Initial High-Grade T1 Urothelial Cell Carcinoma: Feasibility and Prognostic Significance of Lamina Propria Invasion Microstaging (T1a/b/c) in BCG-Treated and BCG-Non-Treated Patients

Orsola, Anna; Trias, Isabel; Raventós, Carles X.; Español, Ignacio; Rosell, L. Cecchini; Búcar, S.; Salinas, Danieli; Orsola, I.

doi:10.1016/j.eururo.2005.04.013

Cited by 166 publications

(153 citation statements)

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“…4 Adverse prognostic features that have been associated with a high risk of progression include number of tumours (>3 lesions), tumour size (>3 cm), hydronephrosis, invasion of the lamina propria (T1), depth of sub-mucosal invasion (T1a vs. T1b), high-grade, concomitant CIS, T1 disease on re-TUR, tumour recurrence on first follow-up cystoscopy, T1 recurrence and superficial prostatic urethral recurrence. [5][6][7][8][9][10] To identify patients who should be considered for early radical cystectomy, we evaluated the clinical and pathological variables that may affect the outcome of patients with high-risk NMIBC who underwent re-TUR. Outcome was defined in terms of recurrence-free survival (RFS) and progression-free survival (PFS).…”

Section: Introductionmentioning

confidence: 99%

Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer

Bishr

Lattouf

Latour

et al. 2014

CUAJ

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Introduction: To identify patients who should be considered for early radical cystectomy, we evaluated the clinical and pathological variables affecting the outcome of patients with high-risk nonmuscle invasive bladder cancer (NMIBC) who underwent re-staging transurethral resection (re-TUR). Methods: We reviewed the clinical data of 453 patients treated for urothelial carcinoma between 2006 and 2010. In total, 94 patients underwent re-TUR after their initial TUR. Of these, 72 were not upstaged to muscle invasive disease and were therefore included in our study. Results: On re-TUR, 31 patients had no residual tumour (T0) and 41 patients had residual NMIBC. A statistically significant difference was noted between patients with pT0 and patients with residual NMIBC on re-TUR in regard to tumour recurrence and progression (39% vs. 83%, p < 0.001) (6% vs. 34%, p = 0.005), respectively. On multivariate analysis, tumour stage on re-TUR and the regimen of intravesical bacillus Calmette-Guérin (BCG) therapy (induction vs. maintenance) remained independent predicting factors for recurrence-free survival (RFS) (p = 0.001, hazard ratio [HR]: 1.77), (p < 0.001 HR: 0.16) and progression-free survival (PFS) (p = 0.014, HR: 2.11), (p = 0.008, HR: 0.097), respectively. Conclusions: The presence of T0 on re-TUR is associated with better RFS and PFS and could be a predictive factor for candidates for conservative management. Patients with persistent NMIBC on re-TUR require close follow-up and, in some cases, could be considered for early cystectomy. Maintenance intravesical BCG therapy can improve RFS and PFS in patients with high-risk NMIBC. This study is limited by its retrospective nature and the relatively small number of patients in the cohort.

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Section: Introductionmentioning

confidence: 99%

Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer

Bishr

Lattouf

Latour

et al. 2014

CUAJ

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“…In contrast, Orsola et al reported that patients with high-grade T1 bladder cancer invading the muscularis mucosa (T1b) had a seven times higher risk of a positive repeat TUR at 3 months after the initial TUR and BCG therapy if the initial tumor was greater than 3 cm and a five-fold increased risk if associated with CIS [21,22]. However, this result has not been confirmed in a prospective study.…”

Section: T1 Substagingmentioning

confidence: 41%

“…Several reports in the past 10 years have demonstrated a worse prognosis for T1 tumors with deep lamina propria invasion, with progression rates ranging from 29% to 55% [20][21][22]. Subgrouping of T1 tumors uses the muscularis mucosa as a landmark of microstaging.…”

Section: T1 Substagingmentioning

confidence: 99%

“…Subgrouping of T1 tumors uses the muscularis mucosa as a landmark of microstaging. According to the muscularis mucosa, T1 tumors are classified into T1a when the tumor involves the subepithelial connective tissue superficial to the muscularis mucosa, T1b when it goes into the level of the muscularis mucosa, and T1c when it goes beyond the muscularis mucosa [21]. In a study of 49 patients with T1…”

Section: T1 Substagingmentioning

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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“…33 patients from Toronto and Rotterdam with primary highgrade NMIBC patients treated with BCG and found that substaging was a very significant predictor of BCG recurrence and progression when separating minimal and extensive pT1 high-grade NMIBC (manuscript in preparation).…”

Section: Prediction Of Bcg Failurementioning

confidence: 99%

The management of BCG failure in non-muscle-invasive bladder cancer: an update

Zlotta

Fleshner

Jewett

2013

CUAJ

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Up to 40% of patients with non-muscle-invasive bladder cancer (NMIBC) will fail intravesical bacillus Calmette-Guérin (BCG) therapy. There is unfortunately no current gold standard for salvage intravesical therapy after appropriate BCG treatment. Indeed, outcomes are at best suboptimal. The vast majority of low-grade NMIBC are prone to recur but very rarely progress. Failure after intravesical BCG in these patients is usually superficial and lowgrade. At the other end of the spectrum, failure to respond to BCG in high-risk T1 bladder cancer and/or carcinoma in situ (CIS or TIS) is more problematic, since those tumours often have the potential to progress to muscle invasion. In these cases, radical cystectomy remains the mainstay after BCG failure. With appropriate selection, certain patients who "fail" BCG (but with favourable risk factors) can be managed with intravesical regimens, including repeated BCG, BCG plus cytokines, intravesical chemotherapy, thermochemotherapy or new immunotherapeutic modalities. In this review, reasons explaining BCG failure, how to define BCG failure, optimal risk stratification and prediction of response and management of BCG failures are discussed.

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Initial High-Grade T1 Urothelial Cell Carcinoma: Feasibility and Prognostic Significance of Lamina Propria Invasion Microstaging (T1a/b/c) in BCG-Treated and BCG-Non-Treated Patients

Cited by 166 publications

References 15 publications

Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer

Tumour stage on re-staging transurethral resection predicts recurrence and progression-free survival of patients with high-risk non-muscle invasive bladder cancer

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

The management of BCG failure in non-muscle-invasive bladder cancer: an update

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