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Abd Elwahab KM, Desky EAE, Eldery MS, Mohammad FF, Seleem MM, El-Babouly IM. Apparent Diffusion Coefficient Value can Predict Poor Bacillus Calmette-Guérin Responders in T1HG/NMIBC: Prospective Cohort Study. Clin Genitourin Cancer 2021; 19:e248-e254. [PMID: 33839041 DOI: 10.1016/j.clgc.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Prediction of recurrence and progression and the choice of type of management are largely based on stage and grade; however, these prognostic features are limited in the prediction of clinical outcomes. The objective was to investigate the relation between the apparent diffusion coefficient (ADC) value and recurrence and progression of T1G3 of urothelial carcinoma after transurethral resection of the bladder tumor (TURBT) and Bacillus Calmette-Guérin instillation. MATERIALS AND METHODS This prospective study included 65 patients with single bladder mass T1G3 less than 3 cm without carcinoma in situ or lymphovascular invasion. Mean ADC values of the tumors were compared between patients with and without recurrence and progression following TURBT. The relation of ADC value and other factors were determined by univariate and multivariate analyses. The following tests were used to test differences for significance: difference and association of qualitative variable by χ2 test; differences between quantitative independent groups by t-test or Mann-Whitney U test; survival by Kaplan-Meier; Cox regression (or Cox proportional hazards model) was used to analyze the effect of several risk factors on time until event (recurrence and progression); correlation by Pearson or Spearman, and we calculated the most suitable cutoff and validity by receiver operating characteristic curve. RESULTS In relation to recurrence, smoking, nonpapillary shape and higher size, and lower ADC were significant predictors for recurrence. In relation to progression, female sex, nonpapillary shape, and lower ADC were significant predictors for progression. Multivariate analysis showed that ADC < 1.09 was the only significant independent predictors for recurrence. Also, it showed that ADC < 0.98 was the only significant independent predictors for progression. CONCLUSION Low ADC value group of T1G3 bladder cancer showed significant recurrence and progression than high ADC value group of T1G3 bladder cancer. ADC value in conjunction with other risk stratifications will have a promising role in stratifying patients with T1G3 who need to proceed to early radical cystectomy versus conservative treatment.
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Abdel-Rahman O. Bladder cancer mortality after a diagnosis of nonmuscle-invasive bladder carcinoma. Future Oncol 2019; 15:2267-2275. [PMID: 31237444 DOI: 10.2217/fon-2018-0861] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess mortality from bladder cancer following a diagnosis of nonmuscle-invasive bladder cancer. Materials & methods: This is a SEER registry-based study. The risk of death from bladder cancer was compared with that of the general population. Cox proportional model was performed to calculate the hazard ratio (HR) for death according to baseline characteristics. Results: The bladder cancer-specific mortality at 20 years was 11%; and it was higher for black patients compared with white patients (adjusted HR: 1.711 [95% CI: 1.564-1.872]; p < 0.0001); additionally, it was higher for patients older than 70 years old compared with younger patients (adjusted HR: 2.005 [95% CI: 1.916-2.099]; p < 0 .0001). The risk of bladder cancer mortality increased after diagnosis of a recurrent bladder cancer (both nonmuscle-invasive and muscle-invasive; adjusted HR: 6.97 [95% CI: 6.56-7.40]; p < 0 .0001). Conclusion: Important predictors for death from bladder cancer following a diagnosis of nonmuscle-invasive bladder cancer include older age at diagnosis and black race.
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Affiliation(s)
- Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo 11351, Egypt.,Department of Oncology, University of Calgary, Tom Baker Cancer Centre, Calgary T2N4N2, Alberta, Canada
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Expression of E-cadherin, β-catenin, and epithelial membrane antigen does not predict survival in patients with high-risk non-muscle-invasive bladder cancer. Cent Eur J Immunol 2018; 43:421-427. [PMID: 30799990 PMCID: PMC6384421 DOI: 10.5114/ceji.2018.79509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/23/2018] [Indexed: 11/17/2022] Open
Abstract
The aim of the study The aim of the study was to validate the value of E-cadherin and β-catenin expression and to test an alternative prognostic marker, epithelial membrane antigen (EMA). Material and methods Forty-nine consecutive patients with primary stage T1 non-muscle-invasive bladder cancer (NMIBC) were enrolled in this study. Tissue specimens were stained with the following mouse anti-human antibodies: anti-E-cadherin, anti-β-catenin, and anti-EMA. Reaction intensity within cancer cells was assessed according to the immunoreactive score (IRS). Finally, the association between the expression of selected proteins and patient survival was assessed. Results The mean follow-up was 34.8 months. Recurrence-free survival, progression-free survival, and overall survival (OS) were 47.5%, 72.5%, and 72.5%, respectively. Differences in the IRS for β-catenin and EMA were found clinically, but were not statistically significant in prediction of the risk of disease progression (p > 0.05). No difference in protein expression was observed regarding the risk of recurrence, OS, or cancer-specific mortality (p > 0.05). Stratification of patients based on the IRS into three groups (poor, moderate, and intensive reaction) failed to identify a prognostic marker among the tested proteins (p > 0.05). Conclusions Expression of E-cadherin, β-catenin, and EMA cannot reliably predict survival in patients with high-risk NMIBC. Further searches are needed to identify tissue markers of progression and recurrence in NMIBC.
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Palou-Redorta J, Solsona E, Angulo J, Fernández J, Madero R, Unda M, Martínez-Piñeiro J, Portillo J, Chantada V, Moyano J. Retrospective study of various conservative treatment options with bacille Calmette-Guérin in bladder urothelial carcinoma T1G3: Maintenance therapy. Actas Urol Esp 2016; 40:370-7. [PMID: 26922518 DOI: 10.1016/j.acuro.2015.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare various conservative treatment options for high-grade T1 nonmuscle-invasive bladder cancer (NMIBC). Bacille Calmette-Guérin (BCG) is the preferred intravesical treatment for high-grade T1 tumours; however, a number of experts still question the need for maintenance BCG. MATERIAL AND METHODS We retrospectively analysed data from 1039 patients with primary and recurrent T1G3 NMIBC. All patients underwent complete transurethral resection of the bladder tumour (TURBT), with muscle in the sample and multiple bladder biopsies. The patients were treated with the following: only one initial TURBT (n=108), re-TURBT (n=153), induction with 27mg of BCG (Connaught strain) (n=87), induction with 81mg of BCG (n=489) or induction with 81mg of BCG+maintenance (n=202). The time to first recurrence, progression (to T2 or greater or to metastatic disease) and specific mortality of the disease was assessed using the Kaplan-Meier survival function and were compared using the log-rank test and the Cox multivariate regression model of proportional risks. RESULTS The mean follow-up was 62±39 months. The risk of recurrence was significantly lower for the patients treated with maintenance therapy of 81mg of BCG than in the other treatment groups (P<.001). The risk of tumour progression was also significantly lower for the patients treated with maintenance BCG than for the patients treated only with one TURBT, re-TURBT and with induction therapy with 27mg of BCG (P=.0003). The specific disease mortality was significantly lower with BCG maintenance (9.4%) than with only one TURBT (27.8%; P=.003). CONCLUSIONS In the case of T1G3 NMIBC, a complete dose of BCG with maintenance is associated with better recurrence results than are other conservative treatment modalities. The results of progression and survival specific to the disease were also better with induction BCG, with or without maintenance.
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Steinberg RL, Thomas LJ, O'Donnell MA. Bacillus Calmette-Guérin (BCG) Treatment Failures in Non-Muscle Invasive Bladder Cancer: What Truly Constitutes Unresponsive Disease. Bladder Cancer 2015; 1:105-116. [PMID: 27376112 PMCID: PMC4927833 DOI: 10.3233/blc-150015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Bacillus Calmette-Guérin (BCG) remains the most effective intravesical therapy for non-muscle invasive bladder cancer but will fail in up to 40% of patients. The ability to identify patients who are least likely to respond to further BCG therapy allows urologists to pursue secondary treatments more likely to convey a recurrence or survival benefit to the patient. We examined the literature to determine what constitutes BCG unresponsive disease. After review, we believe that BCG unresponsive disease should be defined as (1) patients with recurrent high grade T1 disease within 6 months of their primary tumor after at least one course of BCG or patients who have failed at least 2 courses of BCG with either (2) persistent or recurrent pure papillary (Ta) disease within 6 months or (3) persistent or recurrent carcinoma in situ (CIS) within 12 months.
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Affiliation(s)
| | - Lewis J Thomas
- University of Iowa Department of Urology, Iowa City, IA, USA
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Kitamura H, Kakehi Y. Treatment and management of high-grade T1 bladder cancer: what should we do after second TUR? Jpn J Clin Oncol 2015; 45:315-22. [PMID: 25583419 DOI: 10.1093/jjco/hyu219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Most T1 bladder cancers are high grade and have the potential to progress to muscle invasion and extravesical dissemination. Many studies reported that ∼50% of patients displayed residual tumors when a second transurethral resection was performed 2-6 weeks after the initial resection for patients who were diagnosed with T1 bladder cancer. Furthermore, muscle-invasive disease was detected by the second transurethral resection in 10-25% of those patients. Therefore, a second transurethral resection is strongly recommended for patients newly diagnosed with high-grade T1 bladder cancer in various guidelines. T1 bladder cancers are heterogeneous in terms of progression and prognosis after the second transurethral resection. Optimal management and treatment should be considered for patients with T1 bladder cancer based on the pathological findings for the second transurethral resection specimen. If the second transurethral resection reveals residual tumors, aggressive treatments based on the pathological findings should be performed. Conversely, overtreatment with respect to the tumor status should be avoided. Since the evidence of pathological diagnosis at the second transurethral resection is insufficient and many retrospective studies were carried out before the second transurethral resection era, prospective randomized studies should be conducted.
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Affiliation(s)
- Hiroshi Kitamura
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo
| | - Yoshiyuki Kakehi
- Department of Urology, Kagawa University Faculty of Medicine, Kagawa, Japan
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Liu WH, Chen YY, Zhu SX, Li YN, Xu YP, Wu XJ, Guo YH, Wang JL. B7-H4 expression in bladder urothelial carcinoma and immune escape mechanisms. Oncol Lett 2014; 8:2527-2534. [PMID: 25364421 PMCID: PMC4214455 DOI: 10.3892/ol.2014.2522] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 07/23/2014] [Indexed: 11/16/2022] Open
Abstract
B7-H4 is a recently identified member of the B7 family considered to negatively regulate the immune response, and has been associated with the occurrence and development of certain types of tumor. However, little is known regarding the importance of human B7-H4 expression in bladder urothelial carcinoma. In the present study, B7-H4 expression in the tissues and sera of patients with bladder urothelial carcinoma was investigated, along with the clinical significance. In addition, the effects of activated T-lymphocyte in vitro cytotoxicity in the BIU-87 bladder cancer cell line following the blockade of the B7-H4 signaling pathway were also analyzed. The results showed that in normal bladder tissues, B7-H4 was not detected, but in the bladder urothelial carcinoma tissue samples, B7-H4 was detected in 24/49 (49.0%) specimens. Additionally, positive B7-H4 expression was significantly associated with increased TNM stage and pathological grade (P<0.05). Compared with the healthy control group, the serum-B7-H4 (sB7-H4) concentrations in the patients were also significantly increased (P<0.05). The sB7-H4 concentrations in cases with high-grade histology were significantly higher than those in patients with low-grade histology (P<0.05). Following the blockade of the B7-H4 antigen in BIU-87 cells, the cytotoxic activity of activated T cells against such BIU-87 cells was significantly enhanced compared with that against the control BIU-87 cells. This occurred in a T cell density-dependent and blocking antibody dose-dependent manner. These observations suggest that B7-H4 is involved in tumor occurrence, and the development and immune escape of bladder urothelial carcinoma cells. Therefore, B7-H4 may be an important target in the diagnosis and/or treatment of bladder urothelial carcinoma.
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Affiliation(s)
- Wei-Hui Liu
- Department of Urinary Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Ya-Yu Chen
- Department of Stomatology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Shao-Xing Zhu
- Department of Urinary Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Yi-Ning Li
- Department of Urinary Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Yi-Peng Xu
- Department of Urinary Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, P.R. China
| | - Xue-Jing Wu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian 350001, P.R. China
| | - Yi-Hong Guo
- Department of Urinary Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Jia-Liang Wang
- Department of Urinary Surgery, Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
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Sengiku A, Ito M, Miyazaki Y, Sawazaki H, Takahashi T, Ogura K. A Prospective Comparative Study of Intravesical Bacillus Calmette-Guérin Therapy with the Tokyo or Connaught Strain for Nonmuscle Invasive Bladder Cancer. J Urol 2013; 190:50-4. [DOI: 10.1016/j.juro.2013.01.084] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Atsushi Sengiku
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Masaaki Ito
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Yu Miyazaki
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Harutake Sawazaki
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Takeshi Takahashi
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
| | - Keiji Ogura
- Department of Urology, Japanese Red Cross Otsu Hospital, Otsu, Shiga, Japan
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Daneshmand S. Determining the Role of Cystectomy for High-grade T1 Urothelial Carcinoma. Urol Clin North Am 2013; 40:233-47. [DOI: 10.1016/j.ucl.2013.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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10
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Chen J, Yao Z, Qiu S, Chen L, Wang Y, Yang J, Li J. Comparing intra-arterial chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone: a randomised prospective pilot study for T1G3 bladder transitional cell carcinoma after bladder-preserving surgery. Cardiovasc Intervent Radiol 2013; 36:1521-1526. [PMID: 23511989 DOI: 10.1007/s00270-013-0594-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 01/30/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the efficacy of intra-arterial chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone for T1G3 bladder transitional cell carcinoma (BTCC) followed by bladder-preserving surgery. MATERIALS AND METHODS Sixty patients with T1G3 BTCC were randomly divided into two groups. After bladder-preserving surgery, 29 patients (age 30-80 years, 24 male and 5 female) received intra-arterial chemotherapy in combination with intravesical chemotherapy (group A), whereas 31 patients (age 29-83 years, 26 male and 5 female) were treated with intravesical chemotherapy alone (group B). Twenty-nine patients were treated with intra-arterial epirubicin (50 mg/m(2)) + cisplatin (60 mg/m(2)) chemotherapy 2-3 weeks after bladder-preserving surgery once every 4-6 weeks. All of the patients received the same intravesical chemotherapy: An immediate prophylactic was administered in the first 6 h. After that, therapy was administered one time per week for 8 weeks and then one time per month for 8 months. The instillation drug was epirubicin (50 mg/m(2)) and lasted for 30-40 min each time. The end points were tumour recurrence (stage Ta, T1), tumour progression (to T2 or greater), and disease-specific survival. During median follow-up of 22 months, the overall survival rate, tumour-specific death rate, recurrence rate, progression rate, time to first recurrence, and adverse reactions were compared between groups. RESULTS The recurrence rates were 10.3 % (3 of 29) in group A and 45.2 % (14 of 31) in group B, and the progression rates were 0 % (0 of 29) in group A and 22.6 % (7 of 31) in group B. There was a significant difference between the two groups regarding recurrence (p = 0.004) and progression rates (p = 0.011). Median times to first recurrence in the two groups were 15 and 6.5 months, respectively. The overall survival rates were 96.6 and 87.1 %, and the tumour-specific death rates were 0 % (0 of 29) and 13.5 % (4 of 31) in groups A and B, respectively. During the intra-arterial chemotherapy cycle, although more than 50 % patients experienced some toxicities, most were minor and reversible [grade 1-2 (46.7 %) vs. grade 1-2 (6.9 %)]. CONCLUSION These findings suggest that combining intra-arterial chemotherapy with intravesical chemotherapy could delay tumour recurrence and progression compared with intravesical chemotherapy alone and this type treatment is relatively safe.
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MESH Headings
- Administration, Intravesical
- Adult
- Aged
- Aged, 80 and over
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/therapeutic use
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/surgery
- Chemotherapy, Adjuvant/methods
- Cisplatin/administration & dosage
- Cisplatin/therapeutic use
- Disease Progression
- Drug Therapy, Combination/methods
- Epirubicin/administration & dosage
- Epirubicin/therapeutic use
- Female
- Follow-Up Studies
- Humans
- Infusions, Intra-Arterial/methods
- Male
- Middle Aged
- Neoplasm Recurrence, Local/prevention & control
- Organ Sparing Treatments
- Pilot Projects
- Prospective Studies
- Survival Analysis
- Treatment Outcome
- Urinary Bladder/surgery
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/surgery
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Affiliation(s)
- Junxing Chen
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Zhijun Yao
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Shaopeng Qiu
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Lingwu Chen
- Department of Urology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yu Wang
- Department of Interventional Oncology, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jianyong Yang
- Department of Interventional Oncology, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China
| | - Jiaping Li
- Department of Interventional Oncology, First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080, Guangdong, China.
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Branchereau J, Larue S, Vayleux B, Karam G, Bouchot O, Rigaud J. Prognostic value of the lymphovascular invasion in high-grade stage pT1 bladder cancer. Clin Genitourin Cancer 2012; 11:182-8. [PMID: 23276589 DOI: 10.1016/j.clgc.2012.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 01/27/2023]
Abstract
PURPOSE High-grade (HG) stage pT1 bladder cancers have the highest recurrence and progression rates of all non-muscle-invasive bladder cancers. Some prognostic factors for recurrence and progression have been identified: multifocal HG pT1, concomitant carcinome in situ, tumor diameter >3 cm, infiltration of the deep lamina propria, and persistence of pT1 tumor on a second transurethral resection of the bladder. The objective of this study was to determine whether the presence of lymphovascular invasion (LVI) is also a prognostic factor that must be taken into account. MATERIALS AND METHODS This retrospective study was performed with 108 patients with HG stage pT1 bladder cancer: 89 patients were treated conservatively (transurethral resection of the bladder plus bacille Calmette-Guérin therapy), and 19 patients underwent early cystectomy. The mean (SD) follow-up was 47.8 ± 41.2 months. Classic prognostic factors and LVI were analyzed in terms of overall survival, specific survival, recurrence-free survival, and progression-free survival. RESULTS Thirty-six percent of patients had LVI on the chips of the first transurethral resection of the bladder. Five-year overall survival and specific survival were 40% and 75%, respectively. Multivariate analysis of risk factors showed a significant reduction of overall survival in the presence of LVI (P = .007). The presence of LVI was also a factor of poor prognosis in the case of delayed cystectomy (P = .010) but not in the case of early cystectomy. CONCLUSIONS Identification of LVI on the first resection of a HG stage pT1 bladder cancer is a significant prognostic factor for overall survival.
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Okamura T, Ando R, Akita H, Hashimoto Y, Iwase Y, Naiki T, Kawai N, Tozawa K, Kohri K. Are there Time-period-related Differences in the Prophylactic Effects of Bacille Calmette-Guérin Intravesical Instillation Therapy in Japan? Asian Pac J Cancer Prev 2012; 13:4357-61. [DOI: 10.7314/apjcp.2012.13.9.4357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Moskovitz B, Halachmi S, Moskovitz M, Nativ O, Nativ O. 10-year single-center experience of combined intravesical chemohyperthermia for nonmuscle invasive bladder cancer. Future Oncol 2012; 8:1041-9. [DOI: 10.2217/fon.12.90] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Owing to the limited efficacy and significant toxicity of most topical intravesical agents for the management of nonmuscle invasive bladder cancer (NMIBC), a search for new therapeutic modalities continues. This study evaluates the safety and efficacy of a relatively new modality, combined intravesical chemotherapy and hyperthermia, using the intravesical chemohyperthermia system. Methods: The data summarize our 10 years of experience in the Department of Urology at Bnai Zion Medical Center, Israel. Ninety two patients with NMIBC (88 evaluable) were treated according to the adjuvant (66 patients) and the neoadjuvant (26 patients) protocols, with up to 7 years follow-up. Results: Over the follow-up period, 56 out of 64 patients (72%) treated according to the adjuvant protocol remained free from recurrences. The progression rate was 4.7% (three out of 64 patients). An initial complete response was documented in 19 out of 24 patients (79%) treated according to the neoadjuvant protocol. During the follow-up period, 16 out of these 19 patients (84%) remained free from recurrences. All of the recurrences in this group had stage Ta grade 1 tumors. Conclusion: Microwave-induced chemohyperthermia is a safe and effective treatment option for patients with NMIBC, both in the adjuvant and neoadjuvant settings. The use of this treatment modality did not expose the patients to an increased risk of progression.
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Affiliation(s)
- Boaz Moskovitz
- The Department of Urology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel
- The Faculty of Medicine, Technion Israeli Institute of Technology, 47 Golomb St, Haifa 31048, Israel
| | - Sarel Halachmi
- The Department of Urology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel
| | - Michal Moskovitz
- The Department of Urology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel
| | - Omri Nativ
- The Department of Urology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel
| | - Ofer Nativ
- The Department of Urology, Bnai Zion Medical Center, 47 Golomb St, Haifa 31048, Israel
- The Faculty of Medicine, Technion Israeli Institute of Technology, 47 Golomb St, Haifa 31048, Israel
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14
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Nguyen-Huu Y, Delorme G, Lillaz J, Bedgedjian I, Le Ray-Ferrières I, Chabannes E, Bernardini S, Guichard G, Bittard H, Kleinclauss F. Atteinte de la Muscularis Mucosae dans les tumeurs urothéliales T1 de vessie : facteur pronostique de progression après immunothérapie par BCG. Prog Urol 2012; 22:284-90. [DOI: 10.1016/j.purol.2011.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 09/30/2011] [Accepted: 10/05/2011] [Indexed: 01/17/2023]
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15
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Should Follow-up Cystoscopy in Bacillus Calmette-Guérin–Treated Patients Continue After Five Tumour-Free Years? Eur Urol 2012; 61:503-7. [DOI: 10.1016/j.eururo.2011.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 11/07/2011] [Indexed: 11/23/2022]
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16
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Single monthly bacillus Calmette-Guérin intravesical instillation is effective maintenance therapy to prevent recurrence in Japanese patients with non-muscle-invasive bladder cancer. Int J Clin Oncol 2011; 17:477-81. [PMID: 21947596 DOI: 10.1007/s10147-011-0314-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2011] [Accepted: 08/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND A series of bacillus Calmette-Guérin (BCG) bladder instillations is the gold standard therapy to prevent recurrence after transurethral resection of bladder tumor (TUR-Bt) of non-muscle-invasive bladder cancer (NMIBC). However, in some cases the outcome is not optimal with the standard 6- to 8-week protocol and therefore interest has focused on additional maintenance therapy. The present study was conducted to assess the utility of single monthly intravesical instillation treatments for up to 1 year in Japanese patients. METHODS A total of 75 stage Ta and T1 patients who had undergone TUR-Bt were retrospectively evaluated, all first receiving 80 mg BCG (Tokyo 172 strain) given once a week, 6-8 times, for primary prophylaxis. Comparison was then made of groups with (group A, 48 patients) and without (group B, 27 patients) additional maintenance BCG therapy given once a month 6-8 times. RESULTS Recurrence-free survival rates at 5 years in groups A and B were 83.0 and 51.9% (P = 0.006), despite the greater proportion of T1 patients and the longer follow-up period in the group A patients. Significant protection against recurrence persisted on multivariate analysis with adjustment for age, stage, grade, and tumor number. CONCLUSIONS These findings indicate maintenance BCG therapy of single intravesical instillations given once a month with our protocol to be definitely effective for prophylactic use, especially in stage Ta patients. Further evaluation of parameters such as the continuance period and dose protocol is warranted.
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Long-term Cancer-specific Survival in Patients with High-risk, Non–muscle-invasive Bladder Cancer and Tumour Progression: A Systematic Review. Eur Urol 2011; 60:493-500. [DOI: 10.1016/j.eururo.2011.05.045] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/23/2011] [Indexed: 11/20/2022]
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Leliveld AM, Bastiaannet E, Doornweerd BH, Schaapveld M, Jong IJD. High risk bladder cancer: current management and survival. Int Braz J Urol 2011; 37:203-10; discussion 210-2. [DOI: 10.1590/s1677-55382011000200007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2010] [Indexed: 11/21/2022] Open
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Long-term outcomes of intravesical therapy for non-muscle invasive bladder cancer. World J Urol 2010; 29:59-71. [DOI: 10.1007/s00345-010-0617-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 11/09/2010] [Indexed: 11/26/2022] Open
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Okajima E, Fujimoto H, Mizutani Y, Kikuchi E, Koga H, Hinotsu S, Shinohara N, Miki T. Cancer death from non-muscle invasive bladder cancer: Report of the Japanese Urological Association of data from the 1999-2001 registry in Japan. Int J Urol 2010; 17:905-12. [DOI: 10.1111/j.1442-2042.2010.02633.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gschwend JE, Retz M, Kuebler H, Autenrieth M. Indications and Oncologic Outcome of Radical Cystectomy for Urothelial Bladder Cancer†. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.eursup.2010.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kulkarni GS, Hakenberg OW, Gschwend JE, Thalmann G, Kassouf W, Kamat A, Zlotta A. An Updated Critical Analysis of the Treatment Strategy for Newly Diagnosed High-grade T1 (Previously T1G3) Bladder Cancer. Eur Urol 2010; 57:60-70. [DOI: 10.1016/j.eururo.2009.08.024] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 08/26/2009] [Indexed: 11/16/2022]
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Halachmi S, Moskovitz B, Maffezzini M, Conti G, Verweij F, Kedar D, Sandri SD, Nativ O, Colombo R. Intravesical mitomycin C combined with hyperthermia for patients with T1G3 transitional cell carcinoma of the bladder. Urol Oncol 2009; 29:259-64. [PMID: 19395285 DOI: 10.1016/j.urolonc.2009.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 02/23/2009] [Accepted: 02/25/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Non-muscle invasive bladder cancer (NMIBC) classified as T1G3 represents one of the most challenging issues in urologic oncology. Although it is still considered a lesion amenable for conservative management, the risk for recurrence and progression remains high. The aim of this study was to define both recurrence and progression rate in patients with T1G3 UCC treated by complete transurethral resection (TURT) and adjuvant thermochemotherapy approach. MATERIALS AND METHODS We retrospectively evaluated the clinical data of patients with T1G3 NMIBC who underwent TURT followed by thermochemotherapy (TCT) treatment. Data recorded included age, gender, previous resections, previous intravesical treatment, time to tumor recurrence, and progression. TCT was given once weekly for 6 consecutive weeks, followed by 6 maintenance sessions at 4 to 6 weeks intervals. During each treatment session, 40 mg of mitomycin C (MMC) was instilled into the bladder in combination with bladder wall hyperthermia of 42 ± 2 °C for 60 minutes. Follow-up cystoscopy and urinary cytology were performed every 3 months for the first 2 years and than biannually. RESULTS A total of 56 T1G3 patients were treated with adjuvant TCT treatment at 7 urologic centers. Mean age was 68 years (range 35-91), 10 were females and 46 were males. Twenty-six patients failed on at least 1 previous intravesical treatment. Five patients who dropped out due to adverse events before reaching the first outcome evaluation cystoscopy were referred to another intravesical therapy, and were therefore excluded from the current analysis. A total 51 patients were available for analysis. Median follow-up time of tumor-free patients was 18 months (average 20, range 2-49 months). Seventeen patients (33.3%) had tumor recurrence and 4 of them progressed to muscle invasive disease. The median time to recurrence was 9 months (average 11, range 2-31 months). The Kaplan-Meier estimated recurrence rate for this group is: 42.9% at 2 years, 51.0% at 4 years. CONCLUSIONS TCT can be an effective adjuvant treatment option after TURT to prevent recurrence in patients with T1G3 NMIBC. Progression rate after this treatment was low (7.9%). TCT treatment was documented to be effective also in those who failed previous intravesical BCG. Treatment was confirmed to be safe and well tolerated.
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Affiliation(s)
- Sarel Halachmi
- Bnai Zion Medical Center and the Faculty of Medicine, Technion Israeli Institute of Technology, Haifa, Israel.
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Karl A, Tritschler S, Stanislaus P, Gratzke C, Tilki D, Strittmatter F, Knüchel R, Stief CG, Zaak D. Positive urine cytology but negative white-light cystoscopy: an indication for fluorescence cystoscopy? BJU Int 2009; 103:484-7. [DOI: 10.1111/j.1464-410x.2008.08032.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Okamura T, Akita H, Imura M, Kaneko T, Mizuno K, Tozawa K, Kohri K. Efficacy of bacillus Calmette-Guérin in the treatment of superficial bladder cancer: The impact of previous intravesical treatment. Int J Urol 2008; 15:976-80. [DOI: 10.1111/j.1442-2042.2008.02146.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The Clinical Management of “Superficial” (≤pT1/cT1) Micropapillary Carcinoma of the Urinary Bladder: Are Times Changing? Adv Anat Pathol 2007. [DOI: 10.1097/pap.0b013e318159474d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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