Comparative Outcomes of Primary Versus Recurrent High-risk Non-muscle-invasive and Primary Versus Secondary Muscle-invasive Bladder Cancer After Radical Cystectomy: Results from a Retrospective Multicenter Study.
Disease progression
Mycobacterium bovis
Recurrence
Survival
Urinary bladder neoplasms
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
accepted:
27
02
2022
entrez:
9
5
2022
pubmed:
10
5
2022
medline:
10
5
2022
Statut:
epublish
Résumé
Radical cystectomy (RC) is indicated in primary or secondary muscle-invasive bladder cancer (primMIBC, secMIBC) and in primary or recurrent high- or very high-risk non-muscle-invasive bladder cancer (primHR-NMIBC, recHR-NMIBC). The optimal timing for RC along the disease spectrum of nonmetastatic urothelial carcinoma remains unclear. To compare outcomes after RC between patients with primHR-NMIBC, recHR-NMIBC, primMIBC, and secMIBC. This retrospective, multicenter study included patients with clinically nonmetastatic bladder cancer (BC) treated with RC. We assessed oncological outcomes for patients who underwent RC according to the natural history of their BC. primHR-NMIBC and primMIBC were defined as no prior history of BC, and recHR-NMIBC and secMIBC as previously treated NMIBC that recurred or progressed to MIBC, respectively. Log-rank analysis was used to compare survival outcomes, and univariable and multivariable Cox and logistic regression analyses were used to identify predictors for survival. Among the 908 patients included, 211 (23%) had primHR-NMIBC, 125 (14%) had recHR-NMIBC, 404 (44%) had primMIBC, and 168 (19%) had secMIBC. Lymph node involvement and pathological upstaging were more frequent in the secMIBC group than in the other groups ( Patients with recHR-NMIBC and primHR-MIBC had similar survival outcomes, while those with sec-MIBC had the worst outcomes. Therefore, early radical intervention may be indicated in selected patients, and potentially neoadjuvant systemic therapies in some patients with recHR-NMIBC. We compared cancer outcomes in different bladder cancer scenarios in a large, multinational series of patients who underwent removal of the bladder with curative intent. We found that patients who experienced recurrence of non-muscle-invasive bladder cancer (NMIBC) had similar survival outcomes to those with initial muscle-invasive bladder cancer (MIBC), while patients who experienced progression of NMIBC to MIBC had the worst outcomes. Selected patients with non-muscle-invasive disease may benefit from early radical surgery or from perioperative chemotherapy or immunotherapy.
Sections du résumé
Background
UNASSIGNED
Radical cystectomy (RC) is indicated in primary or secondary muscle-invasive bladder cancer (primMIBC, secMIBC) and in primary or recurrent high- or very high-risk non-muscle-invasive bladder cancer (primHR-NMIBC, recHR-NMIBC). The optimal timing for RC along the disease spectrum of nonmetastatic urothelial carcinoma remains unclear.
Objective
UNASSIGNED
To compare outcomes after RC between patients with primHR-NMIBC, recHR-NMIBC, primMIBC, and secMIBC.
Design setting and participants
UNASSIGNED
This retrospective, multicenter study included patients with clinically nonmetastatic bladder cancer (BC) treated with RC.
Outcome measurements and statistical analysis
UNASSIGNED
We assessed oncological outcomes for patients who underwent RC according to the natural history of their BC. primHR-NMIBC and primMIBC were defined as no prior history of BC, and recHR-NMIBC and secMIBC as previously treated NMIBC that recurred or progressed to MIBC, respectively. Log-rank analysis was used to compare survival outcomes, and univariable and multivariable Cox and logistic regression analyses were used to identify predictors for survival.
Results and limitations
UNASSIGNED
Among the 908 patients included, 211 (23%) had primHR-NMIBC, 125 (14%) had recHR-NMIBC, 404 (44%) had primMIBC, and 168 (19%) had secMIBC. Lymph node involvement and pathological upstaging were more frequent in the secMIBC group than in the other groups (
Conclusions
UNASSIGNED
Patients with recHR-NMIBC and primHR-MIBC had similar survival outcomes, while those with sec-MIBC had the worst outcomes. Therefore, early radical intervention may be indicated in selected patients, and potentially neoadjuvant systemic therapies in some patients with recHR-NMIBC.
Patient summary
UNASSIGNED
We compared cancer outcomes in different bladder cancer scenarios in a large, multinational series of patients who underwent removal of the bladder with curative intent. We found that patients who experienced recurrence of non-muscle-invasive bladder cancer (NMIBC) had similar survival outcomes to those with initial muscle-invasive bladder cancer (MIBC), while patients who experienced progression of NMIBC to MIBC had the worst outcomes. Selected patients with non-muscle-invasive disease may benefit from early radical surgery or from perioperative chemotherapy or immunotherapy.
Identifiants
pubmed: 35528782
doi: 10.1016/j.euros.2022.02.011
pii: S2666-1683(22)00054-4
pmc: PMC9068727
doi:
Types de publication
Journal Article
Langues
eng
Pagination
14-21Informations de copyright
© 2022 The Author(s).
Références
Arch Esp Urol. 2019 Jul;72(6):590-595
pubmed: 31274124
J Urol. 2004 Jul;172(1):70-5
pubmed: 15201740
JAMA Oncol. 2016 Aug 1;2(8):1094-6
pubmed: 27310333
World J Urol. 2009 Jun;27(3):347-51
pubmed: 19319539
Urology. 2008 Feb;71(2):302-7
pubmed: 18308108
BJU Int. 2016 Apr;117(4):604-10
pubmed: 25851271
Cancers (Basel). 2021 May 20;13(10):
pubmed: 34065365
Cancer Cell. 2016 Jul 11;30(1):27-42
pubmed: 27321955
Eur Urol. 2019 Nov;76(5):639-657
pubmed: 31443960
Nat Commun. 2021 Apr 16;12(1):2301
pubmed: 33863885
BJU Int. 2010 Sep;106(5):710-5
pubmed: 20128783
Urologia. 2020 May;87(2):49-56
pubmed: 31942831
Eur Urol. 2015 Jan;67(1):74-82
pubmed: 25043942
Eur Urol. 2020 Oct;78(4):533-537
pubmed: 32684305
Clin Genitourin Cancer. 2017 Aug;15(4):e661-e666
pubmed: 28188046
Eur Urol. 2013 Jan;63(1):145-54
pubmed: 22985746
Eur Urol. 2008 Jan;53(1):146-52
pubmed: 17624657
Curr Opin Urol. 2021 Jul 1;31(4):304-314
pubmed: 33973536
J Clin Oncol. 2001 Feb 1;19(3):666-75
pubmed: 11157016
Lancet Oncol. 2021 Jul;22(7):919-930
pubmed: 34051177
J Urol. 2021 Nov;206(5):1258-1267
pubmed: 34184926
Eur Urol. 2019 Feb;75(2):231-239
pubmed: 30290956
Sci Rep. 2018 May 15;8(1):7543
pubmed: 29765120
PLoS One. 2013 May 01;8(5):e62483
pubmed: 23650517
Int J Surg. 2018 Apr;52:214-220
pubmed: 29496649
Eur Urol. 2021 Apr;79(4):480-488
pubmed: 33419683
Int J Cancer. 2014 Oct 15;135(8):1978-82
pubmed: 24599551
Eur Urol. 2021 Jan;79(1):82-104
pubmed: 32360052
J Urol. 2006 Dec;176(6 Pt 1):2414-22; discussion 2422
pubmed: 17085118
Eur Urol. 2017 Dec;72(6):952-959
pubmed: 28583311
Urol Oncol. 2021 Jul;39(7):436.e1-436.e8
pubmed: 33485764