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Özsoy Ç, Demir Y, Yılmaz K, Ölçücü MT, Kılıç Ş, Ateş M. Prospective evaluation of surgical margins in non-muscle invasive bladder cancer following primary transurethral resection. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102705. [PMID: 39059766 DOI: 10.1016/j.fjurol.2024.102705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Non-muscle invasive bladder cancers (NMIBC) constitute approximately 75% of bladder cancer cases. Primary transurethral resection (TUR) plays a pivotal role in both diagnosis and treatment. However, despite initial resection, tumors are often missed, leaving behind microscopic residual tumors. This study aims to prospectively investigate the surgical margins of tumors, which may serve as a potential source of residual tumors. MATERIALS AND METHODS Seventy patients diagnosed with NMIBC who underwent primary TUR were enrolled in this study. Following initial resection, samples were collected from the normal-appearing mucosa extending 1cm beyond the surgical margins. Lesions were categorized as 'healthy margins' for benign lesions, 'tumoral margins' for urothelial cancer, and 'dysplastic margins' for urothelial dysplasia. Clinical and pathological features of these groups were compared, and risk factors for detecting transitional cell carcinoma (TCC) in the normal-looking mucosa were analyzed. RESULTS The tumoral margins group showed a significantly higher rate of T1 stage tumors compared to the healthy margins group, and a significantly higher rate of high-grade (HG) tumors compared to the dysplastic margins group. Moreover, the tumoral margins group had a significantly higher proportion of high-risk patients (85.7%) compared to the other groups, while the healthy margins group had a significantly higher proportion of low-risk patients (35.3%) compared to the tumoral margins group (0.0%). Additionally, the tumoral margins group demonstrated a significantly higher rate of carcinoma in situ (CIS) compared to the healthy margins group (35.7% vs. 5.9%). Detection of urothelial cancer at the margins was associated with T1 stage, HG stage, and the presence of CIS based on univariate analyses. CONCLUSION To minimize residual tumors and prevent recurrence in patients undergoing primary TUR, we advocate for the resection of macroscopically visible tumors with nearly 2cm of intact bladder tissue, thereby enhancing the quality of TUR. LEVEL OF EVIDENCE This study provides Level II evidence, based on its design as a prospective observational study. The findings are derived from well-designed cohort analyses, providing significant associations and insights into the factors affecting surgical margins in NMIBC patients.
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Affiliation(s)
- Çağatay Özsoy
- Adnan Menderes University Medical Faculty, Department of Urology, Aydın, Turkey.
| | - Yiğit Demir
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Kayhan Yılmaz
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Mahmut Taha Ölçücü
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Şahin Kılıç
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
| | - Mutlu Ateş
- Antalya Training and Research Hospital, Department of Urology, Antalya, Turkey
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Shkolyar E, Zhou SR, Carlson CJ, Chang S, Laurie MA, Xing L, Bowden AK, Liao JC. Optimizing cystoscopy and TURBT: enhanced imaging and artificial intelligence. Nat Rev Urol 2024:10.1038/s41585-024-00904-9. [PMID: 38982304 DOI: 10.1038/s41585-024-00904-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 07/11/2024]
Abstract
Diagnostic cystoscopy in combination with transurethral resection of the bladder tumour are the standard for the diagnosis, surgical treatment and surveillance of bladder cancer. The ability to inspect the bladder in its current form stems from a long chain of advances in imaging science and endoscopy. Despite these advances, bladder cancer recurrence and progression rates remain high after endoscopic resection. This stagnation is a result of the heterogeneity of cancer biology as well as limitations in surgical techniques and tools, as incomplete resection and provider-specific differences affect cancer persistence and early recurrence. An unmet clinical need remains for solutions that can improve tumour delineation and resection. Translational advances in enhanced cystoscopy technologies and artificial intelligence offer promising avenues to overcoming the progress plateau.
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Affiliation(s)
- Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Steve R Zhou
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Camella J Carlson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Shuang Chang
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Mark A Laurie
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Audrey K Bowden
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Joseph C Liao
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
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3
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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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4
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McNall S, Hooper K, Sullivan T, Rieger-Christ K, Clements M. Treatment Modalities for Non-Muscle Invasive Bladder Cancer: An Updated Review. Cancers (Basel) 2024; 16:1843. [PMID: 38791924 PMCID: PMC11120410 DOI: 10.3390/cancers16101843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/01/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
The landscape of treatment for non-muscle invasive bladder cancer is rapidly changing. A complete and careful transurethral resection is the mainstay of initial treatment and is followed by intravesical therapy in intermediate or high-risk cases. The standard of care is intravesical BCG. Many alternative or additive approaches to this are being explored. We divided this review into three relevant spaces to consider these novel treatment approaches: (1) low-risk disease, for which intravesical therapy is not usually considered, (2) BCG-naïve disease (i.e., considering alternatives to the standard therapy), and (3) BCG-unresponsive disease. We performed a review of published literature and summarized ongoing trials in the United States. Novel approaches that we explored include surgical techniques for resection, alterations in dwell time for intravesical therapy, delivery method and schedule of intravesical therapies, new intravesical therapy agents, and systemic therapies (especially immunotherapy). These are thoroughly outlined throughout this review article, and the numerous modalities being studied demonstrate significant promise for the future treatment of the expanding space of NMIBC.
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Affiliation(s)
- Shannon McNall
- Department of Urology, Lahey Hospital & Medical Center, Burlington, MA 01805, USA; (K.R.-C.); (M.C.)
| | - Kailey Hooper
- Department of Translational Research, Lahey Hospital & Medical Center, Burlington, MA 01805, USA; (K.H.); (T.S.)
| | - Travis Sullivan
- Department of Translational Research, Lahey Hospital & Medical Center, Burlington, MA 01805, USA; (K.H.); (T.S.)
| | - Kimberly Rieger-Christ
- Department of Urology, Lahey Hospital & Medical Center, Burlington, MA 01805, USA; (K.R.-C.); (M.C.)
- Department of Translational Research, Lahey Hospital & Medical Center, Burlington, MA 01805, USA; (K.H.); (T.S.)
| | - Matthew Clements
- Department of Urology, Lahey Hospital & Medical Center, Burlington, MA 01805, USA; (K.R.-C.); (M.C.)
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5
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Beijert IJ, Hentschel AE, Bründl J, Compérat EM, Plass K, Rodríguez O, Subiela Henríquez JD, Hernández V, de la Peña E, Alemany I, Turturica D, Pisano F, Soria F, Čapoun O, Bauerová L, Pešl M, Bruins HM, Runneboom W, Herdegen S, Breyer J, Brisuda A, Calatrava A, Rubio-Briones J, Seles M, Mannweiler S, Bosschieter J, Kusuma VRM, Ashabere D, Huebner N, Cotte J, Contieri R, Mertens LS, Claps F, Masson-Lecomte A, Liedberg F, Cohen D, Lunelli L, Cussenot O, El Sheikh S, Volanis D, Côté JF, Rouprêt M, Haitel A, Shariat SF, Mostafid AH, Nieuwenhuijzen JA, Zigeuner R, Dominguez-Escrig JL, Hacek J, Zlotta AR, Burger M, Evert M, Hulsbergen-van de Kaa CA, van der Heijden AG, Kiemeney LALM, Soukup V, Molinaro L, Gontero P, Llorente C, Algaba F, Palou J, N'Dow J, Ribal MJ, van der Kwast TH, Babjuk M, Sylvester RJ, van Rhijn BWG. Second TURB, restaging TURB or repeat TURB in primary T1 non-muscle invasive bladder cancer: impact on prognosis? Int Urol Nephrol 2024; 56:1323-1333. [PMID: 37980689 DOI: 10.1007/s11255-023-03867-9] [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: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE A re-transurethral resection of the bladder (re-TURB) is a well-established approach in managing non-muscle invasive bladder cancer (NMIBC) for various reasons: repeat-TURB is recommended for a macroscopically incomplete initial resection, restaging-TURB is required if the first resection was macroscopically complete but contained no detrusor muscle (DM) and second-TURB is advised for all completely resected T1-tumors with DM in the resection specimen. This study assessed the long-term outcomes after repeat-, second-, and restaging-TURB in T1-NMIBC patients. METHODS Individual patient data with tumor characteristics of 1660 primary T1-patients (muscle-invasion at re-TURB omitted) diagnosed from 1990 to 2018 in 17 hospitals were analyzed. Time to recurrence, progression, death due to bladder cancer (BC), and all causes (OS) were visualized with cumulative incidence functions and analyzed by log-rank tests and multivariable Cox-regression models stratified by institution. RESULTS Median follow-up was 45.3 (IQR 22.7-81.1) months. There were no differences in time to recurrence, progression, or OS between patients undergoing restaging (135 patients), second (644 patients), or repeat-TURB (84 patients), nor between patients who did or who did not undergo second or restaging-TURB. However, patients who underwent repeat-TURB had a shorter time to BC death compared to those who had second- or restaging-TURB (multivariable HR 3.58, P = 0.004). CONCLUSION Prognosis did not significantly differ between patients who underwent restaging- or second-TURB. However, a worse prognosis in terms of death due to bladder cancer was found in patients who underwent repeat-TURB compared to second-TURB and restaging-TURB, highlighting the importance of separately evaluating different indications for re-TURB.
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Affiliation(s)
- Irene J Beijert
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Anouk E Hentschel
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Johannes Bründl
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Eva M Compérat
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Pathology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Karin Plass
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Oscar Rodríguez
- Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Virginia Hernández
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Isabel Alemany
- Pathology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Diana Turturica
- Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Francesca Pisano
- Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
- Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Francesco Soria
- Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Otakar Čapoun
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Lenka Bauerová
- Pathology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Michael Pešl
- Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - H Maxim Bruins
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Radboud University Medical Center, Nijmegen, The Netherlands
- Urology, Zuyderland Medical Center, Sittard/Heerlen, The Netherlands
| | | | - Sonja Herdegen
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Antonin Brisuda
- Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Ana Calatrava
- Pathology, Fundación Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
| | - José Rubio-Briones
- Urology, Fundación Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
| | | | | | - Judith Bosschieter
- Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Venkata R M Kusuma
- Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - David Ashabere
- Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Nicolai Huebner
- Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Juliette Cotte
- Urology, Pitié Salpétrière Hospital, AP-HP, GRC no 5, ONCOTYPE-URO, Sorbonne University, 75013, Paris, France
| | - Roberto Contieri
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Laura S Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Francesco Claps
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Alexandra Masson-Lecomte
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Fredrik Liedberg
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Daniel Cohen
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Royal Free London-NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Luca Lunelli
- Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Olivier Cussenot
- Urology, Tenon Hospital, AP-HP, Sorbonne University, Paris, France
| | - Soha El Sheikh
- Pathology, Royal Free London-NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Dimitrios Volanis
- Urology, Royal Free London-NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Jean-François Côté
- Pathology, Pierre et Marie Curie Medical School, Pitié Salpétrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Morgan Rouprêt
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Pitié Salpétrière Hospital, AP-HP, GRC no 5, ONCOTYPE-URO, Sorbonne University, 75013, Paris, France
| | - Andrea Haitel
- Pathology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Shahrokh F Shariat
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - A Hugh Mostafid
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, The Stokes Centre for Urology, Royal Surrey Hospital, Guildford, UK
| | - Jakko A Nieuwenhuijzen
- Urology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Richard Zigeuner
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Medical University of Graz, Graz, Austria
| | - Jose L Dominguez-Escrig
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Fundación Instituto Valenciano de Oncología (I.V.O.), Valencia, Spain
| | - Jaromir Hacek
- Pathology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Alexandre R Zlotta
- Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Maximilian Burger
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Matthias Evert
- Pathology, University of Regensburg, Regensburg, Germany
| | | | | | | | - Viktor Soukup
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University Praha, Prague, Czech Republic
| | - Luca Molinaro
- Pathology, Città della Salute e della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Paolo Gontero
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Turin, Italy
| | - Carlos Llorente
- Urology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Ferran Algaba
- Pathology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joan Palou
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Fundacio Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - James N'Dow
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Maria J Ribal
- European Association of Urology, Guidelines Office Board, Arnhem, The Netherlands
| | - Theo H van der Kwast
- Laboratory Medicine Program, University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada
| | - Marko Babjuk
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
- Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Richard J Sylvester
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
- European Association of Urology, Non-Muscle Invasive Bladder Cancer Guidelines Panel, Arnhem, The Netherlands.
- Surgical Oncology (Urology), University Health Network, Princess Margaret Cancer Center, University of Toronto, Toronto, Canada.
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6
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Kikuchi H, Abe T, Miyake M, Miyata H, Matsumoto R, Osawa T, Nishimura N, Fujimoto K, Inokuchi J, Yoneyama T, Tomida R, Numakura K, Matsushita Y, Matsumoto K, Sato T, Taoka R, Kobayashi T, Kojima T, Matsui Y, Nishiyama N, Kitamura H, Nishiyama H, Shinohara N. The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin therapy. Jpn J Clin Oncol 2024; 54:192-200. [PMID: 37974430 PMCID: PMC10849170 DOI: 10.1093/jjco/hyad155] [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: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Several guidelines recommended that second transurethral resection should be performed in patients with diagnosis of high-risk non-muscle-invasive bladder cancer. However, therapeutic benefits of second transurethral resection before bacillus Calmette-Guérin intravesical instillation were conflicting amongst previous studies. We investigated the prognostic impact of second transurethral resection before bacillus Calmette-Guérin instillation in high-risk non-muscle-invasive bladder cancer patients. METHODS This retrospective study included 3104 non-muscle-invasive bladder cancer patients who received bacillus Calmette-Guérin instillations between 2000 and 2019 at 31 collaborative institutions. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors of intravesical recurrence, disease progression, cancer-specific mortality and overall mortality. RESULTS In the entire population, patients undergoing second transurethral resection (33%, 1026/3104) had a lower risk of intravesical recurrence on univariate analysis (hazard ratio 0.85, 95% confidence interval 0.73-0.98, P = 0.027), although it did not remain significant on multivariate analysis (hazard ratio 0.90, 95% confidence interval 0.76-1.07, P = 0.24). Subgroup analysis revealed that, in pT1 patients (n = 1487), second transurethral resection was significantly correlated with a lower risk of intravesical recurrence on multivariate analysis (hazard ratio 0.80, 95% confidence interval 0.64-1.00, P = 0.048), but lower risks of disease progression (hazard ratio 0.75, 95% confidence interval 0.56-1.00, P = 0.049), cancer-specific mortality (hazard ratio 0.54, 95% confidence interval 0.35-0.85, P = 0.007) and overall mortality (hazard ratio 0.73, 95% confidence interval 0.55-0.97, P = 0.027) on univariate analysis. CONCLUSIONS Second transurethral resection confers accurate pathological staging and could be used to safely select good candidates for intravesical bacillus Calmette-Guérin instillation. We further confirm that second transurethral resection could confer an oncological benefit in pT1 bladder cancer patients treated by bacillus Calmette-Guérin instillation, and so strongly recommend second transurethral resection in this patient population.
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Affiliation(s)
- Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Junichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Ryotaro Tomida
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Yuto Matsushita
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazumasa Matsumoto
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takuma Sato
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rikiya Taoka
- Departments of Urology, Kagawa University Faculty of Medicine, Takamatsu, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takahiro Kojima
- Department of Urology, Aichi Cancer Center, Nagoya City, Aichi, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Naotaka Nishiyama
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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7
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Mariappan P, Johnston A, Trail M, Hamid S, Hollins G, Dreyer BA, Ramsey S, Padovani L, Garau R, Enriquez JG, Boden A, Maresca G, Simpson H, Hasan R, Sharpe C, Thomas BG, Chaudhry AH, Khan RS, Bhatt JR, Ahmad I, Nandwani GM, Dimitropoulos K, Makaroff L, Shaw J, Graham C, Hendry D. Achieving Benchmarks for National Quality Indicators Reduces Recurrence and Progression in Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2024:S2588-9311(24)00037-3. [PMID: 38296735 DOI: 10.1016/j.euo.2024.01.012] [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: 10/22/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Noncompliance with evidence-based interventions and guidelines contributes to significant and variable recurrence and progression in patients with non-muscle-invasive bladder cancer (NMIBC). The implementation of a quality performance indicator (QPI) programme in Scotland's National Health Service (NHS) aimed to improve cancer outcomes and reduce nationwide variance. OBJECTIVE To evaluate the effect of hospitals achieving benchmarks for two specific QPIs on time to recurrence and progression in NMIBC. DESIGN, SETTING, AND PARTICIPANTS QPIs for bladder cancer (BC) were enforced nationally in April 2014. NHS health boards collected prospective data on all new BC patients. Prospectively recorded surveillance data were pooled from 12 collaborating centres. INTERVENTION QPIs of interest were (1) hospitals achieving detrusor muscle (DM) sampling target at initial transurethral resection of bladder tumour (TURBT) and (2) use of single instillation of mitomycin C after TURBT (SI-MMC). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary and secondary endpoints were time to recurrence and progression, respectively. Kaplan-Meier and Cox multivariable regression analyses were performed. KEY FINDINGS AND LIMITATIONS Between April 1, 2014 and March 31, 2017, we diagnosed 3899 patients with new BC, of which 2688 were NMIBC . With a median follow up of 60.3 mo, hospitals achieving the DM sampling target had a 5.4% lower recurrence rate at 5 yr than hospitals not achieving this target (442/1136 [38.9%] vs 677/1528 [44.3%], 95% confidence interval [CI] = 1.6-9.2, p = 0.005). SI-MMC was associated with a 20.4% lower recurrence rate (634/1791 [35.4%] vs 469/840 [55.8%], 95% CI = 16.4-24.5, p < 0.001). On Cox multivariable regression, meeting the DM target and SI-MMC were associated with significant improvement in recurrence (hazard ratio [HR] 0.81, 95% CI = 0.73-0.91, p = 0.0002 and HR 0.66, 95% CI = 0.59-0.74, p < 0.004, respectively) as well as progression-free survival (HR 0.62, 95% CI = 0.45-0.84, p = 0.002 and HR 0.65, 95% CI = 0.49-0.87, p = 0.004, respectively). We did not have a national multicentre pre-QPI control. CONCLUSIONS Within a national QPI programme, meeting targets for sampling DM and SI-MMC in the real world were independently associated with delays to recurrence and progression in NMIBC patients. PATIENT SUMMARY Following the first 3 yr of implementing a novel quality performance indicator programme in Scotland, we evaluated compliance and outcomes in non-muscle-invasive bladder cancer. In 2688 patients followed up for 5 yr, we found that achieving targets for sampling detrusor muscle and the single instillation of mitomycin C during and after transurethral resection of bladder tumour, respectively, were associated with delays in cancer recurrence and progression.
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Affiliation(s)
- Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; The University of Edinburgh, Edinburgh, UK.
| | - Allan Johnston
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Matthew Trail
- Department of Urology, Ninewells Hospital, Dundee, UK
| | - Sami Hamid
- Department of Urology, Ninewells Hospital, Dundee, UK
| | | | | | - Sara Ramsey
- Department of Urology, Raigmore Hospital, Inverness, UK
| | - Luisa Padovani
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | - Roberta Garau
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | | | - Alasdair Boden
- Department of Urology, University Hospital Monklands, Airdrie, UK
| | | | - Helen Simpson
- Department of Urology, Victoria Hospital, Kirkcaldy, UK
| | - Rami Hasan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; Department of Urology, University Hospital Ayr, Ayr, UK
| | - Claire Sharpe
- Department of Urology, Dumfries & Galloway Royal Infirmary, Dumfries, UK
| | - Benjamin G Thomas
- Department of Urology, Borders General Hospital, Melrose, UK; Department of Urology, Western General Hospital, Edinburgh, UK
| | - Altaf H Chaudhry
- Department of Urology, Dumfries & Galloway Royal Infirmary, Dumfries, UK
| | - Rehan S Khan
- Department of Urology, University Hospital Monklands, Airdrie, UK
| | - Jaimin R Bhatt
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK; School of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Lydia Makaroff
- Fight Bladder Cancer, Oxfordshire, UK; World Bladder Cancer Patient Coalition, Brussels, Belgium
| | | | - Catriona Graham
- Edinburgh Clinical Research Facility, The University of Edinburgh, Edinburgh, UK
| | - David Hendry
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
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8
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Yanagisawa T, Kawada T, von Deimling M, Bekku K, Laukhtina E, Rajwa P, Chlosta M, Pradere B, D'Andrea D, Moschini M, Karakiewicz PI, Teoh JYC, Miki J, Kimura T, Shariat SF. Repeat Transurethral Resection for Non-muscle-invasive Bladder Cancer: An Updated Systematic Review and Meta-analysis in the Contemporary Era. Eur Urol Focus 2024; 10:41-56. [PMID: 37495458 DOI: 10.1016/j.euf.2023.07.002] [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: 05/06/2023] [Revised: 06/04/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
CONTEXT Repeat transurethral resection (reTUR) is a guideline-recommended treatment strategy in high-risk non-muscle-invasive bladder cancer (NMIBC) patients treated with transurethral resection of bladder tumor (TURBT); however, the impact of recent procedural/technological developments on reTUR outcomes has not been assessed yet. OBJECTIVE To assess the outcomes of reTUR for NMIBC in the contemporary era, focusing on whether temporal differences and technical advancement, specifically, photodynamic diagnosis and en bloc resection of bladder tumor (ERBT), affect the outcomes. EVIDENCE ACQUISITION Multiple databases were queried in February 2023 for studies investigating reTUR outcomes, such as residual tumor and/or upstaging rates, its predictive factors, and oncologic outcomes, including recurrence-free (RFS), progression-free (PFS), cancer-specific (CSS), and overall (OS) survival. We synthesized comparative outcomes adjusting for the effect of possible confounders. EVIDENCE SYNTHESIS Overall, 81 studies were eligible for the meta-analysis. In T1 patients initially treated with conventional TURBT (cTURBT) in the 2010s, the pooled rates of any residual tumors and upstaging on reTUR were 31.4% (95% confidence interval [CI]: 26.0-37.2%) and 2.8% (95% CI: 2.0-3.8%), respectively. Despite a potential publication bias, these rates were significantly lower than those in patients treated in the 1990-2000s (both p < 0.001). ERBT and visual enhancement-guided cTURBT significantly improved any residual tumor rates on reTUR compared with cTURBT based on both matched-cohort and multivariable analyses. Among studies adjusting for the effect of possible confounders, patients who underwent reTUR had better RFS (hazard ratio [HR]: 0.78, 95% CI: 0.62-0.97) and OS (HR: 0.86, 95% CI: 0.81-0.93) than those who did not, while it did not lead to superior PFS (HR: 0.74, 95% CI: 0.47-1.15) and CSS (HR: 0.94, 95% CI: 0.86-1.03). CONCLUSIONS reTUR is currently recommended for high-risk NMIBC based on the persistent high rates of residual tumors after primary resection. Improvement of resection quality based on checklist applications and recent technical/procedural advancements hold the promise to omit reTUR. PATIENT SUMMARY Recent endoscopic/procedural developments improve the outcomes of repeat resection for high-risk non-muscle-invasive bladder cancer. Further investigations are urgently needed to clarify the potential impact of the use of these techniques on the need for repeat transurethral resection in the contemporary era.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tatsushi Kawada
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Markus von Deimling
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kensuke Bekku
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Marcin Chlosta
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Clinic of Urology and Urological Oncology, Jagiellonian University, Krakow, Poland
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, La Croix Du Sud Hospital, Quint Fonsegrives, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Jeremy Yuen-Chun Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.
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9
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Gercek O, Keles I, Saritas TB, Koyuncu B, Topal K, Demirbas A. Effect of obturator nerve block during transurethral resection of bladder tumors on the disease recurrence, progression and surgery outcomes. Int Urol Nephrol 2023; 55:2765-2772. [PMID: 37531039 DOI: 10.1007/s11255-023-03727-6] [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: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE In our study, we aimed to evaluate the effect of the obturator nerve block (ONB) on the operation time, duration of hospital stay, complete resection, presence of muscle tissue in the pathology, second resection, recurrence, and progression, when applied in addition to spinal anesthesia in patients with primary bladder lateral wall tumor and Transurethral Resection of Bladder Tumor (TURBT) was planned. MATERIALS AND METHODS Seventy patients with bladder lateral wall tumors were included in the study. In addition, ONB was applied to 35 of the patients who underwent spinal anesthesia. The two groups were compared in terms of obturator reflex development, perforation, complete resection, presence of muscle tissue in pathology samples, need for second resection, need for second resection due to inadequate muscle tissue, and 1 year recurrence and progression rates. RESULTS When the two groups were compared for obturator reflex and bladder perforation, both were found to be lower in the ONB group (p = 0.002, p = 0.198, respectively). The rate of complete resection and the presence of muscle tissue in the pathology samples were higher in the ONB group (p = 0.045, p = 0.034, respectively). The rates of second resection and second resection due to inadequate muscle tissue were found to be higher in the group without ONB (p = 0.015, p = 0.106, respectively). In the 1-year follow-up, the recurrence rate was significantly lower in the ONB group (p < 0.001), while there was no significant difference between the progression rates (p = 0.106). CONCLUSION In our study, we found out that ONB applied in addition to spinal anesthesia increases the rate of complete and muscle tissue resection by decreasing the obturator reflex, and causes a significant reduction in the need for second resection and tumor recurrence.
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Affiliation(s)
- O Gercek
- Department of Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - I Keles
- Department of Urology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - T B Saritas
- Department of Anesthesiology and Reanimation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - B Koyuncu
- Department of Anesthesiology and Reanimation, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - K Topal
- Department of Urology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - A Demirbas
- Department of Urology, Bursa Doruk Hospital, Bursa, Turkey
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10
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Guler Y. Clinical and pathological risk factors for tumour recurrence and upstaging in second TURBT for patients with NMIBC: a systematic review and meta-analysis. Aktuelle Urol 2023. [PMID: 37263278 DOI: 10.1055/a-2063-3144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
ZIEL: Offenlegung signifikanter Risikofaktoren durch Identifizierung gepoolter Effektschätzungsstatistiken in einer systemischen Überprüfung und Metaanalyse klinischer und pathologischer Risikofaktoren, die ein Tumorrezidiv und ein Upstaging auf eine zweite TURBT bei Patienten mit hochgradigem NMIBC vorhersagen. MATERIAL-METHODE Alle Datenquellen wurden umfassend bis Oktober 2022 untersucht. Die Daten wurden aus den relevanten Studien extrahiert und mit der Software RevMan analysiert. In einem inversen Varianzmodell mit zufälligen und festen Effekten werden Odds Ratio (OR)-Werte mit 95%-Konfidenzintervallen [95%-KI] angegeben. ERGEBNISSE Der Review umfasste insgesamt 18 Studien und 4548 Patienten. Gemäß den gepoolten Effektschätzern waren Carcinoma in situ (CIS), Tumorgrad, Multiplizität und Chirurgenfaktoren signifikante Risikofaktoren. Die gepoolten Effektschätzungen für das Tumorstadium und die Tumormorphologie waren sehr nahe an der Signifikanz. Für CIS, Grad, Multiplizität und Chirurgenfaktor, OR, IVR oder IVF [95%-KI] waren die p- und I2-Werte 1,8 [1,1, 3,0], 0,03, 75%; 2 [1,1, 3,4], 0,02, 53%; 1,3 [1,2, 1,6], <0,01, 40%; und 2 [1,4, 3], <0,01, 66%. SCHLUSSFOLGERUNGEN Als Ergebnis der ersten TURBT; Eine zweite TURBT sollte in den 2-6 Wochen der postoperativen Phase für Patienten mit hochgradigem, begleitendem CIS, multipler, solider Morphologie, DM(-) im pathologischen Präparat und NMIBC, das von Trainern/Juniorchirurgen operiert wird, geplant werden.
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Affiliation(s)
- Yavuz Guler
- Department of Urology, TC Istanbul Rumeli University, Istanbul, Turkey
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11
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Yanagisawa T, Sato S, Hayashida Y, Okada Y, Iwatani K, Matsukawa A, Kimura T, Takahashi H, Egawa S, Shariat SF, Miki J. Do we need repeat transurethral resection after en bloc resection for pathological T1 bladder cancer? BJU Int 2023; 131:190-197. [PMID: 35488409 PMCID: PMC10084154 DOI: 10.1111/bju.15760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess the clinical significance of repeat transurethral resection (reTUR) and surgical margin status after en bloc resection of bladder tumour (ERBT) for pathological T1 (pT1) bladder cancer. PATIENTS AND METHODS We retrospectively analysed the record of 106 patients with pT1 high-grade bladder cancer who underwent ERBT between April 2013 and February 2021 at multiple institutions. All specimens were reviewed by a genitourinary pathologist. The primary outcome measures were recurrence-free survival (RFS) and progression-free survival (PFS) between patients with and those without reTUR. We also analysed the predictive value of surgical margin on the likelihood of residual tumour on reTUR. RESULTS A reTUR was performed in 50 of the 106 patients. The 2-year RFS and 3-year PFS were comparable between patients who underwent reTUR and those who did not (55.1% vs 59.9%, P = 0.6, 80.6% vs 82.6%, P = 0.6, respectively). No patient was upstaged to pT2 on reTUR. Regarding the surgical margin status, there were no recurrences at the original site in 51 patients with negative horizontal margins. Cox proportional hazard analysis revealed that a positive vertical margin was an independent prognostic factor of worse PFS. On reTUR, six pTa/is residues were detected in patients with a positive horizontal margin, and three pT1 residues were detected in one patient with a positive vertical margin or other adverse pathological features. CONCLUSIONS A reTUR after ERBT for pT1 bladder cancer appears not to improve either recurrence or progression. Surgical margin status affects prognosis and reTUR outcomes. A reTUR can be omitted after ERBT in patients with pT1 bladder cancer and negative margins; for those with positive horizontal or vertical margins, reTUR should remain the standard until proven otherwise.
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Affiliation(s)
- Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Yohei Okada
- Department of Urology, Saitama Medical Center, Saitama, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Matsukawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
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12
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Alsyouf M, Ladi-Seyedian SS, Konety B, Pohar K, Holzbeierlein JM, Kates M, Willard B, Taylor JM, Liao JC, Kaimakliotis HZ, Porten SP, Steinberg GD, Tyson MD, Lotan Y, Daneshmand S. Is a restaging TURBT necessary in high-risk NMIBC if the initial TURBT was performed with blue light? Urol Oncol 2023; 41:109.e9-109.e14. [PMID: 36435710 DOI: 10.1016/j.urolonc.2022.10.026] [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: 08/19/2022] [Revised: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate whether a restaging transurethral resection of bladder tumor (TURBT) is necessary in high-risk nonmuscle invasive bladder cancer (NMIBC) if the initial TURBT was performed using blue light (BL) technology. METHODS AND MATERIALS Using the multi-institutional Cysview registry between 2014 and 2021, all consecutive adult patients with known NMIBC (Ta and T1 disease) who underwent TURBT followed by a restaging TURBT within 8 weeks were reviewed. Patients were stratified according to their initial TURBT, BL vs. white light (WL), and compared to determine rates of residual disease and upstaging. Univariate analysis was performed using Mann-Whitney U and chi-square tests, with P < 0.05 considered significant. RESULTS Overall, 115 patients had TURBT for NMIBC followed by a restaging TURBT within 8 weeks and were included in the analysis. Patients who underwent BL compared to WL for their initial TURBT had higher rates of benign pathology on restaging TURBT, although this was not statistically significant (47% vs. 30%; P = 0.08). Of patients with residual tumors on restaging TURBT, there were no differences in rates of Ta (22% vs. 26.5%; P = 0.62), T1 (22% vs. 26.5%; P = 0.62), or CIS (5.5% vs. 13%; P = 0.49) when the initial TURBT was done using BL compared to WL. Rates of upstaging to muscle invasive disease were also not different when initial TURBT was performed using BL compared to WL (3% vs. 4%; P = 0.78). CONCLUSIONS TURBT using BL does not reduce rates of residual disease or risk of upstaging on restaging TURBT in Ta or T1 disease. Thus, a restaging TURBT is still necessary even if initial TURBT was performed using BL.
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Affiliation(s)
- Muhannad Alsyouf
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Seyedeh-Sanam Ladi-Seyedian
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | | | | | | | - Max Kates
- The James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD
| | | | | | | | | | - Sima P Porten
- Department of Urology, University of California San Francisco, San Francisco, CA
| | | | - Mark D Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, AZ
| | - Yair Lotan
- UT Southwestern Medical Center, Dallas, TX
| | - Siamak Daneshmand
- Department of Urology, USC/Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
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13
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Kiełbik A, Sowa PW, Pakhomov AG, Gudvangen E, Mangalanathan U, Kulbacka J, Pakhomova ON. Urine protects urothelial cells against killing with nanosecond pulsed electric fields. Bioelectrochemistry 2023; 149:108289. [DOI: 10.1016/j.bioelechem.2022.108289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/01/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022]
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14
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Li Z, Qi N, Gao Z, Ding L, Zhu J, Guo Q, Wang J, Wen R, Li H. How to Perform Intravesical Chemotherapy after Second TURBT for Non-Muscle-Invasive Bladder Cancer: A Single-Center Experience. J Clin Med 2022; 12:jcm12010169. [PMID: 36614970 PMCID: PMC9820835 DOI: 10.3390/jcm12010169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The objective of this study aimed to explore whether the original IVC regimen should be continued after the second TURBT or whether the IVC induction phase should be restarted from the beginning. METHODS A retrospective analysis was performed on 137 patients who underwent a second TURBT at the Affiliated Hospital of Xuzhou Medical University between April 2014 and June 2022. Based on the pathological findings, patients were divided into two groups: group A patients, who did not have a residual tumor on pathological examination after the second TURBT; and group B patients, who had residual tumor. Recurrence was determined using cystoscopy and imaging every three months. The endpoint was recurrence-free survival. RESULT In the entire cohort, there was a statistically significant difference in the RFS between patients in the two IVC regimens (p = 0.029). The RFS of patients in group B1 was significantly lower than that of patients in group B2 (p = 0.009). There was no significant difference in RFS between the subgroups A1 and A2 (p = 0.560). Multivariate Cox regression analysis confirmed that the IVC regimen after a second TURBT (p = 0.012) and T stage after a second TURBT (p = 0.005) were both independent predictors for patient RFS. CONCLUSION If the pathological findings of the second TURBT specimen is benign, patients can continue their previous treatment regimen without restarting an IVC induction phase. Unnecessary IVC can be avoided in these patients. In contrast, for patients with residual tumors in the second TURBT specimen, the need to restart the IVC induction phase should be emphasized to improve patient prognosis.
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Affiliation(s)
- Zhen Li
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Graduate School, Xuzhou Medical University, Xuzhou 221000, China
| | - Nienie Qi
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Zhimin Gao
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Graduate School, Xuzhou Medical University, Xuzhou 221000, China
| | - Li Ding
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Graduate School, Xuzhou Medical University, Xuzhou 221000, China
| | - Jiawei Zhu
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Graduate School, Xuzhou Medical University, Xuzhou 221000, China
| | - Qingxiang Guo
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Graduate School, Xuzhou Medical University, Xuzhou 221000, China
| | - Junqi Wang
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
| | - Rumin Wen
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Correspondence: (R.W.); (H.L.)
| | - Hailong Li
- Department of Urology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000, China
- Correspondence: (R.W.); (H.L.)
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15
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Zhao H, Peng P, Luo Z, Liu H, Sun J, Wang X, Jia Q, Yang Z. Comparison of hexaminolevulinate (HAL) -guided versus white light transurethral resection for NMIBC: A systematic review and meta-analysis of randomized controlled trials. Photodiagnosis Photodyn Ther 2022; 41:103220. [PMID: 36462704 DOI: 10.1016/j.pdpdt.2022.103220] [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: 09/09/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE We systematically reviewed the effectiveness of hexaminolevulinic acid (HAL) after traditional light cystoscopy vs. only white light cystoscopy (WLC) on nonmuscle-invasive bladder cancer (NMIBC) clinical outcomes. METHODS Systematic literature searches of PubMed, Embase, Web of Science, and the Cochrane database and reference lists were performed. A total of 12 randomized controlled trials (RCTs) of HAL fluorescent cystoscopy (FC) and WLC vs. white light cystoscopy alone for the diagnosis of initial or recurrent bladder cancer that reported bladder cancer recurrence, progression, recurrence-free survival (RFS), and other effects were selected for review. RESULTS Our results included 2,775 patients identified for analysis and showed that the HAL group had a lower recurrence rate than the white light cystoscopy group with a statistically significant difference (RR=0.77, 95% CI 0.69-0.85. P < 0.05), and this advantage still existed for patients receiving intravesical chemotherapy. There was also a statistically significant difference in favour of fluorescent cystoscopy in recurrence-free survival and progression rate (HR=0.79, 95% CI 0.67-0.92. P < 0.05, RR = 0.63, 95% CI 0.43-0.94. P < 0.05, respectively). The time to first recurrence was not significantly different from that in the WLC group (SMD=0.73, 95% CI, -0.39-1.85. P = 0.2). And the HAL group did not have a significantly reduced residual tumor rate (RR=0.59, 95% CI 0.23-1.51. P = 0.27). CONCLUSIONS Fluorescent cystoscopy was associated with a reduced risk of bladder cancer recurrence and reduced progression rate; it also has advantages for RFS. However, there was no significant difference in the rate of residual tumor and the time of first recurrence. More studies are needed to better understand the effects of the photosensitizer used on NMIBC patients.
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Affiliation(s)
- Hang Zhao
- Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China; China-Japan Friendship School Clinical Medicine, Peking University, Beijing 100029, China
| | - Panxin Peng
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Zhenkai Luo
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hailong Liu
- Department of Joint Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Junwei Sun
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Xuming Wang
- China-Japan Friendship School Clinical Medicine, Peking University, Beijing 100029, China; Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China
| | - Qiang Jia
- Department of Anesthesiology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China.
| | - Zhihao Yang
- Department of Urology, China-Japan Friendship Hospital, Yinghuadong Road, Chaoyang District, Beijing 100029, China; China-Japan Friendship School Clinical Medicine, Peking University, Beijing 100029, China.
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16
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Kim H, Lee SH, Wentworth A, Babaee S, Wong K, Collins JE, Chu J, Ishida K, Kuosmanen J, Jenkins J, Hess K, Lopes A, Morimoto J, Wan Q, Potdar SV, McNally R, Tov C, Kim NY, Hayward A, Wollin D, Langer R, Traverso G. Biodegradable ring-shaped implantable device for intravesical therapy of bladder disorders. Biomaterials 2022; 288:121703. [PMID: 36030104 PMCID: PMC10485746 DOI: 10.1016/j.biomaterials.2022.121703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 11/26/2022]
Abstract
Intravesical instillation is an efficient drug delivery route for the local treatment of various urological conditions. Nevertheless, intravesical instillation is associated with several challenges, including pain, urological infection, and frequent clinic visits for catheterization; these difficulties support the need for a simple and easy intravesical drug delivery platform. Here, we propose a novel biodegradable intravesical device capable of long-term, local drug delivery without a retrieval procedure. The intravesical device is composed of drug encapsulating biodegradable polycaprolactone (PCL) microcapsules and connected by a bioabsorbable Polydioxanone (PDS) suture with NdFeB magnets in the end. The device is easily inserted into the bladder and forms a 'ring' shape optimized for maximal mechanical stability as informed by finite element analysis. In this study, inserted devices were retained in a swine model for 4 weeks. Using this device, we evaluated the system's capacity for delivery of lidocaine and resiquimod and demonstrated prolonged drug release. Moreover, a cost-effectiveness analysis supports device implementation compared to the standard of care. Our data support that this device can be a versatile drug delivery platform for urologic medications.
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Affiliation(s)
- Hyunjoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Seung Ho Lee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Adam Wentworth
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Sahab Babaee
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Wong
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joy E Collins
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Jacqueline Chu
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Keiko Ishida
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Johannes Kuosmanen
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Joshua Jenkins
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Kaitlyn Hess
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Aaron Lopes
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Joshua Morimoto
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Qianqian Wan
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Shaunak V Potdar
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ronan McNally
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Caitlynn Tov
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Na Yoon Kim
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alison Hayward
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Daniel Wollin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Giovanni Traverso
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA; Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA; Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA.
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17
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Flaig TW, Spiess PE, Abern M, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, Chan K, Chang S, Friedlander T, Greenberg RE, Guru KA, Herr HW, Hoffman-Censits J, Kishan A, Kundu S, Lele SM, Mamtani R, Margulis V, Mian OY, Michalski J, Montgomery JS, Nandagopal L, Pagliaro LC, Parikh M, Patterson A, Plimack ER, Pohar KS, Preston MA, Richards K, Sexton WJ, Siefker-Radtke AO, Tollefson M, Tward J, Wright JL, Dwyer MA, Cassara CJ, Gurski LA. NCCN Guidelines® Insights: Bladder Cancer, Version 2.2022. J Natl Compr Canc Netw 2022; 20:866-878. [PMID: 35948037 DOI: 10.6004/jnccn.2022.0041] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The NCCN Guidelines for Bladder Cancer provide recommendations for the diagnosis, evaluation, treatment, and follow-up of patients with bladder cancer and other urinary tract cancers (upper tract tumors, urothelial carcinoma of the prostate, primary carcinoma of the urethra). These NCCN Guidelines Insights summarize the panel discussion behind recent important updates to the guidelines regarding the treatment of non-muscle-invasive bladder cancer, including how to treat in the event of a bacillus Calmette-Guérin (BCG) shortage; new roles for immune checkpoint inhibitors in non-muscle invasive, muscle-invasive, and metastatic bladder cancer; and the addition of antibody-drug conjugates for metastatic bladder cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shilajit Kundu
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Ronac Mamtani
- Abramson Cancer Center at the University of Pennsylvania
| | | | - Omar Y Mian
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Jeff Michalski
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | - Anthony Patterson
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Kamal S Pohar
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; and
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18
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Marquardt A, Richterstetter M, Taubert H, Hartmann A, Wullich B, Lieb V, Bellut L, Wach S, Apel H. Reduced Recurrence Rates Are Associated with Photodynamic Diagnostics Compared to White Light after Extended Transurethral Resection of Bladder Tumors. Life (Basel) 2022; 12:life12050641. [PMID: 35629309 PMCID: PMC9143752 DOI: 10.3390/life12050641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
One pillar in treating non-muscle-invasive bladder cancer (NMIBC) is the complete and high-quality transurethral resection of the primary tumor (TURBT). However, even after a high-quality primary resection, the residual tumor risk is considerable, thus requiring a re-TURBT. Resections performed with the aid of a photodynamic diagnostics report improved recurrence-free survival rates and increased detection rates of carcinoma in situ (CIS). This monocentric retrospective study reports on patients treated with an extended TURBT procedure using conventional white-light cystoscopy or photodynamic diagnostics (PDD). Only patients undergoing a TURBT resection for their primary tumor were included in the statistical analysis. Recurrence-free survival and overall survival were the clinical endpoints. Mann−Whitney U tests and chi-squared tests were used for descriptive intergroup comparisons. The associations with overall survival and recurrence-free survival were determined by univariate and multivariate analyses. The test results were considered significant when p was < 0.05. In comparison to conventional white-light cystoscopy, PDD increased the detection rates of CIS (p = 0.004) and tumor multifocality (p = 0.005) and led to reduced residual tumor incidence at the primary resection site (p < 0.001). Likewise, tumor recurrence rates were reduced in the PDD cohort (p < 0.001). Patient age and the presence of residual tumor at the primary resection site were identified as independent predictors of overall survival. For recurrence-free survival, only the PDD resection method was an independent predictor (HR = 0.43; p < 0.001). In summary, we demonstrated that the utilization of PDD techniques was associated with improved detection rates of CIS and multifocal tumors and with reduced recurrence rates. The extended resection protocol allowed us to determine that PDD resections lead to a reduced residual tumor rate at the initial resection site. This residual tumor state at the resection site, determined by extended TURBT, became an independent predictor of long-term survival. On the other hand, the PDD technique was confirmed as the only independent predictor of recurrence-free survival.
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Affiliation(s)
- Alexander Marquardt
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
| | - Mario Richterstetter
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
| | - Helge Taubert
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Arndt Hartmann
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - Bernd Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Verena Lieb
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Laura Bellut
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
| | - Sven Wach
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-9131-8542658; Fax: +49-9131-8523374
| | - Hendrik Apel
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen, Krankenhausstrasse 12, 91054 Erlangen, Germany; (A.M.); (M.R.); (H.T.); (B.W.); (V.L.); (L.B.); (H.A.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), 91054 Erlangen, Germany;
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19
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Shang W, Peng L, He K, Guo P, Deng H, Liu Y, Chen Z, Tian J, Xu W. A clinical study of a CD44v6-targeted fluorescent agent for the detection of non-muscle invasive bladder cancer. Eur J Nucl Med Mol Imaging 2022; 49:3033-3045. [PMID: 35190862 DOI: 10.1007/s00259-022-05701-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/20/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Bladder cancer is the fifth most common malignancy in humans. Cystoscopy under white light imaging is the gold standard for bladder cancer diagnosis, but some tumors are difficult to visualize and can be overlooked, resulting in high recurrence rates. We previously developed a phage display-derived peptide-based near-infrared imaging probe, PLSWT7-DMI, which binds specifically to bladder cancer cells and is nontoxic to animals. Here, we report a clinical research of this probe for near-infrared fluorescence endoscopic detection of bladder cancer. RESULTS The purity, efficacy, safety, and nontoxicity of PLSWT7-DMI were confirmed prior to its clinical application. Twenty-two patients diagnosed with suspected non-muscle invasive bladder cancer were enrolled in the present study. Following intravesical administration of the probe, the entire mucosa was imaged under white and near-infrared imaging using an in-house developed endoscope that could switch between these two modes. The illuminated lesions under near-infrared light were biopsied and sent for histopathological examination. We observed a 5.1-fold increase in the fluorescence intensity in the tumor samples compared to normal tissue, and the probe demonstrated a sensitivity and specificity of 91.2% and 90%, respectively. Common diagnostic challenges, such as small satellite tumors, carcinoma in situ, and benign suspicious mucosa, were visualized and could be distinguished from cancer. Furthermore, no adverse effects were observed in humans. These first-in-human results indicate that PLSWT7-DMI-based near-infrared fluorescence endoscopy is a safe and effective approach for the improved detection of bladder cancer, and may enable thorough resection to prevent recurrence.
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Affiliation(s)
- Wenting Shang
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Li Peng
- Urology Surgery Department, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, People's Republic of China.,NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, Yiyuan Street #37, Nangang District, Harbin, Heilongjiang, 150001, People's Republic of China
| | - Kunshan He
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Zhongguancun East Road #95, Haidian Dist., Beijing, 100191, China
| | - Pengyu Guo
- Urology Surgery Department, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, People's Republic of China.,NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, Yiyuan Street #37, Nangang District, Harbin, Heilongjiang, 150001, People's Republic of China
| | - Han Deng
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yu Liu
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Zhongguancun East Road #95, Haidian Dist., Beijing, 100191, China
| | - Ziyin Chen
- Urology Surgery Department, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, People's Republic of China.,NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, Yiyuan Street #37, Nangang District, Harbin, Heilongjiang, 150001, People's Republic of China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Zhongguancun East Road #95, Haidian Dist., Beijing, 100191, China.
| | - Wanhai Xu
- Urology Surgery Department, The Fourth Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, People's Republic of China. .,NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, Yiyuan Street #37, Nangang District, Harbin, Heilongjiang, 150001, People's Republic of China.
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20
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Regnier S, Califano G, Elalouf V, Albisinni S, Aziz A, Di Trapani E, Krajewski W, Mari A, D'Andrea D, Pradère B, Soria F, Afferi L, Moschini M, Ouzaid I, Xylinas E. Restaging transurethral resection in ta high-grade nonmuscle invasive bladder cancer: a systematic review. Curr Opin Urol 2022; 32:54-60. [PMID: 34812200 DOI: 10.1097/mou.0000000000000949] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The role of a re-transurethral resection (TUR) is clearly demonstrated in T1 high-grade nonmuscle invasive bladder cancer. However, its role remains controversial for Ta high-risk tumors and the recent European guidelines stated that the second look procedure could be avoided for these patients despite harboring a high-risk of both disease recurrence and progression. We aimed to evaluate the added benefit on staging, response to bacillus Calmette-Guérin and oncological outcomes of re-TUR in patients with Ta high-grade nonmuscle invasive bladder cancer. RECENT FINDINGS Overall, we identified 15 studies, including 3912 patients from which 743 harbored Ta high-grade disease. Delay between first and second TUR was ranging from 2 to 12 weeks (median 5.6 weeks). The rate of residual disease was 52.8% (range 17-67%). The rate of overall upstaging to T1 and muscle-invasive disease were 10.9 and 4.7%, respectively. Although there was a trend toward improvement of recurrence-free survival outcomes, no definitive conclusions can be drawn due to the retrospective design of the studies included. SUMMARY Residual tumor is common after initial TUR for Ta high-grade. Re-TUR is useful in reducing the rates of residual disease, may improve staging, response to bacillus Calmette-Guérin and oncological outcomes.
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Affiliation(s)
- Sophie Regnier
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Gianluigi Califano
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
- Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, Federico II University of Naples, Naples, Italy
| | - Vincent Elalouf
- Urology Department, Hôpital Privé Claude Galien, Ramsay Santé, Quincy-Sous-Sénart, France
| | - Simone Albisinni
- Urology Department, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Atiqullah Aziz
- Urology Department, München Klinik Bogenhausen, Munich, Germany
| | | | - Wojciech Krajewski
- Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland
| | - Andrea Mari
- Urology Department, Careggi Hospital, University of Florence, Florence, Italy
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradère
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Soria
- Urology Division, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Luca Afferi
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Marco Moschini
- Department of Medical Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Idir Ouzaid
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
| | - Evanguelos Xylinas
- Urology Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris University, Paris, France
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21
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Parajuli P, Luitel BR, Pradhan MM, Chapagain S, Poudyal S, Chudal S, Guragain B, Pandit D, Gnyawali D, Sigdel PR, Chalise PR, Sharma UK. Clinicopathological patterns of bladder carcinoma over 1 year: experience from University Hospital of Nepal. Int Urol Nephrol 2021; 53:2289-2294. [PMID: 34379255 DOI: 10.1007/s11255-021-02969-6] [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: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To define the clinical and pathological patterns of urinary bladder carcinoma from the University Hospital of Nepal. METHODS This is a retrospective analytical study. Patients with bladder mass who underwent surgery over 1 year and who had data record were included in the study. Demographic profile, type of surgery, findings on clinical examination, cystoscopy findings, histopathological report, tumor stage, and post-surgery adjuvant therapy were analyzed. RESULTS Out of 86 patients who underwent transurethral resection of bladder tumor, 77 patients had biopsy-proven malignant bladder tumor. Urothelial cancer was present in 96.1%. Male were 78.6%. The mean age of diagnosis was 65.5 ± 11.8 years. Non-muscle-invasive bladder cancer (NMIBC) was 3.7 times more common than muscle-invasive bladder cancer (MIBC). High-grade tumors (58.6%) were more common than low grade (41.4%). The detrusor muscle was present inthe biopsy specimen of 48 patients (64%). Re-TURBT within 2-6 weeks was considered based on histopathology reports for about half of the patients (45.3%). Upstaging and upgrading of the tumor was present in 5.8 and 5.8% of the patients, respectively. Residual tumor without upstaging and upgrading was present in 23.5%. One patient (1.3%) had Clavien-Dindo grade 1, three (4%) patients had grade 2 and two patients (2.7%) had grade 3b. CONCLUSION In the present study, patients with bladder cancer are younger than reported in other studies. Smokers are strongly predisposed. The histological pattern is similar to the Western and Asian populations. NMIBC and MIBC occur in proportion to that described as in other studies. We had a lower rate of recurrence, upstaging and upgrading. We had a lesser rate of acceptance for radical cystectomy in our patients.
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Affiliation(s)
- Purushottam Parajuli
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal.
| | - Bhoj Raj Luitel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Manish Man Pradhan
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Suman Chapagain
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Sujeet Poudyal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Sampanna Chudal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Bipin Guragain
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Durga Pandit
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Diwas Gnyawali
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Prem Raj Sigdel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Pawan Raj Chalise
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
| | - Uttam Kumar Sharma
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, 44600, Nepal
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22
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Zou L, Liu R, Xu C, Yang C, Zhang Z, Hu J, Jiang H. Ureteroscopic Cryoablation for Patients with Upper Tract Urothelial Carcinoma of a Solitary Kidney: A Porcine Model and Our Pilot Clinical Experience. Ann Surg Oncol 2021; 28:9201-9208. [PMID: 34129151 PMCID: PMC8591015 DOI: 10.1245/s10434-021-10233-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/09/2021] [Indexed: 12/12/2022]
Abstract
Purpose To investigate the safety and efficacy of ureteroscopic cryoablation by a liquid-nitrogen system in a porcine model and for patients with upper tract urothelial carcinoma (UTUC) of a solitary kidney. Methods In the animal experiment, the right-sided ureter was frozen in nine pigs. Eight were randomly assigned to two different groups according to the freezing duration of 60 or 90 s. The other one was designed to receive a 10-min freeze. The treated ureters were harvested at 30 min, 2 days, 4 weeks, and 3 months after cryoablation for histological evaluation. After the animal study, we conducted a pilot clinical trial that enrolled six patients who were diagnosed with UTUC of a solitary kidney and received therapeutic management with ureteroscopic cryoablation at our center. Perioperative adverse events and oncological outcomes were evaluated. Results In the porcine model, the liquid-nitrogen system was capable of forming a therapeutic ice ball which infiltrated the full-thickness ureter and induced apoptosis and necrosis from mucosa to lamina muscularis through histological examination. In the clinical trial, cryoablation was successfully performed under ureteroscopy in all the patients, without intraoperative ureteral perforation, avulsion, or active hemorrhage. No recurrence in situ was observed during a median follow-up period of 12.5 months. Hydronephrosis and ureteral stricture was observed in one patient and was managed with ureteroscopic balloon dilation. Conclusions Ureteroscopic cryoablation induced by liquid nitrogen is a promising technique for conservative management of UTUC with benefits of improving local tumor control and preservation of a solitary kidney. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-10233-5.
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Affiliation(s)
- Lujia Zou
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Institute of Urology, Fudan University, Shanghai, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Rongzong Liu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Institute of Urology, Fudan University, Shanghai, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chenyang Xu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Institute of Urology, Fudan University, Shanghai, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chen Yang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Institute of Urology, Fudan University, Shanghai, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zheyu Zhang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Institute of Urology, Fudan University, Shanghai, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jimeng Hu
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.,Institute of Urology, Fudan University, Shanghai, People's Republic of China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Haowen Jiang
- Department of Urology, Huashan Hospital, Fudan University, Shanghai, People's Republic of China. .,Institute of Urology, Fudan University, Shanghai, People's Republic of China. .,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
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23
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Hensley PJ, Bree KK, Brooks N, Matulay J, Li R, Nogueras-Gonzalez GM, Nagaraju S, Navai N, Grossman HB, Dinney CP, Kamat AM. Implications of Guideline-based, Risk-stratified Restaging Transurethral Resection of High-grade Ta Urothelial Carcinoma on Bacillus Calmette-Guérin Therapy Outcomes. Eur Urol Oncol 2021; 5:347-356. [PMID: 33935020 DOI: 10.1016/j.euo.2021.04.003] [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: 02/23/2021] [Revised: 03/20/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Guideline indications for restaging transurethral resection (reTUR) for high-grade (HG) Ta bladder tumors vary due to a paucity of data. OBJECTIVE To investigate guideline-based, risk-adapted approaches to reTUR for HG Ta lesions. DESIGN, SETTING, AND PARTICIPANTS An institutional review of HG Ta patients who received adequate bacillus Calmette-Guérin (BCG) from 2000 to 2019 was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Guideline criteria for reTUR were used to stratify patients. Kaplan-Meier product limits estimated survival. Cox regression and log-rank tests identified association of variables with survival. RESULTS AND LIMITATIONS Of the 209 patients with HG Ta bladder cancer, 104 (50%) underwent reTUR, which identified residual disease in 39 patients (38%). Only one patient (1%) was upstaged to pT1 on reTUR. In all unstratified HG Ta patients, reTUR was associated with improved progression-free survival (p = 0.050) and recurrence-free survival (RFS; p = 0.003). The 5-yr RFS for patients who underwent versus those who did not undergo reTUR based on AUA guidelines was 73% (95% confidence interval 63-81%) versus 52% (40-62%), and for those who underwent versus those who did not undergo reTUR based on EAU guidelines was 76% (61-86%) versus 22% (4-49%). In 45 patients meeting both AUA high-risk criteria (large, multifocal tumors) and EAU criteria (lack of detrusor muscle) for reTUR, lack of restaging was associated with over a two-fold increase in recurrence (67% vs 15%, p = 0.002) and progression (25% vs 6%, p = 0.109). Data were limited by selection bias unaccounted for in selecting candidates for reTUR. CONCLUSIONS Restaging TUR in all HG Ta patients, regardless of risk stratification, was associated with improved outcomes. The benefit of reTUR was most notable in high-risk patients without muscle in the index specimen, consistent with components of both AUA and EAU guidelines. These data support a non-risk-adapted approach to reTUR for all HG Ta lesions. PATIENT SUMMARY Restaging bladder tumor resection improves outcomes in patients with high-grade Ta tumors treated with bacillus Calmette-Guérin (BCG).
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Affiliation(s)
- Patrick J Hensley
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kelly K Bree
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nathan Brooks
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Justin Matulay
- Department of Urology, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Roger Li
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Supriya Nagaraju
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - H Barton Grossman
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Colin P Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashish M Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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24
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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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25
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Transurethral Resection of Bladder Tumors (TURBT). Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Bicentric Retrospective Analysis of en Bloc Resection and Muscularis Mucosae Detection Rate in Non-Muscle Invasive Bladder Tumors: A Real-World Scenario. Adv Ther 2021; 38:258-267. [PMID: 33094476 PMCID: PMC7854421 DOI: 10.1007/s12325-020-01529-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/08/2020] [Indexed: 11/16/2022]
Abstract
Introduction For risk stratification of non-muscle invasive bladder cancer (NMIBC), the depth of stromal invasion can be further classified, where the lamina muscularis mucosae (MM) serves as a reference structure. While the overall identifiability of MM in standard transurethral specimens is low, en bloc resection may help in identification and overall orientation. The aims of this study were to report the detection rate of MM in en bloc resected bladder tumors (ERBT) and to provide real-world information on tissue stability and preservation of en bloc architecture during recovery and processing for histopathologic evaluation. Methods Thirty-four ERBT specimens were histologically re-evaluated with regard to MM detectability and structure as well as the presence of en bloc architecture and further histologic features. Associations with tumor size and energy source and within histologic parameters were assessed by standard Pearson's chi-squared analyses and Cramér’s V effect size testing (V). Results The first parameter assessed was MM detection rate. In 19 out of 34 samples (56%) MM was detectable: scattered in 9 cases (26%), interrupted in 8 cases (24%) and continuous in 2 cases (6%). The second parameter assessed was preservation of en bloc architecture. In 11 out of 34 samples (32%), en bloc architecture could not be confirmed, and these samples served as a reference group for the detection of MM. Preservation of en bloc architecture was associated with an increased MM detection rate (MM in en bloc preserved 16/23, 70% vs. non-preserved 3/11, 27%; p = 0.020; V = 0.398) and with tumor size (p = 0.005; V = 0.595). Medium-sized tumors (1.1–2 cm) were best preserved. The choice of energy source did not show relevant association with en bloc architecture (p = n.s.). Conclusions In line with recent publications, ERBT increases the MM detection rate considerably. However, a third of the ERBT specimens lost en bloc architecture during sample recovery and processing. Tumor size is a relevant factor, with optimal architecture preservation between 1 and 2 cm. Optimizing resection techniques, recovery, transport, and diagnostic processing of ERBT samples is warranted to verify the diagnostic value of MM-based substaging.
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27
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Hashem A, Mosbah A, El-Tabey NA, Laymon M, Ibrahiem EH, Elhamid MA, Elshal AM. Holmium Laser En-bloc Resection Versus Conventional Transurethral Resection of Bladder Tumors for Treatment of Non-muscle-invasive Bladder Cancer: A Randomized Clinical Trial. Eur Urol Focus 2020; 7:1035-1043. [PMID: 33386289 DOI: 10.1016/j.euf.2020.12.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/01/2020] [Accepted: 12/05/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND En-bloc resection of bladder tumors achieves complete tumor removal, improves the quality of resection, decreases perioperative complication, and potentially improves recurrence rates. OBJECTIVE To assess the efficacy and safety of holmium laser en-bloc resection (HolERBT) versus conventional transurethral resection of bladder tumor (cTURBT). DESIGN, SETTING, AND PARTICIPANTS Between September 2015 and September 2018, 100 patients with non-muscle-invasive bladder cancer were randomly allocated to cTURBT or HolERBT. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was detection of residual tumor in reTURBT specimens at 4 wk after the primary resection. Operative parameters, specimen quality, perioperative complications, and recurrence-free survival (RFS) were compared. Independent sample t tests, χ2 tests, and Kaplan-Meier curves were used, as appropriate. RESULTS AND LIMITATIONS The patient and tumor baseline characteristics were comparable between the groups. Residual tumors were detected in 7% and 27.7% of cases after HolERBT and cTURBT, respectively (p=0.01). Detrusor muscle was sampled in 98% of HolERBT and 62% of cTURBT cases (p<0.001). Lamina propria invasion substaging was feasible in only 68.2% of HolERBT and 18.4% of cTURBT cases (p<0.001). Following HolERBT, catheterization time (p<0.001) and hospital stay (p=0.001) were shorter when compared to cTURBT. Immediate postoperative instillation of chemotherapy in indicated cases was feasible for 100% of the HolERBT group and 91.5% of the cTURBT group (p=0.04). After follow-up of 20 ± 9.9 mo (13-36), RFS was 31.76 mo (95% confidence interval [CI] 28.67-34.86) in the HolERBT group and 28.25 mo (95% CI 24.87-31.64) in the cTURBT group (hazard ratio 0.43, 95% CI 0.17-1.1; p=0.07). However, this study was not powered to detect a difference in RFS. CONCLUSIONS Compared to cTURBT, HolERBT is a safer procedure for bladder tumor resection. It fulfills the oncological criteria of optimized resection with less residual tumor and better specimen quality. PATIENT SUMMARY En-bloc resection of bladder cancer tumors using a holmium laser is safer than the conventional technique. It has the advantages of less residual tumor and better specimen quality, with a similar tumor recurrence rate. This study is registered at ClinicalTrials.gov as NCT02555163.
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Affiliation(s)
| | - Ahmed Mosbah
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Nasr A El-Tabey
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mahmoud Laymon
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | | | - Ahmed M Elshal
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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28
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Utilization of imaging for staging in bladder cancer: is there a role for MRI or PET-computed tomography? Curr Opin Urol 2020; 30:377-386. [PMID: 32168196 DOI: 10.1097/mou.0000000000000743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Accurate staging of bladder cancer is essential to guide appropriate management. In this review, we discuss the principles, applications and performance of multiparametric MRI (mpMRI) and PET-computer tomography (PET-CT) for local and distant staging of bladder cancer. RECENT FINDINGS Bladder mpMRI has a high diagnostic performance in local staging of bladder cancer, superior to other imaging modalities. It can accurately differentiate muscle invasive bladder cancer (MIBC) from non-MIBC (NMIBC), as well as ≤T2 from ≥T3 stages. mpMRI can be used to assess pelvic lymph nodes, although its sensitivity is relatively low. For the assessment of the upper urinary tract, CT urography is the imaging modality of choice. magnetic resonance urography is a viable alternative to CT in selected cases. Although PET-CT is accurate for nodal and distant staging of bladder cancer, there is no clear evidence on its superior diagnostic performance compared with contrast-enhanced CT. SUMMARY mpMRI is the most accurate imaging modality for local staging of bladder cancer, capable to accurately distinguish MIBC from NMIBC. Nodal and distant staging relies primarily on contrast-enhanced CT.
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29
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Sionov BV, Tsivian M, Taha T, Bass R, Kheifets A, Sidi AA, Tsivian A. Value of separate tumor base biopsy in transurethral resection of bladder tumors. Cent European J Urol 2020; 73:440-444. [PMID: 33552569 PMCID: PMC7848826 DOI: 10.5173/ceju.2020.0073] [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: 07/25/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of our study was to evaluate whether a biopsy from the tumor base after transurethral resection of bladder tumor (TURBT) has an impact on subsequent management of patients with bladder tumors. While tumor base biopsy at the completion of TURBT is a common practice, there is no definition of its role within the major international professional guidelines. Material and methods We retrospectively reviewed the records of consecutive patients undergoing TURBT between 2015 and 2019 at our institution. We recorded demographic and tumor characteristics of initial TURBT, tumor base biopsy and restaging TURBT pathology outcomes. The pathologic outcomes were correlated to assess the additional value of a separate tumor base biopsy. Results A total of 532 patients underwent TURBT. A separate tumor base biopsy after completion of TURBT was performed in 154 patients. The mean patient's age was 72.8 ±11.7 years (range 48–94) and 119 (77.2%) were men. In 40 patients (25.9%) muscle was absent in the pathological specimen of the tumor resection. Muscle was present in all but 6 (3.9%) tumor base biopsies. Of the 33 patients who underwent repeated transurethral resection for pT1 tumors, 2 had residual low-grade pTa, 1 had residual high-grade pT1, and 3 patients were upstaged to pT2. Conclusions Although tumor base biopsy at the completion of TURBT is a common practice, our analysis fails to demonstrate any tangible benefit in the staging of bladder tumors. In our experience tumor base biopsy did not change the management in patients with superficial or muscle invasive disease.
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Affiliation(s)
- Ben Valery Sionov
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tarek Taha
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roman Bass
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kheifets
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abraham Ami Sidi
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Tsivian
- Department of Urologic Surgery, Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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30
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Taoka R, Matsuoka Y, Kohashiguchi K, Miura T, Tohi Y, Miyauchi Y, Kato T, Tsunemori H, Ueda N, Kakehi Y, Sugimoto M. Impact of second transurethral resection on recurrence in patients with high-grade Ta bladder cancer. Int J Urol 2020; 27:1130-1135. [PMID: 32985754 DOI: 10.1111/iju.14372] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To clarify the potential therapeutic benefit of a second transurethral resection for high-grade Ta bladder cancer. METHODS From January 2009 to August 2019, 521 patients with bladder tumors underwent initial transurethral resection procedures at Kagawa University Hospital. Patients diagnosed with high-grade Ta bladder cancer considered to have been resected completely were included in this study. Recurrence and progression rates were compared between patients who received a second transurethral resection and those who did not. RESULTS We identified 97 eligible patients, including 22 patients who received a second transurethral resection. In terms of clinical characteristics, the proportion of patients with bladder cancer and upper urinary tract tumor history was lower in the second transurethral resection group than in the no second transurethral resection group (P < 0.01 and P = 0.03, respectively). The histopathological findings of 22 transurethral resection procedures were no cancer in 13 (59.2%), Ta in six (27.2%) and carcinoma in situ in three patients (13.6%). After the second transurethral resection, one patient (4.6%) had recurrent high-grade T1 bladder cancer. The no second transurethral resection group showed a 44% recurrence rate (33 patients), including five patients (6.7%) with progression, and consequently, had a higher rate of recurrence than in the second transurethral resection group (P < 0.01). Multivariate analysis showed that no second transurethral resection was the independent predictive factor influencing recurrence (hazard ratio 8.662, P = 0.04). The Kaplan-Meier curve showed that a second transurethral resection significantly decreased the recurrence rate than that of patients without a second transurethral resection (P < 0.01). CONCLUSIONS A second transurethral resection can reduce the recurrence rate in high-grade Ta bladder cancer, showing a possible therapeutic benefit of this procedure.
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Affiliation(s)
- Rikiya Taoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yuki Matsuoka
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Kana Kohashiguchi
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Takayoshi Miura
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yoichiro Tohi
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yasuyuki Miyauchi
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Takuma Kato
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Nobufumi Ueda
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Yoshiyuki Kakehi
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Mikio Sugimoto
- Department of Urology, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
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Değer MD, Çelik S, Yıldız A, Sarı H, Yılmaz B, Bozkurt O, Tuna B, Yörükoğlu K, Aslan G. Can we perform frozen section instead of repeat transurethral resection in bladder cancer? Urol Oncol 2020; 39:237.e15-237.e20. [PMID: 32948432 DOI: 10.1016/j.urolonc.2020.08.031] [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: 05/28/2020] [Revised: 07/12/2020] [Accepted: 08/23/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To confirm frozen section (FS) method for muscularis propria (MP) sampling and to compare the FS method with the ReTUR section (RS) procedure to reduce needing for second resection that can cause waste of time for definitive treatment of muscle-invasive bladder cancer. METHODS A total of 27 patients who admitted to our clinic and was performed transurethral resection of bladder tumor (TUR-BT) due to bladder tumor and had an indication of ReTUR were evaluated prospectively in the study. During the first TUR-BT procedure (as permanent section), FS examination was also performed to the patients. ReTUR was performed 2-6 weeks after the first TUR-BT procedure. RESULTS Presences of MP were observed in 51.8% and 77.7% of FS and permanent section examinations. In the comparing of the presence of residual tumor in the methods, although 12 of 27 patients were found to have a residual tumor in FS, it was found to be in only 6 of 12 patients in RS. There was no statistical significance between FS and RS methods for MP sampling and detecting of residual tumor. CONCLUSIONS FS was found to be a comparable method with the RS method (ReTUR procedure) for the sampling of MP and detecting of residual tumor, despite the limitations in the pathological examination FS. Especially in patients with detected residual tumor after the pathological consultation of FS during the procedure, re-resection can be a choice at the end of the first TUR-BT instead of ReTUR.
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Affiliation(s)
- Müslim Doğan Değer
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey.
| | - Serdar Çelik
- Department of Basic Oncology, Dokuz Eylül University, Institute of Oncology, İzmir, Turkey
| | - Alperen Yıldız
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Hilmi Sarı
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Batuhan Yılmaz
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Ozan Bozkurt
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Burçin Tuna
- Department of Pathology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Kutsal Yörükoğlu
- Department of Pathology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
| | - Güven Aslan
- Department of Urology, Dokuz Eylül University, School of Medicine, İzmir, Turkey
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Mastroianni R, Brassetti A, Krajewski W, Zdrojowy R, Salhi YA, Anceschi U, Bove AM, Carbone A, De Nunzio C, Fuschi A, Ferriero M, Nacchia A, Pastore AL, Tema G, Tuderti G, Gallucci M, Simone G. Assessing the Impact of the Absence of Detrusor Muscle in Ta Low-grade Urothelial Carcinoma of the Bladder on Recurrence-free Survival. Eur Urol Focus 2020; 7:1324-1331. [PMID: 32900676 DOI: 10.1016/j.euf.2020.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obtaining detrusor muscle (DM) in transurethral resection of bladder tumor (TURBt) specimen is considered a surrogate marker of resection quality. However, evidence was principally investigated in high-risk tumors. Therefore, DM sampling for low-grade (LG) urothelial carcinoma (UC) remains poorly investigated and certainly requires further investigation. OBJECTIVE To assess whether the absence of DM in TURBt specimen has a negative impact on recurrence-free survival (RFS) in patients with a Ta LG UC. DESIGN, SETTING, AND PARTICIPANTS A multicenter TURBt database was queried for "LG, Ta, UC of the bladder." All patients treated between 1996 and 2018 with tumor grade assessed according to both 1973 World Health Organization and 2004 WHO/International Society of Urological Pathology grading classifications and with a minimum follow-up of 1 yr were included. Patients with a previous history of high-grade UC, upper urinary tract UC, or bladder tumor differentiations other than UC were excluded. INTERVENTION TURBt. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Baseline demographic, clinical, and pathologic data were analyzed. The European Organization for Research and Treatment of Cancer (EORTC) risk group was recorded. Kaplan-Meier analysis was performed to assess the predictive role of clinical and pathologic data for RFS. Univariable and multivariable Cox regression analyses were performed to identify the predictors of recurrence. RESULTS AND LIMITATIONS Overall, 521 patients were included. At Kaplan-Meier analysis, the low-risk cohort displayed significantly higher RFS than the intermediate-risk cohort (1-yr RFS 87% vs 79%; log-rank p = 0.007). At univariable Cox regression analysis, only gender, multiple tumors, tumor diameter ≥3 cm, and EORTC risk group were significant predictors of recurrence. Absence of DM had no impact on RFS. Multivariable Cox regression analysis confirmed gender and EORTC risk group as independent predictors of recurrence. CONCLUSIONS Absence of DM in TURBt specimen has negligible role in RFS of patients with Ta LG tumors of the bladder. PATIENT SUMMARY In this study, we assessed the role that detrusor muscle (DM) in transurethral resection of bladder tumor specimen has in recurrence-free survival, in patients with a Ta low-grade urothelial carcinoma of the bladder. Absence of DM has no impact on tumor recurrence; therefore, it does not require additional attention.
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Affiliation(s)
- Riccardo Mastroianni
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy; Department of Urology, "Sapienza" University, Rome, Italy.
| | - Ado Brassetti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Wojciech Krajewski
- Department of Urology and Urological Oncology, Wrocław Medical University, Wrocław, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wrocław Medical University, Wrocław, Poland
| | - Yazan Al Salhi
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | - Umberto Anceschi
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Alfredo Maria Bove
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Antonio Carbone
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | | | - Andrea Fuschi
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | | | | | - Antonio Luigi Pastore
- Department of Medico Surgical Sciences and Biotechnologies-Urology Unit, "Sapienza" University-I.C.O.T., Latina, Italy
| | - Giorgia Tema
- Department of Urology, "Sant'Andrea" Hospital, Rome, Italy
| | - Gabriele Tuderti
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
| | | | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy
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Mariappan P, Johnston A, Padovani L, Clark E, Trail M, Hamid S, Hollins G, Simpson H, Thomas BG, Hasan R, Bhatt J, Ahmad I, Nandwani GM, Mitchell IDC, Hendry D. Enhanced Quality and Effectiveness of Transurethral Resection of Bladder Tumour in Non-muscle-invasive Bladder Cancer: A Multicentre Real-world Experience from Scotland's Quality Performance Indicators Programme. Eur Urol 2020; 78:520-530. [PMID: 32690321 DOI: 10.1016/j.eururo.2020.06.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical outcomes from non-muscle-invasive bladder cancer (NMIBC) are partly determined by the quality of initial interventions. To improve and standardise treatment for cancer, Scotland implemented a national Quality Performance Indicator (QPI) programme for bladder cancer (BC). OBJECTIVE To evaluate compliance with specific quality indicators (QIs) related to transurethral resection of bladder tumour (TURBT) and to understand clinical outcomes from NMIBC following the introduction of the QPI programme. DESIGN, SETTING, AND PARTICIPANTS Within a robust governance framework, 12 mandatory evidence-based QPIs were implemented nationally in April 2014. We report prospectively collected data for all new BC patients (between April 2014 and March 2017). We include follow-up data for 2689 patients. INTERVENTION The TURBT-related QPIs were (1) using a bladder diagram, (2) single post-TURBT instillation of mitomycin C (SPI-MMC), (3) detrusor muscle (DM) in the specimen, and (4) early re-TURBT in high-risk NMIBC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We measured compliance with these QPIs and (1) recurrence rate at first follow-up cystoscopy (RRFFC), (2) rates of residual cancer, and (3) pT2 cancer at re-TURBT. Associations between QPI compliance, tumour features, and outcomes were assessed with multivariable logistic regression models. RESULTS AND LIMITATIONS Among 4246 new BC patients, SPI-MMC was used in 67% (2029/3023) NMIBC patients. In 1860 NMIBC patients undergoing TURBT, RRFFC, rate of residual cancer, and rate of pT2 at re-TURBT were 13% (116/888), 33% (212/653), and 2.9% (19/653), respectively. SPI-MMC was associated with lower RRFFC, independent of all variables including hospital volume and surgeon. Presence of DM in the specimen halved the likelihood of residual disease in pT1 cancers. The main limitation is the lack of a pre-QPI introduction cohort for comparison. CONCLUSIONS The implementation of a QI programme in Scotland appears to facilitate high-quality TURBT, which in a real-world setting is associated with low early recurrence/residual cancer and accurate pathological staging. PATIENT SUMMARY Following the first 3 yr of implementing a novel Quality Performance Indicator (QPI) programme in Scotland, we assessed compliance and outcomes in non-muscle-invasive bladder cancer. Evaluating over 4000 new bladder cancer patients, we found that the QPI programme was associated with low recurrence and accurate staging following the initial transurethral resection of bladder tumour.
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Affiliation(s)
- Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; University of Edinburgh, Edinburgh, UK.
| | - Allan Johnston
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Luisa Padovani
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK
| | | | - Matthew Trail
- Department of Urology, Ninewells Hospital, Dundee, UK
| | - Sami Hamid
- Department of Urology, Ninewells Hospital, Dundee, UK
| | | | - Helen Simpson
- Department of Urology, Victoria Hospital, Kirkcaldy, UK
| | - Benjamin G Thomas
- Edinburgh Bladder Cancer Surgery, Department of Urology, Western General Hospital, Edinburgh, UK; Department of Urology, Borders General Hospital, Melrose, UK
| | - Rami Hasan
- Department of Urology, University Hospital Ayr, Ayr, UK
| | - Jaimin Bhatt
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - Imran Ahmad
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - David Hendry
- Department of Urology, Queen Elizabeth University Hospital, Glasgow, UK
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Leow JJ, Catto JWF, Efstathiou JA, Gore JL, Hussein AA, Shariat SF, Smith AB, Weizer AZ, Wirth M, Witjes JA, Trinh QD. Quality Indicators for Bladder Cancer Services: A Collaborative Review. Eur Urol 2020; 78:43-59. [PMID: 31563501 DOI: 10.1016/j.eururo.2019.09.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
CONTEXT There is a lack of accepted consensus on what should constitute appropriate quality-of-care indicators for bladder cancer. OBJECTIVE To evaluate the optimal management of bladder cancer and propose quality indicators (QIs). EVIDENCE ACQUISITION A systematic review was performed to identify literature on current optimal management and potential quality indicators for both non-muscle-invasive (NMIBC) and muscle-invasive (MIBC) bladder cancer. A panel of experts was convened to select a recommended list of QIs. EVIDENCE SYNTHESIS For NMIBC, preoperative QIs include tobacco cessation counselling and appropriate imaging before initial transurethral resection of bladder tumour (TURBT). Intraoperative QIs include administration of antibiotics, proper safe conduct of TURBT using a checklist, and performing restaging TURBT with biopsy of the prostatic urethra in appropriate cases. Postoperative QIs include appropriate receipt of perioperative adjuvant therapy, risk-stratified surveillance, and appropriate decision to change therapy when indicated (eg, bacillus Calmette-Guerin [BCG] unresponsive). For MIBC, preoperative QIs include multidisciplinary care, selection for candidates for continent urinary diversion, receipt of neoadjuvant cisplatin-based chemotherapy, time to commencing radical treatment, consideration of trimodal therapy as a bladder-sparing alternative in select patients, preoperative counselling with stoma marking, surgical volume of radical cystectomy, and enhanced recovery after surgery protocols. Intraoperative QIs include adequacy of lymphadenectomy, blood loss, and operative time. Postoperative QIs include prospective standardised monitoring of morbidity and mortality, negative surgical margins for pT2 disease, appropriate surveillance after primary treatment, and adjuvant cisplatin-based chemotherapy in appropriate cases. Participation in clinical trials was highlighted as an important component indicating high quality of care. CONCLUSIONS We propose a set of QIs for both NMIBC and MIBC based on established clinical guidelines and the available literature. Although there is currently a lack of level 1 evidence for the benefit of implementing these QIs, we believe that the measurement of these QIs could aid in the improvement and benchmarking of optimal care for bladder cancer. PATIENT SUMMARY After a systematic review of existing guidelines and literature, a panel of experts has recommended a set of quality indicators that can help providers and patients measure and strive towards optimal outcomes for bladder cancer care.
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Affiliation(s)
- Jeffrey J Leow
- Department of Urology, Tan Tock Seng Hospital, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James W F Catto
- Academic Urology Unit, The University of Sheffield, Sheffield, UK
| | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ahmed A Hussein
- Department of Urology, Cairo University, Cairo, Egypt; Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Departments of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Angela B Smith
- Department of Urology, Lineberger Comprehensive Cancer Center, UNC-Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Manfred Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - J Alfred Witjes
- Department of Urology, Radboud University, Nijmegen, The Netherlands
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Kamalov AA, Sorokin NI, Dymov AM, Kislyakov DA, Kamalov DM, Dzitiev VK, Pshihachev AM, Strigunov AA, Afanasyevskaya EV, Tivtikyan AS, Nesterova OY. TECHNICAL ASPECTS OF LASER EN BLOC RESECTION OF THE BLADDER TUMOR FOR NON-MUSCLE-INVASIVE BLADDER CANCER. SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-1-53-58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract: In recent decades bladder cancer has become one of the most topical problems of modern healthcare due to its widespread distribution. This makes it necessary to investigate new effective methods of surgical treatment.Objective: Assessment of the effectiveness of en bloc resection of the bladder with tumor by analyzing scientific publications on this matter.Materials and methods: We have analyzed current articles related to this topic on the databases Pubmed and Google Scholar. The search was performed using the keywords «Bladder Tumor», «En bloc resection of the bladder wall», «non-muscle-invasive bladder cancer».Results: Most studies confirm the advantages of laser en bloc resection over other methods in terms of such parameters as the frequency of recurrence, macrohematuria, and the quality of morphological material.Conclusions: Laser en bloc resection of a bladder tumor without invasion of the muscle layer is a safe and effective operation that has a number of advantages over classical transurethral resection, namely: no obturator syndrome, high-quality material for pathomorphological research, low recurrence rate.
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Affiliation(s)
| | | | - A. M. Dymov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
| | - D. A. Kislyakov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
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Enikeev D, Taratkin M, Margulis V, Sorokin N, Severgina L, Paramonova N, Kislyakov D, Kozlov V, Rapoport L, Shariat SF, Glybochko P. Safety and Short-Term Oncological Outcomes of Thulium Fiber Laser En Bloc Resection of Non-Muscle-Invasive Bladder Cancer: A Prospective Non-Randomized Phase II Trial. Bladder Cancer 2020. [DOI: 10.3233/blc-200275] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Ongoing efforts aim at overcoming the challenges of conventional transurethral resection of bladder tumor (TURBT) such as the high recurrence rate, difficulty of pathologic interpretation and complications including wall injury. OBJECTIVE: To prospectively assess the safety and efficacy of Thulium fiber en bloc resection of bladder tumor (Tm-fiber ERBT) compared to TURBT. MATERIALS AND METHODS: The prospective non-randomized study included 129 patients with non-muscle-invasive bladder cancer (NMIBC) divided into two groups: 58 patients underwent conventional TURBT and 71 –Tm-fiber ERBT with FiberLase U1 (NTO IRE-Polus, Russia). Relapse-free survival (RFS), detrusor presence and complication rates were assessed. For multivariable analysis we used the Pearson chi-squared Hosmer-Lemeshow goodness of fit test; to compare survival –Cox regression analysis; for operative data comparison –chi-square test with Fisher’s correction; for survival analysis –the Kaplan–Meier method and logrank test. RESULTS: RFS rates at 3 and 6 months were 84.5% and 67.2% for conventional TURBT versus 97.2% and 91.5% for Tm-fiber ERBT (p = 0.011 and p < 0.001, respectively). Detrusor muscle was present in 58.6% of cases treated with conventional TURBT vs 91.6% for the Tm-fiber ERBT group (p < 0.001). The obturator nerve reflex and bleeding were noted in 17.2% and 10.3% of TURBT cases, respectively; and in none of cases treated with Tm-fiber ERBT. Limitations included the non–randomized nature and the small sample size. CONCLUSIONS: Tm-fiber ERBT seems to be a safe and efficacious treatment option for NMIBC. Tm-fiber ERBT had fewer adverse events, was more likely to secure detrusor muscle in the specimen and resulted in better RFS rates than conventional TURBT. Based on these promising data, we have started a prospective randomized clinical trial comparing en bloc TURBT with conventional TURBT (ClinicalTrials.gov NCT03718754).
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Affiliation(s)
- Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vitaly Margulis
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nikolay Sorokin
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Lubov Severgina
- Department of Pathology, Sechenov University, Moscow, Russia
| | - Nina Paramonova
- Centralized Pathology Department, Sechenov University, Moscow, Russia
| | - Dmitry Kislyakov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Vasiliy Kozlov
- Department of Public Health and Healthcare Organization, Sechenov University, Moscow, Russia
| | - Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Shahrokh F. Shariat
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Urology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Weill Medical College of Cornell University, New York, NY, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Glybochko
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Saita A, Lughezzani G, Buffi NM, Hurle R, Nava L, Colombo P, Diana P, Fasulo V, Paciotti M, Elefante GM, Lazzeri M, Guazzoni G, Casale P. Assessing the Feasibility and Accuracy of High-resolution Microultrasound Imaging for Bladder Cancer Detection and Staging. Eur Urol 2020; 77:727-732. [DOI: 10.1016/j.eururo.2019.03.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/28/2019] [Indexed: 10/27/2022]
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Abstract
OBJECTIVE. The purpose of this article is to review the natural history and management of bladder cancer, with insight into MRI applications for the assessment of muscle invasiveness of bladder cancer using the newly developed Vesical Imaging Reporting and Data System (VI-RADS) score. CONCLUSION. Multiparametric MRI and the VI-RADS score have been consistently validated across several different institutions as appropriate tools for local staging of bladder cancer and have been proven to contribute to the diagnostic workup and management of urinary bladder cancer.
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Branchu B, Léon P, Jeglinschi SC, Durlach A, Trigui S, Birembaut P, Larré S. [Interest of reTURB for pTa high grade bladder urothelial carcinoma]. Prog Urol 2019; 30:19-25. [PMID: 31866142 DOI: 10.1016/j.purol.2019.11.006] [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: 09/24/2019] [Revised: 11/01/2019] [Accepted: 11/28/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Second look TURB (Transurethral Resection of Bladder Tumor) is recommended for high-risk pT1 tumors. It is well acquired for tumors classified pT1 high grade but its interest is still discussed for high-grade pTa tumors in the absence of high level of evidence. We evaluated the impact of second-look resection for the high-grade pTa bladder tumor. METHODS We performed a retrospective study in 2 centers from 2007 to 2016. We included all urothelial tumors classified pTa high grade. We studied the anatomopathological findings of reTURB and its consequences on survival without recurrence and progression. RESULTS Eighty-four patients were included. Thirty-five patients (41.7%) had reTURB and residual tumor was found in 42.9% of cases. The anatomopathology of reTURB was in 20% of cases high grade pTa, in 14.3% of cases pTis, and in 8.6% of cases pT1. Forty-three patients had recurrence, 13 reTURB patients (30.2%). In the patients who had a reTURB, 12 had recurrence (34.3%) against 31 without reTURB, (63.3%). After the first TURB, 45 patients (53.6%) had bladder instillation: 38 received BCG (45.2%) and 7 ametycin (8.3%). The main factor decreasing recurrence was BCG adjuvant therapy (HR=0.4 [0.2-0.9], P=0.02). The absence of reRTUV appeared to be a recurrence factor, but the result was not statistically significant (HR=1.4 [0.7-3], P=0.3). CONCLUSION reTURB confirms that residual tumor is often found. His interest in survival without recurrence remains to be proved by a prospective study with a larger number of patients. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- B Branchu
- Service d'urologie, CHU de Reims, 51000 Reims, France.
| | - P Léon
- Service d'urologie, clinique Pasteur, 17200 Royan, France
| | | | - A Durlach
- Laboratoire d'anatomopathologie, CHU de Reims, 51000 Reims, France
| | - S Trigui
- Service d'urologie, Polyclinique Montier-la-celle, 10120 Saint-André-les-Vergers, France
| | - P Birembaut
- Laboratoire d'anatomopathologie, CHU de Reims, 51000 Reims, France
| | - S Larré
- Service d'urologie, CHU de Reims, 51000 Reims, France
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Calò B, Chirico M, Fortunato F, Sanguedolce F, Carvalho-Dias E, Autorino R, Carrieri G, Cormio L. Is Repeat Transurethral Resection Always Needed in High-Grade T1 Bladder Cancer? Front Oncol 2019; 9:465. [PMID: 31214506 PMCID: PMC6558035 DOI: 10.3389/fonc.2019.00465] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/15/2019] [Indexed: 11/15/2022] Open
Abstract
Re-staging transurethral resection, the so-called repeat TUR (Re-TUR), is mandatory in case of incomplete first transurethral resection of bladder tumor (TURBT). In completely resected high grade T1 tumors, Re-TUR is recommended but question remains whether it provides advantages in terms of recurrence-free survival (RFS), progression-free survival (PFS), and cancer specific survival (CSS). The present study aimed to determine whether Re-TUR improves such outcomes in patients with completely resected high-grade T1 bladder cancer (BC). We queried our prospectively maintained database to identify patients with completely resected high-grade T1 BC who underwent (Group A) or not (Group B) Re-TUR before starting intravesical instillations of Bacillus Calmette-Guerin (BCG). The impact of Re-TUR as well as of other tested variables on RFS, PFS, and CSS was tested by Kaplan-Meier method and Log-rank testing. A total of 118 patients underwent Re-TUR, which pointed out no BC in 61 (51.7%), NMIBC in 54 (45.8%) and pT2 disease in 3 (2.5%). The 3 patients with pT2 disease underwent cystectomy, whereas all others were offered BCG treatment. Forty-two patients refused BCG treatment while 2 did not complete it; therefore, Group A (Re-TUR before BCG treatment) consisted of 71 patients whereas Group B consisted of 40 patients who refused Re-TUR but completed BCG treatment. Mean follow-up was 60 months (range 12-142). Kaplan-Meier curves and Log-rank testing showed no difference in RFS, PFS and CSS between patients who had (Group A) or had not (Group B) Re-TUR before starting BCG treatment. Our findings suggest that a Re-TUR in patients with a completely resected high-grade T1 BC does not translate into a better oncological outcome. Given its impact on both patients and healthcare system, the need for Re-TUR in completely resected high grade T1 BC should be further investigated into the framework of a randomized study.
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Affiliation(s)
- Beppe Calò
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Marco Chirico
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Francesca Sanguedolce
- Section of Pathology, Department of Clinical and Experimental Medicine, University Hospital of Foggia, Foggia, Italy
| | | | - Riccardo Autorino
- Division of Urology, Department of Surgery, VCU Health, Richmond, VA, United States
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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Hurle R, Casale P, Lazzeri M, Paciotti M, Saita A, Colombo P, Morenghi E, Oswald D, Colleselli D, Mitterberger M, Kunit T, Hager M, Herrmann TRW, Lusuardi L. En bloc re-resection of high-risk NMIBC after en bloc resection: results of a multicenter observational study. World J Urol 2019; 38:703-708. [PMID: 31114949 DOI: 10.1007/s00345-019-02805-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To investigate the role of en bloc re-resection (EBRS) in patients who had undergone previous en bloc resection for high-risk non-muscle-invasive bladder cancer (NMIBC). METHODS An international, multicenter, observational retrospective analysis of prospectively collected data. Patients with a high-risk NMIBC who had previously undergone en bloc resection were scheduled for EBRS of the resected area after 40 days. The primary outcome was the presence of residual tumor or recurrence-free survival. RESULTS Overall, 78 patients underwent EBRS. Only five (6.41%) residual cancers were found: one patient had a pTa G3 (1.28%) cancer and four (5.13%) had a pTis. The detrusor muscle was preserved in all samples. Only one patient had a positive margin on EBRS. No procedure called for a conversion to traditional re-TURBT. No patient experienced bladder perforation or other intra-operative complications. The recurrence rate at the first follow-up cystoscopy (RRFF-C at 3 months) was 3.85% (three patients). The median follow-up period was 30.8 months (range 6.9-76.0 months). In univariate analysis, the only predictor of recurrence was grade. Overall we observed 11 recurrences. Only one tumor progressed to T2 MIBC. CONCLUSIONS The low rates of residual tumor, recurrence, and progression seem to raise doubts about the efficacy of EBRS in patients who have previously undergone en bloc resection. EBRS appears to be a feasible and safe procedure with a low rate of complications. However, further data will be needed before EBRS can be used in clinical trials or recommended as a treatment modality.
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Affiliation(s)
- Rodolfo Hurle
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Paolo Casale
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Massimo Lazzeri
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Marco Paciotti
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
| | - Alberto Saita
- Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Piergiuseppe Colombo
- Department of Pathology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Emanuela Morenghi
- Department of Biomedical Science, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - David Oswald
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Thomas Kunit
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
| | - Martina Hager
- Department of Pathology, Paracelsus Medical University, Salzburg, Austria
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Lukas Lusuardi
- Department of Urology, Paracelsus Medical University, Salzburg, Austria
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A newly developed porcine training model for transurethral piecemeal and en bloc resection of bladder tumour. World J Urol 2018; 37:1879-1887. [DOI: 10.1007/s00345-018-2602-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 12/07/2018] [Indexed: 02/07/2023] Open
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Abstract
PURPOSE OF REVIEW The optimal management of high-grade T1 (HGT1) urothelial carcinoma (UC) is complex given its high rate of recurrence, progression, and cancer-specific mortality as well as its clinical variability. Our current treatment paradigm has been supplemented by recent data describing the expanding options for salvage intravesical therapy, bladder preservation, and the promising role of molecular epidemiology. In the current review, we attempt to summarize and critically analyze these studies. RECENT FINDINGS Evidence describing new intravesical therapies has demonstrated an adequate safety profile and some efficacy in BCG-unresponsive patients who desire bladder preservation. However, response rates are still poor in this high-risk patient population, and it is important to keep these data in perspective when counseling patients. Concomitantly, the continued molecular characterization of non-muscle-invasive bladder cancer may suggest potential therapeutic targets as well as predictors of treatment response in the future. The integration of new intravesical therapies and molecular data into the current treatment paradigm for HGT1 urothelial carcinoma will be critical to improving oncologic outcomes in this particularly high-risk population.
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Affiliation(s)
- Peter A Reisz
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA.
| | - Aaron A Laviana
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA
| | - Sam S Chang
- Department of Urology, Vanderbilt University Medical Center, A-1302 Medical Center North, Nashville, TN, 37232, USA
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Manoharan V, Mavuduru RS, Kumar S, Kakkar N, Devana SK, Bora GS, Singh SK, Mandal AK. Utility of restage transurethral resection of bladder tumor. Indian J Urol 2018; 34:273-277. [PMID: 30337782 PMCID: PMC6174718 DOI: 10.4103/iju.iju_218_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Transurethral resection of bladder tumor (TURBT) aims at complete resection of all the visible tumors. Existing guidelines recommend restage TURBT in all patients with T1 and high-grade tumors, to avoid under-staging. However, restage TURBT may not be plausible/feasible at all the times. This study was performed with an aim to better define the utility of restage TURBT in a tertiary care hospital of India. Methods: Patients with high grade/T1 tumors at the first TURBT were prospectively enrolled. Their demographic profile, previous cystoscopic findings, and histological reports were recorded. The primary objective was to assess the tumor detection and stage up-migration rates at restage TURBT. The secondary objectives was to identify factors predicting presence of tumor at restage TURBT. Patients were followed up to detect recurrence and progression for a minimum of 3 months. Results: Of 128 prospective patients’ enrolled, 29 patients were lost to follow-up and 11 patients did not undergo restage. A total of eighty-eight patients underwent restage TURBT of which twenty-eight patients (31.8%) had tumor at their second TURBT with five of these patients being upstaged to T2. The risk of having a tumor at restage was significantly higher in patients with solid tumors (56.2% vs. 26.4%, P = 0.02, 95% confidence interval: 0.035–0.024) but was independent of the tumor size (P = 0.472), number of growths (P = 0.267), grade of tumor (P = 0.441), presence or absence of muscle at the initial TURBT (P = 0.371) and place of initial TURBT (P = 0.289). There was a significant difference in the recurrence and progression rates in patients who had tumor at restage as compared to those who did not (recurrence; 33.3% and 23.8%, P = 0.022, respectively vs. progression; 11.1% and 3.7% respectively, P = 0.07; mean follow-up = 10.8 months). Conclusions: We conclude that restage TURBT is necessary in patients with solid looking tumors and the presence of tumor at restage confers a higher risk of recurrence and progression.
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Affiliation(s)
- Vignesh Manoharan
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Santosh Kumar
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer Kumar Devana
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Girdhar Singh Bora
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arup Kumar Mandal
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Differences in Pathologic Results of Repeat Transurethral Resection of Bladder Tumor (TURBT) according to Institution Performing the Initial TURBT: Comparative Analyses between Referred and Nonreferred Group. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9432606. [PMID: 30271788 PMCID: PMC6146742 DOI: 10.1155/2018/9432606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 12/22/2022]
Abstract
Objective Although transurethral resection of bladder tumor (TURBT) is a standard treatment and determines staging for nonmuscle invasive bladder cancer, many deficiencies persist. There is a risk of upstaging and residual cancer when repeat TURBT is performed. Authors compared the results of repeat TURBT by institution performing the initial TURBT. Methods We retrospectively reviewed the medical records of 289 patients who underwent repeat TURBT within 2-6 weeks after initial TURBT between 1998 and 2013. The patients were divided into the referred group and the nonreferred group by institution performing the initial TURBT. And we analyzed the intergroup differences in residual tumor and upstaging rate and the factors significantly correlated with residual tumor. Results The mean age was 69.6 ± 11.1 years and the mean follow-up was 49.7 (range: 0–191) months. The referred group included 69 patients, while the nonreferred group included 220 patients. The referred group included 57 (82.6%) patients with residual tumor after repeat TURBT. Overall upstaging occurred in 15 (21.7%), and upstaging to T2 occurred in 11 (15.9%) of the initial Ta and T1 patients. In the nonreferred group, there were 123 (55.9%) patients with residual tumor. Overall upstaging occurred in 10 (4.5%) and upstaging to T2 occurred in 7 (3.2%) patients. Conclusions Gross hematuria, grade, and tumor quantity and size were significantly associated with residual cancer on multivariate analysis. In the referred group, repeat TURBT and restaging are necessary.
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Role of Restaging Transurethral Resection for T1 Non–muscle invasive Bladder Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2018; 4:558-567. [DOI: 10.1016/j.euf.2016.12.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/03/2016] [Accepted: 12/27/2016] [Indexed: 02/01/2023]
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Building on a Solid Foundation: Enhancing Bacillus Calmette-Guérin Therapy. Eur Urol Focus 2018; 4:485-493. [DOI: 10.1016/j.euf.2018.10.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 01/08/2023]
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Giulianelli R, Gentile BC, Mirabile G, Albanesi L, Mavilla L, Tariciotti P, Rizzo G, Fabi F, Falavolti C, Aloisi P, Vincenti G, Tema G, Lombardo R. Narrow Band Imaging reduces persistence of cancer in patients with pT1 high grade bladder cancer. Eur J Surg Oncol 2018; 45:466-470. [PMID: 30041940 DOI: 10.1016/j.ejso.2018.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/25/2018] [Accepted: 06/04/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate persistence rate on repeated transurethral resection of the bladder (re-TURB) 6 weeks after the first TURB in patients with pT1HG disease undergoing resection of the margins and bed on Narrow Band Imaging. MATERIALS AND METHODS A consecutive series of patients undergoing TURB and a diagnosis of pT1 high grade disease were prospectively enrolled. On initial TURB patients underwent classic white light resection of the tumour followed by narrow band image (NBI) resection of margins and bed. After 6 weeks from the initial TURB, patients underwent a re-TURB under white light. Persistence rates on re-TURB were recorded. RESULTS Overall 797 patients underwent TURB, out of them 126 patients with pT1 high grade disease were included in the study. The total number of lesions was 226 meaning 1.79 lesions per patient. On re-TURB 24/126 (19%) of the patients presented residual disease with a total of 28/226 (12%) lesions identified. All these patients presented a pTa residual disease. Out of them 8/21 (38%) presented bladder cancer on the resection bed and 13/21 (62%) presented bladder cancer on margins. CONCLUSION Narrow Band Imaging trans-urethral resection of the bladder is an oncological effective procedure in the treatment of pT1HG disease. The procedure has a 19% of persistence rate which is inferior when compared to the available evidence on white light TURB. Further multicenter studies are needed in order to validate our results.
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Alharbi H, Alkhateeb S, Murshid E, Alotaibi M, Abusamra A, Rabah D, Almansour M, Alghamdi A, Aljubran A, Eltigani A, Alkushi H, Ahmed I, Alsharm A, Bazarbashi S. Saudi Oncology Society and Saudi Urology Association combined clinical management guidelines for urothelial cell carcinoma of the urinary bladder 2017. Urol Ann 2018. [PMID: 29719322 DOI: 10.4103/ua.ua-176-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is an update to the previously published Saudi guidelines for the evaluation and medical/surgical management of patients diagnosed with urothelial cell carcinoma of the urinary bladder. It is categorized according to the stage of the disease using the tumor node metastasis staging system, 7th edition. The guidelines are presented with their accompanying supporting evidence level, which is based on comprehensive literature review, several internationally recognized guidelines, and the collective expertise of the guidelines committee members (authors) who were selected by the Saudi Oncology Society and Saudi Urological Association. Considerations to the local availability of drugs, technology, and expertise have been regarded. These guidelines should serve as a roadmap for the urologists, oncologists, general physicians, support groups, and health-care policymakers in the management of patients diagnosed with urothelial cell carcinoma of the urinary bladder.
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Affiliation(s)
- Hulayel Alharbi
- Department of Medical Oncology, King Fahed Specialist Hospital, Dammam, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Surgery, Division of Urology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Esam Murshid
- Department of Oncology, Oncology Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Mohammed Alotaibi
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ashraf Abusamra
- Department of Surgery, Urology Section, King Khalid Hospital, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Danny Rabah
- Department of Surgery, College of Medicine and Uro-Oncology Research Chair, King Saud University, Riyadh, Saudi Arabia
| | - Mubarak Almansour
- Department of Oncology, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abdullah Alghamdi
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Aljubran
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amin Eltigani
- Department of Oncology, Division of Medical Oncology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hussein Alkushi
- Department of Pathology, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Imran Ahmed
- Department of Oncology, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdullah Alsharm
- Department of Medical Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shouki Bazarbashi
- Oncology Center, Section of Medical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Leiblich A, Bryant RJ, McCormick R, Crew J. The management of non-muscle-invasive bladder cancer: A comparison of European and UK guidelines. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415818757339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Bladder cancer represents a significant health burden worldwide, with non-muscle-invasive tumours representing the majority of new bladder cancer diagnoses. Non-muscle-invasive bladder cancer (NMIBC) has a high prevalence and forms a large proportion of the caseload in urological practice, accounting for a significant cost in terms of urological healthcare. The last two decades have seen the development and refinement of guidelines from national and international organisations aiming to optimise management of NMIBC and bladder cancer in general. This review outlines the most recent European and United Kingdom guidelines on NMIBC, and in particular focuses on comparing and contrasting key recommendations from guidelines published by the European Association of Urology and the UK-based National Institute for Clinical Excellence. Level of evidence: Not applicable for this multicentre audit.
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Affiliation(s)
- A Leiblich
- Nuffield Department of Surgical Sciences, University of Oxford, Level 6, John Radcliffe Hospital, UK
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - RJ Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Level 6, John Radcliffe Hospital, UK
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - R McCormick
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
| | - J Crew
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, UK
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