Controversial issues and optimal management of stage T1G3 bladder cancer

Metwalli, Adam R.; Kamat, Ashish M.

doi:10.1586/14737140.6.8.1283

Cited by 11 publications

(12 citation statements)

References 126 publications

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“…Other relative indications are high-risk urothelial neoplasia (pT1 high-grade, BCG-resistant pTis), and extensive non-invasive papillary bladder tumor disease (pTa high-grade) that cannot be controlled through conservative measures. Management of stage pT1G3 bladder cancer is still controversial (21), and it is far from certain whether TP53 status can help to select pT1 tumor patients who may benefit from early cystectomy. Recent studies on FGFR3 and TP53 mutations failed to predict, alone or in combination, recurrence or survival of pT1G3 tumor patients (22,23).…”

Section: Discussionmentioning

confidence: 99%

Low level STK15 amplification in histologically benign urothelium of patients with bladder cancer adversely predicts patient outcome following cystectomy

Denzinger

Stoehr²,

Schwarz³

et al. 2007

Int J Oncol

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Abstract. The aim of this study was to investigate STK15 amplification in histologically benign urothelium and invasive tumor tissue of urothelial bladder cancer patients in relation to clinicopathologic and molecular characteristics, and to analyze a hypothesized association between the STK15 single nucleotide polymorphism at site T91A (Phe31Ile) and STK15 gene amplification. A tissue microarray (TMA) was constructed and contained formalin-fixed paraffin-embedded tumor tissue and matching histologically benign urothelium of 44 patients who underwent cystectomy for invasive urothelial carcinoma. Expression of TP53, CK20 and MIB1 was evaluated by immunohistochemistry. UroVysion and STK15 fluorescence in situ hybridization (FISH) analysis was performed for sensitive detection of polysomy, relative p16 deletion and STK15 amplification, respectively. Genotypes of STK15 at the T91A (Phe31Ile) site were analyzed by PCR-RFLP assay. Low level STK15 amplification was found in 2 of 36 analyzable histologically benign urothelium specimens (5.6%) and in 64% (28/44) of urothelial bladder cancers, whereas 36% (16/44) of cancer lesions showed high level of STK15 amplification. In histologically benign urothelium of bladder cancer patients, low level STK15 amplification was associated with shorter recurrence-free and tumor-specific survival. There was no correlation between allelic variants and high/low level of STK15 gene amplification. Applying STK15 FISH to benign urothelium of bladder cancer patients may help to identify patients at increased risk for adverse clinical outcome. A large randomized prospective study comparing early versus delayed cystectomy in patients with pT1 bladder cancer is currently conducted to validate our findings.

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Section: Discussionmentioning

confidence: 99%

Low level STK15 amplification in histologically benign urothelium of patients with bladder cancer adversely predicts patient outcome following cystectomy

Denzinger

Stoehr²,

Schwarz³

et al. 2007

Int J Oncol

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show abstract

“…This treatment provides a good 5-year survival rate of 70-90%, and orthotopic neobladder reconstruction has been established as the standard procedure that provides good quality of life [10,38]. However, cystectomy yields a 2-3% mortality rate and 20-30% complication rates.…”

Section: Radical Cystectomymentioning

confidence: 99%

“…The most debatable issue is when cystectomy should be performed [38]. No prospective randomized trial has evaluated the optimal timing of cystectomy in these patients.…”

Section: Radical Cystectomymentioning

confidence: 99%

“…Herr et al have suggested that tumor response at 6 months was the most important factor for predicting ultimate failure and progression [42]. Therefore, it is recommended that cystectomy should not be delayed in high-risk patients beyond 6 months (two courses of BCG) [38]. after a second course of BCG [44,45].…”

Section: Radical Cystectomymentioning

confidence: 99%

“…These patients, who were classified as BCG refractory, are "true BCG failures" and treatment options other than BCG should be considered. Patients who delay definitive therapy by receiving two doses of initiation therapy or an alternative treatment for BCG-refractory disease may be at increased risk for progression with a proportionate decrease in long-term survival and, therefore, early cystectomy is the best choice of treatment in these patients [10,17,38,41].…”

Section: Radical Cystectomymentioning

confidence: 99%

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Management of BCG Failures in Non-Muscle-Invasive Bladder Cancer

Han

Hong

2009

Korean J Urol

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Purpose: Bacillus Calmette-Guérin (BCG) intravesical therapy is the standard treatment in high-risk patients with non-muscle-invasive bladder cancer, but a significant number of patients experience recurrence after BCG therapy. Although several treatment options are available for recurrence after BCG therapy, the optimal treatment strategy is still controversial. We reviewed current and promising treatment options after BCG failure. Materials and Methods: A search of published literature using PubMed and meeting abstracts was performed. Results: BCG failures are further subdefined as BCG refractory, BCG resistant, BCG relapsing, and BCG intolerance. Several predictors for BCG response have been studied, but prediction or stratification before therapy seems to be difficult in clinical practice. Novel biomarkers associated with immunologic mechanisms appear to be promising to predict BCG failure. Radical cystectomy is the standard treatment for BCG-refractory disease, but the timing of cystectomy is controversial. BCG maintenance or combination with interferon-α is a promising therapy for BCG resistance or relapse. Some salvage therapies or device-assisted instillations have been also promising, but the efficacy and safety of these novel therapies should be confirmed by large prospective studies before their clinical use in BCG failure. Conclusions: Patients with BCG failure are not a homogeneous group and need to be stratified. Radical cystectomy should be performed without delay in patients with BCG-refractory status, but salvage intravesical therapies may be an alternative in cases without true refractory status. Although BCG and interferon intravesical therapy is promising, more efficient salvage therapy after BCG failure is required. (Korean J Urol 2009;50:1037-1047)

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Optimal Treatment of Non-Muscle Invasive Urothelial Carcinoma Including Perioperative Management Revisited

2014

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Non-muscle invasive urothelial carcinoma is a heterogeneous disease that requires the practicing urologist to implement a variety of surgical and non-surgical treatment strategies. The disease course can range from recurrent low grade papillary disease to aggressive disease concerning for progression from initial presentation. Depending on the particular patient and goals of care, treatments similarly span the range from minimally invasive fulgurations to immediate radical cystectomy. For most patients some form of intravesical therapy will bridge the gap between transurethral resections (TUR) and radical surgery. Recent advances in the field continue to emphasize the importance of quality TUR and its strong impact on outcomes. In addition, continued research to optimize intravesical therapies has provided more information about how, when, and in whom these agents should be utilized to enhance their efficacy. This review covers the current state of NMIBC and the standards of care for the management of this disease.

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Controversial issues and optimal management of stage T1G3 bladder cancer

Cited by 11 publications

References 126 publications

Low level STK15 amplification in histologically benign urothelium of patients with bladder cancer adversely predicts patient outcome following cystectomy

Low level STK15 amplification in histologically benign urothelium of patients with bladder cancer adversely predicts patient outcome following cystectomy

Management of BCG Failures in Non-Muscle-Invasive Bladder Cancer

Optimal Treatment of Non-Muscle Invasive Urothelial Carcinoma Including Perioperative Management Revisited

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