muscle-invasive bladder cancer Dotaz Zobrazit nápovědu
BJU international, ISSN 1464-4096 vol. 105, suppl. 2, February 2010
18 stran : ilustrace ; 28 cm
- MeSH
- management nemoci MeSH
- nádory močového měchýře neinvadující svalovinu MeSH
- Publikační typ
- sborníky MeSH
- Konspekt
- Patologie. Klinická medicína
- NLK Obory
- urologie
- onkologie
An early single instillation of intravesical chemotherapy (SICI) used immediately after transurethral resection of the bladder (TURB) can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer (NMIBC). SICI should be used in patients with low-risk and with selected intermediate-risk tumours, in particular for multiple primary small papillary tumours, single primary papillary tumours >3cm, and single recurrent papillary tumours recurring >1yr after the previous resection. The available data do not support any recommendation to reduce the role of SICI in patients after fluorescence cystoscopy-guided TURB or en bloc TURB. SICI can even provide some benefit in patients with intermediate-risk tumours subsequently treated with further instillations. During instillation, contraindications should be taken into account and safety measures should be applied. PATIENT SUMMARY: An early single instillation of intravesical chemotherapy immediately after transurethral resection of the bladder can significantly reduce the recurrence rate in selected patients with non-muscle-invasive bladder cancer. It should be used in patients with low-risk and selected intermediate-risk tumours.
- MeSH
- antitumorózní látky aplikace a dávkování MeSH
- aplikace intravezikální MeSH
- cystektomie škodlivé účinky metody MeSH
- cystoskopie metody MeSH
- invazivní růst nádoru MeSH
- lidé MeSH
- lokální recidiva nádoru prevence a kontrola MeSH
- nádory močového měchýře * farmakoterapie patologie chirurgie MeSH
- pooperační péče metody MeSH
- zohlednění rizika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- směrnice pro lékařskou praxi MeSH
Grade is an important determinant of progression in non-muscle-invasive bladder cancer. Although the World Health Organization (WHO) 2004/2016 grading system is recommended, other systems such as WHO1973 and WHO1999 are still widely used. Recently, a hybrid (three-tier) system was proposed, separating WHO2004/2016 high grade (HG) into HG/grade 2 (G2) and HG/G3 while maintaining low grade. We assessed the prognostic performance of HG/G3 and HG/G2. Three independent cohorts with 9712 primary (first diagnosis) Ta-T1 bladder tumors were analyzed. Time to progression was analyzed with cumulative incidence functions and Cox regression models. Harrell's C-index was used to assess discrimination. Time to progression was significantly shorter for HG/G3 than for HG/G2 in multivariable analyses (cohort 1: hazard ratio [HR] = 1.92; cohort 2: HR = 2.51, and cohort 3: HR = 1.69). Corresponding progression risks at 5 yr were 18%, 20%, and 18% for HG/G3 versus 7.3%, 7.5%, and 9.3% for HG/G2, respectively. Cox models using hybrid grade performed better than models with WHO2004/2016 (all cohorts; p < 0.001). For the three cohorts, C-indices for WHO2004/2016 were 0.69, 0.62, and 0.75, while, for hybrid grade, C-indices were 0.74, 0.68, and 0.78, respectively. Subdividing the HG category into HG/G2 and HG/G3 stratifies time to progression and supports the recommendation to adopt the hybrid grading system for Ta/T1 bladder cancers.
- MeSH
- časové faktory MeSH
- invazivní růst nádoru MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory močového měchýře neinvadující svalovinu MeSH
- nádory močového měchýře * patologie klasifikace MeSH
- prognóza MeSH
- progrese nemoci * 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
BACKGROUND: In the current European Association of Urology (EAU) non-muscle-invasive bladder cancer (NMIBC) guideline, two classification systems for grade are advocated: WHO1973 and WHO2004/2016. OBJECTIVE: To compare the prognostic value of these WHO systems. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data for 5145 primary Ta/T1 NMIBC patients from 17 centers were collected between 1990 and 2019. The median follow-up was 3.9 yr. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariate and multivariable analyses of WHO1973 and WHO2004/2016 stratified by center were performed for time to recurrence, progression (primary endpoint), cystectomy, and duration of survival, taking into account age, concomitant carcinoma in situ, gender, multiplicity, tumor size, initial treatment, and tumor stage. Harrell's concordance (C-index) was used for prognostic accuracy of classification systems. RESULTS AND LIMITATIONS: The median age was 68 yr; 3292 (64%) patients had Ta tumors. Neither classification system was prognostic for recurrence. For a four-tier combination of both WHO systems, progression at 5-yr follow-up was 1.4% in low-grade (LG)/G1, 3.8% in LG/G2, 7.7% in high grade (HG)/G2, and 18.8% in HG/G3 (log-rank, p < 0.001). In multivariable analyses with WHO1973 and WHO2004/2016 as independent variables, WHO1973 was a significant prognosticator of progression (p < 0.001), whereas WHO2004/2016 was not anymore (p = 0.067). C-indices for WHO1973, WHO2004, and the WHO systems combined for progression were 0.71, 0.67, and 0.73, respectively. Prognostic analyses for cystectomy and survival showed results similar to those for progression. CONCLUSIONS: In this large prognostic factor study, both classification systems were prognostic for progression but not for recurrence. For progression, the prognostic value of WHO1973 was higher than that of WHO 2004/2016. The four-tier combination (LG/G1, LG/G2, HG/G2, and HG/G3) of both WHO systems proved to be superior, as it divides G2 patients into two subgroups (LG and HG) with different prognoses. Hence, the current EAU-NMIBC guideline recommendation to use both WHO classification systems remains correct. PATIENT SUMMARY: At present, two classification systems are used in parallel to grade non-muscle-invasive bladder tumors. Our data on a large number of patients showed that the older classification system (WHO1973) performed better in terms of assessing progression than the more recent (WHO2004/2016) one. Nevertheless, we conclude that the current guideline recommendation for the use of both classification systems remains correct, since this has the advantage of dividing the large group of WHO1973 G2 patients into two subgroups (low and high grade) with different prognoses.
- MeSH
- cystektomie MeSH
- lidé MeSH
- nádory močového měchýře * chirurgie terapie MeSH
- prognóza MeSH
- senioři MeSH
- stupeň nádoru MeSH
- urologie * MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Úvod a ciele: Väčšina invazívnych nádorov močového mechúra má inváziu svaloviny prítomnú v čase prvotnej diagnózy (primárne nádory), u zvyšku pacientov k invázii svaloviny dochádza progresiou povrchových nádorov (progresívne nádory). Cieľom práce je zistiť rozdiel v biologickej povahe primárnych a progresívnych nádorov. Materiál a metódy: V r. 1997-2001 sa liečilo 278 pacientov s nádormi močového mechúra, 167 (60,1 %) malo povrchové a 111 invazívne nádory. V čase diagnózy invázia svaloviny močového mechúra bola prítomná u 90 (81,1 %) pacientov, u ostatných invázia vznikla progresiou povrchového nádoru. V retrospektívnej štúdii sa hodnotila a porovnávala charakteristika pacientov (vrátane prežívania) a nádorov v oboch skupinách. Štatistická významnosť sa hodnotila x2 testom. Výsledky: Priemerný vek pacientov s primárnymi nádormi bol 65,2 ± 10,5 rokov oproti 61,7 ± 12,6 rokov u pacientov s progresívnymi nádormi. Pohlavie: pomer muži: ženy bol 3,1:1 u primárnych nádorov oproti pomeru 4,2 :1 u progresívnych. K progresii povrchových nádorov došlo v priemere o 35,4 mesiacov (rozmedzie 7-115). Do roka exitovalo 46 z 90 (51,1 %) pacientov s primárnymi nádormi a 11 z 21 (52,4 s progresívnymi. Tri roky prežívalo 14 zo 61 (23 %) pacientov s primárnymi nádormi a dvaja z 13 (15,4 %) pacientov s progresívnymi (p < 0,001). Záver: Pacienti s progresívnymi invazívnymi nádormi majú horšiu prognózu, ako pacienti s primárnymi. Povrchové nádory treba riešiť už v preinvazívnom štádiu, keď je liečba úspešná.
Objective: In most muscle-invasive bladder cancer muscle invasion is present at the time of first diagnosis (primary tumours), in the rest of the patients muscle invasion is caused by progression of superficial tumours (progressive tumours). The aim of study is to determine whether a difference in natural history is between primary and progressive tumours. Material and methods: In 1997-2001 we treated 278 patients with bladder cancer, 167 (60.1%) patients had superficial tumours and 111 patients had invasive tumours. At the time of diagnosis muscle invasion of the bladder was present in 90 (81.1%) patients, in 21 (18.9%) invasion was formed by progression of superficial tumours. The retrospective study evaluated and compared characteristics of patients (incl. survival) and tumours. Statistical significance was calculated by the x2 test. Results: A mean age of patients with primary tumours was 65.2 ± 10.5 years, compared with mean age of 61.7 ± 12.6 years of patients with progressive tumours. Gender - male : female ratio was 3.1 : 1 in primary tumours, as opposed to 4.2 : 1 in progressive. Progression of superficial tumours was noted on average within 35.4 months (range of 7-115). Within one year died 46 out of 90 (51.1%) patients with primary tumours and 11 out of 21 (52.4%) patients with progressive tumours. Three years survived 14 out of 61 (23%) patients with primary tumours and two out of 13 (15.4%) with progressive tumours. Conclusions: Prognosis of patients with progressive tumours is worse than prognosis of patients with primary invasive tumours. It is vital to detect superficial tumours in their pre-invasive stage, when they can be treated successfully.
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 AND OBJECTIVE: Therapeutic options for patients with non-muscle-invasive bladder cancer (NMIBC) have traditionally been limited to intravesical immunotherapy or chemotherapy. A considerable number of new options have been investigated in recent years. Our aim was to review the efficacy and toxicity of novel therapeutic options (results already reported or currently under investigation) for patients with NMIBC. METHODS: We assessed the efficacy of various novel therapeutic options by examining key endpoints in diverse settings, including recurrence, progression, overall survival, disease-specific survival, and complete response. We identified the principal advantages and limitations for each option. Safety was predominantly evaluated as the incidence of grade ≥3 adverse events. Our investigation focused on evidence from scientific articles and congress abstracts published in English within the past 5 yr. KEY FINDINGS AND LIMITATIONS: To date, pembrolizumab, nadofaragene firadenovec, and the combination of BCG with N-803 have received US Food and Drug administration approval for the treatment of BCG-unresponsive carcinoma in situ of the bladder (with or without papillary tumours). Five phase 3 trials are recruiting BCG-naïve patients with high-risk NMIBC. There is increasing interest in an ablative rather than an adjuvant approach for patients with intermediate-risk NMIBC. CONCLUSIONS AND CLINICAL IMPLICATIONS: Novel drugs and device-assisted drug delivery systems are on the verge of changing the treatment of NMIBC. Novel intravesical options seem to have the same efficacy with fewer adverse events in comparison to systemic therapies. PATIENT SUMMARY: We reviewed new therapy options for non-muscle-invasive bladder cancer. Two agents (pembrolizumab and nadofaragene firadenovec) have been approved to date. Ongoing trials are assessing direct delivery of drugs in solution into the bladder. This route seems to have similar efficacy and fewer side effects than intravenous immunotherapy.
PURPOSE OF REVIEW: This review critically evaluates the current state of bladder-sparing options in muscle-invasive bladder cancer (MIBC) and provides an overview of future directions in the field. RECENT FINDINGS: Bladder-sparing treatments have emerged as viable alternatives to radical cystectomy (RC) for selected patients with MIBC, especially in those who are unfit for RC or elect bladder preservation. Numerous studies have assessed the efficacy of trimodal therapy (TMT), with outcomes comparable to RC in a subgroup of well selected patients. Combining immunotherapy with conventional treatments in bladder-sparing approaches can yield promising outcomes. Current research is making significant progress in optimizing treatment protocols by exploring new combinations of systemic therapy agents, innovative drug delivery methods, and biomarker-based approaches. Furthermore, clinical markers of response are being tested to ensure adequate response assessment. SUMMARY: Bladder preservation promise to offer a viable alternative to RC for selected patients with MIBC with the potential to improve patient quality of life. Careful patient selection and ongoing research are essential to optimize patient selection, response assessment, and salvage strategies. As evidence continues to evolve, the role of bladder preservation in MIBC is likely to expand, providing patients with more treatment options tailored to their needs and preferences.
- MeSH
- cystektomie * metody MeSH
- imunoterapie metody MeSH
- invazivní růst nádoru * MeSH
- léčba šetřící orgány * metody MeSH
- lidé MeSH
- močový měchýř chirurgie patologie MeSH
- nádory močového měchýře * terapie patologie chirurgie MeSH
- výběr pacientů MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
OBJECTIVE: To compare the value of flexible blue-light cystoscopy (BLC) vs flexible white-light cystoscopy (WLC) in the surveillance setting of non-muscle-invasive bladder cancer (NMIBC). METHODS: All major databases were searched for articles published before May 2023 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome was the accuracy of flexible BLC vs WLC in detecting bladder cancer recurrence among suspicious bladder lesions. RESULTS: A total of 10 articles, comprising 1634 patients, were deemed eligible for the quantitative synthesis. In the meta-analysis focusing on the detection of disease recurrence, there was no difference between flexible BLC and WLC (odds ratio [OR] 1.08, 95% confidence interval [CI] 0.82-1.41)]; the risk difference (RD) showed 1% of flexible BLC, corresponding to a number needed to treat (NNT) of 100. In the subgroup meta-analysis of detection of carcinoma in situ (CIS) only, there was again no significant difference between flexible BLC and WLC (OR 1.19, 95% CI 0.82-1.69), BLC was associated with a RD of 2% (NNT = 50). The positive predictive values for flexible BLC and WLC in detecting all types of recurrence were 72% and 66%, respectively, and for CIS they were 39% and 29%, respectively. CONCLUSION: Surveillance of NMIBC with flexible BLC could detect more suspicious lesions and consequently more tumour recurrences compared to flexible WLC, with a increase in the rate of false positives leading to overtreatment. A total of 100 and 50 flexible BLC procedures would need to be performed to find on additional tumor and CIS recurences, respectively. A risk-stratified strategy for patient selection could be considered when using flexible BLC for the surveillance of NMIBC patients.
- MeSH
- cystoskopie * metody MeSH
- invazivní růst nádoru MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory močového měchýře neinvadující svalovinu MeSH
- nádory močového měchýře * patologie diagnóza MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- srovnávací studie MeSH
- systematický přehled MeSH
Standardem léčby invazivních nádorů močového měchýře je radikální cystektomie s pánevní lymfadenektomií. Tato léčba bohužel nepřinesla za posledních 30 let zásadní změnu ve výsledcích léčby. Snahou o zlepšení přežívání pacientů bylo zavedení multimodální kombinované léčby. Na invazivní uroteliální karcinom se začalo pohlížet jako na systémové onemocnění, jelikož 30–50 % invazivních nádorů cT2-T4N0 má již v době radikální cystektomie okultní metastázy. Na základě zkušeností s podáváním paliativní chemoterapie u pacientů s diseminovaným onemocněním byla do léčebného algoritmu invazivního nádoru močového měchýře zařazena perioperační chemoterapie na bázi platiny. Randomizované studie s neadjuvantní chemoterapií prokázaly 5% zlepšení celkového přežití pacientů s invazivními nádory močového měchýře.
Radical cystectomy with pelvic lymph node dissection is a standard of treatment for muscle-invasive bladder cancer. However, nomajor improvement of oncological results was seen in the last 30 years. The multimodal therapy was introduced to achieve bettersurvival of the patients. The muscle-invasive bladder cancer started to be considered a systemic disease as 30–50% of cT2–4N0tumors have occult metastatic disease at the time of radical cystectomy. Based on experience with palliative chemotherapy formetastatatic disease, cisplatin-based perioperative chemotherapy was introduced into treatment algorithm of muscle-invasivetumors. In these patients, randomized trials with neoadjuvant chemotherapy showed a 5 % benefit in overall survival.
- Klíčová slova
- protokol M-VAC,
- MeSH
- cisplatina terapeutické užití MeSH
- cystektomie MeSH
- doxorubicin terapeutické užití MeSH
- karcinom z přechodných buněk diagnóza farmakoterapie chirurgie MeSH
- lidé MeSH
- metastázy nádorů farmakoterapie MeSH
- methotrexát terapeutické užití MeSH
- míra přežití MeSH
- nádory močového měchýře * diagnóza farmakoterapie chirurgie MeSH
- neoadjuvantní terapie * MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- staging nádorů MeSH
- vinblastin terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
