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Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration
C. Lonati, P. Baumeister, L. Afferi, A. Mari, A. Minervini, W. Krajewski, S. Azizi, K. Hendricksen, A. Martini, A. Necchi, F. Montorsi, A. Briganti, R. Colombo, A. Tafuri, A. Antonelli, MA. Cerruto, M. Rouprêt, A. Masson-Lecomte, E. Laukhtina, D....
Jazyk angličtina Země Nizozemsko
Typ dokumentu multicentrická studie, časopisecké články
- MeSH
- BCG vakcína terapeutické užití MeSH
- cystektomie MeSH
- konzervativní terapie MeSH
- lidé MeSH
- lokální recidiva nádoru patologie MeSH
- nádory močového měchýře * chirurgie patologie MeSH
- papilární karcinom * chirurgie patologie MeSH
- progrese nemoci MeSH
- retrospektivní studie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
BACKGROUND: Literature lacks clear evidence regarding the optimal treatment for non-muscle-invasive micropapillary bladder cancer (MPBC) due to its rarity and the presence of only small sample size and single-centre studies. OBJECTIVE: To assess cancer-specific mortality (CSM) and overall mortality (OM) between immediate radical cystectomy (RC) and conservative management among T1 high-grade (HG) MPBC. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analysed a multicentre dataset including 119 T1 HG MPBC patients treated between 2005 and 2019 at 15 tertiary referral centres. The median follow-up time was 35 mo (interquartile range: 19-64). INTERVENTION: Patients underwent immediate RC versus conservative management with bacillus Calmette-Guérin. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. Multivariable Cox analyses were performed to assess independent predictors of disease recurrence and disease progression after conservative management; covariates consisted of pure MPBC, concomitant lymphovascular invasion (LVI), and carcinoma in situ at initial diagnosis. RESULTS AND LIMITATIONS: Immediate RC and conservative management were performed in 27% and 73% of patients, respectively. CSM and OM did not differ significantly among patient treated with immediate RC versus conservative management (Pepe-Mori test p = 0.5 and log-rank test p = 0.9, respectively). Overall, 66.7% and 34.5% of patients experienced disease recurrence and disease progression after conservative management, respectively. At multivariable Cox analyses, concomitant LVI was an independent predictor of disease recurrence (p = 0.01) and progression (p = 0.03), while pure MPBC was independently associated with disease progression (p = 0.03). The absence of a centralised re-review and the retrospective design represent the main limitations of our study. CONCLUSIONS: Conservative management could achieve satisfactory results among T1 HG MPBC patients with neither pure MPBC nor LVI at initial diagnosis. PATIENT SUMMARY: Bacillus Calmette-Guérin seems to be an effective therapy for T1 micropapillary bladder cancer patients with neither pure micropapillary disease nor lymphovascular invasion at initial diagnosis.
APHP Department of Urology Hôpital Saint Louis Université de Paris Paris France
Clinica Luganese Moncucco Lugano Switzerland
Clinica S Anna Swiss Medical Group Sorengo Switzerland
Clinica Santa Chiara Locarno Switzerland
Department of Medical Oncology Urological Research Institute IRCCS Ospedale San Raffaele Milan Italy
Department of Surgery Prince of Wales Hospital The Chinese University of Hong Kong Hong Kong China
Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic
Department of Urology and Oncological Urology Wrocław Medical University Wrocław Poland
Department of Urology Charité Universitätsmedizin Berlin Berlin Germany
Department of Urology Fundación Instituto Valenciano de Oncologia Valencia Spain
Department of Urology IRCCS Humanitas Research Hospital Rozzano Milan Italy
Department of Urology Ludwig Maximilians University Munich Germany
Department of Urology Luzerner Kantonsspital Lucerne Switzerland
Department of Urology Spedali Civili di Brescia Brescia Italy
Department of Urology The Netherlands Cancer Institute Amsterdam The Netherlands
Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
Department of Urology Weill Cornell Medical College New York NY USA
GRC 5 Predictive Onco Uro AP HP Urology Pitie Salpetriere Hospital Sorbonne University Paris France
Institute for Urology and Reproductive Health Sechenov University Moscow Russia
Citace poskytuje Crossref.org
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- $a Lonati, Chiara $u Department of Urology, Spedali Civili di Brescia, Brescia, Italy; Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland. Electronic address: chiara.lonati@libero.it
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- $a Survival Outcomes After Immediate Radical Cystectomy Versus Conservative Management with Bacillus Calmette-Guérin Among T1 High-grade Micropapillary Bladder Cancer Patients: Results from a Multicentre Collaboration / $c C. Lonati, P. Baumeister, L. Afferi, A. Mari, A. Minervini, W. Krajewski, S. Azizi, K. Hendricksen, A. Martini, A. Necchi, F. Montorsi, A. Briganti, R. Colombo, A. Tafuri, A. Antonelli, MA. Cerruto, M. Rouprêt, A. Masson-Lecomte, E. Laukhtina, D. D'Andrea, SF. Shariat, F. Soria, G. Marra, P. Gontero, R. Contieri, R. Hurle, AS. Valiquette, MC. Mir, S. Zamboni, C. Simeone, T. Klatte, JY. Teoh, S. Yoshida, Y. Fujii, R. Carando, GB. Schulz, L. Mordasini, A. Mattei, M. Moschini, European Association of Urology Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group
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- $a BACKGROUND: Literature lacks clear evidence regarding the optimal treatment for non-muscle-invasive micropapillary bladder cancer (MPBC) due to its rarity and the presence of only small sample size and single-centre studies. OBJECTIVE: To assess cancer-specific mortality (CSM) and overall mortality (OM) between immediate radical cystectomy (RC) and conservative management among T1 high-grade (HG) MPBC. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analysed a multicentre dataset including 119 T1 HG MPBC patients treated between 2005 and 2019 at 15 tertiary referral centres. The median follow-up time was 35 mo (interquartile range: 19-64). INTERVENTION: Patients underwent immediate RC versus conservative management with bacillus Calmette-Guérin. OUTCOMES MEASUREMENTS AND STATISTICAL ANALYSIS: Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. Multivariable Cox analyses were performed to assess independent predictors of disease recurrence and disease progression after conservative management; covariates consisted of pure MPBC, concomitant lymphovascular invasion (LVI), and carcinoma in situ at initial diagnosis. RESULTS AND LIMITATIONS: Immediate RC and conservative management were performed in 27% and 73% of patients, respectively. CSM and OM did not differ significantly among patient treated with immediate RC versus conservative management (Pepe-Mori test p = 0.5 and log-rank test p = 0.9, respectively). Overall, 66.7% and 34.5% of patients experienced disease recurrence and disease progression after conservative management, respectively. At multivariable Cox analyses, concomitant LVI was an independent predictor of disease recurrence (p = 0.01) and progression (p = 0.03), while pure MPBC was independently associated with disease progression (p = 0.03). The absence of a centralised re-review and the retrospective design represent the main limitations of our study. CONCLUSIONS: Conservative management could achieve satisfactory results among T1 HG MPBC patients with neither pure MPBC nor LVI at initial diagnosis. PATIENT SUMMARY: Bacillus Calmette-Guérin seems to be an effective therapy for T1 micropapillary bladder cancer patients with neither pure micropapillary disease nor lymphovascular invasion at initial diagnosis.
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