Recurrence and Progression of Stage T1, Grade 3 Transitional Cell Carcinoma of the Bladder Following Intravesical Immunotherapy With Bacillus Calmette-Guerin

Brake, M.; Loertzer, Hagen; Horsch, R; Keller, H.

doi:10.1097/00005392-200006000-00015

Cited by 21 publications

(28 citation statements)

References 34 publications

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“…The recurrence and progression rates observed in our series were comparable with those observed by others [29] ( table 5 ). A significant proportion of our patients, including the pT1 G3 patients, were tumor-free following the full course of BCG.…”

Section: Tumors Before Treatmentsupporting

confidence: 92%

“…Lifelong meticulous surveillance is mandatory for these patients. Reported series of BCG intravesical immunotherapy for pT1 bladder cancer [29] …”

Section: Discussionmentioning

confidence: 99%

“…This is confirmed in our study. The intra-and interindividual differences in the validity of bladder carcinoma grading may explain differences in recurrence (20-53%) and progression (0-28%) rates [29] . It is likely that some of the pT1 G2 bladder cancer tumors are pT1 G3 and vice versa.…”

Section: Tumors Before Treatmentmentioning

confidence: 99%

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Intravesical Bacillus Calmette-Guérin Therapy for T1 Superficial Bladder Cancer

Demkow¹,

Alter

Wiechno³

2008

Urol Int

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Introduction: The management of transitional bladder cancer, which invades the lamina propria (pT1) and has a marked propensity for recurrence and progression, is controversial. Without adjuvant treatment the recurrence rate can be up to 80% and progression up to 50%. We retrospectively analyzed the incidence of recurrence and progression of pT1 transitional bladder cancer (grade 1–3) after complete transurethral resection of a bladder tumor (TURBT) and adjuvant immunotherapy with bacillus Calmette-Guérin (BCG). Materials and Methods: 77 patients with stage pT1 transitional cell carcinoma underwent TURBT of all visible tumors and adjuvant BCG intravesical instillations. Before BCG therapy, 12 patients presented with stage pT1 G1 tumors, 50 presented with pT1, and 15 with pT1 G3 tumors. Results: 51 patients (66.2%) were disease-free throughout the BCG instillation and follow-up period (median of 45 months); 8 patients (10.4%) experienced recurrence during the BCG instillations, but were disease-free following the last instillation; 16 patients (20.8%) experienced recurrence at a median of 17 months, and 2 patients (2.6%) with pT1 G3 died because of progression. Conclusions: Adjuvant intravesical BCG therapy following TURBT appears to be an effective primary treatment for patients with pT1 transitional cell carcinoma.

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Section: Tumors Before Treatmentsupporting

confidence: 92%

“…Lifelong meticulous surveillance is mandatory for these patients. Reported series of BCG intravesical immunotherapy for pT1 bladder cancer [29] …”

Section: Discussionmentioning

confidence: 99%

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Intravesical Bacillus Calmette-Guérin Therapy for T1 Superficial Bladder Cancer

Demkow¹,

Alter

Wiechno³

2008

Urol Int

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“…High grade pT1 bladder neoplasm (pT1HG) really represents a therapeutic challenge due to the high risk of progression (about 15-30%) to muscle-invasive disease, usually within 5 years (6). However, no consensus exists regarding the treatment of patients with recurrent bladder tumours that invade the lamina propria (pT1) (7)(8)(9). Recent studies suggested that the first cTURBT may be incomplete in a significant number of cases (10).…”

Section: Introductionmentioning

confidence: 99%

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

Giulianelli¹,

Gentile²,

Mirabile³

et al. 2017

Arch Ital Urol Androl

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Introduction: Understaging after initial transurethral resection is common in patients with high-risk non muscle infiltrating bladder cancer (NMIBC) and can delay accurate diagnosis and definitive treatment. The rate of upstaging from T1 to T2 disease after repeated transurethral resection ranges from 0 to 28%, although the rate of upstaging may be even higher up to 49% when muscularis propria is absent in the first specimen. A restaging classic transurethral resection of bladder tumour (re-cTURBT) is the better predictor of early stage progression. According to some reports, the rate of positivity for tumor in re-cTURBT performed within eight weeks after initial cTURBT was as high as 18-77%, and in about 40% of the patients a change in tumor stage was reported. We aimed to investigate, in high risk group, the presence of residual tumor following white light classical transurethral resection of bladder tumor (WLre-cTURBT) and the different recurrence and progression rate between patients with persistent or negative (pT0) oncological disease after WLre-cTURBT. Materials and methods: A cohort of 285 patients presenting with primitive bladder cancer underwent to WLcTURBT from January 2011 to December 2015; out of them 92 (32.28%) were T1HG. In according to EAU guidelines 2011, after 4-6 weeks all HG bladder cancer patients underwent a WL recTURBT . All patients were submitted to a subsequent followup including cystoscopy every 3 months with multiple biopsies, randomly and in the previous zone of resection; urinary citology on 3 specimens and kidney/bladder ultrasound every 6 months. The average follow-up was 48 months. Results: Following WLre-cTURBT we observed a persistent disease in 18 (15.2%) patients: 14 (77.7%) with a HG-NMIBC and 4 (22.2%) with a high grade (HG) muscle invasive bladder cancer (pT2HG). After follow up of all 92 patients according to the guidelines EAU, we observed recurrence in 36/92 (39.1%) and progression in 14/92 (15.2%). Of 14 NMIBC with persistent disease, 10 patients (71.4%) showed recurrence: 4 patients (40%) were pT1HG with concomitant carcinoma in situ (CIS), 3 patients (30%) multifocal pTaHG, 2 (20%) patients CIS and one patient (10%) a muscle invasive neoplasm (pT2HG). Instead of the group of 48 patients pT0 following WL recTURBT, we observed recurrence in 26 patients (54.1%) and in two patients (4.1%) progressions, who presented after 3 months in association with CIS. The remaining 22 patients (45.9%) with initial pT1HG are still progression free. Multivariate analysis showed that the most important variable of early progression were persistent neoplasm and histopathological findings at WLre-cTURBt (p = 0.01), followed by the Summary No conflict of interest declared. INTRODUCTION Bladder cancer is a common genito-urinary malignancy, with transitional cell carcinoma comprising nearly 90% of all primary bladder tumours. At the first diagnosis 70% to 80% of urothelial tumours are confined to the epithelium, the remainder is characterized by muscle invasion. A significant number of patients with high risk non-muscle invasive bladder tumours (HG-NMIBT) treated with white light classic transurethral resection of bladder tumours (WLcTURBT) and intravesical BCG will progress to invasive disease (1-3). Progression to muscle invasion (pT2) mandates immediate radical cystectomy (4). WLcTURBT is the standard initial therapy for NMIBT, but the high percentage of recurrence after surgery is still an unresolved problem (5). High grade pT1 bladder neoplasm (pT1HG) really represents a therapeutic challenge due to the high risk of progression (about 15-30%) to muscle-invasive disease, usually within 5 years (6). However, no consensus exists regarding the treatment of patients with recurrent bladder tumours that invade the lamina propria (pT1) (7-9). Recent studies suggested that the first cTURBT may be incomplete in a significant number of cases (10). Understaging at the time of the initial transurethral resection is common for patients with high-risk NMIBC and can delay accurate diagnosis and definitive treatment. It is therefore recommended for patients with high-risk disease and in those with large or multiple tumors or when the initial transurethral resection is incomplete, to repeat WLre-cTURBT within 2-6 DOI: 10.4081/aiua.2017.4.272 result of the first cystoscopy (p = 0.002) and presence of CIS (p = 0.02). Discussion: Following WLre-cTURBt in HG-NMIBC patients we identified in 15% of cases a persistent disease with a 4.3% of MIBC. In the high risk persistent bladder neoplasms group we observed recurrent and progression rate higher than in T0 bladder tumours group (Δ = + 17.3% and = Δ + 62.5%, p < 0.05

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“…The goal of BCG therapy is to eradicate the disease and to inhibit tumor recurrence and prevent the progression of cancer (4)(5)(6). Although used in large number of patients, the immunotherapy mechanism of action of BCG has remained a black box for three decades.…”

Section: Introductionmentioning

confidence: 99%

Dendritic cells in blood and urine samples from bladder cancer patients undergoing BCG immunotherapy

Rossi¹,

Lichtner²,

Iori

et al. 2013

Arch Ital Urol Androl

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Objectives: Immunotherapy with BCG (Bacille Calmette-Guérin) after transurethral resection of the bladder tumor represents a highly effective primary treatment for intermediate and high-risk superficial bladder cancer. The effectiveness of this therapy has been documented, but its mechanism of action is not clear yet. In the present study, we investigated the changes of dendritic cells (DC) numbers in peripheral blood and urine of patients with superficial bladder cancer undergoing BCG intravescical therapy Material and method: We have enumerated plasmacytoid and myeloid DCs in the peripheral blood and in the urine of patients with bladder cancer in order to clarify the role of these cells in the evolution of the disease and the effect of therapy. DCs in blood and urine samples were assessed using the single-platform TruCOUNT assay with monoclonal antibodies. The study population included 37 healthy donors and 13 patients with diagnosis of primitive superficial bladder cancer. Results: At the time of diagnosis a reduction of blood DCs was found in patients as opposed to healthy donors, while DCs were not found in the urine in the same way as in healthy subjects. Six of these patients were followed before and after weekly and monthly instillations of BCG. In the peripheral blood, we observed an immunological recovery of DCs from the third weekly instillation up to the sixth. In the urine of patients, we didn't find mDCs or pDCs at T0, but we found a statistically significant change from the third instillation up to the sixth. On the contrary, we didn't find mDCs in urine during monthly instillation. Conclusions: DC Count could be used in the monitoring of patients undergoing BCG therapy. Immunological restoration of mDC numbers in peripheral blood and the efflux in urine could be important for confirming the effectiveness of BCG instillation.

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Recurrence and Progression of Stage T1, Grade 3 Transitional Cell Carcinoma of the Bladder Following Intravesical Immunotherapy With Bacillus Calmette-Guerin

Abstract: Adjuvant immunotherapy with BCG after complete transurethral resection of bladder tumor represents a highly effective primary treatment of stage pT1, grade 3 carcinoma of the bladder. Immediate radical cystectomy does not appear necessary.

Cited by 21 publications

References 34 publications

Intravesical Bacillus Calmette-Guérin Therapy for T1 Superficial Bladder Cancer

Intravesical Bacillus Calmette-Guérin Therapy for T1 Superficial Bladder Cancer

Can re-cTURBT be useful in pT1HG disease as a risk indicator of recurrence and progression? A single centre experience

Dendritic cells in blood and urine samples from bladder cancer patients undergoing BCG immunotherapy

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