Low compliance to guidelines in nonmuscle-invasive bladder carcinoma: A systematic review

Mori, Keiichiro; Miura, Noriyoshi; Babjuk, Marek; Karakiewicz, Pierre I.; Mostafaei, Hadi; Laukhtina, Ekaterina; Quhal, Fahad; Motlagh, Reza Sari; Pradère, Benjamin; Kimura, Shoji; Egawa, Shin; Shariat, Shahrokh F.

doi:10.1016/j.urolonc.2020.06.013

Cited by 37 publications

(32 citation statements)

References 49 publications

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“…Previous studies suggested that BCG therapy with maintenance was superior to BCG induction only or chemotherapy induction with maintenance for preventing recurrence or progression in patients with intermediate-risk NMIBC [26,27]. However, given the heterogeneity of this population, variety of available options, and adverse effects of BCG, urologists have often been unsure about the type, schedule, and length of adjuvant therapy, resulting in low compliance with NMIBC guidelines [28]. Our findings suggest that pre-therapy SII would help guide individual treatment strategies of patients with intermediate-risk NMIBC, leading to improved outcomes and compliance with guidelines.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer

Katayama

Mori²,

Pradère³

et al. 2021

World J Urol

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Purpose We assessed the prognostic value of systemic immune-inflammation index (SII) to refine risk stratification of the heterogeneous spectrum of patients with non-muscle-invasive bladder cancer (NMIBC) Methods In this multi-institutional cohort, preoperative blood-based SII was retrospectively assessed in 1117 patients with NMIBC who underwent transurethral resection of bladder (TURB) between 1996 and 2007. The optimal cut-off value of SII was determined as 580 using the best Youden index. Cox regression analyses were performed. The concordance index (C-index) and decision curve analysis (DCA) were used to assess the discrimination of the predictive models. Results Overall, 309 (28%) patients had high SII. On multivariable analyses, high SII was significantly associated with worse PFS (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.23–2.77; P = 0.003) and CSS (HR 2.53; 95% CI 1.42–4.48; P = 0.001). Subgroup analyses, according to the European Association of Urology guidelines, demonstrated the main prognostic impact of high SII, with regards to PFS (HR 3.39; 95%CI 1.57–7.31; P = 0.002) and CSS (HR 4.93; 95% CI 1.70–14.3; P = 0.005), in patients with intermediate-risk group; addition of SII to the standard predictive model improved its discrimination ability both on C-index (6% and 12%, respectively) and DCA. In exploratory intergroup analyses of patients with intermediate-risk, the improved discrimination ability was retained the prediction of PFS and CSS. Conclusion Preoperative SII seems to identify NMIBC patients who have a worse disease and prognosis. Such easily available and cheap standard biomarkers may help refine the decision-making process regarding adjuvant treatment in patients with intermediate-risk NMIBC.

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Section: Discussionmentioning

confidence: 99%

Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer

Katayama

Mori²,

Pradère³

et al. 2021

World J Urol

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“…The discrepancy in these results can probably be attributed to the inclusion of all NMIBC patients regardless of risk group. Nevertheless, as both the EAU and AUA guidelines recommend 1-yr BCG maintenance in intermediate-risk NMIBC [13,30], most of the studies included highlight the poor compliance with NMIBC guidelines worldwide [37].…”

Section: Discussionmentioning

confidence: 99%

Intravesical Therapy in Patients with Intermediate-risk Non–muscle-invasive Bladder Cancer: A Systematic Review and Network Meta-analysis of Disease Recurrence

Laukhtina

Abufaraj

Al-Ani

et al. 2022

European Urology Focus

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Context: Patients with intermediate-risk non-muscle-invasive bladder cancer (NMIBC) may pose a clinical dilemma without an agreed evidence-based decision tree for personalized treatment. Objective: To perform a systematic review and network meta-analysis (NMA) to summarize available evidence on the oncologic outcomes of intravesical therapy in patients with intermediate-risk NMIBC. Evidence acquisition: The MEDLINE, EMBASE, and ClinicalTrials.gov databases were searched in October 2020 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Studies were deemed eligible if they reported on oncologic outcomes in patients with intermediate-risk NMIBC treated with transurethral resection of bladder tumor with and without intravesical chemotherapy or bacillus Calmette-Guérin (BCG) immunotherapy. Evidence synthesis: Twelve studies were included in a qualitative synthesis (systematic review); three were deemed eligible for a quantitative synthesis (NMA). An NMA of five different regimens was conducted for the association of treatment with the 5-yr y These authors contributed equally to this work.

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“…A recent systematic review found that guideline adherence is low in NMIBC including for radical cystectomy, where the overall adherence rate is only 33%; the authors noted that there can be discrepancy between stated and actual medical practice patterns, especially in situations where guideline adherence is lacking. [ 16 ] Current guidelines are not especially helpful for physicians who have BCG-unresponsive patients, with few options listed and no gold-standard care. [ 8 , 9 ]…”

Section: Discussionmentioning

confidence: 99%

Treatment and disease management patterns for bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer in North America, Europe and Asia: A real-world data analysis

Broughton¹,

Chun²,

Gooden³

et al. 2022

Curr Urol

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Background This study examined real-world treatment and management of bacillus Calmette-Guérin (BCG)-unresponsive patients across 3 continents, including patients unable or unwilling to undergo cystectomy. Materials and methods Physicians actively involved in managing patients with nonmuscle invasive bladder cancer completed online case report forms for their 5 consecutive patients from the broad BCG-unresponsive population and a further 5 consecutive BCG-unresponsive patients who did not undergo cystectomy (in Japan, physicians provided a total of 5 patients across both cohorts). Results Most patients had received 1 (37%) or 2 (24%) maintenance courses of BCG. Five or more maintenance BCG courses were received by patients in Japan (59%) and China (31%), while in Germany 76% of patients received only 1 course. Most patients became BCG-unresponsive during their first (44%) or second (22%) treatment course; in Germany, 77% became BCG-unresponsive during their first treatment course. Most countries did not provide another course of BCG after a patient first became unresponsive, whereas unresponsive patients in Japan and China were most likely to be retreated with BCG. “Untreated - on watch and wait” was the main treatment/management approach received post-BCG treatment for 42% or more of patients in most countries except China (39%) and the United States (36%). “Following treatment guidelines” was consistently the top reason for post-BCG treatment selection across all treatment options. Conclusions This study confirmed the global unmet need for patients with nonmuscle invasive bladder cancer, and found that many patients experienced periods of no treatment after not responding to BCG therapy.

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Low compliance to guidelines in nonmuscle-invasive bladder carcinoma: A systematic review

Cited by 37 publications

References 49 publications

Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer

Prognostic value of the systemic immune-inflammation index in non-muscle invasive bladder cancer

Intravesical Therapy in Patients with Intermediate-risk Non–muscle-invasive Bladder Cancer: A Systematic Review and Network Meta-analysis of Disease Recurrence

Treatment and disease management patterns for bacillus Calmette-Guérin unresponsive nonmuscle invasive bladder cancer in North America, Europe and Asia: A real-world data analysis

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