The role of surveillance in the treatment of patients with muscle-invasive bladder cancer after chemotherapy

Nicholas J. Hellenthal, Michelle L. Ramirez, Christopher P Evans, Ralph W deVere White

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Study Type - Prognosis (case series) Level of Evidence 4 Objective To determine the survival of patients at our institution who were clinically tumour-free (cT0) on re-staging transurethral resection (TUR) after treatment with chemotherapy for muscle-invasive bladder cancer. Patients and Methods In all, 55 patients with muscle-invasive, organ-confined transitional cell carcinoma of the bladder were treated with TUR followed by systemic chemotherapy, over a 10-year period. Patients were separated into two groups, those who were clinically T0 and those who showed persistent disease (>cT0) on re-biopsy after chemotherapy. Overall and disease-specific survival rates were calculated for the two groups. The cT0 group was further followed for tumour recurrence and clinical outcomes. Results Thirty-one patients (56%) were clinically T0 on TUR after chemotherapy; of these patients, 22 (71%) either died from other causes (with no disease recurrence) or are alive and with no evidence of disease at a mean follow-up of 53 months. Twenty of the 31 patients (65%) have retained their bladder with no evidence of cancer recurrence at a mean follow-up of 46 months. Disease-free status (cT0) at the time of TUR after chemotherapy was associated with significantly higher overall and cancer-specific survival (hazard ratio 3.40, P = 0.003; and 8.63, P = 0.001, respectively). Conclusion Previous studies suggest that surveillance can be a reasonable option for patients with muscle-invasive transitional cell carcinoma of the bladder who show no evidence of disease on TUR after chemotherapy. Patients with persistent bladder cancer on re-biopsy after chemotherapy tend to fare poorly even with immediate cystectomy.

Original languageEnglish (US)
Pages (from-to)485-488
Number of pages4
JournalBJU International
Volume105
Issue number4
DOIs
StatePublished - Feb 2010

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Urinary Bladder Neoplasms
Drug Therapy
Muscles
Urinary Bladder
Therapeutics
Transitional Cell Carcinoma
Recurrence
Neoplasms
Biopsy
Survival
Cystectomy
Survival Rate

Keywords

  • Bladder cancer
  • Chemotherapy
  • Surveillance
  • Survival

ASJC Scopus subject areas

  • Urology

Cite this

The role of surveillance in the treatment of patients with muscle-invasive bladder cancer after chemotherapy. / Hellenthal, Nicholas J.; Ramirez, Michelle L.; Evans, Christopher P; deVere White, Ralph W.

In: BJU International, Vol. 105, No. 4, 02.2010, p. 485-488.

Research output: Contribution to journalArticle

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abstract = "Study Type - Prognosis (case series) Level of Evidence 4 Objective To determine the survival of patients at our institution who were clinically tumour-free (cT0) on re-staging transurethral resection (TUR) after treatment with chemotherapy for muscle-invasive bladder cancer. Patients and Methods In all, 55 patients with muscle-invasive, organ-confined transitional cell carcinoma of the bladder were treated with TUR followed by systemic chemotherapy, over a 10-year period. Patients were separated into two groups, those who were clinically T0 and those who showed persistent disease (>cT0) on re-biopsy after chemotherapy. Overall and disease-specific survival rates were calculated for the two groups. The cT0 group was further followed for tumour recurrence and clinical outcomes. Results Thirty-one patients (56{\%}) were clinically T0 on TUR after chemotherapy; of these patients, 22 (71{\%}) either died from other causes (with no disease recurrence) or are alive and with no evidence of disease at a mean follow-up of 53 months. Twenty of the 31 patients (65{\%}) have retained their bladder with no evidence of cancer recurrence at a mean follow-up of 46 months. Disease-free status (cT0) at the time of TUR after chemotherapy was associated with significantly higher overall and cancer-specific survival (hazard ratio 3.40, P = 0.003; and 8.63, P = 0.001, respectively). Conclusion Previous studies suggest that surveillance can be a reasonable option for patients with muscle-invasive transitional cell carcinoma of the bladder who show no evidence of disease on TUR after chemotherapy. Patients with persistent bladder cancer on re-biopsy after chemotherapy tend to fare poorly even with immediate cystectomy.",
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N2 - Study Type - Prognosis (case series) Level of Evidence 4 Objective To determine the survival of patients at our institution who were clinically tumour-free (cT0) on re-staging transurethral resection (TUR) after treatment with chemotherapy for muscle-invasive bladder cancer. Patients and Methods In all, 55 patients with muscle-invasive, organ-confined transitional cell carcinoma of the bladder were treated with TUR followed by systemic chemotherapy, over a 10-year period. Patients were separated into two groups, those who were clinically T0 and those who showed persistent disease (>cT0) on re-biopsy after chemotherapy. Overall and disease-specific survival rates were calculated for the two groups. The cT0 group was further followed for tumour recurrence and clinical outcomes. Results Thirty-one patients (56%) were clinically T0 on TUR after chemotherapy; of these patients, 22 (71%) either died from other causes (with no disease recurrence) or are alive and with no evidence of disease at a mean follow-up of 53 months. Twenty of the 31 patients (65%) have retained their bladder with no evidence of cancer recurrence at a mean follow-up of 46 months. Disease-free status (cT0) at the time of TUR after chemotherapy was associated with significantly higher overall and cancer-specific survival (hazard ratio 3.40, P = 0.003; and 8.63, P = 0.001, respectively). Conclusion Previous studies suggest that surveillance can be a reasonable option for patients with muscle-invasive transitional cell carcinoma of the bladder who show no evidence of disease on TUR after chemotherapy. Patients with persistent bladder cancer on re-biopsy after chemotherapy tend to fare poorly even with immediate cystectomy.

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