The Case for Early Cystectomy in the Treatment of Nonmuscle Invasive Micropapillary Bladder Carcinoma

Kamat, Ashish M.; Gee, Jason; Dinney, Colin P.; Grossman, H. Barton; Swanson, David A.; Millikan, Randall E.; Detry, Michelle A.; Robinson, Tracy L.; Pisters, Louis L.

doi:10.1016/s0022-5347(05)00423-4

Cited by 199 publications

(156 citation statements)

References 11 publications

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“…48,50 Other pathological features including lymphovascular invasion and divergent histologic features (for example, micropapillary or small cell carcinoma) can also negatively affect overall survival. [62][63][64] Clinicians, therefore, must use their judgement to account for these factors not included in the staging system. Given the inaccuracy of personal judgement, statistical methods and predictive models should be incorporated into clinical decisions.…”

Section: Pathologic Stagingmentioning

confidence: 99%

“…79,81 Micropapillary bladder carcinoma is a rare variant of urothelial carcinoma that closely resembles papillary serous carcinoma of the ovary, in which the predominant pattern consists of delicate filiform processes of tight infiltrating clusters of micropapillary aggregates without central vascular cores. 63 Micropapillary bladder carcinoma is an aggressive variant in which clinical understaging is common. 63 The optimal treatment for micropapillary urothelial carcinoma is unknown.…”

Section: Tumor Histologymentioning

confidence: 99%

See 1 more Smart Citation

Bladder Cancer in 2010: How Far have We Come?

Jacobs¹,

Lee

Montie

2010

CA: A Cancer Journal for Clinicians

298

275

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Bladder cancer is the fourth most common cancer and ranks eighth as a cause of death from cancer among men in the United States. Although guidelines assist in treatment, the art of managing bladder cancer, such as the decision to use neoadjuvant chemotherapy and the timing of cystectomy, is still variable. Bladder cancer has a propensity to recur, and with recurrence, a significant number of cases progress, which makes the early detection of high-risk patients imperative. Advances in detection, surveillance, and treatment of bladder cancer are reviewed in this article.

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Section: Pathologic Stagingmentioning

confidence: 99%

Section: Tumor Histologymentioning

confidence: 99%

Bladder Cancer in 2010: How Far have We Come?

Jacobs¹,

Lee

Montie

2010

CA: A Cancer Journal for Clinicians

298

275

View full text Add to dashboard Cite

show abstract

“…5,23 The mean patient age was 68 years (median 70 years, range 50-89 years). The majority of specimens were obtained after radical cystectomy with or without previous transurethral resection; four of the specimens were from transurethral resection alone (Table 1).…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…1 It is unclear whether the aggressive nature of micropapillary carcinoma is caused by its rapid growth rate or by its inherent biologically aggressive behavior. 5,6 Treatment options are usually limited to surgical removal of the bladder (cystectomy), as these tumors often demonstrate a poor response to intravesical treatment or chemotherapy. 1,5 As a result, other options for therapy are required to successfully address this lethal disease.…”

mentioning

confidence: 99%

HER2 gene amplification occurs frequently in the micropapillary variant of urothelial carcinoma: analysis by dual-color in situ hybridization

et al. 2011

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Human epidermal growth factor receptor-2 (HER2) is a well-recognized growth-promoting factor in cancer, although its application to urothelial carcinoma has been limited because of a low frequency of gene amplification. We evaluated HER2 protein expression and gene amplification in micropapillary carcinoma, a rare but highly aggressive variant of urothelial carcinoma by dual-color in situ hybridization. Gene amplification was defined by a HER2:CHR17 ratio of Z2.2; low and high levels of amplification were further defined as o2.5 and Z2.5, respectively. Immunohistochemistry was used to determine HER2 protein expression using the American Society of Clinical Oncology/College of American Pathologists Guidelines of HER2 staining. Protein expression, gene amplification, and chromosome 17 aneusomy were compared by Jonchkeere-Terpstra and Cochran-Armitage trend tests. In all, 19 of the 20 micropapillary carcinoma samples yielded usable dual-color in situ hybridization and immunohistochemistry results for evaluation. Overall, 68% (n ¼ 13) demonstrated HER2 protein expression of 2 þ to 3 þ staining. Gene amplification was present in 42% of samples (n ¼ 8), with 100% correlation with 2 þ and 3 þ protein expression. Gene amplification and protein expression were significantly associated (P ¼ 0.01). Overall, 53% of samples (n ¼ 10) had aneusomy of chromosome 17. Chromosome 17 aneusomy was present in approximately half of the samples evaluated, suggesting inherent genomic instability in this variant of urothelial carcinoma. However, increased HER2:CHR17 ratios demonstrate increased HER2 expression due to amplification in the majority of micropapillary carcinomas. These results suggest that HER2-targeted therapy may be successful on the genomic level in patients with this disease.

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“…Aberrant histologies such as micropapillary and sarcomatoid bladder carcinoma have either a reduced or an unknown response to common urothelial chemotherapy regimens. 23 Lack of efficacy would make the additional delay in surgery detrimental, so that primary radical cystectomy is preferred by most. Small cell carcinoma is an exception; it requires immediate multiagent chemotherapy.…”

Section: The Case Against Neoadjuvant Chemotherapymentioning

confidence: 99%

Perioperative chemotherapy for muscle-invasive bladder cancer

Black

2013

CUAJ

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Considerable debate exists concerning the combined use of systemic chemotherapy and radical surgery for muscle-invasive bladder cancer. While there is evidence for a survival benefit after neoadjuvant chemotherapy, the benefit is modest and the potential toxicity and delay of time to surgery prior to cystectomy appears to be deterring many surgeons from its administration. The evidence for adjuvant chemotherapy, on the other hand, is less compelling and substantial. Furthermore, the role of adjuvant compared to salvage chemotherapy requires further investigation. Similarly, research continues on identifying molecular and clinical markers to best stratify patients for optimal perioperative therapy. In this article, the evidence for radical cystectomy and chemotherapy, given either in a neoadjuvant or adjuvant setting, will be reviewed. Can Urol Assoc J 2009;3(Suppl4):S223-7T ransitional cell carcinoma of the bladder is chemosensitive, 1-3 but its use in the neoadjuvant and adjuvant settings combined with radical cystectomy remains controversial. Despite aggressive surgical management, up to 50% of patients with muscle-invasive bladder cancer will develop tumour recurrence, suggesting that a significant proportion of these patients have micro-metastases at the time of surgery. 4 Early application of multimodal therapy in bladder cancer is therefore an attractive paradigm.

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The Case for Early Cystectomy in the Treatment of Nonmuscle Invasive Micropapillary Bladder Carcinoma

Abstract: Intravesical BCG therapy appears to be ineffective against micropapillary UC. Our results suggest that the optimal treatment strategy for nonmuscle invasive micropapillary UC is radical cystectomy performed before progression.

Cited by 199 publications

References 11 publications

Bladder Cancer in 2010: How Far have We Come?

Bladder Cancer in 2010: How Far have We Come?

HER2 gene amplification occurs frequently in the micropapillary variant of urothelial carcinoma: analysis by dual-color in situ hybridization

Perioperative chemotherapy for muscle-invasive bladder cancer

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