Outcomes After Intravesical Bacillus Calmette-Guerin Are Not Affected by Substaging of High Grade T1 Transitional Cell Carcinoma

Kondylis, Filippos I.; Demirci, Salim; Ladaga, Leopold E.; Kolm, Paul; Schellhammer, Paul F.

doi:10.1016/s0022-5347(05)67706-3

Cited by 56 publications

(42 citation statements)

References 17 publications

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“…Platz et al 35 identified muscularis mucosae in only 33% of their cases and found no significant prognostic value in substaging pT1 cancer using this criterion. With median followup of 71 months, Kondylis et al 43 found no difference in recurrence and progression rates between patients with T1a and T1b cancer using muscularis mucosae invasion for substaging. Cancer progression rates were 78 and 71% for T1a and T1b cancer, respectively.…”

Section: Substaging Of Pt1 Bladder Carcinomamentioning

confidence: 99%

Staging and reporting of urothelial carcinoma of the urinary bladder

et al. 2009

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Section: Substaging Of Pt1 Bladder Carcinomamentioning

confidence: 99%

Staging and reporting of urothelial carcinoma of the urinary bladder

et al. 2009

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“…Kondylis et al [29] reported that tumor multi-focality and associated CIS were associated with increased risk of progression. Substaging lesions based on the presence or absence of muscularis mucosae invasion in a series of 49 patients did not improve prediction of recurrence (69 vs. 65%) or progression (22 vs. 29%) after BCG therapy.…”

Section: Discussionmentioning

confidence: 99%

A Six-Week Course of Bacillus Calmette-Guérin Prophylaxis Is Insufficient to Prevent Tumor Recurrence in Nonmuscle Invasive Bladder Cancer with Strong-Positive Expression of p53

Choi

et al. 2010

Oncology

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Objective: To determine the impact of p53 overexpression on tumor recurrence after bacillus Calmette-Guérin (BCG) intravesical therapy in patients with nonmuscle invasive bladder cancer (NMIBC). Methods: Between January 1999 and December 2008, 275 patients who received six BCG intravesical instillations for NMIBC (transitional cell carcinoma) after transurethral resection were assessed for differences in outcomes according to the level of p53 overexpression. A multivariate logistic regression model was applied to assess the predictive capacity of variables for recurrence. Overexpression of p53 was determined using monoclonal p53-DO7 antibody. Results: In 275 subjects, the recurrence rate was higher based on the level of p53 expression (p = 0.019). Based on multivariate analysis, a strong-positive p53 >60% (p = 0.031) and tumor grade (p = 0.015) were significant predictors for recurrence. Patients with a strong-positive p53 >60% had a much lower 5-year biochemical recurrence-free survival rate than patients with p53 ≤60% (72.1 vs. 31.5%, p < 0.001). Conclusions: Strong overexpression of p53 was predictive of recurrence in patients with NMIBC undergoing intravesical BCG treatment. A 6-week induction course of BCG alone is not sufficient to prevent recurrence in patients with NMIBC with high p53 expression; additional prophylactic strategies are needed for these patients.

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“…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%

“…bladder cancer, Kondylis et al showed that substaging of T1 tumors did not affect response to BCG regarding recurrence or progression [20]. 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].…”

Section: T1 Substagingmentioning

confidence: 99%

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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Outcomes After Intravesical Bacillus Calmette-Guerin Are Not Affected by Substaging of High Grade T1 Transitional Cell Carcinoma

Abstract: Substaging of T1 tumors did not affect response to BCG in regard to recurrence or progression. Therefore, intravesical BCG is effective for stages T1a and T1b disease.

Cited by 56 publications

References 17 publications

Staging and reporting of urothelial carcinoma of the urinary bladder

Staging and reporting of urothelial carcinoma of the urinary bladder

A Six-Week Course of Bacillus Calmette-Guérin Prophylaxis Is Insufficient to Prevent Tumor Recurrence in Nonmuscle Invasive Bladder Cancer with Strong-Positive Expression of p53

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

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