Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought
Por:
Palou, J, Pisano, F, Sylvester, R, Joniau, S, Serretta, V, Larre, S, Di Stasi, S, van Rhijn, B, Witjes, AJ, Grotenhuis, A, Colombo, R, Briganti, A, Babjuk, M, Soukup, V, Malmstrom, PU, Irani, J, Malats, N, Baniel, J, Mano, R, Cai, T, Cha, EK, Ardelt, P, Varkarakis, J, Bartoletti, R, Dalbagni, G, Shariat, SF, Xylinas, E, Karnes, RJ, Gontero, P
Publicada:
1 oct 2018
Resumen:
PurposeThe goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG.MethodsIn our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model.ResultsDuring a median follow-up of 5.2years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P<0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P<0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen.ConclusionsPatients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.
Filiaciones:
Palou, J:
Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Pisano, F:
Univ Barcelona, Dept Urol, Fundacio Puigvert, Barcelona, Spain
Osped Citta Salute & Sci Molinette, Dept Urol, Corso Bramante 88, I-10126 Turin, Italy
Sylvester, R:
EORTC Headquarters, Dept Biostat, Brussels, Belgium
Joniau, S:
Univ Hosp Leuven, Oncol & Reconstruct Urol, Dept Urol, Louvain, Belgium
Serretta, V:
Univ Palermo, Dept Surg Oncol & Stomatol Sci, Palermo, Italy
Larre, S:
Univ Oxford, John Radcliffe Hosp, Dept Surg Sci, Oxford, England
Di Stasi, S:
Policlin Tor Vergata Univ Rome, Rome, Italy
van Rhijn, B:
Antoni van Leeuwenhoek Hosp, Netherlands Canc Inst, Dept Urol, Amsterdam, Netherlands
Witjes, AJ:
Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands
Grotenhuis, A:
Radboud Univ Nijmegen, Med Ctr, Dept Urol, Nijmegen, Netherlands
Colombo, R:
Univ Vita Salute, Osped S Raffaele, Dipartimento Urol, Milan, Italy
Briganti, A:
Univ Vita Salute, Osped S Raffaele, Dipartimento Urol, Milan, Italy
Babjuk, M:
Univ Praha, Motol Hosp, Dept Urol, Prague, Czech Republic
Soukup, V:
Univ Praha, Motol Hosp, Dept Urol, Prague, Czech Republic
Malmstrom, PU:
Uppsala Univ, Acad Hosp, Dept Urol, Uppsala, Sweden
Irani, J:
Univ Poitiers, Dept Urol, Ctr Hosp Univ Mil, Poitiers, France
Malats, N:
Spanish Natl Canc Res Ctr CNIO, Genet & Mol Epidemiol Grp, Madrid, Spain
Baniel, J:
Rabin Med Ctr, Dept Urol, Tel Aviv, Israel
Mano, R:
Rabin Med Ctr, Dept Urol, Tel Aviv, Israel
Cai, T:
Santa Chiara Hosp, Dept Urol, Trento, Italy
Cha, EK:
Cornell Univ, Weill Med Coll, Dept Urol, New York, NY 10021 USA
Ardelt, P:
Chirurg Univ Klin, Facharzt Urol, Urol Abt, Freiburg, Germany
Varkarakis, J:
Univ Athens, Sismanoglio Hosp, Dept Urol, Athens, Greece
Bartoletti, R:
Univ Florence, Dept Expt & Clin Med, Florence, Italy
Dalbagni, G:
Mem Sloan Kettering Canc Ctr, Dept Urol, 1275 York Ave, New York, NY 10021 USA
Shariat, SF:
Med Univ Vienna, Vienna, Austria
Xylinas, E:
Cochin Hosp, Dept Urol, Paris, France
Karnes, RJ:
Mayo Clin, Dept Urol, Rochester, MN USA
Gontero, P:
Osped Citta Salute & Sci Molinette, Dept Urol, Corso Bramante 88, I-10126 Turin, Italy
Green Published
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