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A novel treatment strategy for newly diagnosed high-grade T1 bladder cancer: Gemcitabine and cisplatin adjuvant chemotherapy-A single-institution experience
A novel treatment strategy for newly diagnosed high-grade T1 bladder cancer: Gemcitabine and cisplatin adjuvant chemotherapy-A single-institution experience
- Source :
- Urologic oncology. 35(2)
- Publication Year :
- 2016
-
Abstract
- Background Management of high-grade T1 (formerly T1G3) bladder cancer continues to be controversial. Should patients with T1G3 bladder cancer have an immediate radical cystectomy or should they receive intravesical bacillus Calmette-Guerin–preserving bladder? Gemcitabine and cisplatin (GC) adjuvant chemotherapy may help to strike a balance between intravesical and early cystectomy. For purposes of this study, we continue to refer high-grade T1 lesion as “T1G3.” Objective To evaluate the characteristics and the long-term outcome of GC adjuvant chemotherapy in T1G3 bladder cancer after transurethral resection of bladder tumor (TURBT). Materials and methods We retrospectively reviewed 48 patients who were newly diagnosed with T1G3 bladder cancer between January 2009 and December 2012. A total of 48 patients received 4 cycles of GC adjuvant chemotherapy after TURBT. One month after 4 cycles of GC adjuvant chemotherapy, response was evaluated by re-TURBT. Median follow-up was 59.5 (range: 18–70) months, all patients have been observed for more than 3 years. Salvage cystectomy was recommended for patients with persistent disease and for tumor progression after initial complete response. Result Complete response was achieved in 44 (91.7%) patients. Of complete responders, 5 patients experienced recurrence and 5 patients showed progression. The progression rate and disease-specific survival rate were 10.4% and 91.7% at 3 years, respectively. More than 80% of survivors preserved their bladder. Kaplan-Meier curves showed that concomitant carcinoma in situ (CIS) was the only factor that had an influence on progression-free survival ( P = 0.022) and disease-specific survival ( P = 0.017). Concomitant CIS was the prognostic factor for progression rate and disease-specific survival rate at 3 years ( P = 0.008 and P = 0.035). Conclusion GC adjuvant chemotherapy is a safe conservative treatment for T1G3 bladder cancer, but effective is really a phase II study. Patients with T1G3 bladder cancer with concomitant CIS should be treated more aggressively because of the high risk of progression.
- Subjects :
- Oncology
Diarrhea
Male
medicine.medical_specialty
Neutropenia
Urology
medicine.medical_treatment
030232 urology & nephrology
Phases of clinical research
Kaplan-Meier Estimate
Deoxycytidine
Cystectomy
03 medical and health sciences
0302 clinical medicine
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
medicine
Humans
Survival rate
Aged
Retrospective Studies
Bladder cancer
business.industry
Carcinoma in situ
Middle Aged
medicine.disease
Gemcitabine
Treatment Outcome
Urinary Bladder Neoplasms
Tumor progression
Chemotherapy, Adjuvant
030220 oncology & carcinogenesis
Concomitant
Disease Progression
Female
Cisplatin
Neoplasm Grading
business
Constipation
medicine.drug
Subjects
Details
- ISSN :
- 18732496
- Volume :
- 35
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- Urologic oncology
- Accession number :
- edsair.doi.dedup.....1127379b555dc8eb5c3469600322099e