Organ-confined Muscle-invasive Bladder Cancer Research Articles

Radical Transurethral Resection of Bladder Tumor in Organ-confined Muscle-invasive Bladder Cancer: Yes!

Muscle-invasive bladder cancer is a potentially lethal disease often impacting elder and comorbid patients. Neoadjuvant chemotherapy followed by radical cystectomy is associated with morbidity and is an option that many patients refuse. Maximal transurethral resection of bladder tumor (TURBT) as part of a bladder preservation strategy can achieve surgical cure and may improve long-term recurrence-free survival. We encourage bladder preservation after maximal TURBT for appropriate patients.

Radical Transurethral Resection of Bladder Tumor in Seemingly Organ-confined Muscle-invasive Bladder Cancer: Con

Bladder-preserving therapy using radical transurethral resection of bladder tumor is currently not a reasonable curative treatment option given the inaccuracy of diagnostic modalities. However, owing to the disadvantages of radical cystectomy, research on bladder-preserving treatment options remains important.

SIOG2021-0119 - Oncological management of organ-confined muscle invasive bladder cancer – a retrospective audit of outcomes at a single institution

SIOG2021-0119 - Oncological management of organ-confined muscle invasive bladder cancer – a retrospective audit of outcomes at a single institution

Re: Assessing Cancer Progression and Stable Disease after Neoadjuvant Chemotherapy for Organ-Confined Muscle-Invasive Bladder Cancer.

Re: Assessing Cancer Progression and Stable Disease after Neoadjuvant Chemotherapy for Organ-Confined Muscle-Invasive Bladder Cancer.

LP207 - An Analysis of Organ-Confined Muscle-Invasive Bladder Cancer Patients Not Receiving Curative Intent Therapy in Sweden from 1997 to 2014

LP207 - An Analysis of Organ-Confined Muscle-Invasive Bladder Cancer Patients Not Receiving Curative Intent Therapy in Sweden from 1997 to 2014

Predictive role of neutrophil-to-lymphocyte ratio on upstaging of organ-confined invasive urothelial bladder cancer to non-organ-confined disease.

The aim of this study is to examine the usefulness of preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratios to predict pathological upstaging of invasive bladder cancer who underwent radical cystectomy. A total of 126 patients who underwent radical cystectomy at our clinic between January 2006 and March 2015 were retrospectively analysed. One hundred and twelve patients with organ-confined invasive bladder tumors (T2) detected at histopathological examination of transuretral resection material were included in the study. Upstaging was seen at histopathological examination of radical cystectomy specimens of 42 patients. We compared preoperative neutrophile-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio between upstaged and not-upstaged groups. There were no statistically significant correlation between age, time to radical cystectomy, gender, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio ratios and carcinoma in situ in upstaged and non-upstaged groups. Statistical analyses showed that preoperative neutrophile-to-lymphocyte ratio was higher in upstaged patients (p=0.009). In multivariate analysis preoperative neutrophile-to-lymphocyte ratio and positive surgical margin were significantly higher in upstaged group. In organ-confined muscle invasive bladder cancer neutrophile-to-lymphocyte ratio seems to be an acceptable parameter to predict locally advanced disease.

Assessing Cancer Progression and Stable Disease After Neoadjuvant Chemotherapy for Organ-confined Muscle-invasive Bladder Cancer

To propose and validate a new approach to stratify clinically staged, organ-confined, muscle-invasive bladder cancer patients (cT2N0M0) who are pathologic non-responders to neoadjuvant chemotherapy (NAC) to better characterize NAC non-response. We retrospectively identified radical cystectomy patients with cT2N0M0 disease at our institution (2005-2014) and in the National Cancer Database (2004-2012) for external validation. Patients were stratified as stable (pT2N0M0) or progressors (>pT2 or pN+). The primary end points were cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In the institutional cohort, NAC stable patients (n = 17) had better OS (P = .05) and RFS (P = .04) than NAC progressors (n = 50), and had comparable OS (P = .7) and CSS (P = .09) with non-NAC stable patients (n = 27). Multivariable Cox proportional hazard models showed that larger tumor size predicted worse OS (hazard ratio [HR] = 1.20 per centimeter, 95% confidence interval [CI: 1.07, 1.35]), CSS (HR = 1.27, 95% CI [1.11, 1.45]), and RFS (HR = 1.24, 95% CI [1.09, 1.42]). Similarly, in the National Cancer Database, NAC stable patients (n = 223) had improved OS (P < .0001) compared with NAC progressors (n = 232) and comparable (P = .4) OS with non-NAC stable patients (n = 950). Multivariable Cox proportional hazard model showed that larger tumor size (HR = 1.03 per centimeter, 95% CI [1.02, 1.03]) and progression (HR = 2.69, 95% CI [2.40, 3.01]) predicted worse OS. Distinct survival outcomes suggest that NAC non-responders should be further stratified into stable disease and progressors. Comparable survival between non-NAC and NAC stable disease patients suggests that NAC stable disease may represent a chemoresistant but more indolent phenotype on the disease spectrum. Moreover, tumor size is an important prognostic biomarker in NAC non-responders. Clinical predictors of disease progression on NAC were not identified, highlighting the need to explore molecular and genomic subtyping determinants of disease progression.

Trends in the Utilization of Neoadjuvant Chemotherapy in Muscle-invasive Bladder Cancer: Results From the National Cancer Database

To evaluate variation in neoadjuvant chemotherapy (NAC) use among patients with≥ clinical T2 (cT2) bladder cancer and determine changes in staging at radical cystectomy (RC) associated with therapy. Using the National Cancer Database (NCDB), we identified all patients diagnosed with organ-confined, muscle-invasive (cT2+) urothelial carcinoma of the bladder between 2006 and 2010 who underwent RC. Univariate and multivariate analyses were performed examining demographic, clinical, and hospital factors influencing the delivery of NAC. These included age, gender, race, income, geographic location, type of treating hospital, clinical stage, and patient comorbidities. A total of 5692 patients met our inclusion criteria, 962 (16.9%) of whom received NAC. A multivariable logistic regression model revealed several factors that negatively influenced receipt of NAC: increasing age, lower patient income, and treatment at a nonacademic institution (P<.01). Higher clinical stage and fewer comorbid conditions were associated with higher likelihood of receiving NAC (P<.01). The overall use of NAC increased from 7.6% in 2006 to 20.9% in 2010 (P<.01). Those receiving NAC were significantly more likely to be downstaged at RC (31.2% vs 7.6%, P<.01), with 10.6% achieving complete pathologic downstaging. Although the use of NAC for organ-confined muscle invasive bladder cancer remains low, it is increasing over time. Patients receiving NAC are more likely to be downstaged and achieve complete pathologic downstaging. However, there is considerable variation in treatment patterns based on both clinical and nonclinical factors.

A novel algorithm to improve pathologic stage prediction of clinically organ‐confined muscle‐invasive bladder cancer

An algorithm was created to predict pathologic stage in patients with clinically organ-confined muscle-invasive bladder cancer. The sample consisted of 133 consecutive patients scheduled to undergo cystectomy. To develop a tool to predict nonorgan-confined disease before surgery, principal component analysis (PCA) was applied. Patients were stratified into a training set (n = 89) and a validation set (n = 44), and 7 parameters were evaluated: levels of carcinoembryonic antigen, cancer antigen (CA) 125, and carbohydrate antigen (CA) 19-9; clinical stage; presence of hydronephrosis; presence of carcinoma in situ; and initial tumor size >3 cm. PCA was applied to the training set to determine the weight of each parameter. A PCA score was generated for each patient in the set, and a cutoff defining nonorgan-confined disease was established. The accuracy of the cutoff was quantified by the area under the receiver operator characteristics curve (AUC). The model was then applied to the validation set without recalculation; the AUC and the positive and negative predictive values of the validation set were calculated. On pathologic evaluation, 71 patients (53%) were found to have organ-confined tumors and 62 patients (47%) had extravesical disease. The AUC was 0.85 in the training group (95% confidence interval [95% CI], 0.71-0.97) and 0.84 in the validation group (95% CI, 0.75-0.93). The positive and negative predictive values in the validation group were 88% (95% CI, 71%-96%) and 94% (95% CI, 71%-99%), respectively. The newly devised, internally validated, algorithm was 85% accurate in predicting nonorgan-confined bladder disease before cystectomy. Further external validation in a large cohort was recommended as still necessary.

Impact of the Level of Muscle Invasion in Organ-Confined Bladder Cancer

Objective: We evaluated whether there is a survival difference between patients having pT2a and pT2b invasive bladder carcinomas without nodal involvement and distant metastases. Patients and Methods: Three hundred and thirty-six patients with invasive carcinomas of the bladder underwent radical cystectomy. Seventy-five patients with organ-confined disease were evaluated. The pathological stage was used as predictor of survival. Kaplan-Meier method and log-rank test were used to evaluate survival rates. Cox proportional-hazard models were used to identify whether pathological stage, grade, diversion type, age, and gender affect the outcome. Results: Thirty-five patients were in the pT2aN0 group with a mean age of 57.8 ± 1.4 (range 37–76) years, and 40 patients were in the pT2bN0 group with a mean age of 59.5 ± 1.1 (range 37–76) years. There were 2 female patients. The mean follow-up period was 27.41 ± 20.5 (range 3–80) months. The disease-specific 5-year survival rate of the pT2N0 cases was 80.3%. The disease-specific 5-year survival rates for the pT2aN0 and pT2bN0 patients were 84.3 and 66.0%, respectively. The disease-specific mean survival times of pT2aN0 and pT2bN0 cases were 76.2 ± 4.7 and 56.3 ± 7.7 months, respectively. There was no statistically significant survival difference between pT2aN0 and pT2bN0 patients by log-rank test (p = 0.1767). According to the Cox multivariate regression analysis, stage, grade, diversion type, age, and gender were not predictive of the survival in patients with organ-confined bladder cancer (p > 0.05). Conclusions: The level of muscle invasion in organ-confined bladder cancer does not have an influence on the patient survival. Also stage, grade, diversion type, age, and gender are not predictive of survival in patients with organ-confined muscle-invasive bladder cancer.