Primary Ta high grade bladder tumors: Determination of the risk of progression
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Primary Ta high grade bladder tumors: Determination of the risk of progression. / Quhal, Fahad; D'Andrea, David; Soria, Francesco; Moschini, Marco; Abufaraj, Mohammad; Rouprêt, Morgan; Karakiewicz, Pierre I; Yang, Lin; Mostafaei, Hadi; Laukhtina, Ekaterina; Mori, Keiichiro; Sari Motlagh, Reza; Rink, Michael; Shariat, Shahrokh F.
in: UROL ONCOL-SEMIN ORI, Jahrgang 39, Nr. 2, 02.2021, S. 132.e7-132.e11.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Primary Ta high grade bladder tumors: Determination of the risk of progression
AU - Quhal, Fahad
AU - D'Andrea, David
AU - Soria, Francesco
AU - Moschini, Marco
AU - Abufaraj, Mohammad
AU - Rouprêt, Morgan
AU - Karakiewicz, Pierre I
AU - Yang, Lin
AU - Mostafaei, Hadi
AU - Laukhtina, Ekaterina
AU - Mori, Keiichiro
AU - Sari Motlagh, Reza
AU - Rink, Michael
AU - Shariat, Shahrokh F
N1 - Copyright © 2020 Elsevier Inc. All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - PURPOSE: TaG3 bladder cancer is an under-investigated disease and because of its rarity it is commonly studies together with T1G3 disease. We sought to exclusively study TaG3 disease and to determine the factors associated with disease progression.MATERIAL AND METHOD: We retrospectively studied patients with primary TaG3 bladder cancer. Progression to ≥pT1 and pT2 were analyzed using Cox and competing-risk regression analyses.RESULTS: Of 3,505 consecutive patients with nonmuscle invasive bladder cancer, 285 patients had primary TaG3 without concomitant carcinoma in-situ. Progression to ≥pT1 occurred in 21 patients (7.4%). In a multivariable competing-risk regression analysis, intravesical Bacillus Calmette-Guerin (BCG) was significantly associated with a lower risk of progression to ≥pT1 (HR 0.23, 95%CI 0.08-0.64, P = 0.005). Recurrence in the first year of diagnosis was significantly associated with an increased risk of stage progression to ≥pT1 (HR 7.81, 95%CI 2.50-24.44, P < 0.001). Progression to ≥T2 was observed in 9 patients (3.2%). In univariable competing-risk regression analyses, intravesical BCG was significantly associated with a lower risk of progression to ≥pT2 (HR 0.11, 95%CI 0.04-0.47, P = 0.003). On the other hand, recurrence in the first year of diagnosis was significantly associated with an increased risk of stage progression to ≥T2 (HR 7.12, 95%CI 1.50-33.77, P = 0.013). In a subgroup of 199 patients who were treated with BCG, there was no statistically significant association between tumor recurrence in the 1st year of diagnosis and stage progression to ≥pT1 (P = 0.14) or ≥pT2(P = 0.19).CONCLUSION: Patients with TaG3 bladder cancer are considered high risk but if appropriately treated with BCG that risk is considerably mitigated. Our data support that TaG3 without concomitant carcinoma in-situ should not be considered as aggressive as T1G3 as it has a lower risk of progression to muscle-invasive bladder cancer. Recurrence in the first year after diagnosis is the strongest predictor of progression to muscle-invasive bladder cancer.
AB - PURPOSE: TaG3 bladder cancer is an under-investigated disease and because of its rarity it is commonly studies together with T1G3 disease. We sought to exclusively study TaG3 disease and to determine the factors associated with disease progression.MATERIAL AND METHOD: We retrospectively studied patients with primary TaG3 bladder cancer. Progression to ≥pT1 and pT2 were analyzed using Cox and competing-risk regression analyses.RESULTS: Of 3,505 consecutive patients with nonmuscle invasive bladder cancer, 285 patients had primary TaG3 without concomitant carcinoma in-situ. Progression to ≥pT1 occurred in 21 patients (7.4%). In a multivariable competing-risk regression analysis, intravesical Bacillus Calmette-Guerin (BCG) was significantly associated with a lower risk of progression to ≥pT1 (HR 0.23, 95%CI 0.08-0.64, P = 0.005). Recurrence in the first year of diagnosis was significantly associated with an increased risk of stage progression to ≥pT1 (HR 7.81, 95%CI 2.50-24.44, P < 0.001). Progression to ≥T2 was observed in 9 patients (3.2%). In univariable competing-risk regression analyses, intravesical BCG was significantly associated with a lower risk of progression to ≥pT2 (HR 0.11, 95%CI 0.04-0.47, P = 0.003). On the other hand, recurrence in the first year of diagnosis was significantly associated with an increased risk of stage progression to ≥T2 (HR 7.12, 95%CI 1.50-33.77, P = 0.013). In a subgroup of 199 patients who were treated with BCG, there was no statistically significant association between tumor recurrence in the 1st year of diagnosis and stage progression to ≥pT1 (P = 0.14) or ≥pT2(P = 0.19).CONCLUSION: Patients with TaG3 bladder cancer are considered high risk but if appropriately treated with BCG that risk is considerably mitigated. Our data support that TaG3 without concomitant carcinoma in-situ should not be considered as aggressive as T1G3 as it has a lower risk of progression to muscle-invasive bladder cancer. Recurrence in the first year after diagnosis is the strongest predictor of progression to muscle-invasive bladder cancer.
U2 - 10.1016/j.urolonc.2020.07.017
DO - 10.1016/j.urolonc.2020.07.017
M3 - SCORING: Journal article
C2 - 32773232
VL - 39
SP - 132.e7-132.e11
JO - UROL ONCOL-SEMIN ORI
JF - UROL ONCOL-SEMIN ORI
SN - 1078-1439
IS - 2
ER -