7 research outputs found
RISK FACTORS FOR RESIDUAL DISEASE AT RE-TUR IN T1G3 BLADDER CANCER
INTRODUCTION AND OBJECTIVES: Goals of transurethral
resection of a bladder tumour (TUR) are to completely resect the lesions
and to make a correct diagnosis in order to adequately stage the patient.
It is well known that the presence of detrusor muscle in the
specimen is a prerequisite to minimize the risk of under staging.
Persistent disease after resection of bladder tumours is not uncommon
and is the reason why the European Guidelines recommended a reTUR
for all T1 tumours. It was recently published that when there is
muscle in the specimen, re-TUR does not influence progression or
cancer specific survival. We present here the patient and tumour factors
that may influence the presence of residual disease at re-TUR.
METHODS: In our retrospective cohort of 2451 primary T1G3
patients initially treated with BCG, pathology results for 934 patients
(38.1%) who underwent re-TUR are available. 75.4% had multifocal
tumours, 42.7% of tumours were more than 3 cm in diameter and 25.8%
had concomitant CIS. We analyse this subgroup of patients who underwent
re-TUR: there was no residual disease in 267 patients (28.6%)
and residual disease in 667 patients (71.4%): Ta in 378 (40.5%) and T1
in 289 (30.9%) patients. Age, gender, tumour status (primary/recurrent),
previous intravesical therapy, tumour size, tumour multi-focality, presence of concomitant CIS, and muscle in the specimen were analysed
in order to evaluate risk factors of residual disease at re-TUR,
both in univariate analyses and multivariate logistic regressions.
RESULTS: The following were not risk factors for residual disease:
age, gender, tumour status and previous intravesical chemotherapy.
The following were univariate risk factors for presence of
residual disease: no muscle in TUR, multiple tumours, tumours > 3 cm,
and presence of concomitant CISDue to the correlation between tumor
multi-focality and tumor size, the multivariate model retained either the
number of tumors or the tumor diameter (but not both), p < 0.001. The
presence of muscle in the specimen was no longer significant, p ¼ 0.15,
while the presence of CIS only remained significant in the model with
tumor size, p < 0.001.
CONCLUSIONS: The most significant factors for a higher risk of
residual disease at re-TUR in T1G3 patients are multifocal tumours and
tumours more than 3 cm. Patients with concomitant CIS and those without
muscle in the specimen also have a higher risk of residual disease
RECURRENCE AND PROGRESSION ACCORDING TO STAGE AT RE-TUR IN T1G3 BLADDER CANCER PATIENTS TREATED WITH BCG: NOT AS BAD AS PREVIOUSLY THOUGHT
INTRODUCTION AND OBJECTIVES
The goals of transurethral resection of a bladder tumour (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. Persistent disease after TUR is not uncommon and is the reason why re-TUR is recommended in T1G3 patients. When there is T1 tumour in the re-TUR specimen, very high risks of progression (82%) have been reported1 and therefore cystectomy is considered to be mandatory. We analyse the tumour stage at re-TUR and the risk of recurrence, progression to muscle invasive disease and cancer specific mortality (CSM) in T1G3 patients treated with BCG.
METHODS
In our retrospective cohort of 2451 T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. There was no residual disease in 267 patients (28.6%) and residual disease in 667 patients (71.4%): Ta in 378 (40.5%) and T1 in 289 (30.9%) patients. 310 patients (33.2%) received more than 6 instillations of BCG. Event rates in the 3 groups were compared using the chi-square statistic on 2 degrees of freedom
RESULTS
Table 1 shows the observed results with a median follow up of 5.2 years and a maximum follow up of 18.7 years. Similar trends were seen in both patients with and patients without muscle in the original TUR specimen.
CONCLUSIONS
Patients with T1G3 tumours treated with BCG and no residual disease or Ta tumour at re-TUR have better recurrence, progression and CSM rates than those with T1 tumour. The 25.3% progression rate of patients with T1 disease after re-TUR is far lower than that previously reported, with a CSM rate of 13.1%
Prognostic Factors And Risk Groups In T1g3 Patients Initially Treated With Bcg: Results Of A Multicenter Retrospective Series In 2530 Patients
Introduction and Objectives: The impact of prognostic factors
in T1G3 patients (pts) is critical for proper treatment decision
making, however most available data are from small series of
pts. The aim of the current study is to assess prognostic factors
in a large group of pts who received BCG as initial treatment of T1G3 tumours and identify a subgroup of high risk pts who
should be considered for early cystectomy. Patients and
Methods: Individual pt data were collected for 1743 ptsfrom
20 centers who received induction or maintenance BCG
between 1990 and 2008. Using Cox regression analysis, the
prognostic importance of the following variables were
assessed for time to recurrence, progression to muscle invasive
disease and overall survival:age (70yrs), gender,
primary T1G3 vs. recurrent T1G3 after previous non T1G3
tumour, tumour size (3 cm), multiplicity (single vs.
multiple), concomitant CIS (no/yes), and maintenance BCG
(no/yes). Results: Median age was 68yrs, 84% were male,
89% were primary T1G3, 50% had multifocal disease, 67%
had tumours less than 3 cm, 24% had concomitant CIS, 30%
had a restaging TUR, 52% received some sort of maintenance
BCG. With a follow up out to 15 years, 801 pts (46%)
recurred, 326 (19%) progressed, 291 underwent cystectomy
(17%) and 409 (23%) died, 151 (9%) due to bladder cancer. In
multivariate analyses, the most important prognostic factors
(p<0.05) for recurrence were: tumour size and multiplicity;
for progression: age, size and concomitant CIS; for overall
survival: age and size. Maintenance BCG had a positive
impact on recurrence (p<0.001), progression (p=0.059) and
survival (p=0.01). Patients were divided into 4 risk groups
according to the number of bad factors for progression among
age >70, size >3 cm and presence of CIS. Progression free
rates at 10 yrs were 84%, 75%, 66% and 28% for patients
with 0, 1, 2 and 3 bad factors while the corresponding overall
survival rates were 78%, 56%, 45% and 6%, respectively.
Conclusion: T1G3 patients treated with BCG have a
heterogeneous prognosis, with overall survival at 10 yrs
ranging from 78% to 6%. Although maintenance BCG
improves outcome as compared to induction alone, fit pts over
70 yrs of age with tumours greater than 3 cm and concomitant
CIS should be considered for an early cystectomy
Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy
To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG