Long-term oncological outcomes of an active surveillance program in recurrent low grade Ta bladder cancer

Hernández, Virginia; Llorente, C.; Peña, Enrique de la; Pérez‐Fernández, Elia; Guijarro, A.; Sola, Ignacio

doi:10.1016/j.urolonc.2015.11.005

Cited by 46 publications

(38 citation statements)

References 11 publications

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“…Thus, NMIBC is an ideal system to study the stability of molecular characteristics in multiple local recurrences originating from the same premalignant epithelium. In clinical management, the least aggressive forms of NMIBC (Ta, low‐grade) are lacking invasive potential even without resection . On the other hand recurrences frequently occur, also in patients with low‐grade tumors, many experiencing over 10 recurrences over the course of many years .…”

Section: Introductionmentioning

confidence: 99%

“…In clinical management, the least aggressive forms of NMIBC (Ta, low-grade) are lacking invasive potential even without resection. 16 On the other hand recurrences frequently occur, also in patients with low-grade tumors, many experiencing over 10 recurrences over the course of many years. 17,18 The risk of progression to muscle-invasive bladder cancer (MIBC) and cancer-specific death for these patients is minimal but increases to 18% when including stage T1 high-grade disease.…”

Section: Introductionmentioning

confidence: 99%

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Molecular changes during progression from nonmuscle invasive to advanced urothelial carcinoma

Sjödahl

Eriksson

Patschan

et al. 2019

Intl Journal of Cancer

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Molecular changes occurring during invasion and clinical progression of cancer are difficult to study longitudinally in patient‐derived material. A unique feature of urothelial bladder cancer (UBC) is that patients frequently develop multiple nonmuscle invasive tumors, some of which may eventually progress to invade the muscle of the bladder wall. Here, we use a cohort of 73 patients that experienced a total of 357 UBC diagnoses to study the stability or change in detected molecular alterations during cancer progression. The tumors were subtyped by gene expression profiling and analyzed for hotspot mutations in FGFR3, PIK3CA and TERT, the most frequent early driver mutations in this tumor type. TP53 alterations, frequent in advanced UBC, were inferred from p53 staining pattern, and potential genomic alterations were inferred by gene expression patterns at regions harboring frequent copy number alterations. We show that early driver mutations were largely preserved in UBC recurrences. Changes in FGFR3, PIK3CA or TERT mutation status were not linked to changes in molecular subtype and aggressive behavior. Instead, changes into a more aggressive molecular subtype seem to be associated with p53 alterations. We analyze changes in gene expression from primary tumors, to recurrences and progression tumors, and identify two modes of progression: Patients for whom progression is preceded by or coincides with a radical subtype shift, and patients who progress without any systematic molecular changes. For the latter group of patients, progression may be either stochastic or depending on factors already present at primary tumor initiation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Molecular changes during progression from nonmuscle invasive to advanced urothelial carcinoma

Sjödahl

Eriksson

Patschan

et al. 2019

Intl Journal of Cancer

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“…It has been over a decade since Soloway et al [ 7 ] presented the initial series of expectant management and reported the feasibility and safety of this concept in patients with low-risk bladder cancer in 2003. To date, several reports have shown AS (sometimes referred to as expectant management) for this disease is a reasonable option [ 7 36 37 38 39 40 ]. Table 1 shows the study design and outcomes of AS for low-risk bladder cancer.…”

Section: Evidence About Active Surveillance For Nmibcmentioning

confidence: 99%

“…Hernández et al [ 39 40 ] reported two consecutive studies evaluating AS for low-risk NMIBC in 2009 and 2015. Patients were allocated to AS with the criteria similar to the studies by Gofrit et al [ 36 38 ] and low-grade T1 tumors were included.…”

Section: Evidence About Active Surveillance For Nmibcmentioning

confidence: 99%

“…Patients were allocated to AS with the criteria similar to the studies by Gofrit et al [ 36 38 ] and low-grade T1 tumors were included. In the largest and most recent study, Hernandez et al [ 40 ] evaluated 186 patients (252 observation periods) including 161 men and 25 women with a mean age of 66±12 years. During active follow-up including urine cytology plus cystoscopy (first 2 years) or urine cytology plus ultrasound test (thereafter), intervention treatments were performed in 203 (80.2%) out of 252 observation periods.…”

Section: Evidence About Active Surveillance For Nmibcmentioning

confidence: 99%

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Active surveillance for nonmuscle invasive bladder cancer

2016

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Nonmuscle invasive bladder cancer (NMIBC) is known to be a heterogeneous malignancy that requires varying treatment modalities and follow-up schedules. Low-grade Ta papillary tumors are categorized as low-risk NMIBC because of their favorable prognosis. There is an expanding movement that overdiagnosis and overtreatment should be avoided considering the economic impact and the patients' quality of life. It has been over 10 years since the initial assessment of active surveillance for low-risk NMIBC suggested its feasibility and safety. However, urologists are still unfamiliar with this treatment option, which can be ideal in appropriately selected patients. In this review article, we focus on active surveillance for low-risk NMIBC and discuss the evidence and rationale for this treatment option. There are several issues to resolve in order to advocate active surveillance as a standard option in selected patients. A specific follow-up protocol including intervals of cystoscopy, urine cytology, urine markers, and other radiographic examinations need to be optimized and validated. Finally, we integrate the available data into the follow-up strategy and propose a new surveillance protocol for active surveillance of recurrent low-risk bladder cancer.

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