scholarly journals Predictors of Outcome of Non–Muscle-Invasive and Muscle-Invasive Bladder Cancer

2011 ◽  
Vol 11 ◽  
pp. 369-381 ◽  
Author(s):  
Ramy F. Youssef ◽  
Yair Lotan
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Predictive Accuracy ◽  
Staging System ◽  
Tumor Grade ◽  
Invasive Disease ◽  
Tnm Staging ◽  
High Rate ◽  
Recurrence Rates ◽  
Muscle Invasive

Bladder cancer is a major cause of morbidity and mortality. At initial diagnosis, 75% of patients present with non–muscle-invasive disease and 25% of patients have muscle-invasive or metastatic disease.Patients with noninvasive disease suffer from a high rate of recurrence and 10–30% will have disease progression. Patients with muscle-invasive disease are primarily treated with radical cystectomy, but frequently succumb to their disease despite improvements in surgical technique. In non–muscle-invasive disease, multiplicity, tumor size, and prior recurrence rates are the most important predictors for recurrence, while tumor grade, stage, and carcinomain situare the most important predictors for progression. The most common tool that clinicians use to predict outcomes after radical cystectomy is still the tumor-node-metastasis (TNM) staging system, with lymph node involvement representing the most important prognostic factor. However, the predictive accuracy of staging and grading systems are limited, and nomograms incorporating clinical and pathologic factors can improve prediction of bladder cancer outcomes. One limitation of current staging is the fact that tumors of a similar stage and grade can have significantly different biology. The integration of molecular markers, especially in a panel approach, has the potential to further improve the accuracy of predictive models and may also identify targets for therapeutic intervention or patients who will respond to systemic therapies.

Neoadjuvant accelerated MVAC therapy in bladder cancer: toxicity and efficacy correlation

2015 ◽  
Vol 3 (4) ◽  
pp. 582-594
Author(s):  
William M. Grabstald ◽  
Richard H. Sarkis ◽  
Chrisophos A. Jacobus ◽  
Smith V. Feifer
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Cancer Staging ◽  
Invasive Disease ◽  
Fourth Edition ◽  
Muscle Invasive Bladder Cancer ◽  
Common Cancer ◽  
Node Metastases ◽  
Grade 3 ◽  
Muscle Invasive

Bladder cancer is the second most common cancer of the genitourinary tract. Radical cystectomy is considered the gold standard of treatment for patients with localized muscle-invasive disease (MIBC), although chemoradiotherapy protocols using neoadjuvant cisplatin-based chemotherapy is used for muscle-invasive bladder cancer. We explored the toxicity and efficacy of neoadjuvant AMVAC in MIBC. A total of 177 patients with clinical tumor–node–metastases (TNM) stage T2N0M0 to T4aN0M0 bladder cancer who were candidates for radical cystectomy were eligible, tumors were staged according to the criteria in the fourth edition of the American Joint Committee on Cancer staging manual. Grade ≥ 2 toxicities were observed in 8% of patients, with grade 3 and 4 neutropenia in 7% and 5% patients, respectively; grade 3 and 4 anemia in 4% and 2% of patients, respectively; no patients died of drug toxicity; 61% of patients were accrued; 16% were down-staged to non–muscle invasive disease. Further, 31% showing pT0 at cystectomy and the median survival was 16.9 months.

Survival after Radical Cystectomy for Bladder Cancer in Relation to Prior Non-Muscle Invasive Disease in Quebec

2016 ◽  
Vol 97 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Ahmed S. Zakaria ◽  
Fabiano Santos ◽  
Wassim Kassouf ◽  
Simon Tanguay ◽  
Armen Aprikian
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Invasive Disease ◽  
Muscle Invasive

scholarly journals Subcategorization of T1 Bladder Cancer on Biopsy and Transurethral Resection Specimens for Predicting Progression

2021 ◽  
Author(s):  
Anna Budina ◽  
Sahar J. Farahani ◽  
Priti Lal ◽  
Anupma Nayak
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Progression Free Survival ◽  
Tumor Grade ◽  
Invasive Disease ◽  
Intravesical Therapy ◽  
Depth Of Invasion ◽  
Muscularis Mucosa ◽  
The Difference ◽  
Muscle Invasive

Context.— Despite continued surveillance and intravesical therapy, a significant subset of patients with lamina propria–invasive bladder cancer (T1) will progress to muscle-invasive disease or metastases. Objective.— To analyze the value of pathologic subcategorization of T1 disease in predicting progression. Design.— Six substaging methods were applied to a retrospective cohort of 73 patients, with pT1 urothelial carcinoma diagnosed on biopsy/transurethral resection. Additionally, the immunohistochemistry for GATA3 and cytokeratin 5/6 (CK5/6) was performed to study the prognostic value of stratifying T1 cancers into luminal or basal phenotypes. Results.— On follow-up (mean, 46 months), 21 (29%) experienced at least 1 recurrence without progression, and 16 (22%) had progression to muscle-invasive disease and/or distant metastasis. No differences were noted between progressors and nonprogressors with regard to sex, age, treatment status, medical history, tumor grade, and presence of carcinoma in situ. Substaging using depth of invasion (cutoff ≥1.4 mm), largest invasive focus (≥3.6 mm), aggregate linear length of invasion (≥8.9 mm), and number of invasive foci (≥3 foci) correlated significantly with progression and reduced progression-free survival, whereas invasion into muscularis mucosa or vascular plexus, or focal versus extensive invasion (focal when ≤2 foci, each <1 mm) failed. Patients with luminal tumors had higher incidence of progression than those with nonluminal tumors (27% versus 11%), although the difference was statistically insignificant (P = .14). Conclusions.— Substaging of T1 bladder cancers should be attempted in pathology reports. Quantifying the number of invasive foci (≥3) and/or measuring the largest contiguous focus of invasive carcinoma (≥3.6 mm) are practical tools for prognostic substaging of T1 cancers.

scholarly journals Robot-assisted radical cystectomy: state of art and future perspectives

2019 ◽  
pp. 1-7
Author(s):  
Riccardo Mastroianni ◽  
Giuseppe Simone
Keyword(s):  
Bladder Cancer ◽  
Robotic Surgery ◽  
Radical Cystectomy ◽  
Invasive Disease ◽  
Open Approach ◽  
Future Perspectives ◽  
Robot Assisted ◽  
Significant Difference ◽  
Muscle Invasive ◽  
State Of Art

Bladder cancer (BC) remains one of the most common cancer worldwide. Radical cystectomy (RC) and pelvic lymph node dissection (PLND) with urinary diversion (UD) is still considered the gold standard treatment for non-metastatic muscle invasive bladder cancer (MIBC) and for recurrent non-muscle invasive disease. The open approach remains the reference option of treatment for RC, even if robotic surgery is rapidly increasing. Nowadays, several studies have reported perioperative, functional and oncological outcomes of robot-assisted radical cystectomy (RARC), but data are still immature to compare both procedures. All the current randomized controlled trials (RCTs), did not prove any significant difference between open RC and RARC, underlining no superiority between both procedures. Therefore, RARC is still considered an investigational procedure. On the other hand, modern robotic surgical practice has been evolved by the introduction of innovative technologies. The technological progress is improving, in particular in robotic surgery, offering several future perspectives, such as the ICG technique. The aim of the review is to describe the state of art, and to outline future perspectives of RARC, in order to establish the role of robotic surgery in the complex field of radical cystectomy.

Outcome of radical cystectomy series in the management of muscle invasive bladder cancer: Liverpool experience.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 396-396
Author(s):  
Syed A. Hussain ◽  
Altaf Qadir Khattak ◽  
Philip Cornford ◽  
Robin Weston ◽  
Pavlo Somov ◽  
...  
Keyword(s):  
Overall Survival ◽  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Survival Rates ◽  
Real Life ◽  
Invasive Disease ◽  
University Hospital ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

396 Background: Cystectomy has become one of the standard forms of therapy for patients with muscle invasive bladder cancer with long term follow-up data supporting radical surgical management. Methods: Data are collected retrospectively on patients who underwent cystectomy at the Royal Liverpool University Hospital. The aim was to document the overall survival of patients undergoing cystectomy at this centre. Results: Data were collected on 147 patients between September 2007 and June 2013. Median patient age was 66 (IQR: 61, 72) with 33 (23%) females. 107 (73%) patients had muscle invasive TCC, 13 (9%) had recurrent non-muscle invasice disease, 9 (6%) had salvage surgery following radical radiotherapy and 6 (4%) had persistent carcinoma in situ. 28 patients (20%) had hydronephrosis. 34 (23%) patients underwent neo-adjuvant chemotherapy. 2 (1%) patients had Combined synchronous urethrectomy and 5 (3%) had Combined synchronous nephroureterectomy. Post operatively positive lymph nodes were observed in 22 (19%) of surgical specimens and 83 (72%) had persistent muscle invasive disease. Survival rates at 12 and 60 months are 0.92 (0.88, 0.97) and 0.52 (0.39, 0.71) respectively. Multivariate analysis show that post operative T (HR: 3.99 (1.05, 15.18)) and N (HR: 5.40 (2.17, 13.44)) status are both independent predictors of over all survival. Conclusions: Real life data from our centre showed that the patient population and overall survival estimates for patients with muscle invasive bladder cancer treated with radical cystectomy and lymph node dissection are consistent with previous published literature. .

Micropapillary bladder cancer: Stage at presentation and treatment outcome—Analysis of 121 patients from a cancer database.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 289-289 ◽  
Author(s):  
Joshua D. Holyoak ◽  
Zachary Panfili ◽  
Ravi P. Kiran ◽  
Naveen Pokala
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Radical Surgery ◽  
Statistical Tests ◽  
Cell Cancer ◽  
Transitional Cell ◽  
Invasive Disease ◽  
Treatment Type ◽  
The Mean ◽  
Muscle Invasive

289 Background: The micropapillary variant of transitional cell cancer(MPTCC) is an aggressive pathological subtype of bladder cancer and radical cystectomy is recommended for patients with non−muscle invasive disease. This study compares the treatment patterns and survival outcome in 121 patients. Methods: Patients with MPTCC (code 8131) were identified from the Surveillance Epidemiology and End Results (SEER 17) database. Data was analyzed for demographics, stage, treatment, overall (OS) and cancer specific survival (CSS). Appropriate statistical tests were used. Results: 121 patients were identified (2001−08). Mean age was 73.3 years, 76.9% were male (76.9%, n=93), 82.7% were Caucasian. 40.5% (n=49) had non−muscle invasive (NMI) disease and 59.5% had muscle−invasive disease (MI) at diagnosis. The T stage was Ta or Tis (n=17), T1 (n=32), T2 (n=38) T3 (n=20) and T4 (n=14). 23 patients had node positive disease, the nodal status was not known in 4 patients. 10 patients had distant metastasis. Surgical procedures performed include, TURBT (n=83), Radical cystectomy (n=34), pelvic exenteration (n=1) and partial cystectomy (n=3). 8 patients received post−operative radiotherapy. The mean OS was 64.9, 42.9, 16.1 and 50.2 months and the mean CSS was 81.2, 56.3, 15.7 and 64.4 months for NMI, MI, distant and the whole group respectively. The 5−year OS was 40%, 54% and 34% and the 5 year CSS was 62%, 53% and 82% for the whole group, MI and NMI respectively. All patients with distant disease were dead by 28 months. On analysis of CSS by treatment type the 5−yr CSS for NMI was 81% (n=36) after TURBT and 100% (n=3) after Radical surgery. For MI disease the 3−yr CSS was 66% after TURBT (n=18) and the 5−yr CSS was 54% after radical surgery (n=29). On multivariate analysis, higher stage and age were associated with worse survival. TURBT was associated with better survival. Conclusions: MPTCC is a rare variant of TCC. 81% survival can be achieved with TURBT for non-muscle invasive MPTCC.

Is it necessary to obtain a second review on outside pathology for patients referred with non-muscle invasive (NMI) bladder cancer?

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17049-e17049
Author(s):  
Jared Brown ◽  
Caitlin Hensel ◽  
Jiaxian He ◽  
Megan McDonald ◽  
Philip Newhall ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Risk Stratification ◽  
Tumor Grade ◽  
Invasive Disease ◽  
Treatment Recommendations ◽  
Pathology Report ◽  
Number Of Patients ◽  
Muscle Invasive ◽  
Pathology Reports ◽  
Minimum Criteria

e17049 Background: Correct pathological staging is paramount in treatment recommendations for patients with non-muscle invasive disease. As a referral center, we sought to evaluate the quality of outside pathology determined by College of American Pathology (CAP) recommendation as well as discordance in AUA risk group stratification. Methods: We retrospectively reviewed our database of patients who originally underwent resection of bladder tumors at external facilities that were subsequently referred to our cancer institute between 2015 and 2018. 75 initial pathologies were overread by one of our GU pathologists all with non-muscle invasive bladder cancer. We evaluated the discordance rate between outside pathology reports and our overread using the CAP criteria for reporting. Additionally, we included the association in risk stratification category as well as the change in risk stratification group following overread. Cohen’s kappa (κ) statistics were used to evaluate concordance in pathology report between LCI and external facilities. Comparisons of risk stratification between LCI and external facilities were analyzed using Fisher’s exact test. Results: 5 criteria for quality were evaluated to assess reporting. A relatively high agreement in reporting tumor grade between LCI and external facilities (κ = 0.65, p < 0.001) and moderate agreement in microscopic extent (κ = 0.41, p < 0.001). LVI was not commented on in 58.7% of outside reports. 6/12 (50%) of patients were upstaged from Low Risk (LR) to Intermediate Risk (IR), 2/11 (18%) from IR to High Risk (HR), and 6/46 (13%) from HR to MIBC (Table). Conclusions: Initial pathology reports from outside facilities were often lacking minimum criteria as recommended by the CAP. Furthermore, a significant number of patients were upstaged after review, including 13% of HR patients being overread as muscle invasive disease. Second review of outside pathology should strongly be considered as re-review may have implications on treatment recommendations. [Table: see text]

scholarly journals Robotic Radical Cystectomy: Where are We Today, Where will We be Tomorrow?

2010 ◽  
Vol 10 ◽  
pp. 2215-2227 ◽  
Author(s):  
Kyle A. Richards ◽  
A. Karim Kader ◽  
Ashok K. Hemal
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Bowel Function ◽  
Invasive Disease ◽  
Long Term Follow Up ◽  
Oncologic Results ◽  
Robotic Radical Cystectomy ◽  
Open Radical Cystectomy ◽  
Muscle Invasive ◽  
Future Direction

While open radical cystectomy remains the gold-standard treatment for muscle-invasive bladder cancer and high-risk non–muscle invasive disease, robotic assisted radical cystectomy (RARC) has been gaining popularity over the past decade. The robotic approach has the potential advantages of less intraoperative blood loss, shorter hospital stay, less post-operative narcotic requirement, quicker return of bowel function, and earlier convalescence with an acceptable surgical learning curve for surgeons adept at robotic radical prostatectomy. While short to intermediate term oncologic results from several small RARC series are promising, bladder cancer remains a potentially lethal malignancy necessitating long-term follow-up. This article aims to review the currently published literature, important technical aspects of the operation, oncologic and functional outcomes, and the future direction of RARC.

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