Paolo Gontero1, Richard Sylvester2, Francesca Pisano3, Steven Joniau4, Kathy Vander Eeckt4, Vincenzo Serretta5, Stéphane Larré6, Savino Di Stasi7, Bas Van Rhijn8, Alfred J Witjes9, Anne J Grotenhuis9, Lambertus A Kiemeney9, Renzo Colombo10, Alberto Briganti10, Marek Babjuk11, Per-Uno Malmström12, Marco Oderda3, Jacques Irani13, Nuria Malats14, Jack Baniel15, Roy Mano15, Tommaso Cai16, Eugene K Cha17, Peter Ardelt18, John Varkarakis19, Riccardo Bartoletti20, Martin Spahn21, Robert Johansson22, Bruno Frea3, Viktor Soukup23, Evanguelos Xylinas24, Guido Dalbagni25, R Jeffrey Karnes26, Shahrokh F Shariat27, Joan Palou28. 1. Department of Surgical Sciences, Molinette Hospital, University of Studies of Turin, Turin, Italy. Electronic address: paolo.gontero@unito.it. 2. EORTC Headquarters, Brussels, Belgium. 3. Department of Surgical Sciences, Molinette Hospital, University of Studies of Turin, Turin, Italy. 4. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Leuven, Belgium. 5. Department of Urology, Paolo Giaccone General Hospital, Palermo, Italy. 6. Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK. 7. Policlinico Tor Vergata-University of Rome, Rome, Italy. 8. Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 9. Department of Urology and Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands. 10. Dipartimento di Urologia, Università Vita-Salute, Ospedale S. Raffaele, Milan, Italy. 11. Department of Urology, Motol Hospital, 2nd Faculty of Medicine, Charles, University of Prague, Prague, Czech Republic. 12. Department of Surgical Sciences, Uppsala University, Uppsala, Sweden. 13. Department of Urology, Centre Hospitalier Universitaire La Milétrie, University of Poitiers, Poitiers, France. 14. Department of Urology, Spanish National Cancer Research Centre-Madrid, Madrid, Spain. 15. Institute of Urology, Rabin Medical Center, Petach Tikva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 16. Department of Urology, Santa Chiara Hospital, Trento, Italy. 17. Department of Urology, Weill Medical College of Cornell University, New York, NY, USA, and Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 18. Facharzt fur Urologie, Abteilung fur Urologie, Chirurgische Universitatsklinik, Freiburg, Germany. 19. Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece. 20. Urology Unit, S. Maria Annunziata Hospital, University of Florence, Florence, Italy. 21. Department of Urology, University Hospital of Wuerzburg, Wuertzburg, Germany. 22. Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden. 23. Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University in Praha, Praha, Czech Republic. 24. Cochin Hospital, Paris Descartes University, Paris, France. 25. Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 26. Department of Urology, Mayo Clinic, Rochester, MN, USA. 27. Department of Urology, Comprehensive Cancer Center Medical University Vienna, Vienna, Austria. 28. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: The impact of prognostic factors in T1G3 non-muscle-invasive bladder cancer (BCa) patients is critical for proper treatment decision making. OBJECTIVE: To assess prognostic factors in patients who received bacillus Calmette-Guérin (BCG) as initial intravesical treatment of T1G3 tumors and to identify a subgroup of high-risk patients who should be considered for more aggressive treatment. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data were collected for 2451 T1G3 patients from 23 centers who received BCG between 1990 and 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Using Cox multivariable regression, the prognostic importance of several clinical variables was assessed for time to recurrence, progression, BCa-specific survival, and overall survival (OS). RESULTS AND LIMITATIONS: With a median follow-up of 5.2 yr, 465 patients (19%) progressed, 509 (21%) underwent cystectomy, and 221 (9%) died because of BCa. In multivariable analyses, the most important prognostic factors for progression were age, tumor size, and concomitant carcinoma in situ (CIS); the most important prognostic factors for BCa-specific survival and OS were age and tumor size. Patients were divided into four risk groups for progression according to the number of adverse factors among age ≥ 70 yr, size ≥ 3 cm, and presence of CIS. Progression rates at 10 yr ranged from 17% to 52%. BCa-specific death rates at 10 yr were 32% in patients ≥ 70 yr with tumor size ≥ 3 cm and 13% otherwise. CONCLUSIONS: T1G3 patients ≥ 70 yr with tumors ≥ 3 cm and concomitant CIS should be treated more aggressively because of the high risk of progression. PATIENT SUMMARY: Although the majority of T1G3 patients can be safely treated with intravesical bacillus Calmette-Guérin, there is a subgroup of T1G3 patients with age ≥ 70 yr, tumor size ≥ 3 cm, and concomitant CIS who have a high risk of progression and thus require aggressive treatment.
BACKGROUND: The impact of prognostic factors in T1G3 non-muscle-invasive bladder cancer (BCa) patients is critical for proper treatment decision making. OBJECTIVE: To assess prognostic factors in patients who received bacillus Calmette-Guérin (BCG) as initial intravesical treatment of T1G3 tumors and to identify a subgroup of high-risk patients who should be considered for more aggressive treatment. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data were collected for 2451 T1G3 patients from 23 centers who received BCG between 1990 and 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Using Cox multivariable regression, the prognostic importance of several clinical variables was assessed for time to recurrence, progression, BCa-specific survival, and overall survival (OS). RESULTS AND LIMITATIONS: With a median follow-up of 5.2 yr, 465 patients (19%) progressed, 509 (21%) underwent cystectomy, and 221 (9%) died because of BCa. In multivariable analyses, the most important prognostic factors for progression were age, tumor size, and concomitant carcinoma in situ (CIS); the most important prognostic factors for BCa-specific survival and OS were age and tumor size. Patients were divided into four risk groups for progression according to the number of adverse factors among age ≥ 70 yr, size ≥ 3 cm, and presence of CIS. Progression rates at 10 yr ranged from 17% to 52%. BCa-specific death rates at 10 yr were 32% in patients ≥ 70 yr with tumor size ≥ 3 cm and 13% otherwise. CONCLUSIONS: T1G3 patients ≥ 70 yr with tumors ≥ 3 cm and concomitant CIS should be treated more aggressively because of the high risk of progression. PATIENT SUMMARY: Although the majority of T1G3 patients can be safely treated with intravesical bacillus Calmette-Guérin, there is a subgroup of T1G3 patients with age ≥ 70 yr, tumor size ≥ 3 cm, and concomitant CIS who have a high risk of progression and thus require aggressive treatment.
Authors: J Alfred Witjes; Guido Dalbagni; Robert J Karnes; Shahrokh Shariat; Steven Joniau; Joan Palou; Vincenzo Serretta; Stéphane Larré; Savino di Stasi; Renzo Colombo; Marek Babjuk; Per-Uno Malmström; Nuria Malats; Jacques Irani; Jack Baniel; Tommaso Cai; Eugene Cha; Peter Ardelt; John Varkarakis; Riccardo Bartoletti; Martin Spahn; Francesca Pisano; Paolo Gontero; Richard Sylvester Journal: Urol Oncol Date: 2016-09-14 Impact factor: 3.498
Authors: Paolo Gontero; Richard Sylvester; Francesca Pisano; Steven Joniau; Marco Oderda; Vincenzo Serretta; Stéphane Larré; Savino Di Stasi; Bas Van Rhijn; Alfred J Witjes; Anne J Grotenhuis; Renzo Colombo; Alberto Briganti; Marek Babjuk; Viktor Soukup; Per-Uno Malmström; Jacques Irani; Nuria Malats; Jack Baniel; Roy Mano; Tommaso Cai; Eugene K Cha; Peter Ardelt; John Vakarakis; Riccardo Bartoletti; Guido Dalbagni; Shahrokh F Shariat; Evanguelos Xylinas; Robert J Karnes; Joan Palou Journal: BJU Int Date: 2015-11-06 Impact factor: 5.588
Authors: Francesco Soria; Francesca Pisano; Paolo Gontero; J Palou; S Joniau; V Serretta; S Larré; S Di Stasi; B van Rhijn; J A Witjes; A Grotenhuis; R Colombo; A Briganti; M Babjuk; V Soukup; P U Malmstrom; J Irani; N Malats; J Baniel; R Mano; T Cai; E Cha; P Ardelt; J Varkarakis; R Bartoletti; G Dalbagni; S F Shariat; E Xylinas; R J Karnes; R Sylvester Journal: World J Urol Date: 2018-08-31 Impact factor: 4.226
Authors: François Audenet; Caitlyn Retinger; Christine Chien; Nicole E Benfante; Bernard H Bochner; S Machele Donat; Harry W Herr; Guido Dalbagni Journal: Urol Oncol Date: 2017-07-06 Impact factor: 3.498
Authors: J Palou; F Pisano; R Sylvester; S Joniau; V Serretta; S Larré; S Di Stasi; B van Rhijn; A J Witjes; A Grotenhuis; R Colombo; A Briganti; M Babjuk; V Soukup; P U Malmstrom; J Irani; N Malats; J Baniel; R Mano; T Cai; E K Cha; P Ardelt; J Varkarakis; R Bartoletti; G Dalbagni; S F Shariat; E Xylinas; R J Karnes; P Gontero Journal: World J Urol Date: 2018-05-02 Impact factor: 4.226
Authors: Valeria Panebianco; Yoshifumi Narumi; Ersan Altun; Bernard H Bochner; Jason A Efstathiou; Shaista Hafeez; Robert Huddart; Steve Kennish; Seth Lerner; Rodolfo Montironi; Valdair F Muglia; Georg Salomon; Stephen Thomas; Hebert Alberto Vargas; J Alfred Witjes; Mitsuru Takeuchi; Jelle Barentsz; James W F Catto Journal: Eur Urol Date: 2018-05-10 Impact factor: 20.096