Adult urologyEarly-Stage Bladder Cancer Surveillance Does Not Improve Survival If High-Risk Patients Are Permitted to Progress to Muscle Invasion
Section snippets
Patients
From August 1990 to April 2003, 422 patients underwent primary radical cystectomy as treatment of refractory, recurrent or progressive early-stage (cTis, cTa, or cT1) bladder cancer or frank muscle-invasive (cT2) disease.16 Patients with Stage cT3 or cT4 disease and those requiring neoadjuvant radiotherapy or systemic chemotherapy were not included. Because of the tumor grade, refractory nature to TURBT and intravesical therapy, and patterns of recurrence and progression, the population was
Patient Categories and Demographics
Table 1 summarizes the analysis of cohort demographics, surveillance, and pathologic parameters. The distributions of surveillance times were positively skewed in groups 1 and 2. The median surveillance time in groups 1 and 2 was 13 and 17 months, and the mean surveillance time was 32 and 48 months, respectively. The median surveillance time in group 3 was 1.8 months. Most patients in groups 1 (64%) and 2 (61%) underwent surveillance for less than 24 months; however, nearly one third of the
Comment
The bladder cancer surveillance schedule outlined by the National Comprehensive Cancer Network guidelines is most effective in detecting the 50% to 70% of recurrent tumors that develop within the first 3 years3, 4 and also at providing predictive information for those with early tumor recurrence.5, 9 This strategy theoretically permits patients to keep a functional bladder and delay cystectomy until progression is evident. The results of the present study suggest that surveillance is unable to
Conclusions
The results of our study have shown that the traditional surveillance paradigm does not offer added survival benefit to patients with high-risk tumors if allowed to progress to muscle-invasive disease, likely relating to the understaging of tumors. New imaging and/or urinary markers are greatly needed to augment and improve traditional surveillance and clinical staging. Surveillance should be used to identify high-risk and early progressive tumors, not to await muscle invasion. Because many
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Cited by (37)
Intravesical Therapy Compared to Radical Cystectomy Among Patients With Non-Muscle Invasive Bladder Cancer Requiring Additional Treatment After Induction BCG
2022, Clinical Genitourinary CancerCitation Excerpt :Alternatively, several salvage therapies have been investigated as a means of bladder preservation. Still, few patients will have durable disease control with currently available salvage intravesical therapy (IVT) agents,10 up to 50% ultimately require a salvage RC,11 and those who progress to muscle-invasive bladder cancer (MIBC) have a lower cure rate after delayed RC.12 Patients with BCG unresponsive bladder cancer face a difficult decision between RC, which is a life-changing, but potentially life-saving, operation, and bladder preservation with IVT.
Survival after radical cystectomy: Progressive versus De novo muscle invasive bladder cancer
2020, Cancer Treatment and Research CommunicationsIt's all about the perspective: Removing bias when co-managing patients with high-grade T1 bladder cancer and localized prostate cancer—A competing risks analysis
2018, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Other groups have shown that for patients with high-risk NMIBC initially treated with TUR and BCG then salvaged with RC for recurrence or progression, patients who underwent RC within 2 years of the initiation of BCG therapy had improved survival compared to those who underwent RC after 2 years (92% vs. 56%) [14]. Furthermore, patients who progress from NMIBC to MIBC and then undergo cystectomy have consistently worse outcomes than cystectomy patients who present initially with MIBC, stage for stage [15,16]. Clearly, there is variability in the biologic aggressiveness of T1HG tumors [17].
Survival Comparison Between Endoscopic and Surgical Management for Patients With Upper Tract Urothelial Cancer: A Matched Propensity Score Analysis Using Surveillance, Epidemiology and End Results-Medicare Data
2016, UrologyCitation Excerpt :Patients with low-risk, noninvasive bladder cancer have been found to rarely progress to muscle invasion, but those who progress during surveillance have a higher risk of disease-specific mortality.15 Furthermore, patients who progress to muscle-invasive disease during surveillance have similar survival to patients with initial presentation of muscle-invasive bladder cancer.16 The failure of endoscopic surveillance in low-risk bladder cancer to provide a survival benefit suggests that endoscopic surveillance regimens may not be effective at detecting disease progression in a timely manner such that intervention can alter survival outcomes.
EORTC progression score identifies patients at high risk of cancer-specific mortality after radical cystectomy for secondary muscle-invasive bladder cancer
2014, Clinical Genitourinary CancerCitation Excerpt :Although the follow-up of patients with non-MIBC was carried out according to the EAU guidelines in our study with the aim of early detection of muscle invasion,2,17 there was no significant difference in CSS in patients with primary vs. secondary muscle-invasive disease. This has been confirmed in earlier studies.5-10 To our knowledge, currently only 2 studies have been published that could not affirm the same prognosis after RC when comparing patients with primary vs. secondary MIBC.20,21
This study was supported by the Robert and Elizabeth Teeter Bladder Cancer Fund.