Recurrent Superficial Bladder Tumors Research Articles

Role of Flexible Cystoscopy and Ultrasound Together in the Detection of Recurrent Superficial Bladder Tumors; A Comparison With Rigid Cystoscopy

Objective: To evaluate the role of flexible cystoscopy and ultrasound together in thedetection of recurrent superficial bladder tumors
 Method: This hospital based prospective comparative study was carried out in theDepartment of Urology, National Institute of Kidney Diseases and Urology, Sher-E-Banglanagar, Dhaka from January 2013 to June 2014. A total of 85 patients of post transurethralresection (TUR) and post chemotherapy state for superficial bladder tumors were includedin this study. Transabdominal ultrasonography of the bladder was performed for all casesby a consultant radiologist. Flexible cystoscopy was performed by a trained urologist forall. Finally conventional rigid cystoscopy with or without biopsy was performed at thesame setting to confirmed the findings.
 Result:The mean age was found 62.9±9.7 years with range from 41 to 80 years. Majority(82.4%) patients were male and 15(17.6%) patients were female. Male female ratio was4.7:1. It was observed that majority (54.1%) patients was found pT1 stage and 39(45.9%)was pTa stage. It was observed that more than two third (67.1%) patients had grade-Iand 28(32.9%) had grade-II.Sensitivity, specificity, accuracy, positive and negativepredictive values of combine USG and flexible cystoscopy for identification of recurrenttumors were 92.7%, 33.3%, 90.6%, 97.4% and 14.3%.
 Conclusion: Ultrasonography and flexible cytoscopy together can detect recurrentsuperficial bladder tumors as accurate as conventional rigid cytoscopy.
 Bangladesh Journal of Urology, Vol. 22, No. 1, January 2019 p.41-46

Predictive factors of failure of BCG therapy in high-level superficial bladder tumors

Introduction High-grade bladder tumors are superficial, poorly differentiated, they are characterized by there architectural disorganization and marked cytologic abnormalities. The treatment of superficial tumors of the bladder has a twofold objective: the first one is to reduce the frequency of local recurrences and, on the second one is to prevent progression towards muscular infiltration. Hence, the indication of the adjuvant treatment to the transurethral resection of the bladder. The purpose of our work is to study the predictive factors for the failure of intravesical BCG instillations in the management of these tumors. Failure was defined by the progression or recurrence of superficial high-grade bladder tumors. Material and method We undertook in this work a retrospective descriptive study, including 80 patients who were treated in the urology department “A” at the RABAT CHU for high-grade urothelial carcinoma PTa and PT1 between January 2010 and June 2013. Rates of recurrence, progression after BCG therapy were studied. The prognostic factors associated with this type of tumor were then sought after by Cox regression. The overall average decline in the study was 50 months or about 4.5 years. Results The patients were 71 men and 9 women. The average age of our patients was 60 years old with extremes ranging from 38 to 71 years old. At 50 months, 60% of patients treated with BCG therapy are free from recurrence. This rate is 69% for PTa tumors and 53% for pT1 tumors ( P = 0.03); 22 (27%) patients had a recurrence under the same histological grade in the first 24 months, 11 (13%) patients had tumor progression, 4 of which were infiltrating cystectomy treated. In univariate analysis, the significantly identified risk factors for recurrence were: multifocal lesions ( P = 0.001), presence of associated in situ carcinoma, vascular invasion ( P P = 0.001), and the lack of maintenance therapy with BCG therapy. The risk factors for progression were: the presence of CIS, the crossing of the lamina propria especially in PT1G3 tumors, and the size greater than 5 cm. In multi-varied analysis, the presence of CIS, crossing the lamina propria and the tumor size in case of tumor PT1G3 are the significant factors of the failure of BCG therapy ( P = 0.001). The primary or secondary character of the high histological grade of tumor, patient age and multifocality ( P = 0.4) were not significant. This multi-varied study also showed a strong correlation between tumor size and invasion of the lamina propria. Conclusion The results of this retrospective study suggest that high-grade tumors must be compulsorily controlled by BCG therapy with a maintenance protocol. This study also made it possible to select patients with very high-risk of recurrence and progression after BCG therapy who should receive close monitoring and cystectomy if BCG therapy fails.

Fuzzy Modelling for Predicting the Risk of Recurrence and Progression of Superficial Bladder Tumors

Nowadays, bladder cancer is the fourth most common cancer in adults and the second most frequent urogenital tumor. Predicting recurrence and progression of superficial bladder tumors, with available clinical information to decide the therapy to be used is a difficult task. In this work, two mathematical models were developed to help specialists on the decision process. The mathematical tool used to formulate the model was the fuzzy sets theory, due to its capacity in dealing with uncertainties inherent in medical concepts. In the first model, Stage, Grade and Size of the tumor were also considered input variables and Risk of Recurrence of a superficial bladder tumor as output variable of the first Fuzzy Rule-Based Systems (FRBS). In the second model, in addition to the Stage, Grade and Size of the tumor, it was also considered as input variable of a second FRBS Carcinoma in situ and, the Risk of Progression of superficial tumors as an output variable. For each model, simulations were made with data originated from of patients of the Clinics Hospital/ UNICAMP and A. C. Camargo Hospital of Sao Paulo, with the aim to verify the reliability of results generated by the two systems. From a database and the possibility found by FRBS, after the possibility-probability transformation, we can generate the real probability of each fuzzy output set.

Outcomes and prognostic factors of simple partial cystectomy for localized bladder urothelial cell carcinoma

Radical cystectomy has remained the gold standard for recurrent superficial or muscle invasive bladder tumor. However, partial cystectomy still has a role in those who reject or have contraindications for radical cystectomy. In this study, we sought to identify predictors of bladder recurrence and overall survival after simple partial cystectomy. We included 27 patients with bladder tumor who received simple partial cystectomy without pelvic lymph node dissection between March 2000 and September 2013. Adjuvant chemotherapy or radiation therapy was prescribed according to the pathological results. Parameters were compared on the basis of bladder recurrence and overall survival. During a mean follow-up time of 39 months, five patients (18.5%) experienced bladder recurrence. An older age, a higher pathological stage, positive surgical margins, and distant metastases were significant predictors of overall survival (p = 0.031, p = 0.001, p = 0.001, and p = 0.011, respectively). Meanwhile, previous bladder instillation and positive surgical margins were significant predictors of bladder recurrence (p = 0.026 and p = 0.027, respectively). The rate of consecutive distant metastases (33.3%) was almost twice the rate of bladder recurrence (18.5%), and six patients developed consecutive distant metastases without first experiencing bladder recurrence. In patients who received a simple partial cystectomy as an alternative treatment, previous bladder instillation and positive surgical margins were significant predictors of bladder recurrence. Patients with an older age, positive surgical margins, and consecutive distant metastases had worse overall survival. Partial cystectomy with routine lymph node dissection may be a better option for achieving favorable long-term outcomes.

FULGURACIÓN CON LÁSER DE LA RECIDIVA DE TUMORES VESICALES SUPERFICIALES BAJO ANESTESIA LOCAL: DISEÑO DE PROCESOS

Laser fulguration of superficial bladder tumor recurrence under local anesthesia. design process introduction: The process design is one of the most interesting tools to ensure the quality of health care before the start of an activity. Although the gold standard treatment of superficial bladder tumors remains transurethral resection (TUR), the onset of laser energy source with better endourological systems allows us to adopt alternative therapies. The aim of this pilot study is to describe the design and protocol in 37 patients with a novel process consisting of outpatient treatment under local anesthesia of bladder tumors with hol- mium laser. material and methods: Pilot study includes 37 patients between January 2012 and December 2013, for the development of a process of holmium laser bladder fulguration without anesthetic infiltration in outpatient study. It analyzes and studies the procedure tolerance, development of immediate complications, visual analog scale (VAS) of pain, patient satisfaction, hospital stays avoided, problems during the application process and development. results: The mean age of the patients was 69.2 ± 10.3 years, 100% of patients prefer this procedure instead conventional transurethral resection and VAS rating presenting ≤ 3. There were no important complications. Only one patient was admitted at hospital due to hematuria resolved without surgical treatment. conclusions: The development and implementation of fulguration of superficial papillary bladder tumors with holmium laser process is simple, well tolerated, ambulatory and without complications, with no need of hospital stay.

Neutrophil-lymphocyte ratio as a predictor of recurrence and progression in patients with high-grade pT1 bladder cancer.

We investigated the value of the preoperative neutrophil-lymphocyte ratio (NLR) in predicting recurrence and progression of high-grade pT1 non-muscle-invasive tumour in patients with bladder cancer during a 5-year follow-up period. We retrospectively reviewed data of 1100 patients with bladder cancer; these patients underwent transurethral resection and were monitored at multiple centres from 2008 to 2013. In total, 166 consecutive and newly diagnosed patients with high-grade pT1 tumours were included in this study. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Of the 166 patients, 152 were male. The patients were evaluated as two separate groups in terms of recurrence and progression. The mean follow-up period was 24.2 months (interquartile range 13.8-36.6 months). A statistically significant difference was found between recurrence and tumour size (p = 0.001), number of tumours (p < 0.001), NLR (p < 0.001), and smoking (p = 0.007). No statistically significant correlation was found between NLR and progression. According to receiver operating characteristic (ROC) analysis, the optimum cut-off value for the NLR was ≥2.43 (74% sensitivity, 60% specificity, p < 0.001; area under the curve [AUC] 0.687, 95% confidence interval [CI] 0.607-0.767). Multivariate logistic regression analysis determined that the following factors were independent predictors of recurrence in patients with high-grade pT1 non-muscle-invasive bladder cancer: tumour number (OR 5.32, 95% CI 2.10-12.90), NLR of ≥2.43 (OR 2.587; 95% CI 1.156-5.789), and smoking (OR 4.17, 95% CI 1.31-13.21). A high preoperative NLR may play an important role in predicting recurrence of superficial transitional cell type high-grade pT1 bladder tumours. Prospective studies are required to validate the role of NLR as a prognostic marker in high-grade pT1 bladder tumours.

Phase I trial of sorafenib with concurrent radiotherapy (RT) in patients with invasive bladder cancer treated with bladder-sparing intent: A Spanish Oncology Genitourinary Group study.

270 Background: Preclinical studies suggest enhanced radiation-induced cell death when VEGFR inhibitor therapies are combined with RT. Methods: Patients with localized muscle invasive urothelial carcinoma of the bladder in clinical stage T2-3 N0 M0, who were not eligible or rejected radical cystectomy, ECOG PS 0-2, and adequate hematological, renal and hepatic function, were enrolled in this phase I study to assess safety and identify the dose limiting toxicity (DLT), maximum tolerated dose (MTD) and recommended dose (RD) of sorafenib and RT. A 3+3 dose escalation design with cohorts of 3-6 patients was used. Treatment consisted of TUR, followed by normofractionated (2 Gy/day) external-beam RT with high-energy photons, 46 Gy to minor pelvis and 66 Gy to bladder, combined with sorafenib given po continuously. Sorafenib was started two weeks before RT and was administered for 12 weeks, finishing 4 weeks after RT. Dose levels 1, 2 and 3 corresponded to sorafenib 200 mg qd, 200 mg bid and 800 mg bid. Pathological response was assessed by post-treatment TUR. Results: Ten patients were included: median age 71 years (44-84); gender 7M: 3F. Patients were treated at 3 dose levels, the MTD was reached at level 3 and the RD was: sorafenib 200 mg bid with RT. Two DLTs occurred, both at the third dose level: diarrhea grade 3 and digestive bleeding grade 3 with secondary anemia and hemodynamic angor in a patient with previous small bowel angiodysplasia. The most frequent toxicity was diarrhea. Other grade 1-2 toxicities included rash, fatigue, hand-foot syndrome, hypertension, dysuria and urinary frequency. One patient developed late radiation cystitis. Pathological complete response was achieved in 8 of 9 patients evaluated. Salvage cystectomy has been performed in one patient due to recurrent superficial bladder tumor. After a median follow up of 30 months, 6 patients remain disease-free with intact bladder. Conclusions: The combination of sorafenib and RT appears to be feasible and safe allowing long-term bladder preservation in selected patients. A phase II study to assess the activity of this promising combination is warranted.

UP-01.065 Randomized Biopsy in the Diagnosis and Treatment of Superficial Bladder Cancer

The combination of various pathological changes in visually intact urothelium ranging from dysplasia to carcinoma in situ, with invasive carcinoma of the bladder has been proved in many studies. This phenomenon associated with the multicentric origin of bladder tumors, explains the development of relapses and requires the use of radical surgical treatment for invasive bladder tumors. Later, it was proved that the superficial tumors can be combined with the microscopic changes in the mucous layer. On this basis, it was found that these lesions cause progression and recurrence of superficial bladder tumors. In order to determine the prognosis and treatment strategy it was proposed to use a randomized biopsy of cystoscopically unchanged urothelium with superficial bladder tumors. The objective of this study was to evaluate the role of randomized biopsies in the diagnosis and treatment of superficial bladder tumors.

Thérapie photodynamique et carcinomes urothéliaux

PurposePhotodynamic therapy (PDT) is an innovative therapeutic modality in urologic oncology. Material and methodsWe reviewed the current literature on principles and modalities of PDT in urothelial and penile oncology. ResultsPDT has been tested for the treatment recurrent superficial bladder tumors and in situ carcinoma. Carcinologic efficacy has been observed with first generation photosensitizer. The lack of selectivity for tumoral cells was responsible of serious adverse events. Development of selective photosensitizers has reduced the importance of side effects. Data concerning PDT for upper urinary tract urethra and carcinoma are still limited. ConclusionFirst PDT clinical applications in urothelial oncology have shown some effectiveness at the cost of significant morbidity. The development of selective photosensitizers should help to reduce side effects.

Pneumovesicum Approach to En-Bloc Laparoscopic Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Cancer: Midterm Oncological Results

We reported the pneumovesicum (PV) approach to lower ureter and bladder cuff excision and closure. We believe that this approach bears the closest resemblance to the laparoscopic skill set of intravesical dissection and suturing. Herein, we report the midterm oncological results of the approach's use in a series of patients with upper tract urothelial cancer. From July 2004 to May 2010, 10 patients with upper tract urothelial cancer who underwent PV-assisted laparoscopic nephroureterectomy (LNU) were reviewed. Laparoscopic ports were inserted into the bladder via a suprapubic route, and carbon dioxide PV was induced. Laparoscopic dissection of the lower ureter and excision of the bladder cuff were then performed. The bladder defect was securely closed using laparoscopic suturing, and standard LNU followed. Nine men and one woman with a mean age of 71.6 years (47-82) underwent the procedure. Six of the patients had renal pelvic tumor, two had upper ureter tumor, one had midureter tumor, and one had synchronous renal pelvis and upper ureter tumor. In terms of final pathology, there were three, two, and five patients with T1, T2, and T3 diseases, respectively. All of the patients had grade 2 (G2) disease, except for two with grade 3 (G3) disease. Over a median follow-up of 46 months (22-67 months), four patients developed superficial bladder tumor recurrence. The bladder and systemic recurrence rates were 40% and 10%, respectively. There was no port site recurrence. Based on our midterm follow-up information, it can be concluded that the PV approach to en-bloc bladder cuff excision and LNU for upper tract urothelial cancer provides intermediate oncological results comparable to those of other approaches to en-bloc excision of the bladder cuff.

Sequential Chemoimmunotherapy Using Mitomycin Followed by Bacillus Calmette-Guerin (MCC + BCG) Versus Single-Agent Immunotherapy (BCG) for Recurrent Superficial Bladder Tumors

Sequential Chemoimmunotherapy Using Mitomycin Followed by Bacillus Calmette-Guerin (MCC + BCG) Versus Single-Agent Immunotherapy (BCG) for Recurrent Superficial Bladder Tumors

Predictors of Bladder Tumor Recurrence after Curative Surgery for Upper Urinary Tract Transitional Cell Carcinoma

Purpose: We investigated the predictors for developing intravesical recurrence following curative surgery for primary upper tract transitional cell carcinoma (UTTCC). Materials and Methods: The data of 207 patients without a prior history of bladder tumor or distant metastasis were analyzed. We evaluated the influence of multiple clinicopathologic parameters, such as age, sex, T stage, N stage, grade, carcinoma-in-situ, anatomical location, multifocality, lymphovascular invasion (LVI), preoperative urine cytology, and operative methods, on intravesical recurrence. Considering the possibility of bias from the effect of adjuvant treatment, the same analyses were performed in 184 patients excluding those who underwent adjuvant therapy. Mean follow-up was 59.7 months. Results: Of 207 patients, 91 (44%) experienced intravesical recurrence at a mean interval of 13.2 months. Among them, 66% (60/91) experienced intravesical recurrence within 12 months postoperatively. Eighty-nine percent of the recurred bladder tumors were superficial tumors and 64% were grade 1 or 2. Among the multiple parameters analyzed, LVI was the only significant predictor for intravesical recurrence in univariate and multivariate analysis (p=0.008; HR=1.911), whereas preoperative urine cytology was marginally significant. Similar results were obtained in the analysis for 184 patients without adjuvant therapy. Ten patients (11%) underwent muscle-invasive bladder tumor recurrence. Muscle-invasive bladder tumor recurrence was significantly associated with the presence of LVI compared with superficial bladder tumor recurrence (70% vs. 30%; p=0.005). Conclusions: LVI in primary UTTCC was a significant predictor of intravesical recurrence after curative surgery, whereas preoperative urine cytology was a possible predictor. Therefore, we recommend more rigorous cystoscopic follow-up in patients with these risk factors. (Korean J Urol 2009;50:635-641)

Intravescical Gemcitabine versus Mitomycin for recurrent superficial bladder tumours (stages pTa and pT1): A randomized prospective study

Intravescical Gemcitabine versus Mitomycin for recurrent superficial bladder tumours (stages pTa and pT1): A randomized prospective study

Comparative Promoter Methylation Analysis of p53 Target Genes in Urogenital Cancers

Introduction: The methylation status of selected new p53 target genes in bladder, kidney and testicular cancer was investigated to find similarities in methylation frequency and individual levels of methylation with regard to the histopathological classification and biological behavior. Material and Methods: The patients’ samples were evaluated using real-time methylation-specific PCR (MSP) investigating the methylation status of APAF-1, CASP-8, DAPK-1 and IGFBP-3. Included were 103 patients with bladder cancer, 85 patients with kidney cancer and 42 patients with testicular cancer in non-advanced and advanced tumor stages. Non-cancerous tissue from 49 patients was used as control. Results: Methylation frequency was highest for APAF-1 (88–100%) and DAPK-1 (17–86%) through all the different tumor types. Highest APAF-1 and DAPK-1 levels of methylation were found in the advanced tumor groups. In normal tissue, methylation frequency and methylation levels were significantly lower. APAF-1 methylation was also frequent in normal testicular tissue but to lower methylation levels as in cancerous tissue. APAF-1 and IGFBP-3 methylation levels were significantly higher in recurrent superficial and muscle-invasive bladder tumors. Methylation levels of APAF-1 also correlated with higher risk for recurrent metastatic disease in non-advanced tumors of the kidney. Conclusions: The methylation profile observed demonstrates a substantial role of the APAF-1 gene in tumorigenesis. The different methylation pattern in testicular cancer might represent a different methylotype of this cancer. The extent of promoter methylation may be a promising target for application as a tumor marker in urogenital cancer disease.

Intravesical gemcitabine versus mitomycin for recurrent superficial bladder tumors (Stages pTa and pT1): A randomized prospective study

5075 Background: Approximately 30–40% of patients with a superficial bladder cancer treated with Bacille Calmette-Guerin (BCG) or epirubicin do not respond and other 35% of initial responders have a relapse within 5 years. We have compared the therapeutic efficacy and toxicity of intravesical Gemcitabine (GEM) with Mitomycin C (MMC) in patients with recurrent superficial bladder cancer. Methods: Patients with previously treated recurrent Ta-T1, G1-G2 bladder transitional cell carcinoma were enrolled in the present study and randomized to a 6-week course of GEM instillations (2000 mg in 50 ml saline) or 4-week course of MMC (40 mg). In both arms, for the initial responders who remained free of recurrences, maintenance therapy consisted of a 10 monthly treatment during the first year. All patients were followed every 6 months by cystourethroscopy. Results: 120 patients were included in the present study. 109 patients (55 in MMC arm and 54 in GEM arm) were evaluable. The median duration of follow-up was (ide...

Synchronous and multiple transitional cell carcinoma of the bladder and urachal cyst

Incomplete involution of the allantoic duct can result in different pathological forms of urachus which can give rise to inflammation or late malignant changes. Among urachal tumors, adenocarcinoma is most frequent, although other histological types can also be found. The synchronous presentation of a urachal transitional cell tumor, along with recurrent superficial bladder tumors has not been reported previously. We are reporting a 49-year-old male patient in whom transitional cell carcinoma of a urachal cyst was found with recurrent, multiple bladder tumors. The diagnosis of urachal cyst tumor was established according to ultrasonography and computed tomography. Most of the bladder tumors were resected transurethrally while open surgical excision of the urachal cyst with en bloc resection of the bladder dome was performed. Recurrent bladder tumors were afterwards treated with Bacillus Calmette Guerin (BCG) instillations. A year after surgery the patient has no signs of local recurrence or distant metastases of transitional cell carcinoma.

Place de la cystectomie radicale par voie laparoscopique dans le traitement des carcinomes urothéliaux infiltrants de vessie

Radical cystectomy is the reference treatment for recurrent superficial or invasive bladder tumours. The most standardized incision is midline infra-umbilical laparotomy. The first laparoscopic cystectomy was performed in 1992 in a patient with neurogenic bladder and several teams have subsequently described this incision for the treatment of bladder tumours. The advantages of laparoscopy have been reported in terms of morbidity and earlier return to daily activities. The current oncological results of this incision are difficult to compare with those of conventional open surgery due to the insufficient follow-up. However, published series have not reported any significant difference in the intermediate term. Until convincing results become available, it therefore appears legitimate to allow teams skilled in laparoscopy to demonstrate the oncological efficacy of this approach. At the present time, the reference treatment for invasive bladder cancer remains open cystectomy.

Clinical Significance of the Expression of Gli2 and Gli3 in Bladder Cancer

Purpose: The HedgehogGli (HHGli) signaling pathway controls many aspects of tissue patterning, cell proliferation, differentiation and regeneration, and regulates the number of cells in various organs. Inappropriate and uncontrolled activation of the HHGli signaling pathway has been demonstrated in a variety of human cancers. The Gli1, Gli2, and Gli3 genes encoding the Gli family transcription factors play a role as HH effectors. This study examined the significance in Gli2 and Gli3 expression in human bladder cancer. Materials and Methods: The tumor tissues were obtained from 144 patients with a primary bladder cancer. The mRNA levels of Gli2, and Gli3 were examined using a real-time polymerase chain reaction (PCR) assay in 144 tumor specimens, and immunohistochemical staining was performed on 127 tumor paraffin blocks. The relationships between their expression and the pathological or clinical characteristics, such as tumor stage, grade, recurrence and progression were also analyzed. Results: Gli2 mRNA expression was higher in the invasive bladder tumors than in the superficial bladder tumors (p<0.001) but, there was no difference in Gli3 mRNA expression according to the tumor stage and grade. The multivariate Cox regression model revealed that Gli2 mRNA expression (hazards ratio (HR): 2.329, 95% confidence interval (CI): 1.0435.202, p=0.039) was the only strong predictor of superficial bladder tumor recurrence. Kaplan-Meier analysis also showed identical results (log-rank test, p=0.043). Conclusions: The enhanced expression of Gli2 mRNA was strongly correlated with the recurrence of superficial bladder cancer. These results suggest that Gli2 may be a useful marker for assessing the recurrence of superficial bladder cancer in human bladder cancers. (Korean J Urol 2008; 49:696-702) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

The Prognostic Significance of Elevated Serum Creatinine for the Recurrence and Progression in Superficial Bladder Tumors

Purpose: There are many prognostic indicators of bladder tumors including clinical, pathological and molecular markers based on tumor-related factors. This study was performed to evaluate the significance of an elevated level of serum creatinine for predicting progression and recurrence of superficial bladder tumors. Materials and Methods: One hundred forty-seven patients that initially presented with a superficial bladder tumor (pTa or pT1) except for a carcinoma in situ were retrospectively analyzed according to several factors such as tumor stage, grade, size, multiplicity and serum creatinine for tumor recurrence and progression after a primary transurethral resection. Results: The elevated serum creatinine group consisted of 20 patients 11 patients experienced recurrence (55.0%) and 3 patients experienced progression (15.0%). The control group consisted of 127 patients 39 patients experienced recurrence (30.7%) and 13 patients experienced progression (10.2%). The presence of an elevated level of serum creatinine and tumor multiplicity were statistically significant prognostic factors for tumor recurrence. Conclusions: These results can be helpful for predicting the prognosis of transitional cell carcinoma of the bladder and for planning therapeutic and follow-up strategies. (Korean J Urol 2007;48:927-932)

Short-Schedule Intravesical Gemcitabine with Ablative Intent in Recurrent Ta–T1, G1–G2, Low- or Intermediate-Risk, Transitional Cell Carcinoma of the Bladder

ObjectivesPrimary objective: to assess ablative efficacy and tolerability of short-schedule intravesical gemcitabine for intact, low- and intermediate-risk, recurrent superficial bladder tumours. Secondary objective: to assess effect on prophylaxis. MethodsPatients with a diagnosis of recurrence and a history of previous superficial, low- or intermediate-risk bladder tumours were selected for the study. They received 2000mg gemcitabine in 50ml, that is 40mg/ml, intravesically, weekly for 4 wk, followed by resection of any residual lesions. Complete responses consisted of absence of any macroscopic, histologically confirmed, residual lesion, and no response in the presence of residual lesions. The effect on prophylaxis was measured in months as disease-free interval to first recurrence, and as percentage of patients recurring within the first 12 mo. Toxicity was assessed as local and systemic. ResultsOf 34 recruited patients, 28 consecutive patients were evaluable, with complete responses observed in 13 of 28 (46.4%) and no response in 15 (53.6%). Median time to first recurrence was 9.1 mo (range: 2.9–26.5) for 19 of 28 (67.8%) patients experiencing recurrence during the first year. Local or systemic toxicity was observed in 9 of 34 (26.4%) patients, resulting in protocol interruption in 6 patients. ConclusionsIntravesical gemcitabine alone showed ablative efficacy in nearly one half of the patients under study. Drug tolerability was good, both locally and systemically.