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Prospective Validation of the ROL System in Substaging pT1 High-Grade Urothelial Carcinoma: Results from a Mono-Institutional Confirmatory Analysis in BCG Treated Patients. Cancers (Basel) 2023; 15:cancers15030934. [PMID: 36765894 PMCID: PMC9913603 DOI: 10.3390/cancers15030934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Patients with pT1 high-grade (HG) urothelial carcinoma (UC) and a very high risk of progression might benefit from immediate radical cystectomy (RC), but this option remains controversial. Validation of a standardized method to evaluate the extent of lamina propria (LP) invasion (with recognized prognostic value) in transurethral resection (TURBT) specimens is still needed. The Rete Oncologica Lombarda (ROL) system showed a high predictive value for progression after TURBT in recent retrospective studies. The ROL system was supposed to be validated on a large prospective series of primary urothelial carcinomas from a single institution. From 2016 to 2020, we adopted ROL for all patients with pT1 HG UC on TURBT. We employed a 1.0-mm threshold to stratify tumors in ROL1 and ROL2. A total of 222 pT1 HG UC were analyzed. The median age was 74 years, with a predominance of men (73.8%). ROL was feasible in all cases: 91 cases were ROL1 (41%), and 131 were ROL2 (59%). At a median follow-up of 26.9 months (IQR 13.8-40.6), we registered 81 recurrences and 40 progressions. ROL was a significant predictor of tumor progression in both univariable (HR 3.53; CI 95% 1.56-7.99; p < 0.01) and multivariable (HR 2.88; CI 95% 1.24-6.66; p = 0.01) Cox regression analyses. At Kaplan-Meier estimates, ROL showed a correlation with both PFS (p = 0.0012) and RFS (p = 0.0167). Our results confirmed the strong predictive value of ROL for progression in a large prospective series. We encourage the application of ROL for reporting the extent of LP invasion, substaging T1 HG UC, and improving risk tables for urological decision-making.
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Naspro R, La Croce G, Finati M, Roscigno M, Pellucchi F, Sodano M, Manica M, Gianatti A, Da Pozzo LF. Oncological outcomes of concomitant carcinoma in situ at radical cystectomy in pure urothelial bladder cancer and in histological variants. Urol Oncol 2021; 40:61.e9-61.e19. [PMID: 34334293 DOI: 10.1016/j.urolonc.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/14/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The presence of carcinoma in situ at transurethral resection is known to increase the risk of recurrence and progression to invasive disease. However, the evidence regarding the prognostic role of concomitant carcinoma in situ after radical cystectomy due to bladder cancer is controversial. Moreover, concomitant carcinoma in situ was found to be significantly associated with bladder histological variants. The aim of our study is to evaluate whether the presence of concomitant carcinoma in situ at radical cystectomy, impacts on recurrence and survival outcomes in pure urothelial bladder cancer, compared to histological variants. METHODS We evaluated 410 consecutive patients diagnosed with non-metastatic bladder cancer and treated with radical cystectomy at a single tertiary referral centre between January 2009 and May 2019. Patients were stratified according to the presence of carcinoma in situ. The Kaplan-Meier method was used to compare recurrence free, cancer specific and overall survival in pure urothelial and histological variants. Cox proportional hazards regression analyses model was used to predict recurrence, cancer specific and overall mortality in pure urothelial and histological variants bladder cancer, according to pathological stage. RESULTS Median age was 71 years. 340 patients (82%) were male. At a median follow-up of 32 months, disease recurrence, cancer specific mortality and overall mortality were, 37% (155 patients), 32.9% (135 patients) and 46.6% (191 patients), respectively. Concomitant and pure carcinoma in situ were found in 39% and 19% of radical cystectomy specimens, respectively. Concomitant carcinoma in situ was more frequent in patients with histological variants (50.9%) compared to pure urothelial bladder cancer (35.4%) (P-value <.001) and was associated with worst pathological features (lymphovascular invasion, lymph node involvement and non-organ confined disease). Recurrence free survival at Kaplan-Meyer analyses was significantly higher in patients with pure carcinoma in situ compared to those with concomitant or no carcinoma in situ (all P <.001), similarly for patients without carcinoma in situ compared with those with concomitant Cis (P =.02) at radical cystectomy. Cancer specific and overall survival were significantly higher in patients with pure carcinoma in situ compared to those with concomitant or no carcinoma in situ (all P <.001). Conversely no significant difference was found between patients without carcinoma in situ and with concomitant carcinoma in situ (P>0.1) at radical cystectomy Moreover, concomitant carcinoma in situ at radical cystectomy in histological variants is associated with higher free recurrence rate compared to the other groups. At multivariate Cox proportional hazards regression analyses the presence of carcinoma in situ at radical cystectomy was not associated with any survival effect or recurrence (all P > .05) in the overall population and when patients are stratified according to histology. However, concomitant carcinoma in situ represents an independent predictor of recurrence in the subgroup of patients with organ confined disease in case of urothelial bladder cancer and histological variants. CONCLUSION Concomitant carcinoma in situ should be considered a proxy of aggressiveness in bladder cancer after radical cystectomy. Based on its prognostic implications, concomitant carcinoma in situ should be considered for strict follow-up in patients with organ confined disease which may deserve adjuvant treatment both in pure urothelial bladder cancer and histological variants.
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Affiliation(s)
- Richard Naspro
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | | | | | - Marco Roscigno
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Mario Sodano
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Manica
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Luigi F Da Pozzo
- Department of Urology, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Milano-Bicocca, Milan, Italy
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Yilmaz M, Sahin Y, Ates HA, Hacibey I, Cil G. De Ritis ratio: how effectively can we use in bladder cancer management? Biomark Med 2020; 14:1453-1460. [PMID: 33151096 DOI: 10.2217/bmm-2020-0212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: This study aims to determine the relationship between the pre-operative De Ritis ratio (DRR) and bladder cancer (BCa) pathological subtypes. Results & methodology: A total of 248 patients with primary BCa were included. Univariate and multivariate analyses were performed to identify whether DRR can be a risk factor for the presence of carcinoma in situ (CIS). There was a statistically significant difference between the nonmuscle invasive BCa risk groups and the muscle-invasive BCa group according to the median DRR levels (p < 0.001). DRR was an independent risk factor for the presence of CIS in multivariate analysis (OR: 1.909; 95% CI: 0.030-0.196; p = 0.008). Discussion & conclusion: DRR can be considered as an independent risk factor for the presence of CIS in patients with primary BCa.
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Affiliation(s)
- Mehmet Yilmaz
- Department of Urology, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Yusuf Sahin
- Department of Urology, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Huseyin A Ates
- Department of Urology, Gebze Fatih State Hospital, Kocaeli, Turkey
| | - Ibrahim Hacibey
- Department of Urology, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Gokhan Cil
- Department of Urology, University of Health Sciences, Bagcilar Training & Research Hospital, Istanbul, Turkey
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Zhang L, Wu B, Zha Z, Qu W, Zhao H, Yuan J. Clinicopathological factors in bladder cancer for cancer-specific survival outcomes following radical cystectomy: a systematic review and meta-analysis. BMC Cancer 2019; 19:716. [PMID: 31324162 PMCID: PMC6642549 DOI: 10.1186/s12885-019-5924-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Assessing the prognostic significance of specific clinicopathological features plays an important role in surgical management after radical cystectomy. This study investigated the association between ten clinicopathological characteristics and cancer-specific survival (CSS) in patients with bladder cancer. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a literature search was conducted through the PubMed, EMBASE and Web of Science databases using appropriate search terms from the dates of inception until November 2018. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the CSS. Fixed- or random-effects models were constructed according to existence of heterogeneity. Results Thirty-three articles met the eligibility criteria for this systematic review, which included 19,702 patients. The overall results revealed that CSS was associated with advanced age (old vs. young: pooled HR = 1.01; 95% CI:1.00–1.01; P < 0.001), higher tumor grade (3 vs. 1/2: pooled HR = 1.29; 95% CI:1.15–1.45; P < 0.001), higher pathological stage (3/4 vs. 1/2: pooled HR = 1.60; 95% CI:1.37–1.86; P < 0.001), lymph node metastasis (positive vs. negative: pooled HR = 1.51; 95% CI:1.37–1.67; P < 0.001), lymphovascular invasion (positive vs. negative: pooled HR = 1.36; 95% CI:1.28–1.45; P < 0.001), and soft tissue surgical margin (positive vs. negative: pooled HR = 1.42; 95% CI:1.30–1.56; P < 0.001). However, gender (male vs. female: pooled HR = 0.98; 95% CI: 0.96–1.01; P = 0.278), carcinoma in situ (positive vs. negative: pooled HR = 0.98; 95% CI: 0.88–1.10; P = 0.753), histology (transitional cell cancer vs variant: pooled HR = 0.90; 95% CI: 0.79–1.02; P = 0.089) and adjuvant chemotherapy (yes vs. no: pooled HR = 1.16; 95% CI: 1.00–1.34; P = 0.054) did not affect CSS after radical resection of bladder cancer. Conclusions Our results revealed that several clinicopathological characteristics can predict CSS risk after radical cystectomy. Prospective studies are needed to further confirm the predictive value of these variables for the prognosis of bladder cancer patients after radical cystectomy. Electronic supplementary material The online version of this article (10.1186/s12885-019-5924-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China.
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Wei Qu
- Department of Pharmacy, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, Jiang-yin, 214400, China
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The clinicopathological characteristics and prognostic value of squamous differentiation in patients with bladder urothelial carcinoma: a meta-analysis. World J Urol 2019; 38:323-333. [PMID: 31011874 DOI: 10.1007/s00345-019-02771-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/15/2019] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Urothelial carcinoma with squamous differentiation (UCSD) is the most common histologic variant in bladder cancer (BCa). Previously, some studies have linked the presence of UCSD with the risk of worse survival outcomes in BCa patients. However, such association is still controversial. In this study, we performed a meta-analysis to clarify the clinicopathological characteristics and to further investigate the prognostic value of UCSD in BCa. METHODS A systematic literature search was performed in electronic databases including PubMed, Embase, Chinese National Knowledge Infrastructure and Wanfang Data until October 2018. Subgroup analyses were performed according to different treatments and study outcomes. RESULTS Total of 13,284 patients were enrolled in 19 studies which were included in this meta-analysis. The percentage of female patients with UCSD was significantly higher than those with pure urothelial carcinoma. UCSD was correlated with tumor stage T3/T4, tumor grade 3, positive surgical margin, and lymph node involvement. Moreover, the recurrence rate was higher in patients with UCSD after surgery. UCSD was associated with poorer disease-free survival (DFS). No significant difference of cancer-specific survival (CSS) or overall survival (OS) was found on multivariable analysis between the two groups. CONCLUSIONS Our study demonstrated that UCSD in BCa was associated not only with unfavorable clinicopathological features, but also with high risk of recurrence and poorer prognosis for DFS. However, UCSD is not independently significant for CSS and OS. Well-designed randomized study with larger sample size is warranted to verify the findings and to further explore the role of UCSD in BCa.
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Concomitant carcinoma in situ may not be a prognostic factor for patients with bladder cancer following radical cystectomy: a PRISMA-compliant systematic review and meta-analysis. World J Urol 2019; 38:129-142. [PMID: 30919100 DOI: 10.1007/s00345-019-02738-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/21/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Numerous recent studies have shown that concomitant carcinoma in situ (CIS) can be closely associated with the prognosis of patients with bladder cancer (BCa). However, the prognostic value of CIS in BCa is still not conclusive. Hence, we performed a systematic review and meta-analysis to explore the association between CIS and clinicopathological features and the prognostic value for BCa following radical cystectomy. METHODS We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were systematically collected from PubMed, EMBASE, and Web of Science, with an expiration date of August 2018. Hazard ratios and 95% confidence intervals (CIs) were pooled to assess the intensity of association. All data were analyzed by Stata 12.0. Moreover, heterogeneity and publication bias were determined, and sensitivity analysis was performed to examine whether the findings of the meta-analysis were robust. RESULTS A total of 18,845 patients from 24 studies were included in the analysis. Our results indicated that CIS has no significant correlation with cancer-specific mortality (CSM) (pooled HR = 0.97, 95% CI 0.93-1.00, p = 0.059), overall mortality (OM) (pooled HR = 0.93, 95% CI 0.85-1.01, p = 0.076), overall survival (OS) (pooled HR = 1.04, 95% CI 0.96-1.12, p = 0.386), cancer-specific survival (CSS) (pooled HR = 1.06, 95% CI 0.97-1.16, p = 0.186), recurrence-free survival (RFS) (HR = 1.05, 95% CI 0.99-1.11, p = 0.098) or recurrence (pooled HR = 1.04, 95% CI 0.98-1.11, p = 0.212) in BCa patients. In addition, CIS was not correlated with gender (male vs. female, OR = 1.00, 95% CI 0.74-1.34, p = 0.978), pathological stage (III/IV vs. I/II: OR = 0.74, 95% CI 0.50-1.10, p = 0.132), tumor grade (1/2 vs. 3: OR = 3.38, 95% CI 0.73-15.65, p = 0.119), soft tissue surgical margin (STSM) (+ vs. - : OR = 1.20, 95% CI 0.97-1.48, p = 0.093) or lymphovascular invasion (LVI) (+ vs. - : OR = 0.92, 95% CI 0.62-1.38, p = 0.702),but was closely related to adjuvant chemotherapy (ACT) (yes vs. no, OR = 1.17, 95% CI 1.03-1.32, p = 0.019). Furthermore, these findings were demonstrated to be reliable by our sensitivity and subgroup analysis. CONCLUSIONS The prognostic value of CIS in BCa remains inconclusive in patients submitted to RC. Our data indicated that CIS may have no significant correlation with the prognosis and clinicopathological parameters of BCa patients, and also may not be applied to risk stratification or individualized therapy in BCa patients. Further research should be conducted to confirm our findings.
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Amini E, Ahmadi N, Clifford TG, Hugen CM, Bazargani ST, Cai J, Miranda G, Sherrod AE, Daneshmand S, Djaladat H. Long term oncologic outcome in patients with bladder cancer after radical cystectomy: Impact of carcinoma in situ in the era of neoadjuvant chemotherapy. Int Urol Nephrol 2019; 51:435-441. [PMID: 30706249 DOI: 10.1007/s11255-019-02087-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE To assess the impact of carcinoma in situ (CIS) on oncologic outcomes in patients who underwent radical cystectomy, with a focus on those who received neoadjuvant chemotherapy (NAC) including patients with down-staging to ≤ pT1cancer after chemotherapy. MATERIALS AND METHODS All patients who underwent radical cystectomy for urothelial cancer with curative intent from 1985 to 2011 were included. The impact of CIS on recurrence free and overall survival (OS) was assessed in the whole cohort and a subgroup who received NAC as well as those with response to chemotherapy and down-staging to ≤ pT1. RESULTS A total of 2518 patients with a median follow-up period of 9 years were included. Among all, 1397 (55.5%) had concomitant CIS on final pathology. CIS was associated with high risk pathologic features including high-grade disease, multifocality, and nodal involvement as well as worse recurrence free survival (RFS) with no impact on OS. We did not find a significant association between CIS and oncologic outcomes in a subset of patients who received NAC including those with down-staging to ≤ pT1 disease. In multivariate analysis, CIS had no association with either recurrence free or OS. CONCLUSIONS Concomitant CIS in radical cystectomy specimens is associated with decreased RFS; however, in multivariate analysis, it was not an independent predicting factor of oncologic outcomes. Moreover, the impact of CIS on oncologic outcomes in a subset of patients who received NAC was insignificant.
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Affiliation(s)
- Erfan Amini
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Urology, Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nariman Ahmadi
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Thomas G Clifford
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Cory M Hugen
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Soroush T Bazargani
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jie Cai
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Gus Miranda
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Andy E Sherrod
- Department of Pathology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Siamak Daneshmand
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Hooman Djaladat
- Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
- Institute of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA, 90089-9178, USA.
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Colombo R, Hurle R, Moschini M, Freschi M, Colombo P, Colecchia M, Ferrari L, Lucianò R, Conti G, Magnani T, Capogrosso P, Conti A, Pasini L, Burgio G, Guazzoni G, Patriarca C. Feasibility and Clinical Roles of Different Substaging Systems at First and Second Transurethral Resection in Patients with T1 High-Grade Bladder Cancer. Eur Urol Focus 2018; 4:87-93. [DOI: 10.1016/j.euf.2016.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/13/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Mari A, Campi R, Tellini R, Gandaglia G, Albisinni S, Abufaraj M, Hatzichristodoulou G, Montorsi F, van Velthoven R, Carini M, Minervini A, Shariat SF. Patterns and predictors of recurrence after open radical cystectomy for bladder cancer: a comprehensive review of the literature. World J Urol 2017; 36:157-170. [PMID: 29147759 PMCID: PMC5799348 DOI: 10.1007/s00345-017-2115-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose To review the currently available literature reporting the patterns of recurrence and their predictive factors after open radical cystectomy (RC) for bladder cancer. Methods A review of the literature was performed using the MEDLINE, Scopus and Web of Sciences databases from January 1997 to May 2017. The PRISMA guidelines were followed for the conduct of the study. Results Local recurrence rate ranges between 30 and 54%. Distant recurrence is not often standardized and is reported in up to 50% of cases. The overall 5-year recurrence-free survival rates from 58 to 81%. The mean follow-up of studies included in the analysis ranged from 18 to 350 months. Details on the most important demographic and epidemiological, clinical, histologic and pathologic predictors of recurrence after radical cystectomy are provided through an evidence-based approach. The impact of the extension of lymph node dissection on recurrence after RC is investigated. Conclusions A correct prognostic assessment is essential for patients undergoing radical cystectomy for bladder cancer, thereby potentially improving their oncologic outcomes. Electronic supplementary material The online version of this article (10.1007/s00345-017-2115-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Mari
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy.,Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Simone Albisinni
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | | | - Francesco Montorsi
- Division of Oncology/Unit of Urology, IRCCS San Raffaele Hospital, URI, Milan, Italy
| | - Roland van Velthoven
- Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marco Carini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Careggi Hospital, Florence, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria. .,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. .,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA. .,Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Thomas DE, Kaimakliotis HZ, Rice KR, Pereira JA, Johnston P, Moore ML, Reed A, Cregar DM, Franklin C, Loman RL, Koch MO, Bihrle R, Foster RS, Masterson TA, Gardner TA, Sundaram CP, Powell CR, Beck SDW, Grignon DJ, Cheng L, Albany C, Hahn NM. Prognostic Effect of Carcinoma In Situ in Muscle-invasive Urothelial Carcinoma Patients Receiving Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2017; 15:479-486. [PMID: 28040424 PMCID: PMC5449261 DOI: 10.1016/j.clgc.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Carcinoma in situ (CIS) is a poor prognostic finding in urothelial carcinoma. However, its significance in muscle-invasive urothelial carcinoma (MIUC) treated with neoadjuvant chemotherapy (NAC) is uncertain. We assessed the effect of CIS found in pretreatment transurethral resection of bladder tumor (TURBT) biopsies on the pathologic and clinical outcomes. MATERIALS AND METHODS Subjects with MIUC treated with NAC before cystectomy were identified. The pathologic complete response (pCR) rates stratified by TURBT CIS status were compared. The secondary analyses included tumor response, progression-free survival (PFS), overall survival (OS), and an exploratory post hoc analysis of patients with pathologic CIS only (pTisN0) at cystectomy. RESULTS A total of 137 patients with MIUC were identified. TURBT CIS was noted in 30.7% of the patients. The absence of TURBT CIS was associated with a significantly increased pCR rate (23.2% vs. 9.5%; odds ratio, 4.08; 95% confidence interval, 1.19-13.98; P = .025). Stage pTisN0 disease was observed in 19.0% of the TURBT CIS patients. TURBT CIS status did not significantly affect the PFS or OS outcomes. Post hoc analysis of the pTisN0 patients revealed prolonged median PFS (104.5 vs. 139.9 months; P = .055) and OS (104.5 vs. 152.3 months; P = .091) outcomes similar to those for the pCR patients. CONCLUSION The absence of CIS on pretreatment TURBT in patients with MIUC undergoing NAC was associated with increased pCR rates, with no observed differences in PFS or OS. Isolated CIS at cystectomy was frequently observed, with lengthy PFS and OS durations similar to those for pCR patients. Further studies aimed at understanding the biology and clinical effect of CIS in MIUC are warranted.
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Affiliation(s)
- Derek E Thomas
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Hristos Z Kaimakliotis
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Kevin R Rice
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Jose A Pereira
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Paul Johnston
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Marietta L Moore
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Angela Reed
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Dylan M Cregar
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Cindy Franklin
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Rhoda L Loman
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael O Koch
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Bihrle
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Richard S Foster
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Timothy A Masterson
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Thomas A Gardner
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Chandru P Sundaram
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Charles R Powell
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Stephen D W Beck
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - David J Grignon
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Liang Cheng
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN; Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Costantine Albany
- Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Noah M Hahn
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD.
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Moschini M, Shariat SF, Abufaraj M, Soria F, Klatte T, Croce GL, Mattei A, Damiano R, Salonia A, Montorsi F, Briganti A, Colombo R, Gallina A. The presence of carcinoma in situ at radical cystectomy increases the risk of urothelial recurrence: Implications for follow-up schemes. Urol Oncol 2016; 35:151.e17-151.e23. [PMID: 27932269 DOI: 10.1016/j.urolonc.2016.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 10/27/2016] [Accepted: 11/04/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To evaluate the incidence of carcinoma in situ (CIS) in patients treated with radical cystectomy (RC) due to bladder cancer and to assess its effect on recurrence and survival rates. METHODS The study focused on 1,128 consecutive nonmetastatic patients with bladder cancer treated with RC at a single tertiary care referral center from 1994 to 2014. The Kaplan-Meier method was used to compare recurrence, cancer-specific mortality (CSM), and overall mortality-free rates in the overall population and in pT0-pT2 and pT3-pT4 patients after stratifying according to the presence of CIS. Multivariable (MVA) Cox regression analyses tested the effect of the presence of CIS on survival outcomes. MVA competing risk analyses were performed to assess the effect of CIS on urothelial recurrence. RESULTS The presence of CIS was reported in 277 (24.6%) patients. During a median follow-up of 6 years, 355 recurrences, 377 CSM, and 468 overall mortality were reported. At MVA Cox regression analyses, the presence of concomitant CIS was not associated with any survival effect when the overall population was considered (all P≥0.3). At MVA Cox regression analyses, there was no effect of CIS on survival outcomes in pT3-pT4 patients (all P>0.2); on the contrary, the presence of CIS was associated with worse CSM in pT0-pT2 patients only (hazard ratio [HR] = 1.82; CI: 1.01-3.29; P = 0.04). At MVA competing risk analyses predicting urothelial recurrence only, the presence of CIS was associated to an increased risk of urothelial recurrence in pT0-pT2 patients (HR = 2.99; CI: 1.05-8.53; P = 0.04), pT3-pT4 patients (HR = 10.29; CI: 1.40-75.75; P = 0.02), and in the overall population (HR = 4.47; CI: 1.81-11.07; P = 0.001). CONCLUSION An increased risk of developing urothelial recurrence only was recorded in patients diagnosed with CIS at RC. Physicians should consider this aspect ensuring a more severe follow-up schemes in patients who harbored this pathological feature.
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Affiliation(s)
- Marco Moschini
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy; Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy; Department of Urology, Medical University of Vienna, Vienna, Austria.
| | | | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Giovanni La Croce
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy
| | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Rocco Damiano
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Andrea Salonia
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy
| | - Renzo Colombo
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy
| | - Andrea Gallina
- Unit of Urology, Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Italy
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Pietzak EJ, Sterling ME, Smith ZL, Malkowicz SB, Guzzo TJ. Outcomes of radical cystectomy in potential candidates for bladder preservation therapy. Urology 2015; 85:869-75. [PMID: 25681831 DOI: 10.1016/j.urology.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/15/2014] [Accepted: 01/03/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the outcomes of patients with urothelial-type bladder cancer (UBC) who optimally met selection criteria for bladder preservation therapy (BPT) but were treated with radical cystectomy (RC) instead. METHODS We identified consecutive patients with clinical stage cT2N0M0 UBC who underwent RC with curative intent at our center. Patients without carcinoma in situ, hydronephrosis, multifocality, or mixed histology were classified as BPT eligible. Patients with ≥1 contraindications were considered BPT ineligible. Clinicopathologic characteristics and survival outcomes for BPT-eligible patients were compared with those of the ineligible patients. RESULTS Of the 275 patients who had cT2N0M0 UBC, 157 (57.1%) were BPT ineligible (carcinoma in situ = 54; hydronephrosis = 77; multifocality = 29; mixed histology = 55; ≥2 contraindications = 51). BPT-eligible and -ineligible patients did not statistically differ with regard to age, sex, race, or neoadjuvant chemotherapy. Of the BPT-eligible patients, 24.1% had occult positive lymph nodes and 36.4% had pT3 or pT4 tumors at RC. On multivariate analysis, mixed histology (odds ratio = 3.18; 95% confidence interval [CI], 1.18-8.56) and progression from noninvasive disease to cT2 (odds ratio = 4.81 [95% CI, 1.67-13.85]) were independently associated with upstaging. Two-year overall survival was higher in BPT-eligible patients (76.7% vs 57.1%; P = .003; hazard ratio = 0.48 [95% CI, 0.3-0.78]). BPT-eligible patients also had better cancer-specific mortality on competing risk analysis (sub-hazard ratio = 0.46 [95% CI = 0.29-0.72]; P = .001). CONCLUSION Substantial clinicopathologic stage discrepancies occurred even in patients seemingly ideal for BPT, which may provide insight into BPT failures. Furthermore, substantial survival discrepancies existed for BPT-eligible and BPT-ineligible patients, underscoring the heterogeneity of cT2 disease. In the absence of randomized trials, comparisons between RC and BPT must factor in selection bias.
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Affiliation(s)
- Eugene J Pietzak
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
| | - Matthew E Sterling
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Zachary L Smith
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - S Bruce Malkowicz
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
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13
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Parker WP, Ho PL, Melquist JJ, Scott K, Holzbeierlein JM, Lopez-Corona E, Kamat AM, Lee EK. The effect of concomitant carcinoma in situ on neoadjuvant chemotherapy for urothelial cell carcinoma of the bladder: inferior pathological outcomes but no effect on survival. J Urol 2014; 193:1494-9. [PMID: 25451834 DOI: 10.1016/j.juro.2014.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE It is generally believed that carcinoma in situ is refractory to chemotherapy but specific data are lacking to validate this. We evaluated the effect of concomitant clinical carcinoma in situ on cancer specific outcomes after neoadjuvant chemotherapy for muscle invasive bladder cancer. MATERIALS AND METHODS We performed an institutional review board approved, multi-institutional, retrospective review of the records of patients treated with neoadjuvant chemotherapy followed by radical cystectomy for muscle invasive bladder cancer from 2008 to 2012. Pretreatment clinical variables were collected and patients were stratified by the presence of clinical carcinoma in situ on precystectomy transurethral bladder tumor resection specimens. Pathological outcomes, including the complete response rate (pT0N0Mx) after neoadjuvant chemotherapy, were compared between the 2 groups. Recurrence-free, cancer specific and overall survival was analyzed. RESULTS Of 189 patients who met study criteria 56 (29.6%) had concomitant carcinoma in situ. The condition was associated with a significant decrease in the pathological complete response rate (10.7% vs 26.3%, p = 0.02). This difference was significant on univariate and multivariable analysis (OR 0.34, 95% CI 0.13-0.85, p = 0.02 and OR 0.31, 95% CI 0.12-0.81, p = 0.02, respectively). Despite the decreased complete response rate clinical carcinoma in situ was not associated with a difference in recurrence-free, cancer specific or overall survival. Additionally, when down-staging to pathological carcinoma in situ only disease was considered a complete response, there was no significant change in recurrence-free, cancer specific or overall survival. CONCLUSIONS Concomitant carcinoma in situ is associated with a decrease in the complete response rate but this does not appear to impact the survival outcome.
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Affiliation(s)
| | | | | | - Katie Scott
- University of Kansas Medical Center, Kansas City, Kansas
| | | | | | | | - Eugene K Lee
- University of Kansas Medical Center, Kansas City, Kansas.
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