Concomitant Carcinoma In Situ Research Articles

Do we need a re-TUR after en bloc resection of T1 stage bladder cancer?

BackgroundA second look trans-urethral resection of the bladder (re-TUR) is recommended after the diagnosis of T1 high grade (T1HG) bladder cancer. Few studies have evaluated the results of re-TUR after a first en bloc resection (EBR) and none of them have specifically reported the pathological results on the field of previous T1 disease.ObjectiveTo report the rate of upstaging and the rate of residual disease (RD) on the field of T1HG lesions resected with EBR.Materials and methodsBetween 01/2014 and 06/2022, patients from 2 centers who had a re-TUR after an EBR for T1HG urothelial carcinoma were retrospectively included. Primary endpoint was the rate of RD including the rate of upstaging to T2 disease on the scar of the primary resection. Secondary endpoints were the rate of any residual disease outside the field.ResultsSeventy-five patients were included. No muscle invasive bladder cancer lesions were found after re-TUR. Among the 16 patients who had a RD, 4 were on the resection scar. All of these lesions were papillary and high grade. RD outside the field of the first EBR was observed in 12 patients.ConclusionAfter EBR of T1HG disease, none of our patients had an upstaging to MIBC. However, the rate of RD either on and outside the field of the EBR remains quite significant. We suggested that predictive factors of residual papillary disease (number of tumors at the initial TUR and concomitant CIS) might be suitable to select patient who will benefit of the re-TUR.

Can We Go beyond Pathology? The Prognostic Role of Risk Scoring Tools for Cancer-Specific Survival of Patients with Bladder Cancer Undergoing Radical Cystectomy.

Radical cystectomy (RC) remains a mainstay surgical treatment for non-metastatic muscle-invasive and BCG-unresponsive bladder cancer. Various perioperative scoring tools assess comorbidity burden, complication risks, and cancer-specific mortality (CSM) risk. We investigated the prognostic value of these scores in patients who underwent RC between 2015 and 2021. Cox proportional hazards were used in survival analyses. Risk models' accuracy was assessed with the concordance index (C-index) and area under the curve. Among 215 included RC patients, 63 (29.3%) died, including 53 (24.7%) cancer-specific deaths, with a median follow-up of 39 months. The AJCC system, COBRA score, and Charlson comorbidity index (CCI) predicted CSM with low accuracy (C-index: 0.66, 0.65; 0.59, respectively). Multivariable Cox regression identified the AJCC system and CCI > 5 as significant CSM predictors. Additional factors included the extent of lymph node dissection, histology, smoking, presence of concomitant CIS, and neutrophil-to-lymphocyte ratio, and model accuracy was high (C-index: 0.80). The internal validation of the model with bootstrap samples revealed its slight optimism of 0.06. In conclusion, the accuracy of the AJCC staging system in the prediction of CSM is low and can be improved with the inclusion of other pathological data, CCI, smoking history and inflammatory indices.

Early experience with sequential intravesical gemcitabine and docetaxel for micropapillary variant non-muscle invasive bladder cancer

BackgroundGuidelines lack clear recommendations regarding conservative management of micropapillary (MP) variant non-muscle invasive bladder cancer (NMIBC). Bladder-sparing therapy using intravesical Bacillus Calmette-Guerin (BCG) has been reported although there are concerns regarding recurrence and progression with this approach. Due to the ongoing BCG shortage, we have utilized sequential intravesical gemcitabine and docetaxel (Gem/Doce) as primary therapy for NMIBC, including some cases with limited MP urothelial carcinoma (MPUC). To compare oncologic outcomes of patients with non-muscle invasive MPUC and conventional UC treated with Gem/Doce. MethodsA secondary analysis of 138 patients with high-risk NMIBC treated with intravesical Gem/Doce from January 2011 to December 2021 was performed. Oncologic outcomes were compared in patients with or without MPUC using the Kaplan-Meier method. ResultsMedian follow-up (f/u) for all patients was 23 months (IQR 13–34). There were 129 patients with pure UC and 9 with MPUC. In those with MPUC, all were high-grade (HG), 8/9 were stage T1, 7/9 had a focal MP component (extent < 10%), 3/9 had concomitant CIS, and 2/9 had lymphovascular invasion. All MPUC tumors were re-resected, and 4 had T0, 3 had T1 HG, 1 had Ta HG, 1 had carcinoma in situ (CIS); none had residual MP or LVI tumors before Gem/Doce treatment. The 24-month high-grade recurrence-free survival was 89% and 80% in patients with MPUC and pure UC, respectively. Survival outcomes did not significantly differ between patients with and without MPUC. Four patients with MPUC experienced recurrent NMIBC after Gem/Doce, and all were treated successfully with rescue sequential intravesical valrubicin and docetaxel (Val/Doce). Pathology of these four recurrent patients revealed more aggressive histologic features in the original tumor including: multifocal tumor (3/4), T1 HG disease (4/4), concomitant CIS (2/4), and moderate MP variant extent (30%) (1/4). No patient with MPUC underwent cystectomy, experienced progression, or died at last follow-up (median f/u of 43 months). ConclusionsGem/Doce with Val/Doce rescue appears to have activity against carefully selected non-muscle invasive MPUC with favorable histology. Larger prospective trials are needed to validate these results.

Advanced Age Impacts Survival After Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma

Upper tract urothelial carcinoma is rare but has a poor prognosis. Prognostic factors have been extensively studied in order to provide the best possible management for patients. We have aimed to investigate commonly available factors predictive of recurrence and survival in this patient population at high risk of death and recurrence, with an emphasis on the effects of age (using a cutoff of 70 years) on survival outcomes. From 1387 patients with clinically nonmetastatic upper tract urothelial carcinoma treated with radical nephroureterectomy at 21 academic hospital centers between 2005 and 2021, 776 patients were eligible and included in the study. Univariable and multivariable Cox regression models were built to evaluate the independent prognosticators for intravesical and extravesical recurrence, overall survival, and cancer-specific survival according to age groups. A P value of <.05 was considered statistically significant. We did not find an association between groups aged <70 and >70 years old and preoperatively clinical or histopathological characteristics. Kaplan-Meier analysis was found no statistical significance between the 2 age groups in terms of intravesical or extravesical recurrence (P = .09 and P = .57). Overall survival (P = .0001) and cancer-specific survival (P = .0001) have been found to be statistically significantly associated with age as independent predictors (confounding factors: gender, tumor size, tumor side, clinical T stage, localization, preoperative hydronephrosis, tumor localization, type of surgery, multifocality of the tumor, pathological grade, lymphovascular invasion, concomitant CIS, lymph node status, necrosis, or history of previous bladder cancer). This research confirms that patients aged 70 and above who undergo radical nephroureterectomy may have worse outcomes compared to younger patients, older patients needing an improved care and management of UTUC to improve their outcomes in the setting of an increase in this aged population group.

The Impact of the Initial Clinical Presentation of Bladder Cancer on Histopathological and Morphological Tumor Characteristics

This study investigated the impact of the initial clinical presentation of bladder cancer on tumor characteristics. A cross-sectional, retrospective study was performed, and it involved 515 patients who underwent transurethral bladder cancer resection at the University Hospital Center Split between April 2019 and April 2023, excluding recurrent cases. The association between symptomatic versus asymptomatic presentation and bladder cancer characteristics was analyzed. A subgroup analysis compared tumor characteristics between patients with gross and microscopic hematuria. Multiple regression analyses revealed a significant association between symptomatic presentation and the detection of high-grade bladder cancer (OR 3.43, 95% CI 2.22–5.29, p &lt; 0.001), concomitant CIS (OR 3.41, 95% CI 1.31–8.88, p = 0.012), T2 stage bladder cancer (OR 5.79, 95% CI 2.45–13.71, p &lt; 0.001), a higher number of tumors (IRR 1.24, 95% CI 1.07–1.45, p = 0.005), and larger tumor size (B 1.68, 95% CI 1.19–2.18, p &lt; 0.001). In the subgroup analysis, gross hematuria was associated with the detection of high-grade bladder cancer (OR 2.07, 95% CI 1.12–3.84, p = 0.020), T2 stage bladder cancer (OR 6.03, 95% CI 1.42–25.49, p = 0.015), and larger tumor size (B 1.8, 95% CI 0.99–2.6, p &lt; 0.001). The identified associations between symptomatic presentation and unfavorable bladder cancer characteristics, likely attributed to early detection in asymptomatic cases, underscore the importance of additional research in the development of bladder cancer screening strategies.

Clinical practice of UroVysion® urine test in patients with bladder carcinoma in situ treated with intravesical Bacillus Calmette-Guerin.

In January 2019, the use of the UroVysion® urine test for surveillance of non-muscle invasive bladder cancer with carcinoma in situ (CIS) was approved in Japan. Clinical evidence of its use remains limited. Herein, we report the real-world clinical practice of the UroVysion test. Of 29 patients underwent at least one UroVysion test at our hospital from 2019 to 2022, only two (6.9%) tested positive without any visible tumor on the cystoscopy after the initial transurethral resection: a 77-year-old man with T1 high-grade tumor and concomitant CIS and a 76-year-old woman with CIS. The remaining 27 patients (93.1%) tested negative post-transurethral resection. This study was the first to report the Japanese real-world practice of the UroVysion test, demonstrating relatively low positive rate as compared to the previous reports from other countries. Further clinical evidence from other Japanese institutes needs to be accumulated to update the true value of this test.

PD44-06 CHEMOTHERAPY VS IMMUNOTHERAPY AS NEOADJUVANT THERAPIES IN CISPLATIN-ELIGIBLE PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023PD44-06 CHEMOTHERAPY VS IMMUNOTHERAPY AS NEOADJUVANT THERAPIES IN CISPLATIN-ELIGIBLE PATIENTS UNDERGOING RADICAL CYSTECTOMY FOR MUSCLE INVASIVE BLADDER CANCER Luigi Nocera, Marco Bandini, Giuseppe Basile, Marco Moschini, Shreyas Naidu, Kyle Rose, Roger Li, Philippe Spiess, and Andrea Necchi Luigi NoceraLuigi Nocera More articles by this author , Marco BandiniMarco Bandini More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Shreyas NaiduShreyas Naidu More articles by this author , Kyle RoseKyle Rose More articles by this author , Roger LiRoger Li More articles by this author , Philippe SpiessPhilippe Spiess More articles by this author , and Andrea NecchiAndrea Necchi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003354.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Chemotherapy has represented one of the cornerstone of the treatment landscape of muscle invasive bladder cancer (MIBC), due to its improvement in survival outcomes. Recently, also immunotherapy also showed to improve both pathological response, as well as survival outcomes. However, no comparison has ever been performed between the two neoadjuvant treatments. We aimed to compare cisplatinum-based chemotherapy and pembrolizumab in MIBC patients undergoing radical cystectomy (RC). METHODS: We retrospectively identified patients with MIBC and treated with RC after neoadjuvant treatment with either cisplatin or pembrolizumab in two tertiary referral centers. Cisplatinum-eligibility represented an inclusion criterion. Conversely, clinical node positive disease and adjuvant chemotherapy administration were exclusion criteria. The endpoint of the analyses was recurrence-free survival (RFS). Statistical analyses consisted of Kaplan-Meier (KM) curves before and after inverse-probability treatment weighting (IPTW), adjusting for age, gender, pathological stage, concomitant CIS and variant histology (VH). RESULTS: Of all 346 patients, median age was 67 years (IQR 60-73) and the majority of patients were male (80.3%). The majority of patients harbored a pT0N0 disease (30.3%) at RC pathology followed by pT2-4N0 (29.5%), pTanyN1-3 (20.5%) and pT1-a-isN0 (19.6%). Moreover, 113 patients (32.6%) exhibited concomitants CIS, while 255 patients (73.7%), 27 patients (7.8%) and 64 patients (18.5%) showed respectively presence of pure/mixed urothelial carcinoma, pure VH and other histology. Overall, 70 patients (20.2%) experienced recurrence (33.9% pelvic vs 66.1% distant) after a median follow-up of 24 months (12-39). KM showed a 24-months RFS of 76.9 vs 86.6% for cisplatinum-based chemotherapy versus pembrolizumab (p<0.01). After IPTW for age, gender, pathological stage, concomitant CIS and VH, KM showed 76.8 vs 93.2% for cisplatinum-based chemotherapy versus pembrolizumab (p=0.01). CONCLUSIONS: We compared RFS after cisplatinum chemotherapy vs pembrolizumab as neoadjuvant treatment in MIBC undergoing RC. Our findings suggest a potentially higher benefit of pembrolizumab, that was confirmed after adjustment for confounders. Source of Funding: NONE © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1126 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luigi Nocera More articles by this author Marco Bandini More articles by this author Giuseppe Basile More articles by this author Marco Moschini More articles by this author Shreyas Naidu More articles by this author Kyle Rose More articles by this author Roger Li More articles by this author Philippe Spiess More articles by this author Andrea Necchi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-11 ADVANCED AGE (&gt;70 YEARS) DOES NOT AFFECT ONCOLOGICAL OUTCOMES IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS TREATED WITH ADEQUATE BACILLUS CALMETTE-GUERIN: A COMPETING RISK ANALYSIS FROM a TERTIARY CARE CENTER.

You have accessJournal of UrologyCME1 Apr 2023MP63-11 ADVANCED AGE (>70 YEARS) DOES NOT AFFECT ONCOLOGICAL OUTCOMES IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS TREATED WITH ADEQUATE BACILLUS CALMETTE-GUERIN: A COMPETING RISK ANALYSIS FROM a TERTIARY CARE CENTER. Roberto Contieri, Valentina Grajales, Wei Shen Tan, Kelly Bree, Patrick Hensley, Charles C. Guo, Graciela M. Nogueras-Gonzalez, Neema Navai, Colin P. Dinney, and Ashish M. Kamat Roberto ContieriRoberto Contieri More articles by this author , Valentina GrajalesValentina Grajales More articles by this author , Wei Shen TanWei Shen Tan More articles by this author , Kelly BreeKelly Bree More articles by this author , Patrick HensleyPatrick Hensley More articles by this author , Charles C. GuoCharles C. Guo More articles by this author , Graciela M. Nogueras-GonzalezGraciela M. Nogueras-Gonzalez More articles by this author , Neema NavaiNeema Navai More articles by this author , Colin P. DinneyColin P. Dinney More articles by this author , and Ashish M. KamatAshish M. Kamat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: According to the newly released European Association of Urology (EAU) prognostic factor risk groups, age over 70 should be considered an additional clinical risk factor for progression amongst patients with non-muscle invasive bladder cancer (NMIBC). However, this statement is based on an analysis of patients who did not receive intravesical BCG therapy. Herein, we aim to evaluate the impact of age on oncological outcomes in NMIBC patients treated with adequate BCG. METHODS: We performed an IRB approved retrospective study analyzing patients with NMIBC treated with adequate BCG at our institution from 2000 to 2020. Based on EAU guidelines, patients were stratified into two groups according to age ( <70 yrs and>70 yrs). Primary endpoint was cancer-specific mortality (CSM). The cumulative incidence method was used to estimate the risk of CSM, high-grade (HG) recurrence and progression to muscle-invasive BC or metastatic disease after accounting for other causes of death (OCD) as a competing risk event; curves were compared with the Pepe-Mori test. Multivariate competing-risks regression analyses were used to predict HG recurrence and progression according to age after accounting for OCD. RESULTS: A total of 632 patients treated with adequate BCG were identified (355 <70 yrs versus 277>70 yrs). The median follow-up was 64.6 months (Interquartile range: 35.3–99.4) . Older patients were more likely to have a concomitant CIS (29.0% vs. 35.7%, p=0.072), and less likely to undergo second resection (reTUR) (66.2% vs. 56.5%, p=0.013). Despite this, at multivariate competing-risk regression analyses, age>70 did not emerge as an independent predictor of HG recurrence or progression (SHR 1.07, 95% CI: 0.78–1.46; p=0.687 and SHR: 1.60; 95% CI: 0.89–2.89; p=0.118). OS at 5 (94.2% vs. 78.5%) and 10 years (81.1% vs 42.3%) was considerably lower in the>70 yrs group. However, the 5-yr CSM overlap between the age groups (5.1% 95% CI: 2.7-8.7 vs. 2.0% 95% CI: 0.8–4.2). CONCLUSIONS: Age >70 was not associated with significantly worse oncological outcomes in NMIBC patients treated with adequate BCG Source of Funding: This research was supported by the Wayne B. Duddlesten Professorship in Cancer Research, the Raymond and Maria Floyd Bladder Cancer Research Foundation Grant, NIH/NCI UTMD Anderson SPORE in Genitourinary Cancer (p50CA091846), the Cancer Center Support Grant (NCI Grant P30 CA016672). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e875 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roberto Contieri More articles by this author Valentina Grajales More articles by this author Wei Shen Tan More articles by this author Kelly Bree More articles by this author Patrick Hensley More articles by this author Charles C. Guo More articles by this author Graciela M. Nogueras-Gonzalez More articles by this author Neema Navai More articles by this author Colin P. Dinney More articles by this author Ashish M. Kamat More articles by this author Expand All Advertisement PDF downloadLoading ...

Is CIS a Contraindication to Hyperthermic Intravesical Chemotherapy (HIVEC) after BCG-Failure?

CIS of the bladder is associated with a high risk of progression. In the case of BCG failure, radical cystectomy should be performed. For patients who refuse or are ineligible, bladder-sparing alternatives are evaluated. This study aims to investigate the efficacy of Hyperthermic IntraVesical Chemotherapy (HIVEC) depending on the presence or absence of CIS. This retrospective, multicenter study was conducted between 2016 and 2021. Patients with non-muscle-invasive bladder cancer (NMIBC) with BCG failure received 6-8 adjuvant instillations of HIVEC. The co-primary endpoints were recurrence-free survival (RFS) and progression-free survival (PFS). A total of 116 consecutive patients met our inclusion criteria of whom 36 had concomitant CIS. The 2-year RFS rate was 19.9% and 43.7% in patients with and without CIS, respectively (p = 0.52). Fifteen patients (12.9%) experienced progression to muscle-invasive bladder cancer with no significant difference between patients with and without CIS (2-year PFS rate = 71.8% vs. 88.8%, p = 0.32). In multivariate analysis, CIS was not a significant prognostic factor in terms of recurrence or progression. In conclusion, CIS may not be considered a contraindication to HIVEC, as there is no significant association between CIS and the risk of progression or recurrence after treatment.

Prognosis of Primary Papillary Ta Grade 3 Bladder Cancer in the Non–muscle-invasive Spectrum

BackgroundTa grade 3 (G3) non–muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive. ObjectiveTo evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas. Design, setting, and participantsIndividual patient data for 5170 primary Ta–T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018. Outcome measurements and statistical analysisTime to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution. Results and limitationsTa G3 represented 7.5% (387/5170) of Ta–T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7–4.8%) of Ta G2, 13% (95% CI 9.3–17%) of Ta G3, and 20% (95% CI 17–23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p < 0.001) and longer than for T1 G3 (p = 0.002). Patients with Ta G3 NMIBC with concomitant carcinoma in situ (CIS) had worse prognosis and a similar time to progression as for patients with T1 G3 NMIBC with CIS (p = 0.5). Multivariable analyses for recurrence and progression showed similar results. ConclusionsThe prognosis of Ta G3 tumors in terms of progression appears to be in between that of Ta G2 and T1 G3. However, patients with Ta G3 NMIBC with concomitant CIS have worse prognosis that is comparable to that of T1 G3 with CIS. Our results support the recent EAU NMIBC guideline changes for more refined risk stratification of Ta G3 tumors because many of these patients have better prognosis than previously thought. Patient summaryWe used data from 17 centers in Europe and Canada to assess the prognosis for patients with stage Ta grade 3 (G3) non–muscle-invasive bladder cancer (NMIBC). Time to cancer progression for Ta G3 cancer differed from both Ta G2 and T1 G3 tumors. Our results support the recent change in the European Association of Urology guidelines for more refined risk stratification of Ta G3 NMIBC because many patients with this tumor have better prognosis than previously thought.

Serum IL-6 level is associated with clinical outcome of intravesical gemcitabine therapy in T1 non-muscle-invasive bladder cancer.

Serum biomarkers are valuable tools to predict the prognosis of anticancer therapies. This study aimed to evaluate the impact of serum interleukin-6 (IL-6) level on the clinical outcome of intravesical gemcitabine (GEM) therapy in non-muscle-invasive bladder cancer (NMIBC). This retrospective study enrolled 71 patients initially diagnosed with T1 NMIBC who underwent intravesical GEM therapy between 2017 and 2019. The expression of IL-6 gene was examined by real-time PCR. Serum IL-6 level was determined by enzyme-linked immunosorbent assay (ELISA). The cell viability after gemcitabine treatment was measured by CCK-8 assay. The optimal serum IL-6 cutoff values for recurrence prediction were calculated using receiver-operating characteristic curve analysis with reference to cancer recurrence. Recurrence-free survival was compared by the log-rank test. Univariate and multivariate Cox regression analysis was conducted to identify the prognostic factors influencing recurrence-free survival after treatment with intravesical GEM. Increased expression and secretion of IL-6 were observed in GEM-resistant sublines compared with parental bladder cancer cell lines. Serum IL-6 level rendered a sensitivity of 82.6% and a specificity of 77.1% to correlate with the cancer recurrence after intravesical GEM. Patients with a high serum IL-6 level exhibited shorter recurrence-free survival after intravesical GEM. Moreover, serum IL-6 level in our NMIBC cohort was significantly associated with clinicopathological characteristics, such as tumor diameter, multifocality, concomitant CIS, and grade. Serum IL-6 level was an independent prognostic factor for recurrence-free survival in NMIBC patients treated with intravesical GEM. Given that it was significantly associated with clinical outcome of intravesical GEM therapy, serum IL-6 level might be used as a potential prognostic biomarker for intravesical GEM in T1 NMIBC.

The prognostic role of pre-cystectomy thrombocytosis in invasive bladder cancer.

We aim to evaluate the impact of preoperative thrombocytosis on oncological outcomes in patients with bladder cancer (BC) who undergo radical cystectomy (RC). Retrospective data collection of 1092 patients managed by RC for BC from 2 tertiary-care centers was performed. Elevated platelet count (PLT) was defined as > 450 × 109/L. Univariable and multivariable logistic regression analyses were used to investigate the impact of thrombocytosis on oncological outcomes. These outcomes were also compared using Kaplan-Meier survival analysis. The median follow-up was 50months (32-64months). Thrombocytosis was detected in 18.6% of the patients. The 3-year cancer-specific survival (CSS) for patients with normal PLT count was 92% which was higher than those with elevated PLT count (55%, P < 0.001). Similar results were found for the 6-year CSS with 82% for the no thrombocytosis group and 27% for the thrombocytosis group. Thrombocytosis was still significantly associated with poor prognosis for overall survival and recurrence-free survival (P < 0.001). In the multivariate analysis, CSS was significantly lower in patients with thrombocytosis (HR = 1.71, 95% CI = 1.22-2.39, P = 0.002). Patients with elevated PLT counts were also significantly more likely to receive adjuvant chemotherapy, to have a T stage > pT2b (P = 0.024), to have a positive lymph node, to have variant histology and positive resection margins, and to have concomitant carcinoma in situ (CIS) on final pathology (all P < 0.001). Preoperative thrombocytosis was valuable for predicting the oncological outcomes of patients undergoing RC for BC.

The probability of residual tumor detection in the second transurethral resection of pT1 urothelial bladder cancer according to the risk factors

ObjectiveTo analyze the predictive factors for residual tumors in the second resection after the initial transurethral resection of bladder tumor (TUR-BT) in patients with pT1 tumors and to develop a simple method to predict the probability of residual tumor detection. Material and MethodsPatients with pT1 bladder cancer who underwent a second resection within two to six weeks after the initial TUR-BT were included in our retrospective study. The patients’ demographics and the tumor characteristics of the initial and second resections were recorded. ResultsA total of 144 patients were included in our analysis with a 53-month follow-up. In the univariate logistic regression analysis, tumor grade, concomitant carcinoma in situ (CIS), macroscopic appearance of the tumor (solid vs papillary), and presence of a variant histology, were significant risk factors for residual tumor. In the multivariate analysis, tumor grade was the only independent predictor of residual tumor at second TUR (OR: 5.62, 95% CI: 1.228–25.708, p = 0.026). According to our findings, the patients with the highest risk have a 90.9% residual tumor detection probability at the second resection, and the patients with the lowest risk have 25.4%. ConclusionsTumor grade, macroscopic appearance of the tumor (solid vs papillary), and concomitant CIS, were important predictors of residual tumors at second resection of primary pT1 NMIBC patients. We were able to calculate the probability of residual tumor which helped us determine risk adapted strategies according to these probabilities.

MP50-20 SURGICAL MANAGEMENT AND OUTCOMES OF NATIVE UPPER URINARY TRACT UROTHELIAL CARCINOMA AFTER KIDNEY TRANSPLANTATION

You have accessJournal of UrologyCME1 May 2022MP50-20 SURGICAL MANAGEMENT AND OUTCOMES OF NATIVE UPPER URINARY TRACT UROTHELIAL CARCINOMA AFTER KIDNEY TRANSPLANTATION Shi-Jie Tsai, Eric Yi-Hsiu Huang, Tzu-Hao Huang, Tzu-Chun Wei, Chih-Chieh Lin, Tzu-Ping Lin, Hsiao-Jen Chung, William J.S. Huang, and Yen-Hwa Chang Shi-Jie TsaiShi-Jie Tsai More articles by this author , Eric Yi-Hsiu HuangEric Yi-Hsiu Huang More articles by this author , Tzu-Hao HuangTzu-Hao Huang More articles by this author , Tzu-Chun WeiTzu-Chun Wei More articles by this author , Chih-Chieh LinChih-Chieh Lin More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung More articles by this author , William J.S. HuangWilliam J.S. Huang More articles by this author , and Yen-Hwa ChangYen-Hwa Chang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002625.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplant (KT) recipients were associated with increased incidence of malignancy due to use of immunosuppressant. Urothelial carcinoma (UC) was one of the leading de novo malignancies following KT. For UC arising from native upper urinary tract after KT, radical nephroureterectomy (RNU) was the gold standard of treatment. We aim to analyze the surgical and oncological outcomes of KT recipients with native upper urinary tract UC underwent RNU. METHODS: We retrospectively reviewed KT patients underwent RNU due to upper tract urothelial carcinoma (UTUC) at our institute from 2005 to 2016. Demographic data and oncologic outcomes were collected from medical records. RESULTS: A total of 26 patients were included in this study. The average age at RNU was 59.4±12.2 years (range 22-73), and the time interval from KT to RNU was 10.7±5.6 years (range 1.5-20). Five patients (19%) received unilateral RNU. Twenty-one patients (81%) received simultaneous bilateral radical nephroureterectomy (SBRNU). The methods of surgical approach were open in 13 (50%) cases, laparoscopy in 10 (38%) cases, and robotic-assisted in 3 (12%) cases. The perioperative complication rate was 30%, and 11% was ≥ grade III Clavien-Dindo classification. Function loss of the graft kidney was not observed in all cases.The histopathology results showed 11 (42%) cases were locally advanced stage (pT3/4 or node positive). Twenty-two (85%) patients had multifocal tumors, and 13 (50%) patients had concomitant carcinoma in situ (CIS) lesions. Among 21 patients received SBRNU, synchronous UC in bilateral upper urinary tracts were identified in 11 (52%) patients, while only three of them (27%) had pre-operative image or pathology suspicion of bilateral lesions. Two out of five patients received unilateral RNU eventually experienced contralateral recurrence with mean interval of 5.5 years. The mean follow-up period of our cohort was 46 months (range 2-138). Local recurrence and/or metastasis were observed in 9 (35%) patients. Intravesical recurrences were noted in 14 (54%) patients, with a median time of 8.5 months from surgery to recurrence. The cancer-specific and overall survival rate was 67% and 62%, respectively. CONCLUSIONS: Native UTUC after KT is a unique patient cohort that is commonly associated with multifocal tumors, concomitant CIS lesions, and locally advanced stage, thus warranted timely surgical intervention and further therapy. SBRNU should be performed if possible due to high prevalence of synchronous bilateral UTUC and high contralateral recurrence rate. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e874 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shi-Jie Tsai More articles by this author Eric Yi-Hsiu Huang More articles by this author Tzu-Hao Huang More articles by this author Tzu-Chun Wei More articles by this author Chih-Chieh Lin More articles by this author Tzu-Ping Lin More articles by this author Hsiao-Jen Chung More articles by this author William J.S. Huang More articles by this author Yen-Hwa Chang More articles by this author Expand All Advertisement PDF DownloadLoading ...

PD26-09 PRIMARY TA HIGH GRADE BLADDER TUMORS: DETERMINATION OF THE RISK OF PROGRESSION

You have accessJournal of UrologyCME1 May 2022PD26-09 PRIMARY TA HIGH GRADE BLADDER TUMORS: DETERMINATION OF THE RISK OF PROGRESSION Fahad Quhal, Keiichiro Mori, Ekaterina Laukhtina, Benjamin Pradere, Francesco Soria, Marco Moschini, Alberto Briganti, Pierre I. Karakiewicz, and Shahrokh F. Shariat Fahad QuhalFahad Quhal More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Francesco SoriaFrancesco Soria More articles by this author , Marco MoschiniMarco Moschini More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002574.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: TaG3 bladder cancer is an under-investigated disease and because of its rarity it is commonly studies together with T1G3 disease. We sought to exclusively study TaG3 disease and to determine the factors associated with disease progression. METHODS: Of 3505 patients with NMIBC, 285 patients had primary TaG3 and with no concomitant carcinoma in-situ. The median follow-up was 43 months; 70% of the patients received adjuvant BCG. RESULTS: Progression to ≥pT1 occurred in 21 patients (7.4%). In a multivariable competing-risk regression analysis, intravesical BCG was significantly associated with a lower risk of progression to ≥pT1 (HR 0.23, 95%CI 0.08-0.64, p=0.005). Recurrence in the first year of diagnosis was significantly associated with an increased risk of stage progression to ≥pT1 (HR 7.81, 95%CI 2.50-24.44, p<0.001). Progression to ≥T2 was observed in 9 patients (3.2%). In univariable competing-risk regression analyses, intravesical BCG was significantly associated with a lower risk of progression to ≥pT2 (HR 0.11, 95%CI 0.04-0.47, p=0.003). On the other hand, recurrence in the first year of diagnosis was significantly associated with an increased risk of stage progression to ≥T2 (HR 7.12, 95%CI 1.50-33.77, p=0.013). In a subgroup of 199 patients who were treated with BCG, there was no statistically significant association between tumor recurrence in the 1st year of diagnosis and stage progression to ≥pT1 (p=0.14) or ≥pT2 (p=0.19). CONCLUSIONS: Patients with TaG3 bladder cancer are considered high risk but if appropriately treated with BCG that risk is considerably mitigated. Our data support that TaG3 without concomitant CIS should not be considered as aggressive as T1G3 as it has a lower risk of progression to muscle-invasive bladder cancer (MIBC). Recurrence in the first year after diagnosis is the strongest predictor of progression to MIBC. Source of Funding: No funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e491 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fahad Quhal More articles by this author Keiichiro Mori More articles by this author Ekaterina Laukhtina More articles by this author Benjamin Pradere More articles by this author Francesco Soria More articles by this author Marco Moschini More articles by this author Alberto Briganti More articles by this author Pierre I. Karakiewicz More articles by this author Shahrokh F. Shariat More articles by this author Expand All Advertisement PDF DownloadLoading ...

Impact of carcinoma in situ on the outcome of intravesical Bacillus Calmette-Guérin therapy for non-muscle-invasive bladder cancer: a comparative analysis of large real-world data.

This study investigated the clinical impact of carcinoma in situ (CIS) in intravesical Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle-invasive bladder cancer (NMIBC). This study retrospectively evaluated 3035 patients who were diagnosed with NMIBC and treated by intravesical BCG therapy between 2000 and 2019 at 31 institutions. Patients were divided into six groups according to the presence of CIS as follows: low-grade Ta without concomitant CIS, high-grade Ta without concomitant CIS, high-grade Ta with concomitant CIS, high-grade T1 without concomitant CIS, high-grade T1 with concomitant CIS, and pure CIS (without any papillary lesion). The endpoints were recurrence- and progression-free survival after the initiation of BCG therapy. We analyzed to identify factors associated with recurrence and progression. At a median follow-up of 44.4months, recurrence and progression were observed in 955 (31.5%) and 316 (10.4%) patients, respectively. Comparison of six groups using univariate and multivariate analysis showed no significant association of CIS. However, CIS in the prostatic urethra was an independent factors associated with progression. Concomitant CIS did not show a significant impact in the analysis of Ta and T1 tumors which were treated using intravesical BCG. Concomitant CIS in the prostatic urethra was associated with high risk of progression. Alternative treatment approaches such as radical cystectomy should be considered for patients with NMIBC who have a risk of progression.

Oncological outcomes of concomitant carcinoma in situ at radical cystectomy in pure urothelial bladder cancer and in histological variants.

The presence of carcinoma in situ at transurethral resection is known to increase the risk of recurrence and progression to invasive disease. However, the evidence regarding the prognostic role of concomitant carcinoma in situ after radical cystectomy due to bladder cancer is controversial. Moreover, concomitant carcinoma in situ was found to be significantly associated with bladder histological variants. The aim of our study is to evaluate whether the presence of concomitant carcinoma in situ at radical cystectomy, impacts on recurrence and survival outcomes in pure urothelial bladder cancer, compared to histological variants. We evaluated 410 consecutive patients diagnosed with non-metastatic bladder cancer and treated with radical cystectomy at a single tertiary referral centre between January 2009 and May 2019. Patients were stratified according to the presence of carcinoma in situ. The Kaplan-Meier method was used to compare recurrence free, cancer specific and overall survival in pure urothelial and histological variants. Cox proportional hazards regression analyses model was used to predict recurrence, cancer specific and overall mortality in pure urothelial and histological variants bladder cancer, according to pathological stage. Median age was 71 years. 340 patients (82%) were male. At a median follow-up of 32 months, disease recurrence, cancer specific mortality and overall mortality were, 37% (155 patients), 32.9% (135 patients) and 46.6% (191 patients), respectively. Concomitant and pure carcinoma in situ were found in 39% and 19% of radical cystectomy specimens, respectively. Concomitant carcinoma in situ was more frequent in patients with histological variants (50.9%) compared to pure urothelial bladder cancer (35.4%) (P-value <.001) and was associated with worst pathological features (lymphovascular invasion, lymph node involvement and non-organ confined disease). Recurrence free survival at Kaplan-Meyer analyses was significantly higher in patients with pure carcinoma in situ compared to those with concomitant or no carcinoma in situ (all P <.001), similarly for patients without carcinoma in situ compared with those with concomitant Cis (P =.02) at radical cystectomy. Cancer specific and overall survival were significantly higher in patients with pure carcinoma in situ compared to those with concomitant or no carcinoma in situ (all P <.001). Conversely no significant difference was found between patients without carcinoma in situ and with concomitant carcinoma in situ (P>0.1) at radical cystectomy Moreover, concomitant carcinoma in situ at radical cystectomy in histological variants is associated with higher free recurrence rate compared to the other groups. At multivariate Cox proportional hazards regression analyses the presence of carcinoma in situ at radical cystectomy was not associated with any survival effect or recurrence (all P > .05) in the overall population and when patients are stratified according to histology. However, concomitant carcinoma in situ represents an independent predictor of recurrence in the subgroup of patients with organ confined disease in case of urothelial bladder cancer and histological variants. Concomitant carcinoma in situ should be considered a proxy of aggressiveness in bladder cancer after radical cystectomy. Based on its prognostic implications, concomitant carcinoma in situ should be considered for strict follow-up in patients with organ confined disease which may deserve adjuvant treatment both in pure urothelial bladder cancer and histological variants.

The Predictive Value of Systemic Immune-Inflammation Index on Bladder Recurrence on Upper Tract Urothelial Carcinoma Outcomes after Radical Nephroureterectomy.

Background: This study aimed to assess the prognostic significance of pre-treatment lymphocyte-related systemic inflammatory biomarkers in upper tract urothelial carcinoma (UTUC) patients. Methods: This study included non-metastatic UTUC patients treated at our hospital between 2001 and 2013. The receiver operating characteristic curve was used to obtain the optimal neutrophile-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Multivariate logistic regression was performed to investigate the relationship between NLR, PLR, and SII and clinical pathologic characteristics. The Kaplan–Meier method was used to calculate the metastasis-free survival (MFS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS), and the log-rank test was used to compare the survival rate. Results: Overall, 376 patients were included in the current study. An elevated SII was associated with symptomatic hydronephrosis, bladder cancer history, advanced pathologic tumor stage, lymph node invasion, adjuvant chemotherapy and concomitant carcinoma in situ (CIS); high NLR was associated with older age, symptomatic hydronephrosis, hemodialysis status, anemia, multifocal tumor, advanced pathologic tumor stage, and adjuvant chemotherapy; and high PLR was associated with older age, anemia, advanced pathologic tumor stage, and adjuvant chemotherapy. The Kaplan–Meier analysis indicated that patients exhibiting higher NLR, PLR, and SII showed significantly poor MFS and CSS rates. Only high SII showed significantly worse BRFS rates. Conclusions: The NLR, PLR, and SII were independent predictive factors for both MFS and CSS in UTUC patients. Among the factors, only elevated SII can predict bladder recurrence. Therefore, the patients might need close bladder monitoring during the follow-up.

Urinary pH is an independent predictor of upper tract recurrence in non-muscle-invasive bladder cancer patients with a smoking history

Limited information is currently available on predictors of upper tract urothelial carcinoma (UTUC) recurrence in non-muscle-invasive bladder cancer (NMIBC) patients according to smoking history, although smoking probably contributes to urothelial carcinogenesis. Therefore, the present study aimed to identify independent predictors of UTUC recurrence in all patients and those with a smoking history. Our study population comprised 1190 NMIBC patients who underwent transurethral resection of bladder tumor. UTUC developed in 43 patients during the follow-up. A history of bacillus Calmette-Guérin (BCG) therapy was independently associated with a lower incidence of UTUC (HR = 0.43; P = 0.011). In a subgroup of NMIBC patients with a smoking history, concomitant carcinoma in situ (CIS) and a lower urinary pH (< 6) were independently associated with a higher incidence of UTUC recurrence (HR = 3.34, P = 0.006 and HR = 3.73, P = 0.008, respectively). Among patients with a longer smoking duration (≥ 20 years) or larger smoking intensity (≥ 20 cigarettes per day), those with lower urinary pH (< 6) had a significantly higher UTUC recurrence rate than their counterparts. These results suggest that BCG instillation may prevent UTUC recurrence in NMIBC patients, while a lower urinary pH and concomitant CIS increase the risk of UTUC recurrence in those with a smoking history.

Prognostic Significance of the Neutrophil-to-Lymphocyte Ratio in Patients with Non-Muscle Invasive Bladder Cancer treated with Intravesical Bacillus Calmette-Guérin and the Relationship with the CUETO Scoring Model.

In this study, we evaluated the predictability of a modified Club Urológico Español de Tratamiento Oncológico (CUETO) scoring model and preoperative neutrophil-to-lymphocyte ratio (NLR) in patients with non-muscle invasive bladder cancer (NMIBC). From August 2005 to May 2016, a total of 281 patients received intravesical bacillus Calmette-Guérin therapy after transurethral resection of a bladder tumor. The pathologic stage of all patients was Ta or T1. Of 281 patients, 84 (29.9%) experienced recurrence and 14 (5.0%) developed progression. The mean follow-up period was 46 months. The cut-off value for NLRs was 2.29. One hundred-eight patients (38.4%) displayed a high NLR (> 2.29). In Kaplan-Meier curve analysis, a high NLR was associated with lower recurrence-free survival (RFS) (P < .001) and progression-free survival (PFS) (P = .002). CUETO scores were associated with RFS (P < .001), but not with PFS (P = .423). A combination of NLRs and the CUETO risk model correlated with RFS (P < .001) and PFS (P = .002). In multivariate analysis, female gender, concomitant carcinoma in situ (CIS), tumor number >3, recurrent tumors, and a high NLR were independent factors predicting recurrence (all P < .05). Concomitant CIS, recurrent tumors, and a high NLR were independent factors for predicting progression (all P < .05). In patients with NMIBC, an NLR >2.29 was identified as a significant factor for predicting tumor recurrence and progression. Inclusion of preoperative NLR enhanced the accuracy of the CUETO model to predict disease progression.