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Saint F, Pasquier D, Villers A, Massa J, Colin P, Vankemmel O, Leroy X, Bonnal JL, Plouvier SD. Incidence, initial management and survival of high-risk non-muscle invasive bladder cancer in Northern France. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102675. [PMID: 38969304 DOI: 10.1016/j.fjurol.2024.102675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/25/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Information on bladder cancer (BC) according to the risk scoring for recurrence or progression in a general population is scarce despite its clinical relevance. The objective was to describe the characteristics of incident BC in a general population, with a focus on the initial management of high-risk non-muscle invasive BC (HR-NMIBC). MATERIALS BC incident in 2011-2012 recorded in a population-based cancer registry were studied. Data was extracted from medical files. NMIBC were classified according to potential risk for recurrence/progression. Individual and tumor characteristics of incident BC were described. Incidence, initial management and survival (12/31/2021) of HR-NMIBC were assessed. RESULTS Among 538 BC cases, 380 were NMIBC [119 low (22.1%), 163 intermediate (30.3%), 98 high (18.2%) risk] and 147 (27.3%) were MIBC. HR-NMIBC diagnostic and therapeutic management [imaging, re-TUR, multidisciplinary team meetings (MDT) assessment, specific treatment] revealed discrepancies with guidelines recommendations. Seventy-two out of 98 cases were assessed in an MDT with a median time from diagnosis of 18days [first quartile: 12-third quartile: 32]. Globally, treatment agreed with MDT decisions. Intravesical instillation was the most common treatment (n=56) but 27 HR-NMIBC did not receive specific treatment after TUR. Five and 10years overall survival was 52% [42-63] and 41% [31-51], respectively. Five years net survival was 63% [47-75]. CONCLUSIONS Despite National cancer plans aiming to improve care giving and despite the severity of HR-NMIBC, guideline-recommended patterns of care were underused in this region. This may deserve attention to identify obstacles to guideline adoption to try to improve BC patient care and survival. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Fabien Saint
- Université de Lille, CHU de Lille, Department of Urology, 59000 Lille, France; EPROAD Laboratory EA 4669, Picardie Jules-Verne University, Lille, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar-Lambret, Lille, France; Université de Lille, CRIStAL UMR 9189, Lille, France
| | - Arnauld Villers
- Université de Lille, CHU de Lille, Department of Urology, 59000 Lille, France
| | - Jordan Massa
- Université de Lille, CHU de Lille, Department of Urology, 59000 Lille, France
| | - Pierre Colin
- Service d'Urologie, Hôpital Privé La Louvière, 59800 Lille, France
| | | | - Xavier Leroy
- Université de Lille, CHU de Lille, Department of Pathology, 59000 Lille, France
| | - Jean-Louis Bonnal
- Service d'Urologie, Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Nord de France, Lille, France
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Plouvier SD, Marcq G, Vankemmel O, Colin P, Bonnal JL, Leroy X, Saint F, Pasquier D. Practice patterns and survival outcomes for muscle-invasive bladder cancer: real-life experience in a general population setting. Int J Qual Health Care 2024; 36:mzae040. [PMID: 38722033 DOI: 10.1093/intqhc/mzae040] [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: 10/24/2023] [Revised: 02/05/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
Bladder cancer (BC) is a common malignancy in Europe and North America. Among BCs, muscle-invasive BCs (MIBCs) are distinguished, as they require aggressive treatment due to their spreading potential and poor prognosis. Despite its clinical relevance, little information on MIBC in a general population setting is available. This study aims to report practice patterns and survival outcomes for MIBC patients in a general population setting. MIBCs among BC incidence in 2011 and 2012 recorded in a French population-based cancer registry (810 000 inhabitants) were included in the study. Data were extracted from the medical files. Individual, tumour-related characteristics and initial management including diagnostic tools, multidisciplinary team meeting (MDT) assessment, and treatment delivered were described. Cystectomy, chemoradiation, radiotherapy, and chemotherapy were considered as specific treatments. Matching between MDT decision and the treatment provided was detailed. Management practices were discussed according to the guideline's recommendations. Overall survival (using the Kaplan-Meier method) and net survival (using the Pohar-Perme estimator) were calculated. Among 538 incident BC cases, 147 (27.3%) were MIBCs. Diagnostic practices displayed a relevant locoregional assessment of BC. Almost all cases (n = 136, 92.5%) were assessed during an uro-oncological MDT with a median time from diagnosis of 18 days (first quartile:12-third quartile:32). Discrepancies appeared between MDT decisions and treatments delivered: 71 out of 86 subjects received the recommended cystectomy or chemoradiation (with or without neoadjuvant chemotherapy); 6 out of 11 had the recommended radio- or chemotherapy; and 9 patients did not undergo any specific treatment despite the MDT decision. Cystectomy was the most common treatment performed; the time to surgery appeared consistent with the guideline's recommendations. Forty people only received supportive care. Still, the 5-year overall and net survival was poor, with 19% (13-26) and 22% (14-31), respectively. The 5-year net survival was 35% (23-48) for people who underwent curative-intent treatments. MIBC management remains challenging even for cases assessed during an MDT. Many people did not undergo any specific treatment. Prognosis was poor even when curative-intent therapies were delivered. Efforts to reduce exposure to risk factors such as tobacco smoking and occupational exposures must be maintained.
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Affiliation(s)
- Sandrine D Plouvier
- General Cancer Registry of Lille area, C2RC, Bld du Pr Jules Leclercq, Lille 59037, France
| | - Gautier Marcq
- Urology Department, Claude Huriez Hospital, CHU Lille, Rue Michel Polonowski, Lille F-59000, France
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, Lille F-59000, France
| | - Olivier Vankemmel
- Cabinet urologie, Hôpital privé Le Bois, 85 av Marx Dormoy, Lille 59000, France
| | - Pierre Colin
- Service d'Urologie, Hôpital privé La Louvière, rue des Vicaires, Lille 59000, France
| | - Jean-Louis Bonnal
- Service d'Urologie, Groupement des hôpitaux de l'Institut Catholique de Lille, Université nord de France, Rue du Grand But, 59160
| | - Xavier Leroy
- Department of Pathology, CHU Lille, Université de Lille, Bld du Pr Jules Leclercq, Lille 59037, France
| | - Fabien Saint
- Service d'Urologie Transplantation CHU Amiens Picardie, Laboratoire EPROAD EA 4669 UPJV, 1 Rond-Point du Professeur Christian Cabrol, Amiens cedex 01 80054, France
| | - David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, 3 rue Combemale, CEDEX Lille F-59020, France
- University Lille & CNRS, Centrale Lille, UMR 9189-CRIStAL, Lille F-59000, France
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Plouvier SD, Bonnal JL, Machuron F, Colin P, Vankemmel O, Leroy X, Duhamel A, Villers A, Saint F, Pasquier D. Impact of age on bladder cancer management practices: a general population study. Acta Oncol 2020; 59:462-466. [PMID: 32043407 DOI: 10.1080/0284186x.2020.1723164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Jean-Louis Bonnal
- Service d’Urologie, Groupement des hôpitaux de l’Institut Catholique de Lille, Université nord de France
| | - François Machuron
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Pierre Colin
- Service d'urologie, Hôpital privé La Louvière, Lille, France
| | | | - Xavier Leroy
- Department of Pathology, University of Lille, CHU Lille, Lille, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Arnauld Villers
- Department of Urology, University of Lille, CHU Lille, Lille, France
| | - Fabien Saint
- Department of Urology, University of Lille, CHU Lille, Lille, France
| | - David Pasquier
- Academic department of radiation oncology, Centre Oscar Lambret, Lille, France
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Simon M, Bosset PO, Rouanne M, Benhamou S, Radulescu C, Molinié V, Neuzillet Y, Paoletti X, Lebret T. Multiple recurrences and risk of disease progression in patients with primary low-grade (TaG1) non-muscle-invasive bladder cancer and with low and intermediate EORTC-risk score. PLoS One 2019; 14:e0211721. [PMID: 30811419 PMCID: PMC6392242 DOI: 10.1371/journal.pone.0211721] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/18/2019] [Indexed: 11/18/2022] Open
Abstract
AIM To assess the prognostic value of multiple recurrences on the risk of progression in a large cohort of TaG1 bladder cancer of low and intermediate risk based on the EORTC score and to evaluate prognostic factors of multiple recurrences. MATERIALS AND METHODS We retrospectively analyzed a French cohort of 470 patients with primary TaG1 bladder cancer diagnosed between 1986 and 2010 and followed until 2012. They were classified at low and intermediate risk using the EORTC risk score. Associations between the number of recurrences and the risk of progression to high grade Ta/T1 bladder cancer and progression to muscle-invasive disease were assessed. The characteristics of recurrences, as occurrence time or localization, and risk of other recurrences were evaluated. RESULTS Out of 470 patients, 251 had recurrence, 34 progressed to high grade Ta/T1 and 17 to muscle-invasive disease, including 4 who had non muscle-invasive progression first. The median follow-up was 7.2 years (interquartile range: 4.2-10.9). In half the progressions, no previous recurrence was observed. No association between the number of recurrences and the risk of progression was detected. Even after 5 years free of event, patients had a 15% risk of recurrence. History of two or more recurrences increased by 4.5 the risk of subsequent recurrence. Time between two recurrences inferior to six months and multifocal localization increased the risk of recurrence. CONCLUSION Surveillance of patients with TaG1 should be continued beyond 5 years of follow-up. However, cystoscopy exams could be spaced after 5 years. Multiple TaG1 recurrences did not appear to be prognostic for disease progression, but increased significantly the risk of subsequent recurrences. Short time between two recurrences and multifocal localization may serve to adapt monitoring of patients with TaG1 Bladder cancer.
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Affiliation(s)
- Marie Simon
- Service de Biostatistique et d'Epidémiologie & CESP OncoStat, INSERM, Institut Gustave Roussy, Université Paris Saclay, UVSQ, Villejuif, France
| | - Pierre-Olivier Bosset
- Department of Urology, Hôpital Foch, Université Paris-Saclay, UVSQ, Suresnes, France
| | - Mathieu Rouanne
- Department of Urology, Hôpital Foch, Université Paris-Saclay, UVSQ, Suresnes, France
| | - Simone Benhamou
- INSERM, UMR 946, Genetic Variation and Human Diseases Unit, Paris, France
| | - Camelia Radulescu
- Department of Pathology, Hôpital Foch, Université Paris-Saclay, UVSQ, Suresnes, France
| | - Vincent Molinié
- Department of Pathology, University Hospital of Martinique, Fort-de-France, France
| | - Yann Neuzillet
- Department of Urology, Hôpital Foch, Université Paris-Saclay, UVSQ, Suresnes, France
| | - Xavier Paoletti
- Service de Biostatistique et d'Epidémiologie & CESP OncoStat, INSERM, Institut Gustave Roussy, Université Paris Saclay, UVSQ, Villejuif, France
| | - Thierry Lebret
- Department of Urology, Hôpital Foch, Université Paris-Saclay, UVSQ, Suresnes, France
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5
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Neuzillet Y, Colin P, Comperat E, Dubosq F, Houede N, Larre S, Masson-Lecomte A, Pignot G, Puech P, Roumiguie M, Xylinas E, Mejean A, Roupret M. [Observational survey of the French Urological Association Oncology Committee (CCAFU) evaluating the practice of immediate postoperative instillation (IPOP) using mitomycin C for non-muscle invasive bladder cancer (NMIBC) treatment]. Prog Urol 2016; 26:181-90. [PMID: 26777686 DOI: 10.1016/j.purol.2015.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the practice of immediate postoperative instillation (IPOP) using mitomycin C for non-muscle invasive bladder cancer (NMIBC) treatment by urologists members of the French Association of Urology (AFU). MATERIAL AND METHOD Internet-based observational survey evaluating indications and practical modalities of IPOP in NMIBC treatment using questionnaire sent in May 2014 to 915 urologists. RESULTS Two hundred ninety-eight urologists participated in the survey (response rate: 32.6%) and 57% prescribed the IPOP. The median frequency of IPOP prescription was 3.3%, and was higher in the academic public sector. The CASE recommendations were self-assessed as known or well-known in 67% of cases. The selections criteria for IPOP were adequately identified by 62% of urologists, without differences according to sectors of activity. The IPOP prescription modalities were declared as an obstacle to the completion for 41.9% of urologists, and especially in the private sector. Completion times of IPOP were declared <24h in 91% of cases. We see that 28.5% of urologists prescribed an urinary alkalization. The average frequency of complications of IPOP was 0.91 per urologist. CONCLUSIONS The IPOP prescription frequency was higher among urologists practicing in the academic sector. Neither the level of knowledge of the recommendations nor the frequency of complications of IPOP had explained this difference. However, the prescription modalities were more frequently reported as an obstacle to their completion in the private sector. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - P Colin
- Service d'urologie, hôpital privé de la Louvière - générale de santé, 59000 Lille, France
| | - E Comperat
- Service d'anatomopathologie, groupe hospitalier Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - F Dubosq
- Clinique de l'Alma, 75007 Paris, France
| | - N Houede
- Service d'oncologie médicale, CHU de Nîmes, 30000 Nîmes, France
| | - S Larre
- Service d'urologie, CHU de Reims, 51000 Reims, France
| | - A Masson-Lecomte
- Service d'urologie, hôpital Henri-Mondor, université Paris-Est, 94010 Créteil, France
| | - G Pignot
- Service d'urologie, hôpital Bicêtre, université Paris-Sud, 94270 Le Kremlin-Bicêtre, France
| | - P Puech
- Service de radiologie, CHRU de Lille, 59037 Lille, France
| | - M Roumiguie
- Service d'urologie, CHU Rangueil, 31400 Toulouse, France
| | - E Xylinas
- Service d'urologie, hôpital Cochin, université Paris-Descartes, 75679 Paris, France
| | - A Mejean
- Service d'urologie, groupe hospitalier Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 75013 Paris, France
| | - M Roupret
- Service d'urologie, hôpital européen Georges-Pompidou, université Paris-Descartes, 75015 Paris, France
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Rigaud J, Leger A, Devilder MC, Bouchot O, Bonneville M, Scotet E. Development of Predictive Value of Urinary Cytokine Profile Induced During Intravesical Bacillus Calmette-Guérin Instillations for Bladder Cancer. Clin Genitourin Cancer 2015; 13:e209-e215. [DOI: 10.1016/j.clgc.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 01/09/2015] [Accepted: 01/16/2015] [Indexed: 11/25/2022]
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7
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Pignot G. [Role of blue-light cystoscopy in the management of non-muscle invasive bladder cancer]. Prog Urol 2015; 25:607-15. [PMID: 26088583 DOI: 10.1016/j.purol.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/11/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
Blue-light cystoscopy aims to facilitate the detection of bladder tumors in order to optimize the completeness of resection. We performed a literature analysis using data from Medline and according to PRISMA guidelines. Several meta-analyses have confirmed the interest of the blue-light cystoscopy in terms of improved detection rate and disease-free survival compared to standard white-light cystoscopy. These benefits outweigh the initial costs related to the acquisition of specific equipment, allowing an improvement in quality-adjusted life-years and a reduction of costs over time. Indications vary according to guidelines and must take into account equipment and logistic constraints on each center. The objective of this article is to make a focus on the role and the interest of blue-light cystoscopy in the management of NMIBC in 2015.
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Affiliation(s)
- G Pignot
- Service d'urologie, hôpital Bicêtre, université Paris-Sud, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
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Pommier JD, Ben Lasfar N, Van Grunderbeeck N, Burdet C, Laouénan C, Rioux C, Pierre-Audigier C, Meybeck A, Choudat L, Benchikh A, Nguyen S, Bouvet E, Yeni P, Yazdanpanah Y, Joly V. Complications following intravesical bacillus Calmette-Guerin treatment for bladder cancer: a case series of 22 patients. Infect Dis (Lond) 2015; 47:725-31. [PMID: 26077036 DOI: 10.3109/23744235.2015.1055794] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intravesical bacillus Calmette-Guerin (BCG) therapy is an effective and widely used treatment for superficial bladder carcinoma. Local complications are frequent whereas systemic complications are rare but can be serious, and their management is not well known. METHODS We describe retrospectively the records of 22 patients treated in 3 infectious disease departments, for complications related to intravesical BCG therapy as treatment of bladder cancer. RESULTS All the patients were male, with a median age of 68 years (range 56-88). Complications occurred after a median of 5 instillations (range 1-11) and were observed within 24 h following BCG instillation for 14 patients. Common symptoms were fever (n = 20), impaired general condition (n = 14), and shortness of breath (n = 7). Six patients had a systemic septic reaction leading to transfer into the intensive care unit for five of them. Lung infiltration was the most frequent presentation (n = 11). Mycobacterium bovis was isolated from only two patients, but histology showed the presence of a granuloma in nine patients. Antimycobacterial treatment was initialized in 17 patients; the outcome was favorable in 16 patients, with a median length of symptoms resolution of 22.5 days (range 5-425 days). Eleven patients received corticosteroids in addition to specific treatment and had a more rapid improvement. One patient died with disseminated BCGitis proved by biopsy. CONCLUSIONS Complications following intravesical BCG therapy are rare but can be severe and fatal. Histology seems to be the method that contributes most in confirmation of the diagnosis. Antimycobacterial therapy is effective, and probably more efficient when combined with corticosteroids, but the regimen and duration of the treatment are not standardized.
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Affiliation(s)
- J D Pommier
- Infectious and Tropical Diseases Department, Bichat Hospital, AP-HP , Paris , France
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9
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Pfister C, Kerkeni W, Rigaud J, Le Gal S, Saint F, Colombel M, Guy L, Wallerand H, Irani J, Soulie M. Efficacy and tolerance of one-third full dose bacillus Calmette-Guérin maintenance therapy every 3 months or 6 months: two-year results of URO-BCG-4 multicenter study. Int J Urol 2014; 22:53-60. [PMID: 25256813 DOI: 10.1111/iju.12609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess bacillus Calmette-Guérin maintenance treatment schedule for non-muscle invasive bladder cancer at 2 years, using one-third of the full dose and fewer instillations every 3 months or 6 months. METHODS This was a prospective, randomized, multicenter study. All patients had an intermediate- or high-risk non-muscle invasive bladder cancer. They received three weekly instillations of one-third dose bacillus Calmette-Guérin every 6 months (group I) and two weekly instillations every 3 months (group II) during 3 years. In the two schedules we assessed efficacy, tolerance, leukocyturia and prostate-specific antigen. RESULTS No significant difference was observed between the two groups for recurrence at 6, 12 or 18 months. At 2 years, tumor recurrence was observed in 10.9% and muscle invasion in 2.9% of cases. Bacillus Calmette-Guérin tolerance was comparable - the adverse events score was 0.8 in group I and 1 in group II (P = 0.242). No statistical correlation was observed between the adverse events score over 2 years, either for leukocyturia (P = 0.8891) or prostate-specific antigen level (P = 0.7155). Leukocyturia level was not significantly associated with tumor recurrence or progression. CONCLUSION One-third dose maintenance bacillus Calmette-Guérin is effective with no impact on tumor recurrence or muscle invasion. Furthermore, there seems to be no difference in tumor response or side-effects between patients receiving two or three maintenance instillations every 3 months or 6 months. In clinical practice, the use of leukocyturia or total prostate-specific antigen levels do not appear to be useful in predicting bacillus Calmette-Guérin toxicity.
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Affiliation(s)
- Christian Pfister
- Urology Department, Charles Nicolle University Hospital, Rouen, France; Clinical Investigation Center, Inserm 6204, Onco-Urology Group, Rouen, France
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10
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Lacarrière E, Smaali C, Benyoucef A, Pfister C, Grise P. The efficacy of hemostatic radiotherapy for bladder cancer-related hematuria in patients unfit for surgery. Int Braz J Urol 2014; 39:808-16. [PMID: 24456773 DOI: 10.1590/s1677-5538.ibju.2013.06.06] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 09/07/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of our study was to assess short and mid-term clinical efficacy of external beam radiation therapy to achieve hemostasis in patients with bladder-cancer related gross hematuria who were unfit for surgery. We also assessed hypofractionation as a possible alternative option for more severe patients. PATIENTS AND METHODS Thirty-two patients were included for hemostatic radiation therapy, with two schedules based on Eastern Cooperative Oncology Group performance status. The standard treatment was 30 Gy in 10 fractions over 2 weeks. More severe patients underwent a hypofractionated regimen, with 20 Gy in 5 fractions over a one week period. Clinical evaluation was performed at 2 weeks and 6 months. RESULTS At 2 weeks, 69% of patients were hematuria-free. Subgroup analysis showed that 79% of patients undergoing hypofractionated regimen were hematuria-free. A total of 54% were hematuria-free with the standard regimen. Based on tumor stage, hematuria was controlled at 2 weeks for 57% of non-muscle invasive tumors and 72% of muscle-invasive tumors. After 6 months, 69% of patients had relapsed, regardless of tumor stage or therapy schedules. CONCLUSIONS Hemostatic radiotherapy is an effective option for palliative-care hematuria related to bladder cancer in patients unfit for surgery. Although it appears to be rapidly effective, its effect is of limited duration. Hypofractionation also seems to be an effective option; however larger cohorts and prospective trials are needed to evaluate its efficacy compared to standard schedules.
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Affiliation(s)
- E Lacarrière
- Department of Urology, Rouen University Hospital, Rouen, France
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11
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Mise au point du FRancilian Oncogeriatric Group (FROG) pour la prise en charge du cancer de vessie du sujet âgé. Bull Cancer 2014; 101:841-55. [DOI: 10.1684/bdc.2014.1939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Zagouri F, Peroukidis S, Tzannis K, Kouloulias V, Bamias A. Current clinical practice guidelines on chemotherapy and radiotherapy for the treatment of non-metastatic muscle-invasive urothelial cancer: a systematic review and critical evaluation by the Hellenic Genito-Urinary Cancer Group (HGUCG). Crit Rev Oncol Hematol 2014; 93:36-49. [PMID: 25205597 DOI: 10.1016/j.critrevonc.2014.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/30/2014] [Accepted: 08/14/2014] [Indexed: 12/15/2022] Open
Abstract
Radical cystectomy is the treatment of choice in localized muscle-invasive urothelial cancer. Nevertheless, relapses are frequent and systemic chemotherapy has been employed in order to reduce this risk. In addition, bladder preservation strategies are appealing. During the last decade, there has been a difficulty in conducting and completing large-scale trials in urothelial cancer. This has resulted in relatively few changes in the existing guidelines. Recent studies have created renewed interest in certain fields, such as the role of chemo-radiotherapy and management of unfit patients. In addition, application of certain guidelines has been limited in everyday practice. We conducted a systematic review of the existing guidelines and recent randomized trials not included in these guidelines, and developed a treatment algorithm, regarding non-surgical therapies for non-metastatic, muscle-invasive urothelial cancer based predominantly on patients' fitness for the available therapeutic modalities.
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Affiliation(s)
- F Zagouri
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - S Peroukidis
- Medical Oncology Department, University of Patras, Rion, Greece
| | - K Tzannis
- Department of Clinical Therapeutics, University of Athens, Athens, Greece
| | - V Kouloulias
- Radiotherapy Department, Attikon University Hospital, Athens, Greece
| | - A Bamias
- Department of Clinical Therapeutics, University of Athens, Athens, Greece.
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13
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Charbit D, Arnoux V, Gobet F, Pasquier D, Descotes JL, Pfister C. [Usefulness of endoscopic evaluation with fluorescence after endovesical BCG in the management of non-invasive bladder tumors]. Prog Urol 2014; 24:551-5. [PMID: 24975789 DOI: 10.1016/j.purol.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/23/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The objective of this retrospective study was to assess the usefulness of fluorescence during cystoscopy after BCG-therapy in the management of non-invasive bladder tumors. PATIENTS AND METHODS Fifty-four patients were enrolled: Ta (15 cases), T1 (27 cases) carcinoma in situ (CIS) alone (12 cases) or associated (14 cases). Urine cytology was of high grade and a second look was systematically performed in case of lamina propria infiltration. Initial therapy with 6 intravesical BCG instillations (81 mg) was performed with histologic and endoscopic bladder evaluation 3 months after initial resection using hexylaminolevulinate fluorescence (Hexvix(®) 85 mg). RESULTS Urine cytology was negative in 27 cases, suspicious in 12 cases and positive in 15 cases. With standard endoscopy under white light, mucosal bladder was normal in 32 cases, the use of fluorescence detected 8 tumour lesions confirmed with histology (CIS). When mucosal bladder was suspect under white light (22 patients), fluorescence was positive in 16 cases with 10 matching histological analysis (CIS and/or residual tumoral lesion). Therefore, despite high false positive rate with persistent mucosal bladder inflammation (38%), fluorescence guided endoscopy has allowed the diagnosis of suspect lesions not detected with white light with negative urine cytology. CONCLUSION Hexvix(®) fluorescence after intravesical BCG instillations may improve persistent carcinoma in situ detection when performed 3 months after induction treatment. However, a multicenter prospective study will be necessary in future to confirm these preliminary results. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- D Charbit
- Service d'urologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - V Arnoux
- Service d'urologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France
| | - F Gobet
- Service d'anatomopathologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France
| | - D Pasquier
- Service d'anatomopathologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France
| | - J-L Descotes
- Service d'urologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 9, France
| | - C Pfister
- Service d'urologie, hôpital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
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Traitement d’entretien par bacille Calmette-Guérin : enfin un schéma optimal ? Prog Urol 2014; 24:1-2. [DOI: 10.1016/j.purol.2013.08.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/26/2013] [Accepted: 08/26/2013] [Indexed: 11/22/2022]
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15
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Elalouf V, Klap J, Delongchamps NB, Conquy S, Sibony M, Saighi D, Peyromaure M, Flam T, Zerbib M, Xylinas E. Facteurs pronostiques des tumeurs de la voie excrétrice urinaire supérieure. Prog Urol 2013; 23:1382-8. [DOI: 10.1016/j.purol.2013.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 11/26/2022]
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Pfister C, Roupret M, Neuzillet Y, Larré S, Pignot G, Quintens H, Houedé N, Compérat E, Colin P, Roy C, Davin JL, Guy L, Irani J, Lebret T, Coloby P, Soulié M. Recommandations en onco-urologie 2013 du CCAFU : Tumeurs de la vessie. Prog Urol 2013; 23 Suppl 2:S105-25. [DOI: 10.1016/s1166-7087(13)70049-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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17
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Recommandations en onco-urologie 2013 du CCAFU : Tumeurs de la voie excrétrice urinaire supérieure. Prog Urol 2013; 23 Suppl 2:S126-32. [DOI: 10.1016/s1166-7087(13)70050-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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Descotes F, Dessen P, Bringuier PP, Decaussin M, Martin PM, Adams M, Villers A, Lechevallier E, Rebillard X, Rodriguez-Lafrasse C, Devonec M, Paparel P, Perrin P, Lazar V, Ruffion A. Microarray gene expression profiling and analysis of bladder cancer supports the sub-classification of T1 tumours into T1a and T1b stages. BJU Int 2013; 113:333-42. [PMID: 24053469 DOI: 10.1111/bju.12364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To try and identify a molecular signature for pathological staging and/or grading. through microarray analysis. PATIENTS AND METHODS We performed a prospective multicentre study between September 2007 and May 2008 that included 108 bladder tumours (45 pTa, 35 pT1 and 28>pT1). Microarray analysis was performed using Agilent Technologies Human Whole Genome 4 × 44K oligonucleotide microarrays (Agilent, Santa Clara, CA, USA). A 'dual colour' method was used vs a reference pool of tumours. From the lists of genes provided by the Biometric Research Branch class comparison analyses, we validated the microarray results of 38 selected differentially expressed genes using reverse transcriptase quantitative PCR in another bladder tumour cohort (n = 95). RESULTS The cluster 'superficial vs invasive stage' correctly classified 92.9% of invasive stages and 66.3% of superficial stages. Among the superficial tumours, the cluster analysis showed that pT1b tumours were closer to invasive stages than pT1a tumours. We also found molecular differences between low and high grade superficial tumours, but these differences were less well defined than the difference observed for staging. CONCLUSIONS We confirmed that the histopathological classification into subgroups pTa, pT1a and pT1b can be translated into a molecular signature with a continuous progression of deregulation (overexpression or repression of these genes) from superficial (pTa) to more invasive (pT1a then b) stages.
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Affiliation(s)
- Françoise Descotes
- Service de Biochimie Biologie Moléculaire, Hospices Civils de Lyon (HCL), Centre Hospitalier Lyon Sud, Pierre Bénite, France
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Guy L, Mahammedi H, Bastide C, Bruyere F, Karsenty G, Bay JO. [Medical treatment of bladder carcinoma]. Prog Urol 2013; 23:1238-45. [PMID: 24183082 DOI: 10.1016/j.purol.2013.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 09/15/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
AIM To describe drugs used in bladder carcinoma. METHOD Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). RESULTS The drugs used in the treatment of bladder cancer are represented by the products referred to diagnosis (hexyl aminolevulinate), the intravesical instillations for the treatment of tumors not infiltrating the muscle and the infiltrating tumor chemotherapy (neo-adjuvant treatment or metastatic tumors). The hexyl aminolevulinate cystoscopy allows to identify a significantly greater number of lesions, including carcinoma in situ, compared to conventional white light cystoscopy. For intravesical instillations, BCG has a superior efficacy to mitomycin C with a lower tolerance. The chemotherapies for invasive tumors are effective in metastatic disease in 15-20% of cases with a mean survival of 12 to 14 months. CONCLUSION Except the use of hexyl aminolevulinate for improving the diagnosis, there was no emergence in recent years of new drugs for the treatment of bladder cancer. Targeted therapies currently available for many neoplasms were ineffective for bladder cancer.
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Affiliation(s)
- L Guy
- Faculté de médecine, université d'Auvergne, 28, place Henri-Dunant, BP 38, 63001 Clermont-Ferrand cedex 1, France; Service d'urologie, hôpital G.-Montpied, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 1, France.
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20
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Michaud S, Kuntz A, Dupas D, Campion L, Bouchot O, Pfister C, Rigaud J. [Multicentric evaluation of a self-screening questionnaire for occupational bladder cancer]. Prog Urol 2013; 23:977-85. [PMID: 24090782 DOI: 10.1016/j.purol.2013.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 03/14/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Evaluate a self-screening questionnaire for bladder cancer of occupational origin and analyse an influence of exposure to a carcinogen bladder tumor on prognosis. PATIENTS AND METHODS Five hundred and thirty-one patients followed, between 2005 and 2010, for bladder cancer in two university centers have received a self-screening questionnaire derived from questionnaire KVP 08. Patients who responded positively to at least one of the items were considered to have a self-screening questionnaire "positive". Patients were finally invited to take an appointment for consultation in occupational pathology. RESULTS The response rate to self-screening questionnaire was 39.9% (212/531). It was "positive" in 82 cases (38.7%). Among the 82 patients with a self-screening questionnaire "positive", 46 patients consulted in occupational pathology (56%). Occupational exposure to a bladder carcinogen was documented in 91.3% of cases. Among the 22 patients who consulted in occupational pathology with a self-screening questionnaire "negative", an occupational exposure to a bladder carcinogen was documented in 13.6% of cases. The sensibility of the self-screening questionnaire was 91.3%, the specificity 86.4% and the accuracy 89.7%. The relative risk to have an occupational exposure if the self-screening questionnaire was "positive" was 6.69. The analysis of groups "positive" versus "negative" does not reveal any statistically significant difference in terms of tumor aggressiveness and disease-free survival. CONCLUSION The self-screening questionnaire was considered relevant with good reliability for detection of occupational exposure to a bladder carcinogen.
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Affiliation(s)
- S Michaud
- Clinique urologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
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21
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Ploussard G, Albrand G, Rozet F, Lang H, Paillaud E, Mongiat-Artus P. Challenging treatment decision-making in older urologic cancer patients. World J Urol 2013; 32:299-308. [DOI: 10.1007/s00345-013-1158-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/21/2013] [Indexed: 12/27/2022] Open
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22
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Neuzillet Y, Rouprêt M, Larré S, Irani J, Davin JL, Moreau JL, Pfister C. Diagnostic et prise en charge des événements indésirables sévères survenant au décours des instillations endovésicales de BCG pour le traitement des tumeurs de vessie n’infiltrant pas le muscle (TVNIM). Presse Med 2013; 42:1100-8. [DOI: 10.1016/j.lpm.2012.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/12/2012] [Accepted: 10/23/2012] [Indexed: 11/28/2022] Open
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Neuzillet Y, Larré S, Comperat E, Rouprêt M, Pignot G, Houede N, Quintens H, Wallerand H, Roy C, Soulie M, Pfister C. [Surgical treatment of metastatic urothelial carcinoma of the bladder: Review of the Cancer Committee of the French Association of Urology]. Prog Urol 2013; 23:951-7. [PMID: 24090779 DOI: 10.1016/j.purol.2013.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 02/18/2013] [Accepted: 03/09/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The role of surgery in the treatment of patients with metastatic urothelial bladder cancer is controversial. The aim was to review situations where surgical resection of the bladder tumor and/or metastatic urothelial carcinoma has been reported and analyze its results. MATERIALS AND METHODS A bibliographic research in French and English using the keywords BCG, bladder cancer, metastases, cystectomy, metastasectomy, radiotherapy, curative treatment and palliative treatment was performed, 177 articles have been reviewed, and 18 have been selected. RESULTS Synchronous or metachronous urothelial carcinoma metastases were diagnosed in 4 and 50% of the cases, respectively. The surgical treatment of metastatic urothelial carcinoma of the bladder has been proposed to achieve oncologic resection of all detectable lesions after a first-line chemotherapy or to treat symptoms, which were refractory to other treatment modalities. In achieving complete resection of the primary tumor and metastases after MVAC chemotherapies, the 5years overall survival was 28%. CONCLUSION There was no evidence in favouring surgical treatment of metastatic urothelial carcinoma. Considering the high perioperative mortality rate of cystectomy in imperative indications, particularly in the case of hematuria, all therapeutic alternatives must have been exhausted and urine derived in the simplest way.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, hôpital Foch, université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40, rue Worth, 92150 Suresnes, France.
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Galliot I, Le Gall S, Rigaud J, Saint F, Colombel M, Guy L, Wallerand H, Fantoni JC, Staerman F, Irani J, Soulie M, Pfister C. Traitement d’entretien par BCG-thérapie des tumeurs de vessie n’infiltrant pas le muscle (TVNIM) : résultats à un an de l’étude multicentrique URO-BCG-4. Prog Urol 2013; 23:336-46. [DOI: 10.1016/j.purol.2012.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 12/11/2012] [Accepted: 12/23/2012] [Indexed: 11/24/2022]
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Champy CM, Phé V, Drouin SJ, Comperat E, Parra J, Vaessen C, Mozer P, Bitker MO, Rouprêt M. [Prognostic influence of prostate gland invasion by bladder tumour and/or prostate cancer in cystoprostatectomy specimen: a review]. Prog Urol 2013; 23:165-70. [PMID: 23446280 DOI: 10.1016/j.purol.2012.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/06/2012] [Accepted: 11/09/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cystoprostatectomy (CPT) is the gold standard surgical treatment for muscle invasive bladder cancer (MIBC). In certain cases, MIBC can invade the prostate gland and/or a prostate cancer (PCa) can be discovered fortuitously on the pathologic specimen. The aim of the current study was to report the prognostic influence of PCa in patients who underwent a CPT for MIBC. MATERIALS AND METHODS A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: prostatic neoplasm; urinary bladder neoplasm; cystectomy; surgery; recurrence; prognosis; survival. Clinical cases and series of less than five cases were deliberately excluded herein. RESULTS Overall, ten studies published between 2004 and 2011 and involving 2196 patients were selected. Only retrospective studies of low level of evidence (NP 4) were available. The incidence of neoplastic invasion of the prostate gland by MIBC ranged from 25 to 48%. Preoperative predictors were multiple BC, recurrent, location in the trigone and existence of CIS. Overall survival at 3 years was significantly affected by the invasion of the prostate gland (pT4a) in these patients. The incidence of PCa discovered incidentally pathologic specimen CPT ranged from 14 to 49%. Only age was found as a positive predictor. The diagnosis of PCa did not influence survival of patients with MIBC and no specific PCa adjuvant treatment was systematically advocated. CONCLUSION Fortuitous diagnosis of PCa and/or neoplastic invasion of the prostatic gland by BC on CPT specimen is not uncommon but this is variable across studies, depending on the quality of the pathological analysis. The invasion of the prostate gland by MIBC is a serious situation (pT4a) and linked with a poor prognosis. In case of concomitant PCa and MIBC, the prognosis is much more related to the natural history of the bladder tumour.
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Affiliation(s)
- C M Champy
- Service d'urologie, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 83, boulevard de l'Hôpital, 75013 Paris, France
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[Bladder tumor targeting by Hexvix(®) fluorescence: 4 years results after prospective monocentric evaluation]. Prog Urol 2013; 23:195-202. [PMID: 23446284 DOI: 10.1016/j.purol.2012.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Revised: 10/06/2012] [Accepted: 12/02/2012] [Indexed: 11/20/2022]
Abstract
PURPOSE Prospective evaluation of bladder tumor targeting by Hexvix(®) fluorescence. PATIENTS AND METHODS From September 2008 to April 2012, 107 patients have been evaluated using Hexvix(®) technique (blue light) for typically papillary bladder tumor or suspected bladder tumor. Clinical and pathological data have been collected prospectively and patients have been classified using EORTC score. RESULTS From the 107 patients, 67 have been identified with bladder cancer and 328 samples have shown positive fluorescence in blue light. Compared to white light, 13 additional tumors have been diagnosed by Hexvix(®) for 11 patients: Cis (n=6), LMP (n=3), pTa low grade (n=3), pT1 low grade (n=1) (P=0.003). The false positive rate for Hexvix(®) was 53.4% versus 52% for white light. Previous TCC history, multifocality and EORTC score for recurrence and progression have been associated with better bladder cancer targeting by Hexvix(®) (P=0.007; P=0.01; P=0.03; P=0.04). CONCLUSION In our experience, Hexvix(®) targeting was associated with better diagnosis for bladder cancer with 9% (13/144) of new positive samples (P=0.003). In our study, false positive rate is a critical point (53.4%). Multifocality, previous TCC, and EORTC score for recurrence and progression might allow selecting patients to be targeted by Hexvix(®).
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Hitier-Berthault M, Ansquer C, Branchereau J, Renaudin K, Bodere F, Bouchot O, Rigaud J. 18 F-fluorodeoxyglucose positron emission tomography-computed tomography for preoperative lymph node staging in patients undergoing radical cystectomy for bladder cancer: a prospective study. Int J Urol 2012; 20:788-96. [PMID: 23279605 DOI: 10.1111/iju.12045] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/14/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of our study was to analyze the diagnostic performance of (18) F-fluorodeoxyglucose positron emission tomography-computed tomography for lymph node staging in patients with bladder cancer before radical cystectomy and to compare it with that of computed tomography. METHODS A total of 52 patients operated on between 2005 and 2010 were prospectively included in this prospective, mono-institutional, open, non-randomized pilot study. Patients who had received neoadjuvant chemotherapy or radiotherapy were excluded. (18) F-fluorodeoxyglucose positron emission tomography-computed tomography in addition to computed tomography was carried out for lymph node staging of bladder cancer before radical cystectomy. Lymph node dissection during radical cystectomy was carried out. Findings from (18) F-fluorodeoxyglucose positron emission tomography-computed tomography and computed tomography were compared with the results of definitive histological examination of the lymph node dissection. The diagnostic performance of the two imaging modalities was assessed and compared. RESULTS The mean number of lymph nodes removed during lymph node dissection was 16.5 ± 10.9. Lymph node metastasis was confirmed on histological examination in 22 cases (42.3%). This had been suspected in five cases (9.6%) on computed tomography and in 12 cases (23.1%) on (18) F-fluorodeoxyglucose positron emission tomography-computed tomography. Sensitivity, specificity, positive predictive value, negative predictive value, relative risk and accuracy were 9.1%, 90%, 40%, 57.4%, 0.91 and 55.7%, respectively, for computed tomography, and 36.4%, 86.7%, 66.7%, 65%, 2.72, 65.4%, respectively, for (18) F-fluorodeoxyglucose positron emission tomography-computed tomography. CONCLUSIONS (18) F-fluorodeoxyglucose positron emission tomography-computed tomography is more reliable than computed tomography for preoperative lymph node staging in patients with invasive bladder carcinoma undergoing radical cystectomy.
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Recommandations du comité de cancérologie de l’Association française d’urologie (CC-AFU) pour la bonne pratique des instillations endovésicales de BCG et de mytomycine C dans le traitement des tumeurs de la vessie n’envahissant pas le muscle (TVNIM). Prog Urol 2012; 22:920-31. [DOI: 10.1016/j.purol.2012.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 04/24/2012] [Accepted: 05/10/2012] [Indexed: 11/18/2022]
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Noël N, Couteau J, Maillet G, Gobet F, d'Aloisio F, Minier C, Pfister C. [Preliminary study of p53 and FGFR3 gene mutations in the urine for bladder tumors]. Prog Urol 2012; 23:29-35. [PMID: 23287481 DOI: 10.1016/j.purol.2012.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 07/27/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Two major pathways are described in bladder carcinogenesis: one for invasive or high grade tumors characterized by alteration of the p53 tumor suppressor gene and the other for non-invasive tumors or low grade involving mutations FGFR3. The objective of our study was to validate the research in the urine of mutations in these two genes in patients with a bladder tumor. PATIENTS AND METHODS In our preliminary study, we investigated 36 patients the FGFR3 and p53 mutations in tumors and urine collected during endoscopic resection. The p53 mutations were sought in FASAY, which allows a functional analysis of the protein P53. The FGFR3 mutations were sought in SNaPshot that searches the eight most frequent mutation points of this gene. RESULTS For 24 patients (66% of cases), we found at least one of the two mutations in the tumor. This mutation was present in the urine in 15 patients (sensitivity=62.5%). In only one patient, we found a mutation in the urinary sediment that did not exist in the tumor (specificity=91.7%). CONCLUSION The search for mutations of p53 and FGFR3 in the urine was a simple and non-invasive assay, which seems superior to urinary cytology for the detection of bladder tumors, raising hopes of an interest in this bio-assay for surveillance of bladder tumors and screening risk populations.
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Affiliation(s)
- N Noël
- Service d'urologie, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
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The oncologic impact of a delay between diagnosis and radical nephroureterectomy due to diagnostic ureteroscopy in upper urinary tract urothelial carcinomas: results from a large collaborative database. World J Urol 2012; 31:69-76. [PMID: 23070533 DOI: 10.1007/s00345-012-0959-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/18/2012] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES According to the current upper urinary tract urothelial carcinomas (UTUC) guidelines, ureteroscopic evaluation (URS) is recommended to improve diagnostic accuracy and obtain a grade (by biopsy or cytology). However, URS may delay radical surgery [e.g., nephroureterectomy (RNU)]. The objective of this study was to evaluate the influence of URS implementation before RNU on patient survival. METHODS A French multicentre retrospective study including 512 patients with nonmetastatic UTUC was conducted between 1995 and 2011. Achievement of ureteroscopy (URS), treatment time (time between imaging diagnosis and RNU), tumour location, pT-pN stage, grade, lymphovascular invasion (LVI) and the presence of invaded surgical margins (R+) were evaluated as prognostic factors for survival using univariate and multivariate Cox regression analyses. Cancer-specific survival (CSS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were calculated using the Kaplan-Meier method. RESULTS A total of 170 patients underwent ureteroscopy prior to RNU (URS+ group), and 342 did not undergo URS (URS-). The median treatment time was significantly longer in the URS+ group (79.5 vs. 44.5 days, p = 0.04). Ureteroscopic evaluation was correlated with ureteral location and lower stage and tumour grade (p = 0.022, 0.005, 0.03, respectively). Tumour stage, LVI+ and R+ status were independently associated with CSS (p = 0.024, 0.049 and 0.006, respectively). The 5-year CSS, RFS and MFS did not differ between the two groups (p = 0.23, 0.89 and 0.35, respectively). These results were confirmed for muscle-invasive (MI) UTUC (p = 0.21, 0.44 and 0.67 for CSS, RFS and MFS, respectively). CONCLUSIONS Despite the increased time to radical surgery, diagnostic ureteroscopy can be systematically performed for the appraisal of UTUC to refine the therapeutic strategy without significantly affecting oncological outcomes, even for MI lesions.
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Toledano H, Bastide C, Thoulouzan M, Arroua F, Carcenac A, Ragni E, Huyghe E, Plante P, Rossi D, Soulie M. [Radical cystectomy for urothelial bladder cancer: prognostic impact of lymph node metastasis and soft tissue surgical margins]. Prog Urol 2012; 22:705-10. [PMID: 22999117 DOI: 10.1016/j.purol.2012.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 05/14/2012] [Accepted: 07/14/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the association of soft tissue surgical margins (STSM) and/or lymph node metatstasis (pN+) with characteristics and outcomes of patients treated with radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). MATERIALS AND METHODS We retrospectively collected the data of 242 patients treated with RC and pelvic lymphadenectomy for UCB between January 2005 and June 2009. Different parameters were studied: age, PSAt, pathological stage of cystectomy specimen (pT and pN), tumor grade, number (nb) of nodes (N) in lymphadenectomy, nb of metastatic nodes (nb N+), bigger diameter of N+, ganglionic density, nb of N with capsular ruptur, associated CIS, associated prostate cancer, follow-up, global and specific survival, date and etiology of death. RESULTS Positive STSM were identified in 22 patients (9.1%) and lymph node metastasis in 59 (24.4%). pN+ status was significantly associated with lower global (GS) and specific survival (SS) (P<0.003). So was it for patients with positive STSM R+ with actuarial 3-year GS and SS respectively of 5% and 25% versus 35% and 43.9% no STSM (P<0.001). CONCLUSIONS Positive soft tissue surgical margin and/or lymph node metatstasis on cystectomy specimen is a strong predictor of GS and SS from urothelial carcinoma of the bladder. So it is for capsular rupture, ganglionic density greater or equal to 0.10 and nb of N in lymphadenectomy less than 14 for pN+ patients.
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Affiliation(s)
- H Toledano
- Service de chirurgie urologique, hôpital Nord, Marseille, France.
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Neuzillet Y, Rouprêt M, Wallerand H, Pignot G, Larré S, Irani J, Davin JL, Moreau JL, Soulié M, Pfister C. [Diagnosis and management of adverse events occuring during BCG therapy for non-muscle invasive bladder cancer (NMIBC): review of the Cancer Committee of the French Association of Urology]. Prog Urol 2012. [PMID: 23178094 DOI: 10.1016/j.purol.2012.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Intravesical BCG immuno-therapy with maintenance therapy is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression. In practice, adverse events (AEs) of BCG therapy could restrict its prescription by urologists. The aim of this article was to present a review of these AEs and of their management. MATERIALS AND METHODS A bibliographic research in French and English using Medline(®) and Embase(®) with the keywords "BCG", "bladder", "complication", "toxicity", "adverse reaction", "prevention" and "treatment" was performed. RESULTS The main mechanism of AEs of BCG are infectious (cystitis, fever), immuno-allergic (granulomatous prostatitis, epididymo-orchitis, and granulomatous reactions) and auto-immune (arthralgies, rash). Management of AEs is based on their pathophysiological mechanisms. Classifications of BCG therapy AEs based on clinical features allow to adapt their treatments. CONCLUSION The combination of antibiotics directed against BCG, steroid or non-steroidal anti-inflammatory medication and symptomatic treatment is currently the triad on which is set up the appropriate treatment of severe AEs. Reductions of BCG doses and ofloxacin medication after instillation decrease the frequency and severity of minor and moderate AEs. Severe or more than 7 days long infectious AEs, immuno-allergic AEs or auto-immune during more than 7 days impose cessation of BCG immuno-therapy.
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Affiliation(s)
- Y Neuzillet
- Service d'urologie, université de Versailles-Saint-Quentin-en-Yvelines, hôpital Foch, Suresnes, France.
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Tumeurs de vessie intradiverticulaires : revue du Comité de cancérologie de l’Association française d’urologie. Prog Urol 2012; 22:495-502. [DOI: 10.1016/j.purol.2012.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/02/2012] [Accepted: 03/26/2012] [Indexed: 11/23/2022]
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Larré S, Quintens H, Houéde N, Compérat E, Roy C, Pignot G, Rouprêt M, Neuzillet Y, Wallerand H, Soulié M, Pfister C. Intérêt du curage ganglionnaire dans les tumeurs urothéliales infiltrantes de la vessie (TVIM) et de la voie excrétrice supérieure (TVES) : article de revue du Comité de cancérologie de l’Association française d’urologie. Prog Urol 2012; 22:380-7. [DOI: 10.1016/j.purol.2012.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 01/02/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
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Traduction en langue française et validation linguistique de l’auto-questionnaire Bladder Cancer Index évaluant la qualité de vie dans les tumeurs de vessie. Prog Urol 2012; 22:350-3. [DOI: 10.1016/j.purol.2011.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/30/2011] [Accepted: 12/18/2011] [Indexed: 11/24/2022]
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Coz F, Vivaldi B, Zambrano N, Domenech A, Schiappacasse G, Retamal Y, Maurin C. Carcinosarcome du bassinet sur rein en fer à cheval : à propos d’un cas. Prog Urol 2012; 22:360-2. [DOI: 10.1016/j.purol.2011.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 11/14/2011] [Indexed: 11/27/2022]
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Rôle pronostique des emboles vasculaires tumoraux dans les tumeurs des voies excrétrices urinaires supérieures : analyse rétrospective monocentrique. Prog Urol 2012; 22:331-8. [DOI: 10.1016/j.purol.2012.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/04/2012] [Accepted: 01/18/2012] [Indexed: 11/22/2022]
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Ballouhey Q, Thoulouzan M, Lunardi P, Bellec L, Huyghe E, Plante P, de Petriconi R, Soulié M. Étude prospective chez 100 patients des résultats de la technique d’anastomose urétéro-iléale en double cheminée dans la néovessie de Hautmann. Prog Urol 2012; 22:255-60. [DOI: 10.1016/j.purol.2011.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 10/29/2011] [Accepted: 11/13/2011] [Indexed: 11/30/2022]
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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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Abstract
Cancer of the bladder is the seventh most common of all cancers observed in France, and is the second urological cancer after prostate cancer. It is mainly related to nicotine addiction. When doing the initial tests, ultrasound examination of the bladder can enable the clinician to diagnose a polypoid tumour and thus avoid his having to organise diagnostic fibroscopy. When the bladder tumour infiltrates the detrusor muscle, the situation becomes life-threatening for the patient and radical treatment is envisaged. Uro-CT is the standard examination to characterise the lesion and describe its relationship with neighbouring organs. It is essential, and must be performed before endoscopic resection of the tumour, to be correctly interpreted. It is imperative for imaging to look for a synchronous lesion in the upper urinary tract (ureters, renal pelvis), because the presence of such a lesion changes the prognosis of the disease and the sequence of therapy, which is decided by the urologist in a multidisciplinary consultation.
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Affiliation(s)
- M Rouprêt
- Department of Urology, University Pierre-et-Marie-Curie, Paris-VI, Pitié-Salpêtrière Hospital, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Quintens H, Roupret M, Larré S, Neuzillet Y, Pignot G, Compérat E, Wallerand H, Houédé N, Roy C, Soulié M, Pfister C. Radiochimiothérapie pour le traitement des cancers de vessie infiltrant le muscle : modalités, surveillance et résultats. Mise au point du comité de cancérologie de l’Association française d’urologie. Prog Urol 2012; 22:13-6. [DOI: 10.1016/j.purol.2011.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/28/2011] [Accepted: 09/28/2011] [Indexed: 10/15/2022]
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Wallerand H, Rouprêt M, Larré S, Houédé N, Neuzillet Y, Compérat E, Quintens H, Pignot G, Roy C, Soulié M, Pfister C. [The role and method of fluorescence-guided cystoscopy in 2011 for management of bladder cancer: Review of the Oncology Committee of the French Urology Association]. Prog Urol 2011; 21:823-8. [PMID: 22035906 DOI: 10.1016/j.purol.2011.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 08/09/2011] [Accepted: 08/10/2011] [Indexed: 10/17/2022]
Abstract
AIM Fluorescence-guided cystoscopy is a useful tool for bladder tumour detection in association with white-light cystoscopy and decreases the residual tumour rate. The aim of the study was to provide an overview of the pertinent literature on this subject. MATERIALS AND METHODS The data were provide from a Medline(®) research by using the follow keywords: urinary bladder neoplasms; cystoscopy; fluorescence; prognosis; intraepithelial neoplasm. RESULTS No evidence 1 level data was available. The fluorescence-guided cystoscopy improves the bladder cancer detection rate, especially the flat lesions, and improve the recurrence-free survival by decreasing the residual tumour rate. The specific indications for fluorescence-guided cystoscopy in the diagnosis and management of non-muscle invasive bladder cancer (NMIBC) should benefit the patients. CONCLUSION The fluorescence-guided cystoscopy is a benefical tool in association with white-light cystoscopy in NMIBC diagnosis. It has been shown to have a positive impact on recurrence-free survival but not on progression-free survival. More investigations with significant follow-up should be lead in the future to accurately assess its therapeutic impact on patients.
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Affiliation(s)
- H Wallerand
- Service d'urologie du CHU Pellegrin, le tripode, université Victor-Segalen, 33074 Bordeaux, France.
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Rouprêt M, Drouin SJ, Larré S, Neuzillet Y, Botto H, Hitier M, Rigaud J, Crew J, Xylinas E, Salomon L, Cornu JN, Iborra F, Champetier D, Rozet F, Flamand V, Bastide C, Cormier L, Durand X, Lunardi P, Rischmann P, Nouhaud FX, Ferlicot S, Patard JJ, Floch AP, Irani J, Peyronnet B, Bensalah K, Poissonnier L, Grès P, Droupy S, Casenave J, Wallerand H, Soulié M, Pfister C. Oncologic Outcomes and Survival in pT0 Tumors After Radical Cystectomy in Patients Without Neoadjuvant Chemotherapy: Results from a Large Multicentre Collaborative Study. Ann Surg Oncol 2011; 18:3833-8. [PMID: 21647762 DOI: 10.1245/s10434-011-1824-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Indexed: 11/18/2022]
Affiliation(s)
- Morgan Rouprêt
- Academic Department of Urology of la Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Pierre et Marie Curie, University Paris VI, Paris, France.
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Meyer F, Al Qahtani S, Gil-Diez de Medina S, Geavlete B, Thomas A, Traxer O. [Narrow band imaging: description of the technique and initial experience with upper urinary tract carcinomas]. Prog Urol 2011; 21:527-33. [PMID: 21872155 DOI: 10.1016/j.purol.2011.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/03/2011] [Accepted: 03/13/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Endoscopic treatment of upper urinary tract carcinomas (UUTC) is becoming more and more prevalent compared to non-conservative surgery. Our goal was to determine if NBI technology could improve tumour detection. MATERIAL Twenty-seven patients with known or suspected UUTC were prospectively enrolled and treated using the Olympus URF-V flexible ureteroscope. We report 13 new cases (48%) and 14 known cases as follow up (52%). White light and NBI were subsequently performed to examine the upper urinary tract. Visual aspect of the lesions could be compared using both types of light. Biopsies were taken for all apparent lesions prior to vaporization by Holmium laser. RESULTS Forty-three lesions were detected in 21 patients. Five lesions (14.2%) in four patients were detected through NBI light only among the 35 lesions containing UUTC. Two out of four of these patients were new cases and would not have been diagnosed with white light alone. Three UUTC-treated (8.5%) had extended margins in NBI. Thirteen biopsies (26%) were not valid. Altogether, the tumour detection rate improved by 22.7% in seven patients (25.9%) by using the NBI method. CONCLUSION Upper urinary tract endoscopy with NBI light is a new technology that improves visualization of UUCT and enables diagnosis of lesions non visible in white light. This procedure cannot yet be recommended for daily practice and further validation of the technique is required.
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Affiliation(s)
- F Meyer
- Service d'Urologie, Hôpital Tenon, 4 Rue de la Chine, 75020 Paris, France
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Rouprêt M. [Is conservative endoscopic management of upper urinary tract tumour by flexible ureteroscopy about to replace nephroureterectomy?]. Prog Urol 2011; 21:367-8. [PMID: 21514542 DOI: 10.1016/j.purol.2011.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Accepted: 02/18/2011] [Indexed: 11/17/2022]
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