Long-term cancer-specific outcomes of TaG1 urothelial carcinoma of the bladder

TY - JOUR

T1 - Long-term cancer-specific outcomes of TaG1 urothelial carcinoma of the bladder

AU - Rieken, Malte

AU - Xylinas, Evanguelos

AU - Kluth, Luis

AU - Crivelli, Joseph J

AU - Chrystal, James

AU - Faison, Talia

AU - Lotan, Yair

AU - Karakiewicz, Pierre I

AU - Holmäng, Sten

AU - Babjuk, Marek

AU - Fajkovic, Harun

AU - Seitz, Christian

AU - Klatte, Tobias

AU - Pycha, Armin

AU - Bachmann, Alexander

AU - Scherr, Douglas S

AU - Shariat, Shahrokh F

N1 - Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Few studies have investigated the natural history of TaG1 urothelial carcinoma of the bladder (UCB).OBJECTIVE: To assess the long-term outcomes of patients with TaG1 UCB and the impact of immediate postoperative instillation of chemotherapy (IPIC).DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 1447 patients with TaG1 UCB treated between 1996 and 2007 at eight centers. Median follow-up was 67.2 mo (interquartile range: 67.9). Patients were stratified into three European Association of Urology (EAU) guidelines risk categories; high-risk patients (n=11) were excluded.INTERVENTION: Transurethral resection of the bladder with or without IPIC.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable Cox regression models addressed factors associated with disease recurrence, disease progression, death of disease, and any-cause death.RESULTS AND LIMITATIONS: Of the 1436 patients, 601 (41.9%) and 835 (58.1%) were assigned to low- and intermediate-risk categories, respectively. The actuarial estimate of 5-yr recurrence-free survival was 56% (standard error: ± 1). Advancing age (p=0.04), tumor >3 cm (p=0.001), multiple tumors (p<0.001), and recurrent tumors (p<0.001) were independently associated with increased risk of disease recurrence, whereas IPIC was associated with decreased risk (p=0.001). The actuarial estimate of 5-yr progression-free survival was 95% ± 1. Advancing age (p<0.001) and multiple tumors (p=0.01) were independent risk factors for disease progression. Five-year cancer-specific survival was 98% ± 1. Advancing age (p=0.001) and previous recurrence (p=0.04) were associated with increased risk, whereas female gender (p=0.02) was associated with decreased risk of cancer-specific mortality. Compared with low-risk patients, intermediate-risk patients were at significantly higher risk of disease recurrence, disease progression, and cancer-specific mortality (all p<0.01). Limitations include the retrospective design of the study and the lack of a central pathology review.CONCLUSIONS: TaG1 UCB patients experience heterogeneous risks of disease recurrence. We validated the EAU guidelines risk stratification in TaG1 UCB patients. IPIC was associated with a reduced risk of disease recurrence in patients with low- and intermediate-risk TaG1 UCB.

AB - BACKGROUND: Few studies have investigated the natural history of TaG1 urothelial carcinoma of the bladder (UCB).OBJECTIVE: To assess the long-term outcomes of patients with TaG1 UCB and the impact of immediate postoperative instillation of chemotherapy (IPIC).DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 1447 patients with TaG1 UCB treated between 1996 and 2007 at eight centers. Median follow-up was 67.2 mo (interquartile range: 67.9). Patients were stratified into three European Association of Urology (EAU) guidelines risk categories; high-risk patients (n=11) were excluded.INTERVENTION: Transurethral resection of the bladder with or without IPIC.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Univariable and multivariable Cox regression models addressed factors associated with disease recurrence, disease progression, death of disease, and any-cause death.RESULTS AND LIMITATIONS: Of the 1436 patients, 601 (41.9%) and 835 (58.1%) were assigned to low- and intermediate-risk categories, respectively. The actuarial estimate of 5-yr recurrence-free survival was 56% (standard error: ± 1). Advancing age (p=0.04), tumor >3 cm (p=0.001), multiple tumors (p<0.001), and recurrent tumors (p<0.001) were independently associated with increased risk of disease recurrence, whereas IPIC was associated with decreased risk (p=0.001). The actuarial estimate of 5-yr progression-free survival was 95% ± 1. Advancing age (p<0.001) and multiple tumors (p=0.01) were independent risk factors for disease progression. Five-year cancer-specific survival was 98% ± 1. Advancing age (p=0.001) and previous recurrence (p=0.04) were associated with increased risk, whereas female gender (p=0.02) was associated with decreased risk of cancer-specific mortality. Compared with low-risk patients, intermediate-risk patients were at significantly higher risk of disease recurrence, disease progression, and cancer-specific mortality (all p<0.01). Limitations include the retrospective design of the study and the lack of a central pathology review.CONCLUSIONS: TaG1 UCB patients experience heterogeneous risks of disease recurrence. We validated the EAU guidelines risk stratification in TaG1 UCB patients. IPIC was associated with a reduced risk of disease recurrence in patients with low- and intermediate-risk TaG1 UCB.

U2 - 10.1016/j.eururo.2013.08.034

DO - 10.1016/j.eururo.2013.08.034

M3 - SCORING: Journal article

C2 - 23998688

VL - 65

SP - 201

EP - 209

JO - EUR UROL

JF - EUR UROL

SN - 0302-2838

IS - 1

ER -