Immediate radical cystectomy versus BCG immunotherapy for T1 high-grade non-muscle-invasive squamous bladder cancer: an international multi-centre collaboration

Lonati, Chiara; Afferi, Luca; Mari, Andrea; Krajewski, Wojciech; Borghesi, Marco; Schulz, Gerald Bastian; Rink, Michael; Montorsi, Francesco; Briganti, Alberto; Colombo, R.; Martini, Alberto; Necchi, Andrea; Contieri, Roberto; Hurle, Rodolfo; Umari, Paolo; Zamboni, Stefania; Simeone, Claudio; Soria, Francesco; Marra, Giancarlo; Teoh, Jeremy Yuen‐Chun; Klatte, Tobias; Bajeot, A.; Roumiguié, M.; Rouprêt, Morgan; Masson-Lecomte, A.; Laukhtina, Ekaterina; Valiquette, Anne Sophie; Mir, Maria Carmen; Antonelli, Alessandro; Einerhand, Sarah; Hendricksen, Kees; Carando, Roberto; Fankhauser, Christian Daniel; Baumeister, Philipp; Mattei, Agostino; Shariat, Shahrokh F.; Moschini, Marco

doi:10.1007/s00345-022-03958-9

Cited by 11 publications

(8 citation statements)

References 29 publications

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“…For high-risk non-muscle-invasive urothelial bladder cancer, intravesical instillation of Bacillus Calmette-Guérin (BCG) is a treatment option, as is immediate RC with lymphadenectomy. A recently published multicenter study showed that patients with pT1 SCC bladder cancer had a significantly higher risk of disease progression after BCG instillation compared with immediate RC treatment [6]. Consistent with these data, Deuker et al [7] observed higher 5-year survival rates (85.9 vs. 65.7%) in patients with SSC bladder cancer who underwent RC than in patients without surgery.…”

Section: Scc Evidencementioning

confidence: 78%

Metastatic Squamous Cell Carcinoma of the Urinary Bladder: Urgent Call for New Therapies

Banek,

Hoeh,

Cano Garcia

et al. 2023

Urol Int

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Background: Squamous cell carcinoma (SCC) of the urinary bladder is the most common non-urothelial variant histology. Currently, upfront radical cystectomy is the gold standard for non-metastatic SCC of the bladder. However, several studies have shown that SCC of the bladder is associated with higher aggressiveness and worse survival outcomes, such as progression-free and cancer-specific survival, relative to the urothelial histological subtype. Moreover, metastatic SCC seems to poorly respond to systemic treatments and/or radiotherapy. Summary: This review summarizes the current knowledge and medical evidence regarding local and systematic treatment of mSCC of the bladder, including a case series of four initially locally advanced and later metastatic SCC patients of our tertiary care hospital. Key Messages: Despite being the second most common variant histology of bladder cancer, current therapies for SCC do not provide satisfactory therapeutic responses.

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Section: Scc Evidencementioning

confidence: 78%

Metastatic Squamous Cell Carcinoma of the Urinary Bladder: Urgent Call for New Therapies

Banek,

Hoeh,

Cano Garcia

et al. 2023

Urol Int

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“… 17 Recent multicenter reports suggest that immediate cystectomy should be preferred in the case of T1HG with pure squamous or micropapillary differentiation. 18 Multiple tumor locations and large size are regarded as risk factors for recurrence and progression according to several available nomograms. 1 – 3 , 19 Our data demonstrated that the location of the tumor also matters—multiple site lesions and tumors of overlapping sites have worse prognoses.…”

Section: Discussionmentioning

confidence: 99%

Cancer-Specific Survival of Patients with Non-Muscle-Invasive Bladder Cancer: A Population-Based Analysis

Ślusarczyk

Zapała

et al. 2023

Ann Surg Oncol

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Background and Purpose Non-muscle-invasive bladder cancer (NMIBC) constitutes a heterogeneous group of tumors with different prognoses. This population-based study aimed to report real-world cancer-specific survival (CSS) of NMIBC and create a prognostic nomogram based on the identified risk factors. Methods The Surveillance, Epidemiology, and End Results database was searched for patients diagnosed with NMIBC from 2004 to 2015, who underwent transurethral resection of the bladder tumor. The dataset was divided into development and validation cohorts. Factors associated with CSS were identified using Cox proportional hazards and used to develop a prognostic nomogram. Results In total, 98,238 patients with NMIBC were included. At the median follow-up of 124 months (IQR 81–157 months), cancer-specific mortality (CSM) was highest for T1HG (19.52%), followed by Tis (15.56%), similar for T1LG and TaHG (10.88% and 9.23%, respectively), and lowest for TaLG (3.76%). Multivariable Cox regression for CSS prediction was utilized to develop a nomogram including the following risk factors: tumor T category and grade, age, tumor size and location, histology type, primary character, race, income, and marital status. In the validation cohort, the model was characterized by an AUC of 0.824 and C-index that reached 0.795. Conclusions To conclude, NMIBC is associated with a significant risk of long-term CSM especially, but not only, in patients with T1HG. Rarely diagnosed TaHG and T1LG tumors should be regarded as high-risk due to approximately 10% CSM. T category, grading, and age remain the most powerful determinants of CSS in NMIBC, but sociodemographic factors might also influence its prognosis.

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“…Variant histology has been verified to influence the prognostic behavior in both NMIBC (54) and MIBC (55). For example, being nested in the high-risk category showed limited response to BCG therapy while BCG was proven as an effective treatment in pT1 squamous NMIBC (54,56). However, the baseline characteristics of bladder tumor type in all studies we included were provided based on the novel WHO 2022 classification, with a lack of a description of the samples' histology, which certainly impacted the analysis result.…”

Section: Discussionmentioning

confidence: 99%

Hyperthermia intravesical chemotherapy acts as a promising alternative to bacillus Calmette–Guérin instillation in non-muscle-invasive bladder cancer: a network meta-analysis

Zeng

Sun

et al. 2023

Front. Oncol.

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IntroductionWith the shortage of bacillus Calmette–Guérin (BCG) vaccine, it is important to find an alternative to BCG instillation, which is the most commonly used adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC) patients after transurethral resection of bladder tumor treatment (TURBt) to delay tumor recurrence. Hyperthermia intravesical chemotherapy (HIVEC) with mitomycin C (MMC) is a potential treatment choice. We aim to compare HIVEC with BCG instillation for the preventive efficacy of bladder tumor recurrence and progression.MethodsA network meta-analysis (NMA) was taken with MMC instillation and TURBt as the attached comparators. Randomized controlled trials (RCTs) with NIMBC patients after TURBt were included. Articles with pure BCG unresponsive patients and combined therapies were excluded. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42023390363).ResultsIt was found that HIVEC had a non-significant 22% relative reduction in bladder tumor recurrence compared with BCG instillation [HIVEC vs. BCG: HR 0.78, 95% credible interval (CrI) 0.55–1.08] and a nonsignificant higher risk of bladder tumor progression (BCG vs. HIVEC: HR 0.77, 95% CrI 0.22–3.03).DiscussionHIVEC is a potential alternative to BCG, and it is expected to be the standard therapy for NMIBC patients after TURBt during the global shortage of BCG.Systematic Review RegistrationPROSPERO identifier, CRD42023390363

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Immediate radical cystectomy versus BCG immunotherapy for T1 high-grade non-muscle-invasive squamous bladder cancer: an international multi-centre collaboration

Cited by 11 publications

References 29 publications

Metastatic Squamous Cell Carcinoma of the Urinary Bladder: Urgent Call for New Therapies

Metastatic Squamous Cell Carcinoma of the Urinary Bladder: Urgent Call for New Therapies

Cancer-Specific Survival of Patients with Non-Muscle-Invasive Bladder Cancer: A Population-Based Analysis

Hyperthermia intravesical chemotherapy acts as a promising alternative to bacillus Calmette–Guérin instillation in non-muscle-invasive bladder cancer: a network meta-analysis

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