Restaging transurethral resection in ta high-grade nonmuscle invasive bladder cancer

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Sophie Regnier ◽  
Gianluigi Califano ◽  
Vincent Elalouf ◽  
Simone Albisinni ◽  
Atiqullah Aziz ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Nonmuscle Invasive Bladder Cancer

scholarly journals Role of second transurethral resection in determining residual tumor in nonmuscle-invasive bladder cancer

2017 ◽  
Vol 20 (2) ◽  
pp. 35-42
Author(s):  
Pukar Maskey ◽  
Pawan Raj Chalise ◽  
Uttam Kumar Sharma ◽  
Prem Raj Gyawali ◽  
Guna Kumar Shrestha ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Growth Pattern ◽  
Demographic Data ◽  
Residual Tumor ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Second Resection ◽  
T1 Stage ◽  
Nonmuscle Invasive Bladder Cancer

Introduction: Presence of residual tumors is not an uncommon event after transurethral resection of bladder tumor, and no studies from Nepal so far has addressed this issue. We conducted this study to determine the rate of residual tumors after first transurethral resection of nonmuscle-invasive bladder cancer, and to determine the factors associated with the presence of residual tumors and upstaging of nonmuscle-invasive bladder cancer. Methods: This was a prospective observational study of 43 patients of bladder cancer who had a diagnosis of nonmuscle-invasive bladder cancer following an initial transurethral resection. Demographic data and data on tumor characteristics were obtained. Patients underwent a second transurethral resection within 2 to 8 weeks. Histopathological findings at first and second resection were compared. Results: There were 20 patients with Ta tumor and 23 patiens with T1 tumor at initial resection. Residual tumor was detected in 18 (41.86%) patients overall, 2 in patients with Ta tumor (10%) and 16 in patients with T1 tumor (69.5%). Tumors with T1 stage, high grade, size more than 3 centimeters and sessile growth pattern were seen to have significant association with the presence of residual tumors. Six patients with T1 disease upstaged to T2 disease after second resection (26%), while there were no upstaging with Ta tumors. Tumors with T1 stage, sessile configuration and size more than 3 centimeters were found to be significantly associated with upstaging. Conclusion: A second transurethral resection for nonmuscle-invasive bladder cancer should be considered if the initial tumor is T1 stage, high grade, more than 3 centimeters in size and has sessile growth pattern.

scholarly journals Radical Cystectomy Against Intravesical BCG for High-Risk High-Grade Nonmuscle Invasive Bladder Cancer: Results From the Randomized Controlled BRAVO-Feasibility Study

2020 ◽  
pp. JCO.20.01665
Author(s):  
James W. F. Catto ◽  
Kathryn Gordon ◽  
Michelle Collinson ◽  
Heather Poad ◽  
Maureen Twiddy ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Controlled Trial ◽  
Invasive Bladder Cancer ◽  
High Grade ◽  
Bacillus Calmette Guerin ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Nonmuscle Invasive Bladder Cancer

PURPOSE High-grade nonmuscle invasive bladder cancer (HRNMIBC) is a heterogeneous disease. Treatments include intravesical maintenance Bacillus Calmette-Guerin (mBCG) and radical cystectomy (RC). We wanted to understand whether a randomized trial comparing these options was possible. MATERIALS AND METHODS We conducted a two-arm, prospective multicenter randomized study to determine the feasibility in Bacillus Calmette-Guerin-naive patients. Participants had new high-risk HRNMIBC suitable for both treatments. Random assignment was stratified by age, sex, center, stage, presence of carcinoma in situ, and prior low-risk bladder cancer. Qualitative work investigated how to maintain equipoise. The primary outcome was the number of patients screened, eligible, recruited, and randomly assigned. RESULTS We screened 407 patients, approached 185, and obtained consent from 51 (27.6%) patients. Of these, one did not proceed and therefore 50 were randomly assigned (1:1). In the mBCG arm, 23/25 (92.0%) patients received mBCG, four had nonmuscle invasive bladder cancer (NMIBC) after induction, three had NMIBC at 4 months, and four received RC. At closure, two patients had metastatic BC. In the RC arm, 20 (80.0%) participants received cystectomy, including five (25.0%) with no tumor, 13 (65.0%) with HRNMIBC, and two (10.0%) with muscle invasion in their specimen. At follow-up, all patients in the RC arm were free of disease. Adverse events were mostly mild and equally distributed (15/23 [65.2%] patients with mBCG and 13/20 [65.0%] patients with RC). The quality of life (QOL) of both arms was broadly similar at 12 months. CONCLUSION A randomized controlled trial comparing mBCG and RC will be challenging to recruit into. Around 10% of patients with high-risk HRNMIBC have a lethal disease and may be better treated by primary radical treatment. Conversely, many are suitable for bladder preservation and may maintain their prediagnosis QOL.

Prognostic utility of the combination of pretreatment monocyte-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in patients with NMIBC after transurethral resection

2019 ◽  
Vol 13 (18) ◽  
pp. 1543-1555
Author(s):  
Qinghai Wang ◽  
Tao Huang ◽  
Jianlei Ji ◽  
Hongyang Wang ◽  
Chen Guo ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Transurethral Resection ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Predictive Biomarker ◽  
Neutrophil To Lymphocyte Ratio ◽  
Invasive Bladder Cancer ◽  
Lymphocyte Ratio ◽  
Prognostic Utility ◽  
Nonmuscle Invasive Bladder Cancer

Aim: To investigate and validate predictive value of combination of pretreatment monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) for disease free survival (DFS) and overall survival (OS) in nonmuscle invasive bladder cancer after transurethral resection. Materials & methods: Total 358 patients enrolled were assigned into three (MLR-NLR 0, 1 and 2) groups per the cut-off values of MLR and NLR. Results: Kaplan–Meier curves showed MLR, NLR and their combination were statistically associated with DFS (p < 0.001) and OS (p < 0.001). Univariate and multivariate COX regression analyses revealed that combination of MLR with NLR was an independent prognostic predictor for both DFS (HR: 3.080; 95% CI: 1.870–5.074; p < 0.001 for MLR-NLR 2 vs MLR-NLR 0) and OS (HR: 2.815; 95% CI: 1.778–4.456; p < 0.001 for MLR-NLR 2 vs MLR-NLR 0). Calibration plots and decision curve analysis exhibited combination of MLR and NLR had good calibration accuracy with potential clinical usefulness. Conclusion: Combined MLR and NLR is a prognostic predictive biomarker in nonmuscle invasive bladder cancer after transurethral resection.

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