Cases Of Non-muscle Invasive Bladder Cancer Research Articles

Are we following the guidelines on non-muscle invasive bladder cancer?

ABSTRACTObjectives To evaluate the clinical practice of non-muscle invasive bladder cancer (NMIBC) treatment in Brazil in relation to international guidelines: Sociedade Brasileira de Urologia (SBU), European Association of Urology (EAU) and American Urological Association (AUA).Materials and Methods Cross-sectional study using questionnaires about urological practice on treatment of NMIBC during the 32nd Brazilian Congress of Urology. A total of 650 question forms were answered.Results There were 73% of complete answers (total of 476 question forms). In total, 246 urologists (51.68%) lived in the southeast region and 310 (65.13%) treat 1 to 3 cases of NMIBC per month. Low risk cancer: Only 35 urologists (7.5%) apply the single intravesical dose of immediate chemotherapy with Mitomicin C recommended by the above guidelines. Adjuvant therapy with BCG 2 to 4 weeks after TUR is used by 167 participants (35.1%) and 271 urologists (56.9%) use only TUR. High risk tumors: 397 urologists (83.4%) use adjuvant therapy, 375 (78.8%) use BCG 2 to 4 weeks after TUR, of which 306 (64.3%) referred the use for at least one year. Intravesical chemotherapy with Mitomicin C (a controversial recommendation) was used by 22 urologists (4.6%). BCG dose raised a lot of discrepancies. Induction doses of 40, 80 and 120mg were referred by 105 (22%), 193 (40.4%) and 54 (11.3%) respectively. Maintenance doses of 40, 80 and 120mg were referred by 190 (48.7%), 144 (37.0%) and 32 (8.2%) urologists, respectively. Schemes of administration were also varied and the one cited by SWOG protocol was the most used: 142 (29.8%).Conclusion SBU, EAU and AUA guidelines are partially respected by Brazilian urologists, particularly in low risk tumors. In high risk tumors, concordance rates are comparable to international data. Further studies are necessary to fully understand the reasons of such disagreement.

“En Bloc” Resection of Nonmuscle Invasive Bladder Cancer: A Prospective Single-center Study

To describe our "en bloc" technique for nonmuscle invasive bladder cancer (NMIBC), assess the quality of resection, and report the midterm oncological outcome. This is an observational prospective longitudinal study, from June 2010 to February 2014, enrolling patients with clinically NMIBC, having tumors of ≤3 cm and ≤4 lesions who underwent electrical en bloc bladder resection. The primary study end point was recurrence-free survival. Secondary outcomes were feasibility, safety, the presence of detrusor muscle, and the recurrence rate at the first follow-up cystoscopy (3 months). Statistical analysis was complemented with multivariable analysis. Of 87 enrolled patients, 2 showed a nonurothelial carcinoma and 11 showed muscle invasive bladder carcinoma at the definitive pathology. The study cohort consisted of 74 transitional cell carcinoma NMIBC cases, mean age 71 years ± 8, presenting with a mean tumor diameter of 1.98 ± 0.59 cm and a median number of resected tumors per patients of 1 (range 1-4). The 2-year recurrence-free survival was 85.59%. All the en bloc resection of bladder tumor samples showed the presence of detrusor muscle and the recurrence rate at the first follow-up cystoscopy (3 months) was 5.4% (4/74). An extraperitoneal bladder perforation occurred in only one patient. At multivariable analysis, only gender and the presence of carcinoma in situ were independent predictors of recurrence. The midterm follow-up and the absence of a control group are the main limitations. Our findings confirmed the feasibility and safety of en bloc resection of bladder tumor, with a recurrence-free survival of 85% after 2 years.

Value of detection of preoperative urinary soluble Fas expression in predicting the recurrence of non-muscle invasive bladder cancer

To investigate the clinical value of detection of preoperative urinary soluble Fas (sFas) expression in predicting the recurrence of non-muscle invasive bladder cancer (NMIBC). We performed a prospective research, which included 128 cases with NMIBC from January 2008 to April 2011. Expression levels of sFas in urine, which was saved at the first morning from preoperative NMIBC patients, were analyzed by ELISA. Clinical and pathological data, European Organization for Research and Treatment of Cancer (EORTC) risk group category, follow-up data and urinary sFas values were collected from each patient, and each prognostic outcome was evaluated by statistical analysis of non-parametric test. Urinary sFas values and recurrence-free probabilities were estimated by the Kaplan-Meier method and compared by the log rank test. Cox proportional hazards regression models were performed to determine the independent predictors of NMIBC recurrence. The prognosis index (PI) was established. The urinary sFas level was significantly elevated in the NMIBC cases with a higher stage or grade or high-risk EORTC group category than in those with a lower stage or grade or low-risk EORTC group category (each P<0.05), regardless of age or gender (P>0.05). Kaplan-Meier analysis revealed a significant increase in incidence of recurrence in the NMIBC patients with high sFas levels in the urine (P<0.001). According to Cox regression analysis, the urinary sFas level and EORTC risk group category (each P<0.05) were the independent predictors of NMIBC recurrence. Based on the outcome of Cox regression, the formula of PI=(0.004×sFas value+1.179×EORTC score) was established. Our study indicates that urinary sFas test may help to identify NMIBC patients at risk of tumor recurrence and it deserves further research.

MP65-06 COLLINS LOOP EN BLOC RESECTION ( CLEBR) FOR ACCURATE STAGING OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER: EARLY EXPERIENCE

You have accessJournal of UrologyBladder Cancer: Staging1 Apr 2014MP65-06 COLLINS LOOP EN BLOC RESECTION ( CLEBR) FOR ACCURATE STAGING OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER: EARLY EXPERIENCE Rodlolfo Hurle, Silvia Zandegiacomo De Zorzi, Luigi Castaldo, Luisa Pasini, Gianluigi Taverna, Paolo Puppo, Angelo Naselli, and Pierpaolo Graziotti Rodlolfo HurleRodlolfo Hurle More articles by this author , Silvia Zandegiacomo De ZorziSilvia Zandegiacomo De Zorzi More articles by this author , Luigi CastaldoLuigi Castaldo More articles by this author , Luisa PasiniLuisa Pasini More articles by this author , Gianluigi TavernaGianluigi Taverna More articles by this author , Paolo PuppoPaolo Puppo More articles by this author , Angelo NaselliAngelo Naselli More articles by this author , and Pierpaolo GraziottiPierpaolo Graziotti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1903AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A primary aim of transurethral resection of bladder tumors is to determine the depth of invasion or clinical stage. Transurethral resection is a stochastic procedure subject to variations in tumor type, surgical technique and pathological evaluation.One limiting factor is the surgical ‘incise and scatter’ technique that might contribute to tumour recurrence.We present initial results with using a Collins loop en bloc resection of bladder tumours for treatment and accurate staging of solitary transitional cell carcinoma of the bladder. METHODS April 2011-February 2013,67 patients(48 male – 19 female with non muscle-invasive bladder cancer (NMIBC) underwent transurethral en bloc resection using a Collins Loop. Tumor size ranged to 0.5- 45 mm and multifocality was present in 6% of cases. En bloc resection was applied on all of the tumours. On 59 of the 67 patients, a re-resection was performed after 6 weeks. The bladder wall is incised around the lesion using a Collins loop, starting from apparently ‘ normal ’ mucosa surrounding the base and then extending through the subepithelial connective tissue, muscularis mucosae and muscularis propria strata. The resected 1-piece specimen was grasped with a loop electrode and retrieved. After bladder tumor resection the resected base was observed carefully to assess perforation and bleeding. When the tumor size was greater than 3 cm, excision of the lesion could be easily achieved by mean of a resectoscope with a 5 mm working channel. After resection, the lesion is grasped with the forceps and retrieved with the resectoscope. All cases of high-risk NMIBC underwent second-look after 30-45 days. RESULTS Pathology reported urothelial carcinoma with low grade stage Ta, T1 high –grade and T2 high-grade respectively in 38 ( 56,7% ), 23 ( 34,3%), 6 ( 8,9%). All of the resected specimens provided detrusor muscle, no uncontrollable bleeding, perforation or other serious complications were observed. To date, with a mean follow up of 16.5 months, the recurrence rate in patients with NMIBC is 13.5% CONCLUSIONS CLebR has been proven safe and effective for both, treatment and pathological staging of NMIBC.The objective advantage of accurate pathological examination ( identification of microfocal invasion of lamina propria or of muscular wall, surgical margins assessment) is associated with a substantial safe technique. Long term data and larger dataset of cases are necessary to demonstrate an advantage in terms of recurrence or progression. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e693 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Rodlolfo Hurle More articles by this author Silvia Zandegiacomo De Zorzi More articles by this author Luigi Castaldo More articles by this author Luisa Pasini More articles by this author Gianluigi Taverna More articles by this author Paolo Puppo More articles by this author Angelo Naselli More articles by this author Pierpaolo Graziotti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic Factors Including Ki-67 and p53 in Bacillus Calmette-Guérin-Treated Non-Muscle-Invasive Bladder Cancer: A Prospective Study

Objectives: To prospectively evaluate the prognostic utility of the traditional prognostic factors and molecular markers p53 and Ki-67 in a homogeneous series of patients with non-muscle-invasive bladder cancer (NMIBC) treated with Bacillus Calmette-Guérin (BCG). Patients and Methods: 192 intermediate- and high-risk NMIBC cases were enrolled. The variables in study were age, stage, grade, focality, tumour size, presence of associated carcinoma in situ, recurrence rate before BCG, maintenance for BCG, Ki-67 and p53. The endpoints considered were recurrence-free survival, progression-free survival, cancer-specific survival (CSS) and overall survival (OS). Results: T stage resulted in being associated with CSS, whereas age with OS. BCG maintenance was a significantly favourable independent predictor of OS, CSS, recurrence and progression. In univariate analysis, the labelling index of Ki-67 was significantly associated with OS, CSS and progression. Multivariate analysis, however, confirmed this association only for OS. On the contrary, the labelling index of p53 was a significant predictor of recurrence, both in uni- and multivariate analyses, but with a HR inferior to 1. Conclusions: Ki-67 was an independent predictor of survival. p53 overexpression showed a significant yet inverse correlation with recurrence, thus showing little clinical utility. Age, stage and maintenance were confirmed as independent predictors of BCG response.

Who needs numbers more: patients or doctors?

Who needs numbers more: patients or doctors?

Economic and Humanistic Consequences of Preventable Bladder Tumor Recurrences in Nonmuscle Invasive Bladder Cancer Cases

Perioperative intravesical chemotherapy following transurethral resection of bladder tumor has been underused despite level 1 evidence supporting its performance. The primary objective of this study was to estimate the economic and humanistic consequences associated with preventable recurrences in patients initially diagnosed with nonmuscle invasive bladder cancer. Using population based estimates of nonmuscle invasive bladder cancer incidence, a 2-year model was developed to estimate the number of preventable recurrences in eligible patients untreated with perioperative intravesical chemotherapy. Therapy utilization rates were obtained from a retrospective database analysis and a chart review study of 1,010 patients with nonmuscle invasive bladder cancer. Recurrence rates of nonmuscle invasive bladder cancer were obtained from a randomized clinical trial comparing transurethral resection of bladder tumor with or without perioperative mitomycin C. Costs were estimated using prevailing Medicare reimbursement rates. Quality adjusted life-year estimates and disutilities for complications were obtained from the literature. The model estimated that 7,827 bladder recurrences could be avoided if all patients received immediate intravesical chemotherapy. It estimated an economic savings of $3,847 per avoidable recurrence, resulting in an aggregate savings of $30.1 million. The model also estimated that 1,025 quality adjusted life-years are lost every 2 years due to preventable recurrences, resulting in 0.13 quality adjusted life-years (48 quality adjusted days) lost per avoidable recurrence. This translates into 0.02 quality adjusted life-years (8.1 quality adjusted days) lost per patient not receiving immediate intravesical chemotherapy. Greater use of immediate intravesical chemotherapy in the United States has the potential to substantially decrease the economic and humanistic burdens of nonmuscle invasive bladder cancer.

Are there Time-period-related Differences in the Prophylactic Effects of Bacille Calmette-Guérin Intravesical Instillation Therapy in Japan?

The guidelines on indications for prophylactic use of Bacille Calmette-Guerin (BCG) against non- muscle-invasive bladder cancer (NMIBC) have changed over the years. In order to assess the impact on outcome, the present retrospective comparison of BCG efficacy by time period with Japanese patients was conducted. A total of 146 cases of NMIBC treated with BCG since February 1985 were retrospectively evaluated. All patients received 80 mg of BCG (Tokyo 172 strain) six to eight times a week for prophylactic use. Comparison was made among three historical groups (Group A: 1980's, 39 cases; Group B: 1990's, 61 cases; Group C: 2000's, 46 cases). In total, recurrence was seen in 55 of the 146 cases (37.7%), and progression in 14 (9.6%), 1 patient dying of cancer. These overall results were similar to those outlined in previous reports. However, the outcomes of this time-period-based analysis indicated a tendency for a shorter time to recurrence in patients after 2000, although a log-rank test showed no significance (P=0.229). Seven of the cases featuring progression (i.e., half of all such cases) were among the 46 Group C patients (15.2%). Excluding these progressive cases, there was no significant difference among the remaining 132 patients in the three groups. This study results revealed a tendency for a lower non-recurrence rate after 2000 in our series. This could stem from a number of factors, including changes in BCG indication criteria and the evolution of histopathological diagnostic criteria.

1264 A PROSPECTIVE, RANDOMIZED COMPARISON BETWEEN THE HEXAMINOLEVULINATE BLUE LIGHT AND THE STANDARD WHITE LIGHT CYSTOSCOPY CONCERNING THE LONG TERM RECURRENCE RATES IN NON-MUSCLE INVASIVE BLADDER CANCER CASES

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20121264 A PROSPECTIVE, RANDOMIZED COMPARISON BETWEEN THE HEXAMINOLEVULINATE BLUE LIGHT AND THE STANDARD WHITE LIGHT CYSTOSCOPY CONCERNING THE LONG TERM RECURRENCE RATES IN NON-MUSCLE INVASIVE BLADDER CANCER CASES Bogdan Geavlete, Razvan Multescu, Florin Stanescu, Dragos Georgescu, Marian Jecu, Cristian Moldoveanu, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Razvan MultescuRazvan Multescu Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , Dragos GeorgescuDragos Georgescu Bucharest, Romania More articles by this author , Marian JecuMarian Jecu Bucharest, Romania More articles by this author , Cristian MoldoveanuCristian Moldoveanu Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1596AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A prospective, randomized, long term study was performed aiming to compare the long term recurrence rates provided by the hexaminolevulinate blue light cystoscopy (HAL-BLC) versus the standard white light cystoscopy (WLC) in cases of non-muscle invasive bladder cancer (NMIBC). METHODS A total of 362 NMIBC suspected patients were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumors. The 181 cases of the study group underwent both WLC and HAL-BLC, while patients in the control group benefited from standard cystoscopy alone. A single postoperative mytomicin-C instillation was performed in all resection cases. No additional instillations were used in low risk patients, while adjuvant chemotherapy was applied in intermediate risk cases and BCG immunotherapy for high risk patients. The follow-up protocol consisted of abdominal ultrasound, urinary cytology and WLC, performed every 3 months for a period of 2 years and every 6 months in the third year. RESULTS In the 142 NMIBC patients of the study group, HAL-BLC emphasized significantly improved CIS (95.2% versus 71.4%), pTa (95.3% versus 87.1%) and overall (95.8% versus 85.9%) cases' detection rates. Additional tumors were found by HAL-BLC in a significantly higher proportion of cases (35.2% versus 14.1%). Consequently, the recurrence (16.2% versus 4.9%) and progression (21.1% versus 7%) risk categories of patients changed significantly due to HAL-BLC by comparison to WLC. As a result, the postoperative treatment was modified due to HAL-BLC for a significantly larger proportion of patients (19% versus 6.3%). A total of 115 and respectively 106 NMIBC cases of the two study arms completed the 36 months' evaluation period. The 3 months' recurrence rate was significantly lower in the HAL-BLC series (6.9% versus 15.1%) due to fewer other site recurrences (0.9% versus 6.6%). During the long term follow-up, the overall 1 (20.9% versus 31.1%), 2 (30.4% versus 44.3%) and 3 (35.6% versus 51.9%) years' recurrence rates were significantly reduced in the HAL-BLC study arm. CONCLUSIONS HAL-BLC emphasized superior NMIBC patients' detection rates as well as a significant impact in terms of additional tumors' cases, risk category changes and postoperative treatment modifications. Subsequently, the 3 months', 1, 2 and 3 years' recurrence rates were significantly improved in the HAL-BLC group. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e511-e512 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Razvan Multescu Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Dragos Georgescu Bucharest, Romania More articles by this author Marian Jecu Bucharest, Romania More articles by this author Cristian Moldoveanu Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

955 A prospective, randomized comparison between the hexaminolevulinate blue light and the standard white light cystoscopy concerning the long term recurrence rates in non-muscle invasive bladder cancer cases

955 A prospective, randomized comparison between the hexaminolevulinate blue light and the standard white light cystoscopy concerning the long term recurrence rates in non-muscle invasive bladder cancer cases

Treatment changes and long‐term recurrence rates after hexaminolevulinate (HAL) fluorescence cystoscopy: does it really make a difference in patients with non‐muscle‐invasive bladder cancer (NMIBC)?

• To evaluate in a prospective, randomized study the impact of hexaminolevulinate blue-light cystoscopy (HAL-BLC) on the diagnostic accuracy and treatment changes in cases of non-muscle invasive bladder cancer (NMIBC) compared with standard white-light cystoscopy (WLC). • To compare the long-term recurrence rates in the two study arms. • In all, 362 patients suspected of NMIBC were included in the trial based on positive urinary cytology and/or ultrasonographic suspicion of bladder tumours and underwent transurethral resection of bladder tumours. • A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate-risk patients and BCG instillations for high-risk cases. • The follow-up protocol consisted of urinary cytology and WLC every 3 months for 2 years. • Only first-time recurrences after the initial diagnosis were considered. • In the 142 patients with NMIBC in the HAL-BLC series, tumour detection rates significantly improved for carcinoma in situ, pTa andoverall cases. • In 35.2% of the cases, additional malignant lesions were found by HAL-BLC and consequently, the recurrence- and progression-risk categories of patients and subsequent treatment improved in 19% of the cases due to fluorescence cystoscopy. • In all, 125 patients in the HAL-BLC group and 114 of the WLC group completed the follow-up. • The recurrence rate at 3 months was lower in the HAL-BLC series (7.2% vs 15.8%) due to fewer 'other site' recurrences when compared with the WLC series (0.8% vs 6.1%). • The 1 and 2 years recurrence rates were significantly decreased in the HAL-BLC group compared with the WLC group (21.6% vs 32.5% and 31.2% vs 45.6%, respectively). • HAL-BLC was better than WLC for detecting NMIBC cases and improved tumour detection rates. • HAL-BLC significantly modified the postoperative treatment of cases. • The 3 months, 1 and 2 years recurrence rates were significantly improved in the HAL-BLC arm.

1649 THE BENEFIT OF CONTINUOUS SALINE BLADDER IRRIGATION AFTER TRANSURETHRAL RESECTION IN NON-MUSCULAR INVASIVE BLADDER CANCER

non-muscle invasive bladder cancer (NMIBC). A prospective, long term, randomized comparison with a similar series initially diagnosed by white light cystoscopy (WLC) alone with regard to recurrence rates was also performed. METHODS: A total of 362 patients suspected of NMIBC were included in the trial, based on positive urinary cytology and ultrasonographic suspicion of bladder tumors. The 181 patients of the BL arm underwent both WLC and BLC. A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate risk patients and BCG instillations for high-risk cases. The follow-up protocol consisting of urinary cytology and WLC was also performed in accordance with the risk category of NMIBC cases for a period of two years. Only first time recurrences after the initial diagnostic were taken into consideration. RESULTS: A total of 142 NMIBC patients were diagnosed in the BL arm and 129 in the WL arm. In the BL series, the CIS, pTa, pT1 and overall cases’ and tumors’ detection rates were significantly improved for BLC. Additional tumors were found by WLC and BLC in 14.1% versus 35.2% of the cases. Consequently, the recurrence and progression risk categories of patients changed in 4.9% and 7% of the cases due to WLC and in 16.2% and 21.1% due to BLC additionally found tumors. The postoperative treatment changed in 6.3% of the cases due to WLC and in 19% due to BLC results. A total of 125 patients of the BL group and 114 of the WL group completed the follow-up protocol. The recurrence rate at 3 months was 15.8% in the WL series versus 7.2% in the BL series. The rates of primary site and other site recurrences in the WL and BL arms were 7.9% versus 5.6% and 6.1% versus 0.8%. The one and two years’ recurrence rates were significantly higher in the WLC group by comparison to the BLC group (32.5% versus 21.6% and 45.6% versus 31.2%). CONCLUSIONS: HAL-BLC cystoscopy emphasized superior patients’ and tumors’ detection rates in NMIBC cases, as well as a significant impact in terms of risk category changes and consequent postoperative treatment modifications. At the 3 months’ follow-up, significantly improved recurrence rates were determined in the BL arm, mostly due to fewer other site recurrences. The one and two years’ recurrence rates confirmed the long term advantages of HAL-BLC.

1648 TREATMENT CHANGES AND LONG-TERM RECURRENCE RATES AFTER HAL FLUORESCENCE CYSTOSCOPY – DOES BLUE LIGHT REALLY MAKE A DIFFERENCE IN THE LONG RUN?

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20111648 TREATMENT CHANGES AND LONG-TERM RECURRENCE RATES AFTER HAL FLUORESCENCE CYSTOSCOPY – DOES BLUE LIGHT REALLY MAKE A DIFFERENCE IN THE LONG RUN? Bogdan Geavlete, Razvan Multescu, Marian Jecu, Dragos Georgescu, Florin Stanescu, and Petrisor Geavlete Bogdan GeavleteBogdan Geavlete Bucharest, Romania More articles by this author , Razvan MultescuRazvan Multescu Bucharest, Romania More articles by this author , Marian JecuMarian Jecu Bucharest, Romania More articles by this author , Dragos GeorgescuDragos Georgescu Bucharest, Romania More articles by this author , Florin StanescuFlorin Stanescu Bucharest, Romania More articles by this author , and Petrisor GeavletePetrisor Geavlete Bucharest, Romania More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This study aimed to evaluate the diagnostic accuracy of hexaminolevulinate blue light cystoscopy (HAL-BLC) and the related treatment changes in cases of non-muscle invasive bladder cancer (NMIBC). A prospective, long term, randomized comparison with a similar series initially diagnosed by white light cystoscopy (WLC) alone with regard to recurrence rates was also performed. METHODS A total of 362 patients suspected of NMIBC were included in the trial, based on positive urinary cytology and ultrasonographic suspicion of bladder tumors. The 181 patients of the BL arm underwent both WLC and BLC. A single postoperative mytomicin-C instillation was performed in all cases, intravesical chemotherapy for intermediate risk patients and BCG instillations for high-risk cases. The follow-up protocol consisting of urinary cytology and WLC was also performed in accordance with the risk category of NMIBC cases for a period of two years. Only first time recurrences after the initial diagnostic were taken into consideration. RESULTS A total of 142 NMIBC patients were diagnosed in the BL arm and 129 in the WL arm. In the BL series, the CIS, pTa, pT1 and overall cases' and tumors' detection rates were significantly improved for BLC. Additional tumors were found by WLC and BLC in 14.1% versus 35.2% of the cases. Consequently, the recurrence and progression risk categories of patients changed in 4.9% and 7% of the cases due to WLC and in 16.2% and 21.1% due to BLC additionally found tumors. The postoperative treatment changed in 6.3% of the cases due to WLC and in 19% due to BLC results. A total of 125 patients of the BL group and 114 of the WL group completed the follow-up protocol. The recurrence rate at 3 months was 15.8% in the WL series versus 7.2% in the BL series. The rates of primary site and other site recurrences in the WL and BL arms were 7.9% versus 5.6% and 6.1% versus 0.8%. The one and two years' recurrence rates were significantly higher in the WLC group by comparison to the BLC group (32.5% versus 21.6% and 45.6% versus 31.2%). CONCLUSIONS HAL-BLC cystoscopy emphasized superior patients' and tumors' detection rates in NMIBC cases, as well as a significant impact in terms of risk category changes and consequent postoperative treatment modifications. At the 3 months' follow-up, significantly improved recurrence rates were determined in the BL arm, mostly due to fewer other site recurrences. The one and two years' recurrence rates confirmed the long term advantages of HAL-BLC. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e661-e662 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bogdan Geavlete Bucharest, Romania More articles by this author Razvan Multescu Bucharest, Romania More articles by this author Marian Jecu Bucharest, Romania More articles by this author Dragos Georgescu Bucharest, Romania More articles by this author Florin Stanescu Bucharest, Romania More articles by this author Petrisor Geavlete Bucharest, Romania More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

1748 ANGIOTENSIN II TYPE 1 RECEPTOR AND MICROVESSEL DENSITY PREDICT THE EARLY INTRAVESICAL RECURRENCE IN BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Superficial1 Apr 20111748 ANGIOTENSIN II TYPE 1 RECEPTOR AND MICROVESSEL DENSITY PREDICT THE EARLY INTRAVESICAL RECURRENCE IN BLADDER CANCER Suguru Shirotake, Akira Miyajima, Takeo Kosaka, Takahiro Maeda, Nobuyuki Tanaka, Eiji Kikuchi, and Mototsugu Oya Suguru ShirotakeSuguru Shirotake Tokyo, Japan More articles by this author , Akira MiyajimaAkira Miyajima Tokyo, Japan More articles by this author , Takeo KosakaTakeo Kosaka Tokyo, Japan More articles by this author , Takahiro MaedaTakahiro Maeda Tokyo, Japan More articles by this author , Nobuyuki TanakaNobuyuki Tanaka Tokyo, Japan More articles by this author , Eiji KikuchiEiji Kikuchi Tokyo, Japan More articles by this author , and Mototsugu OyaMototsugu Oya Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2075AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has recently been reported that the angiotensin II type 1 receptor (AT1R) is expressed in several tumors and involved in tumor angiogenesis. We have previously reported that AT1R was expressed in bladder cancer (BCa) cells in vivo and that AT1R blockade inhibited tumor progression in xenograft models. However, no study has investigated the role of AT1R expression and microvessel density (MVD) in bladder cancer. The aim of the present study was to examine whether AT1R expression and MVD in BCa correlate with a particular focus on intravesical recurrence and progression. METHODS Clinical tissue samples were obtained from 108 patients (non-muscle invasive BCa (NMIBC) 79 cases and muscle invasive BCa (MIBC) 29 cases, low grade 54 cases and high grade 54 cases) undergoing primary TUR for bladder tumor between January 1995 and December 2002. The mean duration of follow-up of the cases was 84 months (range, 26–174 months). Histologically, all specimens were diagnosed as urothelial carcinoma. AT1R and CD34 as MVD were immunostained for all specimens. Clinical and pathological characteristics were reviewed retrospectively. RESULTS MVD was higher in MIBC (34.4 ± 4.1 /0.25 mm2) than in NMIBC (17.4 ± 1.1 /0.25 mm2, p<0.0001). AT1R expression was higher in MIBC (p=0.0004) and high grade (p=0.0063) than in NMIBC and low grade. The higher expression of AT1R was significantly associated with MVD (p<0.05). In NMIBC, univariate analysis could not demonstrate that AT1R expression and MVD were correlated with the progression to MIBC (p=0.27, p=0.17), however, the factors significantly affecting intravesical recurrence-free survival (iRFS) in univariate analysis were AT1R (p=0.02), MVD (p<0.0001), tumor multiplicity (p=0.0007), and BCG intravesical instillation after TUR (p=0.0026). Multivariate analysis revealed that tumor multiplicity and no BCG treatment after TUR were independent predictors of 5-year iRFS, while AT1R (p=0.001, HR 7.8, 95%CI 2.26–26.98) and MVD (p=0.01, HR 4.0, 95%CI 1.38–11.51) were independent predictors of 1-year iRFS. Furthermore multivariate analysis revealed that AT1R and MVD were independent predictors of RFS after BCG treatment in 26 cases of NMIBC (p=0.0012, HR 3.2, 95%CI 0.55–19.25, p=0.0011, HR 4.4, 95%CI 0.90–21.18). CONCLUSIONS Our results suggest that AT1R expression as well as MVD was related to early intravesical recurrence in NMIBC, and that NMIBC cases with higher MVD and AT1R may require stricter follow-up for earlier intravesical recurrence and the response to BCG intravesical instillation. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e701-e702 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Suguru Shirotake Tokyo, Japan More articles by this author Akira Miyajima Tokyo, Japan More articles by this author Takeo Kosaka Tokyo, Japan More articles by this author Takahiro Maeda Tokyo, Japan More articles by this author Nobuyuki Tanaka Tokyo, Japan More articles by this author Eiji Kikuchi Tokyo, Japan More articles by this author Mototsugu Oya Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...