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1. Induction therapy with ipilimumab and nivolumab followed by consolidative chemoradiation as organ-sparing treatment in urothelial bladder cancer:study protocol of the INDIBLADE trial

Author

Stockem, C. F., Mellema, J. J.J., van Rhijn, B. W.G., Boellaard, T. N., van Montfoort, M. L., Balduzzi, S., Boormans, J. L., Franckena, M., Meijer, R. P., Robbrecht, D. G.J., Suelmann, B. B.M., Schaake, E. E., van der Heijden, M. S., Stockem, C. F., Mellema, J. J.J., van Rhijn, B. W.G., Boellaard, T. N., van Montfoort, M. L., Balduzzi, S., Boormans, J. L., Franckena, M., Meijer, R. P., Robbrecht, D. G.J., Suelmann, B. B.M., Schaake, E. E., and van der Heijden, M. S.

Abstract

Introduction: Studies that assessed the efficacy of pre-operative immune checkpoint blockade (ICB) in locally advanced urothelial cancer of the bladder showed encouraging pathological complete response rates, suggesting that a bladder-sparing approach may be a viable option in a subset of patients. Chemoradiation is an alternative for radical cystectomy with similar oncological outcomes, but is still mainly used in selected patients with organ-confined tumors or patients ineligible to undergo radical cystectomy. We propose to sequentially administer ICB and chemoradiation to patients with (locally advanced) muscle-invasive bladder cancer. Methods: The INDIBLADE trial is an investigator-initiated, single-arm, multicenter phase 2 trial. Fifty patients with cT2-4aN0-2M0 urothelial bladder cancer will be treated with ipilimumab 3 mg/kg on day 1, ipilimumab 3 mg/kg plus nivolumab 1 mg/kg on day 22, and nivolumab 3 mg/kg on day 43 followed by chemoradiation. The primary endpoint is the bladder-intact event-free survival (BI-EFS). Events include: local or distant recurrence, salvage cystectomy, death and switch to platinum-based chemotherapy. We will also evaluate the potential of multiparametric magnetic resonance imaging of the bladder to identify non-responders, and we will assess the clearance of circulating tumor DNA as a biomarker for ICB treatment response. Discussion: This is the first trial in which the efficacy of induction combination ICB followed by chemoradiation is being evaluated to provide bladder-preservation in patients with (locally advanced) urothelial bladder cancer. Clinical Trial Registration: The INDIBLADE trial was registered on clinicaltrials.gov on January 21, 2022 (NCT05200988).

Published
2023

2. Induction therapy with ipilimumab and nivolumab followed by consolidative chemoradiation as organ-sparing treatment in urothelial bladder cancer: study protocol of the INDIBLADE trial

Author

MS Urologische Oncologie, Cancer, MS Medische Oncologie, Stockem, C. F., Mellema, J. J.J., van Rhijn, B. W.G., Boellaard, T. N., van Montfoort, M. L., Balduzzi, S., Boormans, J. L., Franckena, M., Meijer, R. P., Robbrecht, D. G.J., Suelmann, B. B.M., Schaake, E. E., van der Heijden, M. S., MS Urologische Oncologie, Cancer, MS Medische Oncologie, Stockem, C. F., Mellema, J. J.J., van Rhijn, B. W.G., Boellaard, T. N., van Montfoort, M. L., Balduzzi, S., Boormans, J. L., Franckena, M., Meijer, R. P., Robbrecht, D. G.J., Suelmann, B. B.M., Schaake, E. E., and van der Heijden, M. S.

Published
2023

3. Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy:a nationwide study of 5417 patients

Author

van Hoogstraten, L. M.C., van Gennep, E. J., Kiemeney, L. A.L.M., Witjes, J. A., Voskuilen, C. S., Deelen, M., Mertens, L. S., Meijer, R. P., Boormans, J. L., Robbrecht, D. G.J., Beerepoot, L. V., Verhoeven, R. H.A., Ripping, T. M., van Rhijn, B. W.G., Aben, K. K.H., Hermans, T. J.N., van Hoogstraten, L. M.C., van Gennep, E. J., Kiemeney, L. A.L.M., Witjes, J. A., Voskuilen, C. S., Deelen, M., Mertens, L. S., Meijer, R. P., Boormans, J. L., Robbrecht, D. G.J., Beerepoot, L. V., Verhoeven, R. H.A., Ripping, T. M., van Rhijn, B. W.G., Aben, K. K.H., and Hermans, T. J.N.

Abstract

Purpose: Little is known about the prevalence of occult lymph node metastases (LNM) in muscle-invasive bladder cancer (MIBC) patients with pathological downstaging of the primary tumor. We aimed to estimate the prevalence of occult LNM in patients without residual MIBC at radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or neoadjuvant radiotherapy (NAR), and to assess overall survival (OS). Methods: Patients with cT2-T4aN0M0 urothelial MIBC who underwent RC plus pelvic lymph node dissection (PLND) with curative intent between January 1995–December 2013 (retrospective Netherlands Cancer Registry (NCR) cohort) and November 2017–October 2019 (prospective NCR-BlaZIB cohort (acronym in Dutch: BlaaskankerZorg In Beeld; in English: Insight into bladder cancer care)) were identified from the nationwide NCR. The prevalence of occult LNM was calculated and OS of patients with <(y)pT2N0 vs. <(y)pT2N+ disease was estimated by the Kaplan–Meier method. Results: In total, 4657 patients from the NCR cohort and 760 patients from the NCR-BlaZIB cohort were included. Of 1374 patients downstaged to <(y)pT2, 4.3% (N = 59) had occult LNM 4.1% (N = 49) of patients with cT2-disease and 5.6% (N = 10) with cT3-4a-disease. This was 4.0% (N = 44) in patients without NAC or NAR, 4.5% (N = 10) in patients with NAC, and 13.5% (N = 5) in patients with NAR but number of patients treated with NAR and downstaged disease was small. The prevalence of <(y)pT2N+ disease was 4.2% (N = 48) in the NCR cohort and 4.6% (N = 11) in the NCR-BlaZIB cohort. For patients with <(y)pT2N+ and <(y)pT2N0, median OS was 3.5 years (95% CI 2.5–8.9) versus 12.9 years (95% CI 11.7–14.0), respectively. Conclusion: Occult LNM were found in 4.3% of patients with cT2-4aN0M0 MIBC with (near-) complete downstaging of the primary tumor following RC plus PLND. This was regardless of NAC or clinical T-stage. Patients with occult LNM showed considerable worse survival. These results can help

Published
2022

4. Validation and reliability of the Dutch version of the EORTC QLQ-BLM30 module for assessing the health-related quality of life of patients with muscle invasive bladder cancer

Author

MS Urologische Oncologie, Cancer, Arts-assistenten Radiotherapie, Ripping, T. M., Rammant, E., Witjes, J. A., Aaronson, N. K., van Hemelrijck, M., van Hoogstraten, L. M.C., Boormans, J., Goossens, C. A., van der Heijden, A. G., Hulshof, M.C.C.M., van Leenders, G. J.L.H., van Leliveld, A. M., Meijer, R. P., van Moorselaar, R. J.A., Mulder, S. F., Nooter, R. I., Noteboom, J. L., Oddens, J. R., de Reijke, T. M., van Rhijn, B. W.G., van Roermund, J. G.H., Smilde, T. J., Vanderbosch, G. W.J., Wijsman, B. P., Kiemeney, L. A., Aben, K. K.H., BlaZIB Study Group, MS Urologische Oncologie, Cancer, Arts-assistenten Radiotherapie, Ripping, T. M., Rammant, E., Witjes, J. A., Aaronson, N. K., van Hemelrijck, M., van Hoogstraten, L. M.C., Boormans, J., Goossens, C. A., van der Heijden, A. G., Hulshof, M.C.C.M., van Leenders, G. J.L.H., van Leliveld, A. M., Meijer, R. P., van Moorselaar, R. J.A., Mulder, S. F., Nooter, R. I., Noteboom, J. L., Oddens, J. R., de Reijke, T. M., van Rhijn, B. W.G., van Roermund, J. G.H., Smilde, T. J., Vanderbosch, G. W.J., Wijsman, B. P., Kiemeney, L. A., Aben, K. K.H., and BlaZIB Study Group

Published
2022

5. Occult lymph node metastases in patients without residual muscle-invasive bladder cancer at radical cystectomy with or without neoadjuvant chemotherapy: a nationwide study of 5417 patients

Author

MS Urologische Oncologie, Cancer, van Hoogstraten, L M C, van Gennep, E J, Kiemeney, L A L M, Witjes, J A, Voskuilen, C S, Deelen, M, Mertens, L S, Meijer, R P, Boormans, J L, Robbrecht, D G J, Beerepoot, L V, Verhoeven, R H A, Ripping, T M, van Rhijn, B W G, Aben, K K H, Hermans, T J N, BlaZIB Study Group, MS Urologische Oncologie, Cancer, van Hoogstraten, L M C, van Gennep, E J, Kiemeney, L A L M, Witjes, J A, Voskuilen, C S, Deelen, M, Mertens, L S, Meijer, R P, Boormans, J L, Robbrecht, D G J, Beerepoot, L V, Verhoeven, R H A, Ripping, T M, van Rhijn, B W G, Aben, K K H, Hermans, T J N, and BlaZIB Study Group

Published
2022

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

Author

Pisano, F, Gontero, P, Sylvester, R, Joniau, S, Serretta, V, Larré, S, Di Stasi, S, van Rhijn, B, Witjes, A, Grotenhuis, A, Colombo, R, Briganti, A, Babjuk, M, Soukup, V, Malmström, Per-Uno, Irani, J, Malats, N, Baniel, J, Mano, R, Cai, T, Cha, E, Ardelt, P, Varkarakis, J, Bartoletti, R, Dalbagni, G, Shariat, S F, Xylinas, E, Karnes, R J, Palou, J, Pisano, F, Gontero, P, Sylvester, R, Joniau, S, Serretta, V, Larré, S, Di Stasi, S, van Rhijn, B, Witjes, A, Grotenhuis, A, Colombo, R, Briganti, A, Babjuk, M, Soukup, V, Malmström, Per-Uno, Irani, J, Malats, N, Baniel, J, Mano, R, Cai, T, Cha, E, Ardelt, P, Varkarakis, J, Bartoletti, R, Dalbagni, G, Shariat, S F, Xylinas, E, Karnes, R J, and Palou, J

Abstract

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 that may influence the presence of residual disease at re-TUR. MATERIAL AND METHODS: In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. RESULTS: The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors > 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001.

Published
2021
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7. Risk factors for residual disease at re-TUR in a large cohort of T1G3 patients

Author

Pisano, F., Gontero, P., Sylvester, R., Joniau, S., Serretta, V, Larre, S., Di Stasi, S., van Rhijn, B., Witjes, A., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V, Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., Palou, J., Pisano, F., Gontero, P., Sylvester, R., Joniau, S., Serretta, V, Larre, S., Di Stasi, S., van Rhijn, B., Witjes, A., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V, Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., and Palou, J.

Abstract

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 that may influence the presence of residual disease at re-TUR. Material and methods: In our retrospective cohort of 2451 primary T1G3 patients initially treated with BCG, pathology results for 934 patients (38.1%) who underwent re-TUR are available. 74% had multifocal tumors, 20% of tumors were more than 3 cm in diameter and 26% had concomitant CIS. In this subgroup of patients who underwent re-TUR, there was no residual disease in 267 patients (29%) and residual disease in 667 patients (71%): Ta in 378 (40%) and T1 in 289 (31%) patients. Age, gender, tumor status (primary/recurrent), previous intravesical therapy, tumor size, tumor multi-focality, presence of concomitant CIS, and muscle in the specimen were analyzed in order to evaluate risk factors of residual disease at re-TUR, both in univariate analyses and multivariate logistic regressions. Results: The following were not risk factors for residual disease: age, gender, tumor status and previous intravesical chemotherapy. The following were univariate risk factors for presence of residual disease: no muscle in TUR, multiple tumors, tumors >= 3 cm, and presence of concomitant CIS. Due to the correlation between tumor multi-focality and tumor size, the multivariate model retained either the number of tumors or the tumor diameter (but not both), p < 0.001

Published
2021
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8. Hospital volume is associated with postoperative mortality after radical cystectomy for treatment of bladder cancer

Author

MS Urologische Oncologie, Cancer, Richters, A, Ripping, T M, Kiemeney, L A, Leliveld, A M, van Rhijn, B W G, Oddens, J R, van Moorselaar, R J A, Goossens-Laan, C A, Meijer, R P, Boormans, J, Witjes, J A, Aben, K K H, BlaZIB Study Group, MS Urologische Oncologie, Cancer, Richters, A, Ripping, T M, Kiemeney, L A, Leliveld, A M, van Rhijn, B W G, Oddens, J R, van Moorselaar, R J A, Goossens-Laan, C A, Meijer, R P, Boormans, J, Witjes, J A, Aben, K K H, and BlaZIB Study Group

Published
2021

9. Transurethral Resection of Bladder Tumour: The Neglected Procedure in the Technology Race in Bladder Cancer

Author

Mostafid, H, Babjuk, M., Bochner, B., Lerner, S.P., Witjes, F., Palou, J., Roupret, M., Shariat, S., Gontero, P., van Rhijn, B., Zigeuner, R., Sylvester, R., Comperat, E., Burger, M., Malavaud, B., Soloway, M., Williams, S., Black, P., Daneshmand, S., Steinberg, G., Brausi, M., Catto, J., Kamat, A.M., Mostafid, H, Babjuk, M., Bochner, B., Lerner, S.P., Witjes, F., Palou, J., Roupret, M., Shariat, S., Gontero, P., van Rhijn, B., Zigeuner, R., Sylvester, R., Comperat, E., Burger, M., Malavaud, B., Soloway, M., Williams, S., Black, P., Daneshmand, S., Steinberg, G., Brausi, M., Catto, J., and Kamat, A.M.

Abstract

Contains fulltext : 220581.pdf (Publisher’s version ) (Closed access), Transurethral resection of bladder tumour is the initial, most critical step in the management of bladder cancer; as such, this is a call to arms for the urological community to it the due diligence it deserves regarding technology and training.

Published
2020

10. Transurethral Resection of Bladder Tumour: The Neglected Procedure in the Technology Race in Bladder Cancer

Author

Mostafid, H, Babjuk, M., Bochner, B., Lerner, S.P., Witjes, F., Palou, J., Roupret, M., Shariat, S., Gontero, P., van Rhijn, B., Zigeuner, R., Sylvester, R., Comperat, E., Burger, M., Malavaud, B., Soloway, M., Williams, S., Black, P., Daneshmand, S., Steinberg, G., Brausi, M., Catto, J., Kamat, A.M., Mostafid, H, Babjuk, M., Bochner, B., Lerner, S.P., Witjes, F., Palou, J., Roupret, M., Shariat, S., Gontero, P., van Rhijn, B., Zigeuner, R., Sylvester, R., Comperat, E., Burger, M., Malavaud, B., Soloway, M., Williams, S., Black, P., Daneshmand, S., Steinberg, G., Brausi, M., Catto, J., and Kamat, A.M.

Abstract

Contains fulltext : 220581.pdf (Publisher’s version ) (Closed access), Transurethral resection of bladder tumour is the initial, most critical step in the management of bladder cancer; as such, this is a call to arms for the urological community to it the due diligence it deserves regarding technology and training.

Published
2020

11. Transurethral Resection of Bladder Tumour: The Neglected Procedure in the Technology Race in Bladder Cancer

Author

Mostafid, H, Babjuk, M., Bochner, B., Lerner, S.P., Witjes, F., Palou, J., Roupret, M., Shariat, S., Gontero, P., van Rhijn, B., Zigeuner, R., Sylvester, R., Comperat, E., Burger, M., Malavaud, B., Soloway, M., Williams, S., Black, P., Daneshmand, S., Steinberg, G., Brausi, M., Catto, J., Kamat, A.M., Mostafid, H, Babjuk, M., Bochner, B., Lerner, S.P., Witjes, F., Palou, J., Roupret, M., Shariat, S., Gontero, P., van Rhijn, B., Zigeuner, R., Sylvester, R., Comperat, E., Burger, M., Malavaud, B., Soloway, M., Williams, S., Black, P., Daneshmand, S., Steinberg, G., Brausi, M., Catto, J., and Kamat, A.M.

Abstract

Contains fulltext : 220581.pdf (Publisher’s version ) (Closed access), Transurethral resection of bladder tumour is the initial, most critical step in the management of bladder cancer; as such, this is a call to arms for the urological community to it the due diligence it deserves regarding technology and training.

Published
2020

12. Superior Efficacy of Neoadjuvant Chemotherapy and Radical Cystectomy in cT3-4aN0M0 compared to cT2N0M0 Bladder Cancer

Author

Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, van Rhijn, B W G, Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, and van Rhijn, B W G

Published
2019

13. Superior Efficacy of Neoadjuvant Chemotherapy and Radical Cystectomy in cT3-4aN0M0 compared to cT2N0M0 Bladder Cancer

Author

Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, van Rhijn, B W G, Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, and van Rhijn, B W G

Published
2019

14. Superior Efficacy of Neoadjuvant Chemotherapy and Radical Cystectomy in cT3-4aN0M0 compared to cT2N0M0 Bladder Cancer

Author

Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, van Rhijn, B W G, Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, and van Rhijn, B W G

Published
2019

15. Superior Efficacy of Neoadjuvant Chemotherapy and Radical Cystectomy in cT3-4aN0M0 compared to cT2N0M0 Bladder Cancer

Author

MS Urologische Oncologie, Cancer, Urologie Medisch volwassenen, Unit Opleiding Dermatologie, Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, van Rhijn, B W G, MS Urologische Oncologie, Cancer, Urologie Medisch volwassenen, Unit Opleiding Dermatologie, Hermans, T J N, Voskuilen, C S, Deelen, M, Mertens, L S, Horenblas, S, Meijer, R P, Boormans, J L, Aben, K K, van der Heijden, M S, Pos, F J, de Wit, R, Beerepoot, L V, Verhoeven, R H A, and van Rhijn, B W G

Published
2019

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

Author

Soria, Francesco, Pisano, Francesca, Gontero, Paolo, Palou, J., Joniau, S., Serretta, V., Larre, S., Di Stasi, S., van Rhijn, B., Witjes, J. A., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V., Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., Sylvester, R., Soria, Francesco, Pisano, Francesca, Gontero, Paolo, Palou, J., Joniau, S., Serretta, V., Larre, S., Di Stasi, S., van Rhijn, B., Witjes, J. A., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V., Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., and Sylvester, R.

Abstract

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.

Published
2018
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17. 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

Author

Palou, J., Pisano, F., Sylvester, R., Joniau, S., Serretta, V., Larre, S., Di Stasi, S., van Rhijn, B., Witjes, A. J., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V., Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E. K., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., Gontero, P., Palou, J., Pisano, F., Sylvester, R., Joniau, S., Serretta, V., Larre, S., Di Stasi, S., van Rhijn, B., Witjes, A. J., Grotenhuis, A., Colombo, R., Briganti, A., Babjuk, M., Soukup, V., Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E. K., Ardelt, P., Varkarakis, J., Bartoletti, R., Dalbagni, G., Shariat, S. F., Xylinas, E., Karnes, R. J., and Gontero, P.

Abstract

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 (71.4%): Ta in 378 (40.5%), T1 in 289 (30.9%) patients. Times to recurrence, progression and CSM in the three groups were estimated using cumulative incidence functions and compared using the Cox regression model. Results:During a median follow-up of 5.2years, 512 patients recurred. The recurrence rate was significantly higher in patients with a T1 at re-TUR (P<0.001). Progression rates differed according to the pathology at re-TUR, 25.3% in T1, 14.6% in Ta and 14.2% in case of no residual tumor (P<0.001). Similar trends were seen in both patients with and without muscle in the original TUR specimen. Conclusions: Patients with T1G3 tumors and no residual disease or Ta at re-TUR have better recurrence, progression and CSM rates than previously reported, with a CSM rate of 13.1 and a 25.3% progression rate in re-TUR T1 disease.

Published
2018
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25. Prognostic Factors And Risk Groups In T1g3 Patients Initially Treated With Bcg : Results Of A Multicenter Retrospective Series In 1743 Patients

Author

Gonterol, P., Sylvester, R., Pisano, F., Joniau, S., Eeckt, Kathy Vander, Serretta, V., Larre, S., di Stasi, S., Van Rhijn, B., Witjes, A., Grotenhuis, A., Colombo, R., Brigand, A., Babjukl, M., Soukupw, V., Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E., Ardelti, P., Vakarakisis, J., Bartoletti, R., Sphan, M., Dalbagnin, G., Shariat, S. F., Karnes, J., Palou, J., Gonterol, P., Sylvester, R., Pisano, F., Joniau, S., Eeckt, Kathy Vander, Serretta, V., Larre, S., di Stasi, S., Van Rhijn, B., Witjes, A., Grotenhuis, A., Colombo, R., Brigand, A., Babjukl, M., Soukupw, V., Malmström, Per-Uno, Irani, J., Malats, N., Baniel, J., Mano, R., Cai, T., Cha, E., Ardelti, P., Vakarakisis, J., Bartoletti, R., Sphan, M., Dalbagnin, G., Shariat, S. F., Karnes, J., and Palou, J.

Published
2013

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