High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study

Matteo Ferro, Mihai Dorin Vartolomei, Francesco Cantiello, Giuseppe Lucarelli, Savino M Di Stasi, Rodolfo Hurle, Giorgio Guazzoni, Gian Maria Busetto, Ettore De Berardinis, Rocco Damiano, Sisto Perdonà, Marco Borghesi, Riccardo Schiavina, Gilberto L Almeida, Pierluigi Bove, Estevao Lima, Giovanni Grimaldi, Riccardo Autorino, Nicolae Crisan, Abdal Rahman Abu FarhanPaolo Verze, Michele Battaglia, Vincenzo Serretta, Giorgio Ivan Russo, Giuseppe Morgia, Gennaro Musi, Ottavio de Cobelli, Vincenzo Mirone, Shahrokh F Shariat

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).

PATIENTS AND METHODS: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.

RESULTS: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.

CONCLUSIONS: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.

Original languageEnglish
Pages (from-to)7-15
Number of pages9
JournalUrologia Internationalis
Volume101
Issue number1
DOIs
Publication statusPublished - 2018

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Neoplasms
Mycobacterium bovis
Urinary Bladder Neoplasms
Survival
Recurrence
Disease-Free Survival
Maintenance
Carcinoma in Situ
Multicenter Studies
Disease Progression
Therapeutics

Keywords

  • Aged
  • Aged, 80 and over
  • Carcinoma, Transitional Cell/pathology
  • Cystectomy/methods
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local/pathology
  • Prognosis
  • Progression-Free Survival
  • Recurrence
  • Regression Analysis
  • Time Factors
  • Treatment Outcome
  • Urinary Bladder Neoplasms/pathology
  • Urologic Surgical Procedures/methods

Cite this

High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes : Results of a Multi-Institutional Study. / Ferro, Matteo; Vartolomei, Mihai Dorin; Cantiello, Francesco; Lucarelli, Giuseppe; Di Stasi, Savino M; Hurle, Rodolfo; Guazzoni, Giorgio; Busetto, Gian Maria; De Berardinis, Ettore; Damiano, Rocco; Perdonà, Sisto; Borghesi, Marco; Schiavina, Riccardo; Almeida, Gilberto L; Bove, Pierluigi; Lima, Estevao; Grimaldi, Giovanni; Autorino, Riccardo; Crisan, Nicolae; Abu Farhan, Abdal Rahman; Verze, Paolo; Battaglia, Michele; Serretta, Vincenzo; Russo, Giorgio Ivan; Morgia, Giuseppe; Musi, Gennaro; de Cobelli, Ottavio; Mirone, Vincenzo; Shariat, Shahrokh F.

In: Urologia Internationalis, Vol. 101, No. 1, 2018, p. 7-15.

Research output: Contribution to journalArticle

Ferro, M, Vartolomei, MD, Cantiello, F, Lucarelli, G, Di Stasi, SM, Hurle, R, Guazzoni, G, Busetto, GM, De Berardinis, E, Damiano, R, Perdonà, S, Borghesi, M, Schiavina, R, Almeida, GL, Bove, P, Lima, E, Grimaldi, G, Autorino, R, Crisan, N, Abu Farhan, AR, Verze, P, Battaglia, M, Serretta, V, Russo, GI, Morgia, G, Musi, G, de Cobelli, O, Mirone, V & Shariat, SF 2018, 'High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study', Urologia Internationalis, vol. 101, no. 1, pp. 7-15. https://doi.org/10.1159/000490765
Ferro, Matteo ; Vartolomei, Mihai Dorin ; Cantiello, Francesco ; Lucarelli, Giuseppe ; Di Stasi, Savino M ; Hurle, Rodolfo ; Guazzoni, Giorgio ; Busetto, Gian Maria ; De Berardinis, Ettore ; Damiano, Rocco ; Perdonà, Sisto ; Borghesi, Marco ; Schiavina, Riccardo ; Almeida, Gilberto L ; Bove, Pierluigi ; Lima, Estevao ; Grimaldi, Giovanni ; Autorino, Riccardo ; Crisan, Nicolae ; Abu Farhan, Abdal Rahman ; Verze, Paolo ; Battaglia, Michele ; Serretta, Vincenzo ; Russo, Giorgio Ivan ; Morgia, Giuseppe ; Musi, Gennaro ; de Cobelli, Ottavio ; Mirone, Vincenzo ; Shariat, Shahrokh F. / High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes : Results of a Multi-Institutional Study. In: Urologia Internationalis. 2018 ; Vol. 101, No. 1. pp. 7-15.
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title = "High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes: Results of a Multi-Institutional Study",
abstract = "INTRODUCTION: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).PATIENTS AND METHODS: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.RESULTS: A total of 257 (24.6{\%}) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17{\%} (CI 11.8-23); 58.2{\%} (CI 50.7-65); 73.7{\%} (CI 66.3-79.7); and 84.5{\%} (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7{\%} (CI 32.8-40.6); 71.4{\%} (CI 67.3-75.2); 89.8{\%} (CI 86.6-92.3); and 95.7{\%} (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.CONCLUSIONS: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.",
keywords = "Aged, Aged, 80 and over, Carcinoma, Transitional Cell/pathology, Cystectomy/methods, Disease Progression, Disease-Free Survival, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local/pathology, Prognosis, Progression-Free Survival, Recurrence, Regression Analysis, Time Factors, Treatment Outcome, Urinary Bladder Neoplasms/pathology, Urologic Surgical Procedures/methods",
author = "Matteo Ferro and Vartolomei, {Mihai Dorin} and Francesco Cantiello and Giuseppe Lucarelli and {Di Stasi}, {Savino M} and Rodolfo Hurle and Giorgio Guazzoni and Busetto, {Gian Maria} and {De Berardinis}, Ettore and Rocco Damiano and Sisto Perdon{\`a} and Marco Borghesi and Riccardo Schiavina and Almeida, {Gilberto L} and Pierluigi Bove and Estevao Lima and Giovanni Grimaldi and Riccardo Autorino and Nicolae Crisan and {Abu Farhan}, {Abdal Rahman} and Paolo Verze and Michele Battaglia and Vincenzo Serretta and Russo, {Giorgio Ivan} and Giuseppe Morgia and Gennaro Musi and {de Cobelli}, Ottavio and Vincenzo Mirone and Shariat, {Shahrokh F}",
note = "{\circledC} 2018 S. Karger AG, Basel.",
year = "2018",
doi = "10.1159/000490765",
language = "English",
volume = "101",
pages = "7--15",
journal = "Urologia Internationalis",
issn = "0042-1138",
publisher = "S. Karger AG",
number = "1",

}

TY - JOUR

T1 - High-Grade T1 on Re-Transurethral Resection after Initial High-Grade T1 Confers Worse Oncological Outcomes

T2 - Results of a Multi-Institutional Study

AU - Ferro, Matteo

AU - Vartolomei, Mihai Dorin

AU - Cantiello, Francesco

AU - Lucarelli, Giuseppe

AU - Di Stasi, Savino M

AU - Hurle, Rodolfo

AU - Guazzoni, Giorgio

AU - Busetto, Gian Maria

AU - De Berardinis, Ettore

AU - Damiano, Rocco

AU - Perdonà, Sisto

AU - Borghesi, Marco

AU - Schiavina, Riccardo

AU - Almeida, Gilberto L

AU - Bove, Pierluigi

AU - Lima, Estevao

AU - Grimaldi, Giovanni

AU - Autorino, Riccardo

AU - Crisan, Nicolae

AU - Abu Farhan, Abdal Rahman

AU - Verze, Paolo

AU - Battaglia, Michele

AU - Serretta, Vincenzo

AU - Russo, Giorgio Ivan

AU - Morgia, Giuseppe

AU - Musi, Gennaro

AU - de Cobelli, Ottavio

AU - Mirone, Vincenzo

AU - Shariat, Shahrokh F

N1 - © 2018 S. Karger AG, Basel.

PY - 2018

Y1 - 2018

N2 - INTRODUCTION: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).PATIENTS AND METHODS: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.RESULTS: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.CONCLUSIONS: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.

AB - INTRODUCTION: The aim of this multicenter study was to investigate the prognostic impact of residual T1 high-grade (HG)/G3 tumors at re-transurethral resection (TUR of bladder tumor) in a large multi-institutional cohort of patients with primary T1 HG/G3 bladder cancer (BC).PATIENTS AND METHODS: The study period was from January 2002 to -December 2012. A total of 1,046 patients with primary T1 HG/G3 and who had non-muscle invasive BC (NMIBC) on re-TUR followed by adjuvant intravesical Bacillus Calmette-Guerin (BCG) therapy with maintenance were included. Endpoints were time to disease recurrence, progression, and overall and cancer-specific death.RESULTS: A total of 257 (24.6%) patients had residual T1 HG/G3 tumors. The presence of concomitant carcinoma in situ, multiple and large tumors (> 3 cm) at first TUR were associated with residual T1 HG/G3. Five-year recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS), and cancer-specific survival (CSS) were 17% (CI 11.8-23); 58.2% (CI 50.7-65); 73.7% (CI 66.3-79.7); and 84.5% (CI 77.8-89.3), respectively, in patients with residual T1 HG/G3, compared to 36.7% (CI 32.8-40.6); 71.4% (CI 67.3-75.2); 89.8% (CI 86.6-92.3); and 95.7% (CI 93.4-97.3), respectively, in patients with NMIBC other than T1 HG/G3 or T0 tumors. Residual T1 HG/G3 was independently associated with RFS, PFS, OS, and CSS in multivariable analyses.CONCLUSIONS: Residual T1 HG/G3 tumor at re-TUR confers worse prognosis in patients with primary T1 HG/G3 treated with maintenance BCG. Patients with residual T1 HG/G3 for primary T1 HG/G3 are very likely to fail BCG therapy alone.

KW - Aged

KW - Aged, 80 and over

KW - Carcinoma, Transitional Cell/pathology

KW - Cystectomy/methods

KW - Disease Progression

KW - Disease-Free Survival

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasm Recurrence, Local/pathology

KW - Prognosis

KW - Progression-Free Survival

KW - Recurrence

KW - Regression Analysis

KW - Time Factors

KW - Treatment Outcome

KW - Urinary Bladder Neoplasms/pathology

KW - Urologic Surgical Procedures/methods

U2 - 10.1159/000490765

DO - 10.1159/000490765

M3 - Article

C2 - 29975950

VL - 101

SP - 7

EP - 15

JO - Urologia Internationalis

JF - Urologia Internationalis

SN - 0042-1138

IS - 1

ER -