Matteo Ferro1, Mihai Dorin Vartolomei1,2,3, Francesco Cantiello4, Giuseppe Lucarelli5, Savino M Di Stasi6, Rodolfo Hurle7, Giorgio Guazzoni7, Gian Maria Busetto8, Ettore De Berardinis8, Rocco Damiano4, Sisto Perdonà9, Marco Borghesi10, Riccardo Schiavina10, Gilberto L Almeida11, Pierluigi Bove12, Estevao Lima13, Giovanni Grimaldi13, Riccardo Autorino14, Nicolae Crisan15, Abdal Rahman Abu Farhan4, Paolo Verze16, Michele Battaglia5, Vincenzo Serretta17, Giorgio Ivan Russo18, Giuseppe Morgia18, Gennaro Musi1, Ottavio de Cobelli1,19, Vincenzo Mirone16, Shahrokh F Shariat2,20,21,22. 1. Division of Urology, European Institute of Oncology, Milan, Italy. 2. Department of Urology, Medical University of Vienna, Vienna, Austria. 3. Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania. 4. Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy. 5. Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy. 6. Department of Experimental Medicine and Surgery, Tor Vegata University, Rome, Italy. 7. Department of Urology, Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Humanitas University, Department of Biomedical Science, Milan, Italy. 8. Department of Urology, Sapienza University of Rome, Rome, Italy. 9. Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale"-IRCCS, Naples, Italy. 10. Department of Urology, University of Bologna, Bologna, Italy. 11. Departamento de Urologia, University of Vale do Itajai, Itajai, Brazil. 12. UOC of Urology Department of Experimental Medicine and Surgery, Tor Vergata University of Rome, Rome, Italy. 13. Life and Health Sciences Research Institute, University of Minho, Braga, Portugal. 14. Division of Urology, Virginia Commonwealth University, Richmond, Virginia, USA. 15. Department of Urology, University of Medicine and Pharmacy "Iuliu Hațeganu", Cluj-Napoca, Romania. 16. Department of Neurosciences, Sciences of Reproduction and Odontostomatology, Urology Unit, University of Naples "Federico II", Naples, Italy. 17. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy. 18. Department of Surgery, Urology Section, University of Catania, Catania, Italy. 19. Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy. 20. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. 21. Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA. 22. Department of Urology, Weill Cornell Medical College, New York, New York, USA.
Abstract
INTRODUCTION: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC). PATIENTS AND METHODS: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death. RESULTS: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses. CONCLUSIONS: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.
INTRODUCTION: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC). PATIENTS AND METHODS: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death. RESULTS: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses. CONCLUSIONS: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.
Authors: Mihaela Georgiana Musat; Christina Soeun Kwon; Elizabeth Masters; Slaven Sikirica; Debduth B Pijush; Anna Forsythe Journal: Clinicoecon Outcomes Res Date: 2022-01-10