Improving Selection Criteria for Early Cystectomy in High-Grade T1 Bladder Cancer: A Meta-Analysis of 15,215 Patients

2015 ◽  
Vol 33 (6) ◽  
pp. 643-650 ◽  
Author(s):  
William Martin-Doyle ◽  
Jeffrey J. Leow ◽  
Anna Orsola ◽  
Steven L. Chang ◽  
Joaquim Bellmunt
Keyword(s):  
Risk Factors ◽  
Bladder Cancer ◽  
Prognostic Factors ◽  
Lamina Propria ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Depth Of Invasion ◽  
Cochrane Central Register ◽  
High Grade ◽  
Cancer Specific Survival

Purpose High-grade T1 (HGT1) bladder cancer is the highest risk subtype of non–muscle-invasive bladder cancer, with highly variable prognosis, poorly understood risk factors, and considerable debate about the role of early cystectomy. We aimed to address these questions through a meta-analysis of outcomes and prognostic factors. Methods PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and American Society of Clinical Oncology abstracts were searched for cohort studies in HGT1. We pooled data on recurrence, progression, and cancer-specific survival from 73 studies. Results Five-year rates of recurrence, progression, and cancer-specific survival were 42% (95% CI, 39% to 45%), 21% (95% CI, 18% to 23%), and 87% (95% CI, 85% to 89%), respectively (56 studies, n = 15,215). In the prognostic factor meta-analysis (33 studies, n = 8,880), the highest impact risk factor was depth of invasion (T1b/c) into lamina propria (progression: hazard ratio [HR], 3.34; P < .001; cancer-specific survival: HR, 2.02; P = .001). Several other previously proposed factors also predicted progression and cancer-specific survival (lymphovascular invasion, associated carcinoma in situ, nonuse of bacillus Calmette-Guérin, tumor size > 3 cm, and older age; HRs for progression between 1.32 and 2.88, P ≤ .002; HRs for cancer-specific survival between 1.28 and 2.08, P ≤ .02). Conclusion In this large analysis of outcomes and prognostic factors in HGT1 bladder cancer, deep lamina propria invasion had the largest negative impact, and other previously proposed prognostic factors were also confirmed. These factors should be used for prognostication and patient stratification in future clinical trials, and depth of invasion should be considered for inclusion in TNM staging criteria. This meta-analysis can also help define selection criteria for early cystectomy in HGT1 bladder cancer, particularly for patients with deep lamina propria invasion combined with other risk factors.

MP56-02 PROGNOSTIC FACTORS FOR HIGH-GRADE T1 BLADDER CANCER: A META-ANALYSIS BASED ON 7,486 PATIENTS

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
William Martin-Doyle ◽  
Jeffrey J. Leow ◽  
Anna Orsola ◽  
Steven L. Chang ◽  
Joaquim Bellmunt
Keyword(s):  
Bladder Cancer ◽  
Prognostic Factors ◽  
Meta Analysis ◽  
High Grade

1101 Prognostic factors for high-grade T1 bladder cancer: A meta-analysis based on 7,486 patients

2014 ◽  
Vol 13 (1) ◽  
pp. e1101
Author(s):  
W. Martin-Doyle ◽  
J.J. Leow ◽  
A. Orsola ◽  
S.L. Chang ◽  
J. Bellmunt
Keyword(s):  
Bladder Cancer ◽  
Prognostic Factors ◽  
Meta Analysis ◽  
High Grade

646 SECOND-TUR OF INITIAL HIGH GRADE T1 BLADDER CANCER AFTER-BCG AND ACCORDING TO LAMINA PROPRIA INVASION MICROSTAGING (T1 A/B)

2009 ◽  
Vol 8 (4) ◽  
pp. 282 ◽  
Author(s):  
Busquets C.X. Raventos ◽  
A. Orsola ◽  
L. Cecchini ◽  
E. Trilla ◽  
J. Planas ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Lamina Propria ◽  
High Grade ◽  
Second Tur

Risk Factors, Prognosis and A New Nomogram for Predicting Cancer-Specific Survival Among Lung Cancer Patients with Brain Metastasis: A Retrospective Study Based on SEER

2021 ◽  
Author(s):  
Guihong Zhang ◽  
Yue Jiao Liu ◽  
Ming De Ji
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Prognostic Factors ◽  
Brain Metastasis ◽  
Cancer Patients ◽  
Primary Site ◽  
Histological Type ◽  
Extracranial Metastasis ◽  
Cancer Specific Survival ◽  
Lung Cancer Patients

Abstract Purpose: A comprehensive population-based study on risk and prognostic factors of lung cancer with brain metastasis is lacking. Methods: 95191 patients diagnosed with lung cancer between 2010 and 2017 were collected from the Surveillance, Epidemiology and End Results (SEER) database. Patients were stratified by different variables. Multivariable logistic and Cox regression were applied to analyze the risk and prognostic factors of brain metastasis among lung cancer patients, respectively. The Fine and Gray’s competing risk regression model was performed to obtain prognostic factors associated with cancer-specific mortality.Results: Among the 95191 patients diagnosed with lung cancer, 10765 patients have brain metastasis, with a metastatic incidence of 11.31%. The primary site of tumor, residence type, age, histological type, race and extracranial metastasis were all independent risk factors of brain metastasis. Compared with other histological types, small cell lung cancer displayed a highest incidence of brain metastasis (16.62%). The median overall survival (OS) among lung cancer patients with brain metastasis was only 6.05 months. The primary site of tumor, median household income, age, histological type, race, gender and extracranial metastasis were all associated with the prognosis of brain metastasis. Patients with squamous cell carcinoma had the worst prognosis, the median OS was only 3.68 months. And our established new nomogram showed a good discriminative ability on predicting the probability of cancer-specific survival among patients with brain metastasis, the C-index was 0.61.Conclusion: Our study provided a deeper insight into the risk factors and prognosis of brain metastasis among lung cancer patients.

Prognostic factors and outcome in patients with T1 high-grade bladder cancer: can we identify patients for early cystectomy?

2011 ◽  
Vol 109 (7) ◽  
pp. 1026-1030 ◽  
Author(s):  
Robert Segal ◽  
Faysal A. Yafi ◽  
Fadi Brimo ◽  
Simon Tanguay ◽  
Armen Aprikian ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Prognostic Factors ◽  
High Grade

scholarly journals Non-muscle invasive high grade urothelial carcinoma of the bladder. Which factors can influence understaging at the time of radical cystectomy?

2016 ◽  
Vol 88 (1) ◽  
pp. 13 ◽  
Author(s):  
Daniele Minardi ◽  
Giulio Milanese ◽  
Gianni Parri ◽  
Vito Lacetera ◽  
Giovanni Muzzonigro
Keyword(s):  
Risk Factors ◽  
Radical Cystectomy ◽  
Lamina Propria ◽  
Tumor Size ◽  
Vascular Invasion ◽  
Residual Tumor ◽  
Tumor Location ◽  
High Grade ◽  
Microscopic Vascular Invasion ◽  
Muscle Invasive

Objective: To evaluate the main factors which influence understaging in patients with T1G3 non-muscle invasive bladder cancer (NMIBC). Materials and methods: 109 patients with T1/G3 underwent transurethral resection of bladder tumor (TURBT) and then radical cystectomy (RC) with pelvic lymph nodes dissection. A number of variables were considered when evaluating the detection of understaging. We considered the patients age and gender, as well as the size, number, location and morphology of their tumor. We also considered coexistence of bladder carcinoma in situ (CIS), microscopic vascular invasion and deep lamina propria invasion. The level of experience of the surgeon was also analyzed. Results: in RC samples muscle invasion, that is understaging, was detected in 74 (67.9%) patients, while 35 (32.1%) patients were appropriately staged. In these cohort of patients with high grade tumors, understaging was associated with deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size &gt; 6 cm, tumor location (trigone and dome), presence of residual tumor; age, gender, tumor morphology, CIS associated, and experience of urological surgeon were not associated with clinical understaging. Conclusions: in our study, evaluating patients with high grade NMIBC at first TURBT, we identified some risk factors that need to be considered and that are able to increase the risk of understaging: deep lamina propria and microscopic vascular invasion, multiple tumors, tumor size &gt; 6 cm, tumor location (trigone and dome), presence of residual tumor. When these risk factors are present, performing an early cystectomy, and not a re-TURBT, could lower the risk of worse pathological finding due to rapid disease progression of the high grade tumors, and can prolong survival.

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