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1. Clark PE, Stein JP, Groshen SG, Cai J, Miranda G, Lieskovsky G, Skinner DG: Radical cystectomy in the elderly: Comparison of survival between younger and older patients. Cancer; 2005 Feb 1;103(3):546-52
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • BACKGROUND: The authors reported their experience with radical cystectomy for transitional cell carcinoma (TCC) of the bladder.
  • METHODS: The authors retrospectively reviewed the records of 1054 patients who underwent radical cystectomy for bladder TCC between 1971 and 1997.
  • Four age groups were compared: < 60 years old at the time of cystectomy (n = 310), 60-69 years old (n = 381), 70-79 years old (n = 313), and >/= 80 years old (n = 50).
  • RESULTS: There were no significant differences in pathologic features among the groups regarding frequency of carcinoma in situ, high-grade disease, p53 status, and lymph node positivity.
  • Significant differences also were seen in the proportion of patients who received adjuvant chemotherapy (26%, 26%, 15%, and 6%, respectively; P < 0.001).
  • The elderly had a lower probability of receiving adjuvant chemotherapy.
  • CONCLUSIONS: Elderly patients undergoing cystectomy for TCC had similar pathologic features (except for disease stage) as younger patients.
  • In the current series, elderly patients undergoing cystectomy had a higher pathologic stage and were less likely to receive adjuvant chemotherapy.
  • Further work is needed to identify the causes for this and to develop strategies to improve cancer control in elderly patients.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Carcinoma, Transitional Cell / secondary. Carcinoma, Transitional Cell / surgery. Cystectomy. Urinary Bladder Neoplasms / pathology. Urinary Bladder Neoplasms / surgery
  • [MeSH-minor] Age Factors. Aged. Aged, 80 and over. Carcinoma in Situ / pathology. Carcinoma in Situ / surgery. Chemotherapy, Adjuvant. Confidence Intervals. Disease-Free Survival. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoadjuvant Therapy / methods. Neoplasm Staging. Radiotherapy, Adjuvant. Risk Assessment. Survival Analysis. United States / epidemiology

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  • [Copyright] (c) 2004 American Cancer Society
  • [CommentIn] J Urol. 2005 Oct;174(4 Pt 1):1254-5 [16145387.001]
  • (PMID = 15630702.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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2. Kassouf W, Spiess PE, Brown GA, Munsell MF, Grossman HB, Siefker-Radtke A, Dinney CP, Kamat AM: P0 stage at radical cystectomy for bladder cancer is associated with improved outcome independent of traditional clinical risk factors. Eur Urol; 2007 Sep;52(3):769-74
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] P0 stage at radical cystectomy for bladder cancer is associated with improved outcome independent of traditional clinical risk factors.
  • OBJECTIVES: Final pathologic specimen free of detectable disease (P0) is not uncommon in patients undergoing cystectomy for bladder cancer, especially in the era of neoadjuvant chemotherapy.
  • METHODS: Over the last 15 yr, 1104 patients with bladder cancer underwent radical cystectomy at our institution.
  • With mean follow-up of 43 mo, 11 patients developed recurrences, 9 of whom died of disease.
  • Median time to recurrence was 7.7 mo (range: 2.2-45 mo).
  • On multivariate analysis, presence of lymphovascular invasion and concomitant carcinoma in situ on the transurethral resection of the bladder tumor specimen were the only significant prognostic factors associated with shorter OS (p = 0.04) and RFS (p = 0.049), respectively.
  • Notably, patients who received preoperative chemotherapy (n = 77) had 5-yr survival rates similar to those of patients who did not.
  • The favorable prognosis conferred by a P0 state appears to be independent of whether this is achieved by neoadjuvant chemotherapy or by thorough transurethral resection before cystectomy.

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  • [Copyright] European Association of Urology.
  • [Cites] N Engl J Med. 2003 Aug 28;349(9):859-66 [12944571.001]
  • [Cites] J Urol. 1994 Aug;152(2 Pt 1):393-6 [8015078.001]
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  • [CommentIn] Eur Urol. 2007 Sep;52(3):775-6 [17434253.001]
  • [CommentIn] Eur Urol. 2007 Sep;52(3):774-5 [17434255.001]
  • (PMID = 17434254.001).
  • [ISSN] 0302-2838
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / T32 CA079449-06; United States / NCI NIH HHS / CA / P50 CA091846; United States / NCI NIH HHS / CA / CA079449-06; United States / NCI NIH HHS / CA / 5P50CA091846-03; United States / NCI NIH HHS / CA / P50 CA091846-03; None / None / / P50 CA091846-03; United States / NCI NIH HHS / CA / T32 CA079449
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] Switzerland
  • [Other-IDs] NLM/ NIHMS28798; NLM/ PMC2691552
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3. Shariat SF, Karakiewicz PI, Palapattu GS, Amiel GE, Lotan Y, Rogers CG, Vazina A, Bastian PJ, Gupta A, Sagalowsky AI, Schoenberg M, Lerner SP: Nomograms provide improved accuracy for predicting survival after radical cystectomy. Clin Cancer Res; 2006 Nov 15;12(22):6663-76
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • AIMS: To develop multivariate nomograms that determine the probabilities of all-cause and bladder cancer-specific survival after radical cystectomy and to compare their predictive accuracy to that of American Joint Committee on Cancer (AJCC) staging.
  • METHODS: We used Cox proportional hazards regression analyses to model variables of 731 consecutive patients treated with radical cystectomy and bilateral pelvic lymphadenectomy for bladder transitional cell carcinoma.
  • Variables included age of patient, gender, pathologic stage (pT), pathologic grade, carcinoma in situ, lymphovascular invasion (LVI), lymph node status (pN), neoadjuvant chemotherapy (NACH), adjuvant chemotherapy (ACH), and adjuvant external beam radiotherapy (AXRT).
  • RESULTS: During a mean follow-up of 36.4 months, 290 of 731 (39.7%) patients died; 196 of 290 patients (67.6%) died of bladder cancer.
  • Actuarial cancer-specific survival estimates were 67.3% (62.9-71.3%) and 58.7% (52.7-64.2%) at 5 and 8 years, respectively.
  • Similarly, the accuracy of a nomogram for prediction of cancer-specific survival that included pT, pN, LVI, NACH, and AXRT (0.791) was significantly superior (P=0.001) to that of AJCC staging-based risk grouping (0.663).
  • CONCLUSIONS: Multivariate nomograms provide a more accurate and relevant individualized prediction of survival after cystectomy compared with conventional prediction models, thereby allowing for improved patient counseling and treatment selection.
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Carcinoma, Transitional Cell / diagnosis. Carcinoma, Transitional Cell / mortality. Carcinoma, Transitional Cell / surgery. Carcinoma, Transitional Cell / therapy. Disease-Free Survival. Female. Humans. Male. Middle Aged. Prognosis. Proportional Hazards Models. Survival Analysis. Time Factors. Treatment Outcome. Urinary Bladder Neoplasms / diagnosis. Urinary Bladder Neoplasms / mortality. Urinary Bladder Neoplasms / surgery. Urinary Bladder Neoplasms / therapy

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  • [CommentIn] Eur Urol. 2007 Apr;51(4):1140-1 [17415911.001]
  • (PMID = 17121885.001).
  • [ISSN] 1078-0432
  • [Journal-full-title] Clinical cancer research : an official journal of the American Association for Cancer Research
  • [ISO-abbreviation] Clin. Cancer Res.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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4. Satoh A, Hanawa Y, Nakamura S: Clinical study of bladder cancer: Proteinuria as a predictor of recurrence and efficacy of intravesical bacille Calmette-Guerin therapy. Int J Urol; 2004 Jul;11(7):476-82
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Clinical study of bladder cancer: Proteinuria as a predictor of recurrence and efficacy of intravesical bacille Calmette-Guerin therapy.
  • AIM: We studied the clinical characteristics of bladder cancer, with special attention to the clinical and pathological variables that affect tumor stage, relapse and efficacy of intravesical therapy.
  • METHODS: We reviewed the medical records of 152 patients of the Saiseikai Central Hospital who had been diagnosed as having bladder cancer between 1981 and 2001.
  • There was no difference in the incidence of gross hematuria as a presenting symptom among the patients with invasive cancer, superficial cancer and carcinoma in situ (CIS).
  • However, the incidence of urinary frequency and painful urination did differ significantly between patients.
  • Although patients with invasive cancer had a longer time to hospital visit than those with superficial cancer, this time difference was not statistically significant.
  • Presence of proteinuria, multifocality and intravesical bacille Calmette-Guerin (BCG) therapy were the significant predictors of relapse after transurethral resection (TUR).
  • Presence of proteinuria was shown to adversely affect the efficacy of intravesical BCG therapy.
  • CONCLUSIONS: Time to hospital visit did not influence the pathological stage of cancer in patients included in the present study.
  • Presence of proteinuria, multifocality and BCG therapy were the significant predictors of relapse after TUR.
  • Presence of proteinuria was shown to adversely affect the efficacy of intravesical BCG therapy.
  • Proteinuria might be helpful in predicting tumor relapse and efficacy of intravesical BCG therapy in clinical settings, along with other markers.
  • [MeSH-major] Adjuvants, Immunologic / administration & dosage. BCG Vaccine / administration & dosage. Neoplasm Recurrence, Local / urine. Proteinuria / urine. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / urine

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  • (PMID = 15242355.001).
  • [ISSN] 0919-8172
  • [Journal-full-title] International journal of urology : official journal of the Japanese Urological Association
  • [ISO-abbreviation] Int. J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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5. de la Rosa F, Garcia-Carbonero R, Passas J, Rosino A, Lianes P, Paz-Ares L: Primary cisplatin, methotrexate and vinblastine chemotherapy with selective bladder preservation for muscle invasive carcinoma of the bladder: long-term followup of a prospective study. J Urol; 2002 Jun;167(6):2413-8
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Primary cisplatin, methotrexate and vinblastine chemotherapy with selective bladder preservation for muscle invasive carcinoma of the bladder: long-term followup of a prospective study.
  • PURPOSE: We evaluate the efficacy and bladder preservation rate of combined modality therapy consisting of deep transurethral resection of the primary bladder tumor followed by cisplatin, methotrexate and vinblastine chemotherapy in patients with muscle invasive transitional cell carcinoma of the bladder.
  • MATERIALS AND METHODS: A total of 40 consecutive patients with clinical stage T2-T4 NX M0 bladder cancer were included in the study and treated with transurethral resection followed by 3 courses of chemotherapy.
  • Chemotherapy consisted of 100 mg.
  • Patients with disease in complete clinical remission after cycle 3 of therapy received 3 additional chemotherapy courses.
  • Patients in whom complete clinical remission persisted after cycle 6 were closely followed with no further therapy until disease progression.
  • RESULTS: A complete clinical remission was achieved in 21 patients (53%) after the first 3 cycles of therapy and a partial response occurred in 10 (25%), for an overall response rate of 78% (95% confidence interval [CI] 62% to 89%).
  • The 7-year survival rate with a functional bladder for complete clinical remission cases was 52% (95% CI 30% to 74%).
  • Low grade, small tumor, absence of concomitant carcinoma in situ and response to therapy were all significant predictors for an increased probability of bladder preservation in univariate analysis.
  • However, response to therapy was the only variable with independent prognostic value in the multivariate analysis (p = 0.002).
  • CONCLUSIONS: Transurethral resection of bladder tumor followed by cisplatin, methotrexate and vinblastine chemotherapy results in long-term bladder preservation in a significant proportion of responding patients, and may be an acceptable alternative to radical surgery in select patients with muscle invasive bladder cancer.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Transitional Cell / drug therapy. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Cisplatin / administration & dosage. Combined Modality Therapy. Disease-Free Survival. Female. Follow-Up Studies. Humans. Male. Methotrexate / administration & dosage. Middle Aged. Prospective Studies. Survival Rate. Vinblastine / administration & dosage

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  • (PMID = 11992048.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 5V9KLZ54CY / Vinblastine; Q20Q21Q62J / Cisplatin; YL5FZ2Y5U1 / Methotrexate
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6. Shariat SF, Bolenz C, Karakiewicz PI, Fradet Y, Ashfaq R, Bastian PJ, Nielsen ME, Capitanio U, Jeldres C, Rigaud J, Müller SC, Lerner SP, Montorsi F, Sagalowsky AI, Cote RJ, Lotan Y: p53 expression in patients with advanced urothelial cancer of the urinary bladder. BJU Int; 2010 Feb;105(4):489-95
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] p53 expression in patients with advanced urothelial cancer of the urinary bladder.
  • OBJECTIVE: To test whether assessing p53 expression could improve the ability to predict disease recurrence and disease-specific survival in a multi-institutional cohort of patients with advanced urothelial carcinoma of the urinary bladder (UCB).
  • The base model comprised age, gender, stage, grade, lymphovascular invasion, number of lymph nodes removed, number of lymph nodes positive, concomitant carcinoma in situ, and adjuvant chemotherapy.
  • In multivariable analyses, p53 expression was independently associated with disease recurrence (hazard ratio, 1.66; P < 0.001) and cancer-specific mortality (hazard ratio 1.65, P < 0.001).
  • Overall, adding p53 did not significantly improve the PA of the base model (recurrence +0.7%, P = 0.085, and cancer-specific mortality +1.2%, P = 0.050).
  • In the subgroups of pT3N0 (280) and pT4N0 (83) patients, p53 slightly improved the PA of the base model by a statistically significant degree (recurrence +1.7% and +3.6%, respectively; cancer-specific mortality +1.9% and +3.5%, respectively; all P < 0.001).
  • [MeSH-major] Carcinoma in Situ / pathology. Lymph Nodes / pathology. Neoplasm Recurrence, Local / pathology. Tumor Suppressor Protein p53 / metabolism. Urinary Bladder / pathology. Urinary Bladder Neoplasms / pathology

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  • [ErratumIn] BJU Int. 2015 Jun;115(6):E13 [26047313.001]
  • (PMID = 19659466.001).
  • [ISSN] 1464-410X
  • [Journal-full-title] BJU international
  • [ISO-abbreviation] BJU Int.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Tumor Suppressor Protein p53
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7. Efstathiou JA, Bae K, Shipley WU, Kaufman DS, Hagan MP, Heney NM, Sandler HM: Late pelvic toxicity after bladder-sparing therapy in patients with invasive bladder cancer: RTOG 89-03, 95-06, 97-06, 99-06. J Clin Oncol; 2009 Sep 1;27(25):4055-61
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Late pelvic toxicity after bladder-sparing therapy in patients with invasive bladder cancer: RTOG 89-03, 95-06, 97-06, 99-06.
  • PURPOSE: In selected patients with muscle-invasive bladder cancer, combined-modality therapy (transurethral resection bladder tumor [TURBT], radiation therapy, chemotherapy) with salvage cystectomy, if necessary, can achieve survival rates similar to radical cystectomy.
  • PATIENTS AND METHODS: Between 1990 and 2002, 285 eligible patients enrolled on four prospective protocols (Radiation Therapy Oncology Group [RTOG] 8903, 9506, 9706, 9906) and 157 underwent combined-modality therapy, surviving >or= 2 years from start of treatment with their bladder intact.
  • Rates of late genitourinary (GU) and GI toxicity were assessed using the RTOG Late Radiation Morbidity Schema, with worst toxicity grade (scale 0 to 5) occurring >or= 180 days after start of consolidation therapy reported for each patient.
  • Logistic and Cox regression analyses were performed to evaluate relationship between clinical characteristics, frequency, and time to late grade 3+ pelvic toxicity.
  • Covariates included age, sex, stage, presence of carcinoma in situ, completeness of TURBT, and protocol.
  • Notably there were no late grade 4 toxicities and no treatment-related deaths.
  • CONCLUSION: Rates of significant late pelvic toxicity for patients completing combined-modality therapy for invasive bladder cancer and retaining their native bladder are low.

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  • (PMID = 19636019.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / U10 CA32115; United States / NCI NIH HHS / CA / U10 CA21661; United States / NCI NIH HHS / CA / U10 CA37422; United States / NCI NIH HHS / CA / U10 CA037422; United States / NCI NIH HHS / CA / U10 CA021661; United States / NCI NIH HHS / CA / U10 CA032115
  • [Publication-type] Clinical Trial, Phase II; Clinical Trial, Phase III; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural
  • [Publication-country] United States
  • [Other-IDs] NLM/ PMC2734419
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8. Fakhr I, El-Hossieny H, Salama A: Delayed Cystectomy for T1G3 Transitional Cell Carcinoma (TCC) of the Urinary Bladder, NCI Retrospective Case Series. J Egypt Natl Canc Inst; 2008 Dec;20(4):387-94

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Delayed Cystectomy for T1G3 Transitional Cell Carcinoma (TCC) of the Urinary Bladder, NCI Retrospective Case Series.
  • AIM: We aim to evaluate the National Cancer Institute (NCI) treatment protocol and its outcome regarding recurrence, progression and survival in patients with T1G3 urinary bladder transitional cell carcinoma.
  • PATIENTS AND METHODS: In a retrospective study, between January 2001 and December 2007, all 34 patients with T1G3 bladder transitional cell carcinoma (TCC), after complete transurethral resection (TURBT), received intravesical BCG as adjuvant therapy.
  • Two (20.0%) of them, were staged as TNM stage II, 6 (60.0%) as TNM stage III and 2 (20.0%) patients were TNM stage IV.
  • Eight (72.7%) of these 11 patients had post-cystectomy radiotherapy alone; while the 2 (6.0%) other patients with stage IV had adjuvant concomitant Cisplatin and Gemcitabine chemotherapy.
  • CONCLUSION: Adjuvant intravesical therapy with BCG with repeated cystoscopies, and delayed radical cystectomy until progression to the invasive disease carries a significant risk of mortality from invasive disease.
  • This treatment policy may be acceptable for T1G3 bladder TCC, without concomitant carcinoma in situ (CIS), who don't recur after intravesical BCG, however, patients who progress to invasive disease may skip stage II disease and present with stage III or IV, with consequent poor survival.
  • Therefore, due to the aggressive biologic behavior of T1G3 cancer, a determination of a cutoff number for recurrence(s) or better evaluation parameters are needed, to proceed with cystectomy without awaiting muscle invasion.
  • KEY WORDS: Superficial bladder cancer - T1G3 TCC - Delayed cystectomy - BCG.

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  • (PMID = 20571597.001).
  • [ISSN] 1110-0362
  • [Journal-full-title] Journal of the Egyptian National Cancer Institute
  • [ISO-abbreviation] J Egypt Natl Canc Inst
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Egypt
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9. Chung D, Hersey K, Fleshner N: Differences between urologists in United States and Canada in approach to bladder cancer. Urology; 2005 May;65(5):919-25
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Differences between urologists in United States and Canada in approach to bladder cancer.
  • OBJECTIVES: To determine the Canada-United States differences with respect to the detection, diagnosis, surveillance, and treatment of bladder cancer.
  • METHODS: A multiple-choice questionnaire was developed and mailed to 760 American and 516 Canadian urologists between November and December 2002.
  • The areas assessed by the questionnaire included demographics, screening, superficial disease and recurrence, surveillance, muscle-invasive disease, advanced disease, and adjuvant systemic chemotherapy.
  • With respect to bladder cancer detection, U.S. urologists were more likely to use intravenous urography and cystoscopy than were Canadian urologists (P <0.0001).
  • For patients with superficial disease, a significant proportion of urologists in both countries did not routinely use adjuvant chemotherapy.
  • Striking differences were noted in the approach to Stage T2a disease, with U.S. urologists advocating radical cystectomy more frequently (P <0.0001).
  • With respect to the type of urinary diversion, Canadian urologists tended to favor conduits (P <0.0001, male and P = 0.002, female).
  • Canadian urologists were also less likely to use adjuvant chemotherapy among patients with advanced disease.
  • CONCLUSIONS: The results of our study have shown that the trend of urologists in the United States is toward more aggressive screening, closer surveillance, an earlier trigger for cystectomy, and more common indications for intravenous chemotherapy.
  • [MeSH-major] Carcinoma, Transitional Cell / therapy. Practice Patterns, Physicians'. Urinary Bladder Neoplasms / therapy. Urology
  • [MeSH-minor] Adult. Aged. Attitude of Health Personnel. Canada. Carcinoma in Situ. Female. Health Care Surveys. Humans. Male. Middle Aged. Surveys and Questionnaires. United States

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  • (PMID = 15882724.001).
  • [ISSN] 1527-9995
  • [Journal-full-title] Urology
  • [ISO-abbreviation] Urology
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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10. Izawa JI, Slaton JW, Kedar D, Karashima T, Perrotte P, Czerniak B, Grossman HB, Dinney CP: Differential expression of progression-related genes in the evolution of superficial to invasive transitional cell carcinoma of the bladder. Oncol Rep; 2001 Jan-Feb;8(1):9-15
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  • [Title] Differential expression of progression-related genes in the evolution of superficial to invasive transitional cell carcinoma of the bladder.
  • It is generally accepted that there are dichotomous biologic pathways that lead to the development of either: i) superficial papillary (Ta) transitional cell carcinoma (TCC) or ii) precursor lesions to muscle-invasive (CIS, T1) TCC and muscle-invasive (> or =T2) TCC.
  • Using a colorimetric in situ hybridization technique, we examined the expression of mRNAs of several progression-related genes in archival, pathologic specimens from 77 patients with bladder TCC.
  • Gene expression was normalized using poly (dT) and the expression of each factor in a panel of specimens of normal urothelium.
  • Patients were stratified according to disease stage, and the level of gene expression among the stratified groups was compared.
  • The pattern of expression of bFGF, VEGF, IL-8, MMP-9, and EGFR represent the divergent developmental pathways in the pathogenesis of bladder TCC, which characterizes superficial or invasive bladder cancer. bFGF, IL-8, and EGFR appear to be upregulated in early precursor lesions (CIS), whereas VEGF appears to be upregulated at later stages in the development of muscle-invasive TCC.
  • [MeSH-major] Carcinoma, Transitional Cell / genetics. Gene Expression Regulation, Neoplastic. Neoplasm Proteins / genetics. Urinary Bladder Neoplasms / genetics
  • [MeSH-minor] Carcinoma in Situ / genetics. Carcinoma in Situ / metabolism. Carcinoma in Situ / pathology. Colorimetry. Disease Progression. Endothelial Growth Factors / biosynthesis. Endothelial Growth Factors / genetics. Growth Substances / biosynthesis. Growth Substances / genetics. Humans. Image Processing, Computer-Assisted. In Situ Hybridization. Interleukin-8 / biosynthesis. Interleukin-8 / genetics. Lymphokines / biosynthesis. Lymphokines / genetics. Matrix Metalloproteinase 9 / biosynthesis. Matrix Metalloproteinase 9 / genetics. Neoplasm Invasiveness. Neoplasm Staging. RNA, Messenger / biosynthesis. RNA, Messenger / genetics. RNA, Neoplasm / biosynthesis. RNA, Neoplasm / genetics. Receptors, Growth Factor / biosynthesis. Receptors, Growth Factor / genetics. Staining and Labeling. Vascular Endothelial Growth Factor A. Vascular Endothelial Growth Factors

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  • (PMID = 11115562.001).
  • [ISSN] 1021-335X
  • [Journal-full-title] Oncology reports
  • [ISO-abbreviation] Oncol. Rep.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA-16672; United States / NCI NIH HHS / CA / CA56973; United States / NCI NIH HHS / CA / CA67914
  • [Publication-type] Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] GREECE
  • [Chemical-registry-number] 0 / Endothelial Growth Factors; 0 / Growth Substances; 0 / Interleukin-8; 0 / Lymphokines; 0 / Neoplasm Proteins; 0 / RNA, Messenger; 0 / RNA, Neoplasm; 0 / Receptors, Growth Factor; 0 / Vascular Endothelial Growth Factor A; 0 / Vascular Endothelial Growth Factors; EC 3.4.24.35 / Matrix Metalloproteinase 9
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11. Dotan ZA, Kavanagh K, Yossepowitch O, Kaag M, Olgac S, Donat M, Herr HW: Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival. J Urol; 2007 Dec;178(6):2308-12; discussion 2313
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  • [Title] Positive surgical margins in soft tissue following radical cystectomy for bladder cancer and cancer specific survival.
  • PURPOSE: We evaluated risk factors for positive soft tissue surgical margins and the impact of soft tissue surgical margins on metastatic progression and disease specific survival in patients treated with radical cystectomy for bladder cancer.
  • MATERIALS AND METHODS: A total of 1,589 patients who underwent radical cystectomy for primary urothelial cancer at our institution were included in the study.
  • Several variables were analyzed including gender, age, use of perioperative chemotherapy, tumor stage, tumor grade, presence of carcinoma in situ, pathological vascular invasion, bladder pathology, status of soft tissue surgical margins, lymph node status, number of lymph nodes removed and number of positive lymph nodes.
  • RESULTS: Positive soft tissue surgical margins were detected in 67 patients (4.2%).
  • Risk factors for positive soft tissue surgical margins were female gender (p = 0.04), pathological stage, vascular invasion in the radical cystectomy specimen, lymph node metastases (all p < or = 0.001) and median number of positive lymph nodes (p = 0.002).
  • In addition, nonpure transitional cell carcinoma histology (p = 0.001) was associated with positive soft tissue surgical margins.
  • In the 5 years after cystectomy, rates of disease specific survival for the negative and positive soft tissue surgical margin groups were 72% (95% CI 69-75) and 32% (95% CI 19-54), respectively.
  • On multivariate analysis disease specific death was associated with tumor stage, positive soft tissue surgical margins, vascular invasion, presence of positive lymph nodes, number of nodes removed and number of positive nodes.
  • CONCLUSIONS: Risk factors for positive soft tissue surgical margins are female gender, locally advanced cancer, presence of vascular invasion and mixed histology.
  • Patients with positive soft tissue surgical margins have poor prognosis, and positive soft tissue surgical margins were found to be independently associated with disease specific death.
  • [MeSH-major] Carcinoma, Transitional Cell / mortality. Carcinoma, Transitional Cell / surgery. Cystectomy / methods. Neoplasm Recurrence, Local / prevention & control. Urinary Bladder Neoplasms / mortality. Urinary Bladder Neoplasms / surgery

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  • [CommentIn] J Urol. 2007 Dec;178(6):2249 [17936808.001]
  • (PMID = 17936804.001).
  • [ISSN] 1527-3792
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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12. Shariat SF, Chade DC, Karakiewicz PI, Ashfaq R, Isbarn H, Fradet Y, Bastian PJ, Nielsen ME, Capitanio U, Jeldres C, Montorsi F, Lerner SP, Sagalowsky AI, Cote RJ, Lotan Y: Combination of multiple molecular markers can improve prognostication in patients with locally advanced and lymph node positive bladder cancer. J Urol; 2010 Jan;183(1):68-75
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  • [Title] Combination of multiple molecular markers can improve prognostication in patients with locally advanced and lymph node positive bladder cancer.
  • PURPOSE: We tested whether the combination of 4 established cell cycle regulators (p53, pRB, p21 and p27) could improve the ability to predict clinical outcomes in a large multi-institutional collaboration of patients with pT3-4N0 or pTany Npositive urothelial carcinoma of the bladder.
  • MATERIALS AND METHODS: The study comprised 692 patients with pT3-4N0 or pTany Npositive urothelial carcinoma of the bladder treated with radical cystectomy and bilateral lymphadenectomy (median followup 5.3 years).
  • Scoring was performed using advanced cell imaging and color detection software.
  • The base model incorporated patient age, gender, stage, grade, lymphovascular invasion, number of lymph nodes removed, number of positive lymph nodes, concomitant carcinoma in situ and adjuvant chemotherapy.
  • RESULTS: Individual molecular markers did not improve the predictive accuracy for disease recurrence and cancer specific mortality.
  • Moreover addition of number of altered molecular markers to the base model significantly improved the predictive accuracy for disease recurrence (3.9%, p <0.001) and cancer specific mortality (4.3%, p <0.001).
  • CONCLUSIONS: While the status of individual molecular markers does not add sufficient value to outcome prediction in patients with advanced urothelial carcinoma of the bladder, combinations of molecular markers may improve molecular staging, prognostication and possibly prediction of response to therapy.
  • [MeSH-major] Biomarkers, Tumor / analysis. Carcinoma, Transitional Cell / chemistry. Carcinoma, Transitional Cell / mortality. Urinary Bladder Neoplasms / chemistry. Urinary Bladder Neoplasms / mortality

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  • (PMID = 19913255.001).
  • [ISSN] 1527-3792
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Cyclin-Dependent Kinase Inhibitor p21; 0 / Proliferating Cell Nuclear Antigen; 0 / Retinoblastoma Protein; 0 / Tumor Suppressor Protein p53; 0 / p27 antigen
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13. Karakiewicz PI, Shariat SF, Palapattu GS, Gilad AE, Lotan Y, Rogers CG, Vazina A, Gupta A, Bastian PJ, Perrotte P, Sagalowsky AI, Schoenberg M, Lerner SP: Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder. J Urol; 2006 Oct;176(4 Pt 1):1354-61; discussion 1361-2
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  • [Title] Nomogram for predicting disease recurrence after radical cystectomy for transitional cell carcinoma of the bladder.
  • PURPOSE: American Joint Committee on Cancer staging represents the gold standard for prediction of recurrence after radical cystectomy in patients with invasive bladder cancer.
  • We tested the hypothesis that American Joint Committee on Cancer stage based predictions may be improved when pathological tumor and node stage information is combined with additional clinical and pathological variables within a prognostic nomogram.
  • MATERIALS AND METHODS: We used Cox proportional hazards regression analysis to model variables of 728 patients with transitional cell carcinoma of the bladder treated with radical cystectomy and bilateral pelvic lymphadenectomy at 1 of 3 participating institutions.
  • Standard predictors, pT and pN, were complemented by age, gender, tumor grade at cystectomy, presence of lymphovascular invasion, presence of carcinoma in situ in the cystectomy specimen, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiotherapy.
  • Recurrence was recorded in 249 (34.2%) patients with a median time to recurrence of 108 months (range 0.8 to 131.9).
  • Two-hundred bootstrap corrected predictive accuracy of American Joint Committee on Cancer stage based predictions was 0.748.
  • Accuracy increased by 3.2% (0.780) when age, lymphovascular invasion, carcinoma in situ, neoadjuvant chemotherapy, adjuvant chemotherapy and adjuvant radiotherapy were added to pathological stage information and used within a nomogram.
  • CONCLUSIONS: A nomogram predicting bladder cancer recurrence after cystectomy is 3.2% more accurate than American Joint Committee on Cancer stage based predictions.
  • [MeSH-major] Carcinoma, Transitional Cell / surgery. Cystectomy. Lymph Node Excision. Neoplasm Recurrence, Local / etiology. Nomograms. Urinary Bladder Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Cohort Studies. Female. Humans. Male. Middle Aged. Pelvis. Predictive Value of Tests. Proportional Hazards Models. Treatment Outcome

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  • (PMID = 16952631.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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14. Stein JP, Cai J, Groshen S, Skinner DG: Risk factors for patients with pelvic lymph node metastases following radical cystectomy with en bloc pelvic lymphadenectomy: concept of lymph node density. J Urol; 2003 Jul;170(1):35-41
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • MATERIALS AND METHODS: From July 1971 through December 1997, 1,054 patients underwent radical cystectomy and bilateral pelvic-iliac lymphadenectomy for high grade, invasive transitional cell carcinoma of the bladder.
  • Overall 139 of the 244 patients (57%) received some form of chemotherapy.
  • At a median followup of greater than 10 years (range 0 to 28) outcomes data were analyzed in univariate analysis according to tumor grade, carcinoma in situ, primary bladder tumor stage, pathological subgroups, total number of lymph nodes removed and involved with tumor, and lymph node density (total number of positive lymph nodes/total number removed).
  • In addition, the form of urinary diversion and the administration of chemotherapy were also evaluated.
  • RESULTS: The incidence of positive lymph nodes increased with higher p stage and pathological subgroups.
  • Patients with lymph node positive disease and an organ confined primary bladder tumor had significantly improved 10-year recurrence-free survival compared with those with extravesical tumor extension (44% vs 30%, p = 0.003).
  • On multivariate analysis the total number of lymph nodes involved, pathological subgroups of the primary bladder tumor, lymph node density and adjuvant chemotherapy remained significant and independent risk factors for recurrence-free and overall survival.
  • CONCLUSIONS: Patients with lymph node tumor involvement following radical cystectomy may be stratified into high risk groups based on the primary bladder tumor, pathological subgroup, number of lymph nodes removed and total number of lymph nodes involved.
  • Future staging systems and the application of adjuvant therapies in clinical trials should consider applying lymph node density to help standardize this high risk group of patients following radical cystectomy.
  • [MeSH-major] Carcinoma, Transitional Cell / secondary. Carcinoma, Transitional Cell / surgery. Cystectomy. Lymph Node Excision. Urinary Bladder Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Disease Progression. Disease-Free Survival. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Prognosis. Regression Analysis. Risk Factors. Treatment Outcome

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  • (PMID = 12796639.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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15. Isbarn H, Sonpavde G, Shariat SF, Palapattu GS, Sagalowsky AI, Lotan Y, Schoenberg MP, Amiel GE, Lerner SP, Karakiewicz PI: Residual pathologic stage at radical cystectomy and risk stratification of patients with pT2N0 bladder cancer. J Clin Oncol; 2009 May 20;27(15_suppl):5076

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Residual pathologic stage at radical cystectomy and risk stratification of patients with pT2N0 bladder cancer.
  • : 5076 Background: We hypothesized that in patients with pT2N0 transitional cell carcinoma (TCC) of the urinary bladder, residual muscle-invasive disease at radical cystectomy (RC) may confer poorer outcomes than residual non-muscle invasive disease due to larger tumor volume and/or biologically more aggressive disease.
  • Patients with high-risk pT2N0 disease may be candidates for trials of adjuvant therapy.
  • METHODS: Patients from the BCRC database with pT2N0 stage (N = 208) at TUR (transurethral resection) whose tumors were organ-confined at RC (≤pT2N0) were analyzed.
  • None of the patients had received perioperative chemotherapy.
  • The effect of residual pT-stage at RC on outcomes was evaluated in Kaplan-Meier, as well as in univariable and multivariable Cox-regression models.
  • Covariates consisted of age, gender, grade, lymphovascular invasion, concomitant carcinoma-in-situ (CIS), number of lymph nodes removed, and the year of surgery.
  • RESULTS: Among baseline T2N0 patients, residual pT-stage at RC was pT0 in 24 (11.5%), pTa in 9 (4.3%), pCIS in 22 (10.6%), pT1 in 35 (16.8%), and pT2 in 118 patients (56.7%).
  • The 5-year cancer-specific survival rates for the same patient cohorts were 100%, 93%, and 81%, respectively.
  • In multivariable analyses, the effect of residual stage <pT2 at RC achieved independent predictor status for recurrence (adjusted HR 0.20; p = 0.002), as well as for cancer-specific survival (adjusted HR: 0.24; p = 0.02).
  • CONCLUSIONS: Patients with pT2N0 TCC of the urinary bladder with residual non-muscle invasive disease at RC have significantly better long-term outcomes compared to residual muscle-invasive disease.
  • With further validation, these data may facilitate the risk-stratification of patients with pT2N0 disease and enable the selection of high-risk patients for trials of adjuvant therapy.

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  • (PMID = 27964272.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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16. Lamm DL, Blumenstein BA, Crissman JD, Montie JE, Gottesman JE, Lowe BA, Sarosdy MF, Bohl RD, Grossman HB, Beck TM, Leimert JT, Crawford ED: Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study. J Urol; 2000 Apr;163(4):1124-9
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  • [Title] Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study.
  • PURPOSE: Bacillus Calmette-Guerin (BCG) immunotherapy has been widely accepted as the optimal treatment for carcinoma in situ and high grade superficial transitional cell carcinoma.
  • However, controversy remains regarding the role of maintenance therapy, and its long-term effect on recurrence and progression.
  • MATERIALS AND METHODS: All patients in the study had transitional cell carcinoma of the bladder with carcinoma in situ or an increased risk of recurrence.
  • At least 1 week following biopsy of carcinoma in situ and resection of any stage Ta or T1 transitional cell tumors 660 patients were started on a 6-week induction course of intravesical and percutaneous Connaught BCG.
  • Three months following initiation of BCG induction therapy 550 consenting patients were stratified by purified protein derivative skin test and the presence of carcinoma in situ, and then randomized by central computer to receive BCG maintenance therapy (maintenance arm) or no BCG maintenance therapy (no maintenance arm).
  • Maintenance therapy consisted of intravesical and percutaneous BCG each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months from initiation of induction therapy.
  • All patients were followed for adverse effects of treatment, recurrence, disease worsening and survival.
  • Estimated median time for worsening-free survival, defined as no evidence of progression including pathological stage T2 disease or greater, or the use of cystectomy, systemic chemotherapy or radiation therapy, was 111.5 months in the no maintenance and not estimable in the maintenance arm (log rank p = 0.04).
  • CONCLUSIONS: Compared to standard induction therapy maintenance BCG immunotherapy was beneficial in patients with carcinoma in situ and select patients with Ta, T1 bladder cancer.
  • Median recurrence-free survival time was twice as long in the 3-week maintenance arm compared to the no maintenance arm, and patients had significantly longer worsening-free survival.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma in Situ / pathology. Carcinoma in Situ / therapy. Carcinoma, Transitional Cell / pathology. Carcinoma, Transitional Cell / therapy. Neoplasm Recurrence, Local / pathology. Neoplasm Recurrence, Local / therapy. Neoplasms, Multiple Primary / pathology. Neoplasms, Multiple Primary / therapy. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / pathology

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  • (PMID = 10737480.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA04919; United States / NCI NIH HHS / CA / CA32102; United States / NCI NIH HHS / CA / CA38926; etc
  • [Publication-type] Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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17. Kassouf W, Swanson D, Kamat AM, Leibovici D, Siefker-Radtke A, Munsell MF, Grossman HB, Dinney CP: Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the M. D. Anderson Cancer Center experience. J Urol; 2006 Jun;175(6):2058-62
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  • [Title] Partial cystectomy for muscle invasive urothelial carcinoma of the bladder: a contemporary review of the M. D. Anderson Cancer Center experience.
  • PURPOSE: Partial cystectomy is a surgical option for select patients diagnosed with urothelial carcinoma.
  • We review our experience with partial cystectomy for muscle invasive urothelial carcinoma to assess local control and survival rates.
  • MATERIAL AND METHODS: From 1982 to 2003 a total of 37 patients with muscle invasive urothelial carcinoma underwent partial cystectomy with curative intent.
  • Reviewed data included history of superficial tumors, presence of variant histology, tumor location, clinical stage, pathological stage, presence of carcinoma in situ, adjuvant therapy and disease status.
  • Of the 37 patients 19 (51%) did not have tumor recurrence, 9 (24%) had superficial recurrence in the bladder that was treated successfully and 9 (24%) had recurrence with advanced disease.
  • A total of 24 patients (65%) had an intact bladder with no evidence of disease after a median of 53 months.
  • There were 6 patients (16%) who died of bladder cancer, 3 of whom died of late recurrence of muscle invasive cancer (41, 44 and 138 months after partial cystectomy).
  • On multivariate analysis higher pathological stage (HR 3.4, p = 0.04) was associated with shorter recurrence-free survival.
  • A history of superficial tumors (p <0.01) and clinical stage (p = 0.01) was associated with advanced recurrence-free survival.
  • The use of adjuvant chemotherapy (HR 0.18, p = 0.03) was associated with prolonged advanced recurrence-free survival, however adjuvant chemotherapy did not impact overall survival.
  • CONCLUSIONS: Partial cystectomy provides adequate local control of muscle invasive bladder cancer in select patients.
  • [MeSH-major] Carcinoma, Transitional Cell / pathology. Carcinoma, Transitional Cell / surgery. Cystectomy / methods. Urinary Bladder Neoplasms / pathology. Urinary Bladder Neoplasms / surgery

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  • [CommentIn] J Urol. 2006 Jun;175(6):1987-8 [16697781.001]
  • (PMID = 16697803.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA16672; United States / NCI NIH HHS / CA / CA91846
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural
  • [Publication-country] United States
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18. Giannarini G, Kessler TM, Thoeny HC, Nguyen DP, Meissner C, Studer UE: Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution? Eur Urol; 2010 Oct;58(4):486-94
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  • [Title] Do patients benefit from routine follow-up to detect recurrences after radical cystectomy and ileal orthotopic bladder substitution?
  • BACKGROUND: The need for and intensity of follow-up to detect disease recurrence after radical cystectomy (RC) for transitional cell carcinoma (TCC) remains a matter for debate.
  • DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of 479 patients with nonmetastatic bladder TCC receiving no neoadjuvant chemotherapy/radiation therapy and prospectively followed with a standardised protocol for a median 4.3 yr (range: 0.3-20.9) after RC at an academic tertiary referral centre.
  • INTERVENTION: RC and extended pelvic lymph node dissection with ileal orthotopic bladder substitution.
  • MEASUREMENTS: Cancer-specific survival (CSS) and overall survival (OS) probability for asymptomatic and symptomatic recurrent patients were estimated using the Kaplan-Meier method.
  • The effects of age, nerve-sparing surgery, pathologic tumour stage, lymph node status, adjuvant chemotherapy, mode of recurrence diagnosis, and recurrence site on survival were assessed with multivariable Cox regression models.
  • Of 24 patients with urethral recurrences, 13 had carcinoma in situ (CIS).
  • Of these, 12 were successfully managed with urethra-sparing treatment, and 6 are still alive with no evidence of disease.
  • Routine follow-up appears particularly effective in early detection of urethral CIS, which can be treated conservatively.
  • [MeSH-major] Carcinoma, Transitional Cell / diagnosis. Carcinoma, Transitional Cell / surgery. Cystectomy. Ileum / transplantation. Neoplasm Recurrence, Local / diagnosis. Urinary Bladder Neoplasms / diagnosis. Urinary Bladder Neoplasms / surgery. Urinary Reservoirs, Continent
  • [MeSH-minor] Aged. Early Detection of Cancer. Female. Follow-Up Studies. Humans. Male. Middle Aged. Retrospective Studies. Time Factors

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  • [Copyright] Copyright 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.
  • [CommentIn] Eur Urol. 2010 Oct;58(4):495-7 [20609511.001]
  • (PMID = 20541311.001).
  • [ISSN] 1873-7560
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
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19. Peyromaure M, Slama J, Beuzeboc P, Ponvert D, Debré B, Zerbib M: Concurrent chemoradiotherapy for clinical stage T2 bladder cancer: report of a single institution. Urology; 2004 Jan;63(1):73-7
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  • [Title] Concurrent chemoradiotherapy for clinical stage T2 bladder cancer: report of a single institution.
  • OBJECTIVES: To report our experience with concurrent chemoradiotherapy for clinical Stage T2 bladder cancer.
  • METHODS: From 1996 to 2002, 43 patients were treated with concurrent chemotherapy and radiotherapy for clinical Stage T2 bladder cancer.
  • After complete bladder transurethral resection, all patients underwent chemotherapy, consisting of one daily infusion of cisplatin at a dose of 15 mg/m2 and 5-fluorouracil at a dose of 400 mg/m(2) on days 1 to 3 (first cycle) and days 15 to 17 (second cycle).
  • Pelvic irradiation was administered at a dose of 24 Gy, using two daily fractions of 3 Gy on days 1, 3, 15, and 17.
  • Two factors correlated with patient survival: the presence of carcinoma in situ at first resection (P = 0.01) and the response after the first two cycles (half dose; P = 0.004).
  • CONCLUSIONS: In our experience, concurrent chemoradiotherapy is less effective than primary cystectomy for clinical Stage T2 bladder cancer.
  • This treatment may be unwarranted in patients with concomitant carcinoma in situ at the first resection.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Carcinoma, Transitional Cell / therapy. Chemotherapy, Adjuvant. Radiotherapy, Adjuvant. Urinary Bladder Neoplasms / therapy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. BCG Vaccine / therapeutic use. Carboplatin / administration & dosage. Cisplatin / administration & dosage. Combined Modality Therapy. Cystectomy / methods. Disease-Free Survival. Female. Fluorouracil / administration & dosage. Follow-Up Studies. Humans. Life Tables. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Recurrence, Local / surgery. Neoplasm Staging. Survival Analysis. Treatment Outcome

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  • (PMID = 14751352.001).
  • [ISSN] 1527-9995
  • [Journal-full-title] Urology
  • [ISO-abbreviation] Urology
  • [Language] eng
  • [Publication-type] Evaluation Studies; Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / BCG Vaccine; BG3F62OND5 / Carboplatin; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
  • [Number-of-references] 19
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20. Isbarn H, Karakiewicz PI, Shariat SF, Capitanio U, Palapattu GS, Sagalowsky AI, Lotan Y, Schoenberg MP, Amiel GE, Lerner SP, Sonpavde G: Residual pathological stage at radical cystectomy significantly impacts outcomes for initial T2N0 bladder cancer. J Urol; 2009 Aug;182(2):459-65; discussion 465
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  • [Title] Residual pathological stage at radical cystectomy significantly impacts outcomes for initial T2N0 bladder cancer.
  • PURPOSE: We hypothesized that in patients with T2N0 stage disease at transurethral bladder tumor resection a lower residual cancer stage (P1N0 or less) at radical cystectomy may correlate with improved outcomes relative to those with residual P2N0 disease.
  • MATERIALS AND METHODS: We analyzed 208 patients with T2N0 stage disease at transurethral bladder tumor resection whose tumors were organ confined at radical cystectomy (P2 or lower, pN0).
  • None received perioperative chemotherapy.
  • Kaplan-Meier as well as univariable and multivariable Cox regression models addressed the effect of residual pT stage at radical cystectomy on recurrence and cancer specific mortality rates.
  • Covariates consisted of age, gender, grade, lymphovascular invasion, carcinoma in situ, number of lymph nodes removed and year of surgery.
  • RESULTS: Residual pT stage at radical cystectomy was P0 in 24 (11.5%) patients, Pa in 9 (4.3%), PCIS in 22 (10.6%), P1 in 35 (16.8%) and P2 in 118 (56.7%).
  • Median followup of censored patients was 55.7 months for recurrence and 52.1 months for cancer specific mortality analyses.
  • The 5-year recurrence-free survival rates of patients with P0/Pa/PCIS, P1 and P2 stage disease were 100%, 85% and 75%, respectively.
  • The 5-year cancer specific survival rates for the same cohorts were 100%, 93% and 81%, respectively.
  • On multivariable analysis the effect of residual stage P1 or lower at radical cystectomy achieved independent predictor status for recurrence (adjusted HR 0.20, p = 0.002) and cancer specific mortality (adjusted HR 0.24, p = 0.02).
  • CONCLUSIONS: Down staging from initial T2N0 bladder cancer at transurethral bladder tumor resection to lower stage at radical cystectomy significantly reduces recurrence and cancer specific mortality.
  • [MeSH-major] Carcinoma, Transitional Cell / pathology. Carcinoma, Transitional Cell / surgery. Cystectomy. Urinary Bladder Neoplasms / pathology. Urinary Bladder Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Humans. Male. Middle Aged. Neoplasm Staging. Neoplasm, Residual. Treatment Outcome

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  • [CommentIn] J Urol. 2009 Aug;182(2):423-4 [19524952.001]
  • (PMID = 19524971.001).
  • [ISSN] 1527-3792
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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21. Gaya JM, Palou J, Algaba F, Arce J, Rodríguez-Faba O, Villavicencio H: The case for conservative management in the treatment of patients with non-muscle-invasive micropapillary bladder carcinoma without carcinoma in situ. Can J Urol; 2010 Oct;17(5):5370-6
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  • [Title] The case for conservative management in the treatment of patients with non-muscle-invasive micropapillary bladder carcinoma without carcinoma in situ.
  • INTRODUCTION: Micropapillary carcinoma is a rare pathologic variant of urothelial cell carcinoma.
  • We assess the treatment response and disease progression in patients with micropapillary carcinoma of the bladder.
  • MATERIALS AND METHODS: The study comprised 18 patients with micropapillary carcinoma of the bladder who underwent transurethral resection of a bladder tumor and multiple random biopsies between 1997 and 2003.
  • We retrospectively analyzed treatment response and clinical and pathological cancer evolution related to cancer stage and the percentage of the micropapillary component of the cancer.
  • RESULTS: Seven of the 18 patients (38.8%) had carcinoma in situ.
  • At diagnosis, 8 of the 18 patients had non-muscle-invasive bladder cancer; 6 of these patients were treated with intravesical BCG therapy and were alive and free of disease at a median follow up of more than 5 years.
  • Ten of the 18 patients had muscle-invasive bladder cancer; 8 of these patients underwent radical cystectomy, and 7 of the 8 patients (87.5%) had non-organ-confined disease in cystectomy specimens.
  • Seventy percent of patients with muscle-invasive disease at diagnosis had a micropapillary carcinoma component of more than 50% in transurethral resection of the bladder specimens, compared with only 25% of patients with non-muscle-invasive disease.
  • Patients treated successfully with intravesical BCG therapy had a low micropapillary carcinoma component.
  • The 5-year disease-specific survival rate was significantly lower in patients with muscle-invasive disease (30%) than in patients with non-muscle-invasive disease (87.5%) after a median follow up of 52 months (p = 0.001), and it was also significantly lower in patients with a high percentage of the micropapillary component of the carcinoma.
  • CONCLUSIONS: This retrospective study of 18 patients with micropapillary carcinoma of the bladder suggests that tumor stage and patient outcome may be related to the percentage of the micropapillary component of the carcinoma.
  • In non-muscle-invasive disease and in the absence of associated carcinoma in situ, intravesical BCG treatment may be offered when the micropapillary component of the carcinoma component is a small percentage.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma in Situ / drug therapy. Carcinoma in Situ / pathology. Carcinoma, Papillary / drug therapy. Carcinoma, Papillary / pathology. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / pathology
  • [MeSH-minor] Aged. Aged, 80 and over. Cystectomy. Disease Progression. Female. Humans. Kaplan-Meier Estimate. Male. Middle Aged. Neoplasm Invasiveness. Neoplasm Staging. Retrospective Studies. Statistics, Nonparametric. Survival Analysis. Treatment Outcome. Urothelium / pathology

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  • (PMID = 20974029.001).
  • [ISSN] 1195-9479
  • [Journal-full-title] The Canadian journal of urology
  • [ISO-abbreviation] Can J Urol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Canada
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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22. Quek ML, Nichols PW, Yamzon J, Daneshmand S, Miranda G, Cai J, Groshen S, Stein JP, Skinner DG: Radical cystectomy for primary neuroendocrine tumors of the bladder: the university of southern california experience. J Urol; 2005 Jul;174(1):93-6
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  • [Title] Radical cystectomy for primary neuroendocrine tumors of the bladder: the university of southern california experience.
  • PURPOSE: Primary neuroendocrine tumors of the bladder are rare and they include small and large cell variants.
  • MATERIALS AND METHODS: From August 1971 to June 2004, 2,005 patients underwent radical cystectomy for primary bladder cancer at our institution, of whom 25 (1.2%) had neuroendocrine tumors of the bladder, including small cell carcinoma in 20 and large cell carcinoma in 5.
  • Pure neuroendocrine-type histology was identified in 16 cases, including 1 with small and large cell features, while the remaining 9 had mixed histology, that is transitional cell carcinoma in 8 and adenocarcinoma in 1.
  • Multi-agent chemotherapy was administered to 14 patients.
  • These tumors tended to have a flat, ulcerative gross appearance with lymphovascular invasion, carcinoma in situ and necrosis present microscopically.
  • There was no significant survival difference between small and large cell carcinoma.
  • Patients receiving multimodality therapy had significantly better overall (p = 0.051) and recurrence-free (p = 0.003) survival than those treated with cystectomy alone.
  • CONCLUSIONS: Neuroendocrine tumors of the bladder usually present with advanced pathological stage and portend a poor prognosis.
  • Adjuvant chemotherapy protocols may provide improved survival compared with cystectomy alone.
  • [MeSH-major] Cystectomy / methods. Neuroendocrine Tumors / surgery. Urinary Bladder Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Follow-Up Studies. Humans. Male. Middle Aged. Retrospective Studies. Survival Rate. Time Factors

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  • (PMID = 15947585.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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23. Uchio EM, Linehan WM, Figg WD, Walther MM: A phase I study of intravesical suramin for the treatment of superficial transitional cell carcinoma of the bladder. J Urol; 2003 Jan;169(1):357-60
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  • [Title] A phase I study of intravesical suramin for the treatment of superficial transitional cell carcinoma of the bladder.
  • PURPOSE: Suramin is a polysulfonated naphthylurea that inhibits proliferation and DNA synthesis of transitional cell carcinoma cell lines.
  • Its large molecular size and negative charge inhibit bladder absorption, making suramin an excellent candidate for intravesical chemotherapy.
  • MATERIALS AND METHODS: Intravesical suramin treatment was administered in 9 patients with histologically identified transitional cell carcinoma (Tcis, Ta or T1) in whom at least 1 course of standard intravesical chemotherapy (bacillus Calmette-Guerin, thiotepa or mitomycin C) had failed.
  • RESULTS: The 9 patients underwent 54 treatments with suramin.
  • Plasma suramin concentration after treatment was 1.9 to 38.0 microg.
  • /ml. and was not related to treatment dose.
  • Complications included self-limited bladder spasms (less than 24 hours) in 4 of 54 treatments (7%) and new or worsening vesicoureteral reflux in 3 ureters (17%).
  • Another patient who was treated after the Foley balloon was inflated in the urethra experienced bladder spasms, skin flushing and fever (39C).
  • Mean bladder capacity before and after treatment was 600 and 540 ml., respectively.
  • At followup 7 patients had stage Ta tumors and 2 had carcinoma in situ.
  • /ml was defined as a safe treatment parameter with acceptable plasma concentrations and minimal side effects.
  • Phase II studies are needed to assess the antitumor activity of suramin in patients with transitional cell carcinoma of the bladder.
  • [MeSH-major] Antineoplastic Agents / administration & dosage. Carcinoma, Transitional Cell / drug therapy. Suramin / administration & dosage. Urinary Bladder Neoplasms / drug therapy

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  • (PMID = 12478189.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase I; Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 6032D45BEM / Suramin
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24. Karakiewicz PI, Shariat SF, Palapattu GS, Perrotte P, Lotan Y, Rogers CG, Amiel GE, Vazina A, Gupta A, Bastian PJ, Sagalowsky AI, Schoenberg M, Lerner SP: Precystectomy nomogram for prediction of advanced bladder cancer stage. Eur Urol; 2006 Dec;50(6):1254-60; discussion 1261-2
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  • [Title] Precystectomy nomogram for prediction of advanced bladder cancer stage.
  • The first set of models predicted pT(3-4) stage at cystectomy, and the second set predicted pN(1-3) stages at cystectomy.
  • Transurethral resection (TUR) predictors consisted of 2002 T stage, 1973 WHO tumour grade, presence of carcinoma in situ, age, gender, and delivery of neo-adjuvant chemotherapy.
  • The multivariate pT(3-4) nomogram was 75.7% accurate versus 71.4% for TUR T stage.
  • The multivariate pN(1-3) nomogram was 63.1% accurate versus 61.0% for TUR T stage.
  • CONCLUSION: Multivariate nomograms are not perfect, but they do predict more accurately than TUR T stage alone.
  • [MeSH-major] Cystectomy. Nomograms. Preoperative Care / methods. Urinary Bladder Neoplasms / pathology

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  • (PMID = 16831511.001).
  • [ISSN] 0302-2838
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] Switzerland
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25. Saint F, Le Frere Belda MA, Quintela R, Hoznek A, Patard JJ, Bellot J, Popov Z, Zafrani ES, Abbou CC, Chopin DK, de Medina SG: Pretreatment p53 nuclear overexpression as a prognostic marker in superficial bladder cancer treated with Bacillus Calmette-Guérin (BCG). Eur Urol; 2004 Apr;45(4):475-82
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  • [Title] Pretreatment p53 nuclear overexpression as a prognostic marker in superficial bladder cancer treated with Bacillus Calmette-Guérin (BCG).
  • INTRODUCTION: Altered p53 gene product correlates with the stage and grade of bladder tumor, but its value as a predictor of BCG response has been disappointing.
  • In order to revisit the prognostic value of pretreatment p53 nuclear overexpression for the BCG response, we studied a large cohort of consecutive patients with superficial bladder cancer treated with BCG.
  • METHODS: From 1988 to 2001, 102 patients with a history of multifocal, recurrent, and/or high-risk papillary transitional cell carcinoma or carcinoma in situ, were treated for the first time with BCG. p53 immunostaining was performed on paraffin-embedded tissues using monoclonal antibody DO7 and an automated immunostainer.
  • Times to recurrence, progression and cancer death were shorter among patients with p53 overexpression (p = 0.03; p < 0.0001; p = 0.0003).
  • CONCLUSION: Pretreatment p53 nuclear overexpression in superficial bladder tumors is associated with a high risk of disease recurrence, progression and cancer death after BCG therapy.
  • Applying antibody DO7 with an automated immunostainer and stringent fixative conditions, p53 nuclear immunostaining yields clinically relevant information and may be a useful tool for selecting patients with superficial bladder cancer who might be resistant to BCG.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma, Transitional Cell / drug therapy. Carcinoma, Transitional Cell / genetics. Tumor Suppressor Protein p53 / biosynthesis. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / genetics

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  • (PMID = 15041112.001).
  • [ISSN] 0302-2838
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine; 0 / Tumor Suppressor Protein p53
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26. Manyak MJ, Ogan K: Photodynamic therapy for refractory superficial bladder cancer: long-term clinical outcomes of single treatment using intravesical diffusion medium. J Endourol; 2003 Oct;17(8):633-9
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  • [Title] Photodynamic therapy for refractory superficial bladder cancer: long-term clinical outcomes of single treatment using intravesical diffusion medium.
  • BACKGROUND: Diffuse superficial transitional-cell carcinoma (TCC) refractory to standard therapies poses a clinical dilemma.
  • Photodynamic therapy (PDT), which uses an interaction between absorbed light and a retained photosensitizing agent to destroy tissue, has been used to treat diffuse superficial bladder TCC, although there are few reports of long-term outcomes.
  • PATIENTS AND METHODS: A series of 34 patients, 29 with TCC carcinoma in situ (CIS) and 5 with multiple small papillary stage T(a) or T(1) lesions, received porfimer sodium (P) 48 hours before whole-bladder PDT with 630-nm laser light.
  • A 0.02% soybean emulsion diffusion medium was instilled into the bladder, and the laser optical fiber was positioned under triplanar sonography prior to PDT.
  • The mean time to recurrence in the CR group was 9.8 months, and five members of this group (36%) underwent cystectomy (mean time 20 months) for persistent/progressive disease (N = 3) or bladder contracture (N = 2).
  • In the NR group, 6 (43%) underwent cystectomy (mean time 14 months) for persistent/progressive disease.
  • Metastatic bladder cancer was the cause of death in only 4 of the 12 patients who have died.
  • Of the remaining 22 patients, 15 are still alive and have an intact bladder, nine with no disease and six with only superficial disease.
  • CONCLUSION: This is the first report of long-term results following whole-bladder PDT using diffusion medium for isotropic light distribution.
  • More than half of the patients with TCC refractory to traditional intravesical therapy received benefit from a single PDT session.
  • Patients who achieve a CR have less likelihood of and longer time interval before needing cystectomy for progressive disease than NR patients.

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  • (PMID = 14622483.001).
  • [ISSN] 0892-7790
  • [Journal-full-title] Journal of endourology
  • [ISO-abbreviation] J. Endourol.
  • [Language] ENG
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 97067-70-4 / Dihematoporphyrin Ether
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27. Seo HK, Cho KS, Chung J, Joung JY, Park WS, Chung MK, Lee KH: Prognostic value of p53 and Ki-67 expression in intermediate-risk patients with nonmuscle-invasive bladder cancer receiving adjuvant intravesical mitomycin C therapy. Urology; 2010 Aug;76(2):512.e1-7
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  • [Title] Prognostic value of p53 and Ki-67 expression in intermediate-risk patients with nonmuscle-invasive bladder cancer receiving adjuvant intravesical mitomycin C therapy.
  • OBJECTIVES: To analyze the prognostic values of p53 and Ki-67 expression in intermediate-risk patients with nonmuscle-invasive bladder cancer who were treated with adjuvant intravesical mitomycin C.
  • METHODS: From 2001 to 2006, 129 patients with nonmuscle-invasive bladder cancer who had undergone transurethral resection and adjuvant intravesical mitomycin C therapy.
  • Patients with primary, single, Stage TaG1 lesions and those with T1G3 or carcinoma in situ lesions were excluded.
  • The expression of p53 and Ki-67 was measured by immunohistochemistry on tissue sections after transurethral resection.
  • The clinical and pathologic data were collected in a prospectively maintained bladder cancer database program.
  • Of the 129 patients, 61 (47.3%) developed recurrence and 15 (11.6%) developed progression to muscle-invasive disease.
  • CONCLUSIONS: These results suggest that Ki-67 expression can identify a subset of intermediate-risk patients with nonmuscle-invasive bladder cancer in whom intravesical mitomycin C therapy could be effective.
  • [MeSH-major] Antibiotics, Antineoplastic / administration & dosage. Ki-67 Antigen / biosynthesis. Mitomycin / administration & dosage. Tumor Suppressor Protein p53 / biosynthesis. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / metabolism
  • [MeSH-minor] Administration, Intravesical. Adult. Aged. Aged, 80 and over. Chemotherapy, Adjuvant. Female. Humans. Male. Middle Aged. Neoplasm Invasiveness. Prognosis. Prospective Studies. Risk Factors

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  • [Copyright] Copyright 2010 Elsevier Inc. All rights reserved.
  • (PMID = 20579709.001).
  • [ISSN] 1527-9995
  • [Journal-full-title] Urology
  • [ISO-abbreviation] Urology
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antibiotics, Antineoplastic; 0 / Ki-67 Antigen; 0 / Tumor Suppressor Protein p53; 50SG953SK6 / Mitomycin
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28. Boorjian SA, Zhu F, Herr HW: The effect of gender on response to bacillus Calmette-Guérin therapy for patients with non-muscle-invasive urothelial carcinoma of the bladder. BJU Int; 2010 Aug;106(3):357-61
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  • [Title] The effect of gender on response to bacillus Calmette-Guérin therapy for patients with non-muscle-invasive urothelial carcinoma of the bladder.
  • OBJECTIVE: To determine the influence of gender on the outcome of patients with high-risk non-muscle-invasive bladder cancer treated with intravesical bacille Calmette-Guérin (BCG) therapy, as the role of hormone status in the pathogenesis of urothelial carcinoma and the response to treatment remains subject to debate.
  • PATIENTS AND METHODS: We reviewed 1021 consecutive patients (756 men and 265 women) who were treated with induction BCG between 1978 and 2006 for multiple or recurrent high-grade Ta, T1, and/or carcinoma in situ (CIS) bladder cancer.
  • The endpoints of initial response to BCG and the time to disease recurrence and progression were correlated with gender using Kaplan-Meier methods and multivariate Cox regression models.
  • RESULTS: Men were significantly more likely to present with high grade (P = 0.003) tumours and with CIS (P < 0.001), while age and clinical stage at presentation were similar between men and women.
  • There was no significant difference in the initial response to BCG by gender, as 593/756 (78.4%) men and 219/265 (82.6%) women had no evidence of disease at 6 months after BCG treatment (P = 0.14).
  • The median time to recurrence after BCG therapy was also similar for men and women (20 vs 21 months, P = 0.51).
  • Likewise, there was no evidence of a significant association between gender and the risk of disease progression after BCG therapy, such that the 5-year estimated freedom from progression was 77% and 82%, respectively, for men and women (P = 0.08).
  • Moreover, on a multivariate analysis controlling for patient age and tumour stage, grade and CIS, gender was not associated with the risk of recurrence (hazard ratio 0.94, 95% confidence interval 0.79-1.11; P = 0.44) or progression (1.18, 0.85-1.63; P = 0.33) after BCG.
  • CONCLUSION: These data suggest that the outcomes of men and women with high risk non-muscle-invasive urothelial carcinoma treated with BCG are similar.
  • As such, further studies are required to determine the clinical relevance of preclinical evidence that has suggested a potential role for sex steroids in the pathophysiology of bladder cancer.
  • [MeSH-major] Antineoplastic Agents / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma in Situ / drug therapy. Neoplasm Recurrence, Local / drug therapy. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Administration, Intravesical. Adult. Aged. Aged, 80 and over. Epidemiologic Methods. Female. Humans. Male. Middle Aged. Neoplasm Invasiveness. Sex Factors. Treatment Outcome. Urothelium. Young Adult

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  • (PMID = 20002665.001).
  • [ISSN] 1464-410X
  • [Journal-full-title] BJU international
  • [ISO-abbreviation] BJU Int.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / BCG Vaccine
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29. Lebret T, Bohin D, Kassardjian Z, Herve JM, Molinie V, Barre P, Lugagne PM, Botto H: Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations. J Urol; 2000 Jan;163(1):63-7
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  • [Title] Recurrence, progression and success in stage Ta grade 3 bladder tumors treated with low dose bacillus Calmette-Guerin instillations.
  • PURPOSE: Bacillus Calmette-Guerin (BCG) therapy is considered to be an effective prophylactic and therapeutic agent for high risk superficial transitional cell carcinoma of the bladder.
  • Nevertheless, in a select uncommon population of stage Ta grade 3 superficial lamina-free tumors the results of this treatment have not yet been well established.
  • We evaluated recurrence and progression rates, and the success of BCG therapy in a population with stage Ta grade 3 transitional cell carcinoma of the bladder.
  • MATERIALS AND METHODS: Of the 605 patients treated at our institution from 1982 to 1996 for the histopathological diagnosis of primary bladder cancer 32 (5.3%) with stage Ta grade 3 noninvasive primary bladder tumor were treated with intravesical instillations of 75 mg.
  • At a followup of 2 to 13 years (mean 58.4 months) patients were evaluated with urinary cytology, cystoscopy, transurethral resection and random mucosal biopsies.
  • Recurrence, grade and stage progression, death and causality were analyzed.
  • RESULTS: Of the 32 patients 9 (28%) responded positively to BCG without recurrence, while disease recurred as stage Ta in 8 (25%) and T1 in 7 (22%), and progressed to muscle layer infiltration in 8 (25%).
  • Four patients (12%) died of bladder cancer.
  • The number of tumors at primary resection, gross examination, the mitotic index or an association with carcinoma in situ did not appear to be predictive factors of progression to muscle invasion.
  • CONCLUSIONS: Our study demonstrates the high progression potential of stage Ta grade 3 tumors, since nearly 50% recurred and 25% progressed to invasive disease.
  • These results may be closely compared with the results of previous trials of stage T1 grade 3 disease.
  • We suggest that recurrence should be detected at an early stage using long-term followup with strict observance of the surveillance protocols during a minimum 5-year tumor-free period.
  • [MeSH-major] Adjuvants, Immunologic / administration & dosage. BCG Vaccine / administration & dosage. Carcinoma, Transitional Cell / drug therapy. Carcinoma, Transitional Cell / pathology. Neoplasm Recurrence, Local / epidemiology. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / pathology

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  • [CommentIn] J Urol. 2000 Jan;163(1):79-80 [10604318.001]
  • (PMID = 10604315.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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30. Duchek M, Johansson R, Jahnson S, Mestad O, Hellström P, Hellsten S, Malmström PU, Members of the Urothelial Cancer Group of the Nordic Association of Urology: Bacillus Calmette-Guérin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study. Eur Urol; 2010 Jan;57(1):25-31
Hazardous Substances Data Bank. EPIRUBICIN .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Bacillus Calmette-Guérin is superior to a combination of epirubicin and interferon-alpha2b in the intravesical treatment of patients with stage T1 urinary bladder cancer. A prospective, randomized, Nordic study.
  • BACKGROUND: Bacillus Calmette-Guérin (BCG) instillation is regarded as the most effective bladder-sparing treatment for patients with high-grade T1 tumours and carcinoma in situ (CIS).
  • The major problem with this therapy is the side-effects, making maintenance therapy difficult, even impossible, in a proportion of patients.
  • Thus, alternative schedules and drugs have been proposed.
  • OBJECTIVE: To compare BCG to the combination of epirubicin and interferon-alpha2b as adjuvant therapy of T1 tumours.
  • DESIGN, SETTING, AND PARTICIPANTS: This is a Nordic multicenter, prospective, randomised trial in patients with primary T1 G2-G3 bladder cancer.
  • Patients were randomised to receive either regimen, given as induction for 6 wk followed by maintenance therapy for 2 yr.
  • MEASUREMENTS: The drugs were compared with respect to time to recurrence and progression.
  • At 24 mo, there was a significant difference in favour of the BCG-treated patients (p=0.012) regarding recurrence, although there was no difference regarding progression.
  • In a multivariate analysis of association with recurrence/progression status, significant variables for outcome were type of drug, tumour size, multiplicity, status at second-look resection, and grade.
  • A corresponding analysis was performed separately in the two treatment arms.
  • There were no differences regarding progression and adverse events between the two treatments.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / administration & dosage. BCG Vaccine / administration & dosage. Carcinoma / drug therapy. Carcinoma / surgery. Cystectomy. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / surgery
  • [MeSH-minor] Administration, Intravesical. Aged. Chemotherapy, Adjuvant. Disease Progression. Disease-Free Survival. Epirubicin / administration & dosage. Female. Humans. Interferon-alpha / administration & dosage. Kaplan-Meier Estimate. Male. Neoplasm Recurrence, Local. Neoplasm Staging. Proportional Hazards Models. Prospective Studies. Recombinant Proteins. Risk Assessment. Risk Factors. Scandinavian and Nordic Countries. Time Factors. Treatment Outcome. Tumor Burden

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  • [CommentIn] Eur Urol. 2010 Jan;57(1):32-4 [19846251.001]
  • (PMID = 19819617.001).
  • [ISSN] 1873-7560
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / BCG Vaccine; 0 / Interferon-alpha; 0 / Recombinant Proteins; 3Z8479ZZ5X / Epirubicin; 99210-65-8 / interferon alfa-2b
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31. Andius P, Holmäng S: Bacillus Calmette-Guérin therapy in stage Ta/T1 bladder cancer: prognostic factors for time to recurrence and progression. BJU Int; 2004 May;93(7):980-4
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  • [Title] Bacillus Calmette-Guérin therapy in stage Ta/T1 bladder cancer: prognostic factors for time to recurrence and progression.
  • OBJECTIVE: To report prognostic factors for time to recurrence and progression after bacillus Calmette-Guérin (BCG) prophylaxis in patients with stage Ta/T1 papillary bladder cancer.
  • PATIENTS AND METHODS: The clinical records were assessed retrospectively for 236 patients with papillary stage Ta/T1 bladder cancer treated with BCG between 1986 and 2000.
  • Patients with known carcinoma in situ were excluded.
  • The effect of 13 variables on the time to recurrence and progression was evaluated using multivariate Cox proportional hazard regression and Kaplan-Meier analyses.
  • Patients with a negative first cystoscopy and maintenance BCG had a significantly longer time to recurrence than those treated with an induction course alone (P < 0.001).
  • Thirty-seven patients (16%) progressed in stage.
  • The result of the first cystoscopy (P < 0.001), tumour grade (P = 0.003) and six or fewer initial instillations (P = 0.002) had prognostic importance for the time to progression.
  • Twenty-eight patients (12%) had a history of an upper tract tumour, which was 3-10 times the expected rate.
  • Age, number of tumours, number of positive cystoscopies, length of tumour history before BCG, BCG strain and treatment year had no influence on time to recurrence and progression.
  • CONCLUSIONS: Maintenance treatment does not seem to be necessary among patients with TaG1-G2 disease after a negative first cystoscopy, as the progression rate was very low.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma, Transitional Cell / drug therapy. Neoplasm Recurrence, Local / prevention & control. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Administration, Intravesical. Adult. Aged. Aged, 80 and over. Cystectomy / methods. Disease Progression. Epidemiologic Methods. Female. Humans. Male. Middle Aged. Time Factors

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  • (PMID = 15142147.001).
  • [ISSN] 1464-4096
  • [Journal-full-title] BJU international
  • [ISO-abbreviation] BJU Int.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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32. Solsona E, Iborra I, Dumont R, Rubio-Briones J, Casanova J, Almenar S: The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol; 2000 Sep;164(3 Pt 1):685-9
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  • [Title] The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer.
  • PURPOSE: We analyzed the 3-month clinical response to intravesical therapy as a factor predictive of progression in patients with high risk superficial bladder cancer.
  • MATERIAL AND METHODS: We evaluated 191 patients with high risk superficial bladder cancer, 111 with secondary or associated bladder carcinoma in situ and 80 with stage T1 grade 3 disease who were treated with intravesical therapy.
  • To determine the predictive value of the 3-month clinical response we differentiated progression into superficial and invasive types.
  • Moreover, stratifying this variable showed that this response was the only independent factor predictive of invasive progression in cases of no response with stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement (p = 0).
  • In our series 41 patients (21.5%) did not respond after intravesical therapy at the 3-month evaluation, including 29 with stage T1 grade 3 disease, bladder carcinoma in situ, or prostate mucosa or duct involvement.
  • CONCLUSIONS: Invasive progression threatens the cause specific survival of patients with high risk superficial bladder cancer even when cystectomy is performed.
  • Early cystectomy should be considered when stage T1 grade 3 tumor, bladder carcinoma in situ, or prostate mucosa or duct involvement is present at the 3-month clinical evaluation.
  • [MeSH-major] Carcinoma / drug therapy. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Administration, Intravesical. Adult. Aged. Aged, 80 and over. Analysis of Variance. Antineoplastic Agents / administration & dosage. Antineoplastic Agents / therapeutic use. Carcinoma in Situ / drug therapy. Carcinoma in Situ / physiopathology. Chi-Square Distribution. Cystectomy. Cystoscopy. Disease Progression. Female. Follow-Up Studies. Forecasting. Humans. Male. Middle Aged. Multivariate Analysis. Neoplasm Invasiveness. Predictive Value of Tests. Proportional Hazards Models. Prostatic Neoplasms / pathology. Remission Induction. Risk Factors. Survival Rate. Treatment Outcome

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  • [CommentIn] J Urol. 2000 Sep;164(3 Pt 1):690-1 [10953126.001]
  • (PMID = 10953125.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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33. Shackley DC, Briggs C, Gilhooley A, Whitehurst C, O'Flynn KJ, Betts CD, Moore JV, Clarke NW: Photodynamic therapy for superficial bladder cancer under local anaesthetic. BJU Int; 2002 May;89(7):665-70
Hazardous Substances Data Bank. LIDOCAINE .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Photodynamic therapy for superficial bladder cancer under local anaesthetic.
  • OBJECTIVES: To evaluate the use of local anaesthesia (LA) in 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial.
  • PATIENTS AND METHODS: ALA PDT was administered to 19 patients with recurrent superficial TCC (stage Ta/carcinoma in situ, grades 1-3) using escalating doses of ALA (3-6%) and 633 nm laser light (25-50 J/cm2) under various LA (lignocaine) protocols.
  • The endpoints of tolerability and toxicity were assessed for the different LA, light and ALA doses, with lignocaine levels.
  • The discomfort was immediate, associated with bladder spasm, and was a function of the ALA concentration rather than the total light dose given.
  • With 6% ALA the pain was dramatically increased using PD (n=6; median pain score 8, range 5-10) and therefore the more potent LA technique of electromotive drug administration (EMDA) of 2% lignocaine was used, with excellent results (n=3; median pain score 1, range 0-2).
  • All patients had transient bladder irritability that typically lasted 9-12 days, with no subjective/objective change in long-term bladder function.
  • CONCLUSION: Bladder ALA PDT is both safe and feasible under LA.
  • At a dose of 3% ALA, the procedure was well-tolerated using PD of lignocaine.
  • With refinement, ALA PDT may be feasible as an outpatient treatment for superficial bladder TCC.
  • [MeSH-major] Aminolevulinic Acid / therapeutic use. Anesthetics, Local. Carcinoma, Transitional Cell / drug therapy. Lidocaine. Neoplasm Recurrence, Local / drug therapy. Photochemotherapy / methods. Photosensitizing Agents / therapeutic use. Urinary Bladder Neoplasms / drug therapy

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  • (PMID = 11966622.001).
  • [ISSN] 1464-4096
  • [Journal-full-title] BJU international
  • [ISO-abbreviation] BJU Int.
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase I; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Anesthetics, Local; 0 / Photosensitizing Agents; 88755TAZ87 / Aminolevulinic Acid; 98PI200987 / Lidocaine
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34. Sylvester RJ, van der MEIJDEN AP, Lamm DL: Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol; 2002 Nov;168(5):1964-70
The Lens. Cited by Patents in .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials.
  • PURPOSE: We determine if intravesical bacillus Calmette-Guerin (BCG) reduces the risk of progression after transurethral resection to stage T2 disease or higher in patients with superficial (stage Ta, T1 or carcinoma in situ) bladder cancer.
  • MATERIALS AND METHODS: A meta-analysis was performed of the published results of randomized clinical trials comparing transurethral resection plus intravesical BCG to either resection alone or resection plus another treatment other than BCG.
  • The percent of patients with progression was low (6.4% of 2,880 patients with papillary tumors and 13.9% of 403 patients with carcinoma in situ, reflecting the short followup and relatively low risk patients entered in many of the trials.
  • The size of the treatment effect was similar in patients with papillary tumors and in those with carcinoma in situ.
  • There was no statistically significant difference in treatment effect for either overall survival or death due to bladder cancer.
  • CONCLUSIONS: Intravesical BCG significantly reduces the risk of progression after transurethral resection in patients with superficial bladder cancer who receive maintenance treatment.
  • Thus, it is the agent of choice for patients with intermediate and high risk papillary tumors and those with carcinoma in situ.
  • [MeSH-major] BCG Vaccine / administration & dosage. Carcinoma in Situ / drug therapy. Carcinoma, Transitional Cell / drug therapy. Urinary Bladder Neoplasms / drug therapy

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  • (PMID = 12394686.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / 2U10 CA11488-31; United States / NCI NIH HHS / CA / 5U10 CA11488-32
  • [Publication-type] Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / BCG Vaccine
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35. Kowalski M, Entwistle J, Cizeau J, Niforos D, Loewen S, Chapman W, MacDonald GC: A Phase I study of an intravesically administered immunotoxin targeting EpCAM for the treatment of nonmuscle-invasive bladder cancer in BCGrefractory and BCG-intolerant patients. Drug Des Devel Ther; 2010;4:313-20
The Lens. Cited by Patents in .

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  • [Title] A Phase I study of an intravesically administered immunotoxin targeting EpCAM for the treatment of nonmuscle-invasive bladder cancer in BCGrefractory and BCG-intolerant patients.
  • PURPOSE: A Phase I dose-escalation study was performed to determine the maximum tolerated dose (MTD) of the immunotoxin VB4-845 in patients with nonmuscle-invasive bladder cancer (NMIBC) refractory to or intolerant of bacillus Calmette-Guerin (BCG).
  • PATIENTS AND METHODS: Sixty-four patients with Grade 2 or 3, stage Ta or T1 transitional cell carcinoma or in situ carcinoma, either refractory to or intolerant of BCG therapy, were enrolled.
  • Treatment was administered in ascending dose cohorts ranging from 0.1 to 30.16 mg.
  • After receiving weekly instillations of VB4-845 to the bladder via catheter for 6 consecutive weeks, patients were followed for 4-6 weeks post-therapy and assessed at week 12.
  • VB4-845 therapy was safe and well tolerated with most adverse events reported as mild; as a result, no patients were removed from the study in response to toxicity.
  • By the end of the study, the majority of patients had developed antibodies to the exotoxin portion of VB4-845.
  • A complete response was achieved in 39% of patients at the 12-week time point.
  • Although an MTD was not determined at the doses administered, VB4-845 showed evidence of an antitumor effect that warrants further clinical investigation for the treatment of NMIBC in this patient population.
  • [MeSH-major] Antineoplastic Agents / therapeutic use. Drug Delivery Systems. Recombinant Fusion Proteins / therapeutic use. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Aged. Aged, 80 and over. Antigens, Neoplasm / drug effects. Antigens, Neoplasm / metabolism. BCG Vaccine / adverse effects. BCG Vaccine / therapeutic use. Carcinoma in Situ / drug therapy. Carcinoma in Situ / pathology. Carcinoma, Transitional Cell / drug therapy. Carcinoma, Transitional Cell / pathology. Cell Adhesion Molecules / drug effects. Cell Adhesion Molecules / metabolism. Dose-Response Relationship, Drug. Female. Follow-Up Studies. Humans. Male. Maximum Tolerated Dose. Middle Aged. Neoplasm Staging. Treatment Outcome

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  • (PMID = 21151619.001).
  • [ISSN] 1177-8881
  • [Journal-full-title] Drug design, development and therapy
  • [ISO-abbreviation] Drug Des Devel Ther
  • [Language] eng
  • [Publication-type] Clinical Trial, Phase I; Journal Article
  • [Publication-country] New Zealand
  • [Chemical-registry-number] 0 / Antigens, Neoplasm; 0 / Antineoplastic Agents; 0 / BCG Vaccine; 0 / Cell Adhesion Molecules; 0 / Recombinant Fusion Proteins; 0 / VB4-845; 0 / tumor-associated antigen GA733
  • [Other-IDs] NLM/ PMC2998804
  • [Keywords] NOTNLM ; Pseudomonas exotoxin A / anti-EpCAM / fusion protein / targeted therapy
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36. Martínez-Piñeiro JA, Martínez-Piñeiro L, Solsona E, Rodríguez RH, Gómez JM, Martín MG, Molina JR, Collado AG, Flores N, Isorna S, Pertusa C, Rabadán M, Astobieta A, Camacho JE, Arribas S, Madero R, Club Urológico Español de Tratamiento Oncológico (CUETO): Has a 3-fold decreased dose of bacillus Calmette-Guerin the same efficacy against recurrences and progression of T1G3 and Tis bladder tumors than the standard dose? Results of a prospective randomized trial. J Urol; 2005 Oct;174(4 Pt 1):1242-7
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  • [Title] Has a 3-fold decreased dose of bacillus Calmette-Guerin the same efficacy against recurrences and progression of T1G3 and Tis bladder tumors than the standard dose? Results of a prospective randomized trial.
  • PURPOSE: We determined if a third of the dose of intravesical bacillus Calmette-Guerin (BCG) has the same efficacy than a standard dose for decreasing the risk of recurrence and progression after transurethral resection in patients with superficial high risk (stages T1G3 and carcinoma in situ) bladder cancer.
  • MATERIAL AND METHODS: A total of 155 patients with a mean age +/- SD of 67 +/- 10.1 years with superficial bladder cancer, including stages T1G3 in 90, a Tis primary tumor in 23 and associated Tis disease in 42, were enrolled and randomly assigned to be treated after transurethral resection of all visible lesions with intravesical BCG, Connaught strain (weekly x 6 and fortnightly x 6 thereafter) with the standard dose of 81 mg or with the decreased dose of 27 mg.
  • Median time to recurrence was not attained in the standard dose arm and it was 63 months in the decreased dose arm.
  • Kaplan-Meier estimates for time to recurrence did not reveal differences between the 2 doses (p = 0.405).
  • Median time to progression was not attained in either arm.
  • Kaplan-Meier estimates for time to progression did not differ significantly (p = 0.7997).
  • Subgroup analysis by patient age, tumor status, number, size and T stage (T1G3 vs Tis) did not differ significantly.
  • Mean disease specific survival +/- SE was 86.96 +/- 4.14 and 83.73 +/- 4.73 months, respectively.
  • CONCLUSIONS: Our results suggest that a 3-fold decreased dose of intravesical BCG is as effective as the standard dose against progression in patients with high risk stages T1G3 and Tis superficial bladder carcinoma but with significantly less toxicity.
  • [MeSH-major] Adjuvants, Immunologic / administration & dosage. BCG Vaccine / administration & dosage. Neoplasm Recurrence, Local / prevention & control. Urinary Bladder Neoplasms / drug therapy

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  • [CommentIn] J Urol. 2006 May;175(5):1960; author reply 1960-1 [16600806.001]
  • (PMID = 16145378.001).
  • [ISSN] 0022-5347
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article; Randomized Controlled Trial
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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37. Takashi M, Wakai K, Hattori T, Ono Y, Ohshima S: Evaluation of multiple recurrence events in superficial bladder cancer patients treated with intravesical bacillus Calmette-Guérin therapy using the Andersen-Gill's model. Int Urol Nephrol; 2002;34(3):329-34
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  • [Title] Evaluation of multiple recurrence events in superficial bladder cancer patients treated with intravesical bacillus Calmette-Guérin therapy using the Andersen-Gill's model.
  • To evaluate factors affecting recurrence after intravesical bacillus Calmette-Guérin (BCG) therapy (Tokyo 172 strain), we reviewed data for 101 patients with superficial bladder cancer (pTa [n = 80] and pT1 [n = 21]) treated between 1985 and 1999.
  • The recurrence frequency, defined as times per 100 patient-months of follow-up, greatly decreased from 7.3 +/- 9.6 (SD) before the instillation to 2.6 +/- 5.6 after the therapy (p < 0.0001).
  • Multivariate analysis using Cox's proportional hazards model revealed that a history of bladder cancer and pathological stage were independent factors affecting the first tumour recurrence after the BCG therapy.
  • When multiple endpoints of recurrence were evaluated using the Andersen-Gill's model, number of tumours as well as a history of bladder cancer and pathological stage demonstrated significant links to tumour recurrence after the BCG therapy.
  • Because intravesical recurrence may involve multiple events during the clinical course of patients with bladder cancer, the Andersen-Gill's model appears useful for evaluation of risk factors.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma in Situ / drug therapy. Carcinoma in Situ / mortality. Neoplasm Recurrence, Local / prevention & control. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / mortality
  • [MeSH-minor] Administration, Intravesical. Adult. Aged. Aged, 80 and over. Disease-Free Survival. Female. Follow-Up Studies. Humans. Male. Middle Aged. Proportional Hazards Models. Retrospective Studies. Survival Rate. Treatment Outcome

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  • (PMID = 12899223.001).
  • [ISSN] 0301-1623
  • [Journal-full-title] International urology and nephrology
  • [ISO-abbreviation] Int Urol Nephrol
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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38. Orsola A, Trias I, Raventós CX, Español I, Cecchini L, Búcar S, Salinas D, Orsola I: Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients. Eur Urol; 2005 Aug;48(2):231-8; discussion 238
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Initial high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance of lamina propria invasion microstaging (T1a/b/c) in BCG-treated and BCG-non-treated patients.
  • OBJECTIVES: This study aimed to determine the prognostic value of depth of lamina propria invasion in initial high-grade T1 bladder tumors.
  • Secondary aims were to evaluate the prognostic significance of concomitant carcinoma in situ (CIS) and the impact of bacillus Calmette-Guérin (BCG) treatment as well as to assess the feasibility of microstaging by pathologists in a community setting.
  • BCG treatment impact and prognostic significance of CIS were also evaluated (Cox regression).
  • Progression-free intervals were significantly different in patients with (T1b, T1c) or without (T1a) deep lamina propria involvement (p=0.003), regardless of BCG treatment (p=0.02).
  • CONCLUSIONS: The depth of invasion in the TURB specimens is an independent prognostic factor for T1 bladder cancer even in BCG-treated patients.
  • The percentage of cases that can be substaged according to the depth of lamina propria involvement increases over time with the collaboration between urologists and pathologists.
  • Consequently, we support that routine pathological assessment of the level of MM invasion in patients with stage T1 bladder cancer should be included in the histopathological report.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. BCG Vaccine / therapeutic use. Carcinoma, Transitional Cell / drug therapy. Carcinoma, Transitional Cell / pathology. Urinary Bladder Neoplasms / drug therapy. Urinary Bladder Neoplasms / pathology

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  • (PMID = 15963635.001).
  • [ISSN] 0302-2838
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / BCG Vaccine
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39. Järvinen R, Kaasinen E, Sankila A, Rintala E, FinnBladder Group: Long-term efficacy of maintenance bacillus Calmette-Guérin versus maintenance mitomycin C instillation therapy in frequently recurrent TaT1 tumours without carcinoma in situ: a subgroup analysis of the prospective, randomised FinnBladder I study with a 20-year follow-up. Eur Urol; 2009 Aug;56(2):260-5
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Long-term efficacy of maintenance bacillus Calmette-Guérin versus maintenance mitomycin C instillation therapy in frequently recurrent TaT1 tumours without carcinoma in situ: a subgroup analysis of the prospective, randomised FinnBladder I study with a 20-year follow-up.
  • BACKGROUND: The long-term prospective data on bacillus Calmette-Guérin (BCG) and mitomycin C (MMC) instillation therapy are limited.
  • OBJECTIVE: To compare the long-term benefit of BCG and MMC maintenance therapy in patients with recurrent bladder carcinoma.
  • DESIGN, SETTING, AND PARTICIPANTS: Eighty-nine patients with frequently recurrent TaT1 disease without carcinoma in situ (CIS) were eligible.
  • Because of alkalinising the urine and adjusting the dose to bladder capacity, the average concentration of MMC was low: 30-40 mg in 150-200 ml of phosphate buffer.
  • Overall median follow-up time was 8.5 yr, whereas the median follow-up time of the patients who were still alive was 19.4 yr.
  • MEASUREMENTS: Primary end points were time to first recurrence and overall mortality.
  • There was a weak trend for fewer progressions (p=0.1) and cancer-specific deaths (p=0.2) in the cumulative incidence analysis, as 4 patients versus 10 patients progressed and 4 patients versus 9 patients died from the disease in the BCG group versus the MMC group, respectively.
  • CONCLUSIONS: An intensive intravesical BCG immunotherapy results in a sustained and significant long-term reduction in recurrence in frequently recurrent bladder carcinoma.
  • TRIAL REGISTRATION: Registration was not considered to be necessary at this stage of the follow-up because the study was initiated as early as 1984 and the last randomisation took place in July 1987, that is, long before the current requirements concerning study registrations were implemented.
  • [MeSH-major] Adjuvants, Immunologic / therapeutic use. Antibiotics, Antineoplastic / administration & dosage. Antibiotics, Antineoplastic / therapeutic use. BCG Vaccine / therapeutic use. Mitomycin / administration & dosage. Mitomycin / therapeutic use. Neoplasm Recurrence, Local / drug therapy. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Administration, Intravesical. Adult. Aged. Aged, 80 and over. Female. Follow-Up Studies. Humans. Male. Middle Aged. Neoplasm Staging. Prospective Studies. Randomized Controlled Trials as Topic. Time Factors

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  • [CommentIn] Eur Urol. 2009 Aug;56(2):266-8; discussion 268-9 [19427110.001]
  • (PMID = 19395154.001).
  • [ISSN] 1873-7560
  • [Journal-full-title] European urology
  • [ISO-abbreviation] Eur. Urol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Adjuvants, Immunologic; 0 / Antibiotics, Antineoplastic; 0 / BCG Vaccine; 50SG953SK6 / Mitomycin
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40. Berglund RK, Savage CJ, Vora KC, Kurta JM, Cronin AM: An analysis of the effect of statin use on the efficacy of bacillus calmette-guerin treatment for transitional cell carcinoma of the bladder. J Urol; 2008 Oct;180(4):1297-300; discussion 1300
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] An analysis of the effect of statin use on the efficacy of bacillus calmette-guerin treatment for transitional cell carcinoma of the bladder.
  • PURPOSE: Bacillus Calmette-Guerin is an effective immunotherapy for carcinoma in situ of the bladder and it reduces recurrence from resected papillary transitional cell carcinoma of the bladder.
  • Many patients receiving bacillus Calmette-Guerin therapy are concurrently taking statin agents, which have known immunomodulatory properties and may alter the performance of bacillus Calmette-Guerin.
  • Some data have suggested that patients taking a statin while on bacillus Calmette-Guerin therapy experience reduced clinical efficacy.
  • Time to recurrence and progression to surgery were compared between those taking and those not taking a statin by Kaplan-Meier methods and multivariable Cox regression controlling for stage and grade.
  • RESULTS: There were 245 (26%) patients taking a statin before bacillus Calmette-Guerin therapy and 707 not on statin therapy (74%).
  • Median time to recurrence was similar between those who did and those who did not use a statin.
  • On multivariable analysis statin use was not significantly associated with recurrence (hazard ratio 1.04; 95% CI 0.81, 1.34; p = 0.7) or progression to surgery (hazard ratio 0.77; 95% CI 0.52, 1.13; p = 0.17) after bacillus Calmette-Guerin therapy.
  • CONCLUSIONS: This retrospective study in a large cohort of patients showed no statistically significant association between statin use and recurrence or progression to open surgery in patients treated with bacillus Calmette-Guerin for transitional cell carcinoma of the bladder.
  • Based on these data patients should not be discouraged from taking statins while undergoing bacillus Calmette-Guerin treatment.
  • [MeSH-major] BCG Vaccine / therapeutic use. Carcinoma, Transitional Cell / drug therapy. Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use. Neoplasm Recurrence, Local / diagnosis. Urinary Bladder Neoplasms / drug therapy
  • [MeSH-minor] Administration, Intravesical. Aged. Aged, 80 and over. Cohort Studies. Disease Progression. Drug Therapy, Combination. Evaluation Studies as Topic. Female. Humans. Kaplan-Meier Estimate. Male. Middle Aged. Multivariate Analysis. Neoplasm Staging. Prognosis. Proportional Hazards Models. Reference Values. Retrospective Studies. Risk Assessment. Survival Analysis. Treatment Outcome

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  • (PMID = 18707737.001).
  • [ISSN] 1527-3792
  • [Journal-full-title] The Journal of urology
  • [ISO-abbreviation] J. Urol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / BCG Vaccine; 0 / Hydroxymethylglutaryl-CoA Reductase Inhibitors
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