Prognostic Factors of Outcome After Radical Cystectomy for Bladder Cancer: A Retrospective Study of a Homogeneous Patient Cohort

Bassi, Pierfrancesco; Ferrante, Gianluca Drago; Piazza, N.; Spinadin, Renato; Carando, Roberto; Pappagallo, G.L.; Pagano, Francesco

doi:10.1016/s0022-5347(05)68936-7

Cited by 253 publications

(162 citation statements)

References 33 publications

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“…Response rates are comparable to those reported in previous chemoradiotherapy series, including the one randomised comparison with radiotherapy. The outcomes for large locally advanced bladder tumours with extravesical extension are poor regardless of the treatment modality used (Bassi et al, 1999;Gschwend et al, 2002). A majority of patients with complete pathological response retain their bladders free from invasive relapse, while about one-quarter will develop superficial recurrence.…”

Section: Discussionmentioning

confidence: 99%

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

et al. 2004

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We conducted a phase I/II study investigating synchronous chemoradiotherapy with mitomycin C and infusional 5-fluorouracil (5-FU) in muscle invasive bladder cancer. Early dose escalation results were previously published. We report the long-term toxicity and efficacy results with the optimised regimen. Patients with muscle invasive bladder cancer with glomerular filtration rate 425 ml min À1 were eligible. Mitomycin (12 mg m À2 on day 1 only) and infusional 5-FU (500 mg m À2 day À1 ) for 5 days were administered during weeks 1 and 4 of radiotherapy of 55 Gy in 20 fractions. A total of 41 patients were enrolled, median age was 68 years, 33 were male and eight female patients. Out of the 41 patients, 20 (49%) had hydronephrosis at presentation and 25 (62%) had T3b or T4 disease. Four patients experienced Grade III thrombocytopenia and three patients had Grade III neutropenia. There were no episodes of febrile neutropenia. Four patients experienced Grade III diarrhoea and 1 Grade III urgency and dysuria. Six patients did not undergo cystoscopic evaluation due to early metastatic spread although there was no clinical suggestion of bladder failure. In all, out of 35 evaluable patients, 25 (71%) had macroscopic complete response at 3-month cystoscopy, and biopsy confirmed in 24 out of 25. A total of 16 (39%) patients remain alive with a median follow-up of 50.7 (range 23.5 -68.8) months, 14 with a functioning bladder with no reported long-term treatment-related bladder or bowel toxicity. Five out of 41 patients have undergone salvage cystectomy: two for persistent CIS, two T1 and one muscle invasive recurrence. Four patients have received intravesical chemotherapy, of whom two remain alive with a functioning bladder. Overall 12-, 24-and 60-month (m) survival rates were 68, 49 and 36%. Local and distant progression free rates were 82 and 86% at 12-m and 79 and 75% at 24-m. Organ preservation using multimodality therapy is feasible and safe, even in patients with poor renal reserve, and does not compromise salvage therapies. A national phase III trial BC2001 (www.bc2001.org.uk) exploring the effects of synchronous chemoradiotherapy with this regimen is currently recruiting.

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Section: Discussionmentioning

confidence: 99%

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

et al. 2004

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“…[9][10][11] Several studies have evaluated the clinical and pathological prognostic factors after cystectomy for muscle-invasive UC. Advanced pathologic stage, nodal involvement, tumour size greater than 3 cm, elevated creatinine and lymphovascular invasion are independent risk factors for recurrence, [12][13][14][15] while advanced pathologic stage and nodal involvement are independent prognostic factors for survival. 14,16 A nomogram predicting recurrence risk after radical cystectomy for bladder cancer was recently developed to improve the predictability of accurate risk assessment in patients after this procedure.…”

Section: Introductionmentioning

confidence: 99%

“…Advanced pathologic stage, nodal involvement, tumour size greater than 3 cm, elevated creatinine and lymphovascular invasion are independent risk factors for recurrence, [12][13][14][15] while advanced pathologic stage and nodal involvement are independent prognostic factors for survival. 14,16 A nomogram predicting recurrence risk after radical cystectomy for bladder cancer was recently developed to improve the predictability of accurate risk assessment in patients after this procedure. 17 While these traditional prognostic factors provided useful estimates for recurrence risk and survival, significant variations within each prognostic group based on the heterogeneity of tumour biology were observed Similarly, patients with locally advanced (T4b and N2-3) or metastatic disease (M1) at diagnosis or during follow-up demonstrate variable response rates to chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Personalized medicine in advanced urothelial cancer: when to treat, how to treat and who to treat

Ehdaie

Smith

Theodorescu

2013

CUAJ

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The past decade has provided an improved understanding of the molecular mechanism of bladder cancer by defining distinct pathways in tumorigenesis and progression. Advances in technologies, such as high-throughput transcript profiling, microarrays and proteomics, offer a systematic approach to identifying targets for bladder cancer diagnostics and drug discovery. This review presents a select outline of the advances in the development of biomarkers and targets for patient prognosis and therapy selection. This paper describes a representative cohort of recent studies that have the potential to significantly impact the management of muscle invasive and metastatic urothelial carcinoma of the bladder. Space constraints do not permit this review to be comprehensive and we apologize to the authors whose work we do not cite.

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“…The prognostic significance of the presence of lymphovascular invasion (LVI) on transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens is still controversial, with some studies showing an independent prognostic effect [2][3][4][5][6] and others showing no effect [7][8][9][10]. Other studies have shown a correlation of LVI with shorter survival that is not independent of pathological stage [11]. In addition, LVI at TURBT has been shown to be associated with understaging and worsened disease-specific survival (DSS) after RC [12].…”

Section: Introductionmentioning

confidence: 99%

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer

et al. 2009

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TURBT and/or RC specimens to a group of controls who did not have LVI on TURBT (34) or RC (32). RESULTSPatients with LVI present in their TURBT specimen had a shorter disease-specific survival than those without LVI, with a 5-year survival of 33.6% vs 62.9% (log-rank test P = 0.027; hazard ratio 2.21). LVI at TURBT varied with clinical stage ( P = 0.049). Patients with LVI and who were clinical stage I or II had lower survival than those without LVI ( P = 0.049; hazard ratio 2.68). LVI did not affect survival among those with clinical stage III or IV ( P = 0.29). There was a trend for patients with LVI at TURBT to be clinically understaged compared to those without LVI (75% vs 46%) but the difference was not significant ( P = 0.086). Patients with LVI detected in their RC specimen were significantly more likely to have cancer recurrence than were those with no evidence of LVI (48% vs 19%, P = 0.006). For the RC group there was also a significant difference in survival distribution between patients with evidence of LVI vs those without (5-year survival 45.5% vs 78.4%, P = 0.017). Those with LVI were significantly more likely to die from the disease than those without LVI ( P = 0.017; hazard ratio 2.92). CONCLUSIONSOur findings suggest that LVI is a histological feature that might be associated with a poorer prognosis in patients with urothelial carcinoma of the bladder. The presence of LVI in TURBT specimens predicts shorter survival for patients with stage I or II disease. The presence of LVI in RC specimens predicts recurrence of disease and shorter survival. Further studies are needed to determine whether this group of patients would benefit from early RC and/or perioperative chemotherapy to improve clinical outcomes. KEYWORDSbladder cancer, lymphatic metastasis, neoplasm staging, cystectomy Study Type -Prognosis (case series) Level of Evidence 4 OBJECTIVETo test the hypothesis that patients with bladder cancer who had evidence of lymphovascular invasion (LVI) in their transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens would have a worse prognosis and higher likelihood of clinical understaging, and to assess the effect of LVI discovered at RC on subsequent diseaserelated mortality, as the prognostic significance of LVI in TURBT or RC specimens of patients treated for urothelial carcinoma of the bladder is not completely established. PATIENTS AND METHODSWe retrospectively reviewed the records of 163 patients with urothelial carcinoma of the bladder seen at our institution, and who had TURBT (69) or RC (94) between 1995 and 2005. We compared patients with LVI on

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Prognostic Factors of Outcome After Radical Cystectomy for Bladder Cancer: A Retrospective Study of a Homogeneous Patient Cohort

Abstract: Tumor stage and nodal involvement are the only independent predictors of survival to be used to select the optimal therapy after radical cystectomy, stratify patients in controlled trials and evaluate new prognostic factors.

Cited by 253 publications

References 33 publications

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

Long-term results of a phase II study of synchronous chemoradiotherapy in advanced muscle invasive bladder cancer

Personalized medicine in advanced urothelial cancer: when to treat, how to treat and who to treat

The significance of lymphovascular invasion in transurethral resection of bladder tumour and cystectomy specimens on the survival of patients with urothelial bladder cancer

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