T1G3 high-risk NMIBC (non-muscle invasive bladder cancer): conservative treatment versus immediate cystectomy

E, De Berardinis; Busetto, Gian Maria; Antonini, Gabriele; Giovannone, Riccardo; Gentile, Vincenzo

doi:10.1007/s11255-011-9941-x

Cited by 31 publications

(21 citation statements)

References 30 publications

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“…The median follow‐up was 41 months in the earlier decade (mean 72.7 ± 68.0) and 26 months (mean 46.8 ± 3.2) in the later decade. While the follow‐up in the most recent decade is relatively abridged in comparison with the earlier time period, it is within the median times to recurrence and progression (10.4 and 25 months, respectively) reported in a similar study [26]. Furthermore, given the recent endpoint of the most recent decade analyzed, it is to be expected that the follow‐up is shorter and this disparity in follow‐up is not a flaw of the study but rather the nature of a long‐term retrospective series analyzed with reference to the year of diagnosis.…”

Section: Discussionsupporting

confidence: 70%

Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference?

et al. 2012

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Study Type – Aetiology (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? For patients with high grade (HG) non‐muscle invasive urothelial cell cancer (UCC) of the bladder, transurethral resection of bladder tumor (TURBT) in conjunction with induction and maintenance intravesical therapy is a commonly used treatment modality. Early cystectomy, although offering the best opportunity for cure, would in turn constitute overtreatment in some cases. Conservative management strategies, as opposed to radical surgery, are a viable treatment option within a well selected subset of patients with HG T1 UCC. OBJECTIVE To determine whether a survival difference exists between patients with high grade (HG) cT1 urothelial cell carcinoma (UCC) receiving immediate radical cystectomy (IRC) as opposed to those choosing bladder‐sparing therapy. PATIENTS AND METHODS Between January 1990 and August 2010, 349 patients were retrospectively identified with a diagnosis of HG cT1 UCC of the bladder. Patients were divided into two groups: those who underwent IRC and those treated with conservative management (CM), consisting of transurethral resection of the bladder tumour (TURBT) and intravesical therapy. IRC was defined as surgery within 90 days of HG cT1 diagnosis with no intervening transurethral resection (TUR) or intravesical therapy (IVT). Trends in patient selection and cancer‐specific survival (CSS) were analyzed over consecutive decades. The primary outcome was to compare CSS among patients during consecutive decades whereby management paradigms shifted from IRC to CM. The secondary outcome was to examine whether patient selection changed over time for each respective intervention. RESULTS One hundred and thirteen patients underwent IRC and 236 had CM. From 1990 to 1999, only 90 patients were diagnosed with HG cT1 disease, and a majority of patients (n= 54) underwent IRC. From 2000 to 2010, only 23% (59/259) of the patients with HG cT1 underwent IRC. Despite 42.3% more patients successfully maintaining their bladder in the long‐term, no difference in 5 year bladder CSS was noted between decades (77% vs 80% consecutively, P= 0.566). A subset analysis of risk factors for bladder cancer progression/recurrence demonstrated more patients with lymphovascular invasion (LVI) on TUR underwent IRC in the current era (13/59 (22.0%) vs 13/200 (6.5%), P < 0.001). These findings remain to be validated in prospective work at other institutions. CONCLUSION Conservative management strategies are a viable treatment option within a well selected subset of patients with HG cT1 UCC.

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Section: Discussionsupporting

confidence: 70%

Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference?

et al. 2012

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“…Therefore, it is imperative that novel biological markers are developed to predict cancer progression, and to guide the decisionmaking process between BCG instillation and radical cystectomy. 25 The present study had some limitations. It was a small number-scale, single group study with an intermediated follow-up period.…”

Section: Discussionmentioning

confidence: 80%

“…However, it is very difficult to confirm which patients could benefit from cystectomy or chemotherapy before BCG instillation. Therefore, it is imperative that novel biological markers are developed to predict cancer progression, and to guide the decision‐making process between BCG instillation and radical cystectomy …”

Section: Discussionmentioning

confidence: 99%

Insignificant role of bacillus Calmette–Guérin maintenance therapy after complete transurethral resection of bladder tumor for intermediate‐ and high‐risk non‐muscle‐invasive bladder cancer: Results from a randomized trial

et al. 2016

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“…Several studies have recommended the immediate radical cystectomy for patients with T1G3 bladder cancer and the radical cystectomy has proven an improvement in outcome of long-term tumor specific survival. 3 , 4 However, the radical cystectomy is thought to be an excessive treatment for most patients and probably affects the patient’s quality of life. 5 In light of this, conservative therapy sometimes becomes an option.…”

Section: Introductionmentioning

confidence: 99%

Intravenous chemotherapy combined with intravesical chemotherapy to treat T1G3 bladder urothelial carcinoma after transurethral resection of bladder tumor: results of a retrospective study

Zhang¹,

Xie²,

Chen³

et al. 2016

OTT

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ObjectiveThe management of stage 1 and grade 3 (T1G3) bladder cancer continues to be controversial. Although the transurethral resection of bladder tumor (TURBT) followed by intravesical chemotherapy is a conservative strategy for treatment of T1G3 bladder cancer, a relatively high risk of tumor recurrence and progression remains regarding the therapy. This study aimed to compare the efficacy of intravenous chemotherapy combined with intravesical chemotherapy versus intravesical chemotherapy alone for T1G3 bladder cancer after TURBT surgery.MethodsWe retrospectively reviewed the cases of 457 patients who were newly diagnosed with T1G3 bladder urothelial carcinoma between January 2009 and March 2014. After TURBT, 281 patients received intravesical chemotherapy alone, whereas 176 patients underwent intravesical chemotherapy in combination with intravenous chemotherapy. Tumor recurrence and progression were monitored periodically by urine cytology and cystoscopy in follow-up. Recurrence-free survival and progression-free survival of the two chemotherapy strategies following TURBT were analyzed. Univariable and multivariable Cox hazards analyses were performed to predict the prognostic factors for tumor recurrence and progression.ResultsThe tumor recurrence rate was 36.7% for patients who received intravesical chemotherapy alone after TURBT, compared with 19.9% for patients who received intravenous chemotherapy combined with intravesical chemotherapy after TURBT (P<0.001). The progression rate was 10.6% for patients who underwent intravesical chemotherapy alone and 2.3% for patients who underwent the combined chemotherapies (P=0.003). Kaplan–Meier curves showed significant differences in recurrence-free survival and progression-free survival between the two treatment strategies, with a log-rank P-value of <0.001 and 0.003, respectively. Multivariable analyses revealed that intravenous chemotherapy was the independent prognostic factor for tumor recurrence and progression in the cohort.ConclusionIntravenous chemotherapy combined with intravesical chemotherapy offers a better oncologic outcome than the intravesical chemotherapy alone for patients with T1G3 bladder urothelial carcinoma after TURBT, and it may be considered as a new therapy strategy for T1G3 bladder cancer.

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T1G3 high-risk NMIBC (non-muscle invasive bladder cancer): conservative treatment versus immediate cystectomy

Cited by 31 publications

References 30 publications

Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference?

Immediate radical cystectomy vs conservative management for high grade cT1 bladder cancer: is there a survival difference?

Insignificant role of bacillus Calmette–Guérin maintenance therapy after complete transurethral resection of bladder tumor for intermediate‐ and high‐risk non‐muscle‐invasive bladder cancer: Results from a randomized trial

Intravenous chemotherapy combined with intravesical chemotherapy to treat T1G3 bladder urothelial carcinoma after transurethral resection of bladder tumor: results of a retrospective study

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