PURPOSE: A re-transurethral resection of the bladder (re-TURB) is a well-established approach in managing non-muscle invasive bladder cancer (NMIBC) for various reasons: repeat-TURB is recommended for a macroscopically incomplete initial resection, restaging-TURB is required if the first resection was macroscopically complete but contained no detrusor muscle (DM) and second-TURB is advised for all completely resected T1-tumors with DM in the resection specimen. This study assessed the long-term outcomes after repeat-, second-, and restaging-TURB in T1-NMIBC patients. METHODS: Individual patient data with tumor characteristics of 1660 primary T1-patients (muscle-invasion at re-TURB omitted) diagnosed from 1990 to 2018 in 17 hospitals were analyzed. Time to recurrence, progression, death due to bladder cancer (BC), and all causes (OS) were visualized with cumulative incidence functions and analyzed by log-rank tests and multivariable Cox-regression models stratified by institution. RESULTS: Median follow-up was 45.3 (IQR 22.7-81.1) months. There were no differences in time to recurrence, progression, or OS between patients undergoing restaging (135 patients), second (644 patients), or repeat-TURB (84 patients), nor between patients who did or who did not undergo second or restaging-TURB. However, patients who underwent repeat-TURB had a shorter time to BC death compared to those who had second- or restaging-TURB (multivariable HR 3.58, P = 0.004). CONCLUSION: Prognosis did not significantly differ between patients who underwent restaging- or second-TURB. However, a worse prognosis in terms of death due to bladder cancer was found in patients who underwent repeat-TURB compared to second-TURB and restaging-TURB, highlighting the importance of separately evaluating different indications for re-TURB.
- MeSH
- cystektomie MeSH
- lidé MeSH
- močový měchýř chirurgie patologie MeSH
- nádory močového měchýře neinvadující svalovinu * MeSH
- nádory močového měchýře * chirurgie patologie MeSH
- prognóza MeSH
- staging nádorů MeSH
- urologické chirurgické výkony MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC) is a relatively rare diagnosis with an ambiguous character owing to the presence of an aggressive G3 component together with the lower malignant potential of the Ta component. The European Association of Urology (EAU) NMIBC guidelines recently changed the risk stratification for Ta G3 from high risk to intermediate, high, or very high risk. However, prognostic studies on Ta G3 carcinomas are limited and inconclusive. OBJECTIVE: To evaluate the prognostic value of categorizing Ta G3 compared to Ta G2 and T1 G3 carcinomas. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5170 primary Ta-T1 bladder tumors from 17 hospitals were analyzed. Transurethral resection of the tumor was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time to recurrence and time to progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox-regression models with interaction terms stratified by institution. RESULTS AND LIMITATIONS: Ta G3 represented 7.5% (387/5170) of Ta-T1 carcinomas of which 42% were classified as intermediate risk. Time to recurrence did not differ between Ta G3 and Ta G2 (p = 0.9) or T1 G3 (p = 0.4). Progression at 5 yr occurred for 3.6% (95% confidence interval [CI] 2.7-4.8%) of Ta G2, 13% (95% CI 9.3-17%) of Ta G3, and 20% (95% CI 17-23%) of T1 G3 carcinomas. Time to progression for Ta G3 was shorter than for Ta G2 (p < 0.001) and longer than for T1 G3 (p = 0.002). Patients with Ta G3 NMIBC with concomitant carcinoma in situ (CIS) had worse prognosis and a similar time to progression as for patients with T1 G3 NMIBC with CIS (p = 0.5). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS: The prognosis of Ta G3 tumors in terms of progression appears to be in between that of Ta G2 and T1 G3. However, patients with Ta G3 NMIBC with concomitant CIS have worse prognosis that is comparable to that of T1 G3 with CIS. Our results support the recent EAU NMIBC guideline changes for more refined risk stratification of Ta G3 tumors because many of these patients have better prognosis than previously thought. PATIENT SUMMARY: We used data from 17 centers in Europe and Canada to assess the prognosis for patients with stage Ta grade 3 (G3) non-muscle-invasive bladder cancer (NMIBC). Time to cancer progression for Ta G3 cancer differed from both Ta G2 and T1 G3 tumors. Our results support the recent change in the European Association of Urology guidelines for more refined risk stratification of Ta G3 NMIBC because many patients with this tumor have better prognosis than previously thought.
- MeSH
- karcinom * diagnóza patologie MeSH
- lidé MeSH
- močový měchýř patologie MeSH
- nádory močového měchýře * diagnóza terapie patologie MeSH
- prognóza MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The pathological existence and clinical consequence of stage T1 grade 1 (T1G1) bladder cancer are the subject of debate. Even though the diagnosis of T1G1 is controversial, several reports have consistently found a prevalence of 2-6% G1 in their T1 series. However, it remains unclear if T1G1 carcinomas have added value as a separate category to predict prognosis within the non-muscle-invasive bladder cancer (NMIBC) spectrum. OBJECTIVE: To evaluate the prognostic value of T1G1 carcinomas compared to TaG1 and T1G2 carcinomas within the NMIBC spectrum. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5170 primary Ta and T1 bladder tumors from 17 hospitals in Europe and Canada were analyzed. Transurethral resection (TUR) was performed between 1990 and 2018. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Time to recurrence and progression were analyzed using cumulative incidence functions, log-rank tests, and multivariable Cox regression models stratified by institution. RESULTS AND LIMITATIONS: T1G1 represented 1.9% (99/5170) of all carcinomas and 5.3% (99/1859) of T1 carcinomas. According to primary TUR dates, the proportion of T1G1 varied between 0.9% and 3.5% per year, with similar percentages in the early and later calendar years. We found no difference in time to recurrence between T1G1 and TaG1 (p = 0.91) or between T1G1 and T1G2 (p = 0.30). Time to progression significantly differed between TaG1 and T1G1 (p < 0.001) but not between T1G1 and T1G2 (p = 0.30). Multivariable analyses for recurrence and progression showed similar results. CONCLUSIONS: The relative prevalence of T1G1 diagnosis was low and remained constant over the past three decades. Time to recurrence of T1G1 NMIBC was comparable to that for other stage/grade NMIBC combinations. Time to progression of T1G1 NMIBC was comparable to that for T1G2 but not for TaG1, suggesting that treatment and surveillance of T1G1 carcinomas should be more like the approaches for T1G2 NMIBC in accordance with the intermediate and/or high risk categories of the European Association of Urology NMIBC guidelines. PATIENT SUMMARY: Although rare, stage T1 grade 1 (T1G1) bladder cancer is still diagnosed in daily clinical practice. Using individual patient data from 17 centers in Europe and Canada, we found that time to progression of T1G1 cancer was comparable to that for T1G2 but not TaG1 cancer. Therefore, our results suggest that primary T1G1 bladder cancers should be managed with more aggressive treatment and more frequent follow-up than for low-risk bladder cancer.
- MeSH
- lidé MeSH
- nádory močového měchýře neinvadující svalovinu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
BACKGROUND: The European Association of Urology (EAU) prognostic factor risk groups for non-muscle-invasive bladder cancer (NMIBC) are used to provide recommendations for patient treatment after transurethral resection of bladder tumor (TURBT). They do not, however, take into account the widely used World Health Organization (WHO) 2004/2016 grading classification and are based on patients treated in the 1980s. OBJECTIVE: To update EAU prognostic factor risk groups using the WHO 1973 and 2004/2016 grading classifications and identify patients with the lowest and highest probabilities of progression. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for primary NMIBC patients were collected from the institutions of the members of the EAU NMIBC guidelines panel. INTERVENTION: Patients underwent TURBT followed by intravesical instillations at the physician's discretion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Multivariable Cox proportional-hazards regression models were fitted to the primary endpoint, the time to progression to muscle-invasive disease or distant metastases. Patients were divided into four risk groups: low-, intermediate-, high-, and a new, very high-risk group. The probabilities of progression were estimated using Kaplan-Meier curves. RESULTS AND LIMITATIONS: A total of 3401 patients treated with TURBT ± intravesical chemotherapy were included. From the multivariable analyses, tumor stage, WHO 1973/2004-2016 grade, concomitant carcinoma in situ, number of tumors, tumor size, and age were used to form four risk groups for which the probability of progression at 5 yr varied from <1% to >40%. Limitations include the retrospective collection of data and the lack of central pathology review. CONCLUSIONS: This study provides updated EAU prognostic factor risk groups that can be used to inform patient treatment and follow-up. Incorporating the WHO 2004/2016 and 1973 grading classifications, a new, very high-risk group has been identified for which urologists should be prompt to assess and adapt their therapeutic strategy when necessary. PATIENT SUMMARY: The newly updated European Association of Urology prognostic factor risk groups for non-muscle-invasive bladder cancer provide an improved basis for recommending a patient's treatment and follow-up schedule.
- MeSH
- invazivní růst nádoru MeSH
- lidé MeSH
- nádory močového měchýře * terapie MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- Světová zdravotnická organizace MeSH
- urologie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Papillary urothelial neoplasm of low malignant potential (PUN-LMP) was introduced as a noninvasive, noncancerous lesion and a separate grade category in 1998. Subsequently, PUN-LMP was reconfirmed by World Health Organization (WHO) 2004 and WHO 2016 classifications for urothelial bladder tumors. OBJECTIVES: To analyze the proportion of PUN-LMP diagnosis over time and to determine its prognostic value compared to Ta-LG (low-grade) and Ta-HG (high-grade) carcinomas. To assess the intraobserver variability of an experienced uropathologist assigning (WHO) 2004/2016 grades at 2 time points. MATERIALS AND METHODS: Individual patient data of 3,311 primary Ta bladder tumors from 17 hospitals in Europe and Canada were available. Transurethral resection of the tumor was performed between 1990 and 2018. Time to recurrence and progression were analyzed with cumulative incidence functions, log-rank tests and multivariable Cox-regression stratified by institution. Intraobserver variability was assessed by examining the same 314 transurethral resection of the tumorslides twice, in 2004 and again in 2018. RESULTS: PUN-LMP represented 3.8% (127/3,311) of Ta tumors. The same pathologist found 71/314 (22.6%) PUN-LMPs in 2004 and only 20/314 (6.4%) in 2018. Overall, the proportion of PUN-LMP diagnosis substantially decreased over time from 31.3% (1990-2000) to 3.2% (2000-2010) and to 1.1% (2010-2018). We found no difference in time to recurrence between the three WHO 2004/2016 Ta-grade categories (log-rank, P = 0.381), nor for LG vs. PUN-LMP (log-rank, P = 0.238). Time to progression was different for all grade categories (log-rank, P < 0.001), but not between LG and PUN-LMP (log-rank, P = 0.096). Multivariable analyses on recurrence and progression showed similar results for all 3 grade categories and for LG vs. PUN-LMP. CONCLUSIONS: The proportion of PUN-LMP has decreased to very low levels in the last decade. Contrary to its reconfirmation in the WHO 2016 classification, our results do not support the continued use of PUN-LMP as a separate grade category in Ta tumors because of the similar prognosis for PUN-LMP and Ta-LG carcinomas.
- MeSH
- invazivní růst nádoru MeSH
- karcinom z přechodných buněk patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru epidemiologie MeSH
- nádory močového měchýře patologie MeSH
- odchylka pozorovatele MeSH
- papilární karcinom patologie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- stupeň nádoru MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
- Kanada MeSH
Cíl: Zhodnocení perioperačních funkčních a onkologických výsledků laparoskopických nefron‑šetřících operací pro nádor ledvin. Materiál a metoda: Hodnoceny jsou údaje z prospektivně vedené databáze jednoho centra z období od 1/2013 do 6/2018. Výkony prováděli tři operatéři. Finálně bylo vyhodnoceno 174 pacientů. Uvedený počet výkonů zahrnoval také jeden oboustranný výkon, děvet vícečetných jednodobých resekcí (2-5 lézí) a v osmi případech resekce solitární ledviny. Celkem bylo odstraněno 190 ložisek (vlevo 102x, vpravo 88x), u 64 žen a 110 mužů. Mediány souboru (IQR = interkvartilové rozpětí): věk 64 (55-70) let, index komorbidit Charlesonové 3 (2-4), kreatinin 78 (68-95) μmol/L, velikost léze 27 (20-35) mm, PADUA skóre 8 (7-9). Výsledky: Délka výkonu medián 118 (IQR 88-150) min, krevní ztráty medián 150 (IQR 80-300) ml, výkon bez ischemie (IT) 51x/190 lézí, délka IT medián 15 (IQR 12-17) min, 2x proběhla konverze na otevřenou RL, 2x konverze na laparoskopickou nefrektomii. Během 30 dnů bylo zaznamenáno 44 komplikací Claviena‑Dinda (CD): stupeň 1-17x, 2-13x, 3-10x, 4-1x, 5-3x; tj. CD ≥ 3 u 8 % pacientů. Ve čtyřech případech bylo zjištěno symptomatické pseudoaneuryzma, které vždy vyřešeno selektivní embolizací. Pooperační hospitalizace byla s mediánem 6 (IQR 5-7) dní. Histologicky bylo 45 lézí benigních, 145x maligních, z toho 122x pT1a, 16x pT1b, 3x pT2a, 4x pT3a. Pozitivní okraj byl zaznamenám u 11 %. Pouze jedna pacientka podstoupila otevřenou re‑resekci, ostatní byli sledováni. Při sledování byla zaznamenána jedna lokální recidiva v ledvině (při R0 výkonu), 1x rychlá vzdálená progrese (mozkové metastázy) a 1x současně vzdálená (plíce) i lokální progrese v perirenálním tuku (při R0). Trifekta hodnocená dle Montsouris (R0 výkon + IT ≤ 25 min + absence komplikace CD ≥ 3) dosažena u 74,1 %, dle Khalifeha a kol. (R0 + IT ≥ 25 min + žádná komplikace) u 59,2 %, dle Porpiglii a kol. (R0, IT ≥ 20 min, absence komplikace CD ≥ 3) u 69 %. Závěr: Laparoskopická RL je standardním řešením solidních expanzí ledvin poskytující příznivé výsledky. Míra dosažení komplexního klinického úspěchu (= trifekta) byla srovnatelná s literárními údaji.
Aim: Assessment of perioperative and onco‑logical results of laparoscopic nephron‑sparing procedures for renal tumors. Material a methods: We evaluate data from a prospectively collected database in one center between 1/2013 and 6/2018. Operations were per‑formed by 3 surgeons. There were 174 patients available for final analysis. The cohort included also 1 one‑stage bilateral case, 9 cases of multiple one‑stage partial nephrectomy (PN) (2–5 lesions) and in 8 cases PN of solitary kidney. Altogether, 190 renal masses were resected (left side 102×, right side 88×), in 64 women and 110 men. Cohort medians (IQR = interquartile range) were: age 64 (55–70) years, Charleson comorbidity index 3 (2–4), creatinine 78 (68–95) μmol/L, lesion diameter 27(20–35) mm, PADUA score 8 (7–9). Results: Length of surgery median 118 (IQR 88–150) min, blood loss median 150 (IQR 80–300) ml, no warm ischemia (WI) used in 51 of 190 lesions, in other length of WI median 15 (IQR 12–17) min, in 2 patients conversion to open PN was needed and in 2 patients conversion to laparoscopic nephrectomy (1× bleeding; 1× renal vein tumor thrombus). There were 44 complications according to Clavien‑Dindo (CD) classification within 30 post‑operative days: 17× grade 1, 13× grade 2, 10× grade 3, 1× grade 4, 3× grade 5, i.e. CD ≥ 3 in 8 % of patients Symptomatic pseudoaneurysm was diagnosed in 4 pts – all treated by selective embolization. Post‑operative hospital stay was median 6 (IQR 5–7) days. Histology found 45 benign and 145 malignant lesions, of the latter 12 2× pT1a, 16× pT1b, 3× pT2a and 4× pT 3a. Positive margin rate was 11% Only 1 patient underwent new PN via open approach, others were monitored. We detected 1 local kidney recurrence (in R0 surgery), 1 rapid distant progression (cerebral metastases) and 1 combined local (in perirenal fat) and distant (lungs) recurrence (in R0 surgery). Trifecta based on Montsouris (R0 + WI ≤ 25min + absence of CD ≥ 3 complication) was 74,1%, based on Khalifeh et al (R0 + WI ≤ 25 min + no complication) was 59,2% and based on Porpiglia et al (R0 + WI ≤ 20 min + absence of CD ≥ 3 complication) was 69 %. Conclusion: Laparoscopic PN is a standard management option of solid renal masses providing favorable outcomes. Trifecta rate was comparable to published results. The work was supported by a grant project MZ ČR – RVO VFN64165.
We report six cases of anastomosing hemangioma of the ovary. All lesions were unilateral and arose in 43 to 81 year old females. In all but one patient, the tumor was asymptomatic and represented incidental finding. The exception was a tumor associated with massive ascites and elevated CA 125. The tumors were, on cut section, spongy and dark violet in color. The size of tumors ranged from 0.5 to 3.5 cm. All lesions showed the same histological features and consisted of capillary sized anastomosing vessels with sinusoid-like pattern intermingled with sporadic medium sized vessels. Interestingly, in all cases there were areas of luteinized cells at the tumor periphery, which ranged from rare small nests to multiple and commonly confluent areas. In one tumor, components of mature adipose tissue were present. Immunohistochemically, all tumors were CD31 and CD34 positive. Other markers examined were negative, including; estrogen receptor, progesterone receptor, androgen receptor, and D2-40. Proliferative activity (Ki-67 index) was very low in all cases. Anastomosing hemangioma is a rare entity, only 8 lesions occurring in ovary has been described from its initial description in 2009. We report six additional cases with their clinicopathological correlation.
- MeSH
- dospělí MeSH
- hemangiom patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádorové biomarkery analýza MeSH
- nádory vaječníků patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
