Bladder Tumor Recurrence Research Articles

Strategies to Improve Clinical Outcomes and Patient Experience Undergoing Transurethral Resection of Bladder Tumor.

To describe patient experiences of transurethral resection of bladder tumor (TURBT) and review recent advances in enhancing clinical outcomes. High rates of recurrence and progression of non-muscle invasive bladder tumors expose patients to multiple TURBT procedures throughout their disease process. Understanding the impact of TURBT on quality of life and patient experiences is crucial for shared decision-making, thus enhanced recovery protocol trials are being explored to improve patient outcomes. The variability in TURBT practices worldwide contributes to differing bladder tumor recurrence rates, prompting efforts to standardize practices by evaluating the impact of patient, hospital, and surgeon factors. For select cases, less intensive surveillance regimens have reduced toxicities and costs without compromising oncologic outcomes. New innovative approaches such as en bloc- and stratified resection techniques may reduce perioperative complications and improve clinical outcomes. Finally, neoadjuvant and ablative treatments have shown to be promising alternatives to TURBT, necessitating further investigation in this setting. TURBT is essential for diagnosing and treating bladder cancer. Reducing associated morbidities and improving surgical outcomes involve multifaceted approaches, including standardizing surgical practices, exploring innovative techniques, and optimizing surveillance regimens, all while promoting patient quality of life. Neoadjuvant therapies as alternative treatments are on the horizon and may ultimately change the landscape of bladder cancer care.

Bayesian Shrinkage Estimation of Credible Subgroups for Count Data with Excess Zeros

Heterogeneity of treatment effects due to heterogeneous patient characteristics often arises in clinical trials. Subgroup analysis and the analysis of interactions are the most common approaches for evaluating such heterogeneous effects but do not explicitly address multiplicity issues. Another common challenge of analyzing treatment effect heterogeneity is the large number of possible covariates which inevitably causes problems related to multiplicity and lack of power. In this article, we develop a Bayesian credible subgroups method using continuous shrinkage priors to assess heterogeneity in treatment effects and multiplicity-adjusted benefiting subgroup identification for zero-inflated count data, which are often encountered in medical and public health studies. Our proposed method provides two bounding subgroups for the true benefiting subgroup: one that is probably contained by the true benefiting subgroup and one that probably contains the true benefiting subgroup. A simulation study has been conducted to compare the performance of the proposed method with other methods through frequentist properties. We apply our method to a clinical bladder tumor trial studying the effect of thiotepa treatment on the reduction of the recurrence of bladder tumor.

Clinical evolution of bladder carcinosarcoma: A case report and literature review.

Bladder carcinosarcoma (BC) is a malignant tumor composed of a mixture of malignant epithelial and stromal components. Carcinosarcoma mostly occurs in the upper respiratory tract and upper gastrointestinal tract and is less common in the urinary system. The incidence of malignant tumors of the urinary system is <3%. It rarely occurs in the bladder and accounts for approximately 0.31% of all malignant bladder tumors. A literature review and this report will help to further improve our understanding, diagnosis, and treatment of bladder carcinosarcoma (BC). We describe the case of an 80-year-old female patient who was admitted to the hospital with a history of intermittent hematuria for 3 years. Furthermore, total cystectomy was refused when a BC was diagnosed. Palliative resection surgery was necessary because of the recurrent hematuria and abdominal pain. Pathologically confirmed BC after surgery. The patient's first transurethral resection of bladder tumor (TURBT) was diagnosed as BC. However, the patient refused a total cystectomy. Two months after intravesical treatment with epirubicin, bladder tumor recurrence was observed during follow-up cystoscopy. The patient underwent a second TURBT for hemostatic treatment due to persistent hematuria. Due to hematuria and abdominal pain, a third TURBT was performed to reduce tumor size and stop bleeding. Finally, tumor recurrence resulted in bilateral hydronephrosis, and the patient underwent bilateral renal catheter drainage guided by B-ultrasound. Bladder carcinosarcoma caused uremia, electrolyte imbalance, and sepsis. Approximately 19 months after the discovery of the tumor, the patient died. Radical bladder resection is recommended once a BC is diagnosed. By reporting the cases and reviewing the literature in the database, we will summarize the epidemiology, origin, etiology, clinical features, existing treatments, and prognostic factors of BC, and propose new prospects for BC therapy.

Strategies to reduce bladder tumor recurrences following surgery for upper tract urothelial carcinoma

Strategies to reduce bladder tumor recurrences following surgery for upper tract urothelial carcinoma

The influence of anesthesia type on recurrence of the non-muscle invasive bladder tumor according to risk groups: 3 year follow up

Purpose: Many risk factors affecting bladder cancer recurrence, such as genetic and environmental factors, have been previously identified. It has been stated that risk factors that cause immunosuppression play a role in the spread of cancer cells. Anesthetic agent, which is a perioperative factor, may affect the risk of cancer recurrence by disrupting the immune system. The aim of this study was to compare the effect of regional anesthesia (RA) and general anesthesia (GA) on non-muscle invasive bladder cancers (NMIBC) recurrence. Materials and methods: A total of one hundred seventy-eight patients who underwent transurethral bladder tumor resection (TURBT) for NMIBC and underwent surgery under GA or RA between 2011 and 2016 in the urology departments of Pamukkale University and Uludağ University were included in the study. In the first group, 80 patients had RA. In the second group, 98 patients underwent GA during TURBT for NMIBC. Results: The recurrence time was shorter in the GA group (5.5 months) than in the RA group (11 months) (p=0.015). First-year relapse was higher in the GA group than in the RA group (p=0.048), but there was no difference in third-year relapse between groups (p=0.810). The mean recurrence time was 11 months (95% CI; 9.058 - 12.942) in the RA group and 5 months (95% CI; 2.090 - 7.910) in the GA group (p=0.031). Conclusion: During transurethral resection of the bladder tumor, an increase in the recurrence time was observed in patients with intermediate-risk NMIBC who received RA compared to patients who received GA. RA provided a 7-month benefit in relapse delay.

Sequential Intravesical Chemotherapy for Treatment Naïve, High-Risk Non-Muscle Invasive Bladder Cancer: Oncologic Outcomes, Tolerance, and Comparison to Contemporary Controls

ObjectivesTo assess if receiving sequential intravesical chemotherapy (Gemcitabine-Docetaxel, Gem-Doce) therapy was associated with similar oncologic efficacy to bacillus Calmette-Guérin (BCG) in patients with treatment-naïve, high-risk non-muscle invasive bladder cancer (HR-NMIBC). MethodsSingle-center, retrospective cohort study of 80 patients with HR-NMIBC initiating first-line Gem-Doce or BCG between August 2020 and August 2023. Surveillance conducted with cystoscopy, urine cytology, and cross-sectional imaging. The primary oncologic outcome was high-grade bladder tumor recurrence during surveillance. Kaplan-Meier method applied to determine 12- and 24-month recurrence free survival (RFS) after initiation of therapy. Tolerance of each intravesical therapies was assessed. Results53/80 (66%) received Gem-Doce and 27/80 (34%) received BCG with overall 18-month median follow up. There were 10 recurrences after Gem-Doce and seven after BCG. The RFS at 12- and 24-months for Gem-Doce (12-months: 87%, 24-months: 75%) was not significantly different than BCG (12-months: 85%, 24-months: 81%). Lastly, Gem-Doce had significantly fewer patients with AEs compared to BCG (40% vs 74%). Limitations include retrospective design, small cohort size, and intermediate oncologic follow-up. ConclusionsOur data suggest that sequential intravesical Gem-Doce is an oncologically efficacious and, potentially better tolerated, alternative to BCG for treatment-naïve HR-NMIBC.

Efficacy of BCG for non-muscle invasive bladder cancer following nephroureterectomy for upper tract urothelial carcinoma

PurposeTo evaluate the efficacy of intravesical (IVe) Bacillus Calmette-Guerin (BCG) to treat non-muscle invasive bladder cancer (NMIBC) recurrences in patients who have previously undergone nephroureterectomy for upper tract urothelial carcinoma (UTUC). MethodsWe performed a single institution retrospective review of patients who underwent nephroureterectomy for UTUC from 2009 to 2021. Patients who subsequently developed NMIBC treated with transurethral resection followed by IVe BCG were included in the study group. A control cohort was formed by retrospective review of patents with primary NMIBC treated with BCG during the same period. Patients in the control cohort were matched by stage of bladder cancer at a 2:1 ratio of control to study subjects. Demographic data, pathology of bladder tumors prior to and following BCG, use of maintenance BCG (mBCG), time to recurrence, time to progression, progression to cystectomy, and progression to metastatic disease were collected on all patients. Descriptive statistics were utilized to compare the 2 groups. The primary outcome was progression to muscle invasive disease. Secondary outcomes included intravesical recurrence free survival, disease free survival, and progression to metastatic disease. Univariable and multivariable logistic regression analysis was performed to elucidate independent variables associated with bladder tumor recurrence. Multivariable Cox regression analysis was used to assess the impact of prior UTUC on time to bladder tumor recurrence. ResultsOne-hundred and ninety-one patients underwent nephroureterectomy at our institution from 2009 to 2021 for UTUC. Twenty-five patients were identified to have subsequently developed NMIBC recurrences treated with inductions BCG. The control group was comprised of 50 patients with primary NMIBC matched by stage of bladder cancer for which BCG was indicated in the study group. Median (interquartile range [IQR]) follow-up was significantly longer in the control group relative to the study group (64.8 [50.1-85.6] vs 25 months [17-35]; P = 0.001). There were no significant differences in demographics between the study and control groups. The rate of progression to muscle invasive disease was 17% vs 0% in the study group and control group respectively (P = 0.0521). History of UTUC was associated with increased risk of intravesical bladder tumor recurrence post BCG on multivariable analysis (HR 2.5; P = 0.017) and Kaplan Meier survival analysis (P = 0.039). The mean time to bladder tumor recurrence after treatment with BCG was significantly worse in the study group at (7.9 vs. 23.9 months; P = 0.0322). Similarly, the rate of progression to metastatic disease was worse in the study group (24% vs 2%; P = 0.0047). Overall disease-free survival was also noted to be significantly worse on Kaplan Meier survival analysis in the study group (P = 0.0074). No statistically significant differences in the stage grade of bladder tumor recurrence, grade of bladder tumor recurrence, or rate of progression to cystectomy were identified. ConclusionsOur study suggests reduced efficacy of BCG for NMIBC in patients with a history of UTUC. Patients in this population should be counseled accordingly. Research into alternative treatments for bladder tumor recurrence and more aggressive prophylactic regimens after nephroureterectomy for prevention of bladder tumor recurrence in this population is encouraged.

Strategically Staged Tumor Ablation and Inflammation Suppression Using Shell‐Core Nanoparticles to Eradicate Bladder Tumors and Prevent Recurrence

AbstractNanomedicine shows promise in the therapy of eradicating bladder tumors and preventing tumor recurrence caused by cancer‐related inflammation. Shell‐core structured BNN6/Z8@ALA/Z67 nanoparticles with sequential release kinetics is designed, aiming to eliminate tumors and curb inflammation, thereby ablating bladder tumors and preventing their recurrence. The shell of this nanoparticle comprises zeolitic imidazolate framework‐67 (Z67) and 5­aminolevulinic acid (ALA), while the core comprises zeolitic imidazolate framework‐8 (Z8) and N,N’‐di‐sec‐butyl‐N,N’‐dinitroso‐1,4‐phenylenediamine (BNN6). Modified with polydopamine‐methoxypolyethylene glycol amine, these nanoparticles efficiently target bladder tumors. In the acidic tumor environment, the outer‐layered Z67 breaks down rapidly, releasing ALA, which transforms into protoporphyrin IX (PpIX) in mitochondria. Additionally, the degraded Z67 triggers the conversion of hydrogen peroxide into oxygen, aiding PpIX to generate reactive oxygen species under ultrasound, facilitating tumor ablation. As Z67 decomposes, the inner‐layered Z8 releases BNN6 in the acidic environment. Ultrasound exposure prompts the release of nitric oxide, effectively reducing inflammation. Under ultrasound, BNN6/Z8@ALA/Z67 showcased outstanding staged anti‐tumor and anti‐inflammatory effects in both in vitro and murine subcutaneous tumor model tests, and effectively prevents tumor recurrence in rat bladder tumor models. These findings underscore the promising potential of the designed shell‐core nanoparticle with staged tumor ablation and inflammation suppression in preventing bladder tumor recurrence.

Safety and oncological outcome of early intraoperative intravesicle mitomycin C vs. deferred instillation in patients receiving robot-assisted radical nephroureterectomy.

Radical nephroureterectomy with concurrent bladder cuff excision (RNUBCE) is the gold standard surgical approach for high-risk primary upper tract urothelial carcinoma (UTUC). Given the notably high incidence of bladder tumor recurrence following this procedure, this study aimed to evaluate the effect and safety of intraoperative mitomycin-C (MMC) instillation vs. deferred instillation on overall oncological outcomes following robot-assisted RNUBCE. This is a retrospective chart review study. Patients with non-invasive (N0, not T3/T4) UTUC who underwent robotic RNUBCE combined an intraoperative MMC instillation or a deferred MMC instillation after surgery at a medical center in Taiwan between November 2013 and June 2020 were eligible for inclusion. Patients with prior bladder UC, carcinomas of other origins, received neoadjuvant chemotherapy, and had undergone kidney transplantation were excluded. All surgeries were executed by a single surgical team under the guidance of the same surgeon. The primary outcomes was the risk of bladder tumor recurrence between patients received intraoperative (IO) vs. deferred MMC instillation postoperatively (PO) during one-year follow-up. The secondary outcome was postoperative adverse events assessed by the Clavien-Dindo classification. Univariate and multivariable Cox regression analyses were performed to determine the associations between study variables and the outcomes. A total of 54 patients were included in the analysis. 12 (22.2%) patients experienced a bladder tumor recurrence during follow-up (IO: 7.7%, PO: 35.7%, p < 0.021). After adjustment in the multivariable, intraoperative MMC instillation was significantly associated with lower risk of bladder recurrence [adjusted hazard ratio (aHR) = 0.15, 95% CI: 0.03-0.81, p = 0.028]. No MMC-related Clavien-Dindo Grade III-IV adverse events were found in either group. IIntraoperative MMC instillation is safe and associated with a lower bladder tumor recurrence risk in patients undergoing robotic RNUBCE for UTUC than deferred instillation. Future large, prospective studies are still warranted to confirm the findings.

Modified robot-assisted nephroureterectomy with ureteral catheterization for radical resection of the distal ureter: Procedures and short-term outcomes

ObjectivesTo describe a bladder cuff excision method modified with ureteral catheterization to better visualize the ureteral orifice during robot-assisted nephroureterectomy (RANU). MethodsWe retrospectively analyzed 66 patients with upper urinary tract urothelial carcinoma of the renal pelvis and/or upper-mid ureter treated between January 2020 and January 2023. Among them, 32 patients (group A) underwent RANU supported by ureteral catheterization, and the remaining patients (group B) received routine transperitoneal RANU. Postoperative cystoscopy was performed routinely to compare the rates of residual ureteral orifice between the two groups. ResultsSurgeries were completed uneventfully in all 66 patients, without blood transfusion or conversion to open procedures. The operative time, estimated blood loss, and postoperative length of hospital stay were similar between both groups. However, the mean time required for BCE in group A was shorter than that in group B (9.5 min vs. 16.0 min, p = 0.006). Cystoscopy at postoperative three months showed no ipsilateral ureteral orifice in group A, but residual ureteral orifice was found in 23.5% of patients in group B. During a short follow-up period of 16 months, no patients in group A experienced bladder tumor recurrence. However, two patients (5.9%) in group B developed bladder tumor recurrence, with one experiencing local tumor recurrence at the level of the ureteral stump. ConclusionsOur novel technique enables complete ureteral retrieval, accurate and rapid bladder cuff excision, which makes the procedure less invasive and safely reproducible during robot-assisted nephroureterectomy.

Comparison of intravesical chemotherapy regimens after radical nephroureterectomy for upper tract urothelial carcinoma and analysis of risk factors for postoperative recurrence.

Upper tract urothelial carcinoma (UTUC) is a relatively rare but aggressive type of urologic cancer that includes renal pelvic tumors and ureteral tumors with a poor prognosis. Full-length nephroureterectomy plus sleeve bladder resection is the standard treatment for the disease, but patients are prone to recurrence of bladder tumors after surgery. Intravesical infusion therapy is the main means to prevent the recurrence and progression of bladder cancer. Epirubicin and gemcitabine are widely used in clinical practice as first-line or salvage therapy for intravesical chemotherapy; however, the efficacy of these agents is rarely discussed. The purpose of this study was to investigate the effects of epirubicin and gemcitabine on the occurrence of bladder cancer after radical nephroureterectomy for UTUC and to analyze the risk factors affecting the recurrence of postoperative bladder cancer. A total of 215 patients with diagnosed UTUC and treated in our hospital from June 2019 to August 2021 were retrospectively selected as the research subjects, and they were divided into an observation group (120 cases) and a control group (95 cases) according to different treatment methods. The patients in the control group were treated with epirubicin, while those in the observation group received gemcitabine. All patients were followed up by telephone or outpatient examination for 12 months to record the occurrence of adverse reactions. The occurrence of bladder cancer was recorded at 3 months, 6 months, and 12 months after the surgery. According to the occurrence of bladder cancer after surgery, the patients were divided into a bladder cancer group (63 cases) and a non-bladder cancer group (152 cases). Multivariate Logistic regression analysis was used to analyze the risk factors of bladder cancer after surgery. The total incidence of adverse reactions in the control group was 49.47%, which was higher than that in the observation group with 15.00% (p<0.01). The incidence of bladder tumors in the observation group and the control group was 0.00% and 2.11% at 3 months, 5.00% and 8.42% at 6 months, 13.33% and 15.79% at 12 months, without significant difference (p>0.05). After 12 months of perfusion, the levels of acidic fibroblast growth factor (aFGF), basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) in the two groups were significantly lower than those before perfusion (p<0.05). In the observation group, the levels of these three factors were slightly decreased compared with those in the control group, without a significant difference (p>0.05). Between the bladder cancer and non-bladder cancer groups, there were significant differences in tumor location, number of lesions, tumor stage, preoperative ureteral examination, and preoperative history of bladder cancer (p<0.05). The above indexes were all risk factors for postoperative bladder cancer (p<0.05). Epirubicin and gemcitabine reduced the occurrence of bladder cancer and effectively inhibited tumor angiogenesis after radical nephroureterectomy for UTUC. The tumor location, number of lesions, tumor stage, preoperative ureteral examination, and preoperative history of bladder cancer were risk factors for postoperative bladder cancer.

Correlation between urine cytology results on the day after overnight continuous saline irrigation following transurethral resection of bladder tumor and bladder tumor recurrence.

To investigate the relationship between urine cytology results after overnight continuous saline irrigation (OCSI) following transurethral resection of bladder tumor (TURBT) and bladder tumor recurrence in non-muscle invasive bladder cancer (NMIBC). A retrospective study was conducted on patients diagnosed with NMIBC between 2016 and 2020 after undergoing TURBT at our hospital. All patients received OCSI following TURBT and had urine cytology test at postoperative 1 day. Urine cytology was classified into three groups: Negative, low-grade urothelial neoplasm (LGUN)+atypical urothelial cells (AUC), and suspicious for high-grade urothelial carcinoma (SHGUC)+high-grade urothelial carcinoma (HGUC). Recurrence-free survival (RFS) in each group was compared using the Kaplan-Meier method. Univariable and multivariable Cox regression analyses were performed to evaluate independent prognostic factors. A total of 172 patients were included in this study. Based on urine cytology group (after OCSI), RFS did not reach the median value in the Negative group. In the LGUN+AUC group, the median RFS was 615.00 days. In the SHGUC+HGUC group, the median RFS was 377.00 days. In survival analysis, the Negative group had a longer RFS than the SHGUC+HGUC group (p=0.013). However, Cox regression analysis showed that SHGUC+HGUC was not an independent prognostic factor for recurrence. Urine cytology results after OCSI following TURBT in NMIBC were associated with bladder tumor recurrence. Specifically, SHGUC or HGUC in urine cytology after OCSI showed earlier recurrence than negative cases. However, further research is needed to accurately determine whether it is an independent prognostic factor.

Urinary Tract Infection in Patients after Transurethral Resection of Bladder Tumor Procedure in Tertiary Hospital

Introduction: The incidence of UTI after TURBT in the early stages can result in morbidity, increase the length of stay, and patient costs, even if not treated can be a risk factor for bladder tumor recurrence. The global incidence of post-TURBT UTI varies between 2-39%. This study aims to determine the incidence of UTI in post-TURBT patients. Materials and Methods: This study was a cross-sectional retrospective study. The research data was taken from the medical records of patients who underwent TURBT between 2017 - 2021 at a tertiary hospital. UTI after the TURBT was defined by symptoms of fever (≥ 38oC) and the results of urinalysis examination with positive bacteriuria. While asymptomatic bacteriuria (ABU) is defined by the results of a positive bacteriuria examination without symptoms of fever. The results of the study were processed with descriptive statistics and then presented in the form of tables and explanatory narratives. Statistical analysis was performed using SPSS version 26 with a p-value &lt; 0.05 considered statistically significant. Results: 140 patients underwent the TURBT. The data collected were 92 patients. In the pre TURBT, 56 (60,9%) patients were positive for bacteriuria, but 55 (59,8%) patients did not have fever symptoms. There were 1(1.1%) patient who had UTI before the TURBT. This patient was treated first with an antibiotic before the TURBT procedure. After the TURBT, 9 (9,7%) patients underwent urinalysis. A total of 4 (4.3%) patients experienced UTI after the TURBT and 3 (3.3%) experienced ABU after the TURBT. The incidence of UTI after the TURBT increased the length of stay of the patient (p = 0,003). Conclusion: The incidence of post-TURBT UTI is 4.3%. Only 9,8% of patients underwent urinalysis after the TURBT.&#x0D;

Somatic Mutation of the Non-Muscle-Invasive Bladder Cancer Associated with Early Recurrence.

Next-generation sequencing (NGS) is widely used in muscle-invasive bladder cancer but has limited use in non-muscle-invasive bladder cancer (NMIBC) due to significant heterogeneity and high cancer-specific survival. Therefore, we evaluated the genomic information of NMIBC and identified molecular alterations associated with tumour recurrence. A total of 43 patients with NMIBC who underwent transurethral resection of the bladder were enrolled. We performed NGS using an Oncomine panel of tumour specimens and blood samples corresponding to each specimen. The somatic mutation results were analysed by pairwise comparison and logistic regression according to the recurrence of bladder tumours within 1 year. The median incidence of genetic variations in 43 tumour samples was 56 variations per sample, and a high tumour mutation burden (TMB) was associated with tumour recurrence (median variation 33 vs. 64, p = 0.023). The most mutated gene was adipose tissue macrophages (ATM) (79%), followed by neurofibromatosis-1 (NF1) (79%), and neurogenic locus notch homolog protein 1 (NOTCH1) (79%). In multivariable analysis, mutation of epidermal growth factor receptor (EGFR) (odds ratio [OR], 9.95; 95% confidence interval [CI], 1.40-70.96; p = 0.022) and telomerase reverse transcriptase (TERT) (OR, 7.92; 95% CI, 1.22-51.51; p = 0.030) were significant factors associated with the recurrence of bladder tumour within 1 year. Our results revealed that high TMB, EGFR mutation, and TERT mutation had a significant association with tumour recurrence in NMIBC. In addition, somatic mutations in EGFR and TERT could be useful prognostic biomarkers in NMIBC.

An in-progress phase 2 window of opportunity (WOO) trial of targeted therapy with erdafitinib for patients with recurrent FGFR3-altered non–muscle-invasive bladder cancer (NMIBC).

TPS4614 Background: Alterations to FGFR3 are the most common somatic mutations in non-muscle invasive bladder cancer (NMIBC), present in 40-60% of high-grade Ta and &gt; 80% of recurrent low grade Ta tumors. FGFR3 mutations are also known to be associated with a “cold” tumor microenvironment (TME) that may mediate BCG resistance. Erdafitinib, a targeted inhibitor of FGFR 1-4, is the first FDA approved targeted therapy for locally advanced/metastatic bladder cancer. As FGFR3 mutations are present 3-5x more commonly in NMIBC than metastatic disease, erdafitinib is a logical therapeutic candidate for FGFR3-altered NMIBC. Through this ongoing phase II trial, we seek to determine the safety and efficacy of erdafitinib for the treatment of intermediate and high risk FGFR3-altered NMIBC after prior intravesical therapy. Methods: To address the need for expanded targeted therapeutics for NMIBC,, we launched an investigator-initiated phase II window of opportunity (WOO) trial of erdafitinib (NCT04917809, PI Pietzak). We are currently enrolling patients with intermediate or high risk NMIBC with history of ≥1 or more induction courses of BCG and/or intravesical chemotherapy who present with a clinically staged Ta papillary recurrence on office cystoscopy. Patients are also required to have an oncogenic FGFR3 mutation or fusion, as confirmed by OncoKB on MSK-IMPACT, to be included in the trial. Trial patients are treated with 6 mg oral erdafitinib daily for 28 days during the “window of opportunity” time period between office cystoscopy and transurethral resection of the recurrent bladder tumor (TURBT). The primary outcome is the rate of objective response, defined as complete (no visible tumor) or partial ( &gt; 50% reduction of measured diameter by Response Evaluation Criteria for Tumors of the Bladder [RECIT-Bladder]) as compared to cystoscopy at TURBT. We are employing an optimal Simon two-stage binomial design, assuming an objective response of &gt; 15% would and &lt; 2% would not be worthy of further study. We plan to enroll 16 patients in the first stage and 9 in the second (87% power). Secondary outcomes include safety (CTAE 5.0), patient reported outcomes, and recurrence-free survival. Correlative studies will be conducted with urine, blood, and tumor tissue samples. Urine and blood are collected before (day 1), during (day 14) and after treatment (day 28) and will undergo immune and molecular studies to understand shifts in the microenvironment in the setting of response and resistance. This trial is being conducted in parallel with a co-clinical trial of patient derived organoid/xenograft models (MSK 19-015, PI Pietzak) to further refine the understanding of FGFR3 mutational resistance to standard treatment and the effects of targeted immunotherapy on tumor clinicogenomics. Clinical trial information: NCT04917809 .

Effectiveness of BCG in recurrent non-muscle invasive bladder tumor: A 10 year retrospective study from a tertiary care centre

Abstract Introduction: Cancer-a term a word used to be so rare five decades back that people didn’t even know about this but now it has become so common and rampant and interestingly can be compared to a devil whose size seems to be increasing progressively. Even after so much advancement in medical science we have not been able to catch its tail. Urinary Bladder one of the very common cancer in our urological domain with its subtype non-muscle invasive bladder cancer (NMIBC) having high recurrence and progression rates has become very interesting subject for research. Such features led investigators to study the use of drugs to prevent this, out of which Bacillus Calmette–Guerin (BCG) has been successfully used as an intra vesical therapy to prevent recurrence and progression in NMIBC for more than four decades. Materials and Methods: In our study we have analyzed 111 patients retrospectively with only recurrent urinary bladder tumor irrespective of treatment received in the past. After completion Trans Urethral resection of bladder tumor (TURBT) and re-staging TURBT to substantiate the stage, induction and maintenance course of intravesical BCG was given according to Lamm protocol &amp; the impact of this therapy was studied in regards to recurrence free, progression free, cystectomy free &amp; overall survival rates. Result: Out of 111 patients, sixty percent of patient remained disease free, 19 patients had stage progression, nine patients underwent radical cystectomy and there was three cancer specific death. Conclusion: Despite BCG being the gold standard treatment for NMIBC, still intense research is required as there is a wide dark area of BCG failure.

PD13-05 LONG-TERM ONCOLOGICAL OUTCOMES OF OFFICE-BASED FULGURATION OF TA LOW-GRADE NON MUSCLE INVASIVE BLADDER CANCER: A LARGE SINGLE CENTER SERIES

You have accessJournal of UrologyCME1 Apr 2023PD13-05 LONG-TERM ONCOLOGICAL OUTCOMES OF OFFICE-BASED FULGURATION OF TA LOW-GRADE NON MUSCLE INVASIVE BLADDER CANCER: A LARGE SINGLE CENTER SERIES Christian Vitug, Katherine Lajkosz, Julian Chavarriaga, Andres Llano, Shayan Din, Eunice Villegas, Cynthia Kuk, Bruce Gao, Otto Hemminiki, Dhiral Kot, Jimmy Misurka, Theodorus Van Der Kwast, Christopher Wallis, Michael Jewett, Mark Soloway Aventura, Fl, Neil Fleshner, Girish Kulkarni, and Alexandre Zlotta Christian VitugChristian Vitug More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Julian ChavarriagaJulian Chavarriaga More articles by this author , Andres LlanoAndres Llano More articles by this author , Shayan DinShayan Din More articles by this author , Eunice VillegasEunice Villegas More articles by this author , Cynthia KukCynthia Kuk More articles by this author , Bruce GaoBruce Gao More articles by this author , Otto HemminikiOtto Hemminiki More articles by this author , Dhiral KotDhiral Kot More articles by this author , Jimmy MisurkaJimmy Misurka More articles by this author , Theodorus Van Der KwastTheodorus Van Der Kwast More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Michael JewettMichael Jewett More articles by this author , Mark Soloway Aventura, FlMark Soloway Aventura, Fl More articles by this author , Neil FleshnerNeil Fleshner More articles by this author , Girish KulkarniGirish Kulkarni More articles by this author , and Alexandre ZlottaAlexandre Zlotta More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sixty percent of non-muscle-invasive bladder tumors initially present as low grade (LG), which have a high recurrence rate but low risk of progression. Transurethral resection of bladder tumor (TURBT) is standard for the diagnosis, staging, and treatment of bladder cancer (BC). Office-based fulguration under local anesthesia for small, recurrent, apparent Ta LG tumors is an alternative to TURBT. It is convenient for both patients and physicians, avoiding the costs and risks of a hospital-based procedure requiring general or spinal anesthesia. However, despite being part of some guidelines, it has not become the primary management approach in part due to the paucity of large studies with long term follow-up. METHODS: We retrospectively reviewed our experience with 270 patients with a history of Ta LG BC who underwent office-based fulguration for subsequent small recurrent papillary bladder tumors between 1991 and 2021 at the Toronto General Hospital/Princess Margaret Cancer Center, University Health Network, Toronto, Canada. We report the cancer specific survival (CSS) and progression free survival (PFS, defined as muscle invasive disease or metastases). RESULTS: 270 patients with recurrent Ta LG NMIBC treated with office fulguration were included. Mean age was 64.9 (SD 13.3) years, 70.8% were men and 60.3% had single tumors. The mean number of fulgurations per patient was 3.1 (SD 3.2) with a range from 1 to 22. Median follow up was 10.1 years (IQR 5.8−16.2). Patients also underwent a mean of 3.6 (SD 3.0) TURBTs during follow-up. 44.4% of patients never received intravesical therapy during follow-up. At 10 years, the CSS was 100% and PFS was 97.3 (93.8-98.8)%, respectively. CONCLUSIONS: Our results are based on a large patient experience with long follow-up (10 years) and demonstrate that select patients with recurrent apparent Ta LG BC can be safely managed with office-based fulguration under local anesthesia, without compromising long-term oncological outcomes. This approach reduces surgical and anesthetic associated morbidity and may generate cost-savings to healthcare systems. Office-based fulguration for recurrent small tumors after Ta LG NMIBC should be more widely used. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e407 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Vitug More articles by this author Katherine Lajkosz More articles by this author Julian Chavarriaga More articles by this author Andres Llano More articles by this author Shayan Din More articles by this author Eunice Villegas More articles by this author Cynthia Kuk More articles by this author Bruce Gao More articles by this author Otto Hemminiki More articles by this author Dhiral Kot More articles by this author Jimmy Misurka More articles by this author Theodorus Van Der Kwast More articles by this author Christopher Wallis More articles by this author Michael Jewett More articles by this author Mark Soloway Aventura, Fl More articles by this author Neil Fleshner More articles by this author Girish Kulkarni More articles by this author Alexandre Zlotta More articles by this author Expand All Advertisement PDF downloadLoading ...

PD13-14 THE GENETIC INFORMATION OF NON-MUSCLE INVASIVE BLADDER CANCER ASSOCIATED WITH RECURRENCE

You have accessJournal of UrologyCME1 Apr 2023PD13-14 THE GENETIC INFORMATION OF NON-MUSCLE INVASIVE BLADDER CANCER ASSOCIATED WITH RECURRENCE Seong Hyeon Yu, Do Gyeong Lim, Jeong Hoon Oh, Jiwon Ryu, Ho Seok Chung, Eu Chang Hwang, Kyung Jin Oh, Sun-Ouck Kim, Seung Il Jung, Taek Won Kang, Kwangsung Park, and Dong Deuk Kwon Seong Hyeon YuSeong Hyeon Yu More articles by this author , Do Gyeong LimDo Gyeong Lim More articles by this author , Jeong Hoon OhJeong Hoon Oh More articles by this author , Jiwon RyuJiwon Ryu More articles by this author , Ho Seok ChungHo Seok Chung More articles by this author , Eu Chang HwangEu Chang Hwang More articles by this author , Kyung Jin OhKyung Jin Oh More articles by this author , Sun-Ouck KimSun-Ouck Kim More articles by this author , Seung Il JungSeung Il Jung More articles by this author , Taek Won KangTaek Won Kang More articles by this author , Kwangsung ParkKwangsung Park More articles by this author , and Dong Deuk KwonDong Deuk Kwon More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003260.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The next-generation sequencing (NGS) is widely used in muscle invasive bladder cancer (MIBC), but limited use in non-muscle invasive bladder cancer (NMIBC) due to significant heterogeneity and high cancer-specific survival. Therefore, we aimed to evaluate the genomic information of NMIBC and identify molecular alteration associated with tumor recurrence. METHODS: A total of 43 patients with NMIBC who underwent transurethral resection of bladder were enrolled. We performed NGS using oncomine panel on tumor specimen and blood sample corresponding to each specimen. The mutation results were analyzed by pairwise comparison according to the recurrence of bladder tumor within 1 year. RESULTS: The median incidence of genetic variation in 43 tumor samples was 53 variations per sample, and high TMB was associated with tumor recurrence. (median variation 33 vs. 64, p=0.023) The most mutated gene was ATM (79%), followed by NF1 (79%), and NOTCH1 (79%). In the results of pairwise comparison according to the recurrence of bladder tumor within 1-year, epidermal growth factor receptor (EGFR) mutation was significant factor associated with tumor recurrence (odds ratio [OR], 4.81; 95% confidence interval [CI], 1.96-32.92, p=0.045). In addition, TERT (OR, 4.10; 95% CI, 0.92-22.38, p=0.054) and MYCL (OR, 5.22; 95% CI, 0.86-57.88, p=0.068) might be the associated factor of tumor recurrence. CONCLUSIONS: Our results revealed that EGFR mutation has a prognostic value on tumor recurrence of NMIBC; therefore, EGFR might be a useful prognostic biomarker in NMIBC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e411 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seong Hyeon Yu More articles by this author Do Gyeong Lim More articles by this author Jeong Hoon Oh More articles by this author Jiwon Ryu More articles by this author Ho Seok Chung More articles by this author Eu Chang Hwang More articles by this author Kyung Jin Oh More articles by this author Sun-Ouck Kim More articles by this author Seung Il Jung More articles by this author Taek Won Kang More articles by this author Kwangsung Park More articles by this author Dong Deuk Kwon More articles by this author Expand All Advertisement PDF downloadLoading ...

A systematic review of the efficacy of intravesical electromotive drug administration therapy for non-muscle invasive bladder cancer.

Non-muscle invasive bladder cancer (NMIBC) is characterized by a high rate of recurrence and progression, despite surgery and adjuvant therapies. To analyze the published results on the effectiveness of mitomycin C (MMC) applied with an electromotive drug administration device (EMDA) in the treatment of patients with non-muscle invasive bladder tumors. A systematic review was conducted using the PubMed and Google Scholar search platforms. We selected the studies that included the recurrence and/or progression rates or complete response rate in patients diagnosed with NMIBC according to their treatment and included MMC applied with EMDA. The last search was performed in November 2021. The search yielded 64 articles; 11 articles met the selection criteria. In two of the 11 selected articles, mitomycin C was applied with an EMDA device (MMC-EMDA) as an ablative treatment, avoiding surgery in 50% of the patients. In 1 of the 11 studies, the application of MMC-EMDA was used as an induction treatment using a single preoperative instillation with promising results. In the remaining 8 studies, adjuvant MMC was applied with the EMDA device; in 3 of these 8 cases, treatment with MMC-EMDA alone was applied initially. In another3 cases the same treatment was applied after nonresponse to bacillus Calmette Guerin (BCG), and in the last 2 studies, MMC-EMDA was applied in combination with the classic therapy (BCG). All the studies selected supported the efficacy and safety of MMC-EMDA in patients with intermediate and high- risk bladder cancer. In 3 studies, adjuvant therapy with MMC-EMDA was performed in nonresponders to BCG, finding that adjuvant therapy with MMC-EMDA applied to BCG nonresponders without CIS avoided or delayed surgery. The application of EMDA-enhanced MMC has been studied at different times of disease and with different administration protocols. It appears to delay bladder tumor recurrence and progression in certain populations. However, the methodological limitations of the published studies prevent definitive conclusions about its efficacy.

TULA DUAL: Trans Urethral Laser Ablation of recurrent bladder tumors in outpatient setting

To the Editor, Bladder cancer (BCa) is the second most common cancer in urological clinical practice, after prostate adenocarcinoma. Usually occurs in patients between 60 and 70 years old, three times more frequently in men than women. About 75% of bladder cancer are pTa or pT1, even more frequently considering a population younger than 40 years old. Early detection is of paramount importance since allows to find tumors when they are still superficial and therefore with a better prognosis.