Circulating tumor cells detection has independent prognostic impact in high-risk non-muscle invasive bladder cancer
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Circulating tumor cells detection has independent prognostic impact in high-risk non-muscle invasive bladder cancer. / Gazzaniga, Paola; de Berardinis, Ettore; Raimondi, Cristina; Gradilone, Angela; Busetto, Gian Maria; De Falco, Elena; Nicolazzo, Chiara; Giovannone, Riccardo; Gentile, Vincenzo; Cortesi, Enrico; Pantel, Klaus.
In: INT J CANCER, Vol. 135, No. 8, 15.10.2014, p. 1978-1982.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Circulating tumor cells detection has independent prognostic impact in high-risk non-muscle invasive bladder cancer
AU - Gazzaniga, Paola
AU - de Berardinis, Ettore
AU - Raimondi, Cristina
AU - Gradilone, Angela
AU - Busetto, Gian Maria
AU - De Falco, Elena
AU - Nicolazzo, Chiara
AU - Giovannone, Riccardo
AU - Gentile, Vincenzo
AU - Cortesi, Enrico
AU - Pantel, Klaus
N1 - © 2014 UICC.
PY - 2014/10/15
Y1 - 2014/10/15
N2 - High-risk non-muscle invasive bladder cancer (NMIBC) progresses to metastatic disease in 10-15% of cases, suggesting that micrometastases may be present at first diagnosis. The prediction of risks of progression relies upon EORTC scoring systems, based on clinical and pathological parameters, which do not accurately identify which patients will progress. Aim of the study was to investigate whether the presence of CTC may improve prognostication in a large population of patients with Stage I bladder cancer who were all candidate to conservative surgery. A prospective single center trial was designed to correlate the presence of CTC to local recurrence and progression of disease in high-risk T1G3 bladder cancer. One hundred two patients were found eligible, all candidate to transurethral resection of the tumor followed by endovesical adjuvant immunotherapy with BCG. Median follow-up was 24.3 months (minimum-maximum: 4-36). The FDA-approved CellSearch System was used to enumerate CTC. Kaplan-Meier methods, log-rank test and multivariable Cox proportional hazard analysis was applied to establish the association of circulating tumor cells with time to first recurrence (TFR) and progression-free survival. CTC were detected in 20% of patients and predicted both decreased TFR (log-rank p < 0.001; multivariable adjusted hazard ratio [HR] 2.92 [95% confidence interval: 1.38-6.18], p = 0.005), and time to progression (log-rank p < 0.001; HR 7.17 [1.89-27.21], p = 0.004). The present findings provide evidence that CTC analyses can identify patients with Stage I bladder cancer who have already a systemic disease at diagnosis and might, therefore, potentially benefit from systemic treatment.
AB - High-risk non-muscle invasive bladder cancer (NMIBC) progresses to metastatic disease in 10-15% of cases, suggesting that micrometastases may be present at first diagnosis. The prediction of risks of progression relies upon EORTC scoring systems, based on clinical and pathological parameters, which do not accurately identify which patients will progress. Aim of the study was to investigate whether the presence of CTC may improve prognostication in a large population of patients with Stage I bladder cancer who were all candidate to conservative surgery. A prospective single center trial was designed to correlate the presence of CTC to local recurrence and progression of disease in high-risk T1G3 bladder cancer. One hundred two patients were found eligible, all candidate to transurethral resection of the tumor followed by endovesical adjuvant immunotherapy with BCG. Median follow-up was 24.3 months (minimum-maximum: 4-36). The FDA-approved CellSearch System was used to enumerate CTC. Kaplan-Meier methods, log-rank test and multivariable Cox proportional hazard analysis was applied to establish the association of circulating tumor cells with time to first recurrence (TFR) and progression-free survival. CTC were detected in 20% of patients and predicted both decreased TFR (log-rank p < 0.001; multivariable adjusted hazard ratio [HR] 2.92 [95% confidence interval: 1.38-6.18], p = 0.005), and time to progression (log-rank p < 0.001; HR 7.17 [1.89-27.21], p = 0.004). The present findings provide evidence that CTC analyses can identify patients with Stage I bladder cancer who have already a systemic disease at diagnosis and might, therefore, potentially benefit from systemic treatment.
KW - Bone Neoplasms
KW - Carcinoma, Transitional Cell
KW - Disease-Free Survival
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Lymphatic Metastasis
KW - Male
KW - Neoplasm Invasiveness
KW - Neoplasm Recurrence, Local
KW - Neoplastic Cells, Circulating
KW - Prognosis
KW - Proportional Hazards Models
KW - Prospective Studies
KW - Risk
KW - Treatment Outcome
KW - Urinary Bladder Neoplasms
U2 - 10.1002/ijc.28830
DO - 10.1002/ijc.28830
M3 - SCORING: Journal article
C2 - 24599551
VL - 135
SP - 1978
EP - 1982
JO - INT J CANCER
JF - INT J CANCER
SN - 0020-7136
IS - 8
ER -