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1.
J. Alfred Witjes Marek Babjuk Paolo Gontero Didier Jacqmin Alexander Karl Stephan Kruck Paramananthan Mariappan Juan Palou Redorta Arnulf Stenzl Roland van Velthoven Dirk Zaak 《European urology》2014
Context
Non–muscle-invasive bladder cancer (NMIBC) is associated with a high recurrence risk, partly because of the persistence of lesions following transurethral resection of bladder tumour (TURBT) due to the presence of multiple lesions and the difficulty in identifying the exact extent and location of tumours using standard white-light cystoscopy (WLC). Hexaminolevulinate (HAL) is an optical-imaging agent used with blue-light cystoscopy (BLC) in NMIBC diagnosis. Increasing evidence from long-term follow-up confirms the benefits of BLC over WLC in terms of increased detection and reduced recurrence rates.Objective
To provide updated expert guidance on the optimal use of HAL-guided cystoscopy in clinical practice to improve management of patients with NMIBC, based on a review of the most recent data on clinical and cost effectiveness and expert input.Evidence acquisition
PubMed and conference searches, supplemented by personal experience.Evidence synthesis
Based on published data, it is recommended that BLC be used for all patients at initial TURBT to increase lesion detection and improve resection quality, thereby reducing recurrence and improving outcomes for patients. BLC is particularly useful in patients with abnormal urine cytology but no evidence of lesions on WLC, as it can detect carcinoma in situ that is difficult to visualise on WLC. In addition, personal experience of the authors indicates that HAL-guided BLC can be used as part of routine inpatient cystoscopic assessment following initial TURBT to confirm the efficacy of treatment and to identify any previously missed or recurrent tumours. Health economic modelling indicates that the use of HAL to assist primary TURBT is no more expensive than WLC alone and will result in improved quality-adjusted life-years and reduced costs over time.Conclusions
HAL-guided BLC is a clinically effective and cost-effective tool for improving NMIBC detection and management, thereby reducing the burden of disease for patients and the health care system.Patient summary
Blue-light cystoscopy (BLC) helps the urologist identify bladder tumours that may be difficult to see using standard white-light cystoscopy (WLC). As a result, the amount of tumour that is surgically removed is increased, and the risk of tumour recurrence is reduced. Although use of BLC means that the initial operation costs more than it would if only WLC were used, over time the total costs of managing bladder cancer are reduced because patients do not need as many additional operations for recurrent tumours. 相似文献2.
Geavlete B Multescu R Georgescu D Jecu M Stanescu F Geavlete P 《BJU international》2012,109(4):549-556
Study Type – Therapy (individual cohort) Level of Evidence 2b What's known on the subject? and What does the study add? HAL fluorescence cystoscopy is known to improve tumour detection in NMIBC cases and to have a potentially favourable impact concerning the recurrence rates. The present trial assessed the advantages of HAL cystoscopy with regard to postoperative treatment changes and 2 years' recurrence rates, subjects that are poorly evaluated in the literature.
OBJECTIVES
- ? To evaluate in a prospective, randomized study the impact of hexaminolevulinate blue‐light cystoscopy (HAL‐BLC) on the diagnostic accuracy and treatment changes in cases of non‐muscle invasive bladder cancer (NMIBC) compared with standard white‐light cystoscopy (WLC).
- ? To compare the long‐term recurrence rates in the two study arms.
PATIENTS AND METHODS
- ? In all, 362 patients suspected of NMIBC were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumours and underwent transurethral resection of bladder tumours.
- ? A single postoperative mytomicin‐C instillation was performed in all cases, intravesical chemotherapy for intermediate‐risk patients and BCG instillations for high‐risk cases.
- ? The follow‐up protocol consisted of urinary cytology and WLC every 3 months for 2 years.
- ? Only first‐time recurrences after the initial diagnosis were considered.
RESULTS
- ? In the 142 patients with NMIBC in the HAL‐BLC series, tumour detection rates significantly improved for carcinoma in situ, pTa andoverall cases.
- ? In 35.2% of the cases, additional malignant lesions were found by HAL‐BLC and consequently, the recurrence‐ and progression‐risk categories of patients and subsequent treatment improved in 19% of the cases due to fluorescence cystoscopy.
- ? In all, 125 patients in the HAL‐BLC group and 114 of the WLC group completed the follow‐up.
- ? The recurrence rate at 3 months was lower in the HAL‐BLC series (7.2% vs 15.8%) due to fewer ‘other site’ recurrences when compared with the WLC series (0.8% vs 6.1%).
- ? The 1 and 2 years recurrence rates were significantly decreased in the HAL‐BLC group compared with the WLC group (21.6% vs 32.5% and 31.2% vs 45.6%, respectively).
CONCLUSIONS
- ? HAL‐BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates.
- ? HAL‐BLC significantly modified the postoperative treatment of cases.
- ? The 3 months, 1 and 2 years recurrence rates were significantly improved in the HAL‐BLC arm.
3.
Alberto Lapini Andrea Minervini Alberto Masala Luigi Schips Armin Pycha Luca Cindolo Riccardo Giannella Thomas Martini Gianni Vittori Danilo Zani Fania Bellomo Sergio Cosciani Cunico 《Surgical endoscopy》2012,26(12):3634-3641
Background
To date, no study has presented results of photodynamic diagnosis (PDD) cystoscopy compared with white-light cystoscopy (WLC) in daily practice. The aim of the present study is to evaluate the diagnostic accuracy of hexylaminolevulinate hydrochloride (Hexvix?) PDD cystoscopy compared with standard WLC used in daily practice.Methods
An observational, open-label, comparative, controlled (within patient), multicenter study was carried out on 96 consecutive patients with suspected or confirmed bladder cancer. All patients had standard WLC followed by blue-light cystoscopy (BLC). Positive lesions detected using WLC and BLC were recorded. Biopsies/resection of each positive lesion were taken after the bladder was inspected. Sensitivity, specificity, positive predictive value, and negative predictive value with each method were calculated.Results
Overall, 234 suspicious lesions were detected; 108 (46.2?%) were histologically confirmed to be bladder tumors/carcinoma in situ (CIS). The sensitivity of BLC biopsies was significantly higher than for WLC technique (99.1 vs 76.8?%; p?<?0.00001). The relative sensitivity of BLC versus WLC was 1.289, showing superiority of BLC of 28.9?%. The specificity of BLC biopsies was not significantly different compared with WLC (36.5 vs 30.2?%). Positive predictive value for BLC- and WLC-guided biopsies was 54.9 and 50.9?%, respectively. Negative predictive value per biopsy for BLC- and WLC-guided biopsies was 97.4 and 64.8?%, respectively. BLC and WLC reached the correct diagnosis in 97.9 and 88.5?% of patients, respectively. This difference was statistically significant (p?=?0.0265). The lack of a random biopsy protocol was the major limitation of the study.Conclusions
Hexvix? PDD cystoscopy used in daily practice enhances the diagnostic accuracy of standard cystoscopy with higher negative predictive value, potentially permitting an improvement in patient prognosis. 相似文献4.
Introduction
Painless hematuria is the presenting symptom in 85–90% of patients with bladder cancer.Objectives
To evaluate the efficacy of voided urinary cytology and ultrasonography in the diagnosis and follow up of bladder cancer compared to cystoscopy as a gold standard with reference to its grade. To recommend a protocol that improves the overall sensitivity and specificity of detection of new cases and recurrence in the follow up of patients with bladder cancer.Subjects and methods
A prospective analysis of patients with painless hematuria and follow up patients of bladder cancer was done. They were subjected to voided urinary cytology and ultrasonography. The results were compared with the inferences drawn from cystoscopy and histopathological examination of the resected tumor, wherever applicable.Results
The sensitivity of urinary cytology and ultrasonography was 13.33% and 66.67%, respectively, compared to cystoscopy as a gold standard, whereas the specificity of urinary cytology and ultrasonography was 100% and 93.33%, respectively. Cytology was positive only in high grade cases.Conclusions
Voided urinary cytology can be omitted as a screening test. Ultrasonography can be recommended as the initial imaging investigation for detection of bladder carcinoma in patients presenting with hematuria and for follow up of bladder carcinoma patients. 相似文献5.
Zahava Vadasz Jacob Rubinstein Jacob Bejar Hilla Sheffer Sarel Halachmi 《Urologic oncology》2018,36(4):161.e1-161.e6
Objective
A highly sensitive and specific urine marker for the detection of recurrent urothelial cancer and for screening healthy population or people at risk for urothelial cancer has not been found yet. As urine cytology is not sensitive enough, patients with non–muscle-invasive bladder cancer need lifelong follow-up involving multiple invasive cystoscopies. Our aims of study were to examine the expression of semaphorin 3A in urothelial cancer patients and to evaluate semaphorin 3A as a potential marker for urothelial cancer.Materials and methods
Urine samples were taken from patients with known bladder tumor, hospitalized for transurethral resection of lesions, from patients with history of urothelial cancer admitted for endoscopic follow up, from patients with other nonmalignant urological conditions such as prostatic hyperplasia, stress incontinence, urethral stricture, ureteral and kidney stones, and from healthy volunteers with no history of urothelial malignancy and no urological symptoms. Semaphorin 3A (sema3A) protein level was measured using enzyme-linked immunosorbent assay in every sample and levels were correlated with endoscopic and pathological findings.In addition, we performed immunohistochemically staining with semaphorin 3A of 15 tissue samples (various tumors and normal bladder tissues).Results
A total of 183 urine samples were tested. Out of them, 116 patients (mean age 70.7; 94 males and 22 females) had positive cystoscopy, and 67 (mean age 64.7; 51 males and 16 females) had negative cystoscopy. Higher sema3A values were significantly correlated (P = 0.006) with presence of urothelial cancer, as determined by positive cystoscopy or urethroscopy and pathological biopsy. Sema3A levels also showed positive correlation with the number of tumors. Sema3A levels combined with urine cytology showed much higher sensitivity compared with cytology alone (66% vs. 33%), with smaller reduction of specificity (77% vs. 90%).Immunohistochemical staining showed intense staining in high stage and grade tumors, and almost no staining in normal tissue.Conclusions
Semaphorin 3A is overexpressed in urothelial cancer patients, as evidenced both in its presence in urine and in bladder tissue. Semaphorin 3A in urine is a promising potential urothelial cancer biomarker either independently or in conjunction with cytology. Further tests are needed to elucidate the sex difference in the expression of Sema3A in the urine of bladder cancer patients. 相似文献6.
OBJECTIVE
To correlate urine cytology findings before and after flexible cystoscopy.PATIENTS AND METHODS
A total of 153 patients undergoing surveillance for bladder tumour provided voided urine for cytology before and immediately after flexible cystoscopy.RESULTS
Of the 153 patients, 116 had negative urine cytology before and after (96%) a visibly normal cystoscopy and 37 had positive urine cytology before and after cystoscopy that showed recurrent tumour.CONCLUSIONS
Urine cytology immediately after flexible cystoscopy correlates well with results of urine cytology before cystoscopy.7.
A.M. Tawfeek D. Mostafa M.A. Mahmoud A. Radwan I.H. Hamza 《The African Journal of Urology》2018,24(1):73-78
Introduction
Bladder cancer is the second most common genitourinary malignancy. Recent technological advances have led to the development of virtual endoluminal internal views similar to those obtained with conventional endoscopy (virtual cystoscopy).Objectives
To evaluate the potential value of virtual cystoscopy in the detection and follow up of bladder tumors.Patients and methods
A total of 50 patients from Ain Shams University Hospital were studied between August 2012 and April 2014 at Ain Shams’ Radiology Department and Sonoscan Radiology Center. All patients underwent 2D-US, 3D virtual sonographic cystoscopy and conventional cystoscopy, with results compared for sensitivity and specificity in correlation with the site, size and shape of the tumor.Results
3D virtual cystoscopy showed a sensitivity of 96.5%; while its specificity in identifying lesions was 85.7%; positive predictive values were 96.5%; negative predictive value were 85.7%. The sensitivity of the 2D ultrasound was 77.2%; while its specificity in identifying lesions was 57.1%; positive predictive values came at 88%; negative predictive value were 38.1%. Calculations were made taking into consideration the conventional cystoscopy “gold standard”.Conclusion
Additional to lower costs and no radiation exposure, 3D sonography appears comparable to the use of CT scans and MRI in providing virtual cystoscopy in investigating bladder cancer. Virtual sonographic cystoscopy may therefore be a useful alternative for screening and follow up of tumors, particularly if conventional cystoscopy cannot be performed. However, 3D sonography cannot replace pathological staging, and there is still a need to further improve this technology for enhanced assessment of mucosal abnormalities. 相似文献8.
Michael Rink Marko Babjuk James W.F. Catto Patrice Jichlinski Shahrokh F. Shariat Arnulf Stenzl Herbert Stepp Dirk Zaak J. Alfred Witjes 《European urology》2013
Context
Controversy exists regarding the therapeutic benefit and cost effectiveness of photodynamic diagnosis (PDD) with 5-aminolevulinic acid (5-ALA) or hexyl aminolevulinate (HAL) in addition to white-light cystoscopy (WLC) in the management of non–muscle-invasive bladder cancer (NMIBC).Objective
To systematically evaluate evidence regarding the therapeutic benefits and economic considerations of PDD in NMIBC detection and treatment.Evidence acquisition
We performed a critical review of PubMed/Medline, Embase, and the Cochrane Library in October 2012 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) and Standards for the Reporting of Diagnostic Accuracy Studies (STARD) criteria. Forty-four publications were selected for inclusion in this analysis.Evidence synthesis
Included reports used 5-ALA (in 26 studies), HAL (15 studies), or both (three studies) as photosensitising agents. PDD increased the detection of both papillary tumours (by 7–29%) and flat carcinoma in situ (CIS; by 25–30%) and reduced the rate of residual tumours after transurethral resection of bladder tumour (TURBT; by an average of 20%) compared to WLC alone. Superior recurrence-free survival (RFS) rates and prolonged RFS intervals were reported for PDD, compared to WLC in most studies. PDD did not appear to reduce disease progression. Our findings are limited by tumour heterogeneity and a lack of NMIBC risk stratification in many reports or adjustment for intravesical therapy use in most studies. Although cost effectiveness has been demonstrated for 5-ALA, it has not been studied for HAL.Conclusions
Moderately strong evidence exists that PDD improves tumour detection and reduces residual disease after TURBT compared with WLC. This has been shown to improve RFS but not progression to more advanced disease. Further work to evaluate cost effectiveness of PDD is required. 相似文献9.
Joerg Schmidbauer Mesut Remzi Tobias Klatte Matthias Waldert Julian Mauermann Martin Susani Michael Marberger 《European urology》2009
Background
The advantage of photodynamic diagnosis in detecting urothelial cell carcinoma (UCC) of the bladder has been demonstrated clearly, but it comes at the price of a higher false-positive rate. Optical coherence tomography (OCT) is a noninvasive, real-time, microstructural imaging modality that uses near-infrared light for a point analysis of the bladder-wall microstructure.Objective
To evaluate whether adding targeted OCT analysis of lesions that are suspicious at white-light (WL) and hexaminolevulinate (HAL) fluorescence cystoscopy improves diagnostic accuracy in the detection of UCC.Design, setting, and participants
In this prospective single-center study with same-patient comparison, patients with suspected UCC first received an intravesical instillation of HAL. Cystoscopy was performed in WL, followed by blue-light inspection and OCT scanning.Intervention
Suspicious lesions identified by WL or HAL were evaluated by OCT and were subsequently resected or biopsied.Measurements
We measured changes in sensitivity and specificity in detecting UCC using WL, HAL, and targeted OCT.Results and limitations
In 66 patients studied, 232 lesions were detected, were scanned by OCT, and were subsequently resected or biopsied. Additionally, 132 areas of normal-appearing urothelium were investigated by all three methods and biopsied. On a per-lesion basis, sensitivity and specificity were respectively 69.3% and 83.7% for WL, 97.5% and 78.6% for HAL, and 97.5% and 97.9% for HAL combined with OCT. Overall, UCC was diagnosed in 58 patients (87.9%), with a per-patient sensitivity of 89.7% for WL and 100% for both HAL alone and HAL with targeted OCT. Per-patient specificity for HAL alone and targeted HAL was 62.5% and 87.5%, respectively. The limitation of OCT results from poor visualization of flat lesions in WL, making scanning a time-consuming procedure.Conclusions
Combining fluorescence cystoscopy with targeted OCT increases the specificity of fluorescence cystoscopy significantly, with no added morbidity, and reduces the need for unnecessary (false-positive) biopsies. 相似文献10.
Maria Apfelbeck Tobias Grimm Alexander Kretschmer Alexander Buchner Birte-Swantje Schneevoigt Friedrich Jokisch Markus Grabbert Gerald Schulz Christian G. Stief Alexander Karl 《Urologic oncology》2017,35(10):602.e19-602.e23
Purpose
As the use of fluorescence endoscopy is recommended today by different guidelines during the follow-up of high-grade non–muscle-invasive bladder cancer, the aim of this study is to analyze whether the multiple use of hexylaminolevulinate (HAL) for TUR-BT can be performed safely within the same patient over a time interval.Methods
Data of patients diagnosed and treated with HAL-TUR-B at our institute between 2008 and 2013 were analyzed. Special interest was given to side effects observed during the instillation of the substance, on the whole day of the instillation and during the entire hospital stay. We focussed on side effects associated with the use of HAL, such as allergic reactions, urinary tract infections, photosensitization of the skin, and relevant changes in blood pressure.Results
In the time between 2008 and 2013, 2480 HAL-TUR-BTs were performed in total at our institute. In 80 patients, HAL-TUR-BT was used at least 2 times, and on average 4 times (2–12 times). Only patients with multiple uses were included for our final analysis. We observed no allergizations in any of the treated patients. Minor side effects were urinary tract infections (n = 4), dysuria (n = 4), pollakisuria (n = 9), and bladder spasms (n = 17).Conclusion
In our study cohort, the multiple use of HAL-TUR-BT within the same patient caused no major side effects or an induction of allergization against the substance. We, therefore, conclude that HAL-TUR-BT can be performed safely in the same patient during the follow-up of aggressive tumors as recommended by different guidelines today. 相似文献11.
Islam M. El-Babouly Esam A.E. Desoky Diab El Sayed Maged M. Ali Ola A. Harb Ahmed Ragab Ahmed M. Sakr Amr M. Fawzi Nashaat M. Salama Ibrahim I. Samaha 《Urologic oncology》2018,36(5):242.e9-242.e14
Objective
To report the sensitivity and specificity of neural precursor cell-expressed developmentally down-regulated protein 9 (NEDD9) protein high expression in predicting BCG response and its effect on recurrence or progression free survivals.Patients and methods
Between May 2014 and April 2017, a prospective cohort study was conducted on 105 patients with intermediate or high-risk nonmuscle invasive bladder cancer. Immunohistochemical staining with mouse monoclonal anti-NEDD9 antibody was done. Examination of the slides was done to detect NEDD9 cytoplasmic expression. Intravesical induction bacillus Calmette-Guerin (BCG) instillation therapy was started for all patients 2 to 4 weeks after endoscopy with once weekly instillation for 6 weeks. Intravesical maintenance BCG instillation was then continued every 3 months for at least 1 year. Follow up with cystoscopy every 3 months for 2 years and every 6 months after that.Results
The mean age ± SD of the patients was 57 ± 4.5 years. The median follow-up period was 25 (12–36) months. NEDD9 protein was highly expressed in 61 (58.1%) patients, whereas low expression was in 44 (41.9%) patients. Sensitivity and specificity of NEDD9 high expression in predicting recurrence were 83.6% and 64.2%, respectively. Its sensitivity and specificity in predicting progression to muscle invasion or distant metastases were 91.3% and 51.2%, respectively. Its sensitivity and specificity in predicting complete response to BCG therapy were 84.1% and 80.9%. Kaplan-Meier test showed highly significant difference (P<0.0001) in survival without recurrence or progression between patients showing high expression and those showing low expression.Conclusion
NEDD9 protein tissue marker could be used as a predictive marker for BCG response in nonmuscle invasive bladder cancer with reasonable sensitivity and specificity. 相似文献12.
Diagnostic evaluation of patients presenting with hematuria: An electronic health record-based study
Kyle A. Richards Vania Lopez Ruiz Daniel R. Murphy Tracy M. Downs E. Jason Abel David F. Jarrard Hardeep Singh 《Urologic oncology》2018,36(3):88.e19-88.e25
Background
To gain new insights into the origin and prevention of diagnostic delays in the evaluation of hematuria in an electronic health record (EHR)–based integrated care setting.Methods
We performed a retrospective review of 298 consecutive patients with new-onset hematuria at a Veterans Affairs facility from January 1, 2011 to December 31, 2013 excluding those where diagnostic evaluation was unnecessary (i.e., cystoscopy within 3 years prior). We collected data on presentation, such as red flags of painless gross hematuria (PGH) or asymptomatic microhematuria (AMH) and subsequent evaluation (imaging, urologic referral, and cystoscopy). Delay was defined when evaluation was not completed within 60 days. Logistic regression was performed to identify predictors of delay.Results
Of 201 patients, 149 had delays. PGH was present in 99 patients. These patients had a higher rate of urology referral within 1 year than patients with AMH (86.7% vs. 64.7%; P<0.01) and were more likely to undergo cystoscopy (75.8% vs. 52%; P<0.01). Delays occurred in 67% of PGH patients vs. 81% of AMH patients (OR 0.46; P = 0.02), and roughly a third were related to scheduling/coordination, patient-related issues, or delay in primary care referral. Bladder neoplasms were detected in 18% of patients with PGH and 2% of those with AMH.Conclusion
Delays in evaluation for hematuria occur commonly, regardless of strength of the red-flag. Many delays were preventable and could be targeted with interventions including EHR-based tracking systems or reformed scheduling practices. 相似文献13.
Martin E. Gosnell Dmitry M. Polikarpov Ewa M. Goldys Andrei V. Zvyagin David A. Gillatt 《Urologic oncology》2018,36(1):8.e9-8.e15
Objectives
One of the most reliable methods for diagnosing bladder cancer is cystoscopy. Depending on the findings, this may be followed by a referral to a more experienced urologist or a biopsy and histological analysis of suspicious lesion. In this work, we explore whether computer-assisted triage of cystoscopy findings can identify low-risk lesions and reduce the number of referrals or biopsies, associated complications, and costs, although reducing subjectivity of the procedure and indicating when the risk of a lesion being malignant is minimal.Materials and methods
Cystoscopy images taken during routine clinical patient evaluation and supported by biopsy were interpreted by an expert clinician. They were further subjected to an automated image analysis developed to best capture cancer characteristics. The images were transformed and divided into segments, using a specialised color segmentation system. After the selection of a set of highly informative features, the segments were separated into 4 classes: healthy, veins, inflammation, and cancerous. The images were then classified as healthy and diseased, using a linear discriminant, the naïve Bayes, and the quadratic linear classifiers. Performance of the classifiers was measured by using receiver operation characteristic curves.Results
The classification system developed here, with the quadratic classifier, yielded 50% false-positive rate and zero false-negative rate, which means, that no malignant lesions would be missed by this classifier.Conclusions
Based on criteria used for assessment of cystoscopy images by medical specialists and features that human visual system is less sensitive to, we developed a computer program that carries out automated analysis of cystoscopy images. Our program could be used as a triage to identify patients who do not require referral or further testing. 相似文献14.
Ryan L. Steinberg Kenneth G. Nepple Kyla N. Velaer Lewis J. Thomas Michael A. O&#x;Donnell 《Urologic oncology》2017,35(12):670.e7-670.e14
Background
Bacillus Calmette-Guérin (BCG) is the most effective initial intravesical therapy for high-grade non–muscle invasive bladder cancer, but many patients still fail. Combination intravesical BCG and interferon (IFN) will salvage some patients but results remain suboptimal.Objective
We hypothesized that further immunostimulation with intravesical interleukin-2 and subcutaneous granulocyte-macrophage colony-stimulating factor may improve response to intravesical BCG and IFN in patient with prior BCG failure(s).Methods
A retrospective review was performed. Patients received 6 treatments of quadruple immunotherapy (intravesical solution with one-third dose BCG, 50 million units IFN, and 22 million units interleukin-2, along with a 250-mcg subcutaneous sargramostim injection). Surveillance began 4 to 6 weeks after treatment completion. Patients received maintenance if recurrence-free. Success was defined as no recurrence (bladder or extravesical) and bladder preservation. Analysis was performed by Kaplan-Meier method (P<0.05).Results
Fifty-two patients received treatment with a median recurrence follow-up of 16.3 months and overall follow-up of 41.8 months. All patients had at least 1 prior BCG failure and 13% had 2 or more prior failures. Only 3 patients (6%) were unable to tolerate full induction. Treatment success was 55% at 1 year, and 53% at 2 years. Thirteen patients (25%) underwent cystectomy at a median time of 17.3 months with disease progression to T2 in 1 patient and T3 in 2 patients. No patients had positive surgical margins or positive lymph nodes.Conclusions
In patients with non–muscle-invasive bladder cancer with prior BCG failure, quadruple immunotherapy demonstrated good treatment success in some patients and warrants further evaluation. 相似文献15.
Amy Klapheke Stanley A. Yap Kevin Pan Rosemary D. Cress 《Urologic oncology》2018,36(6):308.e19-308.e25
Objective
To evaluate how socioeconomic status and other demographic factors are associated with the receipt of chemotherapy and subsequent survival in patients diagnosed with metastatic bladder cancer.Methods
Using data from the California Cancer Registry, we identified 3,667 patients diagnosed with metastatic urothelial carcinoma of the urinary bladder between 1988 and 2014. The characteristics of patients who did and did not receive chemotherapy as part of the first course of treatment were compared using chi-square tests. Logistic regression was used to identify predictors of chemotherapy treatment. Fine and Gray competing-risks regression and Cox proportional hazards regression were used to estimate bladder cancer-specific and all-cause mortality, respectively.Results
Less than half (46.3%) of patients received chemotherapy. Patients from the lowest socioeconomic quintile were half as likely to have chemotherapy as those from highest quintile (odds ratio = 0.5, 95% CI: 0.4, 0.7). Unmarried patients were significantly less likely to receive treatment (odds ratio = 0.6, 95% CI: 0.5, 0.7). Not receiving chemotherapy was associated with greater mortality from bladder cancer (subdistribution hazard ratio = 1.4, 95% CI: 1.3, 1.5) and from all causes (hazard ratio = 2.0, 95% CI: 1.8, 2.1).Conclusions
We found clear disparities in chemotherapy treatment and survival with respect to socioeconomic and marital status. Future studies should explore the possible reasons why patients with low socioeconomic status and who are unmarried are less likely to have chemotherapy. 相似文献16.
Guo-liang Yang Lian-hua Zhang Qiang Liu Zhao-liang Wang Xue-hui Duan Yi-ran Huang Juan-jie Bo 《Urologic oncology》2017,35(2):38.e9-38.e15
Background
Management of high-grade T1 (formerly T1G3) bladder cancer continues to be controversial. Should patients with T1G3 bladder cancer have an immediate radical cystectomy or should they receive intravesical bacillus Calmette-Guérin–preserving bladder? Gemcitabine and cisplatin (GC) adjuvant chemotherapy may help to strike a balance between intravesical and early cystectomy. For purposes of this study, we continue to refer high-grade T1 lesion as “T1G3.”Objective
To evaluate the characteristics and the long-term outcome of GC adjuvant chemotherapy in T1G3 bladder cancer after transurethral resection of bladder tumor (TURBT).Materials and methods
We retrospectively reviewed 48 patients who were newly diagnosed with T1G3 bladder cancer between January 2009 and December 2012. A total of 48 patients received 4 cycles of GC adjuvant chemotherapy after TURBT. One month after 4 cycles of GC adjuvant chemotherapy, response was evaluated by re-TURBT. Median follow-up was 59.5 (range: 18–70) months, all patients have been observed for more than 3 years. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response.Result
Complete response was achieved in 44 (91.7%) patients. Of complete responders, 5 patients experienced recurrence and 5 patients showed progression. The progression rate and disease-specific survival rate were 10.4% and 91.7% at 3 years, respectively. More than 80% of survivors preserved their bladder. Kaplan-Meier curves showed that concomitant carcinoma in situ (CIS) was the only factor that had an influence on progression-free survival (P = 0.022) and disease-specific survival (P = 0.017). Concomitant CIS was the prognostic factor for progression rate and disease-specific survival rate at 3 years (P = 0.008 and P = 0.035).Conclusion
GC adjuvant chemotherapy is a safe conservative treatment for T1G3 bladder cancer, but effective is really a phase II study. Patients with T1G3 bladder cancer with concomitant CIS should be treated more aggressively because of the high risk of progression. 相似文献17.
Esmee I.M.L. Liem Michael McCormack Eddie S.Y. Chan Yoshiyuki Matsui Petrisor Geavlete Young D. Choi Theo M. de Reijke Yasser Farahat Brant A. Inman Jean J.M.C.H. de la Rosette Seiji Naito 《Urologic oncology》2018,36(7):338.e1-338.e11
Purpose
Traditionally, transurethral resection of bladder tumors (TURB) is performed using monopolar technique. Bipolar resection has been postulated to reduce complications. In this study we compare safety and efficacy between monopolar TURB (mTURB) and bipolar TURB (bTURB) for patients with primary non-muscle invasive bladder cancer (NMIBC).Materials and methods
Data were obtained from an international multicenter randomized clinical trial that compared the use of white light cystoscopy with narrow band imaging-assisted TURB using the Olympus system between 2010 and 2014. Main outcomes of interest were operative time, perioperative, and postoperative complications, and 12-month recurrence-free survival.Results
In total, 716 patients were treated for primary NMIBC with mTURB (310 patients) or bTURB (406 patients). The use of white light cystoscopy or narrow band imaging was equally distributed between the 2 resection techniques. Multilevel logistic and linear regression corrected for possible confounders showed no significant difference between mTURB and bTURB for postoperative complications (OR = 1.76, P = 0.180), postoperative bleeding (OR = 1.27, P = 0.722), and the combination of intra + postoperative bleeding (OR = 1.992, P = 0.108). Additionally, no significant difference was found between mTURB and bTURB concerning operative time (1.05 min. longer for bTURB, P = 0.536), intraoperative bleeding requiring intervention (OR:1.38, P=0.809), incidence of obturator reflex (OR = 0.93, P = 0.854), and bladder perforation (OR = 3.05, P = 0.195). In total, 185 patients (25.8%) developed a recurrence (mTURB = 88, bTURB = 97). Recurrence-free survival at 12 months in the mTURB and bTURB group was 70% and 74% (P = 0.410), respectively.Conclusion
Based on these results, bTURB is as safe and effective as mTURB in treatment of primary NMIBC. bTURB seems to have no evident advantages over mTURB with respect to operation time, perioperative and postoperative complication rates, and recurrence rates at 12 months. 相似文献18.
Johan Abrahamsson Kristina Aaltonen Helgi Engilbertsson Fredrik Liedberg Oliver Patschan Lisa Rydén Gottfrid Sjödahl Sigurdur Gudjonsson 《Urologic oncology》2017,35(10):606.e9-606.e16
Background
There are currently no methods in clinical use that can detect early systemic dissemination of urothelial tumor cells.Objective
To evaluate measurement of circulating tumor cells (CTCs) as a biomarker for disseminated disease in patients with advanced bladder cancer.Design, setting, and participants
Between March 2013 and October 2015, 88 patients were prospectively included in the study: 78 were scheduled for radical cystectomy (RC) ± perioperative chemotherapy and 10 treated with palliative chemotherapy. The CellSearch CTC test was further assessed in this context by investigating expression of epithelial cell adhesion molecule (EpCAM) in primary tumors obtained at cystectomy from an independent cohort of 409 patients.Outcome measurements and statistical analysis
Presence of CTCs was tested for association with tumor stage, lymph node metastases, metastatic disease on [18 F]-fluorodeoxyglucose-positron emission tomography (FDG-PET), and cancer-specific and progression-free survival.Results
CTCs were detected in 17/88 patients (19%). In 61 patients who underwent FDG-PET-computed tomography (CT), a statistically significant association with presence of CTCs was found for radiological metastatic disease but not for normal PET-CT results (12/35 [34%] vs. 2/26 [8%], P = 0.014). After a median follow-up time of 16.5 months (95% CI: 9.6–21.4), presence of CTCs was associated with an increased risk of progression among patients treated with RC with or without perioperative chemotherapy (n = 75, P = 0.049). A multivariate analysis adjusted for clinical tumor stage, clinical lymph node status, and age showed that CTCs were an independent marker of progression (n = 75; hazard ratio = 2.78; 95% CI: 1.005–7.69; P = 0.049) but not of cancer-specific death (P = 0.596). In 409 cystectomised patients, more than 392 (96%) of the bladder tumors expressed EpCAM.Conclusions
CTCs were present in 19% of patients with advanced urothelial tumors and were associated with metastatic disease on FDG-PET-CT and with increased risk of disease progression after RC. A significant portion of urothelial cancer cells do express EpCAM and can thus be identified using EpCAM-antigen–based CTC detection methods. 相似文献19.
Background
Management of high-grade T1 (formerly T1G3) bladder cancer continues to be controversial. Should patients with T1G3 bladder cancer have an immediate radical cystectomy or should they receive intravesical bacillus Calmette-Guérin preserving bladder? Gemcitabine and cisplatin (GC) adjuvant chemotherapy may help to strike a balance between intravesical and early cystectomy. For purposes of this study, we continue to refer high-grade T1 lesion as “T1G3.”Objective
To evaluate the characteristics and the long-term outcome of GC adjuvant chemotherapy in T1G3 bladder cancer after transurethral resection of bladder tumor (TURBT).Materials and methods
We, retrospectively, reviewed 48 patients who were newly diagnosed with T1G3 bladder cancer between January 2009 and December 2012. A total of 48 patients received 4 cycles of GC adjuvant chemotherapy after TURBT. One month after 4 cycles of GC adjuvant chemotherapy, response was evaluated by re-TURBT. Median follow-up was 59.5 (range: 18–70) months, all patients have been observed for more than 3 years. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response.Result
Complete response was achieved in 44 (91.7%) patients. Of complete responders, 5 patients experienced recurrence and 5 patients showed progression. The progression rate and disease-specific survival rate were 10.4% and 91.7% at 3 years, respectively. More than 80% of survivors preserved their bladder. Kaplan-Meier curves showed that concomitant carcinoma in situ (CIS) was the only factor that had an influence on progression-free survival (P = 0.022) and disease-specific survival (P = 0.017). Concomitant CIS was the prognostic factor for progression rate and disease-specific survival rate at 3 years (P = 0.008 and P = 0.035).Conclusion
GC adjuvant chemotherapy is a safe conservative treatment for T1G3 bladder cancer, but effective is really a phase II study. Patients with T1G3 bladder cancer with concomitant CIS should be treated more aggressively because of the high risk of progression. 相似文献20.
Marco Moschini Shahrokh F. Shariat Mohammad Abufaraj Beat Foerster David D′Andrea Francesco Soria Paolo Dell′Oglio Agostino Mattei Francesco Montorsi Renzo Colombo Alberto Briganti Andrea Gallina 《Urologic oncology》2017,35(12):672.e1-672.e6