RECURRENCE-FREE SURVIVAL IN PATIENTS WITH NON-MUSCLE BLADDER CANCER
Abstract
The role of a number of therapeutic interventions for non-muscle invasive bladder cancer (NMIBC) is poorly defined. Taking into account the prognostic heterogeneity of NMIBC and a possible interaction of treatment efficacy with a recurrence risk group, it is reasonable to compare the latter within certain prognostic strata. The objective of this study was to evaluate the effi-cacy of different therapeutic interventions on recurrence-free survival in patients with NMIBC in different prognostic groups.
Retrospectively, we analyzed the results of treatment of 921 patients with NMIBC who were distributed into 4 recurrence risk groups. Recurrence-free survival was calculated using the Kaplan–Meier method and the statistical significance for the differences was assessed during a log rank test.
The median follow-up was 61 months. Transurethral resection (TUR) assisted by photodynamic diagnostic resulted in a significant improvement in recurrence-free survival in the high and very high risk groups. The advantage of TUR performed by an experienced surgeon and BCG immunotherapy was pronounced in the intermediate, high and very high risk groups. Single instillation of doxorubicin and reTUR do not substantially affect prognosis in any risk stratum.
Based on a stratified analysis of various treatments efficacy we defined the indications for TUR performed by an experienced surgeon, adjuvant BCG immunotherapy and photodynamic diagnosis in patients with NMIBC.
Retrospectively, we analyzed the results of treatment of 921 patients with NMIBC who were distributed into 4 recurrence risk groups. Recurrence-free survival was calculated using the Kaplan–Meier method and the statistical significance for the differences was assessed during a log rank test.
The median follow-up was 61 months. Transurethral resection (TUR) assisted by photodynamic diagnostic resulted in a significant improvement in recurrence-free survival in the high and very high risk groups. The advantage of TUR performed by an experienced surgeon and BCG immunotherapy was pronounced in the intermediate, high and very high risk groups. Single instillation of doxorubicin and reTUR do not substantially affect prognosis in any risk stratum.
Based on a stratified analysis of various treatments efficacy we defined the indications for TUR performed by an experienced surgeon, adjuvant BCG immunotherapy and photodynamic diagnosis in patients with NMIBC.
About the Author
A. I. Rolevich
N. N. Alexandrov National Cancer Centre
Belarus
Leading Research of the Laboratory of Oncourology, Department of Surgery
Belarus
Leading Research of the Laboratory of Oncourology, Department of Surgery
References
1. Epidemiology and risk factors of urothelial bladder cancer / M. Burger [et al.] // Eur. Urol. – 2013. – Vol. 63, N 2. – P. 234–241.
2. Recurrence and progression of disease in non-muscle-invasive bladder cancer: from epidemiology to treatment strategy / B. W. van Rhijn [et al.] // Eur. Urol. – 2009. – Vol. 56, N 3. – P. 430–442.
3. Falke, J. Contemporary management of low-risk bladder cancer / J. Falke, J. A. Witjes // Nat. Rev. Urol. – 2011. – Vol. 8, N 1. – P. 42–49.
4. The role of bacillus Calmette-Guérin in the treatment of non-muscle-invasive bladder cancer / P. Gontero [et al.] // Eur. Urol. – 2010. – Vol. 57, N 3. – P. 410–429.
5. Richards, K. A. The importance of transurethral resection of bladder tumor in the management of nonmuscle invasive bladder cancer: a systematic review of novel technologies / K. A. Richards, N. D. Smith, G. D. Steinberg // J. Urol. – 2014. – Vol. 191, N 6. – P. 1655–1664.
6. Herr, H. W. Role of Repeat Resection in Non-Muscle-Invasive Bladder Cancer / H. W. Herr // J. Nat. Compr. Canc. Netw. – 2015. – Vol. 13, N 8. – P. 1041–1046.
7. Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2596 patients from seven EORTC trials / R. J. Sylvester [et al.] // Eur. Urol. – 2006. – Vol. 49, N 3. – P. 465–466.
8. Systematic Review and Individual Patient Data Meta-analysis of Randomized Trials Comparing a Single Immediate Instillation of Chemotherapy After Transurethral Resection with Transurethral Resection Alone in Patients with Stage pTa-pT1 Urothelial Carcinoma of the Bladder: Which Patients Benefit from the Instillation? / R. J. Sylvester [et al.] // Eur. Urol. – 2016. – Vol. 69, N 2. – P. 231–244.
9. Ho, P. L. Immune therapies in non-muscle invasive bladder cancer. / P. L. Ho, S. B. Williams, A. M. Kamat // Curr. Treat. Options Oncol. – 2015. – Vol. 16, N 2. – P. 5.
10. Surgeon has a major impact on long-term recurrence risk in patients with non-muscle invasive bladder cancer /A. I. Rolevich [et al.] // Cent. Eur. J. Urol. – 2016. – Vol. 69. – P. 170–177.
11. Rolevich, A. I. and Mirilenko, L. V. “Evaluation of recurrence and progression risk in non-muscle invasive bladder cancer”, Onkourologiya [Oncourology], 2016 , no. 4.
12. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. / M. Babjuk [et al.] // Eur. Urol. – 2013. – Vol. 64, N 4. – P. 639–653.
13. ICUD-EAU International Consultation on Bladder Cancer 2012: Non-muscle-invasive urothelial carcinoma of the bladder / M. Burger [et al.] // Eur. Urol. – 2013. – Vol. 63, N 1. – P. 36–44.
14. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline [Electronic resource] / S. S. Chang [et al.]. – 2016. – Mode of access: https://www.auanet.org/common/pdf/education/clinical-guidance/Non-Muscle-Invasive-Bladder-Cancer.pdf. – Date of access: 19.07.2016.
15. Management of non-muscle invasive bladder cancer: а comprehensive analysis of guidelines from the United States, Europe and Asia / W. S. Tan [et al.] // Cancer. Treat. Rev. – 2016. – Vol. 47. – P. 22–31.
16. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience / P. Mariappan [et al.] // Eur. Urol. – 2010. – Vol. 57, N 5. – P. 843–849.
17. The presence of detrusor muscle in the pathological specimen after transurethral resection of primary pT1 bladder tumors and its relationship to operator experience / M. Rouprêt [et al.] // Can. J. Urol. – 2012. – Vol. 19, N 5. –P. 6459–6464.
18. Jancke, G. Impact of surgical experience on recurrence and progression after transurethral resection of bladder tumour in non-muscle-invasive bladder cancer / G. Jancke, J. Rosell, S. Jahnson // Scand. J. Urol. – 2014. – Vol. 48, N 3. – P. 276–283.
19. Presence of detrusor muscle in bladder tumor specimens-predictors and effect on outcome as a measure of resection quality / O. Shoshany [et al.] // Urol. Oncol. – 2014. – Vol. 32, N 1. – P. 40.e17–22.
20. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid inpatients with intermediateand high-risk stage Ta T1 urothelial carcinoma of the bladder / R. J. Sylvester [et al.] // Eur. Urol. – 2010. – Vol. 57, N 5. – P. 766–773.
21. Bacillus Calmette-Guérin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study / M. Duchek [et al.] // Eur. Urol. – 2010. – Vol. 57, N 1. – P. 25–31.
22. Shelley, M. D. Intravesical therapy for superficial bladder cancer: a systematic review of randomised trials and metaanalyses / M. D. Shelley, M. D. Mason, H. Kynaston // Cancer Treat. Rev. – 2010. – Vol. 36, N 3. – P. 195–205.
23. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guérin for non-muscle-invasive bladder cancer / P.-U. Malmström [et al.] // Eur. Urol. – 2009. – Vol. 56, N 2. – P. 247–256.
24. Effect of routine repeat transurethral resection for superficial bladder cancer: a long-term observational study /M. O. Grimm [et al.] // J. Urol. – 2003. – Vol. 170 (2 Pt 1). – P. 433–437.
25. The effect of repeat transurethral resection on recurrence and progression rates in patients with T1 tumors of the bladder who received intravesical mitomycin: a prospective, randomized clinical trial / R. T. Divrik [et al.] // J. Urol. – 2006. – Vol. 175, N 5. – P. 1641–1644.
26. The effect of restaging transurethral resection on recurrence and progression rates in patients with nonmuscle invasive bladder cancer treated with intravesical bacillus Calmette-Guérin / J. P. Sfakianos [et al.] // J. Urol. – 2014. – Vol. 191, N 2. – P. 341–345.
Review
For citations:
Rolevich A.I. RECURRENCE-FREE SURVIVAL IN PATIENTS WITH NON-MUSCLE BLADDER CANCER. Proceedings of the National Academy of Sciences of Belarus, Medical series. 2016;(4):44-56. (In Russ.)
Views: 756
Email this article 