Differences in Tumor Characteristics and Prognosis in Newly Diagnosed Ta, T1 Urothelial Carcinoma of Bladder According to Patient Age

Cho, Kang Su; Hwang, Tae‐Kon; Kim, Bup Wan; Yoon, Dae Wui; Chang, Sung Goo; Kim, Sejoong; Park, Jong Yeon; Cheon, Jun; Sung, Gyung Tak; Hong, Sung Joon

doi:10.1016/j.urology.2008.10.038

Cited by 23 publications

(8 citation statements)

References 20 publications

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“…Therefore, we cannot generalize about the effectiveness of BCG in younger patients. However, a recent study found that younger age was associated with more favorable tumor characteristics, 2 and the risk of death as a result of bladder cancer increased with increasing age. 27 Patients with a nonspecific intravesical therapy claim for Current Procedural Terminology code 51720 were included with the BCG group, because more than 97% of adjuvant intravesical therapy administered with a specified drug was for BCG.…”

Section: Discussionmentioning

confidence: 98%

Adjuvant Intravesical Bacillus Calmette-Guérin Therapy and Survival Among Elderly Patients With Non–Muscle-Invasive Bladder Cancer

Spencer

McBride

Hershman

et al. 2013

JOP

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Purpose: National guidelines recommend adjuvant intravesical Bacillus Calmette-Gué rin (BCG) therapy for higher-risk nonmuscle-invasive bladder cancer (NMIBC). Although a survival benefit has not been demonstrated, randomized trials have shown reduced recurrence and delayed progression after its use. We investigated predictors of BCG receipt and its association with survival for older patients with NMIBC. Patients and Methods:We identified individuals with NMIBC registered in the Surveillance, Epidemiology, and End Results-Medicare database from 1991 to 2003. We used logistic regression to compare those treated with BCG within 6 months of initial diagnosis with those not treated, adjusting for demographic and clinical factors. Cox proportional hazards modeling was used to analyze the association between BCG and overall survival (OS) and bladder cancer-specific survival (BCSS) for the entire cohort and within tumor grades. Results:Of 23,932 patients with NMIBC identified, 22% received adjuvant intravesical BCG. Predictors of receipt were stages T is and T 1 , higher grade, and urban residence. Age Ͼ 80 years, fewer than two comorbidities, and not being married were associated with decreased use. In the survival analysis, BCG use was associated with better OS (hazard ratio [HR], 0.87; 95% CI, 0.83 to 0.92) in the entire cohort and BCSS among higher-grade cancers (poorly differentiated: HR, 0.78; 95% CI, 0.72 to 0.85; undifferentiated: HR, 0.66; 95% CI, 0.56 to 0.77). Conclusion: Despite guidelines recommending its use, BCGis administered to less than one quarter of eligible patients. This large population-based study found improved OS and BCSS were associated with use of adjuvant intravesical BCG among older patients with NMIBC. Better-designed clinical trials focusing on higher-grade cancers are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 98%

Adjuvant Intravesical Bacillus Calmette-Guérin Therapy and Survival Among Elderly Patients With Non–Muscle-Invasive Bladder Cancer

Spencer

McBride

Hershman

et al. 2013

JOP

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“…2,[4][5][6][7] Limitations include the retrospective nature of the study, a lack of follow-up on all patients, and a lack of uniform follow-up and treatment. Histologically, no cytologic or stromal features were found to correlate with recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…12 Although rarely fatal, noninvasive low-grade papillary urothelial carcinoma (LPUC) recurs commonly, and in a smaller percentage of cases it progresses to higher grade/stage. 2,[5][6][7] Prior work on noninvasive LPUC found recurrence in approximately 35% to 50% of cases and grade progression in 18% of cases. 6,7 Among cases with grade progression, 37% showed stage progression as well.…”

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confidence: 99%

Invasive Low-Grade Papillary Urothelial Carcinoma

Toll¹,

Epstein

2012

American Journal of Surgical Pathology

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Typically in invasive papillary urothelial carcinoma both the overlying papillary and the invasive components are high grade. We describe a series of patients with invasive low-grade papillary urothelial carcinoma (LPUC) in which both the noninvasive and invasive components are low grade. A retrospective search from The Johns Hopkins Surgical Pathology Database and consult cases from one of the author's files from 1998 to 2011 found 54 cases of invasive LPUC, excluding the more common, unique, and already well-characterized nested variant of urothelial carcinoma. Slides were available for 41 cases and formed the basis of the current study. The mean patient age was 68.4 years, with a male predominance. The specimens consisted of 37 bladder biopsies, 1 renal pelvis biopsy, 1 cystoprostatectomy specimen, 1 nephrectomy specimen, and 1 nephroureterectomy specimen. In all cases, invasion was limited to the superficial lamina propria above the muscularis mucosae. None of the histologic features correlated with tumor recurrence. Follow-up information was available for 73% of cases, with an average time interval of 49 months. Recurrent tumor was identified in 10/29 (34%) cases; however, 34% of cases without recurrence had limited follow-up (<24 mo). Three patients showed progression in tumor grade, and 3 additional patients progressed in both grade and stage (60% stage/grade progression). Four patients developed recurrence with ureteral noninvasive LPUC (2 in the bladder and 2 in the ureter). All are alive without disease. As this lesion is being increasingly recognized, larger studies are needed to determine whether invasion arising in LPUC is a significant risk factor for future disease.

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“…The predominance of low grade tumors in urothelial bladder cancer patients aged <40 years were shown in many studies (5). It was suggested that the more favorable prognosis reported in some cases simply reflected the lower grade and stage of tumors at diagnosis in the young than in the old patients (1,6,7). The results of a majority of previously studies exhibited a significantly higher rate of muscle-invasive bladder cancer among patients aged >50 years compared to younger patients (2).…”

Section: Discussionmentioning

confidence: 99%

Urothelial Bladder Carcinoma in a 17-Year Old Male: A Case Report and Review of the Literature

Ceylan¹,

Günlüsoy²,

Değirmenci³

et al. 2015

uob

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Differences in Tumor Characteristics and Prognosis in Newly Diagnosed Ta, T1 Urothelial Carcinoma of Bladder According to Patient Age

Cited by 23 publications

References 20 publications

Adjuvant Intravesical Bacillus Calmette-Guérin Therapy and Survival Among Elderly Patients With Non–Muscle-Invasive Bladder Cancer

Adjuvant Intravesical Bacillus Calmette-Guérin Therapy and Survival Among Elderly Patients With Non–Muscle-Invasive Bladder Cancer

Invasive Low-Grade Papillary Urothelial Carcinoma

Urothelial Bladder Carcinoma in a 17-Year Old Male: A Case Report and Review of the Literature

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