Pd18-08 active Surveilllance in Low Risk Bladder Cancer. Is It a Safe Option?

Abstract

differentially methylated in LG and HG BC using two different genomewide methylation-profiling platforms. Multivariable logistic regression prediction models were created. RESULTS: There were 211 bladder cancer patients (180 nonmuscle invasive) and 102 controls. In univariate analyses, all methylation biomarkers were statistically significant predictors of cancer vs. no cancer (all p-values <0.01), and HG vs. LG-BC (all p-values<0.01). In multivariable analysis, NID2, TWIST1 and age were independent predictors of BC (all p<0.05). Multivariable models predicting BC overall and discriminating between high-grade and lowgrade bladder cancer reached AUCs of 0.89 and 0.78, respectively. CONCLUSIONS: Our multi-centric study supports the promise of epigenetic urinary markers in non-invasively detecting bladder cancer and discriminating between grades. Validation in different clinical settings including patients with hematuria, bladder cancer surveillance or screening in high-risk populations is warranted to support its utility.

Active surveillance for non-muscle-invasive bladder cancer: fallacy or opportunity?

“…Study/year a Soloway 2003 [32] Martı´ı´nez C aceres 2005 [36] Gofrit 2006 [38] Pruthi 2008 [33] Hernandez 2016 [34] Lozano 2019 [35] Contieri surgical risk due to comorbidities such as Charlson Comorbidity Index >6), AS might be a feasible strategy [43]. After a median time under AS of 13 months, none of the 24 patients experienced disease progression to MIBC and almost 46% were still under AS [43].…”

“…Therefore, it may be argued that including only tumors with a diameter 10 mm might be safer, but this would foreclose the option of AS to many patients without data to support it. Indeed, whereas in primary solitary TaLG NMIBC, there was no difference in PFS and overall survival (OS) between tumors 10 mm or >10 mm, patients with 10 mm tumors had a better RFS with Gofrit 2006 [38] Pruthi 2008 [33] Hernandez 2016 [34] Lozano 2019 [35] Contieri 2018 [29] AS, active surveillance; CIS, carcinoma in situ; FU, follow-up; MIBC, muscle-invasive bladder, mo, months; NR, not reported; P, prospective; PUNLMP, papillary urothelial neoplasm of low malignant potential; R, retrospective; UC, urinary cytology; US, ultrasound.…”

“…All reported the pathological tumor stage and grade at inclusion but not all provided details on the exact inclusion criteria regarding tumor stage. When reported, studies included pTa tumors, with only one study excluding pT1-NMIBC (Table 1) [31 ▪ ,32–36,37 ▪▪ ,38]. Indeed, the pathological tumor stages to be included in AS remain debated.…”

“…There is no widely accepted cut-off regarding the maximal tumor size that could be included in AS. Among previous studies, inclusion criteria were ‘small’ tumors, tumors <10 mm, and some authors did not report any tumor size cut-off [31 ▪ ,32,33,35,36]. Overall, the evidence for a differential risk of progression based on tumor size in Ta tumors is negligible [52].…”

“…The precise definition of AS failure is also a surrogate for establishing a clear AS protocol. Failure criteria for AS were commonly defined in the literature as an increase in the number or size of the tumor, and/or presence of any bothersome symptoms such as hematuria, and/or positive UC (Table 1) [32,34–36,37 ▪▪ ,38]. With a median follow-up of 38 months, approximately 2/3 of patients stopped AS [31 ▪ ,37 ▪▪ ,58].…”