Francesco Soria1, Francesca Pisano2,3, Paolo Gontero4, J Palou5, S Joniau6, V Serretta7, S Larré8, S Di Stasi9, B van Rhijn10, J A Witjes11, A Grotenhuis11, R Colombo12, A Briganti12, M Babjuk13, V Soukup13, P U Malmstrom14, J Irani15, N Malats16, J Baniel17, R Mano17, T Cai18, E Cha19, P Ardelt20, J Varkarakis21, R Bartoletti22, G Dalbagni23, S F Shariat1, E Xylinas24, R J Karnes25, R Sylvester26. 1. Department of Urology, Medical University of Vienna, Vienna, Austria. 2. Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy. francescapisano85@gmail.com. 3. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. francescapisano85@gmail.com. 4. Città della Salute e della Scienza di Torino, University of Studies of Turin, Turin, Italy. 5. Department of Urology, Fundacio Puigvert, University of Barcelona, Barcelona, Spain. 6. Oncologic and Reconstructive Urology, Department of Urology, University Hospitals Leuven, Louvain, Belgium. 7. Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy. 8. Department of Surgical Science, John Radcliffe Hospital, University of Oxford, Oxford, UK. 9. Policlinico Tor Vergata-University of Rome, Rome, Italy. 10. Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. 11. Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 12. Dipartimento di Urologia, Università Vita-Salute. Ospedale S. Raffaele, Milan, Italy. 13. Department of Urology, Motol Hospital, University of Praha, Prague, Czech Republic. 14. Department of Urology, Academic Hospital, Uppsala University, Uppsala, Sweden. 15. Department of Urology, CHU de Bicêtre, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France. 16. Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Centre (CNIO), Madrid, Spain. 17. Department of Urology, Rabin Medical Centre, Tel Aviv, Israel. 18. Department of Urology, Santa Chiara Hospital, Trento, Italy. 19. Department of Urology, Weill Medical College of Cornell University in New York City, New York, NY, USA. 20. Facharzt fur Urologie, Abteilung fur Urologie, Chirurgische Universitats klinik, Freiburg, Germany. 21. Department of Urology, Sismanoglio Hospital, University of Athens, Athens, Greece. 22. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy. 23. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 24. Department of Urology, Cochin Hospital, Paris, France. 25. Department of Urology, Mayo Clinic, Rochester, MN, USA. 26. Formerly Department of Biostatistics, EORTC Headquarters, Brussels, Belgium.
Abstract
PURPOSE: To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG. METHODS: According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups. RESULTS: Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS: Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.
PURPOSE: To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG. METHODS: According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups. RESULTS: Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS:Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery.
Entities:
Keywords:
Bladder cancer; Cystectomy; Extravesical disease; High risk; Outcomes; T1G3
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