Treatment of Muscle Invasive Bladder Cancer: Evidence From the National Cancer Database, 2003 to 2007

Fedeli, Ugo; Fedewa, Stacey A.; Ward, Elizabeth

doi:10.1016/j.juro.2010.09.015

Cited by 169 publications

(95 citation statements)

References 27 publications

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“…Despite the small sample size, which reflects the majority of medically operable patients with MIBC being offered radical surgery (2,32), the present study is one of the very few focused on chemosensitivity markers in BC treated with chemoradiotherapy. Kawashima et al (15) previously evaluated ERCC1 expression in a small and heterogeneous group of 22 patients treated with radiation and platinum agents.…”

Section: Discussionmentioning

confidence: 99%

Expression of ribonucleoside reductase subunit M1, but not excision repair cross-complementation group 1, is predictive in muscle-invasive bladder cancer treated with chemotherapy and radiation

Shilkrut

Thomas

et al. 2014

Molecular and Clinical Oncology

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Abstract. The aim of this study was to determine the prognostic and predictive values of ribonucleoside reductase subunit M1 (RRM1) and excision repair cross-complementation group 1 (ERCC1) expression in patients with muscle-invasive bladder cancer treated with chemoradiotherapy. The expression of RRM1 and ERCC1 in pretreatment tumor samples of retrospectively identified patients was determined by immunohistochemical analysis. A total of 39 patients were included in this study; 49% were treated with neoadjuvant chemotherapy and 67% with concomitant chemoradiotherapy; 56% were treated with gemcitabine-based and 51% with platinum-based chemoradiotherapy. The median follow-up was 19 months (interquartile range, 11-50 months). Based on the immunohistochemical analysis, 44 and 32% of the tumors exhibited increased expression of RRM1 and ERCC1, respectively. The complete response (CR) and local recurrence rates following chemoradiotherapy were 79 and 21%, respectively. A low expression of RRM1 was associated with a higher rate of CR to chemoradiotherapy (95 vs. 57%, P=0.012); however, there was no such association with low ERCC1 expression (67 vs. 84%, P=0.39). RRM1 expression predicted an improved CR in patients treated with gemcitabine-based chemoradiotherapy (57 vs. 100%, P=0.036), but not in those treated with other agents (56 vs. 88%, P=0.29). ERCC1 expression was not found to be correlated with CR (67 vs. 84%, P=0.39), even when restricted to patients treated with platinum agents (71 vs. 75%, P=1.0). In the univariate analysis, RRM1 expression, but not ERCC1 expression, was identified as a prognostic marker for worse cancer-specific survival in all the patients and in those treated with gemcitabine-based regimens. No independent prognostic factor was identified in the multivariate model, which included tumor stage, vascular invasion, hydronephrosis and RRM1 status. Although these findings require further validation, they suggest that RRM1 may be a beneficial stratification variable for the selection of chemotherapy regimens for chemoradiotherapy, with patients with low RRM1 expression being considered suitable for gemcitabine treatment. IntroductionMuscle-invasive bladder cancer (MIBC), which constitutes 30% of all bladder cancers (BCs), is responsible for an annual death toll of ~15,000 individuals in the United States (1). A viable treatment option for MIBC includes trimodality therapy with a combination of transurethral bladder resection (TURBT), chemotherapy and radiation (with cystectomy for failures), although this method has never been compared to radical cystectomy in randomized clinical trials. This type of treatment has achieved cure rates comparable to extirpative surgery, while preserving a functional bladder (2-4). This combined-modality approach is also a treatment of choice for several patients who may be unsuitable for surgery.Chemotherapy administered either sequentially or concomitantly with radiation is crucial for organ preservation in BC by improving local effectiveness (5-7) and increasing ...

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Section: Discussionmentioning

confidence: 99%

Expression of ribonucleoside reductase subunit M1, but not excision repair cross-complementation group 1, is predictive in muscle-invasive bladder cancer treated with chemotherapy and radiation

Shilkrut

Thomas

et al. 2014

Molecular and Clinical Oncology

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“…[43][44][45] There is an apparent underutilization of aggressive bladder-preserving therapies for noncystectomy candidates, especially the elderly and racial minorities. 46,47 Between 23% and 50% of patients with MIBC who are ≥65 years of age receive no treatment or nonaggressive therapy.…”

Section: Bladder Preservationmentioning

confidence: 99%

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Spiess¹,

Agarwal²,

Bangs³

et al. 2017

J Natl Compr Canc Netw

225

173

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OverviewAn estimated 79,030 new cases of urinary bladder cancer (60,490 men and 18,540 women) will be diagnosed in the United States in 2017 and approximately 16,870 deaths (12,240 men and 4630 women) will occur. Please NoteThe NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines Disclosures for the NCCN Bladder Cancer PanelAt the beginning of each NCCN Guidelines panel meeting, panel members review all potential conflicts of interest. NCCN, in keeping with its commitment to public transparency, publishes these disclosures for panel members, staff, and NCCN itself.Individual disclosures for the NCCN Bladder Cancer Panel members can be found on page 1267 (The most recent version of these guidelines and accompanying disclosures are available on the NCCN Web site at NCCN.org.)These guidelines are also available on the Internet. For the latest update, visit NCCN.org.

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“…18,23,26,27 Blacks are less likely to undergo definitive surgery, more likely to be treated by low-volume providers and in low-volume hospital settings, and more likely to experience adverse treatment-related outcomes. [28][29][30][31][32] While our data showed that black patients who accessed care were as equally likely as whites to undergo complete hematuria evaluations, our ability to identify differences in health system engagement between races is limited by the obvious selection bias inherent to claims data of insured individuals.…”

Section: Discussionmentioning

confidence: 82%

Gender, Race, and Variation in the Evaluation of Microscopic Hematuria Among Medicare Beneficiaries

et al. 2014

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Treatment of Muscle Invasive Bladder Cancer: Evidence From the National Cancer Database, 2003 to 2007

Abstract: Recent nationwide data confirm ongoing improvements in process of care measures in patients who undergo cystectomy but also show marked differences in treatment patterns for muscle invasive bladder cancer by patient age, race, insurance status, geographic area and facility type.

Cited by 169 publications

References 27 publications

Expression of ribonucleoside reductase subunit M1, but not excision repair cross-complementation group 1, is predictive in muscle-invasive bladder cancer treated with chemotherapy and radiation

Expression of ribonucleoside reductase subunit M1, but not excision repair cross-complementation group 1, is predictive in muscle-invasive bladder cancer treated with chemotherapy and radiation

Bladder Cancer, Version 5.2017, NCCN Clinical Practice Guidelines in Oncology

Gender, Race, and Variation in the Evaluation of Microscopic Hematuria Among Medicare Beneficiaries

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