Expression of EGFR, HER-2 and p53 predictive of prognosis in muscle-invasive bladder cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15637-15637 ◽  
Author(s):  
W. Sakr ◽  
S. Marur ◽  
M. Che ◽  
L. Heilbrun ◽  
D. Smith ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Survival Data ◽  
Clinical Stage ◽  
Prognostic Significance ◽  
Growth Factor Receptor ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Female Ratio ◽  
Her 2 ◽  
Muscle Invasive

15637 Background: The significance of over expression of Erb-1 (epidermal growth factor receptor/ EGFR) and Erb-2 (Her-2) has been reported in various tumors. The aim of this study was to investigate the correlation of the expression of EGFR, Her-2 and p53 with relapse free survival (RFS) and over all survival (OS) in patients with muscle invasive bladder cancer Methods: All patients with muscle invasive bladder cancer diagnosed at our institution between1993and 2004 were considered for the study. Immunohistochemical staining for EGFR, Her2 and p53 performed on formalin-fixed paraffin-embedded archival tissue was evaluated as positive or negative without knowledge of clinical outcome. Survival data determined by reviewing patients medical records were correlated with the staining results. Results: Of the 46 patients who qualified for the study, 40 had slides interpretable for Her 2 and p 53 staining and 38 had slides interpretable for EGFR staining. 35 of 38 were EGFR +ve, 22/40 were Her-2 +ve and 12/40 were p53+ve. The median age of the 46 patients was 67.5 years with a male/female ratio of 60% and 40%. 83% had clinical Stage 2; of those 42%, 23%, and 35% had pathological stages T2, T3 and T4 respectively. Six of 46 (13%), received adjuvant therapy. Tumor histology was pure transitional carcinoma in 56%, or with other components (squamous or adenocarcinoma) in 44%. Median follow-up was 48.8 months for RFS and 44.9 months for OS. Patients with positive EGFR had a median RFS of 34.8 months and median OS of 59.8 months. In patients with negative EGFR, median RFS and OS were not yet reached. Her 2 positive patients had median RFS of 19.2 months compared to 63.8 months in Her-2 negative patients. Her-2 negative patients had median OS of 59.7 months while median was not reached in Her 2 positive patients. Conclusions: While the differences are not statistically significant, the trends observed warrant prospective investigation of the prognostic significance of these markers in a larger population of muscle invasive bladder cancer patients. No significant financial relationships to disclose.

scholarly journals The role of partial cystectomy in treatment of muscle invasive bladder cancer

2007 ◽  
Vol 54 (4) ◽  
pp. 25-27
Author(s):  
V. Vukotic ◽  
M. Lazic ◽  
S. Savic ◽  
S. Cerovic ◽  
D. Kojic
Keyword(s):  
Bladder Cancer ◽  
Clinical Stage ◽  
Partial Cystectomy ◽  
Long Term Results ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Female Ratio ◽  
Muscle Invasive ◽  
Disease Free

Muscle invasive bladder cancer is usually treated by radical cystectomy, but in some selected cases with solitary tumor with appropriate localization partial cystectomy can be the treatment of choice achieving long term results with bladder preservation. We reviewed records of 11 patients which were treated in 5 year period from June 2002 to June 2007. by partial cystectomy according to the size of the tumor, localization, histology, multifocality, pathological and clinical stage, sex, and age. Male: female ratio was 6:5, mean age of the patients being 64.9 years. All patients bur one had solitary lesions located in the bladder dome in 4, on lateral sides in 5,2 patients had a tumor in diverticulum. TCC gr II was diagnosed 6 pts, TCC gr III in 5. One patient died in a year from disease progression, one from other reason, while all other patients are alive and disease free, the longest disease free interval being 3 years. Bladder capacity is adequate in all patients resulting in good quality of life .Our results suggest that in selected patients cancer control can be achieved with partial cystectomy.

scholarly journals HER-2 overexpression is a negative predictive factor for recurrence in patients with non-muscle-invasive bladder cancer on intravesical therapy

2020 ◽  
Vol 48 (1) ◽  
pp. 030006051989584
Author(s):  
Georgios Moustakas ◽  
Spyridon Kampantais ◽  
Anastasia Nikolaidou ◽  
Ioannis Vakalopoulos ◽  
Valentini Tzioufa ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Predictive Factor ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Muscle Invasive Bladder Cancer ◽  
Her 2 ◽  
Muscle Invasive ◽  
Negative Predictive Factor

Is radical radiotherapy effective for elderly patients with muscle invasive bladder cancer?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 506-506 ◽  
Author(s):  
James Price ◽  
Mayuran Sivanandan ◽  
Rania Elmusharaf ◽  
Prabir R Chakraborti ◽  
Mike Smith-Howell ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Elderly Patients ◽  
Systemic Therapy ◽  
Transitional Cell ◽  
Concurrent Chemotherapy ◽  
Invasive Bladder Cancer ◽  
Radical Radiotherapy ◽  
Muscle Invasive Bladder Cancer ◽  
Female Ratio ◽  
Muscle Invasive

506 Background: Radical radiotherapy (RT) is a curative option for muscle-invasive bladder cancer (MIBC), and offers the chance of bladder preservation. RT and radical cystectomy have not been compared in an RCT, but landmark trials of RT +/- concurrent systemic therapy have demonstrated outcomes comparable to surgery. In clinical practice, patients are often older and less fit compared to trials, and consequently may not be fit for concurrent chemotherapy which may impact treatment outcomes. Methods: A retrospective review of all patients aged 70 years or older treated with radical RT for MIBC from January 2010 – October 2016. Minimum 12 months follow-up. iSOFT manager for used for clinical data and MOSAIQ for radiotherapy parameters. Statistical analysis performed using Stata version 11.2. Results: 71 patients were identified. Male: female ratio 3:1 and median age 79 (range 71 – 93). Median performance status (PS) 1. 81.7% of patients had pT2 disease or greater, 77.5% of patients underwent TURBT prior to RT and 97.2% had transitional cell-carcinoma histology. 38 patients were treated to 60-64Gy/30-32 fractions and 33 patients to 52.5-55Gy/20 fractions. 6 patients (8.5%) received neoadjuvant chemotherapy and 15 (21.1%) received concurrent chemotherapy. Of the 53 patients who did not receive chemotherapy, all were deemed not suitable. 23 of 71 patients (32.4%) developed a loco-regional relapse, either in the bladder (n = 18), pelvic lymph nodes (n = 4), or on cytology alone (n = 1). 24 patients (33.8%) developed distant metastases, only 7 of these were fit for palliative chemotherapy. The median progression-free survival (PFS) was 17 months (95% C.I. 10 – 34 months). Neoadjuvant and concurrent chemotherapy use was not associated with an increased PFS (p = 0.99 and p = 0.97, log rank). The median overall survival was 18 months (95% C.I. 14 – 27 months). Conclusions: Our data demonstrate RT produces favourable outcomes for elderly patients and reasonably well tolerated without significant toxicities. Use of concurrent systemic therapy did not significantly improve outcomes, but numbers were small.

Predictors of pathologic response after radical cystectomy for muscle invasive bladder cancer: A population-based analysis.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 503-503
Author(s):  
Shane M. Pearce ◽  
Akbar Ashrafi ◽  
Matthew Winter ◽  
Saum Ghodoussipour ◽  
Daniel Zainfeld ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Pathologic Response ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Academic Center ◽  
Muscle Invasive ◽  
Over Time

503 Background: Neoadjuvant chemotherapy (NAC) improves overall survival (OS) for patients with muscle invasive bladder cancer (MIBC) undergoing radical cystectomy (RC), possibly through an increase in pathologic complete response (CR), defined as a pathologic stage T0 (pT0). We sought to identify predictors of CR for MIBC. Methods: The National Cancer Database from 2004 to 2013 was used to identify patients with cT2-4cN0cM0 urothelial cell carcinoma treated with RC. Patients were grouped based on pathology as CR (pT0), partial response (PR – pTa/Tis/T1) or no response (NR - pT2 or higher). Predictors of NAC and CR were identified with multivariable logistic regression. Cox proportional hazards model was used to compare OS based on cT stage, receipt of NAC and pathologic response. Results: The study population included 10,820 patients and NAC was administered in 16.4%. Use of NAC was associated with higher cT stage (p < 0.01) and increased over time (10% from 2003-2007 vs. 24% from 2011-2013, p < 0.01). Predictors of NAC use on multivariable analysis include younger age, lower comorbidity score, treatment at an academic center, and diagnosis from 2011-2013 (p < 0.01). Overall, CR was achieved in 3.3% without NAC and 16.3% with NAC (p < 0.01). NAC improved 5-year OS for all cT stages, however the survival benefit was only observed among those achieving CR (p < 0.01). Multivariable Cox regression demonstrates that both PR (HR 0. 58, p < 0.01) and CR (OR 0.26, p < 0.01) were independently associated with improved OS among those treated with NAC. Multivariable analysis identified age (OR 0.98, p < 0.01) and increased clinical stage (cT3: OR 0.47, p < 0.01; cT4 OR 0.54, p < 0.01) as negative predictors of CR. Utilization of NAC (OR 4.82 p < 0.01), academic institution, and diagnosis 2011-2013 (OR 1.92, p < 0.01) increased the odds of CR. Conclusions: Use of NAC increased over time and CR occurred in 16% of patients who received NAC. Treatment at an academic center, diagnosis from 2011-2013 and use of NAC were independently associated with CR, while increased age and clinical stage were negative predictors of CR. PR and CR are independently associated with improved OS relative to non-responders.

Comparing costs of radical cystectomy versus trimodal therapy for patients diagnosed with localized muscle-invasive bladder cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16021-e16021
Author(s):  
Daniel Phillips ◽  
Tamer Dafashy ◽  
Yong Shan ◽  
Mohamed Danny Ray-Zack ◽  
Hogan K Hudgins ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Clinical Stage ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Pathology Laboratory ◽  
Median Difference ◽  
Trimodal Therapy ◽  
Muscle Invasive ◽  
One Year

e16021 Background: Earlier studies on the cost of muscle-invasive bladder cancer treatments lack granularity and are limited to 180 days. The objective of this study is to compare the one-year costs associated with trimodal therapy versus radical cystectomy, accounting for survival and intensity effects on total costs. Methods: This cohort study used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Data analysis was performed from March 5, 2018 through December 4, 2018. A total of 2,963 patients aged 66-85 years diagnosed with clinical stage T2-4a muscle-invasive bladder cancer from January 1, 2002 through December 31, 2011. Total Medicare costs within one year of diagnosis following radical cystectomy versus trimodal therapy were compared using inverse probability of treatment-weighted (IPTW) propensity score models, which included a two-part estimator to account for intrinsic selection bias. Results: Median costs were significantly higher for trimodal therapy than radical cystectomy in 90 days ($83,754 vs. $68,692; median difference $11,805, 95% CI $7,745 to $15,864), 180 days ($187,162 vs. $109,078; median difference $62,370, 95% CI $55,581 to $69,160), and 365 days ($289,142 vs. $148,757; median difference $109,027, 95% CI $98,692 to $119,363), respectively. Outpatient care, radiology, medication expenses and pathology/laboratory costs contributed largely to the higher costs associated with trimodal therapy. On IPTW-adjusted analyses, patients undergoing trimodal therapy had $129,854 (95% CI $115,793-$145,299) higher costs compared with radical cystectomy one year after diagnosis. Conclusions: Compared to radical cystectomy, trimodal therapy was associated with higher costs among patients with muscle-invasive bladder cancer. Extrapolating cost figures resulted in nationwide excess spending of $444 million for trimodal therapy compared with radical cystectomy for patients diagnosed in 2017.

The efficacy of trimodal chemoradiotherapy with gemcitabine and cisplatin as a bladder-preserving strategy for the treatment of muscle invasive bladder cancer: A single-arm prospective study.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 516-516
Author(s):  
Hiroaki Matsumoto ◽  
Kazuhiro Nagao ◽  
Sho Ozawa ◽  
Masahiro Samoto ◽  
Junichi Mori ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Clinical Stage ◽  
Good Prognosis ◽  
Response To Treatment ◽  
Invasive Bladder Cancer ◽  
Muscle Invasive Bladder Cancer ◽  
Bladder Preservation ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Muscle Invasive

516 Background: Radical cystectomy is still the standard treatment for muscle-invasive bladder cancer (MIBC), while the patients with MIBC are not always appropriate candidates due to multiple comorbidities. We establish novel treatment strategy by trimodal treatment. Methods: The regimen was gemcitabine 300 mg/m2, and cisplatin 30mg/m2 in day 1 and concomitant irradiation 2Gy/Fr, 5 fraction per week. Irradiation was administered to whole pelvis up to 30Gy, then boost to true pelvis until total 48Gy to 54Gy. Extensive transurethral resection (TURBT) was performed and we confirmed pathological stage ≥T2. TURBT was also performed after chemoradiotherapy to evaluate the pathological response to treatment. This study was approved in our institutional review board (ID: H23-89) and the information was opened on UMIN (ID: UMIN000006363). We analyzed their treatment efficacy and survival. Results: The patients were 29 men and 9 women, median age was 76.5 y.o. and median follow up was 23 months (1 - 112). Clinical stage T2, T3, T4, N1 and N2 were 23, 10, 5, 4, 2 cases, respectively. The 2- and 5-year metastatic-free survival (MFS), bladder-recurrence free survival (bRFS), cancer-specific survival (CSS), and overall survival (OS) rates after treatment were 91.7 and 84.0%, 59.7 and 42.6%, 87.3 and 87.3%, and 87.3 and 81.8%, respectively. Salvage cystectomy was performed 3 patients and they were still alive. CR rate was 78.9% and overall response rate was 92.1%. cT stage and valiant histology was not associated with treatment response. The patients achieved CR had significant good prognosis in CSS (p=0.0149) and OS (p=0.0149) compared with non-responders. In cox hazard model, CR achievement was significant prognostic factors for OS (p =0.0015, HR 6.804e+26, 95% CI 56.94-1.631e+86). Patients were able to receive 3 to 5 cycle GC radiation and any grade 3 or more adverse event was 7 (18.4%) cases. no treatment related death was recorded. Conclusions: In selected patients, GC radiation for MIBC may provide good oncological outcomes as bladder preservation strategy.

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