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Djug H, Hasukic S, Jagodic S, Ivanic D. Adjuvant Intravesical Chemotherapy Versus Immunotherapy for All Risk Groups of Patients With Non-muscle Invasive Bladder Cancer. Med Arch 2023; 77:460-464. [PMID: 38313102 PMCID: PMC10834055 DOI: 10.5455/medarh.2023.77.460-464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/27/2023] [Indexed: 02/06/2024] Open
Abstract
Background The treatment strategy for non-muscle invasive bladder cancer (NMIBC) has not changed significantly over the past 30 years. Chemotherapeutic agents (mitomycin-C, epirubicin, etc.) and BCG (Bacillus Calmette-Guerin) immunotherapy are used as adjuvant intravesical therapy. Objective To compare the difference between adjuvant chemotherapy and adjuvant immunotherapy in their efficacy of reducing the number of tumor recurrences. Methods In this prospective clinical study, which included 99 patients with NMIBC from March 2018.-March 2023., we publish the results for all risk groups of patients treated with intravesical chemotherapy Epirubicin or with BCG immunotherapy, after TURBT (Trans urethral resection of bladder tumor) within 1 year. Patients were stratified into 2 groups. The first group was treated with Epirubicin (1 dose within 24 hours of surgery, then 6 weekly instillations and 3 maintenance doses), and the second group was treated with BCG (2-3 weeks after TURBT 6 weekly instillations, and 3 maintenance doses). The monitoring period was 24 months. Results In patients treated with intravesical chemotherapy, recurrence occurred in 9 patients (17.64%), and in patients treated with BCG, recurrence occurred in 7 patients (14.58%). A similar incidence of disease recurrence was observed in both groups (p=0.787). Conclusion The results of our study show a similar therapeutic response by risk groups of patients treated with chemotherapy and immunotherapy. Since BCG production will cease in the future, the task of urologists is to introduce intravesical chemotherapy into wider use and to modernize it as a safe and effective method of adjuvant treatment for non-muscle-invasive bladder cancer.
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Affiliation(s)
- Haris Djug
- Clinic for Urology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sefik Hasukic
- Department of Surgery, University Clinical Centre Tuzla, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Samed Jagodic
- Clinic for Urology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Davor Ivanic
- Clinic for Radiology and Nuclear medicine, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Zhang J, Li M, Chen Z, OuYang J, Ling Z. Efficacy of Bladder Intravesical Chemotherapy with Three Drugs for Preventing Non-Muscle-Invasive Bladder Cancer Recurrence. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:2360717. [PMID: 34888022 PMCID: PMC8651429 DOI: 10.1155/2021/2360717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/18/2022]
Abstract
Epirubicin, gemcitabine, and pirarubicin are widely used as first-line drugs for intravesical chemotherapy to prevent tumor recurrence after transurethral bladder tumor resection for non-muscle-invasive bladder cancer (NMIBC). However, which drug is better is less discussed. A total of 335 NMIBC patients administered intravesical chemotherapy underwent transurethral bladder tumor resection (TURBT) in our hospital from October 2015 to October 2019. After TURBT, all the patients received standard intravesical chemotherapy. Through clinical data collection and telephone follow-up, the tumor recurrence and adverse reactions of all patients after bladder perfusion treatment were counted. Recurrence was defined as new tumor appearance in the bladder. Of the 335 patients who underwent intravesical chemotherapy, 109 patients received epirubicin and 114 patients and 112 patients were given gemcitabine and pirarubicin, respectively. According to the general information of the patients, the patients were divided into intermediate-risk and high-risk bladder cancer and compared separately. There was no statistical difference in clinical and pathological features between different groups (P > 0.05). The recurrence rate of intermediate-risk bladder cancer patients shows no difference between three groups (P > 0.05). As for the high-risk bladder cancer patients, it is found that the 1-year recurrence rate between three groups was not statistically significant (P > 0.05), whereas the 2-year recurrence rate of patients given gemcitabine (9.87%) was significantly lower than that of epirubicin (25.37%) and pirarubicin (24.32%), and the difference was statistically significant (P < 0.017, Bonferroni adjusted P value). The Kaplan-Meier survival curves showed that the recurrence-free survival rate of patients received gemcitabine was significantly higher than that of the other two groups. Comparing the incidence of adverse reactions during the infusion of the three groups of patients, the differences were not statistically significant (P > 0.05). In patients with high-risk non-muscle-invasive bladder cancer, the application of gemcitabine intravesical chemotherapy is related with a relatively lower recurrence rate but similar incidence of adverse reactions.
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Affiliation(s)
- Jianglei Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Miao Li
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ze Chen
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jun OuYang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Zhixin Ling
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Xu X, Wang H, Guo Y, Zhang X, Li B, Du P, Liu Y, Lu H. Study Progress of Noninvasive Imaging and Radiomics for Decoding the Phenotypes and Recurrence Risk of Bladder Cancer. Front Oncol 2021; 11:704039. [PMID: 34336691 PMCID: PMC8321511 DOI: 10.3389/fonc.2021.704039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Urinary bladder cancer (BCa) is a highly prevalent disease among aged males. Precise diagnosis of tumor phenotypes and recurrence risk is of vital importance in the clinical management of BCa. Although imaging modalities such as CT and multiparametric MRI have played an essential role in the noninvasive diagnosis and prognosis of BCa, radiomics has also shown great potential in the precise diagnosis of BCa and preoperative prediction of the recurrence risk. Radiomics-empowered image interpretation can amplify the differences in tumor heterogeneity between different phenotypes, i.e., high-grade vs. low-grade, early-stage vs. advanced-stage, and nonmuscle-invasive vs. muscle-invasive. With a multimodal radiomics strategy, the recurrence risk of BCa can be preoperatively predicted, providing critical information for the clinical decision making. We thus reviewed the rapid progress in the field of medical imaging empowered by the radiomics for decoding the phenotype and recurrence risk of BCa during the past 20 years, summarizing the entire pipeline of the radiomics strategy for the definition of BCa phenotype and recurrence risk including region of interest definition, radiomics feature extraction, tumor phenotype prediction and recurrence risk stratification. We particularly focus on current pitfalls, challenges and opportunities to promote massive clinical applications of radiomics pipeline in the near future.
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Affiliation(s)
- Xiaopan Xu
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xi Zhang
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Baojuan Li
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Peng Du
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Yang Liu
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
| | - Hongbing Lu
- School of Biomedical Engineering, Air Force Medical University, Xi’an, China
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Moussa M, Papatsoris AG, Dellis A, Abou Chakra M, Saad W. Novel anticancer therapy in BCG unresponsive non-muscle-invasive bladder cancer. Expert Rev Anticancer Ther 2020; 20:965-983. [PMID: 32915676 DOI: 10.1080/14737140.2020.1822743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Many patients with non-muscle-invasive bladder cancer (NMIBC) failed intravesical BCG therapy. Currently, radical cystectomy is the recommended standard of care for those patients. There is unfortunately no effective other second-line therapy recommended. AREAS COVERED In this review, we present the topics of BCG unresponsive NMIBC; definition, prognosis, and further treatment options: immunotherapy, intravesical chemotherapy, gene therapy, and targeted individualized therapy. EXPERT OPINION There are major challenges of the management of NMIBC who failed BCG therapy as many patients refuse or are unfit for radical cystectomy. Multiple new modalities currently under investigation in ongoing clinical trials to better treat this category of patients. Immunotherapy, especially PD-1/PD-L1 inhibitors, offers exciting and potentially effective strategies for the treatment of BCG unresponsive NMIBC. As the data expands, it is sure that soon there will be established new guidelines for NMIBC.
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Affiliation(s)
- Mohamad Moussa
- Head of Urology Department, Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Athanasios Dellis
- Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Mohamed Abou Chakra
- Faculty of Medical Sciences, Department of Urology, Lebanese University , Beirut,Lebanon
| | - Wajih Saad
- Head of Oncology Department, Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
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Wang Z, Gao W, Li J, Wang T, Zhu M, Duan Y. Development and Validation of a Novel Recurrence Risk Stratification for Initial Non-Muscle Invasive Bladder Cancer in the Han Chinese Population. J Cancer 2020; 11:1668-1678. [PMID: 32194779 PMCID: PMC7052852 DOI: 10.7150/jca.38649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/13/2019] [Indexed: 12/18/2022] Open
Abstract
Background: Some classification models for determining the risk of recurrence after transurethral resection of bladder tumor (TURBT) in patients with non-muscle invasive bladder cancer (NMIBC) had some shortcomings in clinical applications. This study aimed to investigate whether the European Organization for Research and Treatment of Cancer (EORTC) risk stratification was useful to predict the recurrence of NMIBC in the Han Chinese population. In addition, we developed and validated a novel risk stratification method for recurrence prediction of NMIBC. Methods: Excluding cases who do not meet the inclusion criteria, 606 patients with NMIBC from the First Affiliated Hospital of Zhengzhou University were included in the testing and validation groups. The recurrence-free survival (RFS) curve according to the EORTC risk classifications was calculated by the Kaplan-Meier and the log-rank test methods. Receiver operating characteristic (ROC) curve analysis was used to estimate the diagnosis value for recurrence. We built a logistic regression model for recurrence in NMIBC patients combining the independent recurrence prognostic factors. One external validation group including 166 patients with NMIBC from the Zhongnan Hospital of Wuhan University was also used to assess the logistic regression model. Results: There was no significant difference in RFS rates between the groups grouped according to EORTC. We constructed a novel risk model to predict recurrence by classifying patients into two groups using ten independent prognostic factors [bladder cancer-specific nuclear matrix protein 4 (BLCA-4), bladder tumour antigen (BTA), nuclear matrix protein 22 (NMP22), carcinoembryonic antigen (CEA), body mass index, smoking, family history of bladder cancer, occupational exposure to aromatic amine chemicals, number of tumours, bladder instillation of chemotherapeutic agents] to predict tumour recurrence based on logistic regression analyses (testing group). According to the novel recurrence risk classification, there was a significant difference in 5-year RFS rates between the low-risk group and the high-risk group (Validation group and the external validation group). Conclusions: Our novel classification model can be a useful tool to predict recurrence risk in the Han Chinese population with NMIBC.
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Affiliation(s)
- Zhiyong Wang
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China
| | - Wansheng Gao
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China
| | - Jian Li
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China
| | - Tianen Wang
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China
| | - Man Zhu
- Department of Clinical Laboratory & Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430000, P. R. China
| | - Yu Duan
- Department of Clinical Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P. R. China
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Salvage Therapies for Non-muscle-invasive Bladder Cancer: Who Will Respond to Bacillus Calmette-Guérin? Predictors and Nomograms. Urol Clin North Am 2019; 47:5-13. [PMID: 31757300 DOI: 10.1016/j.ucl.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The best predictors of response to intravesical immunotherapy are tumor grade and stage, tumor recurrence pattern, nomograms, panels of urinary cytokines, and fluorescent in situ hybridization patterns of urine cytology examinations. Future investigations on predictors of Bacillus Calmette-Guérin efficacy are needed to better select those patients who will really benefit from a conservative treatment. Hardly any of the proposed nomograms were designed to precisely predict the outcome of Bacillus Calmette-Guérin immunotherapy. A new nomogram for NMIBC recurrence and progression based on all non-muscle-invasive bladder cancer subgroups would include factors already proven in cancer prognosis and prediction.
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Individual patient risk of progression of urinary bladder papillary tumors estimated from biomarkers at initial transurethral resection of bladder tumor. J Cancer Res Clin Oncol 2019; 145:1709-1718. [PMID: 31030273 DOI: 10.1007/s00432-019-02923-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/20/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine if individual, instead of group, patient progression risk could be predicted using p53, Ki67 and CK20 biomarker percentage values at initial transurethral resection of bladder tumor specimens. METHODS This was an observational study where biomarkers were measured with no knowledge of tumor outcome. Initial bladder tumor specimens were classified as non-invasive and invasive to sub-epithelium (pT1). Percentages of stained biomarker cells were tested as progression predictors from non-invasive to pT1 and pT1 to pT2. Progression probability was correlated with biomarker percentages resulting in a regression equation. RESULTS We studied 112 patients (median age = 67, range 37-91, males 83/112 (73%), with median follow-up of 39 months (range 1.7-140). Mean biomarker values were higher in stage pT1 than in non-invasive (all p < 0.001). Cut-off points separating progression from non-progression groups in stage pT1 were higher than in non-invasive for all biomarkers. Correlation R values for progression probability vs. biomarker percentages varied from 0.7 to 0.9 (all p < 0.001), regression slopes from 0.1 to 0.8 and intercepts from 11 to 35. A novel individual progression probability was calculated as the product of biomarker percentage of stained cells and slope, plus the prevalence-adjusted intercept. CONCLUSIONS Identification of individual risk of progression in patients with non-muscle-invasive bladder tumors was possible using p53- and Ki67-derived progression probability using a regression equation. Combining biomarker-derived progression probability to tumor stage pT1 improves progression to pT2 predictive accuracy.
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Zhang G, Steinbach D, Grimm MO, Horstmann M. Utility of the EORTC risk tables and CUETO scoring model for predicting recurrence and progression in non-muscle-invasive bladder cancer patients treated with routine second transurethral resection. World J Urol 2019; 37:2699-2705. [PMID: 30911812 DOI: 10.1007/s00345-019-02681-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/09/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Routine second transurethral resection (TUR) for non-muscle-invasive bladder cancer (NMIBC) is common practice in Germany. Applicability of European Organization for Research and Treatment of Cancer (EORTC) and Spanish Urological Club for Oncological Treatment (CUETO) models in NMIBC patients is still controversial. Aim of the study was to assess the performance of EORTC and CUETO predictive models in NMIBC patients treated with second TUR. METHODS 479 NMIBC patients with routine second TUR were analyzed retrospectively between 2003 and 2011, and investigated with clinical and pathological variables in regard to tumor recurrence and progression. Furthermore, recurrencefree survival (RFS) and progression-free survival (PFS) were evaluated according to EORTC and CUETO, and the discrimination of the models assessed. RESULTS With a median follow-up of 60 months, prior recurrence rate, grade, and second TUR pathology were independent prognostic factors for the risk of disease recurrence and progression. The concordance index of the EORTC and the CUETO model was 0.563 and 0.516 for recurrence and 0.681 and 0.702 for progression, respectively. The positive pathology after second TUR was significantly associated with risk of disease recurrence and progression. EORTC and CUETO risk models estimated progression better than recurrence, especially with higherscore groups. CONCLUSIONS Improved predictive tools should be developed for optimal treatment selection.
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Affiliation(s)
- Guoxian Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
| | - Daniel Steinbach
- Department of Urology, Friedrich Schiller University, Jena, Germany
| | | | - Marcus Horstmann
- Department of Urology, Friedrich Schiller University, Jena, Germany.,Department of Urology, Malteser Krankenhaus St. Josefshospital, Krefeld, Germany
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Alberto M, Demkiw S, Goad J, Jenkins M, Duggan G, Mow T, Wong LM. Assessment of a European Bladder Cancer Predictive Model for Non-Muscle Invasive Bladder Cancer in an Australian Cohort. Bladder Cancer 2019. [DOI: 10.3233/blc-180199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew Alberto
- Department of Urology and Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Stephanie Demkiw
- Department of Urology and Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Jeremy Goad
- Department of Urology and Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Mark Jenkins
- The University of Melbourne, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health Parkville, Melbourne, VIC, Australia
| | - Genevieve Duggan
- Department of Urology and Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Tyler Mow
- Department of Urology and Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Lih-Ming Wong
- Department of Urology and Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
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Novel nomograms to predict recurrence and progression in primary non-muscle-invasive bladder cancer: validation of predictive efficacy in comparison with European Organization of Research and Treatment of Cancer scoring system. World J Urol 2018; 37:1867-1877. [PMID: 30535715 DOI: 10.1007/s00345-018-2581-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To develop and validate novel nomograms to predict recurrence and progression after transurethral resection of bladder tumor (TURBT) in Korean patients with non-muscle-invasive bladder cancer (NMIBC). METHODS We retrospectively analyzed the clinical data on 970 newly diagnosed NMIBC patients after TURBT between 2000 and 2013 in a single institution. We used multivariate Cox proportional hazard models to identify the significant predictors of recurrence and progression, which resulted in the construction of the nomograms predicting the 5-year probability of recurrence and progression. We internally validated the nomograms using the area under the receiver-operating characteristics' curves and calibration plots. In addition, the clinical usefulness of each nomogram was assessed and compared with that of the European Organization of Research and Treatment of Cancer (EORTC)-scoring system using decision curve analysis (DCA). RESULTS The significant factors related to recurrence were gross hematuria at diagnosis, previous or concomitant upper urinary tract urothelial carcinoma (UTUC), pT1 tumor, high tumor grade, multiple tumors, and intravesical therapy. The significant predictors of progression were previous or concomitant UTUC, pT1 tumor, high tumor grade, carcinoma in situ, and lymphovascular invasion. The 5-year predictive accuracy of each nomogram was 65% for recurrence and 70% for progression, respectively. Compared with the EORTC-scoring system, the nomograms were generally well calibrated. On DCA, each nomogram presented better net benefit gains than did the EORTC-scoring system across a wide range of threshold probabilities. CONCLUSIONS Our novel nomograms are not completely accurate, but they show a reasonable level of discriminative ability, adequate calibration, and meaningful net benefit gain for the prediction of recurrence and progression after TURBT in Korean NMIBC patients. Additional external validation will be required to generalize the nomograms which we developed.
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Soukup V, Čapoun O, Cohen D, Hernández V, Burger M, Compérat E, Gontero P, Lam T, Mostafid AH, Palou J, van Rhijn BWG, Rouprêt M, Shariat SF, Sylvester R, Yuan Y, Zigeuner R, Babjuk M. Risk Stratification Tools and Prognostic Models in Non-muscle-invasive Bladder Cancer: A Critical Assessment from the European Association of Urology Non-muscle-invasive Bladder Cancer Guidelines Panel. Eur Urol Focus 2018; 6:479-489. [PMID: 30470647 DOI: 10.1016/j.euf.2018.11.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/28/2018] [Accepted: 11/10/2018] [Indexed: 02/08/2023]
Abstract
CONTEXT This review focuses on the most widely used risk stratification and prediction tools for non-muscle-invasive bladder cancer (NMIBC). OBJECTIVE To assess the clinical use and relevance of risk stratification and prediction tools to enhance clinical decision making and counselling of patients with NMIBC. EVIDENCE ACQUISITION The most frequent, currently used risk stratification tools and prognostic models for NMIBC patients were identified by the members of the European Association of Urology (EAU) Guidelines Panel on NMIBC. EVIDENCE SYNTHESIS The 2006 European Organization for Research and Treatment of Cancer (EORTC) risk tables are the most widely used and validated tools for risk stratification and prognosis prediction in NMIBC patients. The EAU risk categories constitute a simple alternative to the EORTC risk tables and can be used for comparable risk stratification. In the subgroup of NMIBC patients treated with a short maintenance schedule of bacillus Calmette-Guerin (BCG), the Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model is more accurate than the EORTC risk tables. Both the EORTC risk tables and the CUETO scoring model overestimate the recurrence and progression risks in patients treated according to current guidelines. The new concept of conditional recurrence and progression estimates is very promising during follow-up but should be validated. CONCLUSIONS Risk stratification and prognostic models enable outcome comparisons and standardisation of treatment and follow-up. At present, none of the available risk stratification and prognostic models reflects current standards of treatment. The EORTC risk tables and CUETO scoring model should be updated with previously unavailable data and recalculated. PATIENT SUMMARY Non-muscle-invasive bladder cancer is a heterogeneous disease. A risk-based therapeutic approach is recommended. We present available risk stratification and prediction tools and the degree of their validation with the aim to increase their use in everyday clinical practice.
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Affiliation(s)
- Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
| | - Otakar Čapoun
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Daniel Cohen
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - Virginia Hernández
- Department of Urology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Maximilian Burger
- Department of Urology and Paediatric Urology, Julius-Maximilians-University Würzburg, Würzburg, Germany
| | - Eva Compérat
- Department of Pathology, Hôpital Tenon, Assistance Publique Hopitaux de Paris, Institut Universitaire de Cancérologie GRC5, Sorbonne University, Paris, France
| | - Paolo Gontero
- Department of Surgical Sciences, Urology, University of Turin, Turin, Italy
| | - Thomas Lam
- Academic Urology Unit, University of Aberdeen, Scotland, UK
| | - A Hugh Mostafid
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Bas W G van Rhijn
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Morgan Rouprêt
- Department of Urology, Hopital Pitié-Salpêtrière, Assistance Publique Hôpitaux de Paris, Institut Universitaire de Cancérologie GRC5, Sorbonne University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Richard Sylvester
- EAU Guidelines Office Board, European Association of Urology, Arnhem, The Netherlands
| | - Yuhong Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, Ontario, Canada
| | - Richard Zigeuner
- Department of Urology, Medizinische Universität Graz, Graz, Austria
| | - Marek Babjuk
- Department of Urology, Motol University Hospital and Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Wang H, Ding W, Jiang G, Gou Y, Sun C, Chen Z, Xu K, Xia G. EORTC risk tables are more suitable for Chinese patients with nonmuscle-invasive bladder cancer than AUA risk stratification. Medicine (Baltimore) 2018; 97:e12006. [PMID: 30200080 PMCID: PMC6133586 DOI: 10.1097/md.0000000000012006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with non-muscle-invasive bladder cancer (NMIBC) need accurate estimations of the risk of recurrence and progression. Physicians can offer individualized therapy after identifying high-risk tumors. In our study, we compared the applicability of European Organization for Research and Treatment of Cancer (EORTC) risk tables and American Urological Association (AUA) risk stratification in Chinese patients with NMIBC. METHODS We retrospectively studied 301 patients with NMIBC who underwent transurethral resection of bladder tumor (TURBT) between October 2000 and July 2009 at Huashan Hospital of Fudan University and analyzed their parameters. The recurrence and progression rates at 1 and 5 years postoperatively were calculated along with 95% confidence intervals. We compared them with results obtained from the EORTC risk tables and AUA risk stratification. P values <.05 were considered statistically significant. RESULTS The median patient age was 67 years (21-92 years) and the median follow-up duration was 46 months (2-151 months). We used EORTC risk tables to classify patients into 3 groups, depending on whether they suffered recurrence or progression after TURBT. Kaplan-Meier curves showed significant differences among the 3 recurrence-free survival (RFS) levels (P < .0001, log-rank test) and among the 3 progression-free survival (PFS) levels (P < .0001, log-rank test). AUA risk stratification showed the same results. Both classifications were suitable to predict recurrence and progression in Chinese patients. However, for high-risk patients in both series, Kaplan-Meier curves showed significant differences between RFS levels (P < .0001, log-rank test) and between PFS levels (P < .0001, log-rank test). EORTC risk tables were stricter and AUA was more sensitive in assigning patients to a high-risk group. CONCLUSION EORTC risk tables are better than AUA risk stratification for predicting recurrence and progression in Chinese patients with NMIBC, especially among high-risk patients.
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Affiliation(s)
| | | | | | | | | | - Zhongqing Chen
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
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Seo M, Langabeer Ii JR. Demographic and Survivorship Disparities in Non-muscle-invasive Bladder Cancer in the United States. J Prev Med Public Health 2018; 51:242-247. [PMID: 30286596 PMCID: PMC6182276 DOI: 10.3961/jpmph.18.092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/10/2018] [Indexed: 11/23/2022] Open
Abstract
Objectives To examine survivorship disparities in demographic factors and risk status for non–muscle-invasive bladder cancer (NMIBC), which accounts for more than 75% of all urinary bladder cancers, but is highly curable with early identification and treatment. Methods We used the US National Cancer Institute’s Surveillance, Epidemiology, and End Results registries over a 19-year period (1988-2006) to examine survivorship disparities in age, sex, race/ethnicity, and marital status of patients and risk status classified by histologic grade, stage, size of tumor, and number of multiple primary tumors among NMIBC patients (n=29 326). We applied Kaplan-Meier (K-M) and Cox proportional hazard methods for survival analysis. Results Among all urinary bladder cancer patients, the majority of NMIBCs were in male (74.1%), non-Latino white (86.7%), married (67.8%), and low-risk (37.6%) to intermediate-risk (44.8%) patients. The mean age was 68 years. Survivorship (in median life years) was highest for non-Latino white (5.4 years), married (5.4 years), and low-risk (5.7 years) patients (K-M analysis, p<0.001). We found significantly lower survivorship for elderly, male (female hazard ratio [HR], 0.96), Latino (HR, 1.20), and unmarried (married HR, 0.93) patients. Conclusions Survivorship disparities were ubiquitous across age, sex, race/ethnicity, and marital status groups. Non-white, unmarried, and elderly patients had significantly shorter survivorship. The implications of these findings include the need for a heightened focus on health policy and more organized efforts to improve access to care in order to increase the chances of survival for all patients.
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Affiliation(s)
- Munseok Seo
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
| | - James R Langabeer Ii
- School of Public Health, University of Texas Health Science Center, Houston, TX, USA
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Abstract
Bladder cancer is a heterogeneous disease that poses unique challenges to the treating clinician. It can be limited to a relatively indolent papillary tumor with low potential for progression beyond this stage to muscle-invasive disease prone to distant metastasis. The former is best treated as conservatively as possible, whereas the latter requires aggressive surgical intervention with adjuvant therapies in order to provide the best clinical outcomes. Risk stratification traditionally uses clinicopathologic features of the disease to provide prognostic information that assists in choosing the best therapy for each individual patient. For bladder cancer, this informs decisions regarding the type of intravesical therapy that is most appropriate for non-muscle-invasive disease or whether or not to administer neoadjuvant chemotherapy prior to radical cystectomy. More recently, tumor genetic sequencing data have been married to clinical outcomes data to add further sophistication and personalization. In the next generation of risk classification, we are likely to see the inclusion of molecular subtyping with specific treatment considerations based on a tumor’s mutational profile.
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Affiliation(s)
- Justin T Matulay
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Suite 853, Houston, TX, 77030, USA
| | - Ashish M Kamat
- Department of Urology, Division of Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Suite 853, Houston, TX, 77030, USA
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Quan Y, Jeong CW, Kwak C, Kim HH, Kim HS, Ku JH. Dose, duration and strain of bacillus Calmette-Guerin in the treatment of nonmuscle invasive bladder cancer: Meta-analysis of randomized clinical trials. Medicine (Baltimore) 2017; 96:e8300. [PMID: 29049231 PMCID: PMC5662397 DOI: 10.1097/md.0000000000008300] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intravesical bacillus Calmette-Guerin (BCG) instillation is widely used as an adjuvant therapy after transurethral resection of bladder tumor (TURBT) in patients with intermediate- and high-risk nonmuscle invasive bladder cancer (NMIBC). However, the effective dose, duration, and strain of BCG have not yet been clearly determined. We aimed to elucidate the relationship between dose, duration, and strain of BCG and clinical outcomes in NMIBC patients treated with TURBT. METHODS We conducted a literature search in Embase, Scopus, and PubMed databases for all relevant articles published up to October 2016 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The relative risks of clinical outcomes, including recurrence, progression, cancer-specific mortality, and all-cause mortality according to dose (standard vs low), duration (induction vs maintenance), and strain of BCG were presented as the pooled risk ratio (RR) and 95% confidence interval (CI). RESULTS Nineteen studies meeting the inclusion criteria were finally selected in this meta-analysis. The risk of recurrence was significantly highly observed in case of low-dose BCG (RR, 1.17; 95% CI 1.06-1.30) and induction BCG (RR, 1.33; 95% CI 1.17-1.50) only group without heterogeneity among the included studies. Although there were no significant differences between dose or duration and other clinical outcomes. On direct comparison in each study comparing BCG strains, the Tice stain showed a relatively high probability of recurrence compared with the Connaught (RR, 1.29; 95% CI 1.01-1.64) and RIVM (RR, 2.04, 95% CI 1.28-3.25) strains. Funnel plot testing revealed no significant publication bias. CONCLUSION The use of standard dose and maintenance BCG instillation may be effective to reduce recurrence rate after TURBT for NMIBC. Further large scale, well-designed, and prospective studies, with stratification of the patients into risk group at randomization, will be required to determine the optimal guideline of BCG use to improve clinical outcomes in NMIBC.
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Affiliation(s)
- Yongjun Quan
- Department of Urology, Seoul National University Hospital, Seoul
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul
| | - Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul
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16
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Almeida GL, Busato WFS, Ribas CM, Ribas JM, De Cobelli O. External validation of EORTC risk scores to predict recurrence after transurethral resection of brazilian patients with non -muscle invasive bladder cancer stages Ta and T1. Int Braz J Urol 2017; 42:932-941. [PMID: 27509372 PMCID: PMC5066889 DOI: 10.1590/s1677-5538.ibju.2015.0169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/26/2015] [Indexed: 11/22/2022] Open
Abstract
Validate the EORTC risk tables in Brazilian patients with NMIBC. METHODS 205 patients were analyzed. The 6 parameters analyzed were: histologic grading, pathologic stage, size and number of tumors, previous recurrence rate and concomitant CIS. The time for first recurrence (TFR), risk score and probability of re¬currence were calculated and compared to the probabilities obtained from EORTC risk tables. C-index was calculated and accuracy of EORTC tables was analyzed. RESULTS pTa was presented in 91 (44.4%) patients and pT1 in 114 (55.6%). Ninety-seven (47.3%) patients had solitary tumor, and 108 (52.7%) multiple tumors. One hundred and three (50.2%) patients had tumors smaller than 3 cm and 102 (40.8%) had bigger than 3 cm. Concomitant CIS was observed in 21 (10.2%) patients. Low grade was presented in 95 (46.3%) patients, and high grade in 110 (53.7%). Intravesical therapy was utilized in 105 (56.1%) patients. Recurrence was observed in 117 (57.1%) patients and the mean TFR was 14,2 ± 7,3 months. C-index was 0,72 for 1 year and 0,7 for 5 years. The re¬currence risk was 28,8% in 1 year and 57,1% in 5 years, independently of the scoring risk. In our population, the EORTC risk tables overestimated the risk of recurrence in 1 year and underestimated in 5 years. CONCLUSION The validation of the EORTC risk tables in Brazilian patients with NMIBC was satisfactory and should be stimulated to predict recurrence, although these may overestimated the risk of recurrence in 1 year and underestimated in 5 years.
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Affiliation(s)
- Gilberto L Almeida
- Universidade do Vale do Itajaí, SC, Brasil/Instituto Catarinense de Urologia (INCAU), Itajaí, Brasil.,Faculdade Evangélica do Paraná (FEPAR)/Instituto de Pesquisas Médicas (IPEM), Curitiba, Brasil
| | - Wilson F S Busato
- Universidade do Vale do Itajaí, SC, Brasil/Instituto Catarinense de Urologia (INCAU), Itajaí, Brasil
| | - Carmen Marcondes Ribas
- Faculdade Evangélica do Paraná (FEPAR)/Instituto de Pesquisas Médicas (IPEM), Curitiba, Brasil
| | | | - Ottavio De Cobelli
- Università degli Studi di Milano, Milano, Italia.,Dipartimento di Urologia, Istituto Europeo di Oncologia (IEO), Milano, Italia
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Bijalwan P, Pooleri GK, Thomas A. Comparison of sterile water irrigation versus intravesical mitomycin C in preventing recurrence of nonmuscle invasive bladder cancer after transurethral resection. Indian J Urol 2017; 33:144-148. [PMID: 28469303 PMCID: PMC5396403 DOI: 10.4103/iju.iju_371_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Early recurrence of nonmuscle invasive bladder cancer (NMIBC) following transurethral resection (TUR) remains relatively high. An immediate single instillation of mitomycin C (MMC) reduces the recurrence rates in the first 2 years but has not shown benefits in tumor progression or overall survival. Distilled water irrigation has shown to delay tumor recurrence by osmolysis of tumor cells. There are only limited clinical studies comparing the efficacy of MMC with continuous sterile water irrigation (CSWI) in preventing the recurrence of NMIBC after TUR in clinical setting. Materials and Methods: A prospective, randomized, open-label, two-arm, single-center, pilot study was conducted between December 2013 and September 2015 at a tertiary-care center in South India. Patients were randomized into CSWI group (n = 19) or single dose intravesical MMC group (n = 17) following TUR for NMIBC and analyzed. All patients were followed up with flexible cystoscopy and urine cytology at 3 months interval for 1 year. Recurrence-free rate was estimated as the primary criterion for outcome analysis. Results: At the end of 12 months, recurrence-free rates for MMC and CSWI groups were 47.1% and 52.6%, respectively. The mean recurrence-free interval for MMC and CSWI groups were 10.9 months and 9.8 months, respectively. The difference in recurrence-free rate or recurrence-free interval between two groups was statistically nonsignificant. Further, the complications in MMC group were significantly higher than that in CSWI group (P = 0.047). Conclusions: Continuous bladder irrigation with sterile water after TUR may be comparable to immediate single dose intravesical MMC in preventing tumor recurrence in NMIBC.
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Affiliation(s)
- Priyank Bijalwan
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ginil Kumar Pooleri
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Appu Thomas
- Department of Urology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Ieda T, Muto S, Shimizu F, Taguri M, Yanada S, Kitamura K, Terai K, Saito K, Ogishima T, Nagata M, Ide H, Okegawa T, Wakumoto Y, Sakamoto Y, Tsujimura A, Yamaguchi R, Nutahara K, Horie S. Development and Validation of a Novel Recurrence Risk Stratification for Initial Non-muscle Invasive Bladder Cancer in Asia. EBioMedicine 2016; 12:98-104. [PMID: 27614395 PMCID: PMC5078579 DOI: 10.1016/j.ebiom.2016.08.051] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Some risk classifications to determine prognosis of patients with non-muscle invasive bladder cancer (NMIBC) have disadvantages in the clinical setting. We investigated whether the EORTC (European Organization for Research and Treatment of Cancer) risk stratification is useful to predict recurrence and progression in Japanese patients with NMIBC. In addition, we developed and validated a novel, and simple risk classification of recurrence. METHODS The analysis was based on 1085 patients with NMIBC at six hospitals. Excluding recurrent cases, we included 856 patients with initial NMIBC for the analysis. The Kaplan-Meier method with the log-rank test were used to calculate recurrence-free survival (RFS) rate and progression-free survival (PFS) rate according to the EORTC risk classifications. We developed a novel risk classification system for recurrence in NMIBC patients using the independent recurrence prognostic factors based on Cox proportional hazards regression analysis. External validation was done on an external data set of 641 patients from Kyorin University Hospital. FINDINGS There were no significant differences in RFS and PFS rates between the groups according to EORTC risk classification. We constructed a novel risk model predicting recurrence that classified patients into three groups using four independent prognostic factors to predict tumour recurrence based on Cox proportional hazards regression analysis. According to the novel recurrence risk classification, there was a significant difference in 5-year RFS rate between the low (68.4%), intermediate (45.8%) and high (33.7%) risk groups (P<0.001). INTERPRETATION As the EORTC risk group stratification may not be applicable to Asian patients with NMIBC, our novel classification model can be a simple and useful prognostic tool to stratify recurrence risk in patients with NMIBC. FUNDING None.
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Affiliation(s)
- Takeshi Ieda
- Department of Urology, Juntendo University, Graduate School of Medicine, Japan
| | - Satoru Muto
- Department of Urology, Teikyo University, School of Medicine, Japan
| | | | - Masataka Taguri
- Department of Biostatistics, Yokohama City University, School of Medicine, Japan
| | | | - Kousuke Kitamura
- Department of Urology, Juntendo University, Graduate School of Medicine, Japan
| | - Kazutaka Terai
- Department of Urology, Teikyo University, School of Medicine, Japan
| | - Keisuke Saito
- Department of Urology, Teikyo University, School of Medicine, Japan
| | | | - Masayoshi Nagata
- Department of Urology, Juntendo University, Graduate School of Medicine, Japan
| | - Hisamitsu Ide
- Department of Urology, Teikyo University, School of Medicine, Japan
| | | | - Yoshiaki Wakumoto
- Department of Urology, Juntendo University, Graduate School of Medicine, Japan
| | | | | | - Raizo Yamaguchi
- Department of Urology, Teikyo University, School of Medicine, Japan
| | - Kikuo Nutahara
- Department of Urology, Kyorin University School of Medicine
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Japan.
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Kim HS, Ku JH, Kim SJ, Hong SJ, Hong SH, Kim HS, Kwon TG, Cho JS, Jeon SS, Joo KJ, Ahn HJ, Park HS, Seong DH, Kwon DD, Kim HJ, Lim JS, Lee HL. Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study. Yonsei Med J 2016; 57:855-64. [PMID: 27189277 PMCID: PMC4951460 DOI: 10.3349/ymj.2016.57.4.855] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 11/13/2015] [Accepted: 11/25/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.
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Affiliation(s)
- Hyung Suk Kim
- Department of Urology, Dongguk University Ilsan Medical Center, Goyang, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Se Joong Kim
- Department of Urology, Ajou University College of Medicine, Suwon, Korea
| | - Sung Joon Hong
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoo Hong
- Department of Urology, The Catholic University College of Medicine, Seoul, Korea
| | - Hong Sup Kim
- Department of Urology, Konkuk University College of Medicine, Chungju, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University College of Medicine, Daegu, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Kwan Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Han Jong Ahn
- Department of Urology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Hong Seok Park
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Do Hwan Seong
- Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University College of Medicine, Gwangju, Korea
| | - Hyung Jin Kim
- Department of Urology, Chonbuk National University College of Medicine, Jeonju, Korea
| | - Jae Sung Lim
- Department of Urology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hyung Lae Lee
- Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea.
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20
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Systemic Inflammatory Response Based on Neutrophil-to-Lymphocyte Ratio as a Prognostic Marker in Bladder Cancer. DISEASE MARKERS 2016; 2016:8345286. [PMID: 26880857 PMCID: PMC4736380 DOI: 10.1155/2016/8345286] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 11/04/2015] [Indexed: 12/18/2022]
Abstract
A growing body of evidence suggests that systemic inflammatory response (SIR) in the tumor microenvironment is closely related to poor oncologic outcomes in cancer patients. Over the past decade, several SIR-related hematological factors have been extensively investigated in an effort to risk-stratify cancer patients to improve treatment selection and to predict posttreatment survival outcomes in various types of cancers. In particular, one readily available marker of SIR is neutrophil-to-lymphocyte ratio (NLR), which can easily be measured on the basis of absolute neutrophils and absolute lymphocytes in a differential white blood cell count performed in the clinical setting. Many investigators have vigorously assessed NLR as a potential prognostic biomarker predicting pathological and survival outcomes in patients with urothelial carcinoma (UC) of the bladder. In this paper, we aim to present the prognostic role of NLR in patients with UC of the bladder through a thorough review of the literature.
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Busato Júnior WFS, Almeida GL, Ribas CAPM, Ribas Filho JM, De Cobelli O. EORTC Risk Model to Predict Progression in Patients With Non-Muscle-Invasive Bladder Cancer: Is It Safe to Use in Clinical Practice? Clin Genitourin Cancer 2015; 14:176-82. [PMID: 26444918 DOI: 10.1016/j.clgc.2015.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 08/19/2015] [Accepted: 09/11/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the validation of European Organization for Research and Treatment of Cancer (EORTC) risk tables to predict progression in Brazilian patients with non-muscle-invasive bladder cancer (NMIBC). PATIENTS AND METHODS Two hundred five consecutively and prospectively selected patients with NMIBC who underwent transurethral resection were analyzed during 12 years. Six parameters were analyzed: tumor grade, size, and number, pT stage, previous recurrence rate, and carcinoma-in-situ. Time to progression, risk score, and progression probabilities were calculated and compared to probabilities obtained from the EORTC model. The C index was calculated, and accuracy was analyzed for external validation. RESULTS A total of 152 patients had complete follow-up data, 36 died, and 17 were lost to follow-up. One hundred thirty-seven patients had primary tumors and 68 had recurrent tumors. Progression to muscle-invasive disease occurred in 42 patients (20.5%). Significant characteristics related to progression were male gender, pT1 stage, lesion size ≥ 3 cm, high grade of disease, and no combined intravesical therapy. Mean time to progression was 26.9 months; the 1-year progression rate was 3.4% and the 5-year rate was 19.1%. The C index was 0.86 at 1 year and 0.78 at 5 years. For calibration, 1- and 5-year progression rates were lower than the values predicted by EORTC risk tables, mainly in high-risk groups. Although the EORTC model overestimated the short- and long-term risk of progression, an overlapping of the confidence intervals between both populations was detected. CONCLUSION The EORTC model successfully stratified progression risks in a Brazilian cohort, although it overestimated progression rates. This scoring system is useful in predicting progression of NMIBC; however, updating new risk markers is essential to improve risk classification and prediction of progression.
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Affiliation(s)
- Wilson F S Busato Júnior
- University of Vale do Itajaí, Itajaí, Brazil, Instituto Catarinense de Urologia (INCAU), Itajaí, Brazil
| | - Gilberto Laurino Almeida
- University of Vale do Itajaí, Itajaí, Brazil, Instituto Catarinense de Urologia (INCAU), Itajaí, Brazil; Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil.
| | - Carmen A P M Ribas
- Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil
| | - Jurandir M Ribas Filho
- Faculdade Evangélica do Paraná (FEPAR), Instituto de Pesquisas Médicas (IPEM), Curitiba, Brazil
| | - Ottavio De Cobelli
- University of Milan, Milan, Italy; Department of Urology, European Institute of Oncology (IEO), Milan, Italy
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Kluth LA, Black PC, Bochner BH, Catto J, Lerner SP, Stenzl A, Sylvester R, Vickers AJ, Xylinas E, Shariat SF. Prognostic and Prediction Tools in Bladder Cancer: A Comprehensive Review of the Literature. Eur Urol 2015; 68:238-53. [PMID: 25709027 DOI: 10.1016/j.eururo.2015.01.032] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/30/2015] [Indexed: 02/07/2023]
Abstract
CONTEXT This review focuses on risk assessment and prediction tools for bladder cancer (BCa). OBJECTIVE To review the current knowledge on risk assessment and prediction tools to enhance clinical decision making and counseling of patients with BCa. EVIDENCE ACQUISITION A literature search in English was performed using PubMed in July 2013. Relevant risk assessment and prediction tools for BCa were selected. More than 1600 publications were retrieved. Special attention was given to studies that investigated the clinical benefit of a prediction tool. EVIDENCE SYNTHESIS Most prediction tools for BCa focus on the prediction of disease recurrence and progression in non-muscle-invasive bladder cancer or disease recurrence and survival after radical cystectomy. Although these tools are helpful, recent prediction tools aim to address a specific clinical problem, such as the prediction of organ-confined disease and lymph node metastasis to help identify patients who might benefit from neoadjuvant chemotherapy. Although a large number of prediction tools have been reported in recent years, many of them lack external validation. Few studies have investigated the clinical utility of any given model as measured by its ability to improve clinical decision making. There is a need for novel biomarkers to improve the accuracy and utility of prediction tools for BCa. CONCLUSIONS Decision tools hold the promise of facilitating the shared decision process, potentially improving clinical outcomes for BCa patients. Prediction models need external validation and assessment of clinical utility before they can be incorporated into routine clinical care. PATIENT SUMMARY We looked at models that aim to predict outcomes for patients with bladder cancer (BCa). We found a large number of prediction models that hold the promise of facilitating treatment decisions for patients with BCa. However, many models are missing confirmation in a different patient cohort, and only a few studies have tested the clinical utility of any given model as measured by its ability to improve clinical decision making.
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Affiliation(s)
- Luis A Kluth
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Bernard H Bochner
- Department of Urology, Memorial Sloan-Kettering Cancer Center, Kimmel Center for Prostate and Urologic Tumors, New York, NY, USA
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | | | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Evanguelos Xylinas
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, UT Southwestern, Dallas, TX, USA; Division of Medical Oncology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
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23
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Choi SY, Ryu JH, Chang IH, Kim TH, Myung SC, Moon YT, Kim KD, Kim JW. Predicting recurrence and progression of non-muscle-invasive bladder cancer in Korean patients: a comparison of the EORTC and CUETO models. Korean J Urol 2014; 55:643-9. [PMID: 25324946 PMCID: PMC4198762 DOI: 10.4111/kju.2014.55.10.643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 08/06/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to confirm the utility of the European Organization for Research and Treatment of Cancer (EORTC) and the Spanish Urological Club for Oncological Treatment (CUETO) scoring systems and to determine which model is preferred as a prognostic model in Korean patients with non-muscle-invasive bladder cancer. MATERIALS AND METHODS Between 1985 and 2011, 531 patients who were treated by transurethral resection of bladder cancer were retrospectively analyzed by use of the EORTC and CUETO models. Statistically, we performed Kaplan-Meier survival analysis; calculated Harrell's concordance index, receiver operating characteristic (ROC) curve, and cutoff values; and performed univariate and multivariate Cox proportional hazards regression analyses. RESULTS For risk of recurrence, with the use of the EORTC model, all groups had statistically significant differences except between the group with a score of 0 and the group with a score of 1-4. With the use of the CUETO model, all groups differed significantly. For risk of progression, with the use of the EORTC model, significant differences were observed between all groups except between the group with a score of 2-6 and the group with a score of 7-13. With the use of the CUETO model, a significant difference was observed between the group with a score of 0 and the other groups. The concordance index of the EORTC and CUETO models was 0.759 and 0.836 for recurrence and 0.704 and 0.745 for progression, respectively. The area under the ROC curve for the EORTC and CUETO models was 0.832 and 0.894 for recurrence and 0.722 and 0.724 for progression, respectively. CONCLUSIONS Both scoring systems, especially the CUETO model, showed value in predicting recurrence and progression in Korean patients, which will help in individualizing treatment and follow-up schedules.
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Affiliation(s)
- Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Jae Hyung Ryu
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Soon Chul Myung
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Young Tae Moon
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Kyung Do Kim
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
| | - Jin Wook Kim
- Department of Urology, Chung-Ang University Hospital, Seoul, Korea
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Lammers RJM, Palou J, Witjes WPJ, Janzing-Pastors MHD, Caris CTM, Witjes JA. Comparison of expected treatment outcomes, obtained using risk models and international guidelines, with observed treatment outcomes in a Dutch cohort of patients with non-muscle-invasive bladder cancer treated with intravesical chemotherapy. BJU Int 2014; 114:193-201. [PMID: 24304638 DOI: 10.1111/bju.12495] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the risks according to the American Urological Association (AUA), EAU, European Organization for Research and Treatment of Cancer (EORTC) and Club Urológico Español de Tratamiento Oncologico (CUETO) classifications with real outcomes in a cohort of patients in the Netherlands, and to confirm that patients who were undertreated according to these risk models have worse outcomes than adequately treated patients. PATIENTS AND METHODS Patients treated with complete transurethral resection of bladder tumour and intravesical chemotherapy were included. Not all patients would have received intravesical chemotherapy had they been treated to current standards, and thus comparison of the observed outcomes in our Dutch cohort vs expected outcomes based on the EORTC risk tables and CUETO scoring model was possible. The cohort was reclassified according to the definitions of five index patients (IPs), as defined by the AUA guidelines, and three risk groups, defined according to the EAU guidelines, to compare the outcomes of undertreated patients with those of adequately treated patients. RESULTS A total of 1001 patients were available for comparison with the AUA definitions and 728 patients were available for comparison with the EORTC and CUETO models. There was a large overlap between the observed outcomes and expected recurrence and progression probabilities when comparison was made using the EORTC risk tables. The observed recurrence outcomes were in general higher than the expected probabilities according to the CUETO risk classification, especially in the long term. No differences in progression were found when comparing these two models to the Dutch cohort. Patients who were undertreated according to the guidelines showed, in general, a higher risk of developing recurrence and progression. Limitations are i.a. its retrospective nature and the differences in grading system. CONCLUSION Comparisons between the observed outcomes in our Dutch cohort and the expected outcomes based on EAU and CUETO risk models and the EORTC and AUA guidelines showed that lack of adherence to existing guidelines translates into worse outcomes.
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Kohjimoto Y, Kusumoto H, Nishizawa S, Kikkawa K, Kodama Y, Ko M, Matsumura N, Hara I. External validation of European Organization for Research and Treatment of Cancer and Spanish Urological Club for Oncological Treatment scoring models to predict recurrence and progression in Japanese patients with non-muscle invasive bladder cancer treated with bacillus Calmette-Guérin. Int J Urol 2014; 21:1201-7. [PMID: 25074295 DOI: 10.1111/iju.12572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/18/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To validate two prediction models (European Organization for Research and Treatment of Cancer and Spanish Urological Club for Oncological Treatment) for recurrence and progression of non-muscle invasive bladder cancer in Japanese patients who underwent bacillus Calmette-Guérin instillation therapy. METHODS From March 1985 to April 2007, data were analyzed from 366 patients who underwent transurethral resection of bladder tumor followed by bacillus Calmette-Guérin instillation therapy. The ability of two scoring models to predict recurrence and progression was assessed by concordance index. RESULTS For recurrence probability, the concordance index of the European Organization for Research and Treatment of Cancer and Spanish Urological Club for Oncological Treatment models was 0.514 and 0.576, respectively, which was lower than that (0.604) of a selected single prognostic factor (age) by our multivariate analysis. For progression probability, the concordance index of European Organization for Research and Treatment of Cancer and Spanish Urological Club for Oncological Treatment models was 0.693 and 0.764, respectively, which was higher than that (0.633) of a selected single factor (T stage) by our multivariate analysis. The Spanish Urological Club for Oncological Treatment scoring system resulted in better stratification of tumor recurrence and progression when compared with the European Organization for Research and Treatment of Cancer model, probably because more patients underwent bacillus Calmette-Guérin treatment in the Spanish Urological Club for Oncological Treatment cohort than in the European Organization for Research and Treatment of Cancer cohort. CONCLUSIONS The Spanish Urological Club for Oncological Treatment scoring system is a good predictor of tumor recurrence and progression in Japanese patients who underwent bacillus Calmette-Guérin immunotherapy. A large prospective study is warranted to confirm the efficacy of this system.
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Affiliation(s)
- Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Xylinas E, Kent M, Kluth L, Pycha A, Comploj E, Svatek RS, Lotan Y, Trinh QD, Karakiewicz PI, Holmang S, Scherr DS, Zerbib M, Vickers AJ, Shariat SF. Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in non-muscle-invasive urothelial carcinoma of the bladder. Br J Cancer 2013; 109:1460-6. [PMID: 23982601 PMCID: PMC3776972 DOI: 10.1038/bjc.2013.372] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 06/13/2013] [Accepted: 06/22/2013] [Indexed: 11/24/2022] Open
Abstract
Background: The European Organization for Research and Treatment of Cancer (EORTC) risk tables and the Spanish Urological Club for Oncological Treatment (CUETO) scoring model are the two best-established predictive tools to help decision making for patients with non-muscle-invasive bladder cancer (NMIBC). The aim of the current study was to assess the performance of these predictive tools in a large multicentre cohort of NMIBC patients. Methods: We performed a retrospective analysis of 4689 patients with NMIBC. To evaluate the discrimination of the models, we created Cox proportional hazard regression models for time to disease recurrence and progression. We incorporated the patients calculated risk score as a predictor into both of these models and then calculated their discrimination (concordance indexes). We compared the concordance index of our models with the concordance index reported for the models. Results: With a median follow-up of 57 months, 2110 patients experienced disease recurrence and 591 patients experienced disease progression. Both tools exhibited a poor discrimination for disease recurrence and progression (0.597 and 0.662, and 0.523 and 0.616, respectively, for the EORTC and CUETO models). The EORTC tables overestimated the risk of disease recurrence and progression in high-risk patients. The discrimination of the EORTC tables was even lower in the subgroup of patients treated with BCG (0.554 and 0.576 for disease recurrence and progression, respectively). Conversely, the discrimination of the CUETO model increased in BCG-treated patients (0.597 and 0.645 for disease recurrence and progression, respectively). However, both models overestimated the risk of disease progression in high-risk patients. Conclusion: The EORTC risk tables and the CUETO scoring system exhibit a poor discrimination for both disease recurrence and progression in NMIBC patients. These models overestimated the risk of disease recurrence and progression in high-risk patients. These overestimations remained in BCG-treated patients, especially for the EORTC tables. These results underline the need for improving our current predictive tools. However, our study is limited by its retrospective and multi-institutional design.
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Affiliation(s)
- E Xylinas
- 1] Department of Urology, Weill Cornell Medical College, New York, NY, USA [2] Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France
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Borkowska EM, Jędrzejczyk A, Marks P, Catto JWF, Kałużewski B. EORTC risk tables - their usefulness in the assessment of recurrence and progression risk in non-muscle-invasive bladder cancer in Polish patients. Cent European J Urol 2013; 66:14-20. [PMID: 24578979 PMCID: PMC3921849 DOI: 10.5173/ceju.2013.01.art5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 12/31/2012] [Accepted: 01/15/2013] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION The assessment of risk of recurrence and progression of bladder cancer (BC) is still rather difficult. We decided to check the rates of the changes mentioned above in the group of the Polish patients after a year-long observation and next to compare them with the results calculated in the European Organisation of Research and Treatment of Cancer (EORTC) risk tables. METHODS The tested group consisted of 91 patients who underwent transurethral resection of bladder tumour (TURBT). When being diagnosed, 60 cases were in the pTa clinical stage, whereas 30 cases were in T1. The coexisting carcinoma in situ (CIS) was observed in four cases. On the basis of the scores obtained from the EORTC tables, the patients were divided into the groups of low, intermediate or high risk of disease recurrence and progression. RESULTS Recurrence was noticed in 23 patients (25%), while progression was observed in 11 patients (12.1%). The rate of the observed recurrences proved to be lower than it had been predicted in all the groups, except for one of the intermediate-risk group (score 1- 4). Moreover, the rate of the progressions predicted according to the EORTC risk tables was higher in all the risk groups. CONCLUSIONS It can be noticed that the rate of real recurrences is lower than expected, whereas the rate of the observed progressions is overestimated. Partly, it could be the result of using a relatively small group of patients for observation and applying a different method of treatment.
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Affiliation(s)
- Edyta M Borkowska
- Department of Clinical and Laboratory Genetics Medical University of Łódź, Poland ; Institute for Cancer Studies and Academic Urology Unit University of Sheffield, United Kingdom
| | - Adam Jędrzejczyk
- Department of Clinical and Laboratory Genetics Medical University of Łódź, Poland ; Division of Urology, John Paul II Memorial Regional Hospital in Bełchatów, Poland
| | - Piotr Marks
- Division of Urology, John Paul II Memorial Regional Hospital in Bełchatów, Poland
| | - James W F Catto
- Institute for Cancer Studies and Academic Urology Unit University of Sheffield, United Kingdom
| | - Bogdan Kałużewski
- Department of Clinical and Laboratory Genetics Medical University of Łódź, Poland
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Jung SJ, Chang HS, Park CH, Kim CI, Kim BH. Effectiveness of an immediate mitomycin C instillation in patients with superficial bladder cancer receiving periodic mitomycin C instillation. Korean J Urol 2011; 52:323-6. [PMID: 21687391 PMCID: PMC3106164 DOI: 10.4111/kju.2011.52.5.323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/07/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose We analyzed the impact of immediate intravesical mitomycin C instillation after transurethral resection of the bladder (TURB) on tumor recurrence and progression in patients with periodic mitomycin C instillation. Materials and Methods Between June 2000 and June 2006, a retrospective study was performed in a total of 115 patients with primary bladder tumors receiving a 6-week course of mitomycin C instillation after TURB. The patients were assigned to two groups: 53 patients in the immediate mitomycin C (I-MMC) group were treated by immediate instillation of mitomycin C after TURB and periodic instillation (6 times, 1 time per week), and 62 patients in the MMC group received only periodic instillation. Tumor recurrence and progression were compared in the two groups. Results During the mean follow-up period of 46.5 months in the I-MMC group and 47.2 months in the MMC group, early recurrence (within 1 year) occurred in 6 of 53 patients (11.3%) in the I-MMC group and in 18 of 62 patients (29.0%) in the MMC group (p<0.02). Although a significantly lower early recurrence rate was observed in the I-MMC group, this difference was not significant for recurrence within 2 or 3 years or for total recurrence. Progression was not significantly different between the two groups regarding the early and total period. Conclusions Our study confirmed the positive effect of a single, immediate mitomycin C instillation in patients with non-muscle-invasive bladder tumors who received periodic mitomycin C instillation. This benefit was limited to early recurrence and was not maintained with long-term follow-up. This approach can be an alternative to periodic mitomycin C instillation without immediate instillation.
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Affiliation(s)
- Seok Jin Jung
- Department of Urology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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