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Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy

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Abstract

Purpose

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.

Methods

According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups.

Results

Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024)

Conclusions

Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.

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References

  1. Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J (2015) Improving selection criteria for early cystectomy in high-grade T1 bladder cancer: a meta-analysis of 15,215 patients. J Clin Oncol 33:643–650. https://doi.org/10.1200/JCO.2014.57.6967

    Article  PubMed  Google Scholar 

  2. Gontero P, Sylvester R, Pisano F, Joniau S, Vander Eeckt K, Serretta V et al (2015) Prognostic factors and risk groups in T1G3 non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette–Guerin: results of a retrospective multicenter study of 2451 patients. Eur Urol 67:74–82. https://doi.org/10.1016/j.eururo.2014.06.040

    Article  PubMed  Google Scholar 

  3. Cookson MS, Herr HW, Zhang ZF, Soloway S, Sogani PC, Fair WR (1997) The treated natural history of high risk superficial bladder cancer: 15-year outcome. J Urol 158:62–67. https://doi.org/10.1097/00005392-199707000-00017

    Article  PubMed  CAS  Google Scholar 

  4. Segal R, Yafi FA, Brimo F, Tanguay S, Aprikian A, Kassouf W (2012) Prognostic factors and outcome in patients with T1 high-grade bladder cancer: can we identify patients for early cystectomy? BJU Int 109:1026–1030. https://doi.org/10.1111/j.1464-410X.2011.10462.x

    Article  PubMed  Google Scholar 

  5. Shahin O, Thalmann GN, Rentsch C, Mazzucchelli L, Studer UE (2003) A retrospective analysis of 153 patients treated with or without intravesical Bacillus Calmette-Guerin for primary stage T1 grade 3 bladder cancer: recurrence, progression and survival. J Urol 169:96–100. https://doi.org/10.1097/01.ju.0000035543.69161.58

    Article  PubMed  CAS  Google Scholar 

  6. Kim HS, Kim M, Jeong CW, Kwak C, Kim HH, Ku JH (2014) Presence of lymphovascular invasion in urothelial bladder cancer specimens after transurethral resections correlates with risk of upstaging and survival: a systematic review and meta-analysis. Urol Oncol 32:1191–1199. https://doi.org/10.1016/j.urolonc.2014.05.008

    Article  PubMed  Google Scholar 

  7. Denzinger S, Fritsche HM, Otto W, Blana A, Wieland WF, Burger M (2008) Early versus deferred cystectomy for initial high-risk pT1G3 urothelial carcinoma of the bladder: do risk factors Define feasibility of bladder-sparing approach? Eur Urol 53:146–152. https://doi.org/10.1016/j.eururo.2007.06.030

    Article  PubMed  Google Scholar 

  8. De Berardinis E, Busetto GM, Antonini G, Giovannone R, Gentile V (2011) T1G3 high-risk NMIBC (non-muscle invasive bladder cancer): conservative treatment versus immediate cystectomy. Int Urol Nephrol 43:1047–1057. https://doi.org/10.1007/s11255-011-9941-x

    Article  PubMed  Google Scholar 

  9. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BWG, Compérat E et al (2017) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71(3):447–461. https://doi.org/10.1016/j.eururo.2016.05.041

    Article  PubMed  Google Scholar 

  10. Hautmann RE, Volkmer BG, Gust K (2009) Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1 G3). World J Urol 27:347–351. https://doi.org/10.1007/s00345-009-0402-4

    Article  PubMed  Google Scholar 

  11. Herr HW, Faulkner JR, Grossman HB, Natale RB, deVere WR, Sarosdy MF et al (2004) Surgical factors influence bladder cancer outcomes: a cooperative group report. J Clin Oncol 22:2781–2789. https://doi.org/10.1200/JCO.2004.11.024

    Article  PubMed  Google Scholar 

  12. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BWG, Compérat E et al (2013) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol 64:639–653. https://doi.org/10.1016/j.eururo.2013.06.003

    Article  PubMed  Google Scholar 

  13. Zehnder P, Studer UE, Skinner EC, Thalmann GN, Miranda G, Roth B et al (2013) Unaltered oncological outcomes of radical cystectomy with extended lymphadenectomy over three decades. BJU Int 112:E51–E58. https://doi.org/10.1111/bju.12215

    Article  PubMed  Google Scholar 

  14. Shariat SF, Karakiewicz PI, Palapattu GS, Lotan Y, Rogers CG, Amiel GE et al (2006) Outcomes of radical cystectomy for transitional cell carcinoma of the bladder: a contemporary series from the Bladder Cancer Research Consortium. J Urol 176:2414–2422. https://doi.org/10.1016/j.juro.2006.08.004 (discussion 2422)

    Article  PubMed  Google Scholar 

  15. Palou J, Sylvester RJ, Faba OR, Parada R, Peña JA, Algaba F et al (2012) Female gender and carcinoma in situ in the prostatic urethra are prognostic factors for recurrence, progression, and disease-specific mortality in T1G3 bladder cancer patients treated with Bacillus Calmette–Guérin. Eur Urol 62:118–125. https://doi.org/10.1016/j.eururo.2011.10.029

    Article  PubMed  Google Scholar 

  16. Gupta A, Lotan Y, Bastian PJ, Palapattu GS, Karakiewicz PI, Raj GV et al (2008) Outcomes of patients with clinical T1 grade 3 urothelial cell bladder carcinoma treated with radical cystectomy. Urology 71:302–307. https://doi.org/10.1016/j.urology.2007.10.041

    Article  PubMed  Google Scholar 

  17. Ficarra V, Dalpiaz O, Alrabi N, Novara G, Galfano A, Artibani W (2005) Correlation between clinical and pathological staging in a series of radical cystectomies for bladder carcinoma. BJU Int 95:786–790. https://doi.org/10.1111/j.1464-410X.2005.05401.x

    Article  PubMed  Google Scholar 

  18. Thalmann GN, Markwalder R, Shahin O, Burkhard FC, Hochreiter WW, Studer UE (2004) Primary T1G3 bladder cancer: organ preserving approach or immediate cystectomy? J Urol 172:70–75. https://doi.org/10.1097/01.ju.0000132129.87598.3b

    Article  PubMed  Google Scholar 

  19. Fritsche H-M, Burger M, Svatek RS, Jeldres C, Karakiewicz PI, Novara G et al (2010) Characteristics and outcomes of patients with clinical T1 grade 3 urothelial carcinoma treated with radical cystectomy: results from an international cohort. Eur Urol 57:300–309. https://doi.org/10.1016/j.eururo.2009.09.024

    Article  PubMed  Google Scholar 

  20. van den Bosch S, Alfred WJ (2011) Long-term cancer-specific survival in patients with high-risk, non-muscle-invasive bladder cancer and tumour progression: a systematic review. Eur Urol 60:493–500. https://doi.org/10.1016/j.eururo.2011.05.045

    Article  PubMed  Google Scholar 

  21. Bianco FJ, Justa D, Grignon DJ, Sakr WA, Pontes JE, Wood DP (2004) Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy. Urol Oncol 22:290–294. https://doi.org/10.1016/S1078-1439(03)00144-3

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors declare that the development of the manuscript was not supported by an honorarium, a grant, or any other sources of support, including sponsorship or any material sources of support.

Author information

Author notes

  1. Francesco Soria and Francesca Pisano contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Medical University of Vienna, Vienna, Austria

    Francesco Soria & S. F. Shariat

  2. Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy

    Francesca Pisano & Paolo Gontero

  3. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain

    Francesca Pisano & J. Palou

  4. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Louvain, Belgium

    S. Joniau

  5. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy

    V. Serretta

  6. Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK

    S. Larré

  7. Policlinico Tor Vergata-University of Rome, Rome, Italy

    S. Di Stasi

  8. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    B. van Rhijn

  9. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    J. A. Witjes & A. Grotenhuis

  10. Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy

    R. Colombo & A. Briganti

  11. Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic

    M. Babjuk & V. Soukup

  12. Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden

    P. U. Malmstrom

  13. Department of Urology, CHU de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    J. Irani

  14. Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain

    N. Malats

  15. Department of Urology, Rabin Medical Centre, Tel Aviv, Israel

    J. Baniel & R. Mano

  16. Department of Urology, Santa Chiara Hospital, Trento, Italy

    T. Cai

  17. Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA

    E. Cha

  18. Facharzt fur Urologie, Abteilung fur Urologie, Chirurgische Universitats klinik, Freiburg, Germany

    P. Ardelt

  19. Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece

    J. Varkarakis

  20. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    R. Bartoletti

  21. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    G. Dalbagni

  22. Department of Urology, Cochin Hospital, Paris, France

    E. Xylinas

  23. Department of Urology, Mayo Clinic, Rochester, MN, USA

    R. J. Karnes

  24. Formerly Department of Biostatistics, EORTC Headquarters, Brussels, Belgium

    R. Sylvester

Authors
  1. Francesco Soria
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  2. Francesca Pisano
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  3. Paolo Gontero
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  4. J. Palou
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  5. S. Joniau
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  6. V. Serretta
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  7. S. Larré
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  8. S. Di Stasi
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  9. B. van Rhijn
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  12. R. Colombo
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  13. A. Briganti
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  14. M. Babjuk
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  15. V. Soukup
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  16. P. U. Malmstrom
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  17. J. Irani
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  18. N. Malats
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  19. J. Baniel
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  20. R. Mano
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  21. T. Cai
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  22. E. Cha
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  26. G. Dalbagni
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  27. S. F. Shariat
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  28. E. Xylinas
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  29. R. J. Karnes
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  30. R. Sylvester
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Contributions

Study concept and design: PG, RS; Acquisition of data: FP, SJ, VS, JP, SL, SS, BR, AW, AG, RC, AB, MB, VS, PUM, JI, NM, JB, RM, TC, EC, PA, JV, RB, GD, SFS, EX, RJK; Analysis and interpretation of data: RS, FS, PF; Drafting of the manuscript: PF, FS; Critical revision of the manuscript for important intellectual content: RS, SJ, VS, SL, SS, BR, AW, AG, RC, AB, MB, VS, PUM, JI, NM, JB, RM, TC, EC, PA, JV, RB, GD, SFS, EX, RJK, PJ; Statistical analysis: RS; Administrative, technical, or material support: FP; Supervision: RS, PG.

Corresponding author

Correspondence to Francesca Pisano.

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Research involving human participants and/or animals

The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

For this type of study, informed consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Soria, F., Pisano, F., Gontero, P. et al. Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy. World J Urol 36, 1775–1781 (2018). https://doi.org/10.1007/s00345-018-2450-0

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