Treatment Of Cancer Risk Tables Research Articles

Value of European Organisation for Research and Treatment of Cancer score system for predication of immediate postoperative intravesical instillation of pirarubicin after transurethral resection of non-muscle invasive bladder cancer

Objective: To assess value of immediate postoperative intravesical instillation of pirarubicin after transurethral resection (TURBT)of non-muscle invasive bladder cancer. Methods: 484 patients diagnosed with non-muscle-invasive bladder cancer admitted to the Second Affiliated Hospital of Kunming Medical University were divided into two groups after transurethral resection of bladder tumor. 285 patients received postoperative intravesical instillation of pirarubicin within 6 hours after the surgery, 199 patients received first instillation of pirarubicin at 10 days after the surgery, after that, all the patients received routine bladder perfusion chemotherapy. Patients who received intravesical instillation of pirarubicin within 6 hours were defined as immediate intravesical instillation group and the other patients as the control group. Based on the European Organisation for Research and Treatment of Cancer risk tables, scores of recurrence and progression of patients were calculated and then stratified into risk groups accordingly. Recurrence and progression rates of the immediate intravesical instillation group were analyzed and then compared with the corresponding reference of the risk tables. Results: The 1-year and 5-year recurrence rate of patients with EORTC table scoring 0 in the immediate intravesical instillation group were significantly lower than that of the EORTC reference group (5.3% and 14.0% vs 15.0% and 31.0%, P<0.05). 1-year recurrence free rate between the immediate intravesical instillation group and the control group in patients scoring 1-4 was significantly different (81.3% vs 76.7%, P=0.014). However, 1-year recurrence free rate of the immediate intravesical instillation group was comparable with that of the control group in patients scoring 5-9, 10-17(P>0.05), which is quite close to the EORTC reference. The probability rates of 1-year and 5-year progression of the 285 patients who received immediate intravesical instillation group did not show significant difference with the EORTC reference. On multivariate analysis, previous recurrence, tumor grade G2-3, tumor multiplicity, delay of immediate intravesical instillation were independent risk factors of recurrence(P<0.05). Conclusions: With the help of EORTC recurrence risk table stratifying the patients into different risk groups, our study showed that delay of immediate postoperative intravesical instillation of chemotherapy after TURBT was an independent risk factor of post-surgery recurrence of tumor. Moreover, patients with EORTC scoring 1-4 might obtain greatest benefits.

Can the neutrophil-to-lymphocyte ratio be used to predict recurrence and progression of non-muscle-invasive bladder cancer?

The aim of our study was to evaluate whether neutrophil-to-lymphocyte ratio (NLR) is a predictor of disease progression and recurrence in patients with primary non-muscle-invasive bladder cancer (NMIBC). This was a prospective study of 86 patients with newly diagnosed NMIBC. The patients were classified by the number of points assigned by the European Organization for Research and Treatment of Cancer risk tables. The correlation between progression score, recurrence score, age, mean platelet volume, red blood cell distribution width and NLR was assessed statistically. The same parameters were compared between the risk groups. A significant difference in NLR and age values was observed between recurrence and progression risk score groups. The relationships between NLR and recurrence and progression risk scores were no longer significant after correcting for the statistical effect of age on scores. Age was significantly different between groups after adjusting for NLR. Our study revealed that NLR and age were associated with patient age and bladder tumor progression and recurrence risk scores. After correcting for age, the significant relationship with NLR was lost, in contrast to some previous studies. We recommend that patient age should be corrected to avoid misleading results in NLR studies.

The use of European Organization of Research and Treatment of Cancer Risk Tables to predict the prognosis of patients with T1 non-muscle-invasive bladder cancer

The use of European Organization of Research and Treatment of Cancer Risk Tables to predict the prognosis of patients with T1 non-muscle-invasive bladder cancer

Neutrophil-to-lymphocyte ratio predicts progression and recurrence of non–muscle-invasive bladder cancer

ObjectiveNeutrophil-to-lymphocyte ratio (NLR) predicts advanced stage disease and decreased survival in patients undergoing radical cystectomy for urothelial carcinoma of the bladder. The predictive value of NLR in non–muscle-invasive bladder cancer (NMIBC) has not been well studied. We aimed to evaluate whether NLR predicted disease recurrence and progression in NMIBC. Materials and methodsThe medical records of 122 consecutive, newly diagnosed, patients with NMIBC treated with transurethral tumor resection, between the years 2003 and 2010, were reviewed. Patients with hematological malignancies (n = 4) and without preoperative NLR (n = 11) were excluded. Cutoff points for NLR were tested separately for recurrence and progression using the standardized cutoff-finder algorithm. Univariate and multivariate Cox regression analyses were used to evaluate the association between NLR and disease recurrence and progression. ResultsThe study cohort comprised 91 men and 16 women at a median age of 68 years. The median NLR was 2.85 (interquartile range: 2–3.9). In total, 68 patients (64%) had an NLR>2.41. Patients with NLR>2.41 were more often men (P = 0.02) and had T1 category tumors (P = 0.034). Analyzed as a continuous variable, higher NLR showed a weak positive association with high tumor grade (R = 0.21, P = 0.028).The median follow-up for patients without disease recurrence was 40 months (interquartile range: 23–51). The estimated 3-year progression-free survival rate in patients with an NLR>2.41 was 61%, compared with 84% in patients with an NLR≤2.41 (P = 0.004). On multivariate analysis, an NLR>2.41 (hazard ratio [HR] = 3.52; 95% CI: 1.33–9.33; P = 0.012) and high-risk tumors compared with low-intermediate-risk tumors (HR = 4.83; 95% CI: 1.31–17.77; P = 0.018), as defined by the European Organization for Research and Treatment of Cancer risk tables, were associated with disease progression. An NLR>2.43 (HR = 1.75; 95% CI: 1.05–2.92; P = 0.032) and treatment with intravesical instillations (HR = 0.49; 95% CI: 0.28–0.85; P = 0.011) were associated with disease recurrence on multivariate analysis. ConclusionsNLR is an independent predictor of disease progression and recurrence in patients with NMIBC without hematological malignancies. Prospective studies are required to validate the role of NLR as a prognostic marker in NMIBC.

Predicting recurrence and progression in non-muscle-invasive bladder cancer using European organization of research and treatment of cancer risk tables.

We determined the recurrence and progression at 1 year in patients with non-muscle-invasive urothelial carcinoma who underwent transurethral resection of bladder tumor (TURBT) and compared those with the calculated risk according to the European Organization of Research and Treatment of Cancer (EORTC). Follow-up data of 92 patients with non-muscle-invasive bladder cancer who underwent TURBT were reviewed, and their 1st year recurrence and progression were recorded. The risk of recurrence and progression were calculated for 1 year according to the EORTC scoring system, using tumors' stage, grade, size, and multiplicity, and the presence of carcinoma in situ and previous recurrence episodes. The outcomes were compared with the EORTC's predictive scores. The patients were 75 men and 17 women with an age range of 31 to 91 years. Sixteen patients (17.4%) had a recurrent disease, 41 (44.6%) had a tumor larger than 3 cm in diameter, 35 (38.0%) had multiple lesions, 2 (2.2%) had carcinoma in situ, 73 (79.3%) had stage T1 lesions, and 8 (8.7%) had a high-grade disease. Recurrence was found in 34 patients (37.0%). The recurrence rates were 20.0%, 28.2%, 40.5%, and 83.3% in groups with the predicted EORTC risks of 15%, 24%, 38%, and 61%, respectively. There were 2 patients (2.2%) with progression of the diseases. A significant concordance was noted between the EORTC's calculated risk and the recurrence rate of stage Ta T1 bladder cancer at 1 year. Progression was less than that predicted, probably due to our small sample size.

Clinical evaluation of European Organization for Research and Treatment of Cancer risk tables in non-muscle invasive bladder cancer

Objective To evaluate the feasibility of European Organization for Research and Treatment of Cancer (EORTC) risk tables in non-muscle invasive bladder cancer in Chinese patients.Methods A retrospective analysis was performed on the data from 185 patients with non-muscle invaaive urothelial bladder cancer from January 2003 to February 2009. Among the 185 patients, 128 patients were stage Ta compared with 57 patients who were stage T1. There were 87, 53 and 45 patients with grade G1, G2 and G3 respectively. Transurethral resection of the bladder tumor was performed on all the patients and all the patients received routine post-operative intravesical instillation. A telephone interview follow-up was conducted on all the patients, and the average follow-up period was 36 months. EORTC risk tables were used to calculate risk scores for recurrence and progression for each patient. The recurrence and progression rates of different risk groups were recorded and compared with the estimated rates by EORTC risk table. Statistical analysis was used for comparison. ResultsTotal 1-year recurrence rate and progression rate for these patients were 25.9% and 3.8% respectively. According to calculated values of the patients, the 1-year recurrence rates of Group 0, Group 1-4, Group 5-9, Group 10-17 were 10.4%(5/48), 21. 5%(14/65), 35. 2% (19/54), 55.6%(10/18), respectively. The 1-year progression rates of Group 0, Group 2-6, Group 7-13, Group 14-23 were 0% (0/43), 1.5% (1/67), 6. 7% (4/60), 13. 3% (2/15). There was no significant difference between the real rates and estimated rates of the EORTC risk tables (P＞0. 05). However,the 1-year recurrence and progression rates between the low risk group, the medium risk group and the high risk group showed significant differences respectively (P ＜ 0. 05 ). Conclusions The EORTC risk tables are feasible to evaluate the recurrence and progression risk of non-muscle invasive bladder cancer in the present cohort. Nevertheless, the long term value and feasibility need more research to confirm. Key words: Urinary bladder neoplasms; Carcinoma; Non muscle-invasive bladder cancer; European Organization for Research and Treatment of Cancer risk tables; Prognosis