Epidemiology of Disease Conditions in Italy. Has Anything Changed? Environment, Professional Exposure, and Lifestyle. Is Time for Screening?

Risk factors analysis in bladder cancer should consider not only the clinical and pathological features of the tumor but also environmental and lifestyle factors. They may play, in fact, a relevant role not only in the pathogenesis but also in the biological behavior of the tumor. The association between cigarette smoking and bladder cancer has been consistently confirmed in several case-control and cohort studies. The risk of bladder cancer seems to increase with duration and intensity of smoking. Another environmental risk factor, although not definitively proved, is water supply. Chlorination or water pollution by pesticides and other chemical factors is considered a relevant risk facto…

The clinical value of PSA increase during intravesical adjuvant therapy for nonmuscle-invasive bladder cancer.

Introduction Prostatic Specific Antigen (PSA), Bacillus Calmette-Guerin (BCG) increase after intravesical BCG has been reported. The need of prostate biopsy in these patients is object of debate. The aim of our study was to evaluate the effect of intravesical therapy on PSA after transurethral resection (TUR) of nonmuscle-invasive bladder cancer (NMIBC). Materials and methods Patients undergoing intravesical chemotherapy or immunotherapy for NMIBC were entered. PSA was measured before TUR, before the first and after the sixth instillation, 30 and 90 days after the last instillation. Patients with PSA ≥4 ng/ml or palpable prostate nodule were excluded. Results Out of 130 patients, 105 were e…

Concordance and Clinical Significance of Uncommon Variants of Bladder Urothelial Carcinoma in Transurethral Resection and Radical Cystectomy Specimens

To evaluate the concordance and prognostic role of histologic variants of bladder urothelial carcinoma in transurethral resection of bladder tumor (TURBT) and radical cystectomy (RC) specimens. METHODS Clinicopathologic information available at the time of RC and follow-up data from 4110 RC specimens, collected between January 2000 and December 2009 at 17 tertiary referral centers were retrospectively analyzed and evaluated for the presence or absence of uncommon variants of bladder urothelial carcinoma. The presence or absence of uncommon variants of bladder urothelial carcinoma was evaluated on previous TURBT specimens of patients undergoing RC. Cox regression was used to assess the impac…

The clinical use of statistical permutation test methodology: a tool for identifying predictive variables of outcome.

<b><i>Objectives:</i></b> To identify the predictive variables affecting the outcome after radical surgery for bladder cancer by a newer statistical methodology, i.e. nonparametric combination (NPC). <b><i>Methods:</i></b> A multicenter study enrolled 1,312 patients who had undergone radical cystectomy for bladder cancer in 11 Italian oncological centers from January 1982 to December 2002. A statistical analysis<b> </b>of their medical history and diagnostic, pathological and postoperative variables was performed using a NPC test. The<b> </b>patients were included in a comprehensive database with medical history and cli…

THE IMPACT OF RE-TUR ON CLINICAL OUTCOMES IN A LARGE COHORT OF T1G3 PATIENTS TREATED WITH BCG.

LOCAL MICROWAVE HYPERTHERMIA AND INTRAVESICAL CHEMOTHERAPY AS BLADDER SPARING TREATMENT FOR SELECT MULTIFOCAL AND UNRESECTABLE SUPERFICIAL BLADDER TUMORS

Purpose: The role of a combined regimen of local hyperthermia and topical chemotherapy in patients with multifocal and recurrent superficial bladder tumors not curable by transurethral resection was evaluated in a neodjuvant organ sparing clinical study. Materials and Methods: A total of 19 patients with multifocal, superficial grades 1 to 3 bladder tumors that recurred after intravesical chemoprophylaxis or immunoprophylaxis underwent local combined administration of microwave induced hyperthermia and intravesical chemotherapy as a debulking approach. Due to extensive superficial involvement of the bladder walls complete transurethral resection of all tumors seemed technically unfeasible i…

Prognostic Factors And Risk Groups In T1g3 Patients Initially Treated With Bcg: Results Of A Multicenter Retrospective Series In 2530 Patients

INTRODUCTION AND OBJECTIVES: The impact of prognostic factors in T1G3 patients (pts) is critical for proper treatment decision making, however most available data are from small series of pts. The aim of the current study is to assess prognostic factors in a large group of pts who received BCG as initial treatment of T1G3 tumours and identify a subgroup of high risk pts who should be considered for early cystectomy. METHODS: Individual pt data were collected for 2530 pts from 23 centers who received induction or maintenance BCG between 1990 and 2008. Using Cox regression analysis, the prognostic importance of the following variables were assessed for time to recurrence, progression to muscl…

[Clinical practice and adherence to the diagnosis and treatment of NMIBC guidelines: a report of a recognition based clinical cases study]

For non-muscle invasive bladder cancer, a disease with a considerable epidemiological and socio-economic impact, the introduction of the Guidelines has always evoked as a tool for the resolution of long-standing disputes in terms of diagnosis and therapy. Check the degree of routine clinical practice adherence to the Recommendations is for this disease, more than for other uro-oncology pathology, an urgent need felt by the urological community. To assess the level of Guidelines adherence's, and study issues related to the paths of diagnosis and treatment of non-muscle invasive bladder cancer, and identifying the processes actually implemented in daily clinical practice, a series of case st…

Quality-of-Life Outcomes in Female Patients With Ileal Conduit or Orthotopic Neobladder Urinary Diversion: 6-Month Results of a Multicenter Prospective Study

Radical cystectomy (RC) often affects patients’ life as this surgery is a traumatic and invasive event for the patients, with drawbacks on their daily, social, working, and sex life. Such changes in the quality of life (QoL) of patients are commonly studied through retrospective clinical evaluations and rarely with longitudinal studies. To date, studies focusing on functional outcomes, sexual function, and health-related QoL for female patients are lacking. We evaluated 37 patients using EORTC QLQ-C30 (QLQ-30) and Short-Form 36 (SF-36) questionnaires, before and after surgery, at 3 and 6 months of follow-up. The mean values for the emotional functioning in QLQ-C30 as well as the mental heal…

Prognostic factors and risk groups in T1G3 non-muscle-invasive bladder cancer patients initially treated with Bacillus Calmette-Guérin: results of a retrospective multicenter study of 2451 patients.

Contains fulltext : 153742.pdf (Publisher’s version ) (Closed access) BACKGROUND: The impact of prognostic factors in T1G3 non-muscle-invasive bladder cancer (BCa) patients is critical for proper treatment decision making. OBJECTIVE: To assess prognostic factors in patients who received bacillus Calmette-Guerin (BCG) as initial intravesical treatment of T1G3 tumors and to identify a subgroup of high-risk patients who should be considered for more aggressive treatment. DESIGN, SETTING, AND PARTICIPANTS: Individual patient data were collected for 2451 T1G3 patients from 23 centers who received BCG between 1990 and 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Using Cox multivariable re…

RECURRENCE AND PROGRESSION ACCORDING TO STAGE AT RE-TUR IN T1G3 BLADDER CANCER PATIENTS TREATED WITH BCG: NOT AS BAD AS PREVIOUSLY THOUGHT

Combination of intravesical chemotherapy and hyperthermia for the treatment of superficial bladder cancer: preliminary clinical experience

The prevalence of superficial transitional cell carcinoma of the bladder (STCCB) is still increasing in spite of improved adjuvant chemotherapic and/or immunoprophylaxis approaches. Thus, there is certainly an urgent need to improve our ability to control this disease. Local hyperthermia has a therapeutical potential for the treatment of many solid tumors, especially when used in combination with other treatments, such as radiation and chemotherapy. In particular, a synergistic or, at least, supra-additive antitumor cell killing effect was documented when local hyperthermia was administered in combination with selected cytostatic drugs. Recently, advances in miniaturized technology have all…

VISCERAL FAT TISSUE ACTIVITY DOES NOT CORRELATE TO HIGH GRADE PROSTATE CANCER RISK AT BIOPSY

The efficacy of BCG TICE and BCG Connaught in a cohort of 2,099 patients with T1G3 non–muscle-invasive bladder cancer

BACKGROUND Potential differences in efficacy of different bacillus Calmette-Guerin (BCG) strains are of importance for daily practice, especially in the era of BCG shortage. OBJECTIVE To retrospectively compare the outcome with BCG Connaught and BCG TICE in a large study cohort of pT1 high-grade non-muscle-invasive bladder cancer patients. DESIGN, SETTING, AND PARTICIPANTS Individual patient data were collected for 2,451 patients with primary T1G3 tumors from 23 centers who were treated with BCG for the first time between 1990 and 2011. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Using Cox multivariable regression and adjusting for the most important prognostic factors in this nonrandomiz…

Effect on postoperative survival of the status of distal ureteral margin: The necessity to achieve negative margins at the time of radical cystectomy.

Background: Despite several studies, the adequate management of positive distal ureter margins at the time of radical cystectomy (RC) remains controversial. Particularly, it is not clear whether the achievement of negative distal ureter margins at the intraoperative frozen sections (IFS) affects postoperative cancer-specific mortality (CSM). Methods: In all, 1,447 consecutive patients treated with RC at a single center between January 1987 and August 2014 were considered. Multivariable (MVA) logistic regression analyses were used to determine predictors of positive IFS. MVA Cox regression analyses were used to test the effect on CSM of intraoperative conversion to negative margins. Results:…

[Endovesical treatment as an alternative to BCG for intermediate or high-risk NMI bladder cancer].

A shortage of BCG is foreseen till the end of 2013. Which will be the management of intermediate and high-risk NMI-BC if BCG will not be available? In patients harboring high-risk NMI tumors, particularly T1G3 and Tis, the first therapeutic choice is radical cystectomy. Device-assisted therapies, although showing promising results, should be considered only for selected patients. In intermediate risk patients, intravesical chemotherapy remains a legitimate option even if BCG is available. Thus, in a period of BCG shortage, intravesical chemotherapy should be offered, preferably preceded by early instillation, according to the EAU guidelines.

Potential Effect of Antiplatelet and Anticoagulant Therapy on the Timing of the Diagnosis of Bladder Cancer

Abstract Background The most common presenting symptom of bladder cancer (BCa) is hematuria. The present study was designed to define whether patients taking antiplatelet and/or anticoagulant drugs might experience hematuria at an earlier stage or grade of BCa. Patients and Methods The data from 1532 consecutive patients who presented to the emergency unit of our institute from 2004 to 2012 because of gross hematuria as a single symptom were evaluated. Patients (n = 227) with a further diagnosis of BCa were included in our study. For the purpose of the present study, patients were divided into 2 groups: patients receiving antiplatelet or anticoagulant therapy (AAT) (group 1) and patients no…

MP26-19 A PROSPECTIVE STUDY ON THE INFLUENCE ON RECURRENCE OF QUITTING CIGARETTE SMOKING AT DIAGNOSIS OF PRIMARY NON MUSCLE INVASIVE BLADDER CANCER

RISK FACTORS FOR RESIDUAL DISEASE AT RE-TUR IN T1G3 BLADDER CANCER

Factores de riesgo de enfermedad residual en la re-RTU en una gran cohorte de pacientes con enfermedad T1G3

Resumen Introduccion y objetivos Los objetivos de la reseccion transuretral (RTU) del tumor vesical son la reseccion completa de las lesiones y la realizacion de un diagnostico correcto con el objetivo de estadificar adecuadamente al paciente. Es bien sabido que la presencia de musculo detrusor en el especimen es un requisito previo para minimizar el riesgo de infraestadificacion. La persistencia de enfermedad tras la reseccion de los tumores vesicales no es infrecuente, y es la razon por la que las guias europeas recomiendan una re-reseccion transuretral (re-RTU) para todos los tumores T1. Recientemente se ha publicado que, en los casos con inclusion de musculo en el especimen, la re-RTU n…

Predictors of oncological outcomes in T1G3 patients treated with BCG who undergo radical cystectomy

PURPOSE: To evaluate the oncological impact of postponing radical cystectomy (RC) to allow further conservative therapies prior to progression in a large multicentre retrospective cohort of T1-HG/G3 patients initially treated with BCG. METHODS: According to the time of RC, the population was divided into 3 groups: patients who did not progress to muscle-invasive disease, patients who progressed before radical cystectomy and patients who experienced progression at the time of radical cystectomy. Clinical and pathological outcomes were compared across the three groups. RESULTS: Of 2451 patients, 509 (20.8%) underwent RC. Patients with tumors > 3 cm or with CIS had earlier cystectomies (HR = 1…

Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients

Item does not contain fulltext Introduction and objectives: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis in order to adequately stage the patient. It is well known that the presence of detrusor muscle in the specimen is a prerequisite to minimize the risk of under staging. Persistent disease after resection of bladder tumors is not uncommon and is the reason why the European Guidelines recommended a re-TUR for all T1 tumors. It was recently published that when there is muscle in the specimen, re-TUR does not influence progression or cancer specific survival. We present here the patient and tumor factors th…

The Impact of Perioperative Blood Transfusion on Survival of Bladder Cancer Patients Submitted to Radical Cystectomy: Role of Anemia Status.

Background The prognostic role of perioperative blood transfusion (PBT) in patients who underwent radical cystectomy (RC) for bladder cancer (BCa), although supported by clinical evidence, still remains to be assessed definitively. Objective To investigate the impact of PBT on RC patients for overall survival and after stratifying according to preoperative anemia status and to define whether the oncologic impact may be assumed to be a primary effect of PBT or attributed to the reduced preoperative hemoglobin (Hb) level. Design, setting, and participants A total of 1490 consecutive patients with nonmetastatic BCa who underwent RC and pelvic lymph node dissection between January 1990 and Augu…

Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC)

Study Type – Therapy (RCT) Level of Evidence 1b What’s known on the subject? and What does the study add? Microwave-induced hyperthermia and mitomycin C is a device-assisted approach used to treat non-muscle invasive bladder cancer (NMIBC) either in the adjuvant (prophylactic) set-up or in an ablative regimen. Until recently, around 20 different studies have been published with data on the short term results of treatment. Previous prospective randomized studies showed the superiority of the chemo-hyperthermia regimen when compared to intravesical chemotherapy alone in terms of recurrence-free survival in intermediate and high-risk NMIBC patients at minimum 24-month follow-up. The current st…

The impact of re-transurethral resection on clinical outcomes in a large multicentre cohort of patients with T1 high-grade/Grade 3 bladder cancer treated with bacille Calmette-Guerin

Objectives To determine if a re-transurethral resection (TUR), in the presence or absence of muscle at the first TUR in patients with T1-high grade (HG)/Grade 3 (G3) bladder cancer, makes a difference in recurrence, progression, cancer specific (CSS) and overall survival (OS). Patients and methods In a large retrospective multicentre cohort of 2451 patients with T1-HG/G3 initially treated with bacille Calmette–Gu erin, 935 (38%) had a re-TUR. According to the presence or absence of muscle in the specimen of the primary TUR, patients were divided in four groups: group 1 (no muscle, no re-TUR), group 2 (no muscle, re-TUR), group 3 (muscle, no re-TUR) and group 4 (muscle, re-TUR). Clinical out…

Recurrence, progression and cancer-specific mortality according to stage at re-TUR in T1G3 bladder cancer patients treated with BCG: not as bad as previously thought

PURPOSE: The goals of transurethral resection of a bladder tumor (TUR) are to completely resect the lesions and to make a correct diagnosis to adequately stage and treat the patient. Persistent disease after TUR is not uncommon and is why re-TUR is recommended in T1G3 patients. When there is T1 tumor in the re-TUR specimen, very high risks of progression (82%) have been reported. We analyze the risks of recurrence, progression to muscle-invasive disease and cancer-specific mortality (CSM) according to tumor stage at re-TUR in T1G3 patients treated with BCG. METHODS: In our retrospective cohort of 2451 T1G3 patients, 934 patients (38.1%) underwent re-TUR. 667 patients had residual disease (7…

Does the Compliance to Intravesical BCG Differ between Common Clinical Practice and International Multicentric Trials?

<b><i>Introduction:</i></b> The aim of this study was to analyze the reasons for intravesical BCG interruption in clinical practice. BCG for at least one year is advocated as the best regimen to treat high-risk non-muscle invasive bladder cancer (NMIBC). However, almost 50% of patients don't complete it. Toxicity accounts for 10% of dropouts in international trials. <b><i>Materials and Methods:</i></b> Patients with T1HG NMIBC undergoing 1-year BCG were enrolled in this study. BCG was administered for one year. Toxicity and causes of treatment interruption were recorded. <b><i>Results:</i></b> A total of 411 patients we…