6533b852fe1ef96bd12ab978

RESEARCH PRODUCT

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

Paolo GonteroJennifer IraniJ. VarkarakisS. M. Di StasiGuido DalbagniEugene K. ChaE.n. XylinasViktor SoukupVincenzo SerrettaRenzo ColomboT. Tony CaiNúria MalatsS. JoniauAnne J. GrotenhuisPer-uno MalmströmRoy ManoS. LarrèMarek BabjukRichard SylvesterAlberto BrigantiR. BartolettiJack BanielS.f. ShariatJuan PalouP. ArdeltFrancesca PisanoJ.a. WitjesRobert Jeffrey KarnesFrancesco SoriaB.w.g. Van Rhijn

subject

NephrologyMalemedicine.medical_treatment030232 urology & nephrologyKaplan-Meier EstimateSettore MED/24 - UrologiaCohort Studies0302 clinical medicineRetrospective StudieMultivariate AnalysiOutcomeeducation.field_of_studyHigh riskBladder cancerMiddle AgedPrognosisEditorialTreatment OutcomeLocal030220 oncology & carcinogenesisBCG VaccineFemaleSurvival AnalysiBladder cancer; Cystectomy; Extravesical disease; High risk; Outcomes; T1G3; UrologyHumanmedicine.medical_specialtyPrognosiUrologyPopulationUrologyOutcomesT1G3CystectomyRisk AssessmentDisease-Free SurvivalCystectomy03 medical and health sciencesAll institutes and research themes of the Radboud University Medical CenterInternal medicineUrological cancers Radboud Institute for Molecular Life Sciences [Radboudumc 15]medicineHumansNeoplasm InvasivenesseducationSurvival analysisProportional Hazards ModelsRetrospective StudiesAgedNeoplasm StagingNeoplasm InvasiveneCarcinoma Transitional CellBladder cancerbusiness.industryProportional hazards modelBladder cancer; Cystectomy; Extravesical disease; High risk; Outcomes; T1G3; Aged; BCG Vaccine; Carcinoma Transitional Cell; Cohort Studies; Cystectomy; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Recurrence Local; Neoplasm Staging; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Analysis; Treatment Outcome; Urinary Bladder NeoplasmsCarcinomaRetrospective cohort studymedicine.diseaseSurvival AnalysisNeoplasm RecurrenceUrinary Bladder NeoplasmsConcomitantMultivariate AnalysisProportional Hazards ModelTransitional CellCohort StudieNeoplasm Recurrence LocalbusinessExtravesical disease

description

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 = 1.79, p = 0.001 and HR = 1.53, p = 0.02, respectively). Patients with tumors > 3 cm, multiple tumors or CIS had earlier T3/T4 or N + cystectomies. In patients who progressed, the timing of cystectomy did not affect the risk of T3/T4 or N + disease at RC. Patients with T3/T4 or N + disease at RC had a shorter disease-specific survival (HR = 4.38, p < 0.001), as did patients with CIS at cystectomy (HR = 2.39, p < 0.001). Patients who progressed prior to cystectomy had a shorter disease-specific survival than patients for whom progression was only detected at cystectomy (HR = 0.58, p = 0.024) CONCLUSIONS: Patients treated with RC before experiencing progression to muscle-invasive disease harbor better oncological and survival outcomes compared to those who progressed before RC and to those upstaged at surgery. Tumor size and concomitant CIS at diagnosis are the main predictors of surgical treatment while tumor size, CIS and tumor multiplicity are associated with extravesical disease at surgery. ispartof: WORLD JOURNAL OF UROLOGY vol:36 issue:11 pages:1775-1781 ispartof: location:Germany status: published

yearjournalcountryeditionlanguage
2018-01-01
10.1007/s00345-018-2450-0http://hdl.handle.net/10447/359502