MP13-08 the Comparison One Immediate Postoperative Intravesical Chemotherapy with Short-Term Adjuvant Intravesical Chemotherapy After Turbt in Low- and Intermediate Recurrent Risk of Non-Muscle-Invasive Bladder Cancer- a Randomized Prospective Study in Japan (original) (raw)
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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 b 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.
Indian Journal of Urology, 2014
Purpose: Purpose: Conventional, transurethral resection of bladder tumor (TURBT) involves piecemeal resection of the tumor and has a very high recurrence rate. We evaluated the outcome of en-bloc TURBT (ET) in comparison with conventional TURBT (CT) in non-muscle invasive bladder carcinoma in terms of recurrencew and progression. Materials and Methods: Materials and Methods: From September 2007 to June 2011, in a prospective non-randomized interventional setting, ET was compared with CT in patients with solitary tumor of 2-4 cm size in terms of recurrence and progression. Pedunculated tumors, size >4 cm, tumors with associated hydroureteronephrosis and biopsy specimen with absent detrusor muscles were excluded. Fisher's exact test and survival analyses were used to compare the demography and the outcome. Results: Results: A total of 21 patients of ET were compared with 24 patients of CT. Mean tumor size was 2.8 cm in ET and 3.3 cm in CT group. Location of tumor, stage and grade were comparable in both groups. Recurrence rate was 28.6% versus 62.5% (P = 0.03) and progression rate was 19% versus 33.3% (P = 0.32) in ET versus CT group respectively. Recurrence free survival was 45.1 (95% CI: 19.0-38 months) and 28.5 (95% CI: 35.4-54.7 months) in ET and CT group (P = 0.018). Progression free survival in ET and CT was 48.32 (95% CI: 35.5-53.0 months) and 44.26 (95% CI: 39.0-57.5 months), P = 0.46. Conclusion: Conclusion: There was a signifi cant reduction in the recurrence rate and time to recurrence with ET. Rate of progression was also relatively less with ET, though not statistically signifi cant.
Urology Annals, 2015
The therapeutic strategy in intermediate risk (IR) non-muscle invasive bladder cancer (NMIBC) recurring after intravesical therapy (IT) is not well defined. Most patients are usually retreated by Bacillus Calmette-Guerin (BCG). Aims: To evaluate the efficacy of intravesical chemotherapy (ICH) given at recurrence after the first cycle of ICH in IR-NMIBC recurring 6 months or later. Settings and Design: Retrospective analysis of the efficacy of ICH given after previous IT. Materials and Methods: The clinical files of IR-NMIBC patients recurring later than 6 months after transurethral resection (TUR) and IT and retreated by IT were reviewed. The patients should be at intermediate risk both initially and at the first recurrence. BCG should have been given at full dose. Cytology and cystoscopy were performed 3 monthly for 2 years and then 6 monthly. Statistical Analysis: The RFS was estimated by the Kaplan-Meier method and the differences between treatment groups were compared by log-rank test. Mann Whitney U-test was used to compare the parameters' distribution for median time to recurrence. Multivariate Cox proportional hazards models were used. Results: The study included 179 patients. The first IT was ICH in 146 (81.6%) and BCG in 33 (18.4%), re-IT was ICH in 112 (62.6%) and BCG in 67 (37.4%) patients. Median time to recurrence was 18 and 16 months after first and second IT (P = 0.32). At 3 years, 24 (35.8%) and 49 (43.8%) patients recurred after BCG and ICH, respectively (P = 0.90). No difference in RFS was found between BCG and ICH given after a first cycle of ICH (P = 0.23). Conclusions: Re-treatment with ICH could represent a legitimate option to BCG in patients harboring IR-NMIBC recurring after TUR and previous ICH. Prospective trials are needed.
Factors that predict residual tumors in re-TUR patients
African Journal of Urology, 2016
Introduction: The first and foremost rule in the treatment of superficial bladder cancer is correct and complete resection of the tumor. Histopathological analysis of the resected tumor will help to define the correct tumor stage, thus delaying or, ideally, avoiding tumor recurrence and progression. Objectives: To examine the prognostic factors for residual tumors in the tumor base or in another area of the bladder in patients subjected to repeat transurethral resection (re-TUR). Patients and methods: Between September 2009 and August 2014, 188/221 patients advised to undergo re-TUR for stage T1 tumors were subjected to the procedure. The following data were collected for this retrospective study: patients' age and sex, information on whether initial TUR was carried out for a primary tumor/primary tumors, tumor number, tumor size and tumor grade, as well as information on whether muscularis propria was found in the resected specimens of initial TUR, whether there was carcinoma in situ and whether single-dose intracavitary chemotherapy was administered following initial TUR. Results: On re-TUR, new tumors outside of the previous resection area were found in 34 (18%) and residual tumors in the initial resection area in 48 (25.5%) patients. 61.7% of the patients diagnosed with new tumors outside of the previous tumor area and 62.5% of those with residual tumors in the initial resection area had initially undergone TUR for multifocal tumors. Both univariate and multivariate analysis revealed a significant relationship between male sex, multifocal primary tumors and the detection of residual tumors in the previous resection area during re-TUR.
European Urology, 2013
Background: The treatment of high-risk non-muscle-invasive bladder cancer (BCa) is problematic given the variable natural history of the disease. Few reports have compared outcomes for primary high-risk tumours with those that develop following previous BCas (relapses). The latter represent a self-selected cohort, having failed previous treatments. Objective: To compare outcomes in patients with primary, progressive, and recurrent high-risk non-muscle-invasive BCa. Design, setting, and participants: We identified all patients with primary and relapsing high-risk BCa tumours at our institution since 1994. Relapses were divided into progressive (previous low-or intermediate-risk disease) and recurrent (previous high-risk disease) cancers. Outcome measurements and statistical analysis: Relationships with outcome analysed using multivariable Cox regression and log-rank analysis. Results and limitations: We identified 699 primary, 110 progressive, and 494 recurrent high-risk BCa tumours in 809 patients (average follow-up: 59 mo [interquartile range: 6-190]). Muscle invasion occurred most commonly in recurrent (23%) tumours, when compared to progressive (20%) and primary (14.6%) cohorts (log rank p < 0.001). Disease-specific mortality (DSM) occurred more frequently in patients with recurrent (25.5%) and progressive (24.6%) tumours compared to primary disease (19.2%; log rank p = 0.006). Other-cause mortality was similar in all groups (log rank p = 0.57), and overall mortality was highest in the progressive cohort (62%) compared with the recurrent (58%) and primary groups (54%; log rank p < 0.001). In multivariable analysis, progression and DSM were predicted by tumour grouping (hazard ratio [HR]: >1.15; p < 0.026), stage (HR: >1.30; p < 0.001), and patient age and sex (HR: >1.03; p < 0.037). Carcinoma in situ was only predictive of outcome in primary tumors. Limitations include retrospective design and limited details regarding bacillus Camille-Gué rin use. Conclusions: Patients with relapsing, high-risk, BCa tumors have higher progression, DSM, and overall mortality rates than those with primary cancers. The use of bladdersparing strategies in these patients should approached cautiously. Carcinoma in situ has little predicative role in relapsing, high-risk, BCa tumors.
The Bulletin of Urooncology
Objective: To evaluate the potential significance of the second transurethral resection of a bladder tumor (TURBT) in a population of patients whose primary pathology was high-grade pTa (Ta/HG) and who had received Bacillus Calmette-Guérin (BCG) treatment for at least 12 on oncological outcomes, based on the presence or absence of detrusor muscle. Materials and Methods: Patients with primary Ta/HG tumors (n=207) that met the inclusion criteria were grouped based on the presence of muscle tissue in the first TURBT and whether the secondary TURBT was performed. Progression, recurrence, and disease-free survival rates were compared between the groups. Results: Median follow-up period was 24 (12-205) months. In cases with muscle in the first TURBT, a second TURBT significantly increased the median disease-free survival time compared with those that did not undergo the second TURBT [32 months (12-83) vs 12 months (6-67); p<0.005]. In cases without muscle in the first TURBT, the second TURBT significantly reduced the rate of progression (p<0.05). Regression analysis showed that tumor size >3 cm [95% confidence interval (CI)=1.09-2.96, hazard ratio (HR)=1.79, p=0.021], presence of muscle tissue (95% CI=0.35-0.92, HR=0.57, p=0.022), and multiple tumor (95% CI=1.06-2.90, HR=1.75, p=0.028) were independent factors affecting disease relapse in primary Ta/HG tumor. Conclusions: In patients with primary Ta/HG tumors, if there was no muscle in the first TURBT, a second TURBT should be performed to achieve lower progression rates. If there is muscle in the first TURBT, the second TURBT will only increase the median disease-free survival time.
The long‐term outcome of treated high‐risk nonmuscle‐invasive bladder cancer
BACKGROUND: The treatment of high-risk nonmuscle-invasive bladder cancer (NMIBC) is difficult given its unpredictable natural history and patient comorbidities. Because current case series are mostly limited in size, the authors report the outcomes from a large, single-center series. METHODS: The authors reviewed all patients with primary, high-risk NMIBC at their institution from 1994 to 2010. Outcomes were matched with clinicopathologic data. Patients who had muscle invasion within 6 months or had insufficient follow-up (<6 months) were excluded. Correlations were analyzed using multivariable Cox regression and log-rank analysis (2-sided; P < .05). RESULTS: In total, 712 patients (median age, 73.7 years) were included. Progression to muscle invasion occurred in 110 patients (15.8%; 95% confidence interval [CI], 13%-18.3%) at a median of 17.2 months (interquartile range, 8.9-35.8 months), including 26.5% (95% CI, 22.2%-31.3%) of the 366 patients who had >5 years follow-up. Progression was associated with age (hazard ratio [HR], 1.04; P ¼ .007), dysplastic urothelium (HR, 1.6; P ¼ .003), urothelial cell carcinoma variants (HR, 3.2; P ¼ .001), and recurrence (HR, 18.3; P < .001). Disease-specific mortality occurred in 134 patients (18.8%; 95% CI, 16.1%-21.9%) at a median of 28 months (interquartile range, 15-45 months), including 28.7% (95% CI, 24.5%-33.3%) of those who had 5 years of follow-up. Disease-specific mortality was associated with age (HR, 1.1; P < .001), stage (HR, 1.7; P ¼ .003), dysplasia (HR, 1.3; P ¼ .05), and progression (HR, 5.2; P < .001). Neither progression nor disease-specific mortality were associated with the receipt of bacillus Calmette-Guerin (P > .6). CONCLUSIONS: Within a program of conservative treatment, progression of high-risk NMIBC was associated with a poor prognosis. Surveillance and bacillus Calmette-Guerin were ineffective in altering the natural history of this disease. The authors concluded that the time has come to rethink the paradigm of management of this disease. Cancer 2012;118:5525-34.