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Published in: World Journal of Urology 3/2009

01-06-2009 | Topic Paper

Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1 G3)

Authors: Richard E. Hautmann, Bjoern G. Volkmer, Kilian Gust

Published in: World Journal of Urology | Issue 3/2009

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Abstract

Objectives

To review understaging and survival of patients who underwent early versus deferred radical cystectomy (RCX) for high-risk non-muscle invasive bladder cancer (NMIBC; T1 G3).

Methods

The results of 1,521 RCXs including 1,420 for bladder cancer were reviewed: (1) A total of 114 patients with high-risk NMIBC underwent a single TUR-BT followed by immediate RCX to estimate the understaging rate. (2) As much as 260 patients with NMIBC had long-term follow-up before RCX to determine the upgrading and upstaging over time. (3) We compared survival in patients with initial T1 G3 bladder cancer (BC) treated with early RCX (n = 175) versus deferred RCX (n = 99) for recurrent T1 G3.

Results

(1) Our understaging rate was 20.2%. (2) Allowing NMIBC to upgrade portents a 19% survival disadvantage. (3) The 10 years cancer-specific survival rate was 78.7% in early and 64.5% in deferred RCX.

Conclusions

Early, as compared to deferred RCX, has a distinct survival advantage for high-risk NMIBC. Patients should be counselled accordingly.
Literature
5.
go back to reference Denzinger S, Fritsche HM, Otto W, Blana A, Wieland WF, Burger M (2008) Early versus deferred cystectomy for initial high-risk pT1 G3 urothelial carcinoma of the bladder: do risk factors define feasibility of bladder-sparing approach? Eur Urol 53:146–152. doi:10.1016/j.eururo.2007.06.030 PubMedCrossRef Denzinger S, Fritsche HM, Otto W, Blana A, Wieland WF, Burger M (2008) Early versus deferred cystectomy for initial high-risk pT1 G3 urothelial carcinoma of the bladder: do risk factors define feasibility of bladder-sparing approach? Eur Urol 53:146–152. doi:10.​1016/​j.​eururo.​2007.​06.​030 PubMedCrossRef
7.
go back to reference Kamat AM, Gee JR, Dinney CPN, Grossmann HB, Swanson DA, Millikan RE, Detry MA, Robinson TL, Pisters LL (2006) The case for early cystectomy in the treatment of nonmuscle invasive micropapillary bladder carcinoma. J Urol 175:881–885. doi:10.1016/S0022-5347(05)00423-4 PubMedCrossRef Kamat AM, Gee JR, Dinney CPN, Grossmann HB, Swanson DA, Millikan RE, Detry MA, Robinson TL, Pisters LL (2006) The case for early cystectomy in the treatment of nonmuscle invasive micropapillary bladder carcinoma. J Urol 175:881–885. doi:10.​1016/​S0022-5347(05)00423-4 PubMedCrossRef
8.
go back to reference Sylvester RJ, van der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DWW, Kurth K (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2,596 patients from seven EORTC trials. Eur Urol 49:466–477. doi:10.1016/j.eururo.2005.12.031 PubMedCrossRef Sylvester RJ, van der Meijden APM, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, Newling DWW, Kurth K (2006) Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2,596 patients from seven EORTC trials. Eur Urol 49:466–477. doi:10.​1016/​j.​eururo.​2005.​12.​031 PubMedCrossRef
9.
go back to reference Smits G, Schaafsma E, Kiemeney L, Caris C, Debruyne F, Witjes JA (1998) Microstaging of pT1 transitional call carcinoma of the bladder: indentification of subgroups with distinct risks of progression. Urology 52:1009–1014. doi:10.1016/S0090-4295(98)00374-4 PubMedCrossRef Smits G, Schaafsma E, Kiemeney L, Caris C, Debruyne F, Witjes JA (1998) Microstaging of pT1 transitional call carcinoma of the bladder: indentification of subgroups with distinct risks of progression. Urology 52:1009–1014. doi:10.​1016/​S0090-4295(98)00374-4 PubMedCrossRef
14.
go back to reference Serretta V, Ruggirello A, Dispensa N, Allegro R, Darvinio Melloni FA (2008) Multiplicity and history have a detrimental effect on survival of patients with T1 G3 bladder tumors selected for conservative treatment. J Urol 180:886–891. doi:10.1016/j.juro.2008.05.013 PubMedCrossRef Serretta V, Ruggirello A, Dispensa N, Allegro R, Darvinio Melloni FA (2008) Multiplicity and history have a detrimental effect on survival of patients with T1 G3 bladder tumors selected for conservative treatment. J Urol 180:886–891. doi:10.​1016/​j.​juro.​2008.​05.​013 PubMedCrossRef
19.
go back to reference Shahin O, Thalmann GN, Rentsch C, Mazzucchelli L, Studer UE (2003) A retrospective analysis of 153 patients treated with or without intravesical bacillus Calmette-Guerin for primary stage T1 grade 3 bladder cancer: recurrence, progression and survival. J Urol 169:96–100. doi:10.1016/S0022-5347(05)64044-X PubMedCrossRef Shahin O, Thalmann GN, Rentsch C, Mazzucchelli L, Studer UE (2003) A retrospective analysis of 153 patients treated with or without intravesical bacillus Calmette-Guerin for primary stage T1 grade 3 bladder cancer: recurrence, progression and survival. J Urol 169:96–100. doi:10.​1016/​S0022-5347(05)64044-X PubMedCrossRef
21.
go back to reference Wiesner C, Pfitzenmaier J, Faldum A, Gillitzer R, Melchior SW, Thüroff JW (2005) Lymph node metastases in non-muscle invasive bladder cancer are correlated with the number of transurethral resections and tumour upstaging at radical cystectomy. BJU Int 95:301–305. doi:10.1111/j.1464-410X.2005.05287.x PubMedCrossRef Wiesner C, Pfitzenmaier J, Faldum A, Gillitzer R, Melchior SW, Thüroff JW (2005) Lymph node metastases in non-muscle invasive bladder cancer are correlated with the number of transurethral resections and tumour upstaging at radical cystectomy. BJU Int 95:301–305. doi:10.​1111/​j.​1464-410X.​2005.​05287.​x PubMedCrossRef
Metadata
Title
Quantification of the survival benefit of early versus deferred cystectomy in high-risk non-muscle invasive bladder cancer (T1 G3)
Authors
Richard E. Hautmann
Bjoern G. Volkmer
Kilian Gust
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
World Journal of Urology / Issue 3/2009
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-009-0402-4

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