Substratification of patients with highest‐risk non‐muscle invasive bladder cancer helps to identify the candidates for immediate radical cystectomy: A two‐center study

Abstract

Abbreviations & Acronyms AUC = area under the curve BCG = Bacillus Calmette-Gu erin CI = confidence interval CIS = carcinoma in situ DCA = decision curve analysis H&E = hematoxylin and eosin IQR = interquartile range iRC = immediate radical cystectomy LVI = lymphovascular invasion NMIBC = non-muscle invasive bladder cancer PFS = progression-free survival re-TURBt = repeat transurethral resection of bladder tumor RFS = recurrence-free survival ROC = receiver operating characteristic curve SD = standard deviation T1HG = T1 high grade TURBt = transurethral resection of bladder tumor VH = variant histology

Editorial Comment from Dr Ide to Substratification of patients with highest‐risk non‐muscle invasive bladder cancer helps to identify the candidates for immediate radical cystectomy: A two‐center study

“…Meanwhile, the present study appears to be beneficial to T1HG bladder cancer patients because those treated with BCG therapy were included. 5 This study showed that lymphovascular invasion, multiplicity, and the presence of carcinoma in situ were independent predictors of recurrence and progression in them. Moreover, patients with ≥2 risk factors were reported to have a significantly higher risk of recurrence and progression.…”

Editorial Comment from Dr Tellini et al. to Bladder cancer prospective cohort study on high‐risk non‐muscle invasive bladder cancer after photodynamic diagnosis‐assisted transurethral resection of the bladder tumor (BRIGHT study)

“…High-risk non-muscle-invasive bladder cancer (NMIBC) is a common and heterogeneous entity and it often represents a clinical dilemma for urologists due to need to balance the risk of recurrence and progression with the risk of overtreatment (i.e., early radical cystectomy). 1 Transurethral resection of bladder tumor (TURBT) is the standard diagnostic and therapeutic approach to NMIBC. Therefore, it is pivotal to always perform the most accurate procedure to achieve the most precise staging given its relevant impact on subsequent treatment decision-making.…”

“…High‐risk non‐muscle‐invasive bladder cancer (NMIBC) is a common and heterogeneous entity and it often represents a clinical dilemma for urologists due to need to balance the risk of recurrence and progression with the risk of overtreatment (i.e., early radical cystectomy) 1 …”

Editorial Comment from Dr Taoka and Dr Sugimoto to Substratification of patients withhighest‐risk non‐muscle invasive bladder cancer helps to identify the candidates for immediate radical cystectomy: A two‐center study

“…2 In fact, approximately 50% of T1G3 patients receiving BCG therapy develop recurrence, and a half of them face disease progression and require total cystectomy eventually. 3 Therefore, it is essential to identify the predictors of T1HG patients treated with BCG. However, to the best of our knowledge, only a few studies have investigated these predictors.…”

“…In this study, Tao et al . retrospectively evaluated 262 patients with high‐grade primary T1 bladder cancer and found that multiple tumors, concomitant carcinoma in situ, and lymphovascular invasion were significantly associated with recurrence and progression of cancer using multivariable Cox analysis 3 . The authors also predict that patients with two or three risk factors would have poor progression‐free survival and strongly recommend immediate RC for these patients.…”