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Incidence, Clinicopathological Risk Factors, Management and Outcomes of Nonmuscle Invasive Recurrence after Complete Response to Trimodality Therapy for Muscle Invasive Bladder Cancer

2017; Lippincott Williams & Wilkins; Volume: 199; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2017.08.106

1527-3792

Alejandro Sánchez, Matthew Wszolek, Andrzej Niemierko, R.H. Clayman, Michael Drumm, Dayron Rodríguez, Adam S. Feldman, Douglas M. Dahl, Niall M. Heney, William U. Shipley, Anthony L. Zietman, Jason A. Efstathiou,

Prostate Cancer Diagnosis and Treatment

No AccessJournal of UrologyAdult Urology1 Feb 2018Incidence, Clinicopathological Risk Factors, Management and Outcomes of Nonmuscle Invasive Recurrence after Complete Response to Trimodality Therapy for Muscle Invasive Bladder Cancer Alejandro Sanchez, Matthew F. Wszolek, Andrzej Niemierko, Rebecca H. Clayman, Michael Drumm, Dayron Rodríguez, Adam S. Feldman, Douglas M. Dahl, Niall M. Heney, William U. Shipley, Anthony L. Zietman, and Jason A. Efstathiou Alejandro SanchezAlejandro Sanchez Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Matthew F. WszolekMatthew F. Wszolek Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Andrzej NiemierkoAndrzej Niemierko Division of Biostatistics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts , Rebecca H. ClaymanRebecca H. Clayman Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Michael DrummMichael Drumm Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Dayron RodríguezDayron Rodríguez Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Adam S. FeldmanAdam S. Feldman Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Douglas M. DahlDouglas M. Dahl Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Niall M. HeneyNiall M. Heney Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , William U. ShipleyWilliam U. Shipley Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , Anthony L. ZietmanAnthony L. Zietman Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts , and Jason A. EfstathiouJason A. Efstathiou Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts View All Author Informationhttps://doi.org/10.1016/j.juro.2017.08.106AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We describe the incidence, clinicopathological risk factors, management and outcomes of recurrent nonmuscle invasive bladder cancer after a complete response to trimodality therapy of muscle invasive bladder cancer. Materials and Methods: We retrospectively reviewed the records of 342 patients with cT2-4aN0M0 muscle invasive bladder cancer and a complete response after trimodality therapy from 1986 to 2013. Using competing risks analyses we examined the association between baseline clinicopathological variables and nonmuscle invasive bladder cancer outcomes. Kaplan-Meier and the generalized Fleming-Harrington test were used to compare disease specific and overall survival. Results: At a median followup of 9 years nonmuscle invasive bladder cancer recurred in 85 patients (25%) who had had a complete response. On Kaplan-Meier analysis baseline carcinoma in situ was associated with recurrent nonmuscle invasive bladder cancer (p = 0.02). However, on multivariate analysis carcinoma in situ and other baseline clinicopathological characteristics did not predict such recurrence. Patients with recurrent nonmuscle invasive bladder cancer had worse 10-year disease specific survival than those without recurrence (72.1% vs 78.4%, p = 0.002), although overall survival was similar (p = 0.66). Of the 39 patients (46%) who received adjuvant intravesical bacillus Calmette-Guérin 29 (74%) completed induction therapy and 19 (49%) reported bacillus Calmette-Guérin toxicity. Three-year recurrence-free and progression-free survival after induction bacillus Calmette-Guérin was 59% and 63%, respectively. Conclusions: After a complete response to trimodality therapy nonmuscle invasive bladder cancer recurred in 25% of patients, developing in some of them more than a decade after trimodality therapy. No baseline clinicopathological characteristics were associated with such recurrence after a complete response. Patients with nonmuscle invasive bladder cancer recurrence had worse disease specific survival than those without such recurrence but similar overall survival. Adjuvant intravesical bacillus Calmette-Guérin had a reasonable toxicity profile and efficacy in this population. 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Volume 199Issue 2February 2018Page: 407-415Supplementary Materials Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordsneoplasm invasivenessBCG vaccineneoplasm recurrencemortalityurinary bladder neoplasmslocalMetricsAuthor Information Alejandro Sanchez Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Equal study contribution. More articles by this author Matthew F. Wszolek Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Equal study contribution. More articles by this author Andrzej Niemierko Division of Biostatistics, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts More articles by this author Rebecca H. Clayman Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Michael Drumm Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Dayron Rodríguez Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Adam S. Feldman Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Douglas M. Dahl Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Niall M. Heney Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author William U. Shipley Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Anthony L. Zietman Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Jason A. Efstathiou Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts More articles by this author Expand All Advertisement PDF downloadLoading ...