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1. EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort: Under the Auspices of the EAU-ESMO Guidelines Committees.

Author

UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service d'urologie, Witjes, J Alfred, Babjuk, Marek, Bellmunt, Joaquim, Bruins, H Maxim, De Reijke, Theo M, De Santis, Maria, Gillessen, Silke, James, Nicholas, Maclennan, Steven, Palou, Juan, Powles, Tom, Ribal, Maria J, Shariat, Shahrokh F, Der Kwast, Theo Van, Xylinas, Evanguelos, Agarwal, Neeraj, Arends, Tom, Bamias, Aristotle, Birtle, Alison, Black, Peter C, Bochner, Bernard H, Bolla, Michel, Boormans, Joost L, Bossi, Alberto, Briganti, Alberto, Brummelhuis, Iris, Burger, Max, Castellano, Daniel, Cathomas, Richard, Chiti, Arturo, Choudhury, Ananya, Compérat, Eva, Crabb, Simon, Culine, Stephane, De Bari, Berardino, De Blok, Willem, J L De Visschere, Pieter, Decaestecker, Karel, Dimitropoulos, Konstantinos, Dominguez-Escrig, Jose L, Fanti, Stefano, Fonteyne, Valerie, Frydenberg, Mark, Futterer, Jurgen J, Gakis, Georgios, Geavlete, Bogdan, Gontero, Paolo, Grubmüller, Bernhard, Hafeez, Shaista, Hansel, Donna E, Hartmann, Arndt, Hayne, Dickon, Henry, Ann M, Hernandez, Virginia, Herr, Harry, Herrmann, Ken, Hoskin, Peter, Huguet, Jorge, Jereczek-Fossa, Barbara A, Jones, Rob, Kamat, Ashish M, Khoo, Vincent, Kiltie, Anne E, Krege, Susanne, Ladoire, Sylvain, Lara, Pedro C, Leliveld, Annemarie, Linares-Espinós, Estefania, Løgager, Vibeke, Lorch, Anja, Loriot, Yohann, Meijer, Richard, Mir, M Carmen, Moschini, Marco, Mostafid, Hugh, Müller, Arndt-Christian, Müller, Christoph R, N'Dow, James, Necchi, Andrea, Neuzillet, Yann, Oddens, Jorg R, Oldenburg, Jan, Osanto, Susanne, J G Oyen, Wim, Pacheco-Figueiredo, Luís, Pappot, Helle, Patel, Manish I, Pieters, Bradley R, Plass, Karin, Remzi, Mesut, Retz, Margitta, Richenberg, Jonathan, Rink, Michael, Roghmann, Florian, Rosenberg, Jonathan E, Rouprêt, Morgan, Rouvière, Olivier, Salembier, Carl, Salminen, Antti, Sargos, Paul, Sengupta, Shomik, Sherif, Amir, Smeenk, Robert J, Smits, Anita, Stenzl, Arnulf, Thalmann, George N, Tombal, Bertrand, Turkbey, Baris, Lauridsen, Susanne Vahr, Valdagni, Riccardo, Der Heijden, Antoine G Van, Van Poppel, Hein, Vartolomei, Mihai D, Veskimäe, Erik, Vilaseca, Antoni, Rivera, Franklin A Vives, Wiegel, Thomas, Wiklund, Peter, Williams, Andrew, Zigeuner, Richard, Horwich, Alan, UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation, UCL - (SLuc) Service d'urologie, Witjes, J Alfred, Babjuk, Marek, Bellmunt, Joaquim, Bruins, H Maxim, De Reijke, Theo M, De Santis, Maria, Gillessen, Silke, James, Nicholas, Maclennan, Steven, Palou, Juan, Powles, Tom, Ribal, Maria J, Shariat, Shahrokh F, Der Kwast, Theo Van, Xylinas, Evanguelos, Agarwal, Neeraj, Arends, Tom, Bamias, Aristotle, Birtle, Alison, Black, Peter C, Bochner, Bernard H, Bolla, Michel, Boormans, Joost L, Bossi, Alberto, Briganti, Alberto, Brummelhuis, Iris, Burger, Max, Castellano, Daniel, Cathomas, Richard, Chiti, Arturo, Choudhury, Ananya, Compérat, Eva, Crabb, Simon, Culine, Stephane, De Bari, Berardino, De Blok, Willem, J L De Visschere, Pieter, Decaestecker, Karel, Dimitropoulos, Konstantinos, Dominguez-Escrig, Jose L, Fanti, Stefano, Fonteyne, Valerie, Frydenberg, Mark, Futterer, Jurgen J, Gakis, Georgios, Geavlete, Bogdan, Gontero, Paolo, Grubmüller, Bernhard, Hafeez, Shaista, Hansel, Donna E, Hartmann, Arndt, Hayne, Dickon, Henry, Ann M, Hernandez, Virginia, Herr, Harry, Herrmann, Ken, Hoskin, Peter, Huguet, Jorge, Jereczek-Fossa, Barbara A, Jones, Rob, Kamat, Ashish M, Khoo, Vincent, Kiltie, Anne E, Krege, Susanne, Ladoire, Sylvain, Lara, Pedro C, Leliveld, Annemarie, Linares-Espinós, Estefania, Løgager, Vibeke, Lorch, Anja, Loriot, Yohann, Meijer, Richard, Mir, M Carmen, Moschini, Marco, Mostafid, Hugh, Müller, Arndt-Christian, Müller, Christoph R, N'Dow, James, Necchi, Andrea, Neuzillet, Yann, Oddens, Jorg R, Oldenburg, Jan, Osanto, Susanne, J G Oyen, Wim, Pacheco-Figueiredo, Luís, Pappot, Helle, Patel, Manish I, Pieters, Bradley R, Plass, Karin, Remzi, Mesut, Retz, Margitta, Richenberg, Jonathan, Rink, Michael, Roghmann, Florian, Rosenberg, Jonathan E, Rouprêt, Morgan, Rouvière, Olivier, Salembier, Carl, Salminen, Antti, Sargos, Paul, Sengupta, Shomik, Sherif, Amir, Smeenk, Robert J, Smits, Anita, Stenzl, Arnulf, Thalmann, George N, Tombal, Bertrand, Turkbey, Baris, Lauridsen, Susanne Vahr, Valdagni, Riccardo, Der Heijden, Antoine G Van, Van Poppel, Hein, Vartolomei, Mihai D, Veskimäe, Erik, Vilaseca, Antoni, Rivera, Franklin A Vives, Wiegel, Thomas, Wiklund, Peter, Williams, Andrew, Zigeuner, Richard, and Horwich, Alan

Abstract

BACKGROUND: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial. OBJECTIVE: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management. DESIGN: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference. SETTING: Online Delphi survey and consensus conference. PARTICIPANTS: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus). RESULTS AND LIMITATIONS: Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease. CONCLUSIONS: These consensus stateme

Published
2020

2. Pretreatment Risk Stratification for Endoscopic Kidney-sparing Surgery in Upper Tract Urothelial Carcinoma: An International Collaborative Study.

Author

Foerster B, Abufaraj M, Matin SF, Azizi M, Gupta M, Li WM, Seisen T, Clinton T, Xylinas E, Mir MC, Schweitzer D, Mari A, Kimura S, Bandini M, Mathieu R, Ku JH, Marcq G, Guruli G, Grabbert M, Czech AK, Muilwijk T, Pycha A, D'Andrea D, Petros FG, Spiess PE, Bivalacqua T, Wu WJ, Rouprêt M, Krabbe LM, Hendricksen K, Egawa S, Briganti A, Moschini M, Graffeille V, Kassouf W, Autorino R, Heidenreich A, Chlosta P, Joniau S, Soria F, Pierorazio PM, and Shariat SF

Subjects
Humans, Kidney surgery, Retrospective Studies, Risk Assessment, Ureteral Neoplasms surgery, Urologic Neoplasms, Carcinoma, Transitional Cell surgery, Urinary Bladder Neoplasms
Abstract

Background: Several groups have proposed features to identify low-risk patients who may benefit from endoscopic kidney-sparing surgery in upper tract urothelial carcinoma (UTUC)., Objective: To evaluate standard risk stratification features, develop an optimal model to identify ≥pT2/N+ stage at radical nephroureterectomy (RNU), and compare it with the existing unvalidated models., Design, Setting, and Participants: This was a collaborative retrospective study that included 1214 patients who underwent ureterorenoscopy with biopsy followed by RNU for nonmetastatic UTUC between 2000 and 2017., Outcome Measurements and Statistical Analysis: We performed multiple imputation of chained equations for missing data and multivariable logistic regression analysis with a stepwise selection algorithm to create the optimal predictive model. The area under the curve and a decision curve analysis were used to compare the models., Results and Limitations: Overall, 659 (54.3%) and 555 (45.7%) patients had ≤pT1N0/Nx and ≥pT2/N+ disease, respectively. In the multivariable logistic regression analysis of our model, age (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.0-1.03, p = 0.013), high-grade biopsy (OR 1.81, 95% CI 1.37-2.40, p < 0.001), biopsy cT1+ staging (OR 3.23, 95% CI 1.93-5.41, p < 0.001), preoperative hydronephrosis (OR 1.37 95% CI 1.04-1.80, p = 0.024), tumor size (OR 1.09, 95% CI 1.01-1.17, p = 0.029), invasion on imaging (OR 5.10, 95% CI 3.32-7.81, p < 0.001), and sessile architecture (OR 2.31, 95% CI 1.58-3.36, p < 0.001) were significantly associated with ≥pT2/pN+ disease. Compared with the existing models, our model had the highest performance accuracy (75% vs 66-71%) and an additional clinical net reduction (four per 100 patients)., Conclusions: Our proposed risk-stratification model predicts the risk of harboring ≥pT2/N+ UTUC with reliable accuracy and a clinical net benefit outperforming the current risk-stratification models., Patient Summary: We developed a risk stratification model to better identify patients for endoscopic kidney-sparing surgery in upper tract urothelial carcinoma., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Published
2021
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3. Corrigendum to 'EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort Under the Auspices of the EAU-ESMO Guidelines Committees' [European Urology 77 (2020) 223-250].

Author

Witjes JA, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Van Der Kwast T, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, De Blok W, De Visschere PJL, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Mir MC, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, Oyen WJG, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Lauridsen SV, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Rivera FAV, Wiegel T, Wiklund P, Willemse PM, Williams A, Zigeuner R, and Horwich A

Published
2020
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4. EAU-ESMO Consensus Statements on the Management of Advanced and Variant Bladder Cancer-An International Collaborative Multistakeholder Effort † : Under the Auspices of the EAU-ESMO Guidelines Committees.

Author

Witjes JA, Babjuk M, Bellmunt J, Bruins HM, De Reijke TM, De Santis M, Gillessen S, James N, Maclennan S, Palou J, Powles T, Ribal MJ, Shariat SF, Der Kwast TV, Xylinas E, Agarwal N, Arends T, Bamias A, Birtle A, Black PC, Bochner BH, Bolla M, Boormans JL, Bossi A, Briganti A, Brummelhuis I, Burger M, Castellano D, Cathomas R, Chiti A, Choudhury A, Compérat E, Crabb S, Culine S, De Bari B, De Blok W, J L De Visschere P, Decaestecker K, Dimitropoulos K, Dominguez-Escrig JL, Fanti S, Fonteyne V, Frydenberg M, Futterer JJ, Gakis G, Geavlete B, Gontero P, Grubmüller B, Hafeez S, Hansel DE, Hartmann A, Hayne D, Henry AM, Hernandez V, Herr H, Herrmann K, Hoskin P, Huguet J, Jereczek-Fossa BA, Jones R, Kamat AM, Khoo V, Kiltie AE, Krege S, Ladoire S, Lara PC, Leliveld A, Linares-Espinós E, Løgager V, Lorch A, Loriot Y, Meijer R, Mir MC, Moschini M, Mostafid H, Müller AC, Müller CR, N'Dow J, Necchi A, Neuzillet Y, Oddens JR, Oldenburg J, Osanto S, J G Oyen W, Pacheco-Figueiredo L, Pappot H, Patel MI, Pieters BR, Plass K, Remzi M, Retz M, Richenberg J, Rink M, Roghmann F, Rosenberg JE, Rouprêt M, Rouvière O, Salembier C, Salminen A, Sargos P, Sengupta S, Sherif A, Smeenk RJ, Smits A, Stenzl A, Thalmann GN, Tombal B, Turkbey B, Lauridsen SV, Valdagni R, Van Der Heijden AG, Van Poppel H, Vartolomei MD, Veskimäe E, Vilaseca A, Rivera FAV, Wiegel T, Wiklund P, Williams A, Zigeuner R, and Horwich A

Subjects
Humans, International Cooperation, Neoplasm Staging, Urinary Bladder Neoplasms pathology, Urinary Bladder Neoplasms therapy
Abstract

Background: Although guidelines exist for advanced and variant bladder cancer management, evidence is limited/conflicting in some areas and the optimal approach remains controversial., Objective: To bring together a large multidisciplinary group of experts to develop consensus statements on controversial topics in bladder cancer management., Design: A steering committee compiled proposed statements regarding advanced and variant bladder cancer management which were assessed by 113 experts in a Delphi survey. Statements not reaching consensus were reviewed; those prioritised were revised by a panel of 45 experts prior to voting during a consensus conference., Setting: Online Delphi survey and consensus conference., Participants: The European Association of Urology (EAU), the European Society for Medical Oncology (ESMO), experts in bladder cancer management., Outcome Measurements and Statistical Analysis: Statements were ranked by experts according to their level of agreement: 1-3 (disagree), 4-6 (equivocal), and 7-9 (agree). A priori (level 1) consensus was defined as ≥70% agreement and ≤15% disagreement, or vice versa. In the Delphi survey, a second analysis was restricted to stakeholder group(s) considered to have adequate expertise relating to each statement (to achieve level 2 consensus)., Results and Limitations: Overall, 116 statements were included in the Delphi survey. Of these statements, 33 (28%) achieved level 1 consensus and 49 (42%) achieved level 1 or 2 consensus. At the consensus conference, 22 of 27 (81%) statements achieved consensus. These consensus statements provide further guidance across a broad range of topics, including the management of variant histologies, the role/limitations of prognostic biomarkers in clinical decision making, bladder preservation strategies, modern radiotherapy techniques, the management of oligometastatic disease, and the evolving role of checkpoint inhibitor therapy in metastatic disease., Conclusions: These consensus statements provide further guidance on controversial topics in advanced and variant bladder cancer management until a time when further evidence is available to guide our approach., Patient Summary: This report summarises findings from an international, multistakeholder project organised by the EAU and ESMO. In this project, a steering committee identified areas of bladder cancer management where there is currently no good-quality evidence to guide treatment decisions. From this, they developed a series of proposed statements, 71 of which achieved consensus by a large group of experts in the field of bladder cancer. It is anticipated that these statements will provide further guidance to health care professionals and could help improve patient outcomes until a time when good-quality evidence is available., (Copyright © 2019 European Society of Medical Oncology and European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Published
2020
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5. 18F-fluorodeoxyglucose--positron emission tomography/computed tomography aids staging and predicts mortality in patients with muscle-invasive bladder cancer.

Author

Mertens LS, Mir MC, Scott AM, Lee ST, Fioole-Bruining A, Vegt E, Vogel WV, Manecksha R, Bolton D, Davis ID, Horenblas S, van Rhijn BW, and Lawrentschuk N

Subjects
Aged, Cohort Studies, Female, Humans, Male, Muscle, Smooth, Neoplasm Invasiveness, Neoplasm Staging, Predictive Value of Tests, Prognosis, Retrospective Studies, Urinary Bladder Neoplasms diagnosis, Fluorodeoxyglucose F18, Multimodal Imaging, Positron-Emission Tomography, Radiopharmaceuticals, Tomography, X-Ray Computed, Urinary Bladder Neoplasms mortality, Urinary Bladder Neoplasms pathology
Abstract

Objective: To investigate the association between extravesical (18)F-fluorodeoxyglucose (FDG) avid lesions on FDG-positron emission tomography/computed tomography (PET/CT) and mortality in patients with muscle-invasive bladder cancer., Methods: An international, bi-institutional cohort study of 211 patients with muscle-invasive bladder cancer who underwent staging CT and FDG-PET/CT imaging. On the basis of the presence of extravesical FDG-avid lesions suspicious for malignancy on PET/CT images, patients were divided into a PET/CT-positive and PET/CT-negative group. Data on staging and mortality were retrospectively analyzed from prospective databases. Kaplan-Meier analyses were performed to compare overall (OS) and disease-specific survival (DSS) between the groups. Multivariable Cox regression models were used to investigate the association between extravesical PET/CT lesions and mortality. Extravesical lesions suspicious for malignancy on conventional CT were included in the models., Results: Of the 211 patients, 98 (46.4%) had 1 or more extravesical lesions on PET/CT, 113 (53.5%) had a negative PET/CT. Conventional CT revealed extravesical lesions in 51 patients (24.4%). Median follow-up was 18 months. Patients with a positive PET/CT had a significantly shorter OS and DSS (median OS: 14 vs 50 months, P = .001; DSS: 16 vs 50 months, P <.001). In multivariable analysis, the presence of extravesical lesions on PET/CT was an independent prognostic indicator of mortality (OS: hazard ratio = 3.0, confidence interval 95% 1.7-5.1). This association was not statistically significant for conventional CT (hazard ratio = 1.6 (95% confidence interval 0.9-2.7)., Conclusion: On the basis of our results, the presence of extravesical FDG-avid lesions on PET/CT might be considered an independent indicator of mortality., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Published
2014
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