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Tyagi P, Moon CH, Connell M, Ganguly A, Cho KJ, Tarin T, Dhir R, Sholosh B, Maranchie J. Intravesical Contrast-Enhanced MRI: A Potential Tool for Bladder Cancer Surveillance and Staging. Curr Oncol 2023; 30:4632-4647. [PMID: 37232808 PMCID: PMC10217503 DOI: 10.3390/curroncol30050350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
This review article gives an overview of the current state of the art of bladder cancer imaging and then discusses in depth the scientific and technical merit of a novel imaging approach, tracing its evolution from murine cancer models to cancer patients. While the poor resolution of soft tissue obtained by widely available imaging options such as abdominal sonography and radiation-based CT leaves them only suitable for measuring the gross tumor volume and bladder wall thickening, dynamic contrast-enhanced magnetic resolution imaging (DCE MRI) is demonstrably superior in resolving muscle invasion. However, major barriers still exist in its adoption. Instead of injection for DCE-MRI, intravesical contrast-enhanced MRI (ICE-MRI) instills Gadolinium chelate (Gadobutrol) together with trace amounts of superparamagnetic agents for measurement of tumor volume, depth, and aggressiveness. ICE-MRI leverages leaky tight junctions to accelerate passive paracellular diffusion of Gadobutrol (604.71 Daltons) by treading the paracellular ingress pathway of fluorescein sodium and of mitomycin (<400 Daltons) into bladder tumor. The soaring cost of diagnosis and care of bladder cancer could be mitigated by reducing the use of expensive operating room resources with a potential non-surgical imaging option for cancer surveillance, thereby reducing over-diagnosis and over-treatment and increasing organ preservation.
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Affiliation(s)
- Pradeep Tyagi
- Department of Urology, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Lin L, Guo X, Ma Y, Zhu J, Li X. Does repeat transurethral resection of bladder tumor influence the diagnosis and prognosis of T1 bladder cancer? A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:29-38. [PMID: 35752497 DOI: 10.1016/j.ejso.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND To reduce recurrence or progression of tumor, NCCN guidelines recommend repeat transurethral resection of bladder tumors (reTURB) for non-muscle-invasive bladder cancer (NMIBC). The study aims to compare the impact of initial TURB and reTURB on the rate of residual or upstaging tumors and short-term and long-term survival outcomes of T1 bladder cancer (BC). MATERIALS AND METHODS We searched through several public database, including PubMed, Embase, Ovid Medline and Ovid EBM Reviews - Cochrane Central Register of Controlled Trials. The latest search time was October 2021. RESULTS In general, 68 articles were involved. Short-term RFS (1-year and 3-year) of reTURB group was better compared with TURB group in T1 patients. The pooled RR were 1.10 (95%CI: 1.01-1.19) and 1.15 (95%CI: 1.03-1.28), respectively. While reTURB did not improve long-term RFS (5-year, 10-year, 15-year) in T1 patients. The pooled RR were 1.12 (95%CI: 0.97-1.30), 1.11 (95%CI: 0.82-1.50) and 1.37 (95%CI: 0.50-3.74), respectively. Analysis of PFS, OS and CSS demonstrated similar outcomes with RFS. We found that about two-thirds of samples contained detrusor. The residual tumor rate in stage T1 was 0.48 (95%CI: 0.42-0.53). While the rate of upstaging in stage T1 was 0.10 (95%CI: 0.07-0.13). CONCLUSIONS In conclusion, reTURB might provide short-term survival benefits for T1 BC, but it was not the same for long-term outcomes. The residual and upstaging rates of T1 BC in reTURB were around 50% and 10%, respectively. Our study might be conducive to clinically informed consents when patients expressed their concerns about the necessity of reTURB and its impact on diagnosis, treatment and prognosis.
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Affiliation(s)
- Lede Lin
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaotong Guo
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yucheng Ma
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiang Zhu
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Xiang Li
- Department of Urology, Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Yong C, Mott SL, Steinberg RL, Packiam VT, O'Donnell MA. A longitudinal single center analysis of T1HG bladder cancer: An 18 year experience. Urol Oncol 2022; 40:491.e1-491.e9. [PMID: 35831215 DOI: 10.1016/j.urolonc.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/06/2022] [Accepted: 06/12/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To re-evaluate the treatment of T1HG bladder cancer by analyzing our experience over 18 years. METHODS AND MATERIALS An IRB-approved, single-institution retrospective review was performed of all patients with T1HG bladder cancer between August 1999 and July 2017. We assessed clinicopathologic characteristics, treatment history (including intravesical therapy, cystectomy, systemic chemotherapy, and radiation), and oncologic outcomes. RESULTS We identified 191 patients with T1HG. Five patients underwent cystectomy at diagnosis. The five-year recurrence-free survival (RFS) for the 186 patients who initially underwent bladder sparing treatments was 50% (95% CI: 41%-58%). There were 83 patients (45%) with disease recurrence; median time to recurrence was 6.7 months (IQR: 4.9-17.5). Disease characteristics at initial recurrence was T2 or greater in 8 patients (10%), T1HG in 19 (23%), CIS in 30 (36%), TaHG in 10 (12%), T1 low-grade (LG) in 1 (1%), and TaLG in 15 (18%). For patients with no prior recurrences, neither re-resection (P = 0.12), receipt of induction therapy (P = 0.81), prostatic urethra positivity (P = 0.51), or age (P = 0.34) were significantly associated with risk of recurrence. Similarly, patients with a single recurrence also fared well without identifiable risk factors. In fact, baseline hazard function analysis demonstrated no differences in RFS comparing patients stratified by 0, 1, and 2+ prior recurrences (P = 0.46). The five-year overall survival (OS) was 76% (95% CI: 68%-82%), and median OS was 127 months. The five-year cancer-specific survival was 86% (95% CI: 78%-91%) for the overall cohort. Five-year cystectomy-free survival for patients with BCG responsive disease and unresponsive disease was 95% (95% CI: 85%-98%) and 72% (95% CI: 52%-84%), respectively. CONCLUSION For patients who recurred after intravesical therapy, including those with recurrent T1 disease, additional induction courses of intravesical therapy did not negatively affect oncologic outcomes. Pathology of initial recurrence was not found to be a statistically significant risk factor for future recurrence. These findings suggest that BCG-unresponsive disease does not necessarily require immediate cystectomy. A multicenter, pragmatically designed evaluation in a contemporary cohort would more validly interrogate this important patient population.
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Affiliation(s)
- Courtney Yong
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center Biostatistics, College of Public Health Building, Iowa City, IA
| | - Ryan L Steinberg
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Vignesh T Packiam
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Michael A O'Donnell
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA.
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Fan J, Zhang X, Fan J, Li L, He D, Wu K. Risk Stratification for the Rate and Location of Residual Bladder Tumor for the Decision of Re-Transurethral Resection of Bladder Tumor. Front Oncol 2022; 12:788568. [PMID: 35155230 PMCID: PMC8829133 DOI: 10.3389/fonc.2022.788568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 01/07/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction To assess the rate and location of residual tumor in re-transurethral resection of bladder tumor (re-TURBT) and develop a risk stratification tool to assist clinicians in making treatment decisions. Patients and Methods The data of 144 patients with high-risk bladder cancer who received re-TURBT were retrospectively reviewed. The rate and location of residual tumors was recorded. Logistic regression was performed to explore risk factors for residual tumors, and a risk classification tool was developed. Results Among the 144 patients, the rates of residual tumor and tumor location at the base of the primary tumor were 22.2% and 10.4%, respectively. Non-urothelial carcinoma subspecialist, piecemeal resection and the absence of detrusor muscle in the first specimen were defined as risk factors. Patients were categorized into low-, intermediate-, and high-risk groups according to the number of risk factors. The rate of residual tumor in the high-risk group was significantly higher than that in the low- and intermediate-risk groups (50% vs. 7.8%, P=0.001; 50% vs. 18.6%, P=0.002). Moreover, high-risk patients benefitted more from a second resection at the base of the primary tumor due to the high rate of residual tumor located at this site than low- and intermediate-risk patients (23.5% vs. 2.0%, P=0.002; 23.5% vs. 10.2%, P=0.083). Conclusions Risk stratification based on the subspecialist category, operative method, and presence or absence of detrusor muscle in the first specimen could help identify patients who benefit from re-TURBT and second resection the base of the primary tumor.
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Affiliation(s)
- Junjie Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Urology, Baoji Central Hospital, Baoji, China
| | - Xing Zhang
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Lei Li
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Dalin He
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaijie Wu
- Department of Urology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Diagnostic performance of the vesical imaging-reporting and data system for detecting muscle-invasive bladder cancer in real clinical settings: Comparison with diagnostic cystoscopy. Urol Oncol 2021; 40:61.e1-61.e8. [PMID: 34332846 DOI: 10.1016/j.urolonc.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/13/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE We herein compared the diagnostic performance of Vesical Imaging-Reporting and Data System (VI-RADS) scoring with diagnostic cystoscopy and evaluated diagnostic accuracies based on tumor locations. MATERIALS AND METHODS Among 112 bladder cancer patients who underwent multiparametric magnetic resonance imaging and diagnostic cystoscopy preoperatively to detect bladder cancer, 61 were analyzed. VI-RADS was categorized into 5 stages by 2 radiologists (R1 and R2). Cut-off values ≥3 indicated muscle-invasive bladder cancer (MIBC). Muscle invasion (MI) was visually evaluated using diagnostic cystoscopy by 2 urologists (U1 and U2). The sensitivity and specificity of VI-RADS scores and diagnostic cystoscopy for diagnosing MI were compared. RESULTS 16 patients (26.2%) were pathologically diagnosed with MIBC. Regarding MI diagnostic accuracy, the sensitivity/specificity of VI-RADS scores were 93.8/88.9% by R1 and 87.5/86.7% by R2, while those of diagnostic cystoscopy were 56.3/68.9% by U1 and 68.8/84.4% by U2. Therefore, the diagnostic accuracy of VI-RADS was significantly higher than that of cystoscopy, particularly for tumors located on the bladder neck, trigone, dome, and posterior and anterior walls. Over- and under-diagnosis rates were higher with VI-RADS than with diagnostic cystoscopy (25.9% vs. 14.8%) for tumors located on the lateral wall or ureteral orifice. CONCLUSION VI-RADS had superior diagnostic performance for detecting MI, especially in tumors located at the bladder neck/trigone/dome/posterior and anterior wall. However, VI-RADS was inferior to cystoscopy in terms of MI detection for tumors located on the lateral wall or ureteral orifice. Therefore, a combination of diagnostic tools is recommended for the accurate staging of these tumors.
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Bebane S, Denize J, Goujon A, Meria P, Verine J, Mongiat-Artus P, Desgrandchamps F, Masson-Lecomte A. Perioperative outcomes of transurethral resection for t1 bladder tumors: quality evaluation based on patient, tumor and surgeon criteria. World J Urol 2021; 39:4159-4165. [PMID: 34160681 DOI: 10.1007/s00345-021-03765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Transurethral resection of bladder tumor (TURBT) is a fundamental but challenging step in the diagnosis and treatment of non-muscle invasive bladder cancer (NMIBC). The first- and second-look TURBT are central in the management of T1 tumors. MATERIALS AND METHODS We retrospectively reviewed all patients treated with TURBT for T1 urothelial cell carcinoma (UCC) of the bladder in one academic institution between 2007 and 2017. Quality of TURBT was evaluated based on the presence/absence of muscle on pathology report, the presence/absence of residual tumor on the second look and the occurrence of complications. Patient-, surgeon- and tumor-related factors were investigated for their association with TURBT quality. RESULTS 283 patients were included. Second-look resection was performed after a mean delay of 54 days. Muscle was observed in 85.9% of the samples on the first TURBT. On the second-look resection, UCC was observed in 52.3% of the samples. 38 complications were reported after the first TURBT (13.4%). Surgeon's experience was the only factor significantly associated with occurrence of post-operative complications (OR = 0.40; p = 0.04). Location of the tumor at the bottom of the bladder was a risk factor for not finding muscle at pathological analysis (OR = 0.20; p = 0.06). Male gender, multiplicity and tumor located at the bottom of the bladder were significantly associated with residual disease on reTURBT. In multivariate analysis, only male gender (OR = 4.71; p = 0.02) and tumor multiplicity remained significant (OR for unique tumor = 0.36; p = 0.02). CONCLUSION TURBT is a challenging procedure and surgeon's experience is crucial in reducing the rate of post-operative complications. Technical difficulties resulting from patient's gender, tumor location or number of tumors may be as important as oncological factors in deciding whether or not to perform a second-look resection.
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Affiliation(s)
- Sonia Bebane
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Justine Denize
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Annabelle Goujon
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Paul Meria
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Jerome Verine
- Pathology Department, Saint Louis Hospital, APHP, Paris, France
| | - Pierre Mongiat-Artus
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France
- Université de Paris, Paris, France
| | - Francois Desgrandchamps
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France
- Université de Paris, Paris, France
| | - Alexandra Masson-Lecomte
- Service D'Urologie, Hôpital Saint Louis, APHP, 1 avenue Claude Vellefaux, 75010, Paris, France.
- Université de Paris, Paris, France.
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Can repeat biopsy be skipped after initial complete resection of T1 bladder cancer? The role of a novel urinary mRNA biomarker. Urol Oncol 2021; 39:437.e11-437.e19. [PMID: 33785220 DOI: 10.1016/j.urolonc.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To prospectively investigate the role of a urinary mRNA biomarker (Xpert Test) after initial complete resection of T1 bladder cancer (BC) for the prediction of positive repeat biopsy for malignancy. METHODS Patients who underwent TURBT for NMIBC between September 2018 and April 2020 were included. Patients with benign pathology, incomplete resection, concomitant CIS/upper tract urothelial tumor or muscle invasive BC, were excluded. 2 to 6 weeks after primary TURBT, voided urine sample was retrieved for Xpert analysis and patients were scheduled for repeat biopsy. The primary outcome was to determine the role of positive Xpert test to predict positive repeat biopsy for malignancy. RESULTS During the study period, 254 patients met the study inclusion criteria of which 61 (24%) patients had recurrent NMIBC. Complete resection was censured by the presence of detrusor muscle in the specimen with documented T1 disease in all study participants. Xpert test was positive in 128 patients; of whom 85 (66.4%) showed positive repeat biopsy (HR=6.2, 95%CI=3.46-9.4, P = 0.002). The sensitivity, specificity, positive and negative predictive values of Xpert test for repeat biopsy were 85.9% (95%CI: 82-89), 72.3% (95%CI: 68-76), 66.4% (95%CI: 62-71) and 88.9% (95%CI: 85-94), respectively. On median (range) follow up of 12(3-25) months, tumor recurrence was encountered in 84 (35%) patients. On multivariate Cox regression analysis, Xpert test was significantly associated with tumor recurrence (HR= 9.7, 95%CI=5-18, P <0.001). CONCLUSIONS Positive Xpert test after primary complete resection of T1 BC is significantly associated with positive repeat biopsy for malignancy. In addition, Xpert test is an independent predictor of early tumor recurrence. Xpert test might be applied after initial complete resection of NMIBC to minimize unnecessary repeat biopsy with potential saving of healthcare costs and reduction in patient morbidity.
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Bobjer J, Hagberg O, Aljabery F, Gårdmark T, Jahnson S, Jerlström T, Sherif A, Ströck V, Häggström C, Holmberg L, Liedberg F. A population-based study on the effect of a routine second-look resection on survival in primary stage T1 bladder cancer. Scand J Urol 2021; 55:108-115. [PMID: 33678124 DOI: 10.1080/21681805.2021.1892179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the value of second-look resection (SLR) in stage T1 bladder cancer (BCa) with respect to progression-free survival (PFS), and also the secondary outcomes recurrence-free survival (RFS), bladder-cancer-specific survival (CSS), and cystectomy-free survival (CFS). PATIENTS AND METHODS The study included 2456 patients diagnosed with stage T1 BCa 2004-2009 with 5-yr follow-up registration in the nationwide Bladder Cancer Data Base Sweden (BladderBaSe). PFS, RFS, CSS, and CFS were evaluated in stage T1 BCa patients with or without routine SLR, using univariate and multivariable Cox regression with adjustment for multiple confounders (age, gender, tumour grade, intravesical treatment, hospital volume, comorbidity, and educational level). RESULTS SLR was performed in 642 (26%) individuals, and more frequently on patients who were aged < 75 yr, had grade 3 tumours, and had less comorbidity. There was no association between SLR and PFS (hazard ratio [HR] 1.1, confidence interval [CI] 0.85-1.3), RFS (HR 1.0, CI 0.90-1.2), CFS (HR 1.2, CI 0.95-1.5) or CSS (HR 1.1, CI 0.89-1.4). CONCLUSIONS We found similar survival outcomes in patients with and patients without SLR, but our study is likely affected by selection mechanisms. A randomised study defining the role of SLR in stage T1 BCa would be highly relevant to guide current praxis.
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Affiliation(s)
- Johannes Bobjer
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Oskar Hagberg
- Institution of Translational Medicine, Lund University, Malmö, Sweden
| | - Firas Aljabery
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Truls Gårdmark
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Staffan Jahnson
- Department of Clinical and Experimental Medicine, Division of Urology, Linköping University, Linköping, Sweden
| | - Tomas Jerlström
- Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Amir Sherif
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Viveka Ströck
- Department of Urology, Sahlgrenska University Hospital and Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | | | - Lars Holmberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Fredrik Liedberg
- Department of Urology, Skåne University Hospital, Malmö, Sweden.,Institution of Translational Medicine, Lund University, Malmö, Sweden
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Efficacy of three BCG strains (Connaught, TICE and RIVM) with or without secondary resection (re-TUR) for intermediate/high-risk non-muscle-invasive bladder cancers: results from a retrospective single-institution cohort analysis. J Cancer Res Clin Oncol 2021; 147:3073-3080. [PMID: 33675400 PMCID: PMC8397662 DOI: 10.1007/s00432-021-03571-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/15/2021] [Indexed: 11/09/2022]
Abstract
Purpose (I) To evaluate the clinical efficacy of three different BCG strains in patients with intermediate-/high-risk non-muscle-invasive bladder cancer (NMIBC). (II) To determine the importance of performing routine secondary resection (re-TUR) in the setting of BCG maintenance protocol for the three strains. Methods NMIBCs who received an adjuvant induction followed by a maintenance schedule of intravesical immunotherapy with BCG Connaught, TICE and RIVM. Only BCG-naïve and those treated with the same strain over the course of follow-up were included. Cox proportional hazards model was developed according to prognostic factors by the Spanish Urological Oncology Group (CUETO) as well as by adjusting for the implementation of re-TUR. Results n = 422 Ta-T1 patients (Connaught, n = 146; TICE, n = 112 and RIVM, n = 164) with a median (IQR) follow-up of 72 (60–85) were reviewed. Re-TUR was associated with improved recurrence and progression outcomes (HRRFS: 0.63; 95% CI 0.46–0.86; HRPFS: 0.55; 95% CI 0.31–0.86). Adjusting for CUETO risk factors and re-TUR, BGC TICE and RIVM provided longer RFS compared to Connaught (HRTICE: 0.58, 95% CI 0.39–0.86; HRRIVM: 0.61, 95% CI 0.42–0.87) while no differences were identified between strains for PFS and CSS. Sub-analysis of only re-TUR cases (n = 190, 45%) showed TICE the sole to achieve longer RFS compared to both Connaught and RIVM. Conclusion Re-TUR was confirmed to ensure longer RFS and PFS in intermediate-/high-risk NMIBCs but did not influence the relative single BCG strain efficacy. When routinely performing re-TUR followed by a maintenance BCG schedule, TICE was superior to the other strains for RFS outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03571-0.
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Del Giudice F, Campa R, Bicchetti M, De Berardinis E, Panebianco V. Vesical Imaging-Reporting and Data System (VI-RADS) incorporated into bladder cancer clinical practice: what's the perspectives beyond diagnostic accuracy? Transl Androl Urol 2020; 9:2320-2322. [PMID: 33216837 PMCID: PMC7658160 DOI: 10.21037/tau-2020-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy.,Department of Urology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Riccardo Campa
- Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Marco Bicchetti
- Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
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Krajewski W, Moschini M, Nowak Ł, Poletajew S, Tukiendorf A, Afferi L, Teoh J, Muilwijk T, Joniau S, Tafuri A, Antonelli A, Gozzo A, Mari A, Di Trapani E, Hendricksen K, Alvarez-Maestro M, Serrano AR, Simone G, Zamboni S, Simeone C, Marconi MC, Mastroianni R, Ploussard G, Rajwa P, Laukhtina E, Zdrojowy-Wełna A, Kołodziej A, Paradysz A, Tully K, Krajewska J, Piszczek R, Xylinas E, Zdrojowy R. Restaging Transurethral Resection of Bladder Tumours after BCG Immunotherapy Induction in Patients with T1 Non-Muscle-Invasive Bladder Cancer Might not Be Associated with Oncologic Benefit. J Clin Med 2020; 9:jcm9103306. [PMID: 33076249 PMCID: PMC7602446 DOI: 10.3390/jcm9103306] [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: 09/17/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The European Association of Urology guidelines recommend restaging transurethral resection of bladder tumours (reTURB) 2-6 weeks after primary TURB. However, in clinical practice some patients undergo a second TURB procedure after Bacillus Calmette-Guérin immunotherapy (BCG)induction. To date, there are no studies comparing post-BCG reTURB with the classic pre-BCG approach. The aim of this study was to assess whether the performance of reTURB after BCG induction in T1HG bladder cancer is related to potential oncological benefits. MATERIALS AND METHODS Data from 645 patients with primary T1HG bladder cancer treated between 2001 and 2019 in 12 tertiary care centres were retrospectively reviewed. The study included patients who underwent reTURB before BCG induction (Pre-BCG group: 397 patients; 61.6%) and those who had reTURB performed after BCG induction (Post-BCG group: 248 patients, 38.4%). The decision to perform reTURB before or after BCG induction was according to the surgeon's discretion, as well as a consideration of local proceedings and protocols. Due to variation in patients' characteristics, both propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. RESULTS The five-year recurrence-free survival (RFS) was 64.7% and 69.1% for the Pre- and Post-BCG groups, respectively, and progression-free survival (PFS) was 82.7% and 83.3% for the Pre- and Post-BCG groups, respectively (both: p > 0.05). Similarly, neither RFS nor PFS differed significantly for a five-year period or in the whole time of observation after the PSM and IPW matching methods were used. CONCLUSIONS Our results suggest that there might be no difference in recurrence-free survival and progression-free survival rates, regardless of whether patients have reTURB performed before or after BCG induction.
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Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
- Correspondence: ; Tel.: +48-717331010
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland; (M.M.); (L.A.)
| | - Łukasz Nowak
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Andrzej Tukiendorf
- Department of Public Health, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Luca Afferi
- Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland; (M.M.); (L.A.)
| | - Jeremy Teoh
- S.H.Ho Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China;
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (T.M.); (S.J.)
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (T.M.); (S.J.)
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37129 Verona, Italy; (A.T.); (A.A.); (A.G.)
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37129 Verona, Italy; (A.T.); (A.A.); (A.G.)
| | - Alessandra Gozzo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37129 Verona, Italy; (A.T.); (A.A.); (A.G.)
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, 50139 Florence, Italy;
| | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology, 20143 Milan, Italy;
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Mario Alvarez-Maestro
- Department of Urology Hospital Universitario La Paz, 28046 Madrid, Spain; (M.A.-M.); (A.R.S.)
| | | | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, 00144 Rome, Italy; (G.S.); (R.M.)
| | - Stefania Zamboni
- Urology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia 25123, Italy; (S.Z.); (C.S.); (M.C.M.)
| | - Claudio Simeone
- Urology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia 25123, Italy; (S.Z.); (C.S.); (M.C.M.)
| | - Maria Cristina Marconi
- Urology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia 25123, Italy; (S.Z.); (C.S.); (M.C.M.)
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, 00144 Rome, Italy; (G.S.); (R.M.)
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France;
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia, 3 Maja Street 13-15, 41-800 Zabrze, Poland; (P.R.); (A.P.)
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, 119146 Moscow, Russia;
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, 1090 Vienna, Austria
| | - Aleksandra Zdrojowy-Wełna
- Department of Endocrinology, Diabetes and Isothope Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anna Kołodziej
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, 3 Maja Street 13-15, 41-800 Zabrze, Poland; (P.R.); (A.P.)
| | - Karl Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, 44625 Herne, Germany;
| | - Joanna Krajewska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Radosław Piszczek
- Department of Urology and Oncologic Urology, Lower Silesian Specialist Hospital, 50-556 Wroclaw, Poland;
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75018 Paris, France;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
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