Radical Cystectomy - Often Too Late?

Stöckle, Michael; Alken, P.; Engelmann, U.; Jacobi, G. H.; Riedmiller, H.; Hohenfellner, R.

doi:10.1159/000472824

Cited by 145 publications

(61 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 5-year survival among high-risk superficial urothelial carcinomas that undergo early cystectomy is about 90% (23,24). However, the quality of life decreases markedly in patients who undergo cystectomy and the patients can also die because of cystectomy-related complications (2,25,26). it is therefore important to determine in the early stages the patients with superficial urothelial carcinoma who have high risk and whose tumors will have an unfavorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

Profile of gallbladder diseases diagnosed at afyon kocatepe university: a retrospective study

Mazlum¹,

Dılek²,

Yener³

et al. 2011

TJPATH

View full text Add to dashboard Cite

Objective: Superficial tumors including Ta, Tis, and T1 make up 75% of urothelial carcinomas of the bladder. While the behavior of these superficial urothelial cancers is relatively benign, invasive tumors have a significant mortality rate. However, Ta and T1 tumors might display different biological behavior. There is therefore a great need for biomarkers that can accurately distinguish the behavior of urothelial carcinomas in addition to tumor grade and stage. our aim was to determine the immunohistochemical expression profile of insulin like growth factor ii mrna binding Protein 3 (iMP3) and its correlation with tumor stage and grade in benign urothelium and bladder urothelial carcinomas. Material and Method:The expression of iMP3 in 91 patients with benign urothelium (20 cases), low grade invasive (17 cases) / noninvasive (20 cases) urothelial carcinoma and high grade invasive (20 cases) / non-invasive (14 cases) urothelial carcinoma was evaluated by immunohistochemistry in this study.Results: iMP3 was not expressed in benign urothelium, low-grade non-invasive urothelial carcinoma and high grade non-invasive urothelial carcinoma. Expression of iMP3 was found in 11.76% of low-grade invasive urothelial carcinomas and 55% of high grade invasive urothelial carcinomas. Statistical analysis including χ2 tests showed that iMP3 expression of invasive urothelial carcinomas was statistically significant (p<0.000). Conclusion:The detection of iMP3 only in invasive carcinomas although some of them were low grade showed that the expression of iMP3 may be related to aggressive behavior of urothelial carcinomas.Key Words: Urinary bladder, Urothelial carcinoma, iMP3, Transitional cell carcinoma ÖZ Amaç: Ürotelyal karsinomların %75'i yüzeyel tümörler olarak Ta, Tis ve T1 şeklinde karşımıza çıkmaktadır. Yüzeyel tümörler benign davranış gösterirken, invaziv tümörlerde ise yüksek mortalite oranı bildirilmiştir. Bununla birlikte, Ta ve T1 tümörler, farklı biyolojik davranışlar sergileyebilmektedirler. Bu durum, ürotelyal karsinomların davranışının belirlenmesinde, histopatolojik evre ve dereceye ek olarak, bazı biyolojik belirteçlere ihtiyaç olduğunu göstermektedir. Bu çalışmada amacımız, benign ürotelyum ile mesanenin ürotelyal karsinomlarında insulin like growth factor ii mrna binding Protein 3 (iMP3) ekspresyon profilini belirleyerek, tümörün histopatolojik evresi ve derecesi ile ilişkisini saptamaktır. Gereç ve Yöntem:Bu çalışmada 91 hastaya ait benign ürotelyum (20 olgu), düşük dereceli invaziv (17 olgu) / non-invaziv (20 olgu) ürotelyal karsinom ve yüksek dereceli invaziv (20 olgu) / non-invaziv (14 olgu) ürotelyal karsinom tanısı almış olgular immünohistokimyasal olarak iMP3 ekspresyonu açısından değerlendirildi. Bulgular:Benign ürotelyum, düşük dereceli non-invaziv ürotelyal karsinom ve yüksek dereceli non-invaziv ürotelyal karsinom tanısı almış olgularda iMP3 ekspresyonu saptanmadı. Düşük dereceli invaziv ürotelyal karsinom olgularının %11,76'sında, yüksek dereceli invaziv ürotelyal karsinom olgularının %55'inde...

show abstract

Section: Discussionmentioning

confidence: 99%

Profile of gallbladder diseases diagnosed at afyon kocatepe university: a retrospective study

Mazlum¹,

Dılek²,

Yener³

et al. 2011

TJPATH

View full text Add to dashboard Cite

show abstract

“…The signi®cantly worse outcome for patients with pT1 than with pTa tumours is an argument for an aggressive treatment of super®cially invasive bladder tumours. Indeed, several authors have suggested`early cystectomies' at stage pT1 [3,10]. Therefore, the correct staging of super®cial bladder carcinomas in individual cases is of utmost importance.…”

Section: Discussionmentioning

confidence: 99%

“…While some studies suggested a similar prognosis for stage pTa and pT1 tumours [1], there is increasing evidence for a markedly higher risk of subsequent tumour progression of pT1 carcinomas than for pTa tumours [2,3]. Consequently, cystectomy is being considered in patients with pT1 tumours that do not satisfactorily respond to transurethral surgery and intravesical therapy.…”

Section: Introductionmentioning

confidence: 99%

Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer

Tosoni¹,

Wagner²,

Sauter³

et al. 2000

BJU International

117

View full text Add to dashboard Cite

Objective To assess the reliability of the histological diagnosis of bladder cancer by assessing the interobserver variability of staging and grading in pTa/pT1 tumours and evaluating the clinical signi®cance of discrepancies. Materials and methods All sections from 301 super®cial bladder carcinomas were reviewed by one pathologist. The prognostic relevance of grade and stage from both the initial and review diagnosis were determined in 128 patients for whom there was long-term follow-up information. Results There were signi®cant interobserver differences in both the grading and staging of tumours. From a total of 235 tumours that were initially considered pT1, the reviewer classi®ed 35% as pTa, 56% as pT1, 6% as pT1-(at least pT1), and 3% as pT2±4. In 39% of all biopsies there were interobserver differences in tumour grade. The prognostic signi®cance of grade and stage differed between the initial pathology report and the reviewer's diagnosis. The reviewer's staging allowed a better estimate of the risk of subsequent tumour progression than the initial staging. Progression was signi®cantly more common in 49 tumours in which the reviewer agreed with stage pT1 than in 29 tumours that were down-staged from pT1 to pTa (P = 0.0116). However, the initial tumour grade (P = 0.0386) but not the reviewer's grade (P = 0.2645) was signi®cantly linked to progression. Conclusions These results show that grading and staging by different pathologists have varying prognostic implications. If possible, biopsies from bladder tumours should be independently evaluated by two different pathologists before radical therapy is administered.

show abstract

“…2,23 As a result, some studies advocate initial cystectomy based on the perceived acceptable morbidity and a 5-year disease-specific survival rate of 80% to 90%. [24][25][26][27][28] However, the paucity of effective conservative treatment alternatives for stage T1 disease may be misinterpreted as an immediate mortality risk in patients who continue to exhibit organ-confined disease. As we will discuss later, an initial trial of BCG rather than immediate cystectomy appears justified in almost all initial T1Hg cases without undue risk, since progression within the first six months is rare (less than 4%).…”

Section: Patient Counsellingmentioning

confidence: 99%

The optimal management of T1 high-grade bladder cancer

Nepple

O’Donnell²

2013

CUAJ

View full text Add to dashboard Cite

Stage T1Hg bladder cancer should be considered an aggressive and potentially lethal disease. The importance of initial re-resection to identify unrecognized muscle-invasive disease is significant. Most patients with high-risk disease are candidates for initial bladder salvage with intravesical bacillus Calmette-Guerin vaccine for immunotherapy, a procedure with a high survival rate; however, failure of the procedure may result in a guarded prognosis. Even after apparent success, patients should be informed of the risks of the disease progressing to muscle-invasive or metastatic disease and the need for vigilant monitoring. Despite optimal management, a significant number of patients relapse or progress to invasive disease requiring cystectomy. This review provides insight into the optimal management of T1 high-grade bladder cancer.Can Urol Assoc J 2009;3(Suppl4):S188-92

show abstract

Radical Cystectomy - Often Too Late?

Cited by 145 publications

References 10 publications

Profile of gallbladder diseases diagnosed at afyon kocatepe university: a retrospective study

Profile of gallbladder diseases diagnosed at afyon kocatepe university: a retrospective study

Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer

The optimal management of T1 high-grade bladder cancer

Contact Info

Product

Resources

About