Cystectomy for superficial bladder cancer

Bracken, R. Bruce; McDonald, Malcolm; Johnson, Douglas E.

doi:10.1016/0090-4295(81)90289-2

Cited by 51 publications

(18 citation statements)

References 16 publications

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“…The survival of patients with superficial bladder tumours treated with RC is extremely variable, at 62–90%[5–10], and there is great controversy about the timing of RC [5,7,10]. In the present study, we compared progression and survival of patients with superficial or muscle‐invasive bladder tumours and, surprisingly, found no significant difference.…”

Section: Discussionmentioning

confidence: 70%

“…Overall survival is very high (76–90%) in patients with superficial bladder cancer treated with RC [5–9] but conflicting results have been reported when comparing patients treated initially with RC and those having this surgery after recurrence of tumours. Stöckle et al [10] reported significantly better survival (90% vs 62%) in patients treated with immediate rather than delayed RC after recurrent tumour, whereas other authors reported no significant survival difference [5,7].…”

Section: Introductionmentioning

confidence: 99%

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The optimum timing of radical cystectomy for patients with recurrent high‐risk superficial bladder tumour

Solsona¹,

Iborra²,

Rubio³

et al. 2004

BJU International

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OBJECTIVE To establish the optimum time of radical cystectomy (RC) for patients with recurrent high‐risk superficial bladder tumours after the failure of intravesical therapy. PATIENTS AND METHODS Among 318 patients with transitional cell carcinoma treated with RC and with no neoadjuvant therapy, there were 46 with clinical stage Ta, T1 or Tis refractory to transurethral resection associated with intravesical therapy. These patients had at least one of: (i) high‐risk superficial bladder tumours after failure of two consecutive induction courses of intravesical therapy; (ii) superficial bladder tumours with prostatic stromal invasion; (iii) superficial bladder tumours with mucosa/ducts involvement after failure of one course of intravesical therapy; (iv) uncontrolled superficial tumours with transurethral resection associated or not with intravesical therapy. Progression and cause‐specific survival of these patients were compared to those with muscle‐invasive tumours. Univariate and multivariate analyses of predictive factors for cause‐specific survival were also used in patients with superficial tumours. The incidence of significant prognostic factors was compared in both superficial and muscle‐invasive tumours, as were the progression pattern and survival. RESULTS The progression‐free and cause‐specific survival of patients with superficial tumours was 54% and 67%, respectively, with no significant difference from those with muscle‐invasive tumours. In multivariate analysis, positive lymph‐nodes and prostatic stromal invasion were significant and independent variables for survival. The incidence of positive lymph nodes was 15% vs 30% (P < 0.05) and of stromal invasion was 32% vs 1.5% (P < 0.001) in patients with superficial and muscle‐invasive tumours, respectively. Accounting for the progression pattern in patients with superficial tumours, extravesical urothelial recurrence prevailed over local or distant recurrences (30% vs 15%), whereas in patients with muscle‐invasive tumours the opposite occurred (5% vs 33%, respectively). The cause‐specific survival of patients with superficial tumour and prostatic stromal invasion was one of three, and in those who developed extravesical urothelial recurrence was 28.5%. CONCLUSION In patients with recurrent high‐risk superficial bladder cancer after intravesical therapy, our criteria for RC were inappropriate, and patients had a survival rate similar to those with muscle‐invasive tumours. RC might have been used too late, as there was a high incidence of prostatic stromal invasion and extravesical urothelial recurrence after RC. Both events seem to be responsible of the low cause‐specific survival. Predictive factors for progression are needed to indicate early RC in patients with recurrent high‐risk superficial tumours. From a previous analysis the pathological pattern of the clinical lack of response (T1, G3, bladder carcinoma in situ and prostate involvement) to intravesical therapy evaluated at 3 months might be important for predicting progression, and an early RC a...

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

The optimum timing of radical cystectomy for patients with recurrent high‐risk superficial bladder tumour

Solsona¹,

Iborra²,

Rubio³

et al. 2004

BJU International

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“…Therefore, some authors recommend early radical cystectomy for these patients, reporting a 5-year survival rate between 70 and 90% if performed immediately, and 50-60% if delayed [21] . However, though a radical approach may be the best chance to cure patients with pT1G3 TCC, many of them prefer conservative treatment, and furthermore, many patients are unsuitable for a radical cystectomy owing to age or associated comorbid medical illness.…”

Section: Discussionmentioning

confidence: 99%

Intravesical Gemcitabine in BCG-Refractory T1G3 Transitional Cell Carcinoma of the Bladder: A Pilot Study

Gacci

Bartoletti²,

Cai³

et al. 2006

Urol Int

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Objective: The aim of this pilot study is to analyze the safety and short-term efficacy of gemcitabine (GEM) as salvage intravesical therapy in a very selected population of bacille Calmette-Guérin (BCG)-resistant T1G3 patients. Methods: 9 recurrent BCG-refractory pT1G3 patients, unsuitable for radical treatment, were treated with GEM, and compared with 10 pT1G3 patients previously treated with at least two courses of transurethral resection plus BGC, with further conservative endovesical BCG administration. Results: Both intravesical administrations of GEM and BCG were generally well tolerated: no severe adverse events were reported. Of the 9 patients treated with GEM, 3 were recurrence-free after 13, 17 and 21 months and 7 kept an intact bladder, with an overall survival rate of 9 of 9. Among 10 patients treated with BCG instillation, 1 was recurrence-free after 27 months and 6 kept their bladders, with a survival rate of 8 of 10. Conclusions:Our experience confirms the high risk of tumor recurrence and progression of BCG-refractory pT1G3 transitional cell carcinoma. In this case, further BCG courses seem to be unsuitable, resulting in a high risk of tumor progression and mortality. The use of GEM in BCG-refractory pT1G3 patients has to be considered experimental until multicentric randomized studies with adequate follow-up are able to confirm the preliminary results of this pilot study.

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“…Bracken et al. 4 reported a 5‐year survival rate of 88% in 29 patients who received a radical cystectomy after a median of two transurethral resections (TUR). A radical cystectomy at diagnosis may be an overly aggressive treatment for more than half of patients with T1/G3 cancers, so several investigators have recommended conservative therapy instead 5,6 …”

Section: Introductionmentioning

confidence: 99%

Clinical outcome of high‐grade non‐muscle‐invasive bladder cancer: A long‐term single center experience

et al. 2009

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Objectives: To report on the long‐term clinical outcome of high‐grade (G3) non‐muscle‐invasive bladder cancer (NMIBC) patients treated at a single institution. Methods: A retrospective analysis of 93 patients with NMIBC treated between January 1991 and September 2005 was performed. Patients were divided into three groups on the basis of treatment they received after transurethral resection (TUR) of the bladder. Forty‐seven patients received adjuvant intravesical epirubicine after TUR of the bladder (Group 1). Twenty‐four patients received intravesical bacillus Calmette–Guérin (BCG) (Group 2). A radical cystectomy (RC) was performed on twenty‐two patients (Group 3). Results: Median follow up was 68.7 months. Overall, thirty patients (33%) experienced tumor recurrence. The survival rates of Group 3 were significantly higher than the 71 patients undergoing conservative therapy (Group 1 and 2). There was no statistically significant difference between Group 1 and 2, but treatment failure in patients treated with epirubicine was significantly higher than in those with BCG. Cases without concomitant carcinoma in situ (CIS) showed statistically significantly higher survival rates than those with concomitant CIS. Conclusions: RC provides excellent survival rates in patients with high‐grade NMIBC. Adjuvant therapy with BCG after a complete TUR of the bladder may be an effective treatment for high‐grade NMIBC. If a conservative treatment is preferred to RC, co‐existence of a concomitant CIS should be considered with caution.

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Cystectomy for superficial bladder cancer

Cited by 51 publications

References 16 publications

The optimum timing of radical cystectomy for patients with recurrent high‐risk superficial bladder tumour

The optimum timing of radical cystectomy for patients with recurrent high‐risk superficial bladder tumour

Intravesical Gemcitabine in BCG-Refractory T1G3 Transitional Cell Carcinoma of the Bladder: A Pilot Study

Clinical outcome of high‐grade non‐muscle‐invasive bladder cancer: A long‐term single center experience

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