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Robotic cystectomy histopathology outcomes in patients who have ‘failed’ Bacillus Calmette–Guérin: A case series. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415820977993] [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: Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time. Methods: A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B). Results: A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases. Conclusion: RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients. Level of evidence: Level 4.
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CD47-targeted optical molecular imaging and near-infrared photoimmunotherapy in the detection and treatment of bladder cancer. Mol Ther Oncolytics 2022; 24:319-330. [PMID: 35118190 PMCID: PMC8784304 DOI: 10.1016/j.omto.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/28/2021] [Indexed: 12/03/2022] Open
Abstract
Transurethral resection of bladder tumor (TURBT) followed by intravesical therapy remains the most effective strategy for the management of non-muscle-invasive bladder cancer worldwide. TURBT has two purposes: to remove all visible tumors and to obtain tumor specimens for histopathological analysis. However, the detection of flat and small malignant lesions under white-light cystoscopy is extremely challenging, and residual lesions are still the main reason for the high recurrence rate of bladder cancer. We hypothesized that visual enhancement of malignant lesions using targeted optical molecular imaging could potentially highlight residual tumors in the bladder during surgery, and near-infrared photoimmunotherapy (NIR-PIT) could kill exfoliated cancer cells and residual tumors. A mouse model of complete or partial bladder tumor resection was established under the guidance of optical molecular imaging mediated by indocyanine green and anti-CD47-Alexa Fluor 790, respectively. Once the tumor recurred, mouse model received repeated CD47-targeted NIR-PIT. After complete resection, there was no tumor recurrence. Furthermore, the growth rate of recurrent tumor decreased significantly after repeated NIR-PIT. Therefore, CD47-targeted optical molecular imaging can potentially assist urologists to detect and remove all tumors, and repeated NIR-PIT shows the potential to reduce tumor recurrence rates and inhibit the growth of recurrent tumor.
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Shorter Leukocyte Telomere Length Is Associated with Worse Survival of Patients with Bladder Cancer and Renal Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13153774. [PMID: 34359672 PMCID: PMC8345040 DOI: 10.3390/cancers13153774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary Intrinsic telomere shortening promotes tumorigenesis in cells with impaired DNA damage repair mechanisms, as dysfunctional telomeres lead to chromosomal instability. More recent data show that the telomere length of peripheral blood leukocyte (PBL) cells can be a prognostic marker for survival of patients with solid tumors. However, reports on bladder cancer (BC) and renal cell carcinoma (RCC) are not consistent and partly contradictory. Our results show, first, that telomere length is shorter in patients with BC or RCC compared to patients without malignant disease. More importantly, the relative telomere length (RTL) of PBL cells is associated with survival of patients with BC and RCC. Thus, telomere length in PBL cells could be an auxiliary prognostic marker in BC and RCC. Abstract Background: Telomeres are protein–DNA complexes at the tips of linear chromosomes. They protect the DNA from end-to-end fusion and exonucleolytic degradation. Shortening of telomeric DNA during aging can generate dysfunctional telomeres, promoting tumorigenesis. More recent data indicate that both short and long telomeres of peripheral blood leukocyte (PBL) cells can serve as prognostic biomarkers for cancer risk and may be associated with survival of patients with solid cancers. Telomere length in PBL cells could also be a potential prognostic biomarker for survival in bladder cancer (BC) or renal cell carcinoma (RCC). Methods: The relative telomere length (RTL) of PBL cells was assessed in patients with BC (n = 144) and RCC (n = 144) by using qPCR. A control population of patients without malignant disease (NC, n = 73) was included for comparison. The correlation and association of RTL with histopathological parameters and overall survival (OS) were evaluated. Results: Patients with BC and RCC had significantly shorter telomeres compared to patients without malignant disease. Within the cancer cohorts, multivariate analysis revealed that short RTL is an independent predictor of worse survival in BC (p = 0.039) and RCC (p = 0.041). Conclusion: Patients with BC and RCC had significantly shorter telomeres compared to the normal population. Shorter RTL in BC and RCC was an independent predictor of reduced survival.
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Iqbal U, Elsayed AS, Jing Z, Stoeckle M, Wijburg C, Wiklund P, Hosseini A, Dasgupta P, Khan MS, Hemal A, Kim EH, Wagner AA, Gaboardi F, Rha KH, Maatman T, Balbay D, Li Q, Hussein A, Guru KA. Upstaging and Survival Outcomes for Non-Muscle Invasive Bladder Cancer After Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Endourol 2021; 35:1541-1547. [PMID: 34139890 DOI: 10.1089/end.2021.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We sought to describe the incidence, risk factors, and survival outcomes associated with pathological upstaging from non-muscle invasive bladder cancer (NMIBC) to muscle invasive bladder cancer (MIBC) after robot-assisted radical cystectomy (RARC). METHODS We reviewed the International Robotic Cystectomy Consortium database between 2004 and 2020. Upstaging was defined as ≥pT2 or pN+ at final pathology from clinical <T2N0M0. Descriptive statistics were used to summarize data. Cochran-Armitage test was used to depict upstaging trend over time. Multivariate regression models were used to depict variables associated with upstaging. Kaplan Meier curves were used to describe disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). RESULTS 463 patients underwent RARC for NMIBC. Upstaging occurred in 145 (31%) patients. Upstaged patients were older (70 vs 67 years, p <0.01), more likely to have American Society of Anesthesiologists score (≥3) (55% vs 44%, p=0.04) and had higher rate of preoperative hydronephrosis (26% vs 10%, p <0.01). They were more likely to have positive surgical margins (10% vs 3%, p= 0.01), recurrences (28% vs 9%, p<0.01), and to receive adjuvant/salvage treatment (26% vs none, p <0.01). On multivariate analysis, upstaging was associated with older age (OR 1.04; CI 1.01-1.07, p<0.01), cT1 vs cTis (OR 4.25; CI 1.57-11.48, p <0.01), cT1 vs cTa (OR 2.92; CI 1.40-6.06, p<0.01), and preoperative hydronephrosis (OR 3.18; CI 1.60-6.32, p<0.01). Upstaged patients had worse 5-year RFS (53 % vs 85%, log rank p<0.01), DSS (66% vs 93%, log rank p<0.01), and OS (49% vs 74%, log rank p<0.01). The rate of upstaging did not significantly change over time (38% in 2004 to 27% in 2019, p=0.17). CONCLUSION Upstaging to MIBC occurred in a significant proportion of patients after RARC for NMIBC and was associated with worse survival outcomes. Older patients, those with cT1 disease and hydronephrosis were more likely to upstage.
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Affiliation(s)
- Umar Iqbal
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Ahmed S Elsayed
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States.,Cairo University Kasr Alainy Faculty of Medicine, 63527, Cairo, United States;
| | - Zhe Jing
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | - Michael Stoeckle
- Universitat des Saarlandes, 9379, Urologie, Saarbrucken, Germany;
| | | | | | - Abolfazl Hosseini
- Karolinska Institutet, Urology, 171 76 Stockholm, Stockholm, Sweden, 171 76 Stockhol;
| | - Prokar Dasgupta
- King's College London, 4616, MRC Centre for Transplantation, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT.,Guy's and St Thomas' NHS Trust, Department of Urology, Guy's Hospital, London, United Kingdom of Great Britain and Northern Ireland, SE19RT;
| | | | - Ashok Hemal
- Wake Foresty University Baptist Medical Center, Urology, Medical Center Blvd, Winston-Salem, North Carolina, United States, 27157.,United States;
| | - Eric H Kim
- Washington University School of Medicine, Urology, 4960 Children's Place, Box 8242, St. Louis, Missouri, United States, 63110;
| | - Andrew A Wagner
- Beth Israel Deaconess Medical Center and Harvard Medical School, Urology, 330 Brookline Ave., Boston, Massachusetts, United States, 02215;
| | | | - Koon Ho Rha
- Severance Hospital, Yonsei University, Urology, Yonseiro 50-1, Seodaemun-gu, Seoul, Korea, Seoul, Korea (the Republic of);
| | - Thomas Maatman
- Metro Health: University of Michigan Health, Urological Surgery, Wyoming, Michigan, United States;
| | | | - Qiang Li
- Roswell Park Cancer Insitute, Urologic Oncology, Buffalo, New York, United States;
| | | | - Khurshid A Guru
- Roswell Park Cancer Insitute, Urologic Oncology, Elm and Carlton Streets, Buffalo, New York, United States, 14263.,Roswell Park Cancer Institute, Urologic Oncology, Elm and Carlton Streets, Buffalo, United States, 14263;
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Calò B, Sanguedolce F, Falagario UG, Chirico M, Fortunato F, Carvalho-Diaz E, Busetto GM, Bettocchi C, Carrieri G, Cormio L. Assessing treatment response after intravesical bacillus Calmette-Guerin induction cycle: are routine bladder biopsies necessary? World J Urol 2021; 39:3815-3821. [PMID: 33830306 PMCID: PMC8519823 DOI: 10.1007/s00345-021-03690-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/27/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine the need for routine bladder biopsies (BBs) in assessing response to the induction cycle of intravesical bacillus Calmette-Guérin (BCG) for high-risk non-muscle-invasive bladder cancer (NMIBC). METHODS Our prospectively maintained NMIBC database was queried to identify patients with high-risk disease (carcinoma in situ, high-grade Ta/T1) who underwent BBs after BCG induction cycle. Urine cytology, cystoscopy, and BBs findings were evaluated. RESULTS A total of 219 patients met the inclusion criteria. Urine cytology was positive in 20 patients and negative in 199; cystoscopy was positive in 35 patients, suspicious in 32 and normal in 152 patients. BBs yielded bladder cancer (BCa) in 43 (19.6%) patients, with a BCa rate of 9.3% in patients with negative cytology and cystoscopy as opposed to 38.0% in patients whereby one or both exams were suspicious/positive. The diagnostic accuracy of urine cytology, cystoscopy, and combined tests was 0.56, 0.70, and 0.71, respectively. The negative predictive value of combined tests was 90.7%. Performing BBs only in patients with positive cytology and/or positive/suspicious cystoscopy would have spared 140 (64%) patients to undergo this procedure while missing BCa in 13 (9.3%) of them, representing 30% of all BCa cases. CONCLUSION Performing BBs only in patients with positive cytology and suspicious/positive cystoscopy would spare 64% of un-necessary BBs but miss a non-negligible number of BCas. While no data are available regarding the potential consequences of missing such BCas, such information should be taken into account in patient's counselling.
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Affiliation(s)
- Beppe Calò
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy ,Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy
| | | | - Ugo G. Falagario
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy
| | - Marco Chirico
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy
| | | | - Emanuel Carvalho-Diaz
- Department of CUF Urology and Service of Urology, Hospital of Braga, Braga, Portugal
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy
| | - Carlo Bettocchi
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia—Ospedali Riuniti of Foggia, Foggia, Italy ,Department of Urology, Bonomo Teaching Hospital, Andria (BAT), Italy
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Cornelissen SWE, Veenboer PW, Wessels FJ, Meijer RP. Diagnostic Accuracy of Multiparametric MRI for Local Staging of Bladder Cancer: A Systematic Review and Meta-Analysis. Urology 2020; 145:22-29. [PMID: 32721515 DOI: 10.1016/j.urology.2020.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 01/10/2023]
Abstract
To evaluate diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) for local staging of urothelial bladder carcinoma (UBC), a systematic review was performed. Of 2369 records, 20 studies met the inclusion criteria (n=1724). We found a pooled sensitivity and specificity for differentiating between stages ≤T1 and ≥T2 of 0.92 (95% CI 0.88-0.95) and 0.88 (95% CI 0.78-0.94). mpMRI shows high sensitivity and specificity for the differentiation between non-muscle invasive and muscle invasive bladder cancer, but does not appear to be useful for staging per T-stage. It can be used for confirmation when muscle invasive disease is suspected at initial diagnosis.
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Affiliation(s)
| | - Paul W Veenboer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank J Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Unanswered Questions for Bladder Tumours Unresponsive to Bacillus Calmette-Guérin. Eur Urol Oncol 2020; 3:341-342. [DOI: 10.1016/j.euo.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022]
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Yang Y, Yang X, Liu C, Li J. Preliminary study on the application of en bloc resection combined with near-infrared molecular imaging technique in the diagnosis and treatment of bladder cancer. World J Urol 2020; 38:3169-3176. [PMID: 32130476 DOI: 10.1007/s00345-020-03143-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 02/19/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND To evaluate the surgical safety of en bloc resection of bladder tumor (ERBT) and the effectiveness of ERBT combined with near-infrared (NIR) imaging technique in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). METHODS From October 2017 to June 2018, 26 patients newly diagnosed with single NMIBC were included in this retrospectively trial. All patients received ERBT with monopolar current. After surgery, the fresh specimen was incubated with anti-CD47-Alexa Fluor 790, and then imaged under NIR imaging technique. Operative details, intraoperative and postoperative complications of ERBT regarded as safety outcomes, the mean fluorescence intensity (MFI) of tumor tissue and adjacent normal background tissue, and 12 months follow-up data were analyzed. RESULTS Of 26 collected patients, obturator nerve reflex was occurred in six patients during tumor resection, and only one patient was observed with bladder perforation. In NIR gray image, the gray scale of MFI of tumor tissue were 132.31 ± 6.67 and the adjacent normal background tissue were 52.27 ± 12.09. The result showed a significantly higher MFI signals in tumor tissue compared to adjacent normal background tissue (P < 0.001). The recurrence-free survival rate at 12 month was 96.15%. CONCLUSIONS ERBT with monopolar current is a safe and feasible technique to treat patients with NMIBC. A integrated bladder tumor tissue-bound anti-CD47-Alexa Fluor 790 was detected under NIR light, and the NIR image indicates that higher MFI signals in surgical margin is a predictive factor for residual tumor in patients with NMIBC after ERBT.
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Affiliation(s)
- Yongjun Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xiaofeng Yang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China.
| | - Chao Liu
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jiawei Li
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
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The Role and Importance of Timely Radical Cystectomy for High-Risk Non-muscle-Invasive Bladder Cancer. Cancer Treat Res 2019; 175:193-214. [PMID: 30168123 DOI: 10.1007/978-3-319-93339-9_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Non-muscle-invasive bladder cancer accounts for the majority of incident bladder cancers but is a heterogeneous disease with variation in clinical presentation, course, and outcomes. Risk stratification techniques have attempted to identify those at highest risk of cancer recurrence and progression to help personalize and individualize treatment options. Radical cystectomy during the optimal window of curability could improve cancer outcomes; however, identifying the disease and patient characteristics as well as the correct timing to intervene remains difficult. We review the natural history of non-muscle-invasive bladder cancer, discuss different risk-stratification techniques and how they can help identify those most likely to benefit from radical treatment, and examine the evidence supporting the benefit of timely cystectomy.
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Clinical significance of urothelial carcinoma ambiguous for muscularis propria invasion on initial transurethral resection of bladder tumor. World J Urol 2019; 38:389-395. [PMID: 31030230 DOI: 10.1007/s00345-019-02782-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 04/22/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the clinical significance of invasive urothelial carcinoma that is ambiguous for muscularis propria invasion on initial transurethral resection of bladder tumor (TURBT). METHODS All consecutive in-house TURBTs with invasive urothelial carcinoma from 1999 to 2017 that underwent radical cystectomy (RC) were grouped as follows: invasion of the lamina propria (INLP; n = 102; 24%), invasion of muscularis propria (INMP; n = 296; 69%) and ambiguous for muscularis propria invasion (AMP; n = 30; 7%). AMP was defined as extensive invasive carcinoma displaying thin muscle bundles where it is difficult to determine with certainty if those muscle bundles represent muscularis mucosae or muscularis propria (detrusor). Cases with any amount of small cell carcinoma or prior therapy were excluded. RESULTS The average age was 66 years in INLP, 67 years in INMP, and 65 years in AMP. RC showed invasive carcinoma stage pT2 or above in 50/102 (49%) of INLP vs. 255/296 (86%) of INMP (P ≤ 001) vs. 25/30 (83.33%) of AMP (P = 0.002). Lymph nodes showed metastatic carcinoma in 18/98 (18.36%) of INLP vs. 96/272 (35.29%) of INMP (P = 0.002), and 6/25 (24%) in AMP (P = 0.729). The average follow-up was 48 months (range 0-192). Survival of AMP patients was similar to INLP and both were significantly better than INMP (P = 0.002 and P = 0.016). CONCLUSION The great majority of patients with AMP on initial TURBT have advanced disease on RC and emphasizes the need for early repeat TURBT or even consideration of early cystectomy to lower the risk of worse pathological findings and to prolong survival.
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Klaassen Z, Kamat AM, Kassouf W, Gontero P, Villavicencio H, Bellmunt J, van Rhijn BW, Hartmann A, Catto JW, Kulkarni GS. Treatment Strategy for Newly Diagnosed T1 High-grade Bladder Urothelial Carcinoma: New Insights and Updated Recommendations. Eur Urol 2018; 74:597-608. [DOI: 10.1016/j.eururo.2018.06.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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Kim JK, Jeong CW, Kwak C, Kim HH, Ku JH. Progression to T1 High Grade (T1HG) from a Lower Stage/Grade is Associated with Poorer Survival Outcomes than Initial Diagnosis with T1HG Bladder Cancer. Ann Surg Oncol 2017; 24:2413-2419. [PMID: 28560602 DOI: 10.1245/s10434-017-5902-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Several studies have documented a poor prognosis in those patients who were initially diagnosed with non-muscle-invasive bladder cancer (NMBIC) and progressed to muscle-invasive bladder cancer (MIBC) compared with those who initially presented with MIBC. However, studies regarding this issue have not yet been performed in patients with T1 high-grade (T1HG) tumor. We aimed to compare survival outcomes between patients diagnosed as T1HG after initial transurethral resection of the bladder tumor (TUR-BT) and patients who presented with lower stage and/or grade but progressed to T1HG at the time of tumor recurrence. METHODS The study comprised 499 patients who had a diagnosis of T1HG after initial TUR-BT (initial T1HG group) and 62 patients who progressed to T1HG after TUR-BT at the time of tumor recurrence (progressed T1HG group). Progression was defined as recurrence to a higher grade and/or stage than the previous result, while MIBC progression was defined as progression to stage T2 or higher and/or N+, and/or M1. RESULTS The median overall survival (OS) and cancer-specific survival (CSS) durations were 38.0 and 29.0 months, respectively. Kaplan-Meier curve analysis showed significantly decreased 5-year OS (74.4 vs. 57.4%), CSS (86.4 vs. 72.8%), and MIBC progression-free survival (82.6 vs. 62.2%) in the progressed T1HG group. Multivariate analysis revealed that progressed T1HG was a significant predictor of OS, CSS, and MIBC progression (all, p < 0.05). CONCLUSIONS The progressed T1HG group showed poorer survival outcomes compared with the initial T1HG group. Consequently, in patients who progress to T1HG, intensive surveillance and treatment strategies should be considered.
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Affiliation(s)
- Jung Kwon Kim
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of the National Cancer Center, Goyang, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea.
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Gershman B, Boorjian SA, Hautmann RE. Management of T1 Urothelial Carcinoma of the Bladder: What Do We Know and What Do We Need To Know? Bladder Cancer 2015; 2:1-14. [PMID: 27376120 PMCID: PMC4927848 DOI: 10.3233/blc-150022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
T1 bladder cancer constitutes approximately 25% of incident bladder cancers, and as such carries an important public health impact. Notably, it has a heterogeneous natural history, with large variation in reported oncologic outcomes. Optimal risk-stratification is essential to individualize patient management, targeting those at greatest risk of progression for aggressive therapies such as early cystectomy, while allowing others to safely pursue bladder-preserving approaches including intravesical bacillus Calmette-Guerrin (BCG). Current strategies for diagnosis, risk-stratification, and treatment are imperfect, but emerging technologies and molecular approaches represent exciting opportunities to advance clinical paradigms in management of this disease entity.
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Qin X, Zhang H, Wan F, Zhu Y, Shen Y, Dai B, Shi G, Zhu Y, Ye D. Retrograde radical cystectomy and consequent peritoneal cavity reconstruction benefits localized male bladder cancer: results from a cohort study. World J Surg Oncol 2015; 13:132. [PMID: 25886313 PMCID: PMC4382937 DOI: 10.1186/s12957-015-0561-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/23/2015] [Indexed: 01/28/2023] Open
Abstract
Background Bladder cancer is the second most common genitourinary malignancy. Our study was to introduce a standardized surgical procedure of retrograde radical cystectomy and consequent peritoneal cavity reconstruction in localized male bladder cancer. Methods Eighty-four consecutive male patients with localized bladder cancer (clinical stage T2 or lower) underwent surgery in our institute with the proposed procedure between May 2012 and April 2013. Median age was 65 years (range, 35 to 83 years); patient characteristics, surgical parameters, perioperative complications, pathology, and short-term prognosis were analyzed. Median follow-up was 24 months (range, 18 to 30 months). Results The complete procedure including urinary diversion took 4.0 h (2.2 to 5.0 h), with a median exposed peritoneal cavity of 45 min (0 to 75 min); the median blood loss was 140 ml (50 to 600 ml), and 2 patients needed transfusion; neurovascular bundles were reserved in 76 cases; the median abdominal and pelvic drainage was 9.0 days (6 to 15 days), the median gastrointestinal recovery was 2.5 days (1 to 12 days), and the median postoperative hospital stay was 13.0 days (10 to 21 days). Four patients had severe surgical complications, and two had mild to moderate ileus, with recovery in 1 and 2 weeks with supportive treatment. No perioperative deaths or postoperative recurrence were reported. Conclusions The surgical procedure in male localized bladder cancer described in the present study provided surgical facilities, with limited abdominal organ disturbance and satisfactory tumor control. The procedure was associated with good gastrointestinal recovery, few postoperative complications, and a short hospital stay.
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Affiliation(s)
- Xiaojian Qin
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Hailiang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Fangning Wan
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Yiping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Guohai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Yao Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong' an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong' an Road, Shanghai, 200032, China.
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15
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Nishiyama N, Kitamura H, Hotta H, Takahashi A, Yanase M, Itoh N, Tachiki H, Miyao N, Matsukawa M, Kunishima Y, Taguchi K, Masumori N. Construction of predictive models for cancer-specific survival of patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: results from a multicenter retrospective study. Jpn J Clin Oncol 2014; 44:1101-8. [PMID: 25139163 DOI: 10.1093/jjco/hyu119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aims of this study were to clarify the prognostic factors and to validate the bacillus Calmette-Guérin failure classification advocated by Nieder et al. in patients with non-muscle-invasive bladder cancer who had intravesical recurrence after bacillus Calmette-Guérin therapy. METHODS Data from 402 patients who received intravesical bacillus Calmette-Guérin therapy between January 1990 and November 2011 were collected from 10 institutes. Among these patients, 187 with bacillus Calmette-Guérin failure were analyzed for this study. RESULTS Twenty-nine patients (15.5%) were diagnosed with progression at the first recurrence after bacillus Calmette-Guérin therapy. Eighteen (62.1%) of them died of bladder cancer. A total of 158 patients were diagnosed with non-muscle-invasive bladder cancer at the first recurrence after bacillus Calmette-Guérin therapy. Of them, 23 (14.6%) underwent radical cystectomy. No patients who underwent radical cystectomy died of bladder cancer during the follow-up. On multivariate analysis of the 135 patients with bladder preservation, the independent prognostic factors for cancer-specific survival were age (≥70 [P = 0.002]), tumor size (≥3 cm [P = 0.015]) and the Nieder classification (bacillus Calmette-Guérin refractory [P < 0.001]). In a subgroup analysis, the estimated 5-year cancer-specific survival rates in the groups with no positive, one positive and two to three positive factors were 100, 93.4 and 56.8%, respectively (P < 0.001). CONCLUSIONS Patients with stage progression at the first recurrence after bacillus Calmette-Guérin therapy had poor prognoses. Three prognostic factors for predicting survival were identified and used to categorize patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin into three risk groups based on the number of prognostic factors in each one.
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Affiliation(s)
- Naotaka Nishiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo
| | - Hiroshi Kitamura
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo
| | - Hiroshi Hotta
- Department of Urology, Asahikawa Red Cross Hospital, Asahikawa
| | | | - Masahiro Yanase
- Department of Urology, Sunagawa City Medical Center, Sunagawa
| | - Naoki Itoh
- Department of Urology, NTT East Japan Sapporo Hospital, Sapporo
| | - Hitoshi Tachiki
- Department of Urology, Steel Memorial Muroran Hospital, Muroran
| | - Noriomi Miyao
- Department of Urology, Muroran City General Hospital, Muroran
| | | | - Yasuharu Kunishima
- Department of Urology, Hokkaido Social Work Association Obihiro Hospital, Obihiro
| | - Keisuke Taguchi
- Department of Urology, Oji General Hospital, Tomakomai, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo
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Ark JT, Keegan KA, Barocas DA, Morgan TM, Resnick MJ, You C, Cookson MS, Penson DF, Davis R, Clark PE, Smith JA, Chang SS. Incidence and predictors of understaging in patients with clinical T1 urothelial carcinoma undergoing radical cystectomy. BJU Int 2014; 113:894-9. [PMID: 24053444 DOI: 10.1111/bju.12245] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To evaluate predictors of understaging in patients with presumed non-muscle-invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumour (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT. PATIENTS AND METHODS We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease after TURBT who underwent RC at our institution from April 2000 to July 2011. In all, 60 of these cT1 patients had undergone a restaging TURBT before RC. The primary outcome measure was pathological staging of ≥T2 disease at the time of RC. RESULTS In all, 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumour (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.25-0.76, P = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71-1.00, P = 0.05) were independent risk factors for understaging. CONCLUSIONS Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumour and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC.
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Affiliation(s)
- Jacob T Ark
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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17
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Al-Daghmin A, English S, Kauffman EC, Din R, Khan A, Syed JR, Sztorc J, Mehedint D, Sharif M, Shi Y, Wilding G, Guru KA. External validation of preoperative and postoperative nomograms for prediction of cancer-specific survival, overall survival and recurrence after robot-assisted radical cystectomy for urothelial carcinoma of the bladder. BJU Int 2014; 114:253-60. [DOI: 10.1111/bju.12484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ali Al-Daghmin
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Stephen English
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Eric C. Kauffman
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Rakeeba Din
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Aabroo Khan
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Johar R. Syed
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Jenna Sztorc
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Diana Mehedint
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Mohammad Sharif
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
| | - Yi Shi
- Department of Biostatistics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Gregory Wilding
- Department of Biostatistics; Roswell Park Cancer Institute; Buffalo NY USA
| | - Khurshid A. Guru
- Department of Urology; Roswell Park Cancer Institute; Buffalo NY USA
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18
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Lammers RJM, Witjes JA. Developments in intravesical therapy for non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2014; 10:1903-16. [DOI: 10.1586/era.10.155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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19
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Breau RH, Karnes RJ, Farmer SA, Thapa P, Cagiannos I, Morash C, Frank I. Progression to detrusor muscle invasion during urothelial carcinoma surveillance is associated with poor prognosis. BJU Int 2013; 113:900-6. [DOI: 10.1111/bju.12403] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Rodney H. Breau
- Division of Urology; The Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
| | | | - Sara A. Farmer
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester MN USA
| | - Prabin Thapa
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester MN USA
| | - Ilias Cagiannos
- Division of Urology; The Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
| | - Christopher Morash
- Division of Urology; The Ottawa Hospital Research Institute; University of Ottawa; Ottawa ON Canada
| | - Igor Frank
- Department of Urology; Mayo Clinic; Rochester MN USA
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20
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Ahn JJ, McKiernan JM. New Agents for Bacillus Calmette-Guérin–Refractory Bladder Cancer. Urol Clin North Am 2013; 40:219-32. [DOI: 10.1016/j.ucl.2013.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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21
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Zhu YP, Ye DW, Yao XD, Zhang SL, Dai B, Shen YJ, Wang CF. Defining Good Candidates for Extraperitoneal Cystectomy: Results From Random Peritoneum Biopsies of 136 Cases. Urology 2013; 81:820-4. [DOI: 10.1016/j.urology.2012.11.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/20/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
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22
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Tilki D, Shariat SF, Lotan Y, Rink M, Karakiewicz PI, Schoenberg MP, Lerner SP, Sonpavde G, Sagalowsky AI, Gupta A. Lymphovascular invasion is independently associated with bladder cancer recurrence and survival in patients with final stage T1 disease and negative lymph nodes after radical cystectomy. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11455.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Derya Tilki
- Department of Urology; Ludwig-Maximilians-University Munich; Klinikum Grosshadern; Munich; Germany
| | | | - Yair Lotan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas; TX; USA
| | | | - Pierre I. Karakiewicz
- University of Montréal; Cancer Prognostics and Health Outcomes Unit; Montréal; QC; Canada
| | - Mark P. Schoenberg
- Department of Urology; Johns Hopkins University; Brady Urologic Institute; Baltimore; MD; USA
| | - Seth P. Lerner
- Baylor College of Medicine; Department of Urology; Houston; TX; USA
| | - Guru Sonpavde
- UAB Comprehensive Cancer Center; Birmingham; AL; USA
| | - Arthur I. Sagalowsky
- Department of Urology; University of Texas Southwestern Medical Center; Dallas; TX; USA
| | - Amit Gupta
- University of Iowa Department of Urology; Iowa City; IA; USA
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23
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Sternberg IA, Keren Paz GE, Chen LY, Herr HW, Dalbagni G. Role of immediate radical cystectomy in the treatment of patients with residual T1 bladder cancer on restaging transurethral resection. BJU Int 2012; 112:54-9. [PMID: 23146082 DOI: 10.1111/j.1464-410x.2012.11391.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Bladder cancer patients with lamina propria invasion (T1 disease) and residual T1 disease on restaging transurethral resection of bladder tumour (re-TURBT) are at a very high risk for recurrence and progression. Despite this risk, most patients are treated with a bladder preserving approach and not immediate radical cystectomy (RC). In this study we have shown that a quarter of patients with T1 bladder cancer and residual T1 on re-TURBT who are treated with immediate RC are found to have carcinoma invading bladder muscle at RC and 5% have lymph node metastases. We have also found that >30% of patients treated with deferred RC after initial bladder-preserving therapy harbour carcinoma invading bladder muscle and almost 20% of these patients have lymph node metastases. Thus, immediate RC should be considered in all patients with T1 bladder cancer and residual T1 on re-TURBT. OBJECTIVE To report the overall survival (OS) and cancer-specific survival (CSS) of patients with residual T1 bladder cancer on restaging transurethral resection of the bladder tumour (re-TURBT). MATERIALS AND METHODS We performed a retrospective review of 150 evaluable patients treated for T1 bladder cancer with residual T1 disease found on re-TURBT between 1990 and 2007. Patients were treated with immediate radical cystectomy (RC) or a bladder-preserving approach (deferred or no RC). A univariate Cox proportional hazards regression model was used to test the association between treatment approach and survival. RESULTS Residual T1 bladder cancer was found in 150 evaluable patients, of whom 57 received immediate RC and 93 were treated with a bladder-preserving approach. Fourteen out of 57 patients receiving immediate RC and 8/26 patients receiving deferred RC had carcinoma invading bladder muscle in the RC specimen. Three out of 57 and 5/26 patients had lymph node metastases in the RC specimen. Median follow-up was 3.74 years. Thirty-nine patients died during follow-up, 16 from bladder cancer. There was no significant association between immediate RC and CSS (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.43-3.09, P = 0.8) or OS (HR 0.79, 95% CI 0.4-1.53, P = 0.5). CONCLUSIONS Because of the low number of events we cannot conclude whether RC offers a survival advantage in patients with residual T1 bladder cancer on re-TURBT. Since a quarter of patients had carcinoma invading bladder muscle, RC should be considered in these patients. A larger, preferably randomized, study with longer follow-up is needed.
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Affiliation(s)
- Itay A Sternberg
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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24
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Badalato GM, Gaya JM, Hruby G, Patel T, Kates M, Sadeghi N, Benson MC, McKiernan JM. Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference? BJU Int 2012; 110:1471-7. [PMID: 22487512 DOI: 10.1111/j.1464-410x.2012.11116.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether a survival difference exists between patients with high grade (HG) cT1 urothelial cell carcinoma (UCC) receiving immediate radical cystectomy (IRC) as opposed to those choosing bladder-sparing therapy. PATIENTS AND METHODS Between January 1990 and August 2010, 349 patients were retrospectively identified with a diagnosis of HG cT1 UCC of the bladder. Patients were divided into two groups: those who underwent IRC and those treated with conservative management (CM), consisting of transurethral resection of the bladder tumour (TURBT) and intravesical therapy. IRC was defined as surgery within 90 days of HG cT1 diagnosis with no intervening transurethral resection (TUR) or intravesical therapy (IVT). Trends in patient selection and cancer-specific survival (CSS) were analyzed over consecutive decades. The primary outcome was to compare CSS among patients during consecutive decades whereby management paradigms shifted from IRC to CM. The secondary outcome was to examine whether patient selection changed over time for each respective intervention. RESULTS One hundred and thirteen patients underwent IRC and 236 had CM. From 1990 to 1999, only 90 patients were diagnosed with HG cT1 disease, and a majority of patients (n= 54) underwent IRC. From 2000 to 2010, only 23% (59/259) of the patients with HG cT1 underwent IRC. Despite 42.3% more patients successfully maintaining their bladder in the long-term, no difference in 5 year bladder CSS was noted between decades (77% vs 80% consecutively, P= 0.566). A subset analysis of risk factors for bladder cancer progression/recurrence demonstrated more patients with lymphovascular invasion (LVI) on TUR underwent IRC in the current era (13/59 (22.0%) vs 13/200 (6.5%), P < 0.001). These findings remain to be validated in prospective work at other institutions. CONCLUSION Conservative management strategies are a viable treatment option within a well selected subset of patients with HG cT1 UCC.
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Affiliation(s)
- Gina M Badalato
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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25
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Tollefson MK, Boorjian SA, Farmer SA, Frank I. Downstaging to non-invasive urothelial carcinoma is associated with improved outcome following radical cystectomy for patients with cT2 disease. World J Urol 2012; 30:795-9. [PMID: 22447397 DOI: 10.1007/s00345-012-0855-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 03/05/2012] [Indexed: 12/01/2022] Open
Affiliation(s)
- Matthew K Tollefson
- Department of Urology, Mayo Medical School and Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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26
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Turker P, Bostrom PJ, Wroclawski ML, van Rhijn B, Kortekangas H, Kuk C, Mirtti T, Fleshner NE, Jewett MA, Finelli A, Kwast TV, Evans A, Sweet J, Laato M, Zlotta AR. Upstaging of urothelial cancer at the time of radical cystectomy: factors associated with upstaging and its effect on outcome. BJU Int 2012; 110:804-11. [DOI: 10.1111/j.1464-410x.2012.10939.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Prasad SM, Decastro GJ, Steinberg GD. Urothelial carcinoma of the bladder: definition, treatment and future efforts. Nat Rev Urol 2011; 8:631-42. [PMID: 21989305 DOI: 10.1038/nrurol.2011.144] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The identification of patients with high-risk bladder cancer is important for the timely and appropriate treatment of this lethal disease. The understanding of the natural history of bladder cancer has improved; however, the criteria used to define high-risk disease and the relevant treatment strategies have remained the same for the past several decades, despite multiple large, randomized, prospective clinical trials that have evaluated the use of intravesical, surgical and systemic therapies. The genetic signature of high-risk bladder cancer has been a focus of investigation and has led to the discovery of potential molecular targets for disease identification, risk stratification and therapy. These advances, combined with a comprehensive risk assessment profile that incorporates available pathological and clinical characteristics, might improve the diagnosis and treatment of patients with bladder cancer.
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Affiliation(s)
- Sandip M Prasad
- Section of Urology, University of Chicago Medical Center, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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28
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The role of a combined regimen with intravesical chemotherapy and hyperthermia in the management of non-muscle-invasive bladder cancer: a systematic review. Eur Urol 2011; 60:81-93. [PMID: 21531502 DOI: 10.1016/j.eururo.2011.04.023] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 04/12/2011] [Indexed: 01/29/2023]
Abstract
CONTEXT Due to the suboptimal clinical outcomes of current therapies for non-muscle-invasive bladder cancer (NMIBC), the search for better therapeutic options continues. One option is chemohyperthermia (C-HT): microwave-induced hyperthermia (HT) with intravesical chemotherapy, typically mitomycin C (MMC). During the last 15 yr, the combined regimen has been tested in different clinical settings. OBJECTIVE To perform a systematic review to evaluate the efficacy of C-HT as a treatment for NMIBC. EVIDENCE ACQUISITION The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. An electronic search of the Medline, Embase, Cochrane Library, CancerLit, and ClinicalTrials.gov databases was undertaken. Relevant conference abstracts and urology journals were also searched manually. Two reviewers independently reviewed candidate studies for eligibility and abstracted data from studies that met inclusion criteria. The primary end point was time to recurrence. Secondary end points included time to progression, bladder preservation rate, and adverse event (AE) rate. EVIDENCE SYNTHESIS A total of 22 studies met inclusion criteria and underwent data extraction. When possible, data were combined using random effects meta-analytic techniques. Recurrence was seen 59% less after C-HT than after MMC alone. Due to short follow-up, no conclusions can be drawn about time to recurrence and progression. The overall bladder preservation rate after C-HT was 87.6%. This rate appeared higher than after MMC alone, but valid comparison studies were lacking. AEs were higher with C-HT than with MMC alone, but this difference was not statistically significant. CONCLUSIONS Published data suggest a 59% relative reduction in NMIBC recurrence when C-HT is compared with MMC alone. C-HT also appears to improve bladder preservation rate. However, due to a limited number of randomized trials and to heterogeneity in study design, definitive conclusions cannot be drawn. In the future, C-HT may become standard therapy for high-risk patients with recurrent tumors, for patients who are unsuitable for radical cystectomy, and in cases for which bacillus Calmette-Guérin treatment is contraindicated.
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29
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May M, Bastian PJ, Brookman-May S, Burger M, Bolenz C, Trojan L, Michel MS, Herrmann E, Wülfing C, Tiemann A, Müller SC, Ellinger J, Buchner A, Stief CG, Tilki D, Wieland WF, Gilfrich C, Höfner T, Hohenfellner M, Haferkamp A, Roigas J, Zacharias M, Gunia S, Fritsche HM. Pathological upstaging detected in radical cystectomy procedures is associated with a significantly worse tumour-specific survival rate for patients with clinical T1 urothelial carcinoma of the urinary bladder. ACTA ACUST UNITED AC 2011; 45:251-7. [DOI: 10.3109/00365599.2011.562235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Matthias May
- Department of Urology,
St Elisabeth Klinikum Straubing, Straubing, Germany
| | - Patrick J. Bastian
- Department of Urology,
München University, LMU München, München, Germany
| | - Sabine Brookman-May
- Department of Urology,
Regensburg University, Caritas Krankenhaus St. Josef, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology,
Regensburg University, Caritas Krankenhaus St. Josef, Regensburg, Germany
| | | | - Lutz Trojan
- Department of Urology,
Heidelberg University, Mannheim, Germany
| | | | - Edwin Herrmann
- Department of Urology,
Münster University, Münster, Germany
| | | | - Arne Tiemann
- Department of Urology,
Münster University, Münster, Germany
| | | | - Jörg Ellinger
- Department of Urology,
Bonn University, Bonn, Germany
| | - Alexander Buchner
- Department of Urology,
München University, LMU München, München, Germany
| | - Christian G. Stief
- Department of Urology,
München University, LMU München, München, Germany
| | - Derya Tilki
- Department of Urology,
München University, LMU München, München, Germany
| | - Wolf F. Wieland
- Department of Urology,
Regensburg University, Caritas Krankenhaus St. Josef, Regensburg, Germany
| | - Christian Gilfrich
- Department of Urology,
St Elisabeth Klinikum Straubing, Straubing, Germany
| | - Thomas Höfner
- Department of Urology,
Heidelberg University, Heidelberg, Germany
| | | | - Axel Haferkamp
- Department of Urology,
Heidelberg University, Heidelberg, Germany
- Department of Urology,
Frankfurt am Main University, Frankfurt am Main, Germany
| | - Jan Roigas
- Department of Urology,
Vivantes Kliniken Am Urban und Im Friedrichshain Berlin, Berlin, Germany
| | - Mario Zacharias
- Department of Urology,
Vivantes Klinikum AVK Berlin, Berlin, Germany
| | - Sven Gunia
- Institute of Pathology,
Helios-Klinikum Bad Saarow, Bad Saarow, Germany
| | - Hans-Martin Fritsche
- Department of Urology,
Regensburg University, Caritas Krankenhaus St. Josef, Regensburg, Germany
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30
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Canter D, Long C, Kutikov A, Plimack E, Saad I, Oblaczynski M, Zhu F, Viterbo R, Chen DYT, Uzzo RG, Greenberg RE, Boorjian SA. Clinicopathological outcomes after radical cystectomy for clinical T2 urothelial carcinoma: further evidence to support the use of neoadjuvant chemotherapy. BJU Int 2011; 107:58-62. [PMID: 20560950 DOI: 10.1111/j.1464-410x.2010.09442.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the clinicopathological outcomes for patients with clinical T2 (cT2) urothelial carcinoma treated with radical cystectomy (RC) without neoadjuvant chemotherapy (NC). PATIENTS AND METHODS We identified 212 patients with cT2 tumours who underwent RC at our institution without NC. Pathological assessment of RC specimens was correlated with clinical stage. The impact of various clinicopathological factors on the outcome of patients with cT2 disease was analysed. RESULTS In total, 153/212 (73.2%) patients with cT2 bladder cancer had either pT3/T4 or pN+ tumours at RC. Moreover, only 58/153 (37.9%) of these patients received adjuvant chemotherapy. The median follow-up was 28 (months 0.6-107.5) (range). The 5-year recurrence-free survival and cancer-specific survival (CSS) was 56.5% and 59.5%, respectively. On multivariate analysis, increasing age (hazard ratio [HR] 1.04; P= 0.04), advanced pathological stage (HR 1.83; P= 0.02), and positive lymph nodes (HR 3.72; P= 0.001) were adversely associated with CSS, while receipt of adjuvant chemotherapy was protective of disease-specific mortality (HR 0.45; P= 0.04). CONCLUSIONS Pathological upstaging is prevalent and survival remains modest in patients with cT2 tumours treated with RC without NC. Unfortunately, only 40% of patients that had locally advanced and/or regionally metastatic disease received adjuvant treatment. These data further support the value of NC for patients with muscle-invasive bladder cancer, even in those with apparent clinically organ-confined tumours.
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Affiliation(s)
- Daniel Canter
- Departments of Urologic Oncology, Medical Oncology and Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Badalato G, Patel T, Hruby G, McKiernan J. Does the presence of muscularis propria on transurethral resection of bladder tumour specimens affect the rate of upstaging in cT1 bladder cancer? BJU Int 2010; 108:1292-6. [PMID: 21176080 DOI: 10.1111/j.1464-410x.2010.09893.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED OBJECTIVE • To determine how the presence of MP on T1 biopsy specimens affects the outcome of patients undergoing RC as compared to when no MP is identified in the TURBT specimen. PATIENTS AND METHODS • Patients were retrospectively identified from the Columbia University Urologic Oncology Database. • From January 1986 to October 2009, 114 patients diagnosed with cT1N0M0 bladder cancer who underwent RC within 4 months of their last biopsy were identified. • Patients were stratified based on the presence of MP on T1 biopsy, and upstaging was defined as any tumor T2 or greater, N+, or M+ at the time of radical cystectomy. • The rate of upstaging was assessed using univariate and multivariate regression models; Kaplan meier curves were also extrapolated for each cohort to compare disease specific and overall survival patterns. RESULTS • Of the 114 patients evaluated in this study, 24 (20.2%) did not have MP on their T1 biopsy before RC. The rate of upstaging (>=pT2) stratified by the presence of MP on biopsy was 50% and 78%, respectively (p = 0.017). • On univariate analysis, lack of MP on biopsy was associated with an increased risk of upstaging (HR 3.52, p = 0.021, CI 1.2-10.3), however did not reach significance as an independent predictor (HR 2.9, p = 0.056, CI 0.97-8.9). • At a mean follow-up of 33.5 months, there was no difference in disease specific (p = 0.41) and overall survival (p = 0.68) between groups. CONCLUSIONS • The lack of MP on TURBT for high grade cT1N0M0 bladder cancer portends a high likelihood of upstaging at RC, although this risk did not translate into a detectable increased risk of disease specific mortality.
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Affiliation(s)
- Gina Badalato
- Department of Urology, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
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Herr HW. Editorial comment. Urology 2009; 74:1280-1; author reply 1281. [PMID: 19962527 DOI: 10.1016/j.urology.2009.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 06/01/2009] [Accepted: 06/06/2009] [Indexed: 11/25/2022]
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