Rodolfo Hurle1, Massimo Lazzeri2, Elena Vanni3, Giovanni Lughezzani1, NicolòMaria Buffi1, Paolo Casale1, Alberto Saita1, Emanuela Morenghi4, Giovanni Forni1, Pasquale Cardone1, Giuliana Lista1, Piergiuseppe Colombo5, Roberto Peschechera1, Luisa Pasini1, Silvia Zandegiacomo1, Alessio Benetti1, Davide Maffei1, Ivano Vavassori6, Giorgio Guazzoni7. 1. Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy. 2. Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy. Electronic address: massimo.lazzeri@humanitas.it. 3. Business Operations Office, Humanitas Clinical and Research Center, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy. 4. Department of Biostatistics, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy. 5. Department of Pathology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy. 6. Department of Urology, Ospedale di Treviglio, Bergamo, Italy. 7. Department of Urology, Istituto Clinico Humanitas Istituto di Ricovero e Cura a Carattere Scientifico-Clinical and Research Hospital, Milan, Italy; Business Operations Office, Humanitas Clinical and Research Center, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy.
Abstract
PURPOSE: We investigated predictive factors of failure and performed a resource consumption analysis in patients who underwent active surveillance for nonmuscle invasive bladder cancer. MATERIALS AND METHODS: This prospective observational study monitored patients with a history of pathologically confirmed stage pTa (grade 1-2) or pT1a (grade 2) nonmuscle invasive bladder cancer, and recurrent small size and number of tumors without hematuria and positive urine cytology. The primary end point was the failure rate of active surveillance. Assessment of failure predictive variables and per year direct hospital resource consumption analysis were secondary outcomes. Descriptive statistical analysis and Cox regression with univariable and multivariable analysis were done. RESULTS: Of 625 patients with nonmuscle invasive bladder cancer 122 with a total of 146 active surveillance events were included in the protocol. Of the events 59 (40.4%) were deemed to require treatment after entering active surveillance. Median time on active surveillance was 11 months (IQR 5-26). Currently 76 patients (62.3%) remain under observation. On univariable analysis only time from the first transurethral resection to the start of active surveillance seemed to be inversely associated with recurrence-free survival (HR 0.99, 95% CI 0.98-1.00, p = 0.027). Multivariable analysis also revealed an association with age at active surveillance start (HR 0.97, 95% CI 0.94-1.00, p = 0.031) and the size of the lesion at the first transurethral resection (HR 1.55, 95% CI 1.06-2.27, p = 0.025). The average specific annual resource consumption savings for each avoided transurethral bladder tumor resection was €1,378 for each intervention avoided. CONCLUSIONS: Active surveillance might be a reasonable clinical and cost-effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumors.
PURPOSE: We investigated predictive factors of failure and performed a resource consumption analysis in patients who underwent active surveillance for nonmuscle invasive bladder cancer. MATERIALS AND METHODS: This prospective observational study monitored patients with a history of pathologically confirmed stage pTa (grade 1-2) or pT1a (grade 2) nonmuscle invasive bladder cancer, and recurrent small size and number of tumors without hematuria and positive urine cytology. The primary end point was the failure rate of active surveillance. Assessment of failure predictive variables and per year direct hospital resource consumption analysis were secondary outcomes. Descriptive statistical analysis and Cox regression with univariable and multivariable analysis were done. RESULTS: Of 625 patients with nonmuscle invasive bladder cancer 122 with a total of 146 active surveillance events were included in the protocol. Of the events 59 (40.4%) were deemed to require treatment after entering active surveillance. Median time on active surveillance was 11 months (IQR 5-26). Currently 76 patients (62.3%) remain under observation. On univariable analysis only time from the first transurethral resection to the start of active surveillance seemed to be inversely associated with recurrence-free survival (HR 0.99, 95% CI 0.98-1.00, p = 0.027). Multivariable analysis also revealed an association with age at active surveillance start (HR 0.97, 95% CI 0.94-1.00, p = 0.031) and the size of the lesion at the first transurethral resection (HR 1.55, 95% CI 1.06-2.27, p = 0.025). The average specific annual resource consumption savings for each avoided transurethral bladder tumor resection was €1,378 for each intervention avoided. CONCLUSIONS: Active surveillance might be a reasonable clinical and cost-effective strategy in patients who present with small, low grade pTa/pT1a recurrent papillary bladder tumors.
Authors: Vittorio Fasulo; Marco Paciotti; Massimo Lazzeri; Roberto Contieri; Paolo Casale; Alberto Saita; Giovanni Lughezzani; Pietro Diana; Nicola Frego; Pier Paolo Avolio; Piergiuseppe Colombo; Grazia Maria Elefante; Giorgio Guazzoni; Nicolò Maria Buffi; Michael Bates; Rodolfo Hurle Journal: Front Oncol Date: 2022-01-27 Impact factor: 6.244
Authors: Tullika Garg; Amanda J Young; Maureen O'Keeffe-Rosetti; Carmit K McMullen; Matthew E Nielsen; H Lester Kirchner; Terrence E Murphy Journal: Cancer Date: 2018-10-05 Impact factor: 6.921
Authors: Matteo Ferro; Evelina La Civita; Antonietta Liotti; Michele Cennamo; Fabiana Tortora; Carlo Buonerba; Felice Crocetto; Giuseppe Lucarelli; Gian Maria Busetto; Francesco Del Giudice; Ottavio de Cobelli; Giuseppe Carrieri; Angelo Porreca; Amelia Cimmino; Daniela Terracciano Journal: J Pers Med Date: 2021-03-23