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Ourfali S, Matillon X, Ricci E, Fassi-Fehri H, Benoit-Janin M, Badet L, Colombel M. Prognostic Implications of Treatment Delays for Patients with Non-muscle-invasive Bladder Cancer. Eur Urol Focus 2022; 8:1226-1237. [PMID: 34172421 DOI: 10.1016/j.euf.2021.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/13/2021] [Accepted: 06/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Delay in treatment is a prognostic factor in muscle-invasive bladder cancer. OBJECTIVE To evaluate clinical outcomes associated with delays in diagnosis and treatment for patients with non-muscle invasive bladder cancer (NMIBC). DESIGN, SETTING, AND PARTICIPANTS In this retrospective study we analyzed data for patients treated at our center between November 2008 and December 2016 for intermediate risk (IR) or high risk (HR) NMIBC with an additional intravesical treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Time delays from diagnosis to first transurethral resection (TT-TUR), from resection to restaging resection (TT-reTUR), and from the last resection to first instillation (TT-INST) of bacillus Calmette-Guérin (BCG) or mitomycin C (MMC) were documented. To identify the interval of time from which recurrence rates significantly increased, we used nonparametric series regression. Recurrence-free survival (RFS) and progression-free survival for patients in each time delay category were compared using the Kaplan-Meier method. Factors associated with tumor recurrence were analyzed in a multivariable model. RESULTS AND LIMITATIONS A total of 434 patients were included, of whom 168 (38.7%) had IR and 266 (61.3%) had HR NMIBC. Among the patients, 34.6% had reTUR, 63.6% received BCG, and 36.4% received MMC. The median TT-TUR, TT-reTUR, and TT-INST was 4.0 wk, 6.5 wk, and 7.0 wk, respectively. At 40 mo the rate of recurrence was 28.4% and the rate of progression was 7.3%. Nonparametric analysis revealed that each week in delay increased the risk of recurrence, starting from week 6 for TT-TUR for IR and HR cases, and starting from week 7 for TT-INST for IR cases. RFS was significantly lower with TT-TUR > 6 wk among patients in the IR (p < 0.001) and HR (p = 0.04) groups, and with TT-INST >7 wk for patients in the IR group (p = 0.001). TT-reTUR >7 wk had a significant negative impact on progression (p < 0.017). Multivariable analysis revealed that for IR and HR cases, multifocality (p = 0.02 and p = 0.007) and TT-TUR >6 wk (p = 0.001 and p = 0.03) were independent predictors of recurrence, while TT-INST >7 wk predicted recurrence (p = 0.04) for IR NMIBC. CONCLUSIONS Our results suggest that delays of >6 wk to first TUR in IR and HR NMIBC, and >7 wk to first instillation in IR cases are associated with increases in the risk of recurrence. TT-reTUR of >7 wk is also associated with higher risk of progression. PATIENT SUMMARY We evaluated the impact of treatment delays on outcomes for patients with intermediate- and high-risk bladder cancer not invading the bladder wall muscle. We found that delays from diagnosis to first bladder resection, from first resection to repeat resection, and from last resection to bladder instillation treatment increase the rates of cancer recurrence and progression. The medical team should avoid delays in treatment, even for low-grade bladder cancer.
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Affiliation(s)
- Said Ourfali
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard-Lyon 1, Lyon, France.
| | - Xavier Matillon
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard-Lyon 1, Lyon, France
| | - Estelle Ricci
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon, Lyon, France
| | - Hakim Fassi-Fehri
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon, Lyon, France
| | - Mélanie Benoit-Janin
- Service d'Anatomo-Cyto-Pathologie, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Lionel Badet
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard-Lyon 1, Lyon, France
| | - Marc Colombel
- Service d'Urologie et Chirurgie de la Transplantation, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard-Lyon 1, Lyon, France
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Dovey Z, Pfail J, Martini A, Steineck G, Dey L, Renström L, Hosseini A, Sfakianos JP, Wiklund P. Bladder Cancer (NMIBC) in a population-based cohort from Stockholm County with long-term follow-up; A comparative analysis of prediction models for recurrence and progression, including external validation of the updated 2021 E.A.U. model. Urol Oncol 2021; 40:106.e1-106.e10. [PMID: 34840075 DOI: 10.1016/j.urolonc.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 09/26/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Non muscle invasive bladder cancer (NMIBC) has recurrence and progression rates of approximately 55-75% and 5-45% respectively. After diagnosis, risk stratification guides management decisions regarding surveillance, intravesical therapy or surgery. This prospective cohort of patients from Stockholm County is ideal for external validation of the current risk stratification models used in clinical practice. PATIENTS & METHODS The cohort consisted of 395 patients diagnosed with bladder cancer across all the hospitals in Stockholm County between the years 1995-96, with up to 25 years follow up. All patients with pathologic Ta or T1 disease were included. Patients with muscle invasive disease (MIBC) referred for radical treatment at diagnosis were excluded. External validation of EORTC, CUETO and updated EAU Sylvester et al. (2021) models was done and multivariate Cox regression analysis was performed to generate hazard ratios for covariables of interest using both WHO '73 and WHO '04/16 pathological grade classifications. RESULTS Overall Harrel's C-indices (CIs) for EORTC and CUETO models for recurrence were 0.66 and 0.63 respectively. The CIs for the EORTC, CUETO and EAU Sylvester et al. (2021) WHO '73 and '04/16 models for progression were higher at 0.82, 0.84, 0.83 and 0.83 respectively. All models tended to underestimate both recurrence and progression rates at 1 and 5 yrs. A simplified model devised to include only multifocality, tumor stage, size and grade performed with similar accuracy to all models for both recurrence and progression. CONCLUSION Current risk stratification models are clinically useful but only moderately accurate across different patient populations, and the results of this study suggest a model using fewer variables is of similar accuracy to all models tested. In the future, research into the use of genomic classifiers will hopefully contribute to more accurate, modern risk stratification models.
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Affiliation(s)
- Zachary Dovey
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A
| | - Alberto Martini
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Gunnar Steineck
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Linda Dey
- Department of Urology, Karolinska University Hospital Solna, Sweden
| | - Lotta Renström
- Department of Urology, Karolinska University Hospital Solna, Sweden
| | | | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A..
| | - Peter Wiklund
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, U.S.A.; Department of Urology, Karolinska University Hospital Solna, Sweden
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Tanimoto R, Saika T, Ebara S, Kobayashi Y, Nasu R, Yamada D, Takamoto H, Miyaji Y, Nasu Y, Tsushima T, Kumon H. Prospective randomized controlled trial of postoperative early intravesical chemotherapy with pirarubicin (THP) for solitary non-muscle invasive bladder cancer comparing single and two-time instillation. World J Urol 2018; 36:889-895. [PMID: 29387931 DOI: 10.1007/s00345-018-2196-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Single immediate intravesical instillation of chemotherapy after transurethral resection of bladder tumor (TURBT) has been the gold standard treatment for patients with low- and intermediate-risk non-muscle invasive bladder cancer (NMIBC). Herein, we conducted a multicenter prospective randomized controlled trial in Japan, comparing recurrence-free survival between single and two-time instillation of pirarubicin (THP) for solitary NMIBC. METHODS Between 2005 and 2009, 257 patients with solitary NMIBC were enrolled and randomized to single instillation of THP (30 mg/50 mL) immediately after TURBT (Group A) or two-time instillation of THP immediately after and 1 day after TURBT (Group B). The primary endpoint was recurrence-free survival. Secondary endpoints included rates of recurrence and adverse effects, including hematuria, micturition pain, difficult urination, pollakiuria, systemic symptoms, and other complications. This study was registered as UMIN C000000266. RESULTS Of 257 patients, 99 in Group A and 102 in Group B could be evaluated for recurrence. Median follow-up was 71 months. The overall recurrence rate was 39 and 31%, respectively (p = 0.2704). Although the 5-year recurrence-free survival rates were 55.9% and 67.7% in groups A and B, respectively, the difference between groups was not significant (p = 0.2031). No significant differences in adverse effects were observed between groups, except for pollakiuria (7 vs 22%, p = 0.0031). Multivariate analyses did not show that the treatment group was a significant risk factor for bladder cancer recurrence. CONCLUSIONS Postoperative two-time intravesical instillation of THP was not superior to single immediate instillation for preventing recurrence after complete resection of a solitary NMIBC.
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Affiliation(s)
- Ryuta Tanimoto
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Shikata-cho 2-5-1, Okayama, Okayama, 700-8558, Japan.
| | - Takashi Saika
- Department of Urology, Hiroshima City Hospital, Hiroshima, Hiroshima, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Shin Ebara
- Department of Urology, Hiroshima City Hospital, Hiroshima, Hiroshima, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Shikata-cho 2-5-1, Okayama, Okayama, 700-8558, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Ryoji Nasu
- Department of Urology, Kochi Health Science Center, Kochi, Kochi, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Daisuke Yamada
- Department of Urology, Mitoyo General Hospital, Kanonji, Kagawa, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Hitoshi Takamoto
- Department of Urology, Kurashiki Medical Center, Kurashiki, Okayama, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Iwakuni Clinical Center, Iwakuni, Yamaguchi, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Yasutomo Nasu
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Shikata-cho 2-5-1, Okayama, Okayama, 700-8558, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Tomoyasu Tsushima
- Department of Urology, Okayama Medical Center, Oskayama, Okayama, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
| | - Hiromi Kumon
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Shikata-cho 2-5-1, Okayama, Okayama, 700-8558, Japan.,Okayama Urological Research Group (OURG), Okayama, Okayama, Japan
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Gill TS, Das RK, Basu S, Dey RK, Mitra S. Predictive factors for residual tumor and tumor upstaging on relook transurethral resection of bladder tumor in non-muscle invasive bladder cancer. Urol Ann 2014; 6:305-8. [PMID: 25371606 PMCID: PMC4216535 DOI: 10.4103/0974-7796.140990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 11/11/2013] [Indexed: 12/02/2022] Open
Abstract
Context: Relook transurethral resection of bladder tumor (TURBT) improves the diagnostic and therapeutic efficacy of primary TURBT. However, it is still not established as to which category of patients would benefit most from this repeat invasive procedure. Aims: This prospective interventional study was designed to identify the category of patients with non-muscle invasive bladder cancer who may benefit from a routine relook procedure. Setting and Design: A total of 52 consecutive patients with biopsy proven non muscle invasive bladder cancer on primary TURBT underwent a relook TURBT between March 2011 and September 2012. Materials and Methods: The incidence of residual tumor and tumor upstaging on relook procedure was correlated with various histopathological (stage, grade, CIS, presence of muscle) and cystoscopic (type and focality of tumor, any apparent field change) parameters on primary TURBT. Results: Out of the total 52 patients, 23 (44.2%) had a residual tumor on relook TURBT. 12 (23.1%) were upstaged (of these 9 i.e. 17.3% to muscle invasion). While most of the parameters studied showed a positive correlation with incidence of residual tumor and upstaging to muscle invasion, statistical significance (for both) was reached only for tumor stage (P = 0.028 and 0.010), tumor grade (P = 0.010 and 0.002) and tumor type (solid vs. papillary; P = 0.007 and 0.001). Carcinoma in situ showed a significant correlation with incidence of residual tumor (P = 0.016) while the absence of muscle in the primary TURBT specimen was significantly associated with upstaging to muscle invasive disease (P = 0.018). Statistical Analysis: The data was analyzed using SPSS software v. 16.0. Conclusions: Relook TURBT may be especially recommended for high grade and T1 tumors and tumors with a solid/sessile appearance on primary TURBT especially when deep muscle was absent in the primary TURBT specimen.
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Affiliation(s)
- Tejpal S Gill
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ranjit K Das
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Supriya Basu
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Ranjan K Dey
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Subrata Mitra
- Department of Urology, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
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Mian C, Comploj E, Resnyak E, Trenti E, Palermo S, Lodde M, Pycha A, Ambrosini-Spaltro A, Dechet CB, Pycha A. Long-term follow-up of intermediate-risk non-muscle invasive bladder cancer sub-classified by multi-coloured FISH. Anticancer Res 2014; 34:3067-3071. [PMID: 24922674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To examine the long-term follow-up of patients with that previously underwent risk stratification based on multicolour FISH testing. PATIENTS AND METHODS On 81 patients with intermediate-risk urothelial carcinoma, a multicolour-FISH was performed. Patients were sub-divided into low- and high-risk groups based on chromosomal patterns. Univariate analysis, using Mantel-Cox log-rank test for disease-free, progression-free survival and overall survival, was employed to determine the prognostic significance of FISH analysis. Survival times were calculated according to the Kaplan-Meier product-limit method and multivariate analysis using Cox proportional hazards regression model. RESULTS The univariate Mantel-Cox log-rank test showed significant differences between the low-risk and the high-risk group for disease-free survival (p=0.005) and overall survival (p=0.038), but not for progression-free survival (p=0.129). CONCLUSION Our long-term follow-up data appear to be able to divide tumors into low and high risk groups for recurrence based on molecular/genetic changes observed with FISH.
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Affiliation(s)
- Christine Mian
- Department of Pathology, Central Hospital of Bolzano, Bolzano, Italy
| | - Evi Comploj
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Emanuela Trenti
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Michele Lodde
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
| | | | | | - Christopher B Dechet
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Armin Pycha
- Department of Urology, Central Hospital of Bolzano, Bolzano, Italy
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Upadhyay R, Kapoor R, Srivastava A, Krishnani N, Mandhani A. Does En-bloc transurethral resection of bladder tumor give a better yield in terms of presence of detrusor muscle in the biopsy specimen? Indian J Urol 2012. [PMID: 23204654 PMCID: PMC3507395 DOI: 10.4103/0970-1591.102700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aims: Detrusor muscle in initial transurethral resection of the bladder tumor (TURBT) may not be found in up to 50% of the cases. This study was done to assess the safety, feasibility and yield of detrusor muscle on en- bloc TURBT using a conventional electrocautery loop. Materials and Methods: Patients with bladder tumor of size 2-4 cm, from September 2007 to August 2010, who had en-bloc TURBT, were compared with patients who had conventional resection for the presence of detrusor muscle in the biopsy specimen on an initial resection. Tumor size was calculated on ultrasonography or contrast enhanced computerized tomography scan. Tumor with pedunculated base, more than 4 cm in size and tumor with hydroureteronephrosis were excluded. Conventional electrocautery loop was bent to 45° and periphery of the tumor was marked first and then the whole tumor was resected en bloc. The free-lying tumor was then cut into two or three pieces in the bladder for retrieval. Statistical analysis was done using SPSS software Version 13. Statistical Analysis Used: Statistical analysis was done using Pearson chi square test and P value of <.05 was considered significant. Results: A total of 25 patients in the control arm (with conventional TURBT) were compared with 21 patients who had en-bloc TURBT. En-bloc TURBT did not result in bladder perforation as vision was clear due to better hemostasis. Twenty of 21 (94.4%) patients had detrusor muscle but only 15 of 25 (60%) patients in the control arm had detrusor muscle on histopathological examination (P.001) Conclusions: En-bloc TURBT is safe and gives well-controlled resection of the whole tumor due to better visualization. Yield of detrusor muscle present in the specimen is significantly better with en-bloc TURBT.
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Affiliation(s)
- Rohit Upadhyay
- Department of Urology and Renal Transplantation, SGPGIMS, Rae Bareillei Road, Lucknow, Uttar Pradesh, India
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