, Ahn H, Ahn TY, Kim CS. Is intravesical Bacillus Calmette-Guérin therapy superior to chemotherapy for intermediate-risk non-muscle-invasive bladder cancer? An ongoing debate. J Korean Med Sci 2015; 30:252-8. [PMID: 25729246 PMCID: PMC4330478 DOI: 10.3346/jkms.2015.30.3.252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/13/2014] [Indexed: 11/24/2022] Open
Abstract
The objective of this study was to evaluate the risk of recurrence in patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) after intravesical instillation with chemotherapeutic agents or Bacillus Calmette-Guérin (BCG) therapy. A cohort of 746 patients with intermediate-risk NMIBC comprised the study group. The primary outcome was time to first recurrence. The recurrence rates of the transurethral resection (TUR) alone, chemotherapy, and BCG groups were determined using Kaplan-Meier analysis. Risk factors for recurrence were identified using Cox regression analysis. In total, 507 patients (68.1%), 78 patients (10.5%), and 160 (21.4%) underwent TUR, TUR+BCG, or TUR+chemotherapy, respectively. After a median follow-up period of 51.7 months (interquartile range=33.1-77.8 months), 286 patients (38.5%) developed tumor recurrence. The 5-yr recurrence rates for the TUR, chemotherapy, and BCG groups were 53.6%±2.7%, 30.8%±5.7%, and 33.6%±4.7%, respectively (P<0.001). Chemotherapy and BCG treatment were found to be predictors of reduced recurrence. Cox-regression analysis showed that TUR+BCG did not differ from TUR+chemotherapy in terms of recurrence risk. Adjuvant intravesical instillation is an effective prophylactic that prevents tumor recurrence in intermediate-risk NMIBC patients following TUR. In addition, both chemotherapeutic agents and BCG demonstrate comparable efficacies for preventing recurrence.
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Affiliation(s)
- Kyung-Sik Han
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Teakmin Kwon
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tai Young Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Balci M, Tuncel A, Guzel O, Aslan Y, Sezgin T, Bilgin O, Senel C, Atan A. Use of the nuclear matrix protein 22 Bladder Chek test™ in the diagnosis of residual urothelial cancer before a second transurethral resection of bladder cancer. Int Urol Nephrol 2015; 47:473-7. [PMID: 25649031 DOI: 10.1007/s11255-015-0921-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the diagnostic value of the nuclear matrix protein 22 (NMP-22) in residual tumors after complete transurethral resection (TUR) of bladder cancer. METHODS A total of 160 patients diagnosed with non-muscle invasive bladder cancer were prospectively enrolled in the study. Before the initial TUR, the patients were evaluated using urine cytology and the NMP-22 Bladder Chek™. After 4-6 weeks, all patients underwent a second TUR, urine cytology and NMP-22 Bladder Chek™ evaluation. RESULTS The mean patient age was 59.8 ± 1.0 years. Of the 160 patients, 81 (50.6%) had positive NMP-22 findings and 53 (33.1%) had positive urine cytology findings. In 101 (63.1%) patients, at least one marker was positive. There was no correlation between the positivity ratio of the NMP-22 and the degree of risk group (p = 0.156); however, in the high-risk group, the malignant cytology ratio was higher (p < 0.001). In 60 patients (37.5%), there were tumors in the second TUR. NMP-22 results of 40 of these patients (66.7%) were positive, and for 28 (46.7%), the cytology results were positive. The sensitivity, specificity, positive predictive value, and negative predictive value of the NMP-22 alone was 66.7, 81, 67.8, and 80.2 %, respectively; for the cytology, it was 46.7, 98, 93.3, and 75.4%, respectively; and for the NMP-22 and cytology combined, it was 73.3, 79, 67.7, and 83.2%, respectively. CONCLUSIONS NMP-22 Bladder Chek™ test has limited efficacy in detecting residual tumors before a second TUR. The combination of this test with cytology has no additional benefit.
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Affiliation(s)
- Melih Balci
- Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital, Sihhiye, 06120, Ankara, Turkey
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Ong MM, Riffel P, Budjan J, Bolenz C, Schönberg SO, Haneder S. [Oncological diseases and postoperative alterations of the bladder and urinary tract]. Radiologe 2014; 54:1221-34; quiz 1235-6. [PMID: 25425104 DOI: 10.1007/s00117-014-2768-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In the challenging evaluation of upper urinary tract malignancies multidetector computed tomography (CT) has become the standard imaging method. Cross sectional imaging not only allows the detection and visualization of the tumor itself but also provides nodal and metastasis staging in one examination (one-stop-shop). The majority of urothelial carcinomas are located in the urinary bladder. In this case, CT and more recently magnetic resonance imaging (MRI) can also deliver decisive information regarding TNM classification. A combination of clinical, histological, morphological and functional parameters allows both risk stratification and a targeted therapy based on the individual tumor stage.
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Affiliation(s)
- M M Ong
- Institut für Klinische Radiologie und Nuklearmedizin, Medizinische Fakultät Mannheim, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland,
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81
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Gill TS, Das RK, Basu S, Dey RK, Mitra S. Predictive factors for residual tumor and tumor upstaging on relook transurethral resection of bladder tumor in non-muscle invasive bladder cancer. Urol Ann 2014; 6:305-8. [PMID: 25371606 PMCID: PMC4216535 DOI: 10.4103/0974-7796.140990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/11/2013] [Indexed: 12/02/2022] Open
Abstract
Context: Relook transurethral resection of bladder tumor (TURBT) improves the diagnostic and therapeutic efficacy of primary TURBT. However, it is still not established as to which category of patients would benefit most from this repeat invasive procedure. Aims: This prospective interventional study was designed to identify the category of patients with non-muscle invasive bladder cancer who may benefit from a routine relook procedure. Setting and Design: A total of 52 consecutive patients with biopsy proven non muscle invasive bladder cancer on primary TURBT underwent a relook TURBT between March 2011 and September 2012. Materials and Methods: The incidence of residual tumor and tumor upstaging on relook procedure was correlated with various histopathological (stage, grade, CIS, presence of muscle) and cystoscopic (type and focality of tumor, any apparent field change) parameters on primary TURBT. Results: Out of the total 52 patients, 23 (44.2%) had a residual tumor on relook TURBT. 12 (23.1%) were upstaged (of these 9 i.e. 17.3% to muscle invasion). While most of the parameters studied showed a positive correlation with incidence of residual tumor and upstaging to muscle invasion, statistical significance (for both) was reached only for tumor stage (P = 0.028 and 0.010), tumor grade (P = 0.010 and 0.002) and tumor type (solid vs. papillary; P = 0.007 and 0.001). Carcinoma in situ showed a significant correlation with incidence of residual tumor (P = 0.016) while the absence of muscle in the primary TURBT specimen was significantly associated with upstaging to muscle invasive disease (P = 0.018). Statistical Analysis: The data was analyzed using SPSS software v. 16.0. Conclusions: Relook TURBT may be especially recommended for high grade and T1 tumors and tumors with a solid/sessile appearance on primary TURBT especially when deep muscle was absent in the primary TURBT specimen.
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Affiliation(s)
- Tejpal S Gill
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ranjit K Das
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Supriya Basu
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ranjan K Dey
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Subrata Mitra
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
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82
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Al-mansour M, Saadeddin A, Alkhateeb S, Abusamra A, Rabah D, Alotaibi M, Murshid E, Alsharm A, Ahmad I, Alghamdi K, Bazarbashi S. Saudi oncology society and Saudi urology association combined clinical management guidelines for urothelial urinary bladder cancer. Urol Ann 2014; 6:273-7. [PMID: 25371600 PMCID: PMC4216529 DOI: 10.4103/0974-7796.140941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/05/2023] Open
Abstract
In this report, updated guidelines for the evaluation, medical, and surgical management of transitional cell carcinoma of the urinary bladder are resented. They are categorized according the stage of the disease using the TNM staging system 7(th) edition. The recommendations are presented with supporting level of evidence.
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Affiliation(s)
- Mubarak Al-mansour
- Princess Noura Oncology Center, Department of Surgery, King Khaled Hospital, King Abdulaziz Medical City-Jeddah, Saudi Arabia
| | - Ahmad Saadeddin
- Department of Oncology, Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Section of Urology, Department of Surgery, King Khaled Hospital, King Abdulaziz Medical City-Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, Division of Urology, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Princess Al-Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Saudi Arabia
- Address for correspondence: Prof. Danny Rabah, Department of Surgery, Division of Urology, King Khalid University Hospital, College of Medicine, Princess Al-Johora Al-Ibrahim Centre for Cancer Research (Uro-Oncology Research Chair), King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdullah Alsharm
- Department of Oncology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Imran Ahmad
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid Alghamdi
- Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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83
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Daneshmand S, Schuckman AK, Bochner BH, Cookson MS, Downs TM, Gomella LG, Grossman HB, Kamat AM, Konety BR, Lee CT, Pohar KS, Pruthi RS, Resnick MJ, Smith ND, Witjes JA, Schoenberg MP, Steinberg GD. Hexaminolevulinate blue-light cystoscopy in non-muscle-invasive bladder cancer: review of the clinical evidence and consensus statement on appropriate use in the USA. Nat Rev Urol 2014; 11:589-96. [PMID: 25245244 DOI: 10.1038/nrurol.2014.245] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Hexaminolevulinate (HAL) is a tumour photosensitizer that is used in combination with blue-light cystoscopy (BLC) as an adjunct to white-light cystoscopy (WLC) in the diagnosis and management of non-muscle-invasive bladder cancer (NMIBC). Since being licensed in Europe in 2005, HAL has been used in >200,000 procedures, with consistent evidence that it improves detection compared with WLC alone. Current data support an additional role in the reduction of recurrence of NMIBC. Since the approval of HAL by the FDA in 2010, experience of HAL-BLC in the USA continues to expand. To define areas of need and to identify the benefits of HAL-BLC in clinical practice, a focus group of expert urologists specializing in the management of patients with bladder cancer convened to review the clinical evidence, share their experiences and reach a consensus regarding the optimal use of HAL-BLC in the USA. The focus group concluded that HAL-BLC should be considered for initial assessment of NMIBC, surveillance for recurrent tumours, diagnosis in patients with positive urine cytology but negative WLC findings, and for tumour staging.
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Affiliation(s)
- Siamak Daneshmand
- University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA
| | - Anne K Schuckman
- University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90089, USA
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84
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Lipsker A, Hammoudi Y, Parier B, Drai J, Bahi R, Bessede T, Patard JJ, Pignot G. Faut-il proposer une seconde résection systématique pour toutes les tumeurs de vessie n’infiltrant pas le muscle vésical à risque élevé ? Prog Urol 2014; 24:640-5. [DOI: 10.1016/j.purol.2014.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 11/28/2022]
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85
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Analysis of results of recurrence and progression rates of high-grade Ta bladder cancer and comparison with results of high-grade T1. Urologia 2014; 81:237-41. [PMID: 24859184 DOI: 10.5301/uro.5000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We aimed to evaluate the long-term recurrence and progression rates in a Turkish population with high-grade Ta and T1 bladder cancer and to determine malign potential of high-grade Ta bladder cancer. METHODS 191 patients who had non-invasive bladder cancer were evaluated at a single institution between 2005 and 2010. Median follow-up was 55.6 months (13-108). Long-term follow-up results of recurrence and progression rates of high-grade Ta and T1 were analyzed and compared with each other. RESULTS Of the 191 patients, 143 (74.9%) were high-grade T1 and 48 (25.1%) were high-grade Ta. Of the 143 patients who were high-grade T1, 39 (27.2%) responded to the induction BCG without recurrence. 33 (23%) patients had invasion deep into the muscle layer. 61 (42%) patients had recurred as high-grade T1. Of the 48 patients who were high-grade Ta, 15 (31%) responded to induction BCG without recurrence. 18 (37.5%) patients had recurrence as high-grade Ta. 12 (25%) patients had invasion deep into to the muscle layer. Of all the patients, 13 (7%) patients died of causes related to bladder cancer. In a multivariate analysis, concomitant CIS was statistically significant for the progression of high-grade Ta bladder cancer (p<0.005). CONCLUSIONS According to the data of the current study, the presence of concomitant CIS in patients with high-grade bladder cancers is associated with a higher risk of progression. There is a need for larger scale multi-institutional studies in order to support the hypothesis that high-grade Ta tumors should be considered as T1 tumors.
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86
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Sureka SK, Agarwal V, Agnihotri S, Kapoor R, Srivastava A, Mandhani A. Is en-bloc transurethral resection of bladder tumor for non-muscle invasive bladder carcinoma better than conventional technique in terms of recurrence and progression?: A prospective study. Indian J Urol 2014; 30:144-9. [PMID: 24744509 PMCID: PMC3989812 DOI: 10.4103/0970-1591.126887] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Conventional, transurethral resection of bladder tumor (TURBT) involves piecemeal resection of the tumor and has a very high recurrence rate. We evaluated the outcome of en-bloc TURBT (ET) in comparison with conventional TURBT (CT) in non-muscle invasive bladder carcinoma in terms of recurrencew and progression. Materials and Methods: From September 2007 to June 2011, in a prospective non-randomized interventional setting, ET was compared with CT in patients with solitary tumor of 2-4 cm size in terms of recurrence and progression. Pedunculated tumors, size >4 cm, tumors with associated hydroureteronephrosis and biopsy specimen with absent detrusor muscles were excluded. Fisher's exact test and survival analyses were used to compare the demography and the outcome. Results: A total of 21 patients of ET were compared with 24 patients of CT. Mean tumor size was 2.8 cm in ET and 3.3 cm in CT group. Location of tumor, stage and grade were comparable in both groups. Recurrence rate was 28.6% versus 62.5% (P = 0.03) and progression rate was 19% versus 33.3% (P = 0.32) in ET versus CT group respectively. Recurrence free survival was 45.1 (95% CI: 19.0-38 months) and 28.5 (95% CI: 35.4-54.7 months) in ET and CT group (P = 0.018). Progression free survival in ET and CT was 48.32 (95% CI: 35.5-53.0 months) and 44.26 (95% CI: 39.0-57.5 months), P = 0.46. Conclusion: There was a significant reduction in the recurrence rate and time to recurrence with ET. Rate of progression was also relatively less with ET, though not statistically significant.
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Affiliation(s)
- Sanjoy Kumar Sureka
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Vinita Agarwal
- Department of Pathology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Shalini Agnihotri
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Rakesh Kapoor
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Aneesh Srivastava
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anil Mandhani
- Department of Urology and Renal Transplant, SGPGIMS, Lucknow, Uttar Pradesh, India
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87
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Yang J, Yu H, Shen M, Wei W, Xia L, Zhao P. N1-guanyl-1,7-diaminoheptane sensitizes bladder cancer cells to doxorubicin by preventing epithelial-mesenchymal transition through inhibition of eukaryotic translation initiation factor 5A2 activation. Cancer Sci 2014; 105:219-27. [PMID: 24262005 PMCID: PMC4317814 DOI: 10.1111/cas.12328] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 12/12/2022] Open
Abstract
Drug resistance greatly reduces the efficacy of doxorubicin-based chemotherapy in bladder cancer treatment; however, the underlying mechanisms are poorly understood. We aimed to investigate whether N1-guanyl-1,7-diaminoheptane (GC7), which inhibits eukaryotic translation initiation factor 5A2 (eIF5A2) activation, exerts synergistic cytotoxicity with doxorubicin in bladder cancer, and whether eIF5A2 is involved in chemoresistance to doxorubicin-based bladder cancer treatment. BIU-87, J82, and UM-UC-3 bladder cancer cells were transfected with eIF5A2 siRNA or negative control siRNA before incubation with doxorubicin alone or doxorubicin plus GC7 for 48 h. Doxorubicin cytotoxicity was enhanced by GC7 in BIU-87, J82, and UM-UC-3 cells. It significantly inhibited activity of eIF5A2, suppressed doxorubicin-induced epithelial-mesenchymal transition in BIU-87 cells, and promoted mesenchymal-epithelial transition in J82 and UM-UC-3 cells. Knockdown of eIF5A2 sensitized bladder cancer cells to doxorubicin, prevented doxorubicin-induced EMT in BIU-87 cells, and encouraged mesenchymal-epithelial transition in J82 and UM-UC-3 cells. Combination therapy with GC7 may enhance the therapeutic efficacy of doxorubicin in bladder cancer by inhibiting eIF5A2 activation and preventing epithelial-mesenchymal transition.
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Affiliation(s)
- Jinsong Yang
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
| | - Haogang Yu
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
| | - Mo Shen
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medicine UniversityWenzhou, Zhejiang, China
| | - Wei Wei
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
| | - Lihong Xia
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
| | - Peng Zhao
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China
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Kramer MW, Abdelkawi IF, Wolters M, Bach T, Gross AJ, Nagele U, Conort P, Merseburger AS, Kuczyk MA, Herrmann TRW. Current evidence for transurethral en bloc resection of non-muscle-invasive bladder cancer. MINIM INVASIV THER 2014; 23:206-13. [DOI: 10.3109/13645706.2014.880065] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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89
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Bhatt J, Cowan N, Protheroe A, Crew J. Recent advances in urinary bladder cancer detection. Expert Rev Anticancer Ther 2014; 12:929-39. [DOI: 10.1586/era.12.73] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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90
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Metwalli AR, Kamat AM. Controversial issues and optimal management of stage T1G3 bladder cancer. Expert Rev Anticancer Ther 2014; 6:1283-94. [PMID: 16925494 DOI: 10.1586/14737140.6.8.1283] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The management of T1G3 bladder cancer is controversial. Diagnostic methods, such as bladder mapping or second-look transurethral resection are recommended to assess risk. Bacillus Calmette-Guérin intravesical therapy with a maintenance regimen is recommended for solitary T1G3 tumors. The timing of radical cystectomy for these patients is controversial, but early recurrence during intravesical therapy is an indication for radical cystectomy. Multifocal disease, concomitant carcinoma in situ and disease in the prostatic urethra and bladder neck also suggest aggressive disease and cystectomy should be considered in these patients.
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Affiliation(s)
- Adam R Metwalli
- The University of Texas MD Anderson Cancer Center, Department of Urology, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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91
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Abstract
Bladder cancer continues to provide urologists and researchers with a clinical and scientific challenge. Several urinary markers used in the detection and screening of patients with bladder cancer are currently under investigation. Improvements in intravesical therapy are proving to help decrease both tumor recurrence and progression in patients with high-risk disease. In patients with organ-confined, node-negative bladder cancer, radical cystectomy provides excellent local control and long-term disease-free survival. The use of an extended lymphadenectomy at the time of cystectomy may yield improved prognostic information as well as a potential survival benefit. Neoadjuvant chemotherapy and less toxic combination chemotherapy regimens are offering potential improvements in patients with extravesical or nodal extension. The current methods of detection, as well as available therapeutic treatment options are reviewed.
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Affiliation(s)
- Eric S Gwynn
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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92
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Oosterlinck W, Decaestecker K. Current strategies in the treatment of non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2014; 12:1097-106. [DOI: 10.1586/era.12.87] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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93
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Lazica DA, Roth S, Brandt AS, Böttcher S, Mathers MJ, Ubrig B. Second Transurethral Resection after Ta High-Grade Bladder Tumor: A 4.5-Year Period at a Single University Center. Urol Int 2014; 92:131-5. [DOI: 10.1159/000353089] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
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94
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Jancke G, Rosell J, Jahnson S. Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer. Scand J Urol 2013; 48:276-83. [DOI: 10.3109/21681805.2013.864327] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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95
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Hartinger J, Häußermann R, Olbert P, Hofmann R, Hegele A. [Predictors for presence of residual tumor in follow-up transurethral resection of bladder tumors: single center results]. Urologe A 2013; 52:557-61. [PMID: 23358830 DOI: 10.1007/s00120-012-3109-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND European Association of Urology (EAU) guidelines recommend a follow-up transurethral resection of bladder tumors (reTUR-B) for intermediate and high-risk non-muscle invasive bladder cancer (NMIBC) 2-6 weeks after the initial resection. The purpose of this study was to find parameters which indicate the presence of residual tumor in reTUR-B and to evaluate the prognostic value. PATIENTS AND METHODS The data from all patients treated with TUR-B between January 2005 and December 2008 were retrospectively evaluated. The residual tumor rate was correlated with age, sex, staging, grading, risk group, multifocality and surgeon's level of training. RESULTS A total number of 555 TUR-B operations were carried out and 179 patients received reTUR-B according to the EAU guidelines. Age (p=0.8), sex (p=0.7), initial staging (p=0.2), initial grading (p=0.3) and surgeon's level of training (p=0.7) did not have an impact on the rate of residual tumor in reTUR-B. Tumors categorized as high risk according to the EAU risk score in initial TUR-B (p<0.01) and multifocality (p=0.01) were associated with significantly higher rates of residual tumor. CONCLUSIONS A reTUR-B is strongly indicated in high risk bladder tumors as well as multifocal tumors showing a significantly increased residual tumor rate. Other clinical parameters showed no prognostic value for the existence of residual tumor in reTUR-B.
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Affiliation(s)
- J Hartinger
- Abteilung für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Baldingerstraße, 35043 Marburg, Deutschland.
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Sfakianos JP, Kim PH, Hakimi AA, Herr HW. The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin. J Urol 2013; 191:341-5. [PMID: 23973518 DOI: 10.1016/j.juro.2013.08.022] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE We determined whether restaging resection before initiating induction intravesical bacillus Calmette-Guérin improves the recurrence-free rate in patients with high risk nonmuscle invasive bladder cancer. MATERIALS AND METHODS We retrospectively analyzed data on 1,021 patients treated at our institution with intravesical bacillus Calmette-Guérin for nonmuscle invasive high risk bladder cancer. All patients underwent a second resection except those already receiving bacillus Calmette-Guérin at the time of initial consultation and those who refused restaging resection. All patients were assessed every 3 to 12 months for a minimum of 5 years. Univariate and multivariate regression was used to identify predictors of 5-year recurrence. RESULTS Restaging transurethral resection was performed in 894 patients (87.5%). At restaging resection viable tumor was found in 496 patients (55.5%). At 3 months patients with a single resection had a 44.3% recurrence rate compared to 9.6% in those with restaging resection (p <0.01). On multivariate analysis a single transurethral resection was the only predictor of recurrence at 5 years (OR 2.1, 95% CI 1.3-3.3, p = 0.01). Time to recurrence in patients with a single resection was significantly shorter than in those with restaging resection (median 22 vs 36 months, p <0.001). CONCLUSIONS Failure to repeat resection before initiating intravesical bacillus Calmette-Guérin therapy for high risk nonmuscle invasive bladder cancer significantly increases the risk of recurrence. Therefore, we believe that restaging resection should be performed before initiating bacillus Calmette-Guérin therapy in all patients with high risk nonmuscle invasive bladder cancer.
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Affiliation(s)
- John P Sfakianos
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Philip H Kim
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A Ari Hakimi
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Shoshany O, Mano R, Margel D, Baniel J, Yossepowitch O. Presence of detrusor muscle in bladder tumor specimens--predictors and effect on outcome as a measure of resection quality. Urol Oncol 2013; 32:40.e17-22. [PMID: 23911682 DOI: 10.1016/j.urolonc.2013.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 03/31/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To identify predictors of the absence of detrusor muscle in bladder tumor specimens and analyze its effect on clinical outcome as an indicator of resection quality. METHODS The bladder cancer database of a tertiary medical center was queried for patients who underwent complete transurethral resection of bladder tumor (TURBT) between 2008 and 2009. Study end points were absence of detrusor muscle in the surgical specimen and its association with disease recurrence/progression. RESULTS Detrusor muscle in the surgical specimen was found in 265 of the 332 study patients (79%). The likelihood of finding muscle increased with higher clinical stage (Odds Ratio [OR]-1.8), higher tumor grade (OR-3), larger tumor size (OR-3.2), multifocal disease (OR-1.7), and nonpapillary morphology (OR-2.3). History of bladder cancer, surgeon's experience, and tumor location in the bladder had no effect. In the whole study population, neither tumor recurrence nor disease progression was associated with absence of detrusor muscle. In patients with T1 tumors, absence of detrusor muscle in the specimen was associated with higher early recurrence rate but not worse long-term outcome. CONCLUSIONS Absence of detrusor muscle in TURBT specimens is not determined by the technical difficulty of the procedure or surgical experience. Surgeons are more prone to obtain deep muscle in large, nonpapillary-appearing tumors, likely reflecting efforts to attain accurate staging in these cases. The presence or absence of detrusor muscle may serve as a surrogate of resection quality in patients with T1 tumors, but its general applicability to the overall population of patients undergoing TURBT remains questionable.
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Affiliation(s)
- Ohad Shoshany
- Department of Urology, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roy Mano
- Department of Urology, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Margel
- Department of Urology, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jack Baniel
- Department of Urology, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Department of Urology, Rabin Medical Center, Beilinson Campus, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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98
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Lazica DA, Böttcher S, Degener S, von Rundstedt FC, Brandt AS, Störkel S, Roth S. [T1 bladder cancer: role of documentation for bladder tumor findings and targeted second resection]. Urologe A 2013; 52:1110-7. [PMID: 23754611 DOI: 10.1007/s00120-013-3206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND For control resection of T1 bladder tumors an exact relocalization of the previously infiltrating tumor spread can be complicated by postreactive alterations, multiple scar tissue or change of surgeons. In this study the results of control transurethral resection of the bladder (TURB) after T1 high grade bladder tumors with the focus on localization and importance of standardized exact documentation were analyzed. PATIENTS AND METHODS From July to February 2012 a control resection was performed in 167 patients due to a T1 high grade bladder cancer. The rates of residual tumor tissue and localization were investigated with standardized tumor documentation. RESULTS Out of 167 patients with T1 bladder cancer who underwent a control resection tumor tissue was found in 58.1 % (97 out of 167) and in 85.6 % (83 out of 97) the primary site was affected (41.2 % only at primary site and 44.3 % additionally at other locations). In 11 patients (11.3 %) residual tumor tissue at the initial site was only detected histologically. CONCLUSIONS Our results indicate that T1 high grade bladder cancers show a relevant rate of residual tumor tissue at control resection which confirms the clinical guidelines of the European Association of Urology (EAU) on mandatory resection. In most cases the primary tumor site is affected. The standardized bladder tumor documetation allows well-directed control resection also in patients with multiple scars and post-TUR alterations, even when performed by a different surgeon.
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Affiliation(s)
- D A Lazica
- Klinik für Urologie und Kinderurologie, Zentrum für Forschung in der klinischen Medizin (ZFKM), HELIOS Klinikum Wuppertal, Universität Witten/ Herdecke, Heusnerstraße 40, 42283 Wuppertal, Deutschland.
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99
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Süer E, Özcan C, Baltacı S, Gülpınar Ö, Burgu B, Haliloğlu A, Bedük Y. Time between first and second transurethral resection of bladder tumors in patients with high-grade T1 tumors: is it a risk factor for residual tumor detection? Urol Int 2013; 91:182-6. [PMID: 23751593 DOI: 10.1159/000350512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 02/21/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE We evaluated the risk factors for residual tumor detection after transurethral resection of bladder tumors (TURBT) in patients with newly diagnosed high-grade T1 transitional cell carcinoma of the bladder. PATIENTS AND METHODS Overall 132 patients underwent TURBT for primary bladder tumors and were diagnosed as high-grade T1 bladder cancer. Patients with incomplete resections were excluded from the study. Clinical and pathologic characteristics of the patients were compared and multivariate analysis was performed to determine independent prognostic factors. RESULTS Residual tumor was demonstrated in 57 (43.1%) of the patients. The residual tumor rate was significantly lower in patients with solitary tumors, tumors <3 cm in diameter, muscle presence in the initial TURBT pathologic sample and treated by an expert surgeon. In patients with solitary bladder tumors, tumors at the dome and posterior wall of the bladder exhibited higher rates of residual tumor (p < 0.0001). The time elapsed between first and second TURBT was significantly shorter in patients without residual tumor compared to patients with residual tumor at second TURBT (32.6 ± 9.1 vs. 39.3 ± 10.9 days, respectively, p = 0.001). Multivariate analysis demonstrated that time elapsed between first and second TURBT is the most important parameter for residual tumor detection. CONCLUSION Our study revealed that multiple tumors, tumors >3 cm in size, absence of detrusor muscle in the initial TURBT specimen, TURBT performed by trainees and finally, as a new finding, prolonged interval between first and second TURBT are independent predictors for residual tumor detection in patients with high-grade T1 tumors.
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Affiliation(s)
- Evren Süer
- Department of Urology, University of Ankara, Ankara, Turkey
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Sverrisson EF, Espiritu PN, Spiess PE. New therapeutic targets in the management of urothelial carcinoma of the bladder. Res Rep Urol 2013; 5:53-65. [PMID: 24400235 PMCID: PMC3826897 DOI: 10.2147/rru.s29131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Urothelial carcinoma of the bladder, despite the myriad of treatment approaches and our progressively increasing knowledge into its disease processes, remains one of the most clinically challenging problems in modern urological clinical practice. New therapies target biomolecular pathways and cellular mediators responsible for regulating cell growth and metabolism, both of which are frequently overexpressed in malignant urothelial cells, with the intent of inducing cell death by limiting cellular metabolism and growth, creating an immune response, or selectively delivering or activating a cytotoxic agent. These new and novel therapies may offer a potential for reduced toxicity and an encouraging hope for better treatment outcomes, particularly for a disease often refractory or not amenable to the current therapeutic approaches.
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Affiliation(s)
- Einar F Sverrisson
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Patrick N Espiritu
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H Lee Moffitt Cancer Center, Tampa, FL, USA
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