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Effectiveness of Early Radical Cystectomy for High-Risk Non-Muscle Invasive Bladder Cancer. Cancers (Basel) 2022; 14:cancers14153797. [PMID: 35954460 PMCID: PMC9367342 DOI: 10.3390/cancers14153797] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 07/24/2022] [Accepted: 08/01/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: The purpose of this study is to compare perioperative and oncological outcomes of upfront vs. delayed early radical cystectomy (eRC) for high-risk non-muscle-invasive bladder cancer (HR-NMIBC). Methods: All consecutive HR-NMIBC patients who underwent eRC between 2001 and 2020 were retrospectively included and divided into upfront and delayed groups, according to the receipt or not of BCG. Perioperative outcomes were evaluated and the impact of upfront vs. delayed eRC on pathological upstaging, defined as ≥pT2N0 disease at final pathology, was assessed using multivariable logistic regression. Recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) were compared between upfront and delayed eRC groups using inverse probability of treatment weighting (IPTW)-adjusted Cox model. Results: Overall, 184 patients received either upfront (n = 87; 47%) or delayed (n = 97; 53%) eRC. No difference was observed in perioperative outcomes between the two treatment groups (all p > 0.05). Pathological upstaging occurred in 55 (30%) patients and upfront eRC was an independent predictor (HR = 2.65; 95% CI = (1.23−5.67); p = 0.012). In the IPTW-adjusted Cox analysis, there was no significant difference between upfront and delayed eRC in terms of RFS (HR = 1.31; 95% CI = (0.72−2.39); p = 0.38), CSS (HR = 1.09; 95% CI = (0.51−2.34); p = 0.82) and OS (HR = 1.19; 95% CI = (0.62−2.78); p = 0.60). Conclusion: our results suggest similar perioperative outcomes between upfront and delayed eRC, with an increased risk of upstaging after upfront eRC that did impact survival, as compared to delayed eRC.
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Zheng Y, Ye Y, Chen J, Wei Z, Liu Z, Yu K, Zhang X. Prevalence and outcomes of transurethral resection versus radical cystectomy for muscle-infiltrating bladder cancer in the United States: A population-based cohort study. Int J Surg 2022; 103:106693. [PMID: 35690361 DOI: 10.1016/j.ijsu.2022.106693] [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: 11/30/2021] [Revised: 05/05/2022] [Accepted: 05/29/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Although radical cystectomy is considered as the first choice for muscle-invasive bladder cancer (MIBC), there are also concerns regarding the cost of long-term morbidity, loss of body image, and compromised quality of life. Transurethral resection of bladder tumor (TURBT) is a candidate for bladder sparing treatments, but its viability as a substitute for radical cystectomy is questionable. Therefore, we conducted this population-based study to investigate the prevalence of TURBT in the treatments of T2-stage MIBC in the United States, and to compare its therapeutic efficiency with that of radical cystectomy. METHODS Information on patients with T2-stage bladder cancer (BC) between 2000 and 2017 was extracted from the Surveillance, Epidemiology, and End Results program. The overall survival (OS) and disease-specific survival (DSS) of patients with different interventions were fitted. RESULTS A total of 22,074 patients with T2-stage MIBC were enrolled, of whom 14,021 reached the main endpoint. Only 28% of the patients with T2-stage MIBC chose radical cystectomy as the initial surgical treatment, while TURBT was applied as the primary surgical treatment in 66.6% of the patients. The TURBT rate increased significantly with age at cancer diagnosis (40-44 years, 45.5% to > 85 years, 90.9%). The survival rate of patients undergoing TURBT was significantly lower than for those undergoing radical cystectomy (median OS: 1.5 versus 9.7 years; median DSS: 2.7 years versus not reached). Upon multivariable Cox analyses, the OS (HR: 2.34; p < 0.001) and DSS (HR: 2.68; p < 0.001) of TURBT were found to be significantly worse than those of radical cystectomy. CONCLUSION Two-thirds of the patients with T2-stage MIBC were treated by TURBT in the United States. However, the long-term follow-up data indicate that the therapeutic efficiency of current TURBT techniques is far less effective than that of radical cystectomy. Further studies are urgently needed to devise the best management strategy for T2 stage bladder cancer.
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Affiliation(s)
- Yongqiang Zheng
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yuzhong Ye
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiayuan Chen
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhihao Wei
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zekun Liu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Kai Yu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Xiaoping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Zhou Z, Cui Y, Huang S, Chen Z, Zhang Y. The Efficacy of Intra-Arterial Plus Intravesical Chemotherapy Versus Intravesical Chemotherapy Alone After Bladder-Sparing Surgery in High-Risk Bladder Cancer: A Systematic Review and Meta-Analysis of Comparative Study. Front Oncol 2021; 11:651657. [PMID: 34123803 PMCID: PMC8190377 DOI: 10.3389/fonc.2021.651657] [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: 01/10/2021] [Accepted: 05/04/2021] [Indexed: 01/11/2023] Open
Abstract
Background Due to the poor prognosis, the treatment of high-risk bladder cancer (HRBC) remains controversial. This meta-analysis aims to access the efficacy of intra-arterial chemotherapy (IAC) combined with intravesical chemotherapy (IC) versus IC alone after bladder-sparing surgery in HRBC. Methods A systematic search of PubMed, Cochrane Library databases, EMBASE (until June 2020) was conducted. PRISMA checklist was followed. The data were analyzed by RevMan v5.3.0. Results A total of five articles including 843 patients were studied. The analysis demonstrated that the IAC + IC group had a greater improvement of overall survival (P = 0.02) and significant reduction in terms of tumor recurrence rate (P = 0.0006) and tumor progression rate (P = 0.008) compared with the IC group. The recurrence-free survival in the IAC + IC group was significantly higher than that in the IC group (P = 0.004), but there was no significant difference in progression-free survival between the two groups (P = 0.32). In addition, the combination of IAC and IC significantly extended tumor recurrence interval (P = 0.0001) and reduced tumor-specific death rate (P = 0.01) for patients with HRBC compared with IC alone. For side effects related with IAC, although about half of the patients experienced some toxicities, most of them were mild and reversible (grades 1-2, 22.3% vs. grade 3-4, 2.7%), mainly including nausea/vomiting (P = 0.0001), neutropenia (P = 0.002), and alanine aminotransferase (P = 0.0001). Conclusion Patients with HRBC treated with IAC + IC after bladder-sparing surgery had a marked improvement in the overall survival, recurrence-free survival, time interval to first recurrence, tumor recurrence rate, tumor progression rate, and tumor-specific death rate than patients treated with IC alone. However, progression-free survival was not significantly correlated with treatment strategy. In addition, patients seemed to tolerate well the toxicities related with IAC. Systematic Review Registration PROSPERO, identifier CRD42021232679.
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Affiliation(s)
- Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
| | - Yuanshan Cui
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China.,Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Shuangfeng Huang
- Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Zhipeng Chen
- Department of Urology, Weifang People's Hospital, Weifang, China
| | - Yong Zhang
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, China
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Krajewski W, Moschini M, Chorbińska J, Nowak Ł, Poletajew S, Tukiendorf A, Afferi L, Teoh JYC, Muilwijk T, Joniau S, Tafuri A, Antonelli A, Cianflone F, Mari A, Di Trapani E, Hendricksen K, Alvarez-Maestro M, Rodríguez-Serrano A, Simone G, Zamboni S, Simeone C, Marconi MC, Mastroianni R, Ploussard G, Laukhtina E, Tully K, Kołodziej A, Krajewska J, Piszczek R, Xylinas E, Zdrojowy R. Delaying BCG immunotherapy onset after transurethral resection of non-muscle-invasive bladder cancer is associated with adverse survival outcomes. World J Urol 2020; 39:2545-2552. [PMID: 33230571 PMCID: PMC8332577 DOI: 10.1007/s00345-020-03522-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was carried out to assess whether a prolonged time between primary transurethral resection of non-muscle-invasive bladder cancer (TURB) and implementation of bacillus Calmette-Guerin (BCG) immunotherapy (time to BCG; TTBCG) is associated with adverse oncological survival in patients with T1 high-grade (HG) non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS Data on 429 patients from 13 tertiary care centers with primary T1HG NMIBC treated with reTURB and maintenance BCG between 2001 and 2019 were retrospectively reviewed. Change-point regression was applied following Muggeo's approach. The population was divided into subgroups according to TTBCG, whereas the recurrence-free survival (RFS) and progression-free survival (PFS) were estimated with log-rank tests. Additionally, Cox regression analyses were performed. Due to differences in baseline patient characteristics, propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. RESULTS The median TTBCG was 95 days (interquartile range (IQR): 71-127). The change-point regression analysis revealed a gradually increasing risk of recurrence with growing TTBCG. The risk of tumor progression gradually increased until a TTBCG of approximately 18 weeks. When the study population was divided into two subgroups (time intervals: ≤ 101 and > 101 days), statistically significant differences were found for both RFS (p = 0.029) and PFS (p = 0.005). Furthermore, in patients with a viable tumor at reTURB, there were no differences in RFS and PFS. After both PSM and IPW, statistically significant differences were found for both RFS and PFS, with worse results for longer TTBCG. CONCLUSION This study shows that delaying BCG immunotherapy after TURB of T1HG NMIBC is associated with an increased risk of tumor recurrence and progression.
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Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland.
| | - Marco Moschini
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Joanna Chorbińska
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - Łukasz Nowak
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Andrzej Tukiendorf
- Department of Public Health, Wrocław Medical University, Wrocław, Poland
| | - Luca Afferi
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jeremy Yuen-Chun Teoh
- S.H.Ho Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Francesco Cianflone
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | | | - Giuseppe Simone
- Department of Urology, Oncologic Urology "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Stefania Zamboni
- Urology Unit, ASST Spedali Civili, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Maria Cristina Marconi
- Urology Unit, ASST Spedali Civili, Brescia, Italy
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Riccardo Mastroianni
- Department of Urology, Oncologic Urology "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | | | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Karl Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Anna Kołodziej
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - Joanna Krajewska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Radosław Piszczek
- Department of Urology and Oncologic Urology, Lowersilesian Specialistic Hospital, Wroclaw, Poland
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
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5
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Huang B, Huang G, Li W, Chen L, Mao X, Chen J. Intra-arterial chemotherapy combined with intravesical chemotherapy compared with intravesical BCG immunotherapy retrospectively in high-risk non-muscle-invasive bladder cancer after transurethral resection of the bladder tumor. J Cancer Res Clin Oncol 2020; 147:1781-1788. [PMID: 33222014 DOI: 10.1007/s00432-020-03453-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/04/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of intra-arterial chemotherapy (IAC) combined with intravesical chemotherapy (IVC) against intravesical BCG immunotherapy in high-risk non-muscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder tumor (TURBT). MATERIALS AND METHODS 130 patients with high-risk NMIBC who had underwent TURBT were divided into two groups, of which IAC + IVC group received four courses of IAC (cisplatin and epirubicin) combined with IVC (epirubicin or pirarubicin) after surgery and BCG group received intravesical BCG immunotherapy. Recurrence rate and progression rate were assessed by Chi-square test, while recurrence-free survival and progression-free survival were calculated using the Kaplan-Meier method. RESULTS In this study, the recurrence rate was 27.9% (12/43) in IAC + IVC group and 26.4% (14/53) in BCG group, while progression rate was 9.3% (4/43) in IAC + IVC group and 9.4% (5/53) in BCG group. Both of the recurrence and progression rate did not show a significant difference. In the Kaplan-Meier plot, no difference was found with respect to recurrence-free survival and progression-free survival. Moreover, 46.5% (20/43) patients suffered from adverse events of IAC and 83.1% (49/59) patients suffered from adverse events associated with BCG, of which 6 patients discontinued treatment due to serious adverse events of BCG. Univariate analysis suggested that only recurrent tumor could be an independent risk factor related to recurrence. CONCLUSIONS IAC combined with IVC used in high-risk NMIBC could reduce the recurrence and progression as effective as BCG instillation with lower adverse events.
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Affiliation(s)
- Bin Huang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Gaowei Huang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Wenji Li
- Surgical Anesthesia Center, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Lingwu Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
| | - Xiaopeng Mao
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
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Krajewski W, Moschini M, Nowak Ł, Poletajew S, Tukiendorf A, Afferi L, Teoh J, Muilwijk T, Joniau S, Tafuri A, Antonelli A, Gozzo A, Mari A, Di Trapani E, Hendricksen K, Alvarez-Maestro M, Serrano AR, Simone G, Zamboni S, Simeone C, Marconi MC, Mastroianni R, Ploussard G, Rajwa P, Laukhtina E, Zdrojowy-Wełna A, Kołodziej A, Paradysz A, Tully K, Krajewska J, Piszczek R, Xylinas E, Zdrojowy R. Restaging Transurethral Resection of Bladder Tumours after BCG Immunotherapy Induction in Patients with T1 Non-Muscle-Invasive Bladder Cancer Might not Be Associated with Oncologic Benefit. J Clin Med 2020; 9:jcm9103306. [PMID: 33076249 PMCID: PMC7602446 DOI: 10.3390/jcm9103306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The European Association of Urology guidelines recommend restaging transurethral resection of bladder tumours (reTURB) 2-6 weeks after primary TURB. However, in clinical practice some patients undergo a second TURB procedure after Bacillus Calmette-Guérin immunotherapy (BCG)induction. To date, there are no studies comparing post-BCG reTURB with the classic pre-BCG approach. The aim of this study was to assess whether the performance of reTURB after BCG induction in T1HG bladder cancer is related to potential oncological benefits. MATERIALS AND METHODS Data from 645 patients with primary T1HG bladder cancer treated between 2001 and 2019 in 12 tertiary care centres were retrospectively reviewed. The study included patients who underwent reTURB before BCG induction (Pre-BCG group: 397 patients; 61.6%) and those who had reTURB performed after BCG induction (Post-BCG group: 248 patients, 38.4%). The decision to perform reTURB before or after BCG induction was according to the surgeon's discretion, as well as a consideration of local proceedings and protocols. Due to variation in patients' characteristics, both propensity-score-matched analysis (PSM) and inverse-probability weighting (IPW) were implemented. RESULTS The five-year recurrence-free survival (RFS) was 64.7% and 69.1% for the Pre- and Post-BCG groups, respectively, and progression-free survival (PFS) was 82.7% and 83.3% for the Pre- and Post-BCG groups, respectively (both: p > 0.05). Similarly, neither RFS nor PFS differed significantly for a five-year period or in the whole time of observation after the PSM and IPW matching methods were used. CONCLUSIONS Our results suggest that there might be no difference in recurrence-free survival and progression-free survival rates, regardless of whether patients have reTURB performed before or after BCG induction.
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Affiliation(s)
- Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
- Correspondence: ; Tel.: +48-717331010
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland; (M.M.); (L.A.)
| | - Łukasz Nowak
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
| | - Sławomir Poletajew
- Second Department of Urology, Centre of Postgraduate Medical Education, 01-813 Warsaw, Poland;
| | - Andrzej Tukiendorf
- Department of Public Health, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Luca Afferi
- Klinik für Urologie, Luzerner Kantonsspital, 6004 Lucerne, Switzerland; (M.M.); (L.A.)
| | - Jeremy Teoh
- S.H.Ho Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China;
| | - Tim Muilwijk
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (T.M.); (S.J.)
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium; (T.M.); (S.J.)
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37129 Verona, Italy; (A.T.); (A.A.); (A.G.)
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37129 Verona, Italy; (A.T.); (A.A.); (A.G.)
| | - Alessandra Gozzo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, 37129 Verona, Italy; (A.T.); (A.A.); (A.G.)
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, 50139 Florence, Italy;
| | - Ettore Di Trapani
- Department of Urology, European Institute of Oncology, 20143 Milan, Italy;
| | - Kees Hendricksen
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, 1066 CX Amsterdam, The Netherlands;
| | - Mario Alvarez-Maestro
- Department of Urology Hospital Universitario La Paz, 28046 Madrid, Spain; (M.A.-M.); (A.R.S.)
| | | | - Giuseppe Simone
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, 00144 Rome, Italy; (G.S.); (R.M.)
| | - Stefania Zamboni
- Urology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia 25123, Italy; (S.Z.); (C.S.); (M.C.M.)
| | - Claudio Simeone
- Urology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia 25123, Italy; (S.Z.); (C.S.); (M.C.M.)
| | - Maria Cristina Marconi
- Urology Unit, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia 25123, Italy; (S.Z.); (C.S.); (M.C.M.)
| | - Riccardo Mastroianni
- IRCCS “Regina Elena” National Cancer Institute, Department of Urology, 00144 Rome, Italy; (G.S.); (R.M.)
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, 31130 Quint Fonsegrives, France;
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia, 3 Maja Street 13-15, 41-800 Zabrze, Poland; (P.R.); (A.P.)
| | - Ekaterina Laukhtina
- Institute for Urology and Reproductive Health, Sechenov University, 119146 Moscow, Russia;
- Department of Urology, Comprehensive Cancer Centre, Medical University of Vienna, 1090 Vienna, Austria
| | - Aleksandra Zdrojowy-Wełna
- Department of Endocrinology, Diabetes and Isothope Therapy, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Anna Kołodziej
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, 3 Maja Street 13-15, 41-800 Zabrze, Poland; (P.R.); (A.P.)
| | - Karl Tully
- Department of Urology and Neurourology, Marien Hospital Herne, Ruhr-University Bochum, 44625 Herne, Germany;
| | - Joanna Krajewska
- Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Radosław Piszczek
- Department of Urology and Oncologic Urology, Lower Silesian Specialist Hospital, 50-556 Wroclaw, Poland;
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, 75018 Paris, France;
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wrocław Medical University, 50-556 Wroclaw, Poland; (Ł.N.); (A.K.); (R.Z.)
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7
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Chen G, Yang T, Shao Q, Zhang M, Yang B, Zhang P, Fan J. Sub-Staging-Specific Differences in Recurrence-Free, Progression-Free, and Cancer-Specific Survival for Patients with T1 Bladder Cancer: A Systematic Review and Meta-Analysis. Urol Int 2020; 104:580-586. [PMID: 32610323 DOI: 10.1159/000506238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The efficiency of the T1 sub-staging system on categorizing bladder cancer (BC) patients into subgroups with different clinical outcomes was unclear. We summarized relevant evidences, including recurrence-free survival (RFS), progression-free survival (PFS), and cancer-specific survival (CSS), to analyze the prognostic significance of T1 sub-stage. METHODS Systematic literature searches of MEDLINE, EMBASE, and the Cochrane Library were performed. We pooled data on recurrence, progression, and CSS from 35 studies. RESULTS The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) indicated the difference in RFS between T1a sub-stage and T1b sub-stage (HR 1.28, 95% CI 1.14-1.43, p < 0.001). The significant difference was observed in PFS between the 2 arms (HR 2.18, 95% CI 1.95-2.44, p < 0.001). Worse CSS was found in T1b patients than in T1a patients (HR 1.36, 95% CI 1.21-1.54, p < 0.001). CONCLUSIONS T1 sub-staging system based on the invasion depth into muscularis mucosae can be a significant prognostic factor for RFS, PFS, and CSS of patients with T1 BC. Urologists and pathologists are encouraged to work together to give a precise sub-stage classification of T1 BC, and T1 sub-staging system should be a routine part of any histopathological report when possible. Different treatment strategies need to be developed for both T1a BC and T1b BC.
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Affiliation(s)
- Guanqiu Chen
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tao Yang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiuya Shao
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengzhao Zhang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Bo Yang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Pu Zhang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,
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Does restaging transurethral resection of bladder tumour influence outcomes in patients treated with BCG immunotherapy? 491 cases in 20 years' experience. Wideochir Inne Tech Maloinwazyjne 2018; 14:284-296. [PMID: 31118996 PMCID: PMC6528127 DOI: 10.5114/wiitm.2018.79993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/24/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Bladder cancer is one of the most common malignancies worldwide. Aim To analyse the influence of restaging transurethral resection of bladder tumour (reTURB) on outcomes in patients treated with BCG immunotherapy. Material and methods We analysed a database of 491 patients who were treated in a Bacillus Calmette-Guérin (BCG) outpatient department between 1998 and 2016. A minimum of 12 months of follow-up was required. The study included 235 patients with a history of the reTURB procedure and 256 patients without reTURB. The patients were analysed in terms of recurrence-free (RFS), progression-free (PFS), cancer-specific and overall survival. Results The RFS was significantly higher in the reTURB group for both general and subgroup analysis (T1HG, TaHG). The PFS was significantly higher in the reTURB group for both general and subgroup analysis (TaHG). In patients without lamina muscularis in the specimen there was a greater improvement in RFS due to the reTURB procedure than for other patients. ReTURB performed in T1 tumours with massive lamina propria infiltration had a positive influence on RFS. In patients with reTURB the presence of focal invasion was related to lower risk of progression. Both overall and cancer-specific survival were significantly improved by the reTURB procedure in T1HG and HG tumours. Conclusions This study highlights the importance of reTURB. It was found that the patients with TaHG tumours benefited the most in terms of RFS, PFS and cancer-specific survival. It was also demonstrated that massive lamina propria infiltration in T1 tumours is associated with the worst outcomes.
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Klaassen Z, Kamat AM, Kassouf W, Gontero P, Villavicencio H, Bellmunt J, van Rhijn BW, Hartmann A, Catto JW, Kulkarni GS. Treatment Strategy for Newly Diagnosed T1 High-grade Bladder Urothelial Carcinoma: New Insights and Updated Recommendations. Eur Urol 2018; 74:597-608. [DOI: 10.1016/j.eururo.2018.06.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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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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Huang B, Zheng J, Yao Z, Fan W, Qiu S, Chen L, Chen J. Efficacy of intra-arterial chemotherapy combined with intravesical chemotherapy in T1G3 bladder cancer when compared with intravesical chemotherapy alone after bladder-sparing surgery: a retrospective study. World J Urol 2018; 37:823-829. [PMID: 30191393 DOI: 10.1007/s00345-018-2437-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To assess the efficacy of intra-arterial chemotherapy (IAC) combined with intravesical chemotherapy (IVC) in T1G3 bladder cancer (Bca) after transurethral resection of bladder tumor (TURBT). METHODS Our study retrospectively reviewed 200 patients with T1G3 BCa who had all undergone TURBT. The patients' medical records were divided into two groups, one group only had IVC with pirarubicin after surgery, and the other group had IAC (cisplatin and epirubicin) combined with IVC after surgery. The patients were monitored regularly by urine cytology and cystoscopy. Survival and recurrence curves were calculated using the Kaplan-Meier method. Tumor recurrence, progression and tumor-specific death rate were compared with Chi-square test. A multivariate analysis was carried out to find out potential confounders. RESULTS A total of 200 medical record was analyzed, 131 patients received IVC, 69 IAC + IVC treatment, tumor-specific death rate between the combined IAC and IVC compared to IVC alone was 7.25 and 17.6%, respectively (p < 0.05); the tumor recurrence rate between the two groups was 31.8% (22/69) and 44.3%, respectively (58/131) (p < 0.05), and tumor recurred later in the IAC + IVC group (p < 0.05), tumor progression rate was 18.8% (13/69) and 28.2% (37/131), respectively, with p < 0.05. Overall survival was longer in IAC + IVC group (p < 0.05). Using the multivariable regression model, IAC was significantly related to disease recurrence (p < 0.05) and overall survival (p < 0.05). CONCLUSION T1G3 BCa post-TURBT surgery patients who underwent IAC combined with IVC had a longer overall survival and increased time interval to first recurrence, lower tumor recurrence rate, progression rate and tumor-specific death rate than compared with those who only underwent IVC alone.
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Affiliation(s)
- Bin Huang
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Jiabo Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Zhijun Yao
- Department of Urology, The Central Hospital of Hengyang, Hengyang, 421001, China
| | - Wenzhe Fan
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Shaopeng Qiu
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China
| | - Lingwu Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
| | - Junxing Chen
- Department of Urology, The First Affiliated Hospital, Sun Yat-Sen University, No. 58 Zhong Shan 2nd Road, Guangzhou, 510080, China.
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Liu Z, Ye Y, Li X, Guo S, Jiang L, Dong P, Li Y, Shi Y, Fan W, Cao Y, Yao K, Qin Z, Han H, Zhou F, Liu Z. The effects of intra-arterial chemotherapy on bladder preservation in patients with T1 stage bladder cancer. World J Urol 2018; 36:1191-1200. [PMID: 29459997 DOI: 10.1007/s00345-018-2199-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 01/19/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To investigate the effects of intra-arterial chemotherapy on T1 stage bladder cancer (Bca) and evaluate patient outcome with bladder-preserving treatment approaches. MATERIALS AND METHODS A total of 238 patients with T1 stage Bca were retrospectively analyzed. Among them, 35 patients were categorized into the subgroup of highest-risk T1 stage according to the European Association of Urology guidelines and received immediate radical cystectomy (RC group), whereas 62 were classified as being highest-risk T1 patients but were unwilling to undergo RC and were treated with gemcitabine plus cisplatin intra-arterial chemotherapy (GC group). There were 141 T1 patients who had bladder-preserving surgery with intravesical chemotherapy (IVC group). RESULTS For patients with T1 stage Bca, the GC group had a higher estimated recurrence-free survival rate (44.4 vs. 13.9%, P = 0.087), progression-free survival rate (75.4 vs. 32.8%, P = 0.006), and cancer-specific survival (CSS) rate (78.7 vs. 67.5%, P = 0.399) when compared with the IVC group, respectively. Using the multivariable regression model, the GC intra-arterial chemotherapy was significantly related to bladder preservation (P = 0.004), lower recurrence (P = 0.012), and less progression (P = 0.004). For patients with the highest-risk T1 stage, GC group did not have a poorer CSS rate in comparison with the RC group (P = 0.383). Moreover, immediate RC did not confer a survival benefit in terms of CSS when compared with those who underwent deferred RC after failing GC intra-arterial chemotherapy (P = 0.283). CONCLUSIONS Gemcitabine plus cisplatin intra-arterial chemotherapy may be an effective bladder-preserving alternative adjuvant treatment for patients with T1 stage Bca with oncologic benefits, good compliance, and low toxicity.
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Affiliation(s)
- Zefu Liu
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yunlin Ye
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Xiangdong Li
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Shengjie Guo
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Lijuan Jiang
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Pei Dong
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yonghong Li
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yanxia Shi
- Department of Medical Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Weijun Fan
- Department of Imaging and Interventional Radiology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Yun Cao
- Department of Pathology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Kai Yao
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Zike Qin
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Hui Han
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China
| | - Fangjian Zhou
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Zhuowei Liu
- Department of Urology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, 510060, China.
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Kim S. Treatment for T1G3 Tumor. Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yun SJ, Kim SK, Kim WJ. How do we manage high-grade T1 bladder cancer? Conservative or aggressive therapy? Investig Clin Urol 2016; 57 Suppl 1:S44-51. [PMID: 27326407 PMCID: PMC4910762 DOI: 10.4111/icu.2016.57.s1.s44] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/06/2016] [Indexed: 11/24/2022] Open
Abstract
High-grade T1 bladder cancer has a poor prognosis due to a higher incidence of recurrence and progression than other nonmuscle invasive bladder cancer; thus patients with high-grade T1 have to be carefully monitored and managed. If patients are diagnosed with high-grade T1 at initial transurethral resection (TUR), a second TUR is strongly recommended regardless of whether muscle layer is present in the specimen because of the possibility of understating due to incomplete resection. Since high-grade T1 disease shows diverse clinical courses, individual approaches are recommended for treatment. In cases with low risk of progression, cystectomy could represent overtreatment and deteriorate quality of life irreversibly, while, in those with high risk, bacillus Calmette-Guérin (BCG) therapy may worsen survival by delaying definitive therapy. Therefore, a strategy for predicting prognosis based on the risk of progression is needed for managing high-grade T1 disease. Molecular risk classifiers predicting the risk of progression and response to BCG may help identify the optimal management of high-grade T1 disease for each individual.
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Affiliation(s)
- Seok Joong Yun
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Seon-Kyu Kim
- Medical Genomics Research Center, Research Institute of Bioscience and Biotechnology, Daejeon, Korea.; Korean Bioinformation Center, Research Institute of Bioscience and Biotechnology, Daejeon, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
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Prognostic significance of substage and WHO classification systems in T1 urothelial carcinoma of the bladder. Curr Opin Urol 2015; 25:427-35. [DOI: 10.1097/mou.0000000000000202] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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[Non-muscle-invasive high-grade bladder cancer]. Urologe A 2015; 54:491-8. [PMID: 25802103 DOI: 10.1007/s00120-015-3774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Non-muscle-invasive bladder cancer with a low-grade differentiation represents a special challenge. METHOD Although urine cytology is still the most reliable and effective urine-based marker and there are no substantial novel aspects in this field, photodynamic diagnostics have the most important value in transurethral resection of the bladder (TURB) of high-grade T1 tumors and new techniques, such as hybrid knife TURB are coming up. The histopathological assessment of T1 tumors can be supplemented by a description of the exact penetration depth, so-called substaging and the invasion pattern. RESULTS Intravesicle therapy with Bacillus Calmette-Guèrin (BCG) represents the gold standard and a pillar of bladder-preserving therapy and should be planned as maintenance therapy for at least 1 year. With the right risk constellation cystectomy is a safe and proven concept for high-grade bladder cancer, even without proof of muscle invasion.
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Canter DJ, Revenig LM, Smith ZL, Dobbs RW, Malkowicz SB, Issa MM, Guzzo TJ. Re-examination of the Natural History of High-grade T1 Bladder Cancer using a Large Contemporary Cohort. Int Braz J Urol 2014; 40:172-8. [DOI: 10.1590/s1677-5538.ibju.2014.02.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/12/2014] [Indexed: 11/22/2022] Open
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