Prognostic Indices in Transitional Cell Carcinoma of the Bladder

Abel, Paul

doi:10.1111/j.1464-410x.1988.tb04286.x

Cited by 79 publications

(43 citation statements)

References 63 publications

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“…In fact, the recurrence risk in superficial bladder cancer is so high that (as opposed to other cancer sites) a second occurrence of TCC in the bladder is always interpreted as a recurrence, although this is theoretically incorrect (Abel, 1988). The recurrence risk is dependent on a number of prognostic factors (Abel, 1988;Lum & Torti, 1991 Society, 1991). In a recent study in the United Kingdom, the 5-year survival in 150 pTa and 85 pTa patients was 80 and 69%, respectively (Gulliford et al, 1991).…”

Section: Survivalmentioning

confidence: 99%

The clinical epidemiology of superficial bladder cancer

Kiemeney

Witjes²,

Verbeek³

et al. 1993

Br J Cancer

127

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Summary Even though the majority of patients with bladder malignancies initially present with low stage disease, the clinical epidemiology of these so-called superficial bladder tumours is not well known. In this paper, disease characteristics at initial presentation and during follow-up are described in 1,745 primary cases documented prospectively in the Netherlands. The risk of recurrent disease after primary treatment is very high: in 60% of cases, at least one recurrence is diagnosed within 5 years (95% CI: 58-62% Society, 1991). Therefore, the greatest concern in these patients is not to reduce mortality but to lower and postpone the number of recurrences (which are very common in superficial TCC) and thereby to prevent progression to invasive disease (and document) at least four random quadrant biopsies in macroscopically normal-looking urothelium (left and right lateral wall, trigone and dome) at the time of resection of the tumour(s). The therapy to be applied was transurethral resection of the tumour (TUR) in all patients. Urologists were advised to consider adjuvant intravesical instillations with chemotherapy or BCG vaccine in the case of multiple tumours. In pTI grade 3 patients more aggressive therapy, such as radical surgery or external or interstitial radiotherapy, would have to be considered. To detect recurrences, cystoscopy and urine cytology were used every 3 months in the first year after treatment. From the second year onwards, this check-up was performed every 6 months. Follow-up data concerning disease and life status were collected for each patient once every year.Between 1983 and 1990, 2,805 cases were documented. In 1991, all the data in the documentation project were reviewed using the medical files. After this check, the records of 100 cases were excluded. Of these, 30 had an inverted papilloma (which was considered to be benign), 58 had recurrent instead of primary disease at first registration, five did not have TCC in the bladder but in the upper urinary tract. In the records of seven cases, there were major inconsistences, which could not be corrected with information from the medical files. Of the remaining 2,705 cases, 1,745 (64.5%) had superficial TCC. 'Superficial' is defined as tumour extension limited to the mucosa (pTa) or the lamina propria (pTl) of the bladder wall with or without carcinoma in situ in random biopsies. In urology practice, primary carcinoma in situ (pTis) is considered to be very different from pTa and pTI tumours because of its relatively aggressive clinical behaviour. For that reason, patients with primary pTis (n = 52 in our series) were not evaluated in this study. Survival free of recurrence, survival free of progression and survival itself were measured from the data of histological diagnosis to the date of first recurrence, first evidence of disease progression and the date of death, respectively. Survival curves were based on the life table method, statistical significance being determined by the log rank test. The independence of host and tum...

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Section: Survivalmentioning

confidence: 99%

The clinical epidemiology of superficial bladder cancer

Kiemeney

Witjes²,

Verbeek³

et al. 1993

Br J Cancer

127

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“…Bladder carcinoma shows a very high recurrence rate (50 ± 70%) and recurrent disease, when it does occur, is associated in 15 ± 25% of patients with progression to a more advanced tumour stage. Thus, careful and frequent follow-up is of prime importance (Abel, 1988;Heney et al, 1983). Current practice in the follow-up of patients with carcinoma of the urinary bladder favours cystoscopic examinations every 3 months.…”

Section: Problems Complicating the Diagnosis And Follow-up Of Bladdermentioning

confidence: 99%

Telomerase: Its clinical relevance in the diagnosis of bladder cancer

Müller

2002

Oncogene

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More than 50 years ago, Papanicolaou recognized the importance of a non-invasive technique for the diagnosis and follow-up of patients with carcinoma of the urinary bladder. Cystoscopy, however, has remained the`gold standard' since no currently available non-invasive method can compete with cystoscopy's sensitivity and speci®city. The detection of the ribonucleoprotein telomerase or the telomerase subunits human telomerase RNA (hTR) and human telomerase reverse transcriptase (hTERT) in urine samples o er new diagnostic perspectives. The present article presents a review of publications in the literature and evaluates their clinical relevance. The experimental studies reported to date are very promising and show that telomerase exactly ful®ls the requirements for a good diagnostic marker for carcinoma of the urinary bladder. The diagnostic application remains in an experimental stage and telomerase is still several steps away for routine use as a clinical parameter. The remaining steps leading to its routine clinical application will be discussed.

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“…Non-muscle-invasive bladder cancers account for about 70 to 80% of all bladder cancers (Abel 1988;VanDer Meijde et al 1999). The primary approach for Ta and T1 tumors is transurethral resection of bladder tumor.…”

Section: Bladder Biopsymentioning

confidence: 99%

“…There are those who recommend the procedure (Lee et al 2009;Goldberg et al 2008;Cundiff & Bent 1996) and others who restrict it to patients with irritability symptoms together with macro or micro hematuria. In any event, the general consensus is to consider urethral cystoscopy the "gold standard" method to diagnose bladder cancer (Abel 1988;VanDer Meijde et al 1999). In our opinion, we must incorporate urethrocystoscopy into our protocol to examine patients suffering from: 1) mixed urinary incontinence, 2) hyperactive bladder, 3) macro or micro hematuria, 4) bladder or pelvic pain related with LUTS, 5) recurrent urinary tract infection, 6) urinary symptoms related with pelvic surgery, 7) bladder or urethral tenderness, 8) during pelvic surgery to exclude bladder or ureteral lesion.…”

Section: Overviewingmentioning

confidence: 99%